World Health Day: Towards a Fairer and Healthier Tropics
The Future Belongs to the Tropics
On 7 April 2021, the Mahathir Science Award Foundation (MSAF), the International Science Council, Regional Office for Asia and the Pacific (ISC-ROAP), and the Academy of Sciences Malaysia (ASM) jointly organized a webinar themed ‘Towards a Fairer and Healthier Tropics’ in conjunction with World Health Day.
The webinar commenced with welcome remarks from ISC-ROAP Director, Prof. Mazlan Othman. She highlighted that the climate and ecological characteristics of the tropics increase the likelihood of disease transmission. Besides that, the greater rate of poverty in the tropics contribute to the disproportionate effect of infectious diseases on communities living there.
After the useful context provided by Prof. Mazlan, Dr Peter Singer, Special Advisor to the Director-General of the World Health Organisation (WHO) gave a keynote speech titled “Vaccine Equity is in Our Hands”. Dr Singer emphasized that the pandemic has shone a bright light, not only on the importance of science and public health, but also on the inequity within and between countries. He then went on to explain the chokepoints of vaccine equity (the 3Ds): dollars, doses and domestic manufacturing. The keynote speech ended with Dr Singer giving some key advice to the audience: find an important problem not many people are working on and solve it!
Following the keynote speech, the next session of the webinar began. The session, skillfully moderated by public health specialist Dr Khor Swee Kheng, consisted of short talks which would later culminate into a panel discussion.
The first talk was given by Ann Penny from the State of the Tropics project at James Cook University in Australia. She gave an overview on the state of health in the tropics. Like the rest of the world, life expectancy in the tropics has drastically improved over the past 70 years. However, the burden of infectious diseases like tuberculosis, HIV and malaria continue to be higher in the tropics than the rest of the world. Ann also mentioned that 80% of maternal deaths in the world occur in the tropics indicating great inequality.
Dr Khor then asked Ann how tropical countries should best prioritise which problems to solve. Ann responded by saying that most countries are already doing this well by targeting disease that have the greatest economic and social impact, and are preventable. She also said that tropical problems require tropical solutions.
Next, Prof. Vivian Lin of Hong Kong University spoke about the social determinants of health. She emphasized that we need to acknowledge the underlying issues and their intersectionality, in ensuring health equity during the pandemic. These include insecure employment, poor and crowded housing and working conditions. Furthermore, she added that in the tropics, there are also challenges to healthcare access such as geography, language barriers due to the diversity of languages spoken and a barrier in trust in the quality of healthcare. Prof. Lin concluded that we need to build back better after this pandemic with equality by design in healthcare systems.
Dr Khor asked Prof. Lin how we can shift the view of healthcare to beyond hospitals. Prof. Lin said that we need strong primary health care systems that emphasise prevention to complement the service of hospitals.
The next talk was by Prof. Aminata Sall Diallo from the University Cheikh Anta Diop in Senegal on the role of education for better health outcomes. She said that there is no doubt that good education is linked to good health. Therefore, sheemphasized that to improve health outcomes, there must be policy reforms beyond healthcare. Prof. Aminata also mentioned that in Senegal where she is based, 30% of the national budget is allocated to education in acknowledgement of the importance of education in contributing to healthier lives.
Last but not least, Prof. Awang Bulgiba Awang Mahmud talked about community engagement for health through two projects conducted by Universiti Malaya (UM). He started his presentation by advocating for academic research to go beyond academia and have a translatable community impact. The learnings from the UM PARTNER and PEACE projects which dealt with elder abuse were that short-term grants do not lead to lasting community impact and a holistic multi-stakeholder approach is needed for real change. The PEACE project had two-way engagement with the community and involved caregivers, primary care workers and policymakers.
Dr Khor asked Prof. Awang about the role of academics in creating real world outcomes. In response, Prof. Awang spoke about the importance in maintaining contact with university graduates who work in diverse sectors so that academic projects can go beyond academia.
After the four short talks, the panel discussion commenced with an open question from Dr Khor. He asked the panelists if they could share a success story from a tropical nation fighting the COVID-19 pandemic. Prof. Aminata shared the Senegalese experience of dealing with the pandemic. She mentioned that outpatient care was expanded to prevent crowding in major hospitals and specialists working in private hospitals and community workers were deployed to help with the pandemic response. Ann Penny mentioned that during the pandemic, Bangladesh reconfigured state tv and radio channels to deliver education to schoolchildren remotely. Prof. Lin mentioned that a lot of Asian countries acted quickly at the beginning of the pandemic and in addition to this, Prof. Awang mentioned that the countries that have done well not only acted quickly but listened to the science. Concluding the answers nicely, Dr Singer said that “leadership is the ultimate vaccine”.
The panel then went on to discuss the role of patents and domestic manufacturing for vaccines. Dr Singer said “Give a country a vaccine and they vaccinate for a day, teach a country how to make vaccines and the people are vaccinated for a lifetime”. He went on to say that the WHO supports bilateral technology transfer, multilateral technology transfer and also the temporary suspension of intellectual property for the pandemic. Prof. Awang added that in addition to increasing the availability of the vaccine, the trust deficit needs to be addressed through effective public health messaging.
A question was asked on the role of global “superpowers” in ensuring vaccine equity. Prof. Lin responded by stating how the countries that donated the most to the WHO were also ironically, the frontrunners in the vaccine nationalism race. Therefore, domestic policies at multiple levels play a big role in ensuring vaccine equity.
Health infrastructure in low-income countries. Ann Penny said not to underestimate the existing infrastructure of tropical countries. For example, with the experience of SARS, swine flu and ebola, there were existing infrastructure – community workers really good at delivering the last mile of healthcare and communication. Prof. Aminata talked about the importance of building human capital in addition to physical infrastructure.
As a member of the audience Prof. Jomo Kwame Sundaram asked whether it was possible for the WHO to prevail upon the US government to make information on vaccine development available given that vaccines were paid for by public funds. He also mentioned that instead of building back better, we should look to build forward better. Dr Singer said that recently the WHO along with 25 heads of states issued a joint call for an international pandemic treaty. The proposed treaty would be a multilateral approach to ensure future pandemic preparedness through enhanced data-sharing, production and distribution of vaccines at a global and local level.
The panel discussion was then summarized nicely by Dr. Khor. He said that at the local level, tropical nations have the capacity to lead their own change. Meanwhile at the global level, health policy reforms require us to recognize that health and equity is a political, scientific and ethical choice that can be achieved by a coalition of the willing, the able and the relevant.
Overall, the webinar was a success in bringing people from 25 countries together in the interest of a fairer and healthier tropics. Participants indicated in the feedback form that they enjoyed the diverse range of speakers and the learning opportunity the webinar provided.