Flying the Flag for investigating traditional medicines - the G20 Political Declaration in Buenos Ai

Recent blogs suggest that we’re not really fans of political declarations or of motions passed by the World Health Assembly. Sadly we can’t deny this, at least if they are either incoherent or fail to add up to much (and we're even more concerned by some of their subtexts). But last week’s Political Declaration made at the end of the G20 Summit in Argentina[i] signed up to by the leaders of the riches countries in the world included a paragraph that really woke us up. It was its Paragraph 15. It contained the following (our comments included after each extract in italics):

Para 15. We encourage the activities of World Health Organization (WHO), together with all relevant actors, to develop an action plan for the implementation of health-related aspects of SDGs by 2030…

[Note on the above: Sustainable Development Goal (SDG) 3 includes for the elimination of tuberculosis (which includes MDR-TB) by 2030]

And continued:

We recognize the need for further multi-sectoral action to reduce the spread of AMR, as it is increasingly becoming a global responsibility …

[Note on the above: AMR or Anti-Microbial Resistance includes MDR- and XDR-TB, which so far are the only AMR diseases that are infectious by being airborne (and are therefore particularly dangerous from a public health perspective). DR-TB also contributes the most to the growing global AMR deathtoll]

We re-affirm the need for stronger health systems providing cost effective and evidence-based intervention to achieve better access to health care and to improve its quality and affordability to move towards Universal Health Coverage (UHC), in line with their national contexts and priorities. This may encompass, where appropriate, scientifically proven traditional and complementary medicine, assuring the safety, quality and effectiveness of health services.[emphasis ours].

[Note on the above: This is a very significant statement which echoes a similar statement made by these same leaders in Berlin last year. It recognises that the sorts of innovative and appropriate solutions to the challenges of providing effective health care in many countries may include traditional and complementary medicine – and as such certainly endorses efforts to investigate (and ‘scientifically prove’) small cone direct moxa for DR-TB. (It’s worth further noting almost the same language in para. 20 of the parallel G20 Health Ministers’ Declaration: “Countries may wish to integrate, where appropriate, scientifically proven traditional and complementary medicine, assuring the safety, quality and effectiveness of health services.” The same message is evident with both leaders and health ministers signing up to the same idea.]

We will continue to strengthen core capacities required by International Health Regulations (IHR, 2005) for prevention, detection and response to public health emergencies, while recognizing the critical role played by WHO in this regard.

[Note on the above: TB was officially declared a public health emergency by the WHO in 1993; it can be argued that MDR-TB has not yet received a similar endorsement despite its threat, although it is termed as a ‘crisis’ in WHO Reports. We would argue that it is, in every current sense clincally a distinct public health crisis which has yet to be effectively addressed in terms of prevention, detection and response.]

We are committed to ending HIV/AIDS, tuberculosis and malaria, and look forward to a successful 6° replenishment of the Global Fund in 2019.

[Note on the above: No date set, but since this same paragraph quotes the SDGs it implicitly means that this commitment is to end these three killers by 2030.]

There’s little to add to this beyond suggesting that sadly little of this is going to happen unless these same leaders of the 20 richest nations and their health ministers do a lot more than pontificate in Declarations at Summits and High Level Meetings (even if this includes explicitly endorsing our own activities researching moxa for MDR-TB). In fact they need to do a lot more than just see to the replenishment of the Global Fund next year (and adds up to our own tip at a political declaration):

- they must immediately desist from policies which undermine those in lower income nations whose health is imperilled because of a lack of access to benefit from scientific progress (as per the Universal Declaration of Human Rights of 1948).

- they must do so, by relaxing their genocidal grip on patent protections in line with the DOHA Declaration and the TRIPS Agreement, so that those whose health is threatened because of a continuing lack of access to the existing concrete benefits of scientific research finally benefit from this Human Right.

- Immediately this must be in terms of facilitating access to existing essential drugs for the treatment of life-threatening disease as defined by the WHO (which otherwise stands in de facto contravention of Article 27 of the International Declaration of Human Rights) bearing in mind how many are now dying from MDR-TB.

- These G20 leaders must also, under the same terms, fully support research into new vaccines, and new medicines for these same life-threatening diseases (especially for AMR including MDR- and XDR-TB, bearing in mind that these fields of research remain significantly underfunded).

- They must furthermore (and perhaps most significantly of all) proactively strengthen the capacities of the countries of the global south to prevent, detect and respond to the threat of these diseases (including MDR-TB) which they have now committed to ending.

And if they fail to do so, they should surely be held to proper account.

The significance of Argentina hosting this G20 Summit

One final point is worth noting in respect of the above – relating to the coincidental fact that it was Argentina that hosted this most recent G20 gathering.

This same state of Argentina has (as far as we know anyway) been the only country to date that has been successfully taken to task for not properly responding to its citizens suffering from a preventable disease (because it was considered unprofitable to do so). This related to the case of Mariela Viceconte[ii], who sued the Argentinian state for failing to manufacture the existing vaccine against Argentinian haemorrhagic fever which is a common disease in the humid pampas region where she lived and worked.

Human Rights group CELS accused the Argentine state of failing to comply with the UN International Covenant on Economic, Social and Cultural Rights (ICESCR) which mandates all states to seek solutions to these sorts of illnesses. The suit was accepted by a federal court, which ordered the government to manufacture the vaccine within a year. (The International Covenant on Economic Social and Cultural Rights came into force back in 1976.)

It might just be worth dusting this case off again in this age of Globalisation, and reviewing it before the next G20 meeting regarding any signs of real progress and whether any legal actions can be taken if they haven't.

[i] http://www.g20.utoronto.ca/2018/2018-leaders-declaration.html

[ii] https://nacla.org/article/human-rights-after-dictatorship-lessons-argentina