Leveraging Germany’s Role in Global Health: View from an Outsider

Establishing a national Center for Global Public Health in Berlin is critical. [Photo: Lothar Drechsel/Getty Images]
In the past decade, Germany has caught the attention of the world for the high-profile moves it has made in the field of global public health. While the country‚Äôs contributions to social medicine date back two hundred years to the birth of Rudolf Virchow, the waves it has made in global health are more recent. A 2017 article in the Lancet argued that Germany ‚Äúhas become a visible actor in global health [only] in the past ten years.‚ÄĚ The WZB Berlin Social Science Center has been at the center of some of these developments.

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The Coronavirus Response in South Africa

Countries should not face penalties for effective reporting on coronavirus variants; doing so incentivizes staying silent on dangerous new cases. [Photo: Getty Images]

Note: A podcast episode by WZB’s Soziologische Perspektiven auf die Corona-Krise with Joseph Harris on the same topic can be found here.¬†

South Africa was hit hard during the country’s first coronavirus wave that began in March 2020. While an aggressive lockdown was initially praised for stopping spread and saving as many as 20,000 lives, the lockdown had important consequences of its own. And as pressure to reopen grew, by July 2020, the country stood mired in the largest coronavirus outbreak on the continent and one of the largest in the world. What factors left South Africa so vulnerable to the coronavirus? What policies and programs comprised the governmental response? How has the country navigated COVID-19 since that time, and what support can Germany and other industrialized nations offer the country today? Based on a chapter Harris wrote on the politics of South Africa’s coronavirus response in an edited volume that can be accessed for free here, his present article explores these questions.

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New Viruses, Old Foundations. COVID-19, Global Health, and the Bill and Melinda Gates Foundation

A long history: philanthropic foundations & health organizations [Photo: Getty Images/juanmonino]
On May 19 this year, U.S. President Donald Trump threatened to permanently cancel U.S. payments to the World Health Organization (WHO). One month earlier, Trump had already announced that the U.S. would not honour its biannual 500 million USD commitment. The next day, the Bill and Melinda Gates Foundation stated that they would donate an additional 150 million to the WHO, on top of a previous 100 million USD. The Gates’ largesse precedes COVID19. Since 2000, their foundation has granted almost four billion USD to the WHO to support a gigantic program against polio, and additional hundreds of millions for other programs on malaria, HIV, and maternal health, and the escalated use of technology in health. The Gates Foundation is a crucial contributor to the WHO, second only to the U.S.

Despite its pre-existing involvement with the WHO, the Gates Foundation’s statement surprised many. The public wondered how it could be possible for a private actor to replace the contribution of a state to an international organization. In reality, there is nothing to be surprised about. For at least a century, philanthropic foundations have funded international organizations involved in health issues, including fighting pandemics, or even conducted what we call today global health policy. Actually, the continuities are so fundamental that the foundations from the early twentieth and the early twenty-first century seem to choose to globally fund health policies for similar reasons. Because the arguments are similar, and the means they used comparable, the criticisms raised against philanthropic foundations generally and their health policies also remain remarkably stable. The similarities between the past and the present suggest that the criticisms are here to stay. Indeed, certain observers would venture that older and newer philanthropic foundations are built upon the same questionable bases: unequal income distribution and lack of transparency and accountability.

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When norms collide: The COVID-19 pandemic and difficult choices on the hierarchy of norms and values

Norm collisions due to COVID-19 inevitably lead to societal conflicts [Image: Uriel Soberanes/Unsplash]

Note: A shorter version of this post was published earlier on Duck of Minerva.

Politics, as famously defined by David Easton, is the ‚Äúauthoritative allocation of values‚ÄĚ, such as welfare, security, and liberty. Politicians thus have to make decisions on hierarchies between these values ‚Äď and they have to weigh values against each other in cases in which they collide. It is still too early for an in-depth analysis of the numerous norm collisions in the responses to the COVID-19 pandemic. And yet, we can already see how the previously found balance between the three aforementioned values, and the norms revolving around them, is destabilised.

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The WHO’s Paradoxical Mandate

The WHO: Heeded during crises, ignored otherwise [Image: Markus Spiske/Unsplash]
In many countries around the world, the WHO is currently setting the agenda for a strategy to contain the Covid-19 pandemic. Its campaigns and recommendations on how to deal with Covid-19 are, though not entirely uncontroversial, widely distributed, while reaffirming one of its central roles: that of the epidemiological expert and crisis advisor, especially for poor countries.

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The WHO After Corona: Discretionary Powers for the Next Pandemic?

The WHO headquarters in Geneva, Switzerland [Copyright : WHO/Pierre Virot]

Note: This post was originally published on verfassungsblog.de.

Imagine the World Health Organization (WHO) had declared the outbreak of the mysterious lung ailment in the Chinese city of Wuhan a potential public health emergency of international concern already in late December 2019. Imagine it had immediately decreed a precautionary lockdown of the metropolitan area until the severity of the illness was assessed or the virus extinct. It might have been just in time to halt the spread of the disease which by now has become a supreme global emergency of unforeseen proportions.

Of course, this scenario was far from realistic given the WHO’s limited mandate and political authority. In reality, far from stopping the crisis dead in its tracks, its approach of appeasement and applause vis-à-vis China may have exacerbated the situation. The coronavirus crisis exposes deep gaps in the global governance of infectious diseases. Tragically, rectifying those problems would mean painful adaptations not only at the costs of national sovereignty, but also of democracy and constitutionalism.

