Vaccination Nations:  Elevating Health Care Access for Peaceful, Inclusive Societies, Dr. Robert Zuber

11 Mar

Pills

Happiness is nothing more than good health and a bad memory. Albert Schweitzer

If Patents are for Patients then Patients will be for Patents. Kalyan Kankanala

Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates

It is the first morning of daylight savings time in New York which has caused some to miss Sunday appointments but many to hope that spring weather will soon make a lasting appearance.

The winter in the northern hemisphere, here and in many other parts of the planet, has been characterized by a range of health-related problems.  Severe flu outbreaks here have brought tragic death to some children and thrown many millions off their game.  I know personally of several people – most at least enjoying sufficient access to medical care – who have had to stay in bed for many days, with weeks of only semi-functional, partial recovery to follow.   You see such people in half-recovery every morning on the subways of New York, avoiding the many coughers, refusing to hold on to the poles in crowded cars with bare hands, trying to figure out in their heads how they are going to make up for lost work time when they are still only half-whole.

As has been stated so often by so many, health is something we take too much for granted until we lose it.  Then, and sometimes only then, do we recognize how much of our lives – including fulfilling our responsibilities to our jobs, families and communities – is predicated on “feeling up to it.”   And even when we don’t, there are times when we must “soldier on” perhaps because of the non-negotiable responsibilities to work and family that beckon, perhaps because of access-to-healthcare issues, including the seemingly ever-increasing costs.

These impediments of time, opportunity and expense are far more than annoyances, but undermine well-being in ways that impact our ability to participate fully in the affairs of the world and help others to participate also.

At the UN, health care quality and access are thankfully occupying a more prominent place on our collective agenda, in part because far too many people in this world lack sufficient opportunity and access to health resources that can improve the quality of their own lives and their productive service to others; also in part because of a growing understanding of how important personal and community health are to the often-challenging promotion and achievement of “peaceful and inclusive societies.”

In the Sustainable Development Goals (SDGs), target 3.8 directs us to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”  This represents a noble aspiration and, as with other SDG goals and targets, naming it is only the first step to full and fair implementation.

It is hoped that the Commission on the Status of Women, convening this Monday on the theme “Challenges and opportunities in achieving gender equality and the empowerment of rural women and girls,” can also make substantive contributions to greater health care access and awareness.  In areas of the world in which Global Action has cultivated program partnerships, including in Cameroon and El Salvador, access barriers to vaccinations and other health care often drag down women simultaneously discharging family and community responsibilities while seeking pathways  to greater levels of economic and political participation for themselves and others.  It is exhausting just to witness the multiple tasks that many rural women juggle, even more so considering how many of these women must juggle while battling illnesses and injuries that often go untreated and which, in some instances, are a consequence of diseases that have received too-little attention from the scientists and pharmaceutical companies that drive so many medical innovations (and the patents to protect them).   The CSW can hopefully focus some of its formidable policy attention and recommendations on improving health access for rural women (and their families) that can help them achieve both access to markets and increased levels of political and social participation.

Thankfully, health issues seem to be getting tracton across the UN agenda – specifically in terms of preventing and responding to pandemics, addressing antibiotic resistance (and the current lack of pharmaceutical interest in creating viable alternatives), and encouraging shifts in diet and lifestyles that can lower thresholds for non-communicable diseases (from cigarette smoking, opioid addictions, etc.) .  All of these (and related) interventions, as noted, have important implications for peaceful and inclusive societies, as well as for elevating levels of health-related access.

Last Tuesday, the World Health Organization and other UN partners convened a session devoted to “Promoting Innovation and Access to Health Technologies,” which was intended in part as a follow up to the 2016 report by the Secretary-General’s High Level Panel on Access to Medicines.  Despite acknowledged limitations in its mandate, the report deftly outlines impediments to access and suggests trade and finance reforms to ease obstacles.  The report acknowledges the need to fund more research on diseases and related health needs endemic to developing countries — including more resistance-free antibiotics – while ensuring fair protection and compensation for those whose investment risks made new medicines and medical technologies possible.  The report highlights most of the often-systemic, critical barriers to access that must be addressed by the international community, including “inequalities within and between countries,” poor health education, a lack of trained medical personnel, health-related stigmas, lack of access to health insurance, and what it calls “exclusive marketing rights.”  And of course it cites the matter of health-related costs which in some instances (including for insulin, as noted by the WHO on Tuesday) are still rising.

What the report did not take up are the health and human rights implications of “bio-piracy,” research that exploits potential remedies from fields and forests to produce medicines which are then patented and marketed in ways that render them often well beyond the reach of the very people who inhabit the environments of origin.

Nor did the report take up the health access barriers that are created and exacerbated by armed violence, the refugees struggling with severe physical constraints on their long and treacherous journeys, the families under siege who find their clinics and hospitals reduced to rubble.  The nefarious “stripping” of long-awaited relief convoys containing medical supplies headed for besieged areas of Syria (even after a Security Council-authorized cessation of hostilities) is a special case but sadly not a unique one. We can’t seem to stop the bombing — perhaps our primary UN responsibility– but beyond that we can’t even guarantee minimal access by victims to the medicines and equipment that could give them a “punchers chance” for survival and renewal.  Apparently even the most abusive state and non-state actors understand that healthier and more able people are better able to contribute to stabilizing damaged local communities; but on a larger level are also better able to resist the intimidation of bombs and sieges, to more effectively demand cleaner water, lower levels of state corruption, less discrimination and abuse, fairer access to education for their children and energy for their dwellings.  Even abusers recognize that health care access is not a side-show on the path to more peaceful and inclusive societies, but is elemental to their ultimate success.

As one recent TV advertisement in the US seeks to remind us, moms and dads “don’t take sick days.”  But as the Dutch Ambassador to the US intimated during her statement at Tuesday’s event, the world is full of too many people for whom a “sick day” is an indulgence that threatens the basic well-being of families and communities.  It is the obligation of all of us, as the Thailand Ambassador and others noted – health professionals, scientists, parents, the private sector and the global policy community — to ensure a “better balance” of interests between those who develop vaccines, other medicines and medical equipment and those for whom access to context-appropriate health care is literally a lifeline.  We cannot meaningfully propose strategies for the full inclusion and participation of persons who can barely lift their heads to attend to their daily responsibilities in domiciles, fields and markets.

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