[Ip-health] Fwd: The price of ending the neglect for tropical diseases
nicolettadentico at libero.it
Tue Jun 11 02:25:11 PDT 2013
Dear friends and colleagues,
it is my pleasure to share with you a few reflections on territories that we share for our work.
I do hope that we shall be able to raise some healthy debate around current trends in global health.
Janis Lazdins was scientist and researcher at the WHO/TDR for over twenty years.
NTDs is but one chapter of a broader, worrying picture.
Thank you for your attention, and we welcome your comments.
Co-Director, Health Innovation in Practice (HIP)
Inizio messaggio inoltrato:
> Da: "\"Other News - Roberto Savio\"" <soros at other-net.info>
> Data: 06 giugno 2013 18.11.29 GMT+02.00
> A: nicolettadentico at libero.it
> Oggetto: The price of ending the neglect for tropical diseases
> Rispondi a: newsletter at other-net.info
> The price of ending the neglect for tropical diseases
> Janis K. Lazdins-Helds* - Nicoletta Dentico*
> Tropical diseases: A historical perspective
> At the end of the 19th century, the colonial powers of the time coined the terms tropical medicine and tropical diseases. These terms addressed diseases that were found in their colonial territories and impacted directly on their expansionism for access to the strategic resources available in the tropical latitudes, The economic impact of these diseases was of such relevance that these powers prompted the creation of gargantuan tropical medicine institutes, primarily in Europe and only later in the United States of America, and the setting up of satellite field research stations in the colonies, many of which still survive today. From these centres, during the first half of the 20th century, the key knowledge regarding these diseases rapidly emerged. This knowledge prompted pharmaceutical research and development (R&D) initiatives at the powerful chemical and pharmaceutical companies of those times, many of which turned into the multinational pharmaceutical conglomerates of today. The products that emerged then were achieved trough research practices that would be considered profoundly unethical (1) and unacceptable today. The local population were enrolled for the newly available "curative or preventive" interventions without any consent in most cases and usually by force or threat (2). Preventive mass treatment campaigns were common practice (e.g. treatment of sleeping sickness). The "effectiveness" of the medical initiatives surely had a positive impact on the economic and political objectives of the colonialist agenda, to the extent that these interventions - by reducing morbidity and mortality of the native work forces and protecting the colonial contingencies - were considered of paramount strategic value.
> With the struggles for independence by many of the countries under colonial rule in the global south, and the disappearance of the colonial powers in the second half of the 20th century, the interest in these medical activities - and in the products delivered for combating the diseases in those areas - withered. While retained for human use, many of the products found a new life in the animal health business. The academic interest in the research on tropical diseases was also reduced significantly. Perhaps the one exception was the military-related research driven by the medical needs of the troops in action in the tropical latitudes (Korea, Viet Nam, Cambodia, Latin America) - a need that still persists to our days - (Iraq, Libya, Sub-Saharan Africa). Unfortunately, very little of the results of this military research are amenable or applicable to the reality of populations in endemic countries, where the impact of these diseases not only remained as a threat, but in many cases re-emerged in exacerbated forms.
