The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
Week ending 20 April 2019

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
GE2P2 Global Foundation – Governance, Evidence, Ethics, Policy, Practice

PDF: The Sentinel_ period ending 20 Apr 2019

:: Week in Review  [See selected posts just below]
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities   [see PDF]
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals  [see PDF]

UNESCO solemnly expresses the support of the international community to the President of the French Republic following the fire at Notre-Dame

Heritage Stewardship – Notre-Dame de Paris

UNESCO solemnly expresses the support of the international community to the President of the French Republic following the fire at Notre-Dame
19 April 2019
Paris, Elysée, 19 April 2019- Audrey Azoulay, Director-General of UNESCO, H.E Lee Byong-hyun, President of the executive Board and H.E Zohour Alaoui, president of the general Conference, accompanied by a delegation of ambassadors representing UNESCO’s Member States, bestowed this morning to the President of the Republic of France, Emmanuel Macron, a solemn declaration from the Organization’s Executive Board.

Through this unprecedented approach, UNESCO wishes to express the solidarity of the international community in the face of the tragic fire at Notre-Dame de Paris Cathedral, which is part of the “Paris, Rives de la Seine” site, inscribed as a UNESCO World Heritage Site since 1991…

UNESCO protects heritage worldwide, including endangered heritage. Since 2015, emergency missions have been deployed by UNESCO in more than 50 countries around the world to safeguard and rehabilitate heritage following disasters:


Statement by the Executive Board of UNESCO following the fire at Notre-Dame Cathedral in Paris, France
16 April 2019
We, the Member States of UNESCO, meeting today in the Executive Board at UNESCO Headquarters in Paris, wish to solemnly express our deep emotion at the fire that affected Notre-Dame Cathedral in Paris yesterday.

This tragedy reminds us that through the world heritage, it is the bond that unites humanity that is at stake. UNESCO stands always alongside the heritage, as an expression of the values we all share.

Notre-Dame Cathedral, in the heart of Paris, is a powerful symbol not only of France, but of humanity as a whole because of its exceptional architecture, its spiritual function, its place in history and its literary and artistic legacy. This is the outstanding universal value recognized and honoured by UNESCO in 1991, when it included the Cathedral in the World Heritage List.

This episode, like all the other episodes of inestimable loss and destruction that have unfortunately marked our history, reminds us that the heritage is vulnerable and that, accordingly, the commitment of the international community remains crucial for its protection and safeguarding. This is an opportunity to reaffirm our unwavering attachment to the protection of the heritage, an objective that the United Nations has set itself through UNESCO.

We, the Member States, express our full solidarity and determination to act. We share the grief of all those who have lost a majestic figure in the collective imagination of peoples around the world as a result of the destruction, which was fortunately stopped by the heroic efforts of the emergency

We stand resolutely with the French authorities to support the work to restore Notre-Dame Cathedral, and to share UNESCO’s expertise in this task, in line with its mandate for the protection of the world heritage. For us and for future generations, it is our responsibility to ensure a future for our past.

At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices

Access to Medicines

At WHO Forum on Medicines, countries and civil society push for greater transparency and fairer prices
13 April 2019 News release
At a global forum on fair pricing and access to medicines, delegates from governments and civil society organizations called for greater transparency around the cost of research and development as well as production of medicines, to allow buyers to negotiate more affordable prices.

The forum, co-hosted by the World Health Organization (WHO) and the Government of South Africa, aimed to provide a global platform for frank discussion among all stakeholders – including governments, civil society organizations and the pharmaceutical industry – in order to identify strategies to reduce medicine prices and expand access for all.

The affordability of medicines has long been a concern for developing countries, but today it is also a global one. Each year, 100 million people fall into poverty because they have to pay for medicines out-of-pocket. High-income countries’ health authorities are increasingly having to ration medicines for cancer, hepatitis C and rare diseases. The problem extends to older medicines whose patents have expired, such as insulin for diabetes.

“Medical innovation has little social value if most people cannot access its benefits,” said Dr Mariângela Simão, WHO Assistant Director General for Medicines and Health Products. “This is a global human rights issue – everyone has a right to access quality healthcare.”

A report commissioned by WHO in 2017 showed that the cost of production of most medicines on WHO’s Essential Medicines List was a small fraction of the final price paid by governments, patients or insurance schemes. Some delegates at the forum noted that a lack of transparency around prices paid by governments means that many low- and middle-income countries pay higher prices for certain medicines than wealthier countries do.

There was consensus that countries can take an initial step towards fostering greater transparency by sharing price information. Countries from the so-called Beneluxa network have already joined forces to share such information, and the results have been promising. The data highlights discrepancies in what different countries are paying and can serve as a powerful tool to negotiate reduced prices. WHO’s database on vaccine markets and shortages – MI4A – was also highlighted at the forum as a useful tool to achieve competitive vaccine prices.

The event highlighted other successful examples of countries’ collaboration around achieving more affordable medicine prices; these include pooled procurement and voluntary sharing of policies. If several countries in the same region purchase medicines as a block, they can negotiate reduced prices due to the larger volume of medicines purchased. And European countries led by Austria have been sharing different policies to expand access to medicines through the WHO-supported PPRI (Pharmaceutical Pricing and Reimbursement Policies).

Industry bodies at the forum expressed support for the goal of access to medicines for all, and expressed their commitment to the Sustainable Development Agenda, which calls for partnership with the private sector to address global challenges such as access to medicines.

WHO will launch a public online consultation in the coming weeks to collect views and suggestions for a definition of what actually constitutes a ‘fair price’ from relevant stakeholders.


“Global Fragility Landscape” – World Bank

Concept Note – April 2019 :: 14 pages
Fragility, conflict, and violence (FCV) has become the new development frontier. By 2030, at least half of the world’s poor people will be living in fragile and conflict-affected settings.1 The impact of FCV is particularly profound on the most vulnerable people and communities, whose livelihoods and economic opportunities are threatened. The global fragility landscape has worsened significantly, with more violent conflicts than at any time in the past 30 years; the largest forced displacement crisis since World War II; high levels of interpersonal and gang violence; and conflicts driving 80 percent of all humanitarian needs.

Today, conflict and violence impact more civilians than at any point over the last two decades. FCV
situations have a clear impact on poverty and, strikingly, the extreme poverty rate is rising only in fragile countries.2 In many contexts, this is due to large-scale violence, a collapse in basic services delivery, and the weakening of core state functions—dynamics that characterize most FCV situations and represent both a humanitarian and development challenge that calls for comprehensive and coordinated international responses. It will prove impossible to achieve the World Bank Group’s twin goals of ending extreme poverty and boosting shared prosperity unless fragility, conflict, and violence are tackled.

For these reasons, addressing FCV has become the core business of the World Bank Group (WBG)…

Building on the progress made over the past years, notably under IDA18 as well as in a number of MICs, the WBG’s FCV Strategy aims to identify a conceptual and operating framework and a set of priority actions over the next five years, with the ultimate goal of developing a more systematic
approach to strengthen the WBG’s support to client countries and vulnerable populations.

Recognizing the suffering of those affected by FCV, and lost opportunities that can span generations, this comprehensive Strategy will more clearly identify both what to do and how the institution can adapt to deliver to those in greatest need. It will discuss how to scale-up development efforts to address the underlying drivers of FCV and enhance the WBG’s impact in FCV settings.

This Concept Note outlines proposed areas of focus for the FCV Strategy. It outlines the global and institutional FCV context; explains the rationale for, and objectives of, the Strategy; presents key
focus areas; introduces preliminary options to address operational challenges; and lays out the Strategy development process…

Press Release
World Bank Group Launches Worldwide Consultations on Future Strategy for Fragility, Conflict and Violence
WASHINGTON, April 16, 2019 — The World Bank Group today announced the launch of global consultations to inform the development of its first formal strategy for Fragility, Conflict and Violence (FCV). Consultations will be held in more than 30 countries, covering all World Bank Group regions, between April and June 2019, with a final strategy expected in November.

The consultations will focus on gathering perspectives in countries faced with diverse FCV challenges, as well as in countries that support World Bank Group programs in FCV settings. They will aim to capture lessons learned and best practices for reducing fragility, conflict and violence and promoting peace and prosperity. Inputs gathered from representatives of government, civil society organizations, international partners, the private sector and others, will be integrated into a comprehensive operational strategy focused on addressing the drivers of fragility and maximizing the World Bank Group’s support for affected people and communities.

The development of a World Bank Group FCV strategy comes at a pivotal time: By 2030, at least half of the world’s poor will live in fragile and conflict-affected settings. The strategy will therefore support the World Bank Group’s goals of ending extreme poverty and promoting shared prosperity. The strategy is being developed jointly by the International Finance Corporation (IFC), the Multilateral Investment Guarantee Agency (MIGA) and the World Bank. It will cover the period from 2020 to 2025.

“To achieve our goal of ending extreme poverty, we must focus on people living in countries that suffer from conflict and fragility,” said World Bank CEO Kristalina Georgieva. “Our new strategy aims to address the underlying causes of fragility and invest in the long-term development that helps create the conditions for peace and prosperity”.

The consultations will be conducted in two phases: From April to June 2019, stakeholders will be asked to provide feedback on the FCV strategy concept through face-to-face meetings and by completing an online questionnaire. From August to September 2019, a draft of the proposed FCV strategy will be shared online for feedback. Throughout the process, the public is invited to share questions and comments by email and via social media channels, using the hashtag #fragility2stability…

The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis

Featured Journal Content

The Lancet
Apr 20, 2019 Volume 393 Number 10181 p1569-1668, e38
The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis
Thomas J Bollyky, Tara Templin, Matthew Cohen, Diana Schoder, Joseph L Dieleman, Simon Wigley
Open Access
Previous analyses of democracy and population health have focused on broad measures, such as life expectancy at birth and child and infant mortality, and have shown some contradictory results. We used a panel of data spanning 170 countries to assess the association between democracy and cause-specific mortality and explore the pathways connecting democratic rule to health gains.

We extracted cause-specific mortality and HIV-free life expectancy estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 and information on regime type from the Varieties of Democracy project. These data cover 170 countries and 46 years. From the Financing Global Health database, we extracted gross domestic product (GDP) per capita, also covering 46 years, and Development Assistance for Health estimates starting from 1990 and domestic health spending estimates starting from 1995. We used a diverse set of empirical methods—synthetic control, within-country variance decomposition, structural equation models, and fixed-effects regression—which together provide a robust analysis of the association between democratisation and population health.

HIV-free life expectancy at age 15 years improved significantly during the study period (1970–2015) in countries after they transitioned to democracy, on average by 3% after 10 years. Democratic experience explains 22·27% of the variance in mortality within a country from cardiovascular diseases, 16·53% for tuberculosis, and 17·78% for transport injuries, and a smaller percentage for other diseases included in the study. For cardiovascular diseases, transport injuries, cancers, cirrhosis, and other non-communicable diseases, democratic experience explains more of the variation in mortality than GDP. Over the past 20 years, the average country’s increase in democratic experience had direct and indirect effects on reducing mortality from cardiovascular disease (−9·64%, 95% CI −6·38 to −12·90), other non-communicable diseases (−9·14%, −4·26 to −14·02), and tuberculosis (−8·93%, −2·08 to −15·77). Increases in a country’s democratic experience were not correlated with GDP per capita between 1995 and 2015 (ρ=–0·1036; p=0·1826), but were correlated with declines in mortality from cardiovascular disease (ρ=–0·3873; p<0·0001) and increases in government health spending (ρ=0·4002; p<0·0001). Removal of free and fair elections from the democratic experience variable resulted in loss of association with age-standardised mortality from non-communicable diseases and injuries.

When enforced by free and fair elections, democracies are more likely than autocracies to lead to health gains for causes of mortality (eg, cardiovascular diseases and transport injuries) that have not been heavily targeted by foreign aid and require health-care delivery infrastructure. International health agencies and donors might increasingly need to consider the implications of regime type in their efforts to maximise health gains, particularly in the context of ageing populations and the growing burden of non-communicable diseases.

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Islamic Development Bank and Global Partnership for Education Launch Alliance to Address Global Education Crisis


Islamic Development Bank and Global Partnership for Education Launch Alliance to Address Global Education Crisis
The expanding support among world leaders for providing quality education to children in the world’s poorest countries received a major boost today as the Global Partnership for Education (GPE) and the Islamic Development Bank (IsDB) agreed to a multi-pronged collaboration that will broaden and deepen GPE’s engagement with new partners.
15 April 2019
The expanding support among world leaders for providing quality education to children in the world’s poorest countries received a major boost today as the Global Partnership for Education (GPE) and the Islamic Development Bank (IsDB) agreed to a multi-pronged collaboration that will broaden and deepen GPE’s engagement with new partners.

