Episode 09: The Disparate Worlds of the Possible and Struggle

In our latest episode, the clash of two worlds; the possible and the struggle. We are confronted with the insane disparity between a world ripe with potential with the swipe of a smart phone,  and a world that is fighting for basic access to a fifty year old contraceptive technology and links to HIV prevention for African women.
 
 Ben chats with Sean Howell, co-founder of the LGBT social media site Hornet App and Chair of the LGBT Foundation. With all the concerns about privacy and political hacking, social and digital media may seem a curious place to disclose your HIV status, that you are U=U (undetectable equals untransmittable) or that you are on PrEP. Yet, that is exactly the future Sean is building. Join us as we have a rollercoaster of a conversation, up and down the insanely fast-moving world of technology that will affect the health and wellness of everyone.
 
But just beforehand, Ben catches up with South African HIV and women's rights activist, Yvette Raphael, recorded from Durban, South Africa. We met Yvette in the 3rd episode of the podcast, and she is in Durban for the South African HIV Conference. She gives us a direct update on the results of the largest trial ever of just under 8000 women across eastern and southern Africa - looking at whether different contraceptive options affect their risk of HIV transmission. The trial is called ECHO and the bottom line is that a woman's risk of getting HIV is not negatively impacted by whichever contraceptive she takes. This is huge news and can't be ignored by governments and funders. It must transform the way HIV and family planning work together, particularly across sub Saharan Africa.
 
Links you may find useful:

AVAC

https://hornet.com/about

http://video.wired.com/watch/blockchain-explained

IPPF

International Partnerships for Microbcides

https://www.tballiance.org/

https://www.preventionaccess.org/

https://tac.org.za

https://womendeliver.org/
 

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/


And for your delight:

http://www.nilerodgers.com/about/projects/chic

https://www.earthwindandfire.com/

You can find us at:
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Spotify
Stitcher
Google Podcasts

Episode 08: The Rise, Fall and Rise Again of Pangaea

A new episode of A Shot In The Arm is out!

This week it is just me. I tell the story of Pangaea Global AIDS, a global non profit think tank and technical assistance agency that I had to be the privilege to lead for seven years, and which closed in 2017. Its a tough but ultimately positive story. Many listeners have urged me to reflected on the contribution of non-profit, non governmental organizations, what they do and what happens when they know they need to pack up shop.

In addition, an increasing number of listeners have asked why I havent commented yet on the US Prep4All and its campaign to unlock the patent of two HIV medicines that are used in HIV prevention, or PrEP. It is a tough one for me. And does not offer a simple solution.

So firstly, you are never going to hear me criticize other advocates. These are people who have put their lives on hold and some of them even put their lives on the line to fight one of the greatest menaces to human survival, HIV. They deserve our respect and support. Even when - no, especially when - you don’t necessarily understand some of the tactics.

I am deeply grateful to Peter Staley and colleagues, because what they have done is to put HIV prevention back at the top of the agenda. Historically, we have failed singularly in HIV prevention.  I am also not going to criticize Gilead Sciences. Good, committed people work there, trying their best to develop and deliver new medicines, and negotiate the crazy storm that is healthcare in the US. So for total transparency, Yes, Hunuvat work for Gilead’s global access program, and we collaborate on reinvigorating the business response to AIDS.

I believe that the focus must be directed firmly at the US Government. We must collectively grasp this moment, take advantage of this activism, and the extraordinary donation Gilead has made, and demand that US Administration support and fund local agencies to incorporate PrEP into comprehensive HIV testing and prevention strategies. This of course, an administration that has already shown itself to be more than willing to undermine the rights of its citizens in exchange for the continued support of its base.  Whether you like how we got here or not, biomedical HIV prevention is now available in an unparallelled way in the US. We must pull the administration by the scruff of its neck to do the right thing.

Each week, I try to spread light around leaders in the fight for abortion rights. The hugely important Women Deliver Conference took place in Vancouver, Canada. Women Deliver is THE global advocate for gender equallity and the health and human rights of girls and women. It is rooted in sexual and reproductive rights - including judgement free access to safe abortion. Its founder, Jill Sheffield and President & CEO Katya Iversen know that if you invest in girls and women, you get results for everyone.

