O’Neill Institute Briefing: “Ebola, the World Health Organization, and Beyond: Toward a Framework for Global Health Security”

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Screen Shot 2015-06-09 at 2.05.25 PMThe West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and reform the organization to be better able to address the next epidemic. In this Briefing Paper we lay out the present landscape, including reforms needed of the International Health Regulations, and assess the strengths and weaknesses of the outcomes of the 68th WHA, including integrating WHO’s outbreak and emergency response programs; creating a global health emergency workforce, deployable on short notice; and setting up a global health emergency contingency fund. We also consider the vital structural issues the WHA failed to effectively address, including bolstering WHO’s core funding, increasing coherence between the WHO headquarters and regional offices, and enhancing civil society engagement.

The complete briefing, written by O'Neill Institute Associate - Eric Friedman, Fellow - Daniel Hougendobler, and Faculty Director - Lawrence Gostin, can be found here.

Posted in Global Health, Health reform; Tagged: , , , .


What We Know (and Don’t Know) About the South Korean MERS-CoV Outbreak

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Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has been circulating since at least April 2012. Since then it has been confined largely to the Middle East (with some notable exceptions).

The two weeks have seen the largest outbreak of the disease outside of the region, with at least 41 MERS-CoV cases and 4 deaths in South Korea. This post summarizes what we currently know about the outbreak and the disease more generally.

What is MERS-CoV, how does it spread, and how deadly is it?

MERS-CoV is part of a family of viruses, known as coronaviruses (the common cold and severe acute respiratory syndrome (SARS) are other examples). Diagnosis of MERS is complicated as its symptoms mimic those of other respiratory infections, including fever, cough and shortness of breath.

It is currently unknown precisely how MERS-CoV spreads. There appears to be an animal reservoir, most likely camels, and many cases have been zoonotic (passing from animal to human). Until recently, human-to-human transmission has been unusual, with most people infecting just one other person or none at all, leading to outbreaks that naturally die out quickly.

MERS-Cov appears to have a mortality rate of approximately 30-40%. Those with pre-existing conditions (such as chronic lung, heart or kidney disease, diabetes or cancer) are more likely to die from the disease. Read More

Posted in Global Health; Tagged: , , , , .


Global Health Security: A Focus on Prevention

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A depiction of the One Health concept. Courtesy of the One Health Initiative.

A depiction of the One Health concept. Courtesy of the One Health Initiative.

It was a subtle shift. In January, in a special session on Ebola, the World Health Organization’s Executive Board called for WHO’s Director-General to provide options for a contingency fund in the context of WHO’s “need for adequate resources for [its] preparedness, surveillance and response work.” For a moment, it seemed that any additional resources that WHO mobilized for the fund would be directed in part to epidemic preparedness, perhaps to build WHO's capacities to prevent an outbreak from ever needing a major global response in the first place.

It was not to be. The decision at last month’s World Health Assembly was, as the term “contingency fund” implies, that the fund would be used to “scale up WHO’s initial response to outbreaks and emergencies with health consequences.” Response only, not preparedness.

This is part and parcel to a larger question. Is the global health community focusing too narrowly  on responding quickly to an outbreak that has already occurred and reached some level of international concern, without due attention to preventing an outbreak in the first place, or stopping one at its very earliest phases? And are we focused too much on certain discrete – though vitally important – elements of the response – an emergency fund, an emergency workforce – while neglecting longer-term measures to prevent and minimize outbreaks (as well as broader WHO reforms)?

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Posted in Global Health, WHO; Tagged: , , , , , , .


Tim Westmoreland on King v. Burwell – #AskAGUProf

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The U.S. Supreme Court will issue its ruling soon on King v. Burwell, a case that questions whether it is legal for the federal government to provide subsidies to states that rely on federal health exchanges to help low- and middle-income people afford mandated health insurance under the Affordable Care Act (ACA). In the case, David King is the plaintiff. U.S. Secretary of Health and Human Services Sylvia Burwell represents the Obama Administration in the case and is the defendant.