> Precisely at this conjuncture, in 1975, the Special Programme for Research and Training in Tropical Diseases (TDR) was established under the aegis of World Health Organization (WHO), the United Nations Development Programme (UNDP), the World Bank, and later the United Nations Children's Fund (UNICEF) as the first global public alliance to tackle the underlying causes of ill-health that perpetuate the vicious circle of disease and poverty and to support the emergence of local capacities to address the health challenges (3), Critically needed research to enhance disease knowledge was promoted. New drugs and drug combination therapies were identified and developed through compound screening and clinical research networks. Pioneering field research identified effective approaches utilizing local capabilities to control diseases such as onchocerciasis, Chagas disease, lymphatic filariasis, malaria, leishmaniasis, etc. At the same time, TDR supported long-term development of research institutions in disease-endemic countries, and high-level training of hundreds of scientists and health workers (4). This far-sighted innovative approach addressed tropical diseases beyond the mere medical challenges, stimulating research into the socio-economic and cultural contexts and looking at health promotion as one priority issue. Sorely enough, after a decade of key research initiatives and convincing public commitment by several governments, TDR started to find increasing difficulties to adapt and respond to a changing geopolitical environment that began to disrupt the developmental philosophy of public sector engagement and started to view diseases more from a global burden perspective and less from the need to respond to local realities viewpoint. Particularly, the emergence of the HIV/AIDS epidemic and the recognition of this new disease as a global health threat in the late '80s (5) triggered off the design of new global strategies and interventions with substantial resource allocation for research and development, education and prevention,. and access to treatments. Many national and supranational organizations were established to address the fight against this disease: one new agency was created in the UN system to this end, UNAIDS. Meanwhile, tuberculosis (TB) and malaria began to get recognized as epidemics on the global scale. TB received attention because of its parallel life with HIV/AIDS and its re-emergence in developed countries, sometimes in the form of multidrug resistant TB (MDRTB). Malaria, while not at all a disease prevalent in developed countries or of direct threat to the northern regions, started to be considered because of the enormous child mortality in Sub-Saharan Africa and new initiatives began to address the different needs and challenges associated with malaria control (6). Altogether, new financing strategies and business patterns to boost deployment of intervention as well as promotion of R&D for the three pandemics rapidly emerged, through models that blurred the boundaries between the interests of public health and the vested interests of the private sector.
> The return of Tropical Diseases on the geopolitical health agenda.
> To counterbalance the attention given to "the big three", strong voices started to emerge some 10 years ago highlighting that populations living in latitudes under high poverty burden were afflicted by health problems for which there was very limited access to existing therapeutic interventions or even a dire lack of availability of medical tools altogether. A silent global medical neglect. Lifesaving medicines for a range of prevalent diseases were completely out of reach of the national control systems of the affected countries. The term "Neglected Tropical Diseases" (NTDs) was coined. The WHO established a set of criteria that highlighted 17 diseases as Neglected Tropical Diseases of global relevance (7), while many other transmissible diseases prevalent locally but with less global impact were excluded.
> In 1990, the WHO Commission on Health Research for Development had estimated "that only about 5% of the world's resources for health research" which totaled US$ 30 billion in 1986 "were being applied to the health problems of low- and middle-income countries, where 93% of the world's preventable deaths occurred" (8). This inequity was primarily correlated with the lack of interest from the for profit-driven pharma industry to engage in medicinal product R&D for diseases affecting populations with no purchasing power. TheGlobal Forum for Health Research hatched out the term "10/90 gap" to capture the major imbalance between the magnitude of the problem and the resources devoted to addressing it (9). From the "10/90 Gap" narrative, two aspects were clearly made to stand out:
> a) The need for guaranteeing access to available pharmacological therapeutic products
> b) The need for filling the R&D gap to generate treatments for those diseases, when products are suboptimal or do not exist at all.
> This product-focussed narrative has almost completely overlooked the fact that addressing the 10/90 gap in health research must go side by side with strengthening national health systems and health promotion in countries, through involvement of local capacities.
> The WHO response to Neglected Tropical Diseases (NTDs)
> Efforts to combat the neglected tropical diseases reached a turning point in 2007, when the WHO convened the first meeting of global partners. That meeting produced a shared commitment to support WHO strategies and goals., through the Neglected Tropical Disease Department of the WHO (WHO/NTD). 15 of the diseases included in the WHO Neglected Tropical Disease department's portfolio are amenable to etiological chemotherapy. Many of the available products to address these diseases have existed for many years, others were developed for use in the veterinarian fields and later also registered for human use becoming the mainstream of many tropical disease control/elimination programs (e.g ivermectin). Given the availability of these products, efforts have been placed on securing access and utilization of medicinal interventions (curative or preventive) as means to control or eliminate NTDs. This approach has been vigorously implemented thanks to large donation programs from the pharmaceutical industry, leveraged by the WHO/NTD (9). Such a treatment strategy, and the governance structure associated with it, reached a new peak in January 2012, when 13 pharmaceutical companies and a few members of the donor community signed up to the so called "London Declaration" on NTDs(10), offering expanded donations of supplies of drugs with a theoretical commercial value of hundreds of millions of dollars a year that have the potential to prevent and treat many NTDs. The horizon of the London Declaration is to end the neglect and combat 10 Neglected Tropical Diseases by 2020 through coordinated actions at the World Health Organisation, as explained in the strategy report released in October 2012 (11). Some of the most influential media have hailed the new strategy as a new wave of corporate social responsibility (12), though it remains difficult not to think about self interest - tropical diseases can have an impact in the developed world; moreover, research in this field may have a positive knock-on effect in the cancer field (12). WHO acts as the final repository of these actions. While the recent WHO reports on tropical neglected diseases (11) (13) emphasizes the efforts towards achieving universal health coverage with essential interventions, and recognize the unquestionable need to promote healthy environments, sanitation, nutrition, clean water, etc., they hardly formulate any proposals on how the pharmacological approach should be linked up to those other interventions, or how the WHO could play a leading role towards supporting national health system in the context of the social determinants of health and health promotion to hit the targets. The pharmacological approach is obviously necessary and it will no doubt provide an immediate impact on morbidity/mortality; yet, the sustainability of this impact and progression towards the elimination goals stands on very uncertain grounds unless it is framed within strategies aimed at strengthening local health systems and medical product providers (14).