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The ugly face of health politics ‚Äď COVID-19 and the hypocrisy of the ‚Äėsaving lives‚Äô metaphor

Public health must remain a key concern also outside times of crisis [Ashkan Forouzani/Unsplash]

As more and more people are voluntarily or forcefully retreating to their homes and isolating themselves from public life and social contact due to the ongoing global health crisis, it might be a good time to reflect on the circumstance that, according to estimates by WHO and UNICEF, in 2018 globally every five seconds a child or young person under 15 died of preventable infectious diseases, such as measles, or of complications in childbirth ‚Äď many of them a consequence of unsafe births, lacking personnel, equipment, hygiene, infrastructure, and poor maternal health. A few days ago, I met an acquaintance, whose school-aged children have not been vaccinated against measles, carrying a stack of toilet paper packages in preparation for what was bound to come, the German-wide COVID-19 lockdown. The encounter made me aware of the imbalance between our plausible and humane concern for the safety and well-being of ourselves and those close to us on the one hand and a lack of awareness of our own role in preserving public health beyond COVID-19 on the other.

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Ist globale Gesundheitsforschung wirklich global?

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Zur Jahrtausendwende besa√ü Frankreich nach Angaben der WHO eines der besten Gesundheitssysteme weltweit. Zwei Jahrzehnte sp√§ter sieht das Land dem Verlust seiner F√ľhrungsrolle in der Gesundheitspolitik entgegen, wie sowohl die abnehmende Beteiligung franz√∂sischer Experten in internationalen Einsatzfeldern als auch der wachsende Druck auf den nationalen Gesundheitssektor durch Personalmangel und Besch√§ftigtenstreiks zeigen. Diese Ph√§nomene k√∂nnen nicht getrennt voneinander analysiert, sondern m√ľssen als Teil derselben Entwicklung begriffen werden, wie Claire Galesne in ihrem neuen Blogpost schreibt. Zu lange h√§tten sich die Politik wie auch die Fachliteratur nur auf den Globalen S√ľden konzentriert und dabei entwickelte Industrienationen aus den Augen verloren, wo in den letzten Jahren Probleme wie Unterfinanzierung, regionale Unterschiede in der Lebenserwartung sowie ein Anstieg nicht√ľbertragbarer Krankheiten eine zunehmende Belastung darstellen. Das Beispiel Frankreichs zeigt, dass Expert*innen gut darin beraten w√§ren, sich in L√§ndern mit hohem Einkommen nicht nur um die √∂ffentliche Gesundheitsversorgung zu f√∂rdern und sich in Niedriglohnl√§ndern nicht nur um Medikamentenpreise zu k√ľmmern. Mehr dazu gibt es im gesamten Artikel auf Englisch hier.

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Is Global Health Research truly Global?

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At the turn of the millennium, France had the best healthcare system in the world, according to the World Health Organisation (WHO), and it became a Global Health leader by contributing to setting up and funding key Global Health initiatives, such as UNITAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Almost two decades later, the government faces an unprecedented strike in the emergency services, while experts worried about the decrease in French expertise and influence in Global Health. France’s health leadership thus seems to be challenged both at the national and international level. This parallel is quite striking because, traditionally, the Global Health literature is blind to health development in donors’ countries. Rather it studies primarily interventions by high-income countries in the Global South. In this blog post, I want to understand how these domestic and foreign health issues can be related through an analysis of the French case.

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Zahn√§rztliche Therapeut*innen als Beispiel f√ľr periphere Innovation

                                                                                                                                                                  [Photo: Nhia Moua/unsplash]

Wo staatliche Gesundheitsversorgung nicht garantiert ist, muss das Bestehen einer Grundabdeckung anderweitig sichergestellt werden. Zahn√§rztliche Therapeut*innen in entlegenen Gegenden sind das Musterbeispiel f√ľr die Bereitstellung solcher Dienstleistungen. Was in den 1920er Jahren in Neuseeland begann, findet sich mittlerweile in √ľber 53 L√§ndern von Australien bis Simbabwe. Doch nicht nur das ‚Äď die weltweite Verbreitung dieses Berufsfeldes zeigt √ľberdies die erstaunliche Dynamik peripherer Diffusion in einer globalisierten Welt. In g√§ngigen (Imperialismus-) Theorien wird Diffusion normalerweise als Prozess verstanden, der die globalen Machtzentren miteinander verbindet. Die Bewegung der zahn√§rztlichen Therapeut*innen zeigt allerdings, dass die Verbreitung von Wissen auch entlang der R√§nder geschieht und diese vernetzt. In den USA begannen die ersten sechs Dentaltherapeut*innen ihre Arbeit 2004 in Alaska. Mittlerweile gibt es hierzu Gesetzesinitiativen in 10 weiteren Bundesstaaten, und Praktizierende treffen sich regelm√§√üig auf Konferenzen, um neue Kooperationsplattformen zu schaffen. Ihre Aktivit√§ten werden durch zahlreiche Stiftungen gef√∂rdert, die sich auf die Finanzierung neuer Modelle der Gesundheitsf√ľrsorge spezialisieren und oftmals f√ľr die Ausbildung der Therapeut*innen aufkommen. Warum dies klassischen Zahnarztverb√§nden ein Dorn im Auge ist und dieses relativ neue Berufsfeld ein zweischneidiges Schwert darstellt, k√∂nnen Sie auf Englisch in unserem neuen Blogpost von Luis Aue und Tine Hanrieder lesen.

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