Dr. Mohamed Nouri Jouini, IsDB’s Vice President of Partnership Development, Julia Gillard, GPE Board Chair and Alice Albright, GPE’s Chief Executive Officer, today signed a letter of intent outlining the new collaboration, which aims to bolster developing countries’ access to critical financing to strengthen education systems, reduce the number of out-of-school children and enable more children to learn and thrive.

“This exciting new alliance comes at an urgent moment when hundreds of millions of children around the world are not in school and many more are in school, but not learning,” said Julia Gillard, GPE’s Board Chair and former Prime Minister of Australia. “It is a strategic step forward in the campaign to end the global education crisis. The Islamic Development Bank will provide vital political, technical and financial leadership in the education sector and is a privileged partner for GPE. Together we can achieve impressive progress.”

…As part of the collaboration, IsDB will help leverage new funding through the GPE Multiplier, an innovative funding mechanism that provides low- and lower middle-income countries one dollar from GPE for every three dollars they raise from other sources. IsDB will also work with GPE to strengthen coordination and policy dialogue among education groups in developing countries and become an alternate member of the GPE Board of Directors.

The two organizations also agreed to jointly promote greater political commitment for education through global, regional and country-level advocacy and communications efforts, and raise the political profile of education.

“Developing countries understand that education is a pre-requisite to nation building, a game-changer for their economic prosperity, social progress and political stability,” said Alice Albright, GPE’s Chief Executive Officer. “This new partnership between GPE and IsDB will help mobilize more resources, particularly through the GPE Multiplier, so we can extend learning to all children, especially those from vulnerable and marginalized communities.”

In addition to today’s letter of intent, GPE and IsDB each endorsed an agreement last week with several other partners to form a Global Education Coalition, whose goal is to enroll and retain 28 million out-of-school children in member countries of the Organization of Islamic Cooperation (OIC) by 2030. The coalition’s goal is to meet the Sustainable Development Goal for universal and equitable education by 2030.

Combating infectious disease epidemics through China’s Belt and Road Initiative

Featured Journal Content

PLoS Neglected Tropical Diseases
(Accessed 20 Apr 2019)
Policy Platform
Combating infectious disease epidemics through China’s Belt and Road Initiative
Jin Chen, Robert Bergquist, Xiao-Nong Zhou, Jing-Bo Xue, Men-Bao Qian
| published 18 Apr 2019 PLOS Neglected Tropical Diseases
On March 17, 2017, the United Nations (UN) Security Council, backed by the consensus of its 193 member states, adopted Resolution 2344, which calls for strengthening regional economic cooperation through China’s Belt and Road (also called Silk Road) Initiative (BRI) [1]. Based on the cornerstones of peace and cooperation, openness and inclusiveness, and mutual learning and sharing benefit, this initiative was proposed by the Chinese government and is participated in by various parties. Its goal is to provide fundamental solutions to boost global economic development through enhancing policy coordination, facility connection, unimpeded trade, financial integration, and people-to-people bonds. The UN Secretary-General, Mr. António Guterres, acknowledged that the BRI tallies with, and complements, the Sustainable Development Goals (SDGs) in terms of promoting inclusive development, strengthening exchange between countries, and benefiting people within the initiative’s scope [2]. The BRI currently involves 69 countries (mainly those named in the initial Belt and Road outreach and those having signed cooperation agreements), 70% of the world population in total, 30% of the global gross domestic product, and 75% of the world’s energy reserves [2–4].

Although the BRI is primarily economic, it also includes important health dimensions. The Healthy China 2030 plan, promulgated in 2016, considers health as one of the national policy priorities, and the Memorandum of Understanding with the World Health Organization (WHO), signed in 2017, which promotes global health security and development along the terms of the initiative [5, 6]. Based on these agreements, the building of a Health Silk Road has become a core task leading to an extensive engagement in global health development [7, 8]…

