While not always labelled commercial determinants of health (CDOH), some policy attention has been given in sub-Saharan Africa (SSA) to both harms and benefits of commercial impacts on health, particularly from harmful products and processes, and noting rising non-communicable diseases. This discourse analysis highlights differing interests and lenses among the multiple policy actors involved; the forms of narrative, agential and structural power used to advance and contest commercial policy interests in the health sector; and how this has been intensified by COVID-19. The evidence is used to propose actions to advance public health interests. Public health actors and ‘one health’ actions need to build on current efforts to strengthen own discursive power, challenging narratives with evidence; to strengthen their agential power through institutionalising health impact assessment, regulation and control measures; and to deepen initiatives to engage with structural power through support for local producers, harmonised regional standards and engagement on global rules that constrain health promoting activity, as was done in the Trade Related Aspect of Intellectual Property Rights (TRIPS) Waiver. Subregional and continental level organisations play a key role in enabling such actions, as does investment in SSA leadership in locally relevant innovation and production, and in links between state, academic and civil society actors to support evidence and to ensure public interests, transparency and accountability in policy decisions on CDOH.
Health equity in economic and trade policies
In June 2022, the World Trade Organization adopted a decision at its 12th Ministerial Conference, as the outcome of a 20-month long discussion on the TRIPS Waiver. Ultimately what resulted was a rather narrow legal mechanism, essentially clarifying existing rules in the WTO TRIPS Agreement. In this interview, Susan K Sell from the Australian National University explains why words matter and how the Waiver discussions, though disappointing, have broadened and shifted the conversation on intellectual property and public health forever. .
More than a 1,000 Kenyan tea pickers who say that harsh and exploitative working conditions on a Scottish-run tea farm have caused them crippling health complaints can now pursue their class action in an Edinburgh court. Prolonged bending to gather tea for James Finlay Kenya is argued to accelerate ageing of pickers’ backs by up to 20 years. Lawyers acting for the tea pickers have won an order from the court of session, Scotland’s highest civil court, telling James Finlay Kenya Ltd (JFK) to abandon attempts to block the suit through the Kenyan courts. Finlays, an Aberdeen-registered multinational whose estates in Kericho, Kenya, stretch across 10,117 hectares (25,000 acres), is one of the largest suppliers of tea and coffee in the world. The company has defended its health and safety record, and carries the Fairtrade mark on its products, as well as certifications from the Soil Association and the Rainforest Alliance. But in previous testimony, the article reports that workers claimed that oppressive working conditions caused them significant and permanent musculoskeletal damage. They said they had to work up to 12 hours a day in a six-day week, carry up to 26lb of the tea leaf pickings on their back over rough slopes, and in some cases meet a weight target of 66lb of tea a day or not get paid. The article reports that the lawyers hope that the case will impact more broadly on practices in the industry.
The COVID-19 pandemic has brought a new global awareness of the accessibility of diagnostics and the need to test to protect with equal access for all. This episode of Global Health Matters, answers key questions including the availability of essential diagnostics in low- and middle-income countries (LMICs). Host Garry Aslanyan interviews guests who have a deep understanding of diagnostics and their application worldwide: Bill Rodriguez is CEO of FIND, the global alliance for diagnostics, and is also founder of his own diagnostics company, Daktari Diagnostics; and Sikhulile Moyo who led the team that helped discover the Omicron variant in Botswana through careful cross-examination of COVID-19 tests. Join Global Health Matters in this podcast episode to understand the state of diagnostic testing in LMICs and how to achieve equity in access to testing in all countries.
While the supporters of the original TRIPS waiver are still coming to terms with the remains of the 20 month saga that yielded a ministerial decision clarifying the rules of compulsory licensing for the production of vaccines, they are back at the WTO to stomach another fight, this time, to discuss the way forward to boost the production of therapeutics and diagnostics by seeking to extend the applicability of the June decision to these medical products. This puts the co-sponsors, again, directly in opposition to industry interests where companies alone are projected to make billions off a single drug to treat COVID-19. The co-sponsors point out that there are four times as many patent filings related to therapeutics compared to vaccines. Already, more than 5,200 patent applications related to COVID-19 were published across 49 patent offices between 2020-21, according to the World Intellectual Property Organization Patent Landscape Report, the co-sponsors cite. They argue that granting of patents could delay the entry of generic drugs, and in turn lead to price increases affecting access. They seek an extension of the policy tools provided in the June ministerial decision to therapeutics and diagnostics. This, they say, “will help developing countries to address IP barriers to the expansion and diversification of production”.
After its four-day ministerial conference spilled over into a sixth day in June, the World Trade Organization finally arrived at an agreement on the controversial TRIPS waiver. After heavily contested negotiations, member states agreed on a deal that temporarily removes intellectual property barriers around patents for COVID-19 vaccines, and postpone the discussions on extending the waiver to treatments and tests by six months. The five-year agreement was struck after a marathon negotiating session at the WTO’s highest meeting. It allows low- and middle-income countries to temporarily waive protections on those patents to produce the shots, either to use domestically or to send abroad. It pushes a decision on treatments and tests off by six months, though it is noted that WTO is notoriously bad at sticking to its deadlines. It also wiped away the original proposal’s calls to temporarily waive protections on trade secrets, copyrights, and industrial designs. The biggest change — and one of the most contentious points of discussion at the ministerial conference — according to observers, was the limit the new deal imposed on eligibility. Any country was able to take advantage of existing WTO flexibilities. But under the deal, export eligibility is limited to LMICs.
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.
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.
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.
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.