So about Pangaea. It was founded in 2000 by the San Francisco AIDS Foundation’s Pat Christen, and Eric Goosby to be a vehicle to enable San Franciscans concerned about the global nature of AIDS, to contribute to something good and worthwhile. And wow - Pangaea developed workplace programs for large multinationals in HIV and TB. It led harm reduction programs in China and Tanzania and it challenged the status quo in Oakland, across the Bay from SF, which had shoddy HIV testing and linkage to care.

I came into the mix in 2010, when Eric had just moved to DC to become Obama’s Global AIDS Ambassador. Most of the staff went with him. I was left with a desk and a tart instruction from the then Board of the San Francisco AID Foundation that we had to move from our SF office space and find somewhere of our own.

The smartest thing I did was to hire Megan Dunbar (who I think is the world’s leading expert on Implementation Science) and we built up a team to create a compelling set of integrated, mutually reinforcing programs, including

  • Harm reduction in Yunnan Province in China

  • Improving access to HIV testing and scaling up the quality of those tests and linkage to care

  • Helping WHO speed through informal non-normative treatment guidelines - we called them treatment optimization

  • We helped the Breast Cancer awareness and treatment movement in China learn from the experiences of the HIV community

  • We supported the first community PrEP community advisory Board in Oakland to help MSM of color access services.

  • But the jewel in the crown was the collaboration with the Zimbabwe Health authorities to provide life-skills to HIV positive teenage girls, and then extend services to enable young girls and men, negative or positive to enter in the comprehensive HIV treatment and prevention national program.

No technology was too advanced or too radical for it not to be the subject of interest of patients who would one day come to rely on it to save their lives.

I think our peak came in the summer of 2016, at the second World AIDS Conference to be held in Durban, South Africa. Pangaea - in one form or another  - seemed to be present in nearly all key discussions about prevention for girls and women, treatment optimization, community mobilization and private sector engagement. From our little Air BNB down the road, by the coast, we were, you could say, The Forest Gump of the AIDS response.

But even then, there were rumblings.

I remember a skype conversation on a dank, humid even looking over the Indian Ocean, talking to the core members of our Board about the risks of us becoming increasingly reliant on one particular donor. Increasingly, we were no longer an independent agency but a vassal for its bidding.

And we asked the painful question what to do if the cost of operations exceeded the ability to fund or provide services for our partners. Didn’t we have an obligation to “go away” at that point?

During the fall, those rumblings became louder.

And it culminated on a Friday evening in mid December that year. I was sitting in a laundromat off 19th avenue in San Francisco, I had flooded one of the washers by stuffing a large duvet into it, which had been, as we tended to call it “pug poo apocalypsed” by our pug, Eddie. I was waiting for the owner to ring and tell me how stupid I had been.

But the call came from the funder. They had decided not only not to proceed with one new grant proposal, but to re-allocate another major program we had spent months developing, (as usual at no cost) to another organization which in their mind could do the job better than we could.

If this sounds brutal and desperately unfair, I have to say that is how I felt. But I also knew there was no space for such feelings: immediately that the plan that the small group of Pangaea Board members and I had toyed with over the summer needed to be kicked into action.

Over Christmas, and what a joyful time that was, the Executive Committee of the Board and I spoke almost everyday, in complete confidence exploring whatever and whichever way we might save Pangaea. It was clear that if we wanted to retain some modicum of ownership of the process, we needed to act now. It could not be put off any longer.

As soon as New Year’s was out of the way, I met with our staff, and somewhat overly cool and distant from myself, I explained the news, that we were closing, that we would wind down over the coming three months, and that we would do whatever we could to help colleagues find alternative employment.

I came home that note ashen. My partner Erik consoled me with a glass of neat whisky, and I realized that I too had lost my job.

The process then took over, and I was its mouthpiece. It was a frustrating and tedious review, analysis and wrap-up of of all income, all expenditure, all liabilities. No detail was too small. I learned to pore over Excel spread sheets in ways I had not thought possible.  You entered into a realm of drudgery of bureaucracy that was at the same time methodical and mystifying. As we negotiated with funders on the close down of programs, some understandably demanded the balance of funding back, some offered to allow us to keep a percentage to enable us to close down gracefully. I will always be extremely grateful to those people.

