Correspondence
For more on the platform see www.globalhealthtreaty.org
The treaty would set standards and targets, establish processes to monitor progress, and ensure accountability needed to implement the right to health. Measures could range from a domestic and international financing framework sufficient to ensure universal, affordable, and accessible health-care and public health services, through to regulations on nutrition, food marketing, and subsidies. It would assure civil society participation in developing and monitoring health policies. A treaty could facilitate right to health impact assessments, human rights education, capacity building, and national strategies on universality, comprehensiveness, equality, and accountability, with stipulations on health systems that treat all people equally, regardless of income or status. In all these ways, a Framework Convention on Global Health would help usher in an era where every individual on the planet fully benefits from global health advances. Therefore in April, 2014, we launched the platform for a Framework Convention on Global Health,3 aimed at such a treaty.4,5 The platform encompasses global and regional coordination and inclusive national platforms for all who see promise in the Framework. As a first step, we call for next year’s UN Sustainable Development Goals declaration to initiate a process towards a Framework Convention on Global Health. The Framework is surely ambitious, and many will insist that it is politically infeasible. However, the persistence of massive health inequity demands bold new strategies, which broad social mobilisation could achieve. We declare no competing interests.
*Eric A Friedman, K Srinath Reddy, Juliana Nantaba, Geetanjali Misra, Armando De Negri Filho, on behalf of the interim Steering Committee of the Platform for a Framework Convention on Global Health [email protected]
2208
Georgetown University Law Center, Washington, DC 20001, USA (EAF); Public Health Foundation of India, New Delhi, India (KSR); Center for Health, Human Rights and Development, Kampala, Uganda (JN); CREA, New Delhi, India (GM); and World Social Forum on Health and Social Security, Porto Alegre, Brazil (ADNF) 1
2
3
4
5
Ottersen OP, Dasgupta J, Blouin C, et al. The political origins of health inequity: prospects for change. Lancet 2014; 383: 630–67. Jamison T, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. Anon. Platform for a Framework Convention on Global Health: realizing the universal right to health. May 14, 2014. http://www. globalhealthtreaty.org/docs/platform-for-anfcgh-full.pdf (accessed June 13, 2014). Gostin LO, Friedman EA, Buse K, et al. Towards a Framework Convention on Global Health. Bull World Health Organ 2013; 91: 790–93. Sidibé M, Buse K. A framework convention on global health: a catalyst for justice. Bull World Health Organ 2012; 90: 870–70A.
Public health or political health? On May 5, 2014, WHO issued a strong recommendation1 that all residents and long-term visitors from Pakistan, Cameroon, and Syria be immunised against polio from 4 weeks to 1 year before travel and that this be validated with an International Cer tificate of Vaccination or Prophylaxis. Recently, Paul Rutter and Liam Donaldson2 praised WHO’s decision and added: “WHO’s new recommendation on polio should not be controversial; nor should it be seen as some political sanction.” But it is most certainly political. WHO states that they considered countries that had recently exported polio, but then have not included other countries because they “would have had difficulty appearing to stigmatise countries whose number of polio cases has declined substantially, as has been the case in Nigeria and Afghanistan”. 2 If that is not political then what is—especially given the number of exportations of polio cases from Nigeria alone? The recommendation will also provide a reason for countries to limit travellers from Pakistan, Cameroon, and Syria. Before the WHO
announcement, India had mandated that any Indian citizen travelling from a polio affected country needed to have this documentation (non-Indian citizens are exempt),3 a decision now supported by WHO. This new WHO recommendation1 is likely to have minimal effects on preventing the spread of polio for a number of reasons: much crossborder traffic between listed countries (such as between Pakistan and India) is undocumented—International Certificates have no meaning for those illegally crossing the borders; certificates will need to be checked on entry, because qualified staff are not in-place; and a cottage industry of selling fake documents is likely to develop. Pakistan has done a good job of immunising its citizens and controlling the spread of polio, especially given the political situation, and should not be punished because of factors over which it has limited control. The refusal of tribal groups in Waziristan to participate in immunisation campaigns and the opposition of the Taliban, both of which have led to the killing of more than 20 vaccinators and security personnel, have placed understandable limits on Pakistan’s programme. It is time for the public health community to move beyond country borders in the overall control of infectious diseases. I declare no competing interests.
Richard A Cash [email protected] Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02155, USA 1
2
3
WHO. WHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus. http://who.int/ mediacentre/news/statements/2014/ polio-20140505/en/ (accessed June 10, 2014). Rutter PD, Donaldson LJ. Mandatory polio vaccination for travellers: protecting global public health. Lancet 2014; 383: 1695–97. Quam M, Massad E, Wilder-Smith A. Effects of India’s new polio policy on travellers. Lancet 2014; 383: 1632.
www.thelancet.com Vol 383 June 28, 2014
For more on the platform see www.globalhealthtreaty.org
The treaty would set standards and targets, establish processes to monitor progress, and ensure accountability needed to implement the right to health. Measures could range from a domestic and international financing framework sufficient to ensure universal, affordable, and accessible health-care and public health services, through to regulations on nutrition, food marketing, and subsidies. It would assure civil society participation in developing and monitoring health policies. A treaty could facilitate right to health impact assessments, human rights education, capacity building, and national strategies on universality, comprehensiveness, equality, and accountability, with stipulations on health systems that treat all people equally, regardless of income or status. In all these ways, a Framework Convention on Global Health would help usher in an era where every individual on the planet fully benefits from global health advances. Therefore in April, 2014, we launched the platform for a Framework Convention on Global Health,3 aimed at such a treaty.4,5 The platform encompasses global and regional coordination and inclusive national platforms for all who see promise in the Framework. As a first step, we call for next year’s UN Sustainable Development Goals declaration to initiate a process towards a Framework Convention on Global Health. The Framework is surely ambitious, and many will insist that it is politically infeasible. However, the persistence of massive health inequity demands bold new strategies, which broad social mobilisation could achieve. We declare no competing interests.
*Eric A Friedman, K Srinath Reddy, Juliana Nantaba, Geetanjali Misra, Armando De Negri Filho, on behalf of the interim Steering Committee of the Platform for a Framework Convention on Global Health [email protected]
2208
Georgetown University Law Center, Washington, DC 20001, USA (EAF); Public Health Foundation of India, New Delhi, India (KSR); Center for Health, Human Rights and Development, Kampala, Uganda (JN); CREA, New Delhi, India (GM); and World Social Forum on Health and Social Security, Porto Alegre, Brazil (ADNF) 1
2
3
4
5
Ottersen OP, Dasgupta J, Blouin C, et al. The political origins of health inequity: prospects for change. Lancet 2014; 383: 630–67. Jamison T, Summers LH, Alleyne G, et al. Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–955. Anon. Platform for a Framework Convention on Global Health: realizing the universal right to health. May 14, 2014. http://www. globalhealthtreaty.org/docs/platform-for-anfcgh-full.pdf (accessed June 13, 2014). Gostin LO, Friedman EA, Buse K, et al. Towards a Framework Convention on Global Health. Bull World Health Organ 2013; 91: 790–93. Sidibé M, Buse K. A framework convention on global health: a catalyst for justice. Bull World Health Organ 2012; 90: 870–70A.
Public health or political health? On May 5, 2014, WHO issued a strong recommendation1 that all residents and long-term visitors from Pakistan, Cameroon, and Syria be immunised against polio from 4 weeks to 1 year before travel and that this be validated with an International Cer tificate of Vaccination or Prophylaxis. Recently, Paul Rutter and Liam Donaldson2 praised WHO’s decision and added: “WHO’s new recommendation on polio should not be controversial; nor should it be seen as some political sanction.” But it is most certainly political. WHO states that they considered countries that had recently exported polio, but then have not included other countries because they “would have had difficulty appearing to stigmatise countries whose number of polio cases has declined substantially, as has been the case in Nigeria and Afghanistan”. 2 If that is not political then what is—especially given the number of exportations of polio cases from Nigeria alone? The recommendation will also provide a reason for countries to limit travellers from Pakistan, Cameroon, and Syria. Before the WHO
announcement, India had mandated that any Indian citizen travelling from a polio affected country needed to have this documentation (non-Indian citizens are exempt),3 a decision now supported by WHO. This new WHO recommendation1 is likely to have minimal effects on preventing the spread of polio for a number of reasons: much crossborder traffic between listed countries (such as between Pakistan and India) is undocumented—International Certificates have no meaning for those illegally crossing the borders; certificates will need to be checked on entry, because qualified staff are not in-place; and a cottage industry of selling fake documents is likely to develop. Pakistan has done a good job of immunising its citizens and controlling the spread of polio, especially given the political situation, and should not be punished because of factors over which it has limited control. The refusal of tribal groups in Waziristan to participate in immunisation campaigns and the opposition of the Taliban, both of which have led to the killing of more than 20 vaccinators and security personnel, have placed understandable limits on Pakistan’s programme. It is time for the public health community to move beyond country borders in the overall control of infectious diseases. I declare no competing interests.
Richard A Cash [email protected] Department of Global Health and Population, Harvard School of Public Health, Boston, MA 02155, USA 1
2
3
WHO. WHO statement on the meeting of the International Health Regulations Emergency Committee concerning the international spread of wild poliovirus. http://who.int/ mediacentre/news/statements/2014/ polio-20140505/en/ (accessed June 10, 2014). Rutter PD, Donaldson LJ. Mandatory polio vaccination for travellers: protecting global public health. Lancet 2014; 383: 1695–97. Quam M, Massad E, Wilder-Smith A. Effects of India’s new polio policy on travellers. Lancet 2014; 383: 1632.
www.thelancet.com Vol 383 June 28, 2014
