Health equity in economic and trade policies

How the marketing of formula milk influences our decisions on infant feeding.
World Health Organization, UNICEF,: WHO Geneva, 2022

Formula milk companies are reported by World Health Organization (WHO) to be paying social media platforms and influencers to gain direct access to pregnant women and mothers at some of the most vulnerable moments in their lives. The global formula milk industry, valued at some US$ 55 billion, is said to be targeting new mothers with personalized social media content that is often not recognizable as advertising. This new WHO report titled Scope and impact of digital marketing strategies for promoting breast-milk substitutes has outlined the digital marketing techniques designed to influence the decisions new families make on how to feed their babies. Through tools like apps, virtual support groups or ‘baby-clubs’, paid social media influencers, promotions and competitions and advice forums or services, formula milk companies can buy or collect personal information and send personalized promotions to new pregnant women and mothers.

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis
Cossa H; Dietler D; Macete E; Munguambe K: Globalization and Health 18(7), 1-16, 2022

To assess the impact of mines on child health, this study analyses socio-demographic, health, and mining data before and after several mining projects were commissioned in sub-Saharan Africa. Data of 90,951 children living around 81 mining sites in 23 countries in sub-Saharan Africa were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 sub-Saharan Africa countries were analysed for diarrhoea, cough, and anthropometric indicators. The results presented suggest that the impacts of mining on child health vary throughout the mine’s life cycle. Mining development was found to contribute positively to the income and livelihoods of the impacted communities in the initial years of mining operations, but that these benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively.

Inside Facebook's African Sweatshop
Perrigo B: Time, February 2022

This investigative journalism examines the workplace conditions of outsourced Facebook content moderators in Nairobi, Kenya. They perform the task of viewing and removing illegal or banned content from Facebook before it is seen by the average user. While demanding, including of multiple language skills, the workers were reported to be amongst the lowest-paid for the platform anywhere in the world, and to experience a workplace culture characterized by mental trauma, intimidation, and alleged suppression of the right to unionize. The authors question whether the corporate is protecting the wellbeing of the very people upon whom it relies to ensure its platform is safe in the continent.

WTO: Dangers of “take-it-or-leave-it” compromise outcome on TRIPS waiver
Third World Network: SUNS #9521, February 2022

In the face of growing “vaccine inequity” amidst the ongoing COVID-19 pandemic across countries, the authors observe that the chances of finalizing a credible outcome on the temporary TRIPS waiver at the WTO seem to be getting slimmer, with the likelihood of a “take-it-or-leave-it” compromise solution being foisted on the members apparently gaining ground, according to people familiar with the development. In her brief statement at a TRIPS Council meeting on 22 February, the Deputy Director-General (DDG) Ms Anabel Gonzalez from Costa Rica is reported to have said that the progress has been difficult during the ongoing quadrilateral consultations between the four members on the temporary TRIPS waiver and the EU’s proposal on compulsory licensing which mostly restates Article 31 of the TRIPS Agreement. South Africa reminded members that while it welcomes the support from the global community in establishing an mRNA hub in South Africa, as well as manufacturing facilities in Kenya, Tunisia, Nigeria, Senegal and Egypt, it noted that the full operationalization of the mRNA hub faces hurdles due to the intellectual property barriers. At the TRIPS Council meeting, members adopted the draft statement proposed by the TRIPS Council chair to continue discussions on either the waiver or the EU’s proposal on compulsory licensing, due to lack of convergence among the members.

Do international trade and investment agreements generate regulatory chill in public health policymaking? A case study of nutrition and alcohol policy in South Africa
Milsom P; Smith R; Modisenyane S M and Walls H: Globalization and Health 17:104, 1-17, 2021

This study identified barriers to setting regulation (regulatory chill) and implementing regulation related to nutrition and alcohol as a result of trade or investment dispute measures in South Africa. The work was implemented through semi-structured interviews with 36 policy actors, analysed using thematic analysis. Trade obligations were found to generate a significantly greater anticipatory-type chilling effect on nutrition and alcohol regulation than investment treaty obligations, and investor-state and WTO state-state disputes affected implementation of regulation. No cases were reported of trade threats an investor disputes but there were reported cases of these actors using arguments related to South Africa’s trade obligations to oppose policy action in these areas. The risk of policy action was related to the perceived legitimacy or bias of the dispute system, costs involved in pursuing and capacity to pay costs of regulation/defending disputes and social views and confidence in a successful dispute outcome. The authors observe that currently, South Africa’s trade obligations have a more prominent role in inhibiting nutrition and alcohol regulation than investment treaty-related concerns, but that strategies to protect public health policy space in the context of both international trade and investment treaty and dispute settlement contexts remain important.