Perhaps the most difficult part of the experience was while trying to support colleagues find alternative employment - particularly those with young families - one had to assume the mantle of their rage and despair. There was no escaping the overwhelming feeling that I had failed them.

However, in turn, I was supported by a phenomenal Board, in particular, Chair Eric Roberts, a former forensic accountant,  Kathleen Burke a former HR President and former CEO of her own organization, and Kathy Fisher, a tenacious lawyer. They provided the legal and financial framework for me to conduct the matters that needed conducting, but more than that, they provided a place for me to vent, and to grieve.

Whatever people tell you, being an ED of a non profit agency - whether it is a technical support or network of key populations - is one of the toughest jobs there is.

You are directly responsible for delivering a life or death mission, while at the same time, making sure you are in compliance with the most bizarre and byzantine and often contradictory Federal and State laws.

You are directly responsible for the wellbeing of you staff and your consultants.

You are always hustling for money, which is frustrating because the expertise that landed you the ED job in the first place was rooted in challenging the status quo.

For executive directors in HIV, SHRH, Hepatitis, Breast Cancer and other diseases, it is an exceptionally difficult job - and the people who do it are phenomenal. You have to be the glue that holds the organization together, and adapt to, anticipate the changing moods of donors, most of whom have little understanding of the damage that instability causes.

Someone gave me a “How To” book which recommended lessons from the management of military disasters (most notably in Vietnam). For me, of course, being British-born, the temptation was to look at Dunkirk, (which the British have to come to view as an amazing victory, but was in fact a crushing military defeat, possibly the largest by one European power over another). Needless to say, the book was not useful.

Although, actually - through news reports and articles, I did learn lessons from the US military on how to handle the winding down of Pangaea. One story that sticks in my mind (and this may be aprocryphal) is the decision made by Generals at the start of the second Iraq War not to allow any further use of Power Point presentations. The format does not encourage preparatory thinking, and can be as useless as an endless shopping list. I have never liked Powerpoint, and it was indeed very painful in early 2017 to see seven years’ work reduced to a list of bullet points.

The effort needed to be spent on developing a plan - or rather create a the mindset of planning - with the willingness to extemporize when needed. Being singularly bloody-minded also helped. The funniest thing, I still get calls from head hunters inviting me to be short term CEOs of organizations that have decided to close. What am I, a new Prince of Darkness?

No, I never want to do this again. And when experts from funders and think tanks recommend sweeping changes that will bring an end to organizations, we need to be exceptionally wary of them. How many organizations have they actually closed themselves? None? Well, shut up then.

At the end of December 2018, I received a letter from the Attorney General of the State of California informing me that Pangaea, which had closed its doors in March 2017, had now been formally closed and its 501c3 status withdrawn. For just a moment, I panicked. Where on earth should I should file this letter? It ended up in a box of Pangaea papers, hidden at the back of the garage.

However, what might have been a devastating piece of paper in previous times, was now barely a footnote. And I understood that narrative was not about failure. Pangaea’s board and staff explicitly moved programs to homes in the countries where they worked best - you will find that Pangaea still thrives in the Pangaea Zimbabwe AIDS Trust, where an exceptional group of women M&E and community mobilization experts engage communities, the Ministries of Health and the Global Fund. You find it in the work of AIDS Care China, which takes the lessons learned from programs in China, and applies them across the region.

The biggest lesson for me is about humility. Winding down Pangaea, while immensely painful, was absolutely the right thing to do.  If you are doing no more than raising money to keep the lights on, you have no business being in business in the first place.

Many of us working in the AIDS movement knew in the middle of this decade, that a wave of closures was coming towards us. And here we are. There is not a single one of us who does not know of an organization that has closed, or which isn’t under immense pressure to stay afloat.

It is hard, grinding work, and it demands a rigor and gritted determination we have not seen since the start of the AIDS epidemic.  But my responsibility was to own the process, lead it, and not be battered about by funders.

These are still very much exciting times: The community that embraces and incorporates science into practice is still young, and is entering a new, dynamic phase of the journey, anticipating and responding to new epidemics and health challenges. Being nimble and do rapidly what funders and international agencies cannot, will remain central.