The world is currently witnessing increasingly complex epidemics as well as natural disasters with a rising impact on both human health and the economy [1]. Growing commercial trade and more frequent personal exchange following the implementation of the BRI may amplify infectious disease transmission or inadvertently introduce emerging infectious diseases, leading to an increased burden for local medical systems. Moreover, infectious diseases resulting from poverty disproportionately affect poor and marginalised communities, which remains a more serious hurdle to achieving the SDGs and UHC [9, 10]. This is the reason why the initiative has made the need to combat infectious diseases a priority for social and economic development. The implementation of the BRI is expected to facilitate progress in eliminating infectious diseases such as the acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and 17 neglected tropical diseases (NTDs), which make up SDG…

The purpose of this paper is to analyse the existing spectrum of the main infectious diseases in epidemics (based on the Global Burden of Diseases [GBD] study of 2016 [14, 15]), the potential negative effect on the economy, and the challenges to elimination. The paper also aims to explore opportunities and a feasible approach of global disease control with specific consideration of the BRI…

…Challenges regarding infectious diseases in Belt and Road countries
The spectrum of local infectious diseases
The thrust of the BRI has two main directions: the Silk Road, which connects China by land with European countries via central and western Asia and the Middle East, and the 21st Century Maritime connection across the South China Sea, the Indian Ocean, and the Mediterranean to reach sub-Saharan Africa, following the lead of the great Chinese Ming dynasty admiral and explorer Zheng He. These two land and maritime directions from China follow five routes [1].

The Health Silk Road, a core task of the BRI, encourages health development and security along the Road. The 2030 Agenda for SDGs also calls for halting HIV/AIDS, TB, and malaria as well as the termination of the ravages caused by the 17 NTDs by 2030 [13]. Altogether, according to the 2016 GBD study, the cost expressed in disability-adjusted life years (DALYs) amounts to an estimated 63.31 million (with substantial regional variations in the 69 countries), which currently accounts for 36.7% of the total toll of these diseases throughout the world [2, 14, 15].

The DALYs resulting from the ‘big three’ (HIV/AIDS, TB, and malaria) plus those due to the 17 NTDs along the route from China towards Southeast Asia and South Asia (excluding China) amounts to 34.81 million DALYs and are mainly due to HIV/AIDS, TB, and malaria in addition to dengue and intestinal nematode infections. The infectious disease epidemics in countries along the 21st Century Maritime Silk Road are mainly the same set of diseases plus schistosomiasis, which together generate 20.46 million DALYs. The China–central Asia–Russia–Europe route, involving countries in central Asia and eastern Europe, includes many of the same diseases as well as some additional ones—i.e., intestinal nematode infections, cystic echinococcosis, foodborne trematodiases, and cysticercosis—which together cause 2.39 million DALYs. A total of 0.50 million DALYs in the countries along the China–central Asia–west Asia axis are due to TB, leishmaniasis, malaria, HIV/AIDS, intestinal nematode infections, and cystic echinococcosis (Fig 1). Such high endemicity of infectious diseases in the region is a serious hurdle for the global elimination agenda. The DALYs due to these diseases vary across the regions, and so do the collaborative priorities and their expected potential impacts. For example, cooperative actions could lead to regional elimination of lymphatic filariasis (LF) along the Maritime Silk Road while simultaneously having a significant impact on malaria, dengue, intestinal helminth infections, schistosomiasis, and TB [16, 17].

…Conclusion and implication
A major part of the BRI focuses on support and communication to build a new mechanism for global health, prioritising the prevention and control of infectious diseases, preventing outbreaks becoming epidemics, and providing UHC, thus overcoming the vicious circle of poverty and ill health. China will strengthen cooperation with particular regard to the control of TB, echinococcosis, and dengue within the 69 countries and deliver enhanced communication and research leading to the elimination of LF, malaria, and schistosomiasis. Based on opportunities the BRI provides and the cooperative experience gained, the framework shown in Fig 3 should become available and applicable to the response to these challenges by sharing information, joint control, and technical know-how.

UHC and response to the challenges posed by infectious disease epidemics are vital for the new era, with health considerations at the core of the BRI. Despite the serious threats of the infectious disease epidemics, the emphasis on health through the BRI puts us in an excellent position to achieve the health-related aspects of the SDGs by implementing the Health Silk Road concept of improved life through health-related communication. Based on technical experience in this field, mature collaborating mechanisms, and the provision of financial support, the strategies in the context of the BRI reinforce the various countries’ extensive engagement in combating infectious disease epidemics.