Health equity in economic and trade policies

Kenyan tea pickers on Scottish-run farm to pursue health issues in UK court
Bricks L: The Guardian, August 24, 2022

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.

Test to protect: equal access to diagnostics for all
Aslanyan G; Rodriguez B; Moyo S: Global Health Matters Podcast, Episode 14, 2022

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.

TRIPS Waiver proponents back at the table to push for therapeutics and diagnostics
Patnaik P: Geneva Health Files, Newsletter Edition #148, July 2022

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”.

WTO finally agrees on a TRIPS deal. But not everyone is happy
Green A: Devex, June 2022

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.

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.

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