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Health and Place

This paper presents a political economy analysis of global inequities in access to COVID-19 vaccines, treatments, and diagnostic tests. We adapt a conceptual model used for analysing the political economy of global extraction and health to examine the politico-economic factors affecting access to COVID-19 health products and technologies in four interconnected layers: the social, political, and historical context; politics, institutions, and policies; pathways to ill-health; and health consequences. Our analysis finds that battles over access to COVID-19 products occur in a profoundly unequal playing field, and that efforts to improve access that do not shift the fundamental power imbalances are bound to fail. Inequitable access has both direct effects on health (preventable illness and death) and indirect effects through exacerbation of poverty and inequality. We highlight how the case of COVID-19 products reflects broader patterns of structural violence, in which the political economy is structured to improve and lengthen the lives of those in the Global North while neglecting and shortening the lives of those in the Global South.


… The two issues of underdiagnosis and restricted access to low-cost TB drugs are inseparable, says Helen Cox, an epidemiologist at the University of Cape Town in South Africa, who specializes in TB. “Patents on drugs like bedaquiline make TB so expensive to treat,” she says, adding that many high-burden TB countries are reluctant to fund diagnostic services. “If you don’t diagnose the problem, you don’t have to pay for the treatment.” She’s hopeful that the recent J&J-GDF agreement will encourage these countries to invest into diagnosing TB. … Currently, U.S.-based corporations such as Cepheid hold a monopoly over TB DNA diagnostic tests such as GeneXpert MTB/RIF and MTB/RIF Ultra, which are priced at $9.98 per test cartridge. The Doctors without Borders/Médecins Sans Frontières Access Campaign, which advocates for affordable medical treatments, has argued that public funds largely underwrote the development of these tests.


The latest 14-page draft, seen by Devex, lacked the specifics health leaders have called for, such as a “Global Health Threats Council,” a commitment to fully and sustainably finance the Pandemic Fund, and a strong emphasis on monitoring and accountability. [...]

But many are concerned that the opportunity to transform the systems for pandemic preparedness and response might be lost.

Geneva Health Files

In today’s edition, Yassen Tcholakov, a Canadian physician who has also worked in the climate space, shares his perspectives on the application of Common but Differentiated Responsibilities for global health.

Bull of WHO

Objective To assess how national antimicrobial susceptibility data used to inform national action plans vary across surveillance platforms.

Methods We identified available open-access, supranational, interactive surveillance platforms and cross-checked their data in accordance with the World Health Organization’s (WHO’s) Data Quality Assurance: module 1. We compared platform usability and completeness of time-matched data on the antimicrobial susceptibilities of four blood isolate species: Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae from WHO’s Global Antimicrobial Resistance and Use Surveillance System, European Centre for Disease Control’s (ECDC’s) network and Pfizer’s Antimicrobial Testing Leadership and Surveillance database. Using Bland–Altman analysis, paired t-tests, and Wilcoxon signed-rank tests, we assessed susceptibility data and number of isolate concordances between platforms.

Bull WHO

Human African trypanosomiasis, also known as sleeping sickness, is a lifethreatening parasitic infection transmitted by the tsetse fly in sub-Saharan Africa. Although it caused devastating epidemics during the 20th century, its incidence has now fallen to historically low levels1 thanks to sustained and coordinated efforts over the past two decades.

[...] Several tools are available for the screening and diagnosis of gambiense trypanosomiasis, but tools for rhodesiense trypanosomiasis are either missing or, if they exist, are losing ground in the evolving context of health services in rural Africa.


Despite landmark antibody approval, research into potentially serious brain swelling and bleeding still lags.

A sea change is underway in the treatment of Alzheimer’s disease, where for the first time a drug that targets the disease’s pathology and clearly slows cognitive decline has hit the U.S. market. A related therapy will likely be approved in the coming months. As many neurologists, patients, and brain scientists celebrate, they’re also nervously eyeing complications from treatment: brain swelling and bleeding, which in clinical trials affected up to about one-third of patients and ranged from asymptomatic to fatal.

The side effect—amyloid-related imaging abnormalities, or ARIA—remains mysterious. “We don’t really understand what it is, what causes it, and what we can do about it,” says neurologist R. Scott Turner, director of the Memory Disorders Program at Georgetown University.

Bull of WHO

Anand Anandkumar’s description of developing and launching a novel antibiotic resonates with the pain of lived experience. “It’s like climbing a mountain and then going over a cliff,” says the Chief Executive Officer and co-founder of Bugworks Research Inc, a biotech company based in Bangalore, India.

The mountain that Bugworks is climbing is biotechnological (the company has a broad-spectrum antibiotic known as BWC0977 undergoing a Phase I trial in Australia), but the cliff the company will be going over – assuming the drug gets through the trial phases and receives regulatory approval – is, essentially, commercial.

Damiano de Felice, director of development at the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X), a global nonprofit partnership focused on supporting early-stage antibacterial research and development (R&D), explains: “The more antibiotics are used, the more quickly microorganisms develop resistance to them. The public health imperative of antibiotic stewardship necessarily constrains demand.”

Challenging development

To achieve universal health coverage, people need public healthcare systems providing fair access to decent health care. This should be an entitlement for all, regardless of means, requiring adequate, appropriate and sustainable financing over the long term.

Appropriate arrangements can help ensure a financially sustainable, effective and equitable healthcare system. However, insurance-based systems – both private and social – not only incur unnecessary costs, but also undermine ensuring health for all.

Private health insurance
Voluntary private health insurance (PHI) is not an acceptable option for both equity and efficiency reasons. Those with lower health risks are less likely to buy insurance. Paying the same rate will be seen as benefiting those deemed greater risks, especially the less healthy, often also those less well off.

Challenging development

To achieve universal health coverage, all people need access to public healthcare. This should be an entitlement for all, regardless of means, requiring adequate long term sustainable financing.