<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div>From: <b class="gmail_sendername" dir="auto">Editor</b> <span dir="auto"><<a href="mailto:editor@phmovement.org">editor@phmovement.org</a>></span><br><div class="gmail_quote"><br><br><u></u>
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<span class="m_8946635426073001355mcnPreviewText" style="display:none;font-size:0px;line-height:0px;max-height:0px;max-width:0px;opacity:0;overflow:hidