G7 Paris Summit – Reducing inequalities for sustainable development

Development – Inequality

G7 Paris Summit
Reducing inequalities for sustainable development
Paris Joint Statement of the French Minister of Labour, the Managing Director of the International Monetary Fund (IMF), the Director-General of the International Labour Organization (ILO), and the Secretary General of the Organisation for Economic Cooperation and Development (OECD).

Statement | Paris, France | 19 December 2019
Throughout the world, increased inequalities within countries pose risks to inclusive growth, economic stability and social cohesion, both in advanced economies and in developing countries. In the absence of strong and effective policy responses to citizens’ call for social justice and shared prosperity, high inequalities contribute to the erosion of trust in democratic institutions and may ultimately challenge the foundation of our rules-based international cooperation system.

At a time of weak growth, the world of work is also undergoing profound and rapid global changes, driven by technological innovations, demographic shifts as well as environmental and climate change. These are defining global challenges requiring effective and coordinated responses through international cooperation and sustained social dialogue, to develop a human-centered approach which puts the needs, aspirations and rights of all people at the heart of economic, social and environmental policies.

The evidence from the work of our respective organizations has demonstrated that well-managed, digital transformations and transitions to environmentally and socially sustainable economies can become a strong driver of job creation, job upgrading, social justice and inclusion. Economies must be robust and productive to meet the needs of the world’s growing population. Societies must be inclusive, providing opportunities for decent work for all and must generate a fairer and more equitable distribution of income from work, reducing absolute poverty and inequalities.

Enhanced social spending can be a key policy lever for addressing emerging challenges from demographic shifts, technological developments, and climate change. Investment in education, health and social protection plays an essential role in generating equal opportunity, supporting social and political stability, addressing inequalities of income, protecting vulnerable groups and stabilizing economies in the face of shocks.

Adapting, reinforcing and expanding adequate, efficient, and fiscally sustainable social protection systems and investing in education, skills upgrading and health can help reduce inequality in income and opportunities, including in its gender dimension, address the persistence of poverty across generations, enhance social mobility, and ultimately promote sustained inclusive growth. Sound and effective redistributive fiscal policies adapted to national contexts are therefore needed to help governments address high levels of inequality. This requires fostering the adequacy, efficiency and equity, including risk sharing and solidarity, of social spending.

In this regard, and in light of the respective mandates of the International Labour Organization (ILO), the Organisation for Economic Cooperation and Development (OECD) and the International Monetary Fund (IMF), we believe that stronger cooperation and coordination among the international organizations constitutes an opportunity to increase the efficiency and impact in delivering the outcomes identified by our stakeholders and to foster the realization of the 2030 sustainable development goals, as agreed at the G7 Leaders Summit in Biarritz in August 2019.

In line with the G7 Social members’ call for a multilateral dialogue and coordination for the reduction of inequalities, we will strengthen our joint efforts at the institutional and country level, within our respective mandates, to identify areas for collaboration to reduce inequalities and to promote access to education, health and social protection.

Global Wave of Debt Is Largest, Fastest in 50 Years – Emerging/Developing Economies

Development – Debt in Emerging/Developing Economies

Global Wave of Debt Is Largest, Fastest in 50 Years
WASHINGTON, December 19, 2019—Debt in emerging and developing economies (EMDEs) climbed to a record US$55 trillion in 2018, marking an eight-year surge that has been the largest, fastest, and most broad-based in nearly five decades, according to a new World Bank Group study that urges policymakers to act promptly to strengthen their economic policies and make them less vulnerable to financial shocks.

The analysis is contained in Global Waves of Debt, a comprehensive study of the four major episodes of debt accumulation that have occurred in more than 100 countries since 1970. It found that the debt-to-GDP ratio of developing countries has climbed 54 percentage points to 168 percent since the debt buildup began in 2010. On average, that ratio has risen by about seven percentage points a year—nearly three times as fast it did during the Latin America debt crisis of the 1970s. The increase, moreover, has been exceptionally broad-based—involving government as well as private debt, and observable in virtually all regions across the world.

“The size, speed, and breadth of the latest debt wave should concern us all,” said World Bank Group President David Malpass. “It underscores why debt management and transparency need to be top priorities for policymakers—so they can increase growth and investment and ensure that the debt they take on contributes to better development outcomes for the people.”

According to the report, the prevalence of historically low global interest rates mitigates the risk of a crisis for now. But the record of the past 50 years highlights the dangers: Since 1970, about half of the 521 national episodes of rapid debt growth in developing countries have been accompanied by financial crises that significantly weakened per-capita income and investment.

“History shows that large debt surges often coincide with financial crises in developing countries, at great cost to the population,” said Ceyla Pazarbasioglu, the World Bank Group’s Vice President for Equitable Growth, Finance, and Institutions. “Policymakers should act promptly to enhance debt sustainability and reduce exposure to economic shocks.”

The analysis found that this latest wave is different from the previous three in several ways—it involves a simultaneous buildup in both public and private debt; it involves new types of creditors; and it is not limited to one or two regions. Some of the increase in debt has been driven by China, whose debt-to-GDP ratio has risen 72 points to 255 percent since 2010. But debt is substantially higher in developing countries even if China is excluded from the analysis—among EMDEs, it is twice the nominal level reached in 2007.

Those characteristics pose challenges that policymakers haven’t had to tackle before. For example, nonresident investors today account for 50 percent of the government debt of EMDEs, considerably more than in 2010. For low-income countries, much of this debt has been on non-concessional terms, and outside the debt-resolution framework of the Paris Club.

Under the circumstances, policymakers should develop mechanisms to facilitate debt resolution when it becomes necessary, according to the report. Greater debt transparency would also help.

Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study

Featured Journal Content

PLoS Medicine
(Accessed 21 Dec 2019)
Research Article
Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low- and middle-income countries: A modeling study
Victoria B. Chou, Neff Walker, Mufaro Kanyangarara
Research Article | published 18 Dec 2019 PLOS Medicine
In low-resource settings where disease burdens remain high and many health facilities lack essentials such as drugs or commodities, functional equipment, and trained personnel, poor quality of care often results and the impact can be profound. In this paper, we systematically quantify the potential gain of addressing quality of care globally using country-level data about antenatal, childbirth, and postnatal care interventions.
Methods and findings
In this study, we created deterministic models to project health outcomes if quality of care was addressed in a representative sample of 81 low- and middle-income countries (LMICs). First, available data from health facility surveys (e.g., Service Provision Assessment [SPA] and Service Availability and Readiness Assessment [SARA]) conducted 2007–2016 were linked to household surveys (e.g., Demographic and Health Surveys [DHS] and Multiple Indicator Cluster Surveys [MICS]) to estimate baseline coverage for a core subset of 19 maternal and newborn health interventions. Next, models were constructed with the Lives Saved Tool (LiST) using country-specific baseline levels in countries with a linked dataset (n = 17) and sample medians applied as a proxy in countries without linked data. Lastly, these 2016 starting baseline levels were raised to reach targets in 2020 as endline based upon country-specific utilization (e.g., proportion of women who attended 4+ antenatal visits, percentage of births delivered in a health facility) from the latest DHS or MICS population-based reports. Our findings indicate that if high-quality health systems could effectively deliver this subset of evidence-based interventions to mothers and their newborns who are already seeking care, there would be an estimated 28% decrease in maternal deaths, 28% decrease in neonatal deaths, and 22% fewer stillbirths compared to a scenario without any change or improvement in quality of care. Totals of 86,000 (range, 77,800–92,400) maternal and 0.67 million (range, 0.59 million–0.75 million) neonatal lives could be saved, and 0.52 million (range, 0.48 million–0.55 million) stillbirths could be prevented across the 81 countries in the calendar year 2020 when adequate quality care is provided at current levels of utilization. Limitations include the paucity of data to individually assess quality of care for each intervention in all LMICs and the necessary assumption that quality of care being provided among the subset of countries with linked datasets is comparable or representative of LMICs overall.
Our findings suggest that efforts to close the quality gap would still produce substantial benefits at current levels of access or utilization. With estimated mortality rate declines of 21%–32% on average, gains from this first step would be significant if quality was improved for selected antenatal, intrapartum, and postnatal interventions to benefit pregnant women and newborns seeking care. Interventions provided at or around the time of childbirth are most critical and accounted for 64% of the impact overall estimated in this quality improvement analysis.

Author summary
Why was this study done?
:: In low- and middle-income countries, health systems struggle to provide high-quality medical care to pregnant women and their newborns in need.
:: Delivery of key health interventions is critical to save lives and prevent morbidity and mortality in high-burden settings.
:: The impact of extant or poor quality of care at a population level is poorly understood, and quantifying the benefits of improving quality among those already seeking or accessing care would be a critical first step for prioritization.

What did the researchers do and find?
:: To examine the global impact of improvement in the quality of care, we used a linking approach, which combines health facility and population-level survey data to estimate baseline for a subset of important evidence-based interventions.
:: Intervention coverage trends were modeled in 81 countries by setting current levels of reported utilization as the final country-specific targets for 2020.
:: If those seeking medical attention arrived at facilities reimagined with adequate resources and receive high-quality care, our systematic tally indicates that almost one quarter of the maternal deaths, neonatal deaths, and stillbirths would be preventable during the period 2016–2020 if the gaps in quality of care were eliminated.

What do these findings mean?
:: Countries and current health systems are far from ensuring that skilled providers with adequate supplies are providing timely and appropriate healthcare to existing populations in need. Our analysis of potential gains quantifies the consequences of these missed opportunities, ranging from the prenatal to postnatal periods.
:: Bolstering the quality of care is an essential checkpoint because efforts to increase utilization will rely on the same health systems where vulnerable populations are presently accessing care.
:: With greater attention focused on tracking country-level progress, more data will hopefully become available to effectively monitor changes in coverage for key maternal and neonatal interventions. As these parameters or inputs are better defined, modeling can contribute to the body of knowledge by offering an informed approach to examine quality of care gaps so that better strategies can be developed to improve health among mothers and their children seeking care in this context.

Articulating ‘free, prior and informed consent’ (FPIC) for engineered gene drives

Featured Journal Content

Proceedings of the Royal Society B – Biological Sciences
11 December 2019 Volume 286 Issue 1917
Research articles
Articulating ‘free, prior and informed consent’ (FPIC) for engineered gene drives
Dalton R. George, Todd Kuiken and Jason A. Delborne
Published:18 December 2019 https://doi.org/10.1098/rspb.2019.1484
Recent statements by United Nations bodies point to free, prior and informed consent (FPIC) as a potential requirement in the development of engineered gene drive applications. As a concept developed in the context of protecting Indigenous rights to self-determination in land development scenarios, FPIC would need to be extended to apply to the context of ecological editing. Without an explicit framework of application, FPIC could be interpreted as a narrowly framed process of community consultation focused on the social implications of technology, and award little formal or advisory power in decision-making to Indigenous peoples and local communities. In this paper, we argue for an articulation of FPIC that attends to issues of transparency, iterative community-scale consent, and shared power through co-development among Indigenous peoples, local communities, researchers and technology developers. In realizing a comprehensive FPIC process, researchers and developers have an opportunity to incorporate enhanced participation and social guidance mechanisms into the design, development and implementation of engineered gene drive applications.

Earliest hunting scene in prehistoric art: Sulawesi—dated to at least 43.9 thousand years ago

Featured Journal Content

Volume 576 Issue 7787, 19 December 2019
Article | 11 December 2019
Earliest hunting scene in prehistoric art
A rock art panel from Sulawesi—dated to at least 43.9 thousand years ago—represents the oldest currently known figurative art in the world, and provides evidence of early storytelling through narrative hunting scenes.
Maxime Aubert, Rustan Lebe[…] & Adam Brumm
Humans seem to have an adaptive predisposition for inventing, telling and consuming stories1. Prehistoric cave art provides the most direct insight that we have into the earliest storytelling2,3,4,5, in the form of narrative compositions or ‘scenes’2,5 that feature clear figurative depictions of sets of figures in spatial proximity to each other, and from which one can infer actions taking place among the figures5. The Upper Palaeolithic cave art of Europe hosts the oldest previously known images of humans and animals interacting in recognizable scenes2,5, and of therianthropes6,7—abstract beings that combine qualities of both people and animals, and which arguably communicated narrative fiction of some kind (folklore, religious myths, spiritual beliefs and so on). In this record of creative expression (spanning from about 40 thousand years ago (ka) until the beginning of the Holocene epoch at around 10 ka), scenes in cave art are generally rare and chronologically late (dating to about 21–14 ka)7, and clear representations of therianthropes are uncommon6—the oldest such image is a carved figurine from Germany of a human with a feline head (dated to about 40–39 ka)8. Here we describe an elaborate rock art panel from the limestone cave of Leang Bulu’ Sipong 4 (Sulawesi, Indonesia) that portrays several figures that appear to represent therianthropes hunting wild pigs and dwarf bovids; this painting has been dated to at least 43.9 ka on the basis of uranium-series analysis of overlying speleothems. This hunting scene is—to our knowledge—currently the oldest pictorial record of storytelling and the earliest figurative artwork in the world.



Ebola – DRC+
Public Health Emergency of International Concern (PHEIC)

Ebola Outbreak in DRC 72: 17 December 2019
Situation Update
In the week of 9 to 15 December 2019, 24 new confirmed Ebola virus disease (EVD) cases were reported from three health zones in two affected provinces in the Democratic Republic of the Congo. The majority of these new confirmed cases are from Mabalako (22/24; 92%), and the other cases were reported from Biena (1/24; 4%) and Mandima (1/24; 4%) health zones.

The new cases from Mabalako and Biena, are linked to a single chain of transmission, in which one individual was a potential source of infection for 24 people. This was the second documentation of EVD illness in this individual within a 6-month period. Based on the preliminary sequencing of samples from the case, this is being classified as a relapse of EVD. Rare cases of relapse have been documented, in which a person who has recovered from EVD gets disease symptoms again, but this is the first documented relapse in this outbreak.

The volume of alerts reported has returned to levels seen before the security incidents in the past weeks. In general, the overall average proportion of contacts under surveillance in the last seven days has returned to previously observed levels. However, Mabalako, the health zone with the highest volume of contacts, has the lowest performance with 73% of contacts under surveillance…


First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response
December 19, 2019
The U.S. Food and Drug Administration announced today the approval of Ervebo, the first FDA-approved vaccine for the prevention of Ebola virus disease (EVD), caused by Zaire ebolavirus in individuals 18 years of age and older. Cases of EVD are very rare in the U.S., and those that have occurred have been the result of infections acquired by individuals in other countries who then traveled to the U.S., or health care workers who became ill after treating patients with EVD.

“While the risk of Ebola virus disease in the U.S. remains low, the U.S. government remains deeply committed to fighting devastating Ebola outbreaks in Africa, including the current outbreak in the Democratic Republic of the Congo,” said Anna Abram, FDA Deputy Commissioner for Policy, Legislation, and International Affairs. “Today’s approval is an important step in our continuing efforts to fight Ebola in close coordination with our partners across the U.S. Department of Health and Human Services, as well as our international partners, such as the World Health Organization. These efforts, including today’s landmark approval, reflect the FDA’s unwavering dedication to leveraging our expertise to facilitate the development and availability of safe and effective medical products to address urgent public health needs and fight infectious diseases, as part of our vital public health mission.”…

… “Ebola virus disease is a rare but severe and often deadly disease that knows no borders. Vaccination is essential to help prevent outbreaks and to stop the Ebola virus from spreading when outbreaks do occur,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “The FDA’s approval of Ervebo is a major advance in helping to protect against the Zaire ebolavirus as well as advancing U.S. government preparedness efforts. The research approach used to study the effectiveness and safety of this vaccine was precedent-setting during a public health emergency and may help create a model for future studies under similar circumstances. The FDA is committed to continuing our work across the U.S. government and with our international partners to prevent future Ebola outbreaks and mitigate the current outbreak in the DRC, reflecting our nation’s commitment to preparing for and responding to biological threats, like Ebola.”’’’

…The FDA granted this application Priority Review and a Tropical Disease Priority Review Voucher under a program intended to encourage development of new drugs and biologics for the prevention and treatment of certain tropical diseases. The FDA also granted Breakthrough Therapy designation for Ervebo to facilitate the development and scientific evaluation of the vaccine. Because of the public health importance of a vaccine to prevent EVD, the FDA worked closely with the company and completed its evaluation of the safety and effectiveness of Ervebo in less than six months. The approval was granted to Merck & Co., Inc.




Public Health Emergency of International Concern (PHEIC)

Polio this week as of 18 December 2019

Summary of new viruses this week (AFP cases and ES positives):
:: Afghanistan – two WPV1 cases and two WPV1-positive environmental samples.
:: Pakistan – seven WPV1 cases, one cVDPV2 case and 12 WPV1-positive environmental samples.
:: DR Congo – Eight cVDPV2 cases.
:: Somalia – two cVDPV2-positive environmental sample.
:: Angola – 11 cVDPV2 cases and two cVDPV2-positive environmental samples.
:: Chad – one cVDPV2 case.
:: Ethiopia – one cVDPV2-positive environmental sample.
:: Ghana – three cVDPV2 cases.


Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies [to 21 Dec 2019]

Democratic Republic of the Congo
:: Ebola Outbreak in DRC 72: 17 December 2019

Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified


WHO Grade 2 Emergencies [to 21 Dec 2019]
Measles in Europe
:: Nordic countries working together to sustain measles and rubella elimination 20-12-2019
:: 2019: the WHO European Region’s year in review 19-12-2019

:: Bi‐weekly Situation Report 24 – 5 December 2019
:: A total of 1,270,70 doses of oral cholera vaccine (OCV) was approved for the OCV campaign, targeting around 635,000 individuals, which will take place from 8 to 14 December in the Rohingya camps and 8 to 31 December in the host communities.
:: Since 5 September 2019, a total of 213 cases of Acute Watery Diarrhea (AWD) have tested positive by cholera Rapid Diagnostic Tests (RDTs), or culture.
:: An assessment undertaken for the operational risks associated with Fecal Sludge management (FSM) and water sources has concluded that, urgent actions are required to improve the water safety situation in these camps…

Oral Cholera Vaccine and Measles Outbreak Response Immunization campaigns
:: The Civil Surgeon, with support from WHO and UNICEF, established an immunization core group. The first meeting took place at the Ministry of Health and Family Welfare (MoHFW) Coordination Cell offices. Details of the upcoming Oral Cholera Vaccine (OCV) campaign were discussed.
:: A total of 1 270 170 doses of OCV was approved for the OCV campaign targeting around 635 000 individuals. The campaign will take place from 8 to 14 December in the Rohingya camps and 8 to 31 December in the host communities.
:: Several preparatory meetings have taken place. This includes District planning and Coordination meeting on 27 November, Upazila planning and microplanning meetings on 28 November and several advocacy meetings involving different target leaders including political leaders, Imams, Ministry of Education officials, among others.
:: Training has taken place for 34 OCV Camp Coordinators, 34 OCV Associate Camp Coordinators on 23 and 24 November 2019. These trainings were cascaded to over 2750 Community Health Workers and Communication for Development volunteers and 240 team supervisors between 28 and 30 November 2019, with support from partners.
:: For the host community, 300 vaccinators and mobilizers have been trained alongside 50 supervisors. Training for 1 050 and 900 volunteers commenced and will be completed by 4 December 2019, for Teknaf and Ukhia respectively.
:: The Rohingya Camp Wide Measles Rubella Outbreak Response Immunization (MR ORI) is planned in response to the measles outbreak that is currently confirmed in 16 of 34 camps in the Ukhia and Teknaf Upazila. Discussions on MR ORI took place 28 November 2019 during Scientific and Technical Sub- Committee (STSC) of the National Committee for Immunization Practices (NCIP) meeting held in Dhaka. There is need for timely ORI while ensuring quality, good coverage and proper capacity and management plan for any Adverse Events Following Immunization (AEFI).
:: MR ORI implementation planned for first week of January 2020 subject to Government approvals and favorable preparedness assessment. The target age group for this ORI is all children 6 months to less than 10 years of age in the Rohingya camps of Ukhia and Teknaf in Cox’s Bazar district.

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burkina Faso [in French] – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi floods – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified


WHO Grade 1 Emergencies [to 21 Dec 2019]

Chad – No new digest announcements identified
Djibouti – No new digest announcements identified
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified


UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Syrian Arab Republic
:: Syrian Arab Republic: Recent Developments in Northwestern Syria Flash Update No. 1 – As of 20 December 2019
:: Following the intensification of airstrikes and shelling since 16 December in southern Idleb, tens of thousands of civilians are reportedly fleeing from Ma’arrat An-Nu’man area in southern Idleb governorate to north. Thousands of others are reportedly waiting for the bombardment to ease allowing them to move. The shortage of fuel in Idleb area is also limiting the movement of civilians fleeing from hostilities.
:: As of 20 December, ground fighting also resumed along the frontlines in southern Idleb governorate, amplifying displacement from southern Idleb as civilians are fleeing in anticipation of fighting directly affecting their communities.
:: Displacement happening in winter months is exacerbating the vulnerability of people in need. Many of those who fled are in urgent need of humanitarian support, particularly shelter, food, health, non-food and winterization assistance.

Yemen – No new digest announcements identified


UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Editor’s Note:
Ebola in the DRC has bene added as a OCHA “Corporate Emergency” this week:
CYCLONE IDAI and Kenneth – No new digest announcements identified
EBOLA OUTBREAK IN THE DRC – No new digest announcements identified


The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
Week ending 14 December 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 14 Dec 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]