This episode is dedicated to the hard working Executive Directors around the World. You know who you are. You are A Shot In the Arm.

References You May Find Useful:

AVAC

IPPF

International Partnerships for Microbcides

https://www.tballiance.org/

https://www.preventionaccess.org/

https://tac.org.za

https://womendeliver.org/

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/

https://prepfacts.org/prep/the-basics/

And for some groovy British Indie Pop from the 1990s that is still going strong, may I suggest Saint Etienne

http://www.saintetienne.com/

You can find us at:
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and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 07: Staying Alive!

A new episode of A Shot In The Arm Podcast is out!

I chat with Georgia Arnold, one of the world’s leading experts on communicating public health messages through digital and social media. She is the founder and Executive Director of MTV Staying Alive Foundation and one of the giants of the business response to aids. You may also hear the occasional bark from Copper, a mature Golden Retriever mix, who has been hanging out with us recently. He is a huge MTV fan.

Onto serious matters.

Georgia and I agree that the world is on “Code Red” when it comes to health and human rights. We are gobsmacked at how the US has backslid on women’s reproductive rights. She points out that when the US sneezes the world catches a cold, and sees a direct correlation between the recent US State legislature decisions to ban abortion and the increasingly regressive social and health policies across the world, including the shocking Kenyan High Court decision to affirm the illegality of homosexuality in the country.

I’ve said it before and I’ll say it again: women’s and girls’ access to full sexual and reproductive rights - including abortion - is the most critically urgent issue democracy faces at the moment. If we let dark forces win this, they will take away hard-won rights in other areas, prevent long term action to save the environment, and disrupt society in ways we have not seen since the 1940s. Practical conservatives, angry moderates and principled progressives have to put differences aside, and unite to stop this brutal assault on girls and women.

A new feature of A Shot In The Arm is that we give a shout out the grass roots work happening across the US and around the world to defend the rights of girls and women. This week it is PPINK, Planned Parenthood of Indiana and Kentucky, which provides access to high-quality healthcare, by reducing unintended pregnancies and sexually transmitted diseases and advocates for services without judgment. Check them out, and if you are able, please consider supporting them.

On a brighter note, Georgia and I explore how new digital and social media technologies, along with terrestrial broadcasting, can transform communities’ attitudes and approaches to improving global health, particularly with young people. A star in their programming is SHUGA, a TV drama about young Africans. It has shows in Kenya, Nigeria and South Africa - with a spin off about to commence in India. MTV makes this show available across the continent, rights and cost free. It is shown on terrestrial and satellite channels. It has addressed PrEP, HPV vaccines for girls, pregnancy, and lgbt issues. A particularly poignant story is of Reggie (played by Given Stuurman, a young South African who realizes he is gay and we follow his coming out to family and friends. In the adaptation for a Nigerian market, the story is nuanced to downplay his coming out, reframing it rather as his fights with his father to be the creative person he wants to be. Noticeably, However - and with significantly greater ratings across east, west and Southern Africa, the You Tube story line is the unredacted South African plot. MTV has discovered that its audiences relates to Reggie - and has increasingly self-moderated the harmful, usually religion-based comments.

MTV Staying Alive’s SHUGA shows us that is possible to get people to get up, take notice and act on information that is good for their health. It does not have to be painfully paternalistic and patronizing, as much our public health information and education can often be.

Condom, anyone?

For more information, please visit:

http://www.mtvstayingalive.org/

https://www.mtvshuga.com/

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/

https://prepfacts.org/prep/the-basics/

If you are concerned about unwanted pregnancies, and reproductive health justice:

https://www.plannedparenthood.org/

In Indiana and Kentucky:

https://www.plannedparenthood.org/planned-parenthood-indiana-kentucky

and of course…

Pet Shop Boys

You can find us at:
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Episode 06: Of Microbes and Meat

A new episode of A Shot In The Arm podcast is out!

David Evans and I chew the cud about the state of antibiotic resistance, why we are at the end of the golden age of antibiotics, and what is going to happen if we do not get our act together now.

Sounds familiar? It should. There is growing awareness that climate change, global infectious disease, education, economic development and human rights are essentially a “singularity” (to borrow Ray Kurtzweil). That is to say, we face one issue, albeit with many confusing and contradictory aspects.

