Global Health Round Table
The Global Health Round Table will resume in October / November 2019.
Opinion: Finding the ‘right’ solution in the German vaccine debate
Germany has made global headlines after a recent legislative proposal by the German health minister, Jens Spahn. The proposed law aims to increase the rate of measles vaccinations by threatening parents with fines of up to 2500 EUR and by keeping children who have not been vaccinated for measles out of kindergarten. This comes amidst widespread measles outbreaks and a 300% global increase compared to 2018, according to unofficial reports from the World Health Organization. This trend is startling, and as the media are quick to point out, can be partially attributed to the rising voice of so-called ‘anti-vaxxers’. However, this is not the only, or even necessarily the major, reason for suboptimal vaccination rates. Vaccines are effective, safe and are among the greatest achievements of medicine. Debating the details is not the goal here.
What interests me, as a student of health sciences with political leanings, is whether this proposed legislation is really the best approach for increasing vaccinations across Germany in the short- and long- term. This means aiming for ‘herd immunity’– achieving a 95% vaccination rate– while maintaining public trust in the government. This requires us to take a step back and to get a touch philosophical. The duty of a government, as Gostin (2018) aptly summarizes, is to protect its citizens. Major threats to health, including the spread of infectious diseases, thus fall within a government’s power. But this power has its limits. Government can be expected to employ minimally invasive strategies to reach public health goals. So we must ask, does the recent legislative proposal balance these two objectives? Let’s first take a look at the situation in Germany.
Germany does not have mandatory vaccinations and yet, according to a report from the Federal Health Journal (Bundesgesundheitsblatt), over the past 10 years the vaccination rates of children and adolescents have generally risen (Poethko-Müller et al., 2019). The same report notes that 97.1% of German adolescents received their first measles vaccination. However, only 93.8% received the required second one, leaving the country short of its 95% goal in this population. There is a widespread perception, spurred by recent headlines and global trends, to assume that cases of measles are on the rise. However, the numbers do not support this assertion. As is seen in Figure 1, the rates this year are high, but they are not unprecedented.
taken from ARD-faktenfinder (2019).
Health decisions are deeply personal and since the end of WWII Germany has been particularly careful to avoid infringing on these rights when possible. That said, the current legislative proposal is not the first of its kind. After the vaccination against smallpox was introduced, children between one and twelve were obliged to be vaccinated; this was deemed compatible with ‘Basic Law’ by the Federal Court in 1959 (Eichinger & Hollstein, 2019). Smallpox was globally devastating as it was incredibly contagious and could stay in the air even two hours after an infected person left a room. The legislation seemed justified and succeeded in its goal – smallpox was eventually eradicated in Germany. Again, in extreme cases the government has both the duty and power to protect its citizens, but strong-armed actions can have unintended repercussions.
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International Day of Education
January 24 marks the first International Day of Education, a day proclaimed by the General Assembly of the United Nations whose importance is reflected in the 2030 Agenda for Sustainable Development. The Agenda is an ambitious plan adopted in September 2015 by Heads of State, Government and High Representatives that seeks to end poverty, fight inequalities and counter climate change by 2030. At its core, the agenda contains 17 comprehensive goals, also referred to as the 17 Sustainable Development Goals. One of the goals stated is to obtain quality education, in particular to ensure that all girls and boys have the opportunity to complete primary and secondary education and have access to pre-primary education. In addition, efforts are being made to ensure that women and men are given equal chances of receiving high-quality higher education, such as in university institutions, and that gender imbalances in education are eliminated. To read all related objectives in the context of the goal of quality education, please refer to this page.
Of course it is interesting to have a look at where we stand at the moment, what has been achieved and which tendency we can expect. Mr. Hans Rosling has observed and documented encouraging trends in his book ‘Factfulness – Ten Reasons We’re Wrong About the World’, published in April 2018, which illustrate positive developments in the field of global education. The findings include that around 60% of all girls in low-income countries now finish primary school and that the gender gap in education is indeed closing: on average, women worldwide have spent 9 years in school, while men have spent 10 years in school. According to the World Bank Group, the literacy rate among adults aged 15 and above has increased steadily between 1970 and 2016. The global literacy rate was about 69% in 1970 and approximately 86% in 2016. This represents an increase of almost 17% as shown in the graphic below.
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Rolling Back Malaria: a Multi-Sectoral Challenge
Obreniokibo I. Amiesimaka
Rebranded RBM logo ©RBM
October 2018 marked the 20th anniversary of the now-rebranded RBM Partnership to End Malaria. Originally called Roll Back Malaria, RBM was founded by the World Health Organisation (WHO), the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank.
With its foundation build on collaboration, it was charged with building a partnership of stakeholders in order to spearhead the global effort in combatting malaria.
The RBM Partnership has brought together over 500 partners from diverse fields; ranging from the academia and malaria-endemic countries to the donor, public and also private sectors, amongst many others. This collaborative approach – and work in line with Millennium Development Goal (MDG) 6: “combat HIV/AIDS, malaria and other diseases” – yielded fruits. In the 17 years from its inception to 2015, the WHO records that more than 6 million lives were saved and there was a significant reduction of about 18% in the global burden of malaria.
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The WHO REPLACE Trans Fat Action Package – From Policy to Practice
Obreniokibo I. Amiesimaka
In May 2018, the World Health Organisation (WHO) introduced an action package for the elimination of industrially-produced trans fats globally by 2023. The action package, called REPLACE Trans Fat, is in keeping with the Sustainable Development Goal (SDG) 3.4, which aims to reduce non-communicable diseases (NCDs).
Here, we consider the action package and some of the potential challenges to its practical implementation.
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Hepatitis C: the past, present and future, an Egyptian experience
Speaker: Nagwa Elkhafif, Theodor Bilharz Institute, Cairo
“We have a historic opportunity to make transformational improvement in world health. Let us make universal health coverage a reality for many more people” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, stated.
Facing unfortunately one of the highest global burdens of hepatitis C virus (HCV) infections, Egypt started its national comprehensive Infection Prevention and Control programme in the Egyptian Ministry of Health and Population as early as 2001. Now with the use of the DAA’s for HCV infection therapy it has an ambitious goal of eliminating hepatitis by 2023. International partners such as the World Health Organization (WHO), USAID, Centers for Disease Control and Prevention (CDC) and the World Bank are working closely with the Government of Egypt to technically and financially support its goal of eliminating HCV.
Women on the Move - Migrant Women in the Health Professions
The World Health Organization (WHO) has published a report and a policy brief addressing the issue of female migrant care workers. The goal of both the policy brief and report is to raise awareness of the importance of ensuring migrant workers – who in most cases are women - providing home-based care, are given a legal working status in the receiving country, accompanied by appropriate working conditions and access to health and social services. The project was initiated in 2017 at a meeting in Berlin supported by the Federal Ministry of Health.
Considering the current debate around care provision and the lack of qualified personnel in Germany, a translation of the policy brief was considered to be a valuable contribution to the discussion, highlighting the importance of legal protection and health insurance for the migrant care workers the German population increasingly relies upon. While Germany’s laudable contract regulations with care workers from the Philippines are often highlighted, with an ageing population the need for care workers is increasing. This means that new constructs will have to be developed at a larger scale.
Therefore, the goal of the event was to share the German translation of the policy brief and take discussions on female migrant health care workers in Germany further, aiming to connect researchers, policy makers and those working in the healthcare sector.
Women in Global Health - Germany and the Center for Global Health at the Technical University of Munich organised the event “Women on the Move – Migrant Women in the Health Professions” on Wednesday 20th March, 2019 at the Charité in Berlin. The event that was supported by the World Health Summit Foundation GmbH and the German Federal Ministry of Health featured speakers from many different fields and concluded with a networking reception allowing informal exchange and discussions.
Prof. Dr. Dr. h.c. Ilona Kickbusch founder of Women in Global Health-Germany guided the participants through the afternoon/early evening with great passion and insights. Overall, it can be said that there is a real need for interdisciplinary research and work addressing the issue of female migrant care workers. It is important to identify the factors for a successful integration and to turn that into policy measures. In order to take the issue of the global paradox of female migrant care workers, forward, we need to know more about the successes, failures as well as structures that are in place or needed. Finally, it is important to stress again that female migrant care workers represent a neglected part of the workforce agenda who deserve attention.
The report from the event can be accessed here
Kick-Off Meeting "HELMVIT" Study in Lambaréné, Gabon
A joint seminar was held at the Albert-Schweizer-Hospital and the CERMEL (Centre de Recherches Médicales de Lambaréné) in Lambaréné in Gabon from 7th-9th January 2019 to kick-off the consortial project „HELMVIT“ (Full title: “Impact of maternal helminth infection on Vitamin D regulation and on the immune system of the infant”) which is coordinated by Prof. Clarissa Prazeres da Costa, Kodirector of the Center for Global Health, Institute for Medical Microbiology, Immunology and Hygiene of TUM. Collaboration partners are Prof. Akim Adegnika (CERMEL) and Dr. Meral Esen (Institute for Tropical Medicine, University of Tübingen). The consortium is funded for three years by the DFG within the call “German-African Cooperation Projects in Infectiology”.
This seminar had three aims.
1) The first one was to discuss results of a successful pilot study, which took place in Munich and Lambaréné and was performed by students of the Technical University Munich and which will pave the way for the upcoming study.
2) The second aim was to discuss the details of the new DFG study on the influence of maternal helminth infection on Vitamin D regulation and the immune system of the children. Amongst many other staff members, two Gabonese PhD students will be part of this collaborative research project which will cover basic science aspects as well as general women health topics. In this line, a joint German-Gabonese workshop will take place in January 2020 with new partners from other TUM departments as well as representatives from the Ministry of Health in Gabon and other international researchers.
3) Thirdly, new avenues in terms of capacity building (joint teaching, student exchange, knowledge transfer) and timely Global Health-related research topics were explored with the overall intention to intensify and sustain this collaboration.
Women in Global Health - Germany - 2nd Network Meeting
Global Health Day
© Photos: Susanne Dürr, TUM Institute for Medical Microbiology, Immunology and Hygiene