The O'Neill Institute's Professor Tim Westmoreland, Professor from Practice at Georgetown Law, took part in Georgetown University's #AskAGUProf series to discuss King v. Burwell.

What’s at issue in King v. Burwell?

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Posted in Health reform, National Healthcare, Uncategorized; Tagged: , , , , , , .


Banking on the future – Is the Asian Infrastructure Investment Bank a complement to or competition for existing international financial institutions?

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This post was written by  Tsung-Ling Lee, a former Global Health Law LL.M. and SJD student at Georgetown University (2015) and currently a postdoctoral fellow at Asia Research Institute, National Singapore University. It originally appeared on the APPS Policy Forum and can be viewed here.

A new China-led initiative for financing infrastructure projects in Asia may challenge the existing world financial order.

In April, the former United States Secretary of State Madeline Albright said “I think we screwed up” in response to the Obama administration’s refusal to join the Asia Infrastructure Investment Bank (AIIB). The US reaction to the China-led initiative for financing infrastructure projects from Myanmar to Russia, suggests a deep anxiety about the world financial order.

While many operational aspects and details about the governance structure of the AIIB are yet to be publicly expressed, many commentators speculate that the AIIB may mark a new global economic order, particularly when viewed as part of Beijing’s broader economic agenda. China has been supporting the creation of new regional and global economic institutions, including the New Silk Road initiative and the BRICs-led New Development Bank. These institutions will arguably challenge the monopoly of the World Bank and the IMF — the two major international financial institutions within the Bretton Wood system.

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The devil’s in the detail: Mexico’s broken obesity prevention campaign

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17SODA-articleLargeIn recent years, the World Health Organization, as well as regional health organizations have developed guidelines and recommendations to deal with the growing obesity epidemic around the world. Many countries are starting to implement measures to meet the objectives set forth by these international bodies. One such country is Mexico. Praised as a pioneer in Latin America, Mexico has managed to tick off many of the boxes recommended by the WHO. Unfortunately, the food and beverage industries have managed to put pressure on the government to the point of rendering them all practically useless. Read More

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Put away your cigarettes and lighters, May 31 is World #NoTobacco Day!

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This Sunday, put away your cigarettes and lighters and turn on your “reflecting caps.” May 31 marks World No Tobacco Day (WNTD), one of the eight major global health days observed by the World Health Organization (WHO) and other public health advocates worldwide. On this day, we reflect on the various health risks associated with using tobacco, as well as the many ways in which the tobacco industry has achieved hooking millions of people to its products with overwhelming disdain for the value of human life and dignity.

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Posted in Global Health, Tobacco, WHO; Tagged: .



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This post was written by O'Neill Institute Executive Director, Oscar Cabrera and O'Neill Institute Faculty Director, Lawrence O. Gostin. Any questions about this post can be directed to cabrera@law.georgetown.edu or gostin@law.georgetown.edu.

Indonesia recently announced that it will institute a nationwide ban on e-cigarettes. It might seem that banning an addictive and harmful, nicotine-delivering product that is attractive to kids makes sense. But it’s a mistake.  If Indonesia really wanted to protect kids and improve the public health, it would keep e-cigarettes legal and use them effectively as a less-harmful alternative to smoking. Indonesia could strictly regulate e-cigarettes, such as making them safer, banning e-cigarette advertising that reaches children and banning their use (along with smoking) in public places. But banning e-cigarettes will make reducing smoking more difficult.

If there were no cigarettes or smoking, banning e-cigarettes would make good sense. But the main tobacco/nicotine public health problem facing the world today is smoking, and Indonesia has one of the world’s highest rates of cigarette smoking. E-cigarettes should not divert policymakers attention away from implementing strong new measures to sharply reduce smoking and all the unnecessary death, disease, disability and economic costs caused by smoking.

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Posted in Tobacco, Uncategorized; Tagged: , , , , , .