What is that singularity? I don’t think artificial intelligence covers it fully. Rather, it is about how our survival depends on how we empower individual innovation, while ensuring collective responsibility (to ourselves and our neighbors, animal, mineral and vegetable). Climate change and global infectious disease are the end result of over-population and the destruction of habitats to make room for agriculture to feed that population. We come into contact with old and new enemies, bacteria, viruses and heavens knows what. Only to find we are less prepared than ever to accommodate them.

There is a recently published new biography of the French Philosopher Denis Diderot by Andrew Curran. I strongly recommend it, especially for summer beach reading. Seriously. Admittedly, Diderot is not for the faint-hearted, and he had some obscure and hard-to-understand views on pretty much everything. But Andrew Curran engages you in a most satisfying way. And as it relates to a fundamental singularity, Diderot appears to have thought, at times, that far from being the pinnacle of evolution, humanity’s self-awareness may be a dead-end. it offers no promise, and is self-destructive. The planet will move on without us. There have been plenty of extinctions on this planet. What is one more, really? So, it really does not matter what we do or think. I did my very best to ignore Diderot at university, but at times like these, some of his thinking has a strong, if gloomy appeal.

Humanity’s abuse of anti-bacterials is a prime example of our species’ hubris. We, in the North, now blame the global South for the very problems we created - out of control use of antibiotics to treat diseases and grow food. Read this recent New York Times article, which captures exactly the sensationalist, if tone-deaf sentiment.

In the Post Second World War era, as sure as sliced bread, we have assumed that the science boffins are beavering away at solutions that are just around the corner. However, as David Evans points out, a recent review of current anti-bacterial research by the Pew Charitable Trusts shows that research, such as it is, is really not encouraging.

The perilous state of antibiotic research still surprises many people. We hold a simplistic and dismissive view of science and the sheer bloody perseverance that is demanded of our scientists. What do I mean by this? As an example, at the start of this episode, you can hear one of my occasional rants, this time about the otherwise gripping HBO miniseries Chernobyl. I was outraged that a generation of brave Soviet nuclear scientists (who, at great risk to themselves, spoke out about the disaster and how it might be addressed) was “represented” by one fictional character played by the English actor, Emily Watson. This may have made the facts bend more easily into a sloppy and predictable narrative. But it simply is not true. The producers put a lot of effort into the sets, though. And thus learn yet again, that it is easier to spend more attention on scenery than story.

Yet. Diderot, Chernobyl and antibiotic resistance notwithstanding, I cannot but be optimistic about our future. There is a blinking of a new collective realization that can change the way we will live, and it is possible to transform ourselves. We miss the point if we describe this moment through a stale 20th century lens of capitalism versus socialism. If HBO’s Chernobyl tells us anything, it is that stupidity is not a monopoly of today’s nationalist right. Damning the private sector just because it is private strikes me as clueless as complaining about the incompetence of the public sector.

Rather, the key is for a vibrant civil society to force the private and public sectors to work together. Occasionally, there will be flashes of brilliance, but more often it will be a long, hard slog. The framework that has really outlived its usefulness is the nation state. Viruses, bacteria and radiation know no national boundaries. The real lesson from the golden age of antibiotics is that it is pointless to regulate their use in our country, if they are not regulated next door. We have to find better ways of organizing ourselves. A more positive expression of this sentiment is that being a citizen of everywhere, is greater than being being a citizen of somewhere (yes, that’s a reference to that most unfortunate of politicians, Theresa May).

What do we do? I have always giggled at the late Aldous Huxley saying “It's a little embarrassing that after 45 years of research & study, the best advice I can give people is to be a little kinder to each other”. As always (that is, after he moved to California) Huxley is absolutely right.

Our story-tellers are as important to society as our scientists. It is not just a question of having the facts, but how they are woven into how we understand the world. Many of our story tellers are still employing narratives that do not fit the facts, whether be they be politicians, commentators, journalists, authors or show-runners for streamed mini-series spectacles. As many people would expect me to say, Margaret Atwood represents the kind of story-teller we need for the 21st century. She has an inquisitive and mischevious mind, that strikes me as entirely appropriate for our age (by the way, here is a total shameless plug for her sequel to The Handsmaid’s Tale is which is being released this summer. The novel has also been adapted by the streaming service Hulu and enters its third season in June). I would also like to give a shout out to my Oakland neighbor Oakland Buzz On The Street, which interviews A Shot In The Arm Regular, Gloria Lockett.