Feminists for a People’s Vaccine
Development Alternatives with Women for a New Era (DAWN) and Third World Network (TWN): 2021

DAWN and TWN are facilitating the Feminists for a People’s Vaccine Campaign (FPV) for equitable, accessible, and affordable COVID-19 vaccines, drugs, therapeutics, and equipment and access to Medicines. The campaign brings the perspective of feminists from the Global South and partners and allies in the North to challenge the causes and consequences of extreme inequalities in access to medicines. Geography, wealth, income, gender, race, caste, ethnicity, disability, sexual orientation, gender identity and other factors shape who has access and who has not, who will live and who will die. The FPV Campaign analyses the changing pandemic panorama and initiatives such as the Trade-Related Aspects of Intellectual Property Rights Agreement (TRIPS) Waiver proposal, the COVAX Facility and South versus North imbalances in global trade, investment and financing affecting access to these technologies.

Nutrition related non-communicable diseases and sugar sweetened beverage policies: a landscape analysis in Zambia
Mukanu M; Karim SA; Hofman K; Erzse A; et al: Global Health Action, 14:1, 1-11, 2021

This study identified opportunities to strengthen policies relating to sugar-sweetened beverage taxation in Zambia, through: (1) understanding the policy landscape and political context in which policies for nutrition-related non-communicable diseases are being developed, particularly sugar-sweetened beverage taxation, and exploring the potential use of revenue arising from sugar-sweetened beverage taxation to support improved nutrition. The authors conducted a retrospective qualitative policy analysis and key informant interviews with 10 policy actors. Increased regulation of sugar-sweetened beverages was a priority for the health sector, in conflict with economic interests to grow the manufacturing sector, including the food and beverage industries. The authors suggest that this conflict between public health and economic priorities, poor public information and incoherent policy objectives might have contributed to the adoption of a weakened excise tax. The authors suggest that the fact that it did not prevent the introduction of a differential sugar tax on sugar-sweetened beverages implies that there are opportunities to strengthen the existing taxation of sugar-sweetened beverages in Zambia, especially if backed by inclusive in policy formulation and comprehensive monitoring of risk factors.

Waiver from certain provisions of the TRIPS agreement for the prevention, containment and treatment of COVID-19
Third World Network: TWN, 2021

TWN provides gathers a list of interventions by the co-sponsors, statements and op-eds supporting the waiver proposal and news reports about the proposal made by India, South Africa and others (IP/C/W/669) to the World Trade Organization seeking a waiver from certain provisions of the TRIPS Agreement (patents, trade secrets, copyright and industrial designs) in relation to the containment, prevention and treatment of COVID-19. This proposal is now co-sponsored by 62 developing countries (the Africa Group, the Least Developed Country Group, Bolivia, Fiji, Indonesia, Pakistan, Mongolia, Vanuatu and Venezuela) and has received global support from most of the other developing countries and the international community, but still faces opposition and counter measures from some high income countries, elaborated on the TWN website.

Botswana pays equivalent of $15 a dose for Sinovac's COVID-19 vaccine
Reuters: Gaborone, Botswana, July 2021

Botswana's health minister Edwin Dikiloti said on Friday in an address to parliament that the government was paying the equivalent of $15 a dose for the COVID-19 vaccine developed by China's Sinovac Biotech and almost $29 a dose for U.S. company Moderna's vaccine. The minister added that the COVAX facility co-led by the WHO had only delivered 82000 doses despite an upfront payment the government had made as a self-financing participant, in the hopes of securing far more doses. An AU arrangement is expected to deliver over 1.1 million doses of Johnson & Johnson's vaccine in the third and fourth quarters. Apart from the vaccines paid for, the Indian government donated 30000 doses of the COVISHIELD vaccine manufactured by the Serum Institute of India and China donated 200000 doses of Sinovac's vaccine, while Botswana is in talks with Pfizer about a possible 2 million dose deal. In 2019, Botswana had a total population of 2.3 million people.

New consortium working to boost vaccine production in South Africa
World Health Organisation: WHO, Geneva, 2021

The Medicines Patent Pool and the World Health Organization, Afrigen Biologics Limited, the Biologicals and Vaccines Institute of Southern Africa (Biovac), the South African Medical Research Council and Africa Centres for Disease Control and Prevention have signed a letter of intent to bring together partners to establish the South African mRNA technology transfer hub to enable greater and more diversified vaccines manufacturing capability, to respond to the current COVID-19 pandemic and future pandemics.