> Despite assurances and commitments from pharmaceutical industries and donors alike, the whims of the global economy and the volatility of the donor community are both well known dynamics. It is easy then to envision that commitments to NTDs could be the first ones to vanish in situations of prolonged economic crises( 15) , or at a time when new disease priorities gain ground, as it is happening today with Non Communicable Diseases (NCDs). Meanwhile, the high expectations deriving from emphasis on pharmacological approaches have focalized public resource allocation to these programs alone. The current WHO NTD strategy advocates for disease integration - one element of efficiency deriving from better linkages across disease control programmes in countries - but meaningful evidence of progress in this area is yet to be shown. Even less clear is how the WHO pharmacological strategy against NTDs will strengthen health systems in endemic countries. Aspects related to drug regulatory requirements, pharmacovigilance functions or patient safety are of extreme relevance. Currently, all of these are tailored from the disease or a particular drug intervention perspective, rather than from a health system stand (16). The vertical disease approach remains prevalent, placing heavy burdens of fragmentation and loss of ownership on the already weak and poorly staffed national health systems (17).
> In relation to country ownership, the fundamental differences on how the international community has shaped access to medical products for NTDs as compared to HIV/AIDS, TB and malaria need highlighting. As mentioned above, strategies for NTDs hinge on large drug donations from the multinational pharmaceutical sector. For HIV/AIDS, TB or malaria, products are sourced on a market basis by countries or specific organizations (the Global Fund to Fight HIV, Tubercolosis and malaria, UNITAID, the Clinton Health Access Initiative - CHAI, etc.). This dichotomy, far from favouring integration in disease management, imposes additional administrative burdens onto the fragile health systems of recipient countries. In this scenario the first questioni is what is the virtual role of developing countries in shaping the global health initiatives and their governance (18). The additional point is whether WHO is really determined to build country capacities for national players to be in the driving seat when decisions affecting the health of their populations are made.
> The global response to the lack of R&D for new or improved NTDs' treatments "is probably essential to multinational company participation, and plays a catalytic role in encouraging small Western-focussed companies to expand their remit to neglected-disease indications" (19).In 2012, BIO Ventures for Global Health reported that the pipeline for 23 diseases (HIV/AIDS, Malaria, TB, NTD and other diseases) comprised 374 products, of which 49 were in clinical development for 15 diseases; only 5 products were expected to be registered in the short term. 40% of the total pipeline was covered by 26 PDPs at a funding level of US$ 469 million. The remaining part was dealt with by the pharmaceutical and biotechnology industry, as well as by academic institutions. 70% of the developers are in USA and Europe. In disease endemic countries like Brazil, Argentina, Cuba, Mexico, India, Thailand and South Africa existing public and private R&D organizations are addressing NTDs; however, progress has been slow, mainly due to financial and technical limitations (20).
> Emphasis on PDPs has largely shaped the political culture about the management of R&D for NTDs. This has been somewhat passively endorsed by WHO member states, to the extent that today access to funding is limited to working trough collaborations with PDPs, with very little room left for potentially alternative R&D initiatives. Only a very few voices have so far questioned the substantial exclusivity of this approach, and raised points of concern with the growing preponderance of the current PPP model (and PDPs, for that matter) to address global health needs (21) (22) The key arguments allude to the fact that actors and funders in a partnership may have different interests or prioritize solutions from different perspectives "making the dynamics of partnership less than ideal" and that PPPs, given their specific mandate "do not allow for a holistic view of the healthcare concerns faced by a country" and may not be concerned by the sustainability of the provided solutions. The risk is that participation of developing countries may be more than by a real sense of common goals. PDPs research in neglected tropical diseases has certainly engaged policymakers and the scientific community in endemic countries to some extent, but their participation may be often legitimately driven by funding opportunities more than by self-identified health priorities. Besides, the approach adopted by these new initiatives is a mere replication of the classical, pharma approach, adhering to northern R&D principles, standards and values for medical product approval.
> It should come to no surprise if Southern innovative research initiatives are hard to identify on the scene. Potentially different ideas seem to stand with difficult chances in this environment, unless they align with the limited priorities established by PDPs. On the other hand, there are very few alternative sources of funding for R&D options not covered by PDPs, even if they represent a priority for countries. A particular case in point is the lack of progress in promoting R&D for traditional medicine, one area that is almost completely overlooked by international research circles. The same applies to some of the tropical diseases that are not in the NTD disease list and therefore not addressed by the PDPs, despite their relevance at a local level (e.g. amebiasis, hanta viruses, fungal diseases, etc). In conclusion, despite the rhetoric of involving governments from endemic countries in the decisions and activities of PDPs, it is availability of money, rather than political vision in health, that determines some degree of action in the endemic regions.
> WHO's member states looking for new policy solutions
> At the end of 2005, it was two endemic countries - Kenya and Brazil - which became aware of the need to initiate a discussion at the World Health Assembly aimed at securing a new framework for essential health research and development in diseases that disproportionately affect them (23). A global strategy and action plan was unanimously agreed by the WHO member states in 2008 (GSPA) (24) calling for concerted, public health work in specific areas:
> 1) prioritizing research and development needs;
> 2) promoting research and development; 3) building and improving innovative capacity;
> 4) transfer of technology; 5) application and management of intellectual property;
> 6) improving delivery and access; 7) ensuring sustainable financing mechanisms;
> 8) establishing monitoring and reporting systems. This rather protracted debate at the WHO and the results it has delivered with the consensus of all governments - the WHO GSPA - has largely been ignored by the majority of the PDPs (with the exception of the Drugs for Neglected Diseases Initiative, DNDi) and by the big foundations alike. More bizarre still, the WHO/NTD Unit has completely overlooked the endeavour undertaken by the WHO Secretariat and WHO member states to develop a framework on needs-driven innovation and access to medicines aimed at guiding developing countries towards shaping their home grown solutions. Altogether, support to this global strategy - which was supposed to be an incubator for change at country level, and a multiplier for scientific diversity - has been very scanty, and lacking conviction (25), so that progress in translating it into concrete actions for member states has proven anecdotic at best. Even the effect of the recommendations included in the report of the WHO Consultative Expert Working Group on R&D Coordination and Financing to implement one particular element of the GSPA - element 7 - (26) have been procrastinated to 2016. The CEWG report called for enhanced responsibility of the public sector in needs-driven innovation including appropriate fiscal policies to grant sustainable financing. Particularly controversial has been the decision to postpone
> until 2016 any activity around the recommended R&D treaty to promote medical research and development as a common good (27). Such binding norms are considered necessary to establish a process for identifying R&D needs, setting priorities, coordinating R&D efforts, securing sustainable financing, promoting new incentives and managing research outputs in a way that ensures both innovation and access. Given the WHO's role as the directing and co-ordinating authority in global public health, it is uniquely placed to be the forum for such an instrument.Action on this proposal has been and still is strongly opposed by the majority of donor countries in the north, the pharmaceutical companies so committed against neglecting NTDs, and the philanthropic sector alike (28).
> Global investment in NTDs: a Trojan horse?