Scientists and story-tellers apart, what this means for the rest of us, at the end of the second decade of the 21st century, is the need for a democracy of responsibility: We all have to act, and cannot sit back and expect our authorities (public or private) to take care of things. I do not make that assertion lightly - it will require sacrifice in some way or another from all of us.

I promised in the first episode of A Shot In The Arm that we would stay abreast of developments in Venezuela, a topic that is sadly very relevant to this week’s show. Mary Ann Torres who heads ICASO (and for total transparency, I am its Board chair) has provided this harrowing update on impact the country’s collapse is having on people living with HIV.

Also sobering is the coordinated culmination in many southern states of the USA of hard-right and vicious anti-abortion laws. These are attacks on reproductive health justice. They are rooted in the false narrative of “protecting life” from the emergence of a so-called “fetal heart beat” at around six weeks of pregnancy - a claim that is simply not true.

All of us must “do our bit,” as seems fit and proper for each of us, to support of girls and women. There are a range of ways we can do so, and I list three of them below.

Stay strong everyone!

You may find these links useful:

www.who.int

www.cdc.gov

https://www.google.com/amp/www.pewtrusts.org/en/research-and-analysis/issue-briefs/2019/03/tracking-the-global-pipeline-of-antibiotics-in-development%3Famp%3D1

https://www.plannedparenthood.org/

https://yellowhammerfund.org/
https://www.arc-southeast.org/

You can find us at:
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Google Podcasts

and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 05: The Greatest Experiment In Social Services

This week David Evans, internationally respected treatment and science literacy expert, joins us from Pasadena, CA as we explore how healthcare might be delivered in the USA. We look at some proposals for Medicare for All that are on the table, and how different strategies led by the public sector and - or the private sector might be implemented. David explains why it's really important for community organizations providing infectious disease services - particularly HIV - to take notice now. Many of the drugs we use are coming off patent, and this will have major consequences for funding, if we are not prepared.

Links you might find useful:

https://pnhp.org/what-is-single-payer/

https://www.npr.org/2019/04/13/712997046/examining-sanders-medicare-for-all-proposal

https://www.vox.com/policy-and-politics/2019/2/22/18234606/warren-child-care-universal-2020

https://www.nhs.uk/

https://www.cdc.gov/workplacehealthpromotion/pdf/Workplace-Health-Program-Definition-and-Description.pdf

http://www.gbchealth.org/

and of course…
Pet Shop Boys


You can find us at
Apple Podcasts
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Google Play Music

and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 04: Ebola, Measles, HIV: Lessons for Future Epidemics

The latest episode of A Shot In The Arm is out!

The episode was recorded live on April 25th 2019, at The Commonwealth Club in San Francisco. The Commonwealth Club is an amazing venue, with an amazing program, and breathtaking views of the Bay.

This was a special live event, hosted by A Shot In The Arm, and marks the first of a series of live discussions over the next few months to explore in the intersection of global health and human rights.

In this episode, microbiologist Peter Piot and anthropologist Heidi Larson, from the London School of Hygiene and Tropical Medicine share their thoughts on the lessons learned from ebola, measles and HIV for future epidemics. They are the real-life Indiana Jones stars of global infectious disease. I strongly recommend Peter’s memoirs “No Time To Lose.” His life in the former Zaire, now the Democratic Republic of Congo, chasing down ebola is breathtaking. In the second part of the the book, his perseverance in first breaking down the barriers of UN stagnation, creating UNAIDS and then moving the world’s investment in AIDS from millions to billions reminds one of Elizabeth Warren. Heidi is not outshone by Peter. She is founder of the Vaccines Confidence Project, which fights disinformation in the age of vaccines. Her insights into how to engage the “anti vaxxer” movement are telling and inspirational.

This week also sees the United Nations General Assembly meeting in New York to prepare for its Special Session on Universal Health Care (UHC) in September. Thanks to ICASO’s MaryAnn Torres for pointing me in the right direction, I can now doze through sessions in the comfort of my own home, courtesy of the internet.

What is UHC? To be perfectly honest, I am not sure. We can say that it will likely become the pre-eminent global health policy issue of our era. It is deeply intertwined with climate change , as temperatures bring about massive disruptions in populations, clean water access, and the emergence of old and new infectious diseases. As Heidi and Peter remind us, AIDS and measles denialists have chosen deliberately to ignore the facts, placing not only their loved ones, but entire societies at risk. So too with climate denialsts. Their grip on power for the last thirty years will have lasting consequences for humanity.

For right now, we need to recognize that UHC will drive – and unless we deliberately raise additional billions of dollars  - absorb existing and new health access, equity and financing initiatives. We must seize the opportunity.

UHC relates to Sustainable Development Goal target 3.8, “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”   That there is not a specific HIV goal is a conversation for another time. Since 2017, the World Bank and WHO have sought to raise awareness and action on UHC, as now UCH2030 use the following framework definition “all people having access to quality essential health services, without having to suffer financial hardship to pay for health care.

It is a helpful, but incomplete definition, and its continued vagueness, while perhaps smart for shorter-term international negotiations, means that the prediction of the funding needed to achieve it remains obscure. Calls for securing further efficiencies in health care delivery do not suffice, and countries have to face head-on whether to expand public expenditure.

The most effective and efficient way of delivering healthcare is through public funding and service delivery, and a proven model was established in the UK in 1949. The National Health Service is (or would be if not for Tory tinkering) publicly-funded health and wellness for everyone from cradle to grave, regardless of ability to pay. My hero, the Health Secretary of the time, Labour’s Aneurin Bevan said “the NHS is the single greatest experiment in social service that the world has ever seen undertaken.” His words resonate to this day.

Disappointingly, there is currently no global consensus that this the way forward.

As we wrestle with the disruptions of climate change to our way of life, I am optimistic that a new consensus could emerge within my lifetime. As Peter notes, a new influenza pandemic could be a game-changer for humanity. As “Spanish Flu” from 100 years ago shows us, pandemics have no respect for national borders, class, creed or income level. Our survival will require us from the same.

In the meantime, the vast majority of healthcare spending in resource-limited settings will continue to come from Out of Pocket Expenditure (OPE), which is a polite way of saying poor people have to pay exorbitant fees for emergency medical services. Over the next few decades, we should expect that “funding source” to grow, largely unaided and unplanned.

What, then, do we do?

At a bare minimum, donors right now (both in the North and South, public and private) need to meet the 6th replenishment goals of the Global Fund to fight AIDS, TB and Malaria. But they will also need to commit to a 7th replenishment, 8th, 9th and so forth…

It would be a significant, if underwhelming achievement, if we agreed to make OPE work better – supporting our poor to move from paying for emergency health costs, to planning for their future health.  Governments have to lead the way, with the engagement and oversight of their peoples.  Under such a rubric, there are increasingly creative ways for communities and the private sector to make meaningful contributions. These include workplace-based wellness and health programs (in both formal and informal labor markets), low-cost saving schemes for health, co-operatives, and expanded privately and publicly managed health insurance schemes.  

At exactly the same time the UK was creating the National Health Service (its real 20th Century jewel in the crown), India and Pakistan were finally free from the British Empire to experience the joys, challenges and sorrows of self-determination. It is not catchy, but it is direct. Amrit Kaur, women’s rights activist, and independent India’s first Minister of Health could have been offering a definition of UHC when she said, “the welfare state is the economic betterment and provision of minimum standards of living essential for a healthy life for all people.”

There is a question and answer session at the end of the podcast. But do not fear, Peter and Heidi will be back in future episodes. So if you have a burning question, let me know, and Ill be sure to ask them.

You might find these links helpful:

www.lsthm.ac.uk

www.calpep.org

http://sph.berkeley.edu/

https://globalhealthsciences.ucsf.edu/

http://www.csueastbay.edu/

http://med.stanford.edu/

https://www.commonwealthclub.org/

www.sfchc.org

www.sfaf.org

https://www.cdc.gov/vaccines/programs/vfc/index.html

And if you want to know more about HIV:

https://www.hiv.gov/hiv-basics

As always, you can find us at Apple PodcastsSpotify StitcherGoogle Play Music, and on Facebook and Twitter @shotarmpodcast. Subscribe, and if you like us, remember to give us five stars!

