Today, the United Nations General Assembly will, for better or worse, shape the next decade of the global response to the world’s deadliest infectious disease. Millions of people will feel the decisions made today. Millions of lives will be won or lost as member states barter and jockey over the content of the Political Declaration of the United Nations High Level Meeting on Tuberculosis. This is not hyperbole but empirical observation: what happens today matters for millions. And as of this morning, things don’t look good.
From time to time, the United Nations General Assembly, the main decision making body of the UN, convenes a “High Level Meeting” on an issue that demands a coordinated global response. At a High Level Meeting, the countries of the world come together and agree to a plan, normally called a “political declaration,” on how to address the issue. The High Level Meeting on TB will take place in September 2018. The political declaration will be decided long before then. And today is the cut off for introducing new text to the draft.
The UN High Level Meeting on TB is long overdue. In 2016, TB killed 1.7 million people and made 10 million more sick. For those who survive, the devastations that TB leaves behind include catastrophic economic consequences, deep stigma, and brutal “side effects” such as permanent, and complete, hearing loss. Yet TB is preventable and, for the most part, curable. It is precisely the type of problem that persists only for lack of coordinated attention.
We could end TB cheaply and quickly. We know how to do it. Amongst the world’s complex challenges, TB is relatively simple and affordable, if not even lucrative, to fix. Proper investment in the TB response could lead to returns to society on the scale of USD$43 for every USD$1 put in.
Yet, at the current rate of progress, we won’t meet targets set by the UN to “end TB by 2030” for another 150 years. And 28 million more people will die from TB by 2030, at a global economic cost of about USD$1 trillion. We also know that we have a narrow window to act—we can either stop the rise of drug-resistant forms of TB now or we can sit by, let the bacteria grow stronger, and watch helplessly as it kills millions in a few years.
The World Health Organization says that we need about USD$13 billion annually till 2030 to end TB. On the global scale, it’s not a lot of money. And in terms of lives saved and economic benefits reaped, it’s the deal of the millennia. But our current level of investment is only about half way there. This is precisely the type of situation a High Level Meeting is meant to fix. All we need is a coordinated push.
And here we are. It is June 18th, 2018. The world faces a disease that kills millions, devastates economies and grows in its threat to life and national security every day. We know how to fix it. It’s cheap to fix it. And we’re not doing it. We’re letting the moment go. Or, rather, governments across the globe and their representatives at the United Nations are letting it go.
We know what an effective political declaration would have: clear commitments to meet measurable targets on financing, research and development, treatment and prevention, and a handful of other key interventions; strategies to tackle the drivers of TB in populations that require special focus such as detainees and mineworkers; an accountability mechanism that can hold countries to meeting the commitments they make; and a firm anchoring in human rights.
The draft political declaration as we know it this morning doesn’t have these elements. All of them have been on the table. All of them have been proposed, briefed, and debated. But they’re not in the declaration.
The TB High Level Meeting is neither the beginning nor the end of the TB response, but it is an important moment of contingency. Today, people over phones and around conference rooms in New York and across the globe will decide the language to be introduced to the Political Declaration of the United Nations High Level Meeting on TB. They can choose to make it a success or let the moment go by. Millions of lives are at stake. The world will soon know, and feel, the choices they make.
It wasn’t long ago that the ethnic cleansing – quite probably genocide – against the Rohingya people of Burma (Myanmar) made headlines. Beginning near the end of August last year, the most recent and violent episode of a gathering storm of discrimination, deprivation, and destruction, the Burmese military murdered at least 9,000 Rohingya, quite possibly many more, as part of a campaign of unfathomably cruelty. It was not long before world leaders and top UN officials recognized the atrocities as ethnic cleansing, with some, including the UN High Commissioner for Human Rights and the UN Special Rapporteur on Human Rights in Myanmar, suggesting that what was unfolding was quite possibly genocide, that “crime of crimes.”
There was a blip in coverage in the last eek or two as the United Nations and government of Burma (Myanmar) signed an agreement on a framework for the return of the Rohingya refugees from Bangladesh, even as it is difficult to imagine the refugees voluntarily returning soon to a country that seems bent on the utter degradation of their humanity, that not a year ago burned their villages to the ground, murdered them, and raped them. As Matthew Smith of the NGO Fortify Rights observed: “If they [Burma] want to repatriate refugees they should start by shutting down the internment camps [in Rakhine State] and supporting Rohingya from those camps to rebuild their lives with dignity.” And they should grant the Rohingya citizenship and lift restrictions on their movement. Yet Burma’s government has done none of this.
The agreement comes even as a report emerged that it seems that the Burmese military targeted educated Rohingya “so there would be no community leaders left willing to speak up against the pervasive abuse” – still more evidence of genocide. Moreover, as New York Times columnist Nicholas Kristof reported after managing to visit Rakhine State earlier this year, the Rohingya who remained in Burma were being denied education, medical care, and food. Refugees are expected to voluntarily to return to this?
There have been a few other recent developments. In the U.S. Congress, the House has taken a step towards sanctioning Burmese military officials linked to serious human rights abuses in Burma, in a slow move towards perhaps some level of accountability. Yet 9 1/2 months after the extreme violence against Rohingya began, and we have not even been able to manage highly targeted sanctions???
Fears for the safety of refugees grow with the arrival on monsoon season. Cox’s Bazar, home to the refugee camps for the Rohingya in Bangladesh, “is one of the most frequently flooded regions of one of the most flood-prone countries on Earth.” The Wall Street Journal wrote of the deadly danger of elephants. The Los Angeles Times examined the difficult choices facing women who had been raped by Burmese soldiers, whether to give birth out of wedlock (which has great stigma) and while living through a humanitarian crisis, or whether to terminate their pregnancies.
But for the most part, it is hard not to feel that the world has moved on. A crisis persists, but now chiefly as one more – if one that is a particularly large and fraught – refugee crisis, where the central question is, as in other refugee crises, how to ensure basic provisions and safety for the refugees, and how to get them home. That the refugees are so recently displaced as a result of genocide seems almost secondary. And this even as what Nicholas Kristof called “genocide in slow motion” continues.
With the world’s primary response to the genocide little more than a collective sigh, and some words of condemnation that reverberate as loudly as silence insofar as their apparent impact is concerned, the Burmese authorities have continued with a campaign of prosecution against non-Buddhist Burmese, with the military having launched an air and ground campaign against the Christian Kachin.
Elie Wiesel, when accepting his Nobel Peace Prize in 1986, said, “Wherever men or women are persecuted because of their race, religion or political views, that place must – at that moment – become the center of the universe.” How far now are the Rohingya from the center of our universe. But it is no surprise. If we glance back to recent genocides, we see how we have, in these too, averted our eyes even as victims were still victimized, perpetrators still not held to account. Many Yazidi in Iraq, whom Daesh (ISIS) has targeted, leading to significant international intervention against ISIS, remain without enough food and other basics, and feel abandoned. The genocidal government of Sudan remains in place, yet from both American and European policy perspectives, has largely been able to re-enter the international community.
The plight of the Rohingya is the latest part of an intolerable (and yet tolerated), grievous (yet how many are grieving) trend: the normalization of genocide. As we look to battle intolerance and hatred around the globe, which fuels so much of today’s conflict, discrimination, death, and despair, we cannot forget that horrific apex of the “pyramid of hate,” genocide. For if we, the global community, fail to address even that, how can we hope to level the pyramid built of intolerance of “the other” in its entirety?
Last month, the Food and Drug Administration (FDA) approved Truvada as pre-exposure prophylaxis (PrEP) for adolescents at risk for HIV infection. FDA approval represents a critical step toward operationalizing PrEP for adolescents, especially young gay and bisexual men and LGBTQ youth of color, who stand to benefit from this effective HIV prevention tool. In 2016, youth aged 13 to 24 made up 21% of all new HIV diagnoses in the United States, and 81% of these diagnoses were among young gay and bisexual men. Young Black/African American and Latinx people also experience disproportionate rates of HIV diagnoses among this vulnerable population.
The National HIV/AIDS Strategy (NHAS) Progress Report, released on May 24, 2018, demonstrates a need for a more concerted effort to reduce high rates of HIV diagnoses among young gay and bisexual men. A key feature of the Strategy is the 17 indicators that are used to measure progress on NHAS goals. While the Progress Report showed that nine indicators met or exceeded annual targets and that progress was made toward targets for two additional indicators, targets for five indicators were not met and continue to move in the wrong directions. This includes two indicators related to young gay and bisexual men: (1) risk behaviors among young gay and bisexual men and (2) disparities in new HIV diagnoses among young Black gay and bisexual men.
Now that PrEP has been approved for adolescents aged 15 to 17, this creates new opportunities to effect change. While many medical providers are reluctant to prescribe a medication that is not approved by the FDA, providers can now prescribe knowing the FDA has affirmed that PrEP is safe and effective for adolescents. FDA approval should also open up payment options for adolescents to access PrEP since medication assistance programs established by Gilead, the manufacturer of Truvada, generally follow FDA indication.
Notwithstanding FDA approval, adolescents face other challenges to obtaining PrEP. One challenge is that in most states PrEP is not available to adolescents under age 18 without parental consent. This is often a significant barrier to those who are most at risk for HIV diagnosis because they may not have disclosed their sexual orientation or risk behaviors to their parents and may fear the repercussions of disclosure. While minor consent laws exist in all states that allow those under age 18 to consent to health care, including PrEP, under certain circumstances, there is significant confusion over these laws. Additional challenges include cost and concerns about confidentiality among adolescents and young adults on their parents’ health insurance.
To achieve forward progress in reducing HIV diagnoses among young gay and bisexual men and LGBTQ youth of color, we must build upon the recent FDA approval and continue to work to ensure access to PrEP for all young people in need.
This article was written by Lee Swepston, the former Senior Adviser on Human Rights and Human Rights Coordinator for the International Labor Organization
As I was preparing my chapter dealing with occupational safety and health (OSH), developing the contribution on the International Labor Organization (ILO) for Human Rights in Global Health: Rights-Based Governance for a Globalizing World, I was reminded repeatedly of three vital aspects: the crying need for action; the enormous amount of effort by the ILO over the past century; and the fact that international advice and research must be taken into account at the national level if it is to be effective.
The harms to OSH are truly staggering. Every fifteen seconds, a worker dies from a work- related accident or disease. Every fifteen seconds, 153 workers have a work-related accident. Every day, 6,300 people die as a result of occupational accidents or work-related diseases – more than 2.3 million deaths per year. Some 317 million accidents occur on the job annually, many of these resulting in extended absences from work, and millions more are permanently or temporarily disabled either by accidents or by the slower effects of chemicals or infections at work. This means a loss of income and social protection for workers and their families, and a loss of human resources for the national economy.
Given these enduring harms, OSH has been one of the prime focuses of the ILO from the moment it was established, together with the League of Nations, in 1919. One of the ILO’s principal responses to these OSH challenges has been the adoption of international standards – Conventions and Recommendations – with the ILO monitoring their implementation at the national level. The ILO has adopted more than forty standards dealing specifically with OSH, with nearly half of the more than 400 ILO standards touching either directly or indirectly on health issues. Over the years, the ILO has evolved from adopting danger-specific standards – dealing with substances such as radiation and asbestos or processes such as dock work – to adopting broader standards that take a management approach to OSH. For example, there are now a number of standards on the social insurance aspect of OSH, ensuring that workers’ income lost by disease or accident is replaced and that their families are not left destitute. In this standard setting, the main approach has been technical, focusing on the obligations of governments and employers rather than the rights of workers, but the net effect is to protect the human rights of workers to a safe and healthy working environment – a right laid down in article 23 of the Universal Declaration of Human Rights.
In addition to these standards, the ILO has adopted codes of conduct, which are detailed technical guides on how to make workplaces safer and healthier. These are widely used and have had a very positive effect.
What is missing, then? These ILO practices – standard setting, ratification by governments, and ILO supervision of implementation – are lost if the ways in which businesses conduct their work, structured by their governments, do not take ILO advice into account. As evidenced by the huge numbers of occupational accidents and diseases cited at the start of this blog, many lag behind in implementing ILO standards.
There are some real obstacles to implementing these ILO policies at the national level, where lack of resources and expertise limits many countries.
Setting up and operating a national labor inspectorate costs money and talent, and many smaller countries instead prioritize wealth creation and business promotion. Prioritizing business is important, of course, but it is also short-sighted. If the workers employed by those enterprises are not given the basic protection of being safe at work, their productivity is cut, their health may be compromised, and they will be unable to make their own contribution to the economy as consumers. The social costs of throwing people into inadequate safety nets are even greater. Many governments see the immediate return of creating employment as evidence of prudent financial management, but it is only part of the picture – the easier part.
Implementing safety and health at work is also technically difficult, requiring national expertise to advance ILO policy. As an ILO official, I visited many workplaces around the world and met many members of national labor inspectorates. These inspectors were often among the most impressive national officials I encountered – people with advanced degrees in medicine, chemistry, metallurgy, and management, who spent their careers telling companies better ways of carrying out their jobs, alternative chemicals that would be just as effective and not pollute the wider environment, and how to arrange the machinery in a workspace so that workers are less likely to catch their hair in a gear wheel or lose fingers to a clumsy movement. They save thousands of lives and billions of dollars through their expertise and their forethought.
OSH is the cutting edge of the protection of human rights for public health. Most of us spend the largest part of our lives at work, whether it is driving a truck or operating a machine, or working in an office that will function better with adequate light, heat, and ventilation. As a human rights professional working at the international level, I came to understand that the human rights with the most important and immediate impact on the most people involve the right to go home from your work still having the use of your eyes, your hands, and your lungs.
Current attempts to reduce regulation of businesses repeat failed approaches of the past, favoring self-regulation by employers, and are not simply unworkable – leading to serious infringements of a little-publicized but vital part of human rights.
Read more about the International Labor Organization’s efforts to mainstream human rights for occupational safety and health in:
On May 25, Ireland eliminated its near-total ban on abortion, just days before women’s right advocates around the world celebrated the International Day of Action for Women’s Health on May 28. With 64% voter turnout, 66% percent voted in favor of repealing the Eighth Amendment of the Constitution — a 1983 measure that conferred equal rights on the fetus and the mother and banned abortion under almost all circumstances.
Why now? What comes next in Ireland? And what could this mean for the rest of the world? You can find a list of resources that seek to answer these questions included below:
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.