> The 2001 report of the WHO Commission on Macroeconomics and Health (29) marked perhaps the first explicit and comprehensive hint at the global geopolitical implications of the relationship between addressing health and development of low-income countries, from the developed countries' perspective. The report highlights the negative impact of tropical diseases on investment in mining, tourism and agriculture, and cites the construction of the Panama and Suez canal as positive examples of the economic benefits at stake. More recently, an interesting editorial (30) makes a vibrant case why a strong US commitment to NTDs is of strategic geopolitical relevance, in the wake of one article by the United States Secretary of State Hilary Rodham Clinton published in the Foreign Affairs at the end of 2010 (31). Here, Clinton articulated a new vision for American diplomacy and development through the strengthening of what she termed "civilian power", aimed to strengthening "the State Department's capacity to pursue American interests and advance American values".
> A more explicit demonstration of the direct self-serving interest of developed countries in their united fight to address NTDs can be found in the recently published report "Saving lives and creating impact: EU investment in poverty related neglected diseases" (32). The report examines EU investments in R&D for poverty related neglected diseases (PRND) and makes a striking case in favour of the benefits for Europe: "Government funding for PRND R&D generates a net benefit to Europe's economy. Each euro invested by EU governments generates a further €1.05 in investments into Europe from companies, philanthropic organisations and other governments, many of these based outside Europe. These investments support thousands of European jobs and contribute to the high quality of European PRND R&D": so much sothat two thirds of Europe's PRND R&D funding is invested back into Europe. The report further highlights how "PRND R&D funding promotes integration between European countries".
> It is no surprise that developed countries and their partners in the private and philanthropic sectors welcomed the WHO/NTD roadmap which, as we tried to explain, relies primarily on access to NTDs treatment through product donations from pharmaceutical companies (financed through donors' aid programs) and on northern-driven biomedical R&D initiatives.
> Both approaches are likely to distance developing countries further away from their development aspirations and to deplete - or distract - their capacities (33) to use the (sorely shrinking) policy space needed to make autonomous decisions in the management of their health problems.
> As for the WHO, its reform process should provide the right opportunity for a serious reflection on its constitutional mandate. The NTD story shows how the leading role of the WHO has been obfuscated in several ways, and how the agency has been seduced and neutered by a variety of rent-seekers in the health arena who continue to exercise unrestrained power.
> From the above considerations one may ask:
> What will be the price that endemic countries will have to pay to eradicate the last worm from their soil?
> Are NTDs a testing ground for developed countries and their multiple transnational actors to start addressing the challenge of the emergence of Non Communicable Diseases (NCDs) in developing countries?
> How can the role of WHO (and the UN system) be upgraded so as to avoid that global inequality may be writing an epitaph for health justice for all?
> *Janis K. Lazdins-Helds - Medical degree (1970) from the University of Carabobo, Venezuela; Ph.D. (1978) in Cell and Developmental Biology from Harvard University in Boston, USA. Academic tenures at the Venezuelan Institute for Scientific Research, Harvard University, The USA National Institutes of Health and Universita La Sapienza, Rome, Italy.
> *Nicoletta Dentico - Co-director at Health Innovation in Practice, Health Innovation for People (HIP) , Rome Area, Italy
> (1) Bradley D.J., "The situation and the response". In Health in Tropical Africa during the Colonial Period (eds EESabben-Clare, DJBradley, KKirkwood), 1980, Clarendon Press, Oxford, pp. 6-15. Also, Eckart W., "Medical experiments at the periphery: the fight against sleeping sickness in German East Africa and Togo". In Twentieth Century Ethics of Human Subjects Research. (eds VRoelcke & GMaio) . Franz Steiner Verlag, Stuttgart, 2004, pp. 40-57.
> (2) http://www.who.int/global_health_histories/seminars/presentation31.pdf
> (3) http://www.who.int/tdr/en/
> (4) http://www.who.int/tdr/publications/about-tdr/30-year-history/en/index.html
> (5) Joireman S., HIV/AIDS in Africa and US National Security. Work in progress, prepared for the Africa-US Relations in the Era of Globalization conference, UCLA, May 2004. Accessible at http://www.international.ucla.edu/africa/grca/publications/article.asp?parentid=107610. On this topic, see also Garret L., HIV and National Security: Where are the Links?. Council on Foreign Relations, 2005, http://www.cfr.org/national-security-and-defense/hiv-national-security-links/p8256.