Episode 03: Women Are The Cure

We meet Yvette Raphael, the internationally acclaimed South African HIV, Women’s Rights and science activist. She tells her own story of HIV, and how she and a group of women have radically changed the response to HIV prevention and treatment in the country with the highest rates of HIV in the world. She also talks about her fight for women’s empowerment and survival. We also cast our eye across the research in biotechnology and research that is making the news this week.


References You May Find Useful:

AVAC

IPPF

International Partnerships for Microbcides

https://www.tballiance.org/

https://www.preventionaccess.org/

https://tac.org.za

http://thetotalshutdown.org.za/

The People Vs Patriarchy
https://www.youtube.com/watch?v=TAoPFeObqe4

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/

https://prepfacts.org/prep/the-basics/

and of course…

Pet Shop Boys

Episode 02: All About the Money

In the latest episode of A Shot In The Arm Podcast, we explore how much money is needed to end global infectious disease, and talk with the Head of Friends of the Global Fight, Chris Collins about how to protect and nurture US investment in  the Global Fight against AIDS, TB and Malaria.

This episode gets down and dirty about the money - how much funding is needed to end infectious disease, who much is currently being spent, and how to get the US Congress to sustain its investment in global health. The US is by far, the largest donor in infectious disease in the world. We explore with Chris Collins, Head of the Friends of the Global Fight how to build support in Congress, the private sector and the general public. 

I hope you enjoy the podcast. You can find us on iTunesGoogle Play MusicSpotify and Stitcher. Follow us on TwitterFacebook@shotarmpodcast. Be sure to subscribe, and if you like us, give us five stars!

A Shot In the Arm is brought to you by NewsDoc Media and Hunuvat Global

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Links you may find interesting:

www.TheGlobalFight.org

www.theglobalfund.org

 https://lee.house.gov/

https://pelosi.house.gov/

 https://www.lgraham.senate.gov/public/

https://cox.house.gov/

https://www.harris.senate.gov/

https://www.feinstein.senate.gov/public/

https://www.kff.org/

http://www.gbchealth.org/

If you are concerned, or want to learn more about HIV testing, prevention and treatment:

http://www.thebody.com

https://www.calpep.org/

https://sfcommunityhealth.org/

https://prepfacts.org/prep/the-basics/

Episode 01: 21st Century Prevention

In the first episode, “21st Century Prevention,” host Ben Plumley explores the future of HIV prevention with guest, Gloria Lockett, co-founder of California’s Prostitute Education Project (CALPEP). The future isn’t just biomedical, its about incorporating new medicines and diagnostic tests into education and prevention outreach with communities most affected by HIV.

We also meet Venezuelan human rights lawyer, MaryAnn Torres, the head of ICASO, to learn more about how the political and economic crisis is having a devastating impact on the health of everyday citizens. Its a story of medicines stolen by the government, and lives put at risk.

For more information, see the following links:

California Prostitute's Education Project
https://www.calpep.org

ICASO
http://icaso.org

HIV
https://www.hiv.gov/hiv-basics
https://www.avert.org/about-hiv-aids/worried-about-hiv
https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hiv-aids/what-are-symptoms-hivaids
https://aidforaids.org/

HIV Treatment
https://www.preventionaccess.org/

HIV Pre-Exposure Prophylaxis (PrEP)
https://prepfacts.org/
https://www.lovefoundation.or.th/
https://preptaiwan.org/
https://www.gileadadvancingaccess.com/

Venezuela
https://www.icrc.org/en/where-we-work/americas/venezuela

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A Shot in the Arm Podcast is produced by:
www.newsdocmedia.com
www.hunuvatglobal.com

If you enjoyed this episode, please subscribe and follow us at:
Twitter: @shotarmpodcast
Facebook: @shotarmpodcast

Read Ben's blog posts at:
www.hunuvatglobal.com/blog
www.ashotinthearmpodcast.com/blog