International Day of Action for Women’s Health: Our Health, Our Lives, Our Rights

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Image Courtesy of http://www.may28.org/.

Image Courtesy of http://www.may28.org/.

Today is the International Day of Action for Women’s Health. Since 1987, the campaign has provided advocates with a space to identify gaps in the area of women’s health and coordinate calls to action. The collaborative calls to action have focused on a range of topics, including access to quality health care, access to safe and legal abortion, women and HIV/AIDS, violence against women as a global health emergency, and young people’s sexual and reproductive health and rights (SRHR). The campaign is both a celebration of the gains made through efforts to improve women’s health and a reminder of the work that remains to be done. Read More

Posted in Human Rights; Tagged: , , , , , , , , , .


Not your grandmother’s Salmonella. Avoid the risk. Safety tips for summer eating.

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On a recent PBS Frontline investigating the “Trouble with Chicken,” food safety expert Caroline Smith Dewaal of the Center for Science in the Public Interest explained that “the strains of salmonella that are showing up on … chicken aren’t the ones our grandmothers knew about, they are tougher, stronger and many of them are antibiotic resistant.” The hour long investigation reported on the frightening reality of the threat strains of salmonella pose to human health and emphasized – over and over, and over, again - the tremendous weakness in the regulatory infrastructure charged with keeping American consumers safe.

Salmonella poisoning may be the largest culprit of food borne illness, but it is hardly alone. In fact, it is followed by a long of list of bugs sickening 1 in 6 Americans each year. Until (as I blogged about here), proper systemic preventive controls keep dangerous pathogens out of our food supply, individual consumers must be part of the prevention process. Here in the District of Columbia, the warm weather is upon us, and so it is time for a short refresher on preventing foodborne illness at home.

Below is a brief summary of the some of the most important tips for safe summer eating. For more, Foodsafety.gov provides an excellent, concise source of information for safe food handling.

First and foremost, all food items can carry a risk of foodborne illness (even the least obvious, remember the deadly peanut butter outbreak?). Still, it’s important to understand that all risks are not created equal. Meat and poultry, all kinds of produce, and prepared foods in need of refrigeration generally carry the greatest risk of harboring a pathogen. Luckily the consumer has considerable control in mitigating if not eliminating the risk posed by these items.

Meat (meat, poultry, fish)

  • Bottom line- Don’t let raw meat touch anything else. Don’t put raw meat on top of other foods in your grocery cart, don’t put packages of raw meat directly on the shelf in your refrigerator, don’t prepare raw meat next to other foods items on your countertop, don’t touch raw meat and then grab the salt shaker to season it without washing your hands, don’t use the same fork to take cooked meat off the grill as you used to put it on, don’t use the same sponge that you used to wash dishes holding raw meat on other dishes or on your countertop until you disinfect it. Before you begin to cook raw meat, think it through!
  • Do NOT rinse meat before preparing. Studies show this just increases the likelihood of cross-contamination.
  • Use a disinfectant solution to clean everything that comes in contact with raw meat.
  • Microwave your sponges to kill germs.
  • Always use a meat thermometer to make sure cooked meat reaches the right temperature.

Produce (all types of fruits and vegetables, organic and conventional)

  • Wash everything immediately before eating. Note, you still need to wash produce that has a skin or rind, i.e., apples, bananas, cantaloupes. If there is a pathogen on the skin, you may pass it on to the meat of the fruit when you slice through.

Prepared Food Items in Need of Refrigeration

  • Keep your food cold. Put cooked food into the refrigerator within 1-2 hours.
  • When in doubt, throw it out. Don’t rely on your nose to decide if food is edible. If it has been left out of the refrigerator for too long, or is old, throw it out. Unsure how long to keep a particular food item? Download the excellent USDA FoodKeeper App.

And, WASH YOUR HANDS. Often. For twenty seconds with hot soap and water. Dry them on a clean towel.

If you have a few minutes, check out Recipes for Disaster, can’t miss food safety shorts your tax dollars provided:

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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.

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