> (6) See http://www.rbm.who.int/rbmmandate.html.
> (7) Organizzazione Mondiale della Sanità, Working to overcome the global impact of neglected tropical diseases: first WHO report on neglected tropical diseases. Geneva, 2010. http://whqlibdoc.who.int/publications/2010/9789241564090_eng.pdf
> (8) Organizzazione Mondiale della Sanità, Health research: essential link to equity in development. Rapporto della Commission on Health Research for Development. Oxford, Oxford University Press, 1990.
> (9) Sul 10/90 gap si legga Stevens P., Diseases of Poverty and the 10/90 Gap. International Policy Network. London, 2004, http://www.who.int/intellectualproperty/submissions/InternationalPolicyNetwork.pdf&prev=/search%3Fq%3D10/90%2Bgap%26hl%3Dit%26tbo%3Dd%26biw%3D1280%26bih%3D609&sa=X&ei=rz4SUZKNLcWptAbNxIDQBg&sqi=2&ved=0CDkQ7gEwAQ.
> (10) The London Declaration on Neglected Tropical Diseases. In: http://unitingtocombatntds.org/downloads/press/ntd_event_london_declaration_on_ntds.pdf.
> (11) World Health Organization, Accelerating work to overcome the global impact of neglected tropical diseases: a roadmap for implementation. Geneva, 2012. http://www.who.int/neglected_diseases/NTD_RoadMap_2012_Fullversion.pdf .
> (12) Jack A., "Combating Neglected Diseases", Financial Times Special Report, in FT Health, 11th October 2012, http://www.ft.com/intl/cms/00a0a9ba-11ce-11e2-b9fd-00144feabdc0.pdf.
> (13) World Health Organization, Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases: Second WHO Report on Neglected Tropical Diseases, Geneva, January 2013, http://www.who.int/neglected_diseases/2012report/en/.
> (14) Holt F, Gillam SJ, Ngondi JM, "Improving Access to Medicines for Neglected Tropical Diseases in Developing Countries: Lessons from Three Emerging Economies". In PLOS Neglected Tropical Diseases 6(2): e1390. doi:10.1371/ journal.pntd.0001390, 2012.
> (15) http://www.euractiv.com/development-policy/eu-countries-asked-fill-gap-redu-news-517799.
> (16) Pratta B. and Lof B., "Health research systems: promoting health equity or economic competitiveness?". In Bulletin , World Health Organization 2012;90:55-62 | doi:10.2471/BLT.11.092007.
> (17) Bennett S, Adam T, Zarowsky C, Tangcharoensathien V, Ranson K, Evans T et al.; Alliance STAC. From Mexico to Mali: progress in health policy and systems research. Lancet 2008;372:1571-8. doi:10.1016/S0140- 6736(08)61658-X PMID:18984191
> (18) Tucker T.J. and MaKgoba M. W., "Public Private Partnerships and Scientific Imperialism". In Science, Vol. 320, 23 May 2008, pp. 1016-17.
> (19) Moran M, "A Breakthrough in R&D for Neglected Diseases: New Ways to Get the Drugs We Need". In PLoS Med 2(9): e302. doi:10.1371/journal.pmed.0020302, 2005.
> (20) Developing New Drugs & Vaccines for the Poor, The product developer landscape, March 2012 http://www.bvgh.org/LinkClick.aspx?fileticket=h6a0cJK9drg%3D&tabid=39
> (21) Joseph A. "Public Private Partnerships: A Double-Edged Sword". In Harvard College Global Health Review, 16 November 2012, http://www.hcs.harvard.edu/hghr/print/features/public-private/.
> (22) Utting P. and Zammit A., Beyond Pragmatism: Appraising UN Business Partnerships. United Nations Research Institute for Social Development (UNRISD) Market, Business and Regulation, Programme Paper Number 1. Geneva. October 2006, http://www.unrisd.org/80256B3C005BCCF9/%28httpAuxPages%29/225508544695E8F3C12572300038ED22/$file/uttzam.pdf.
> (23) Organizzazione Mondiale della Sanità, Risoluzione WHA59.24. "Public health, innovation, essential health research and intellectual property rights: towards a global strategy and plan of action". In Fifty-ninth World Health Assembly, Geneva, 22-27 May 2006. Volume 1. Resolutions and decisions. Ginevra, 2006 (doc. WHA59/2006/REC/1).
> (24) Organizzazione Mondiale della Sanità, Global Strategy and Plan of Action on Public Health, Innovation and IP, Risoluzione della 61ma Assemblea Mondiale della Salute WHA61.21, Maggio 2008. http://www.who.int/gb/ebwha/pdf_files/A61/A61_R21-en.pdf
> (25) Organizzazione Mondiale della Sanità, EB132 resolution on Neglected Tropical Diseases , 28 gennaio 2013, accessibile al link:
> (26) World Health Organization, Research and Development to Meet the Needs of the People in Developing Countries: Strengthening Global Financing and Coordination. WHO Geneva, April 2102, accessible at
> (27) Hermann R.M., "International Instrument On Medical R&D Still On Negotiating Table At WHO". In Intellectual Property Watch, Geneva, 28 November 2012, accessible at http://www.ip-watch.org/2012/11/28/international-instrument-on-medical-rd-still-on-negotiating-table-at-who/. On this issue see also Hermann R.M., "WHO Members Agree On "Strategic Work Plan" On Health R&D - But No Convention". In Intellectual Property Watch, Geneva, 29 November 2012, accessible at: http://www.ip-watch.org/2012/11/29/who-members-agree-on-strategic-work-plan-on-health-rd-but-no-convention/. Finally, New W., "Debate Erupts At WHO Over "Consensus" On Financing R&D For The Poor". In Intellectual Property Watch, Geneva, 28 January 2013, accessible at: http://www.ip-watch.org/2013/01/28/debate-erupts-at-who-over-consensus-on-financing-rd-for-the-poor/.
> (28) The Lancet, "Neglected Tropical Diseases, Progress and Priorities". In The Lancet, Volume 381, Issue 9863, Page 268, 26 January 2013 doi:10.1016/S0140-6736(13)60115-4. in this regard, see also Balasubramaniam T., " WHO Director-General Chan throws down the gauntlet on the CEWG process: "Let's fight this out at the Assembly!". In Knowledge Ecology International (KEI), 26 January 2013, http://keionline.org/node/1643.
> (29) World Health Organization, Macroeconomics and health: investing in health for economic development . Report of the Commission on Macroeconomics and Health. Geneva, World Health Organization, 2001. Accessible at:
> (28)Hotez P.J., "Unleashing 'Civilian Power': A New American Diplomacy through
> Neglected Tropical Disease Control, Elimination, Research, and Development". In PloS Negl Trop Dis, 2011, 5(6): e1134. doi:10.1371/journal.pntd.0001134.
> In this regard, see also Hotez PJ "New antipoverty vaccines and drugs: a research agenda for the U.S. President's Global Health Initiative (GHI)". In PLoS Negl Trop Dis, 2011, 7: e1133. doi:10.1371/journal.pntd.0001133.
> (29) Clinton H.R., "Leading through civilian power: redefining American diplomacy and development". In Foreign Affairs 89: 13-24. November/December 2010; http://www.foreignaffairs.com/articles/66799/hillary-rodham-clinton/leading-through-civilian-power.
> (30) Deutsche Stiftung Weltbevoelkerung and Policy Cures, Saving lives and creating impact: EU investment in poverty related neglected disease, September 2012, http://policycures.org/downloads/DSW%20presentation%20EU%20Parliament%20FINAL.pdf.
> (31) Morel CM, Acharya T, Broun D, Dangi A, Elias C, et al. (2005) Health innovation: the neglected capacity of developing countries to address neglected diseases. Science 309: 401-404.
>  The Roll Back Malaria Partnership was launched in 1998 by WHO, UNICEF, UNDP and the World Bank, in an effort to provide a coordinated global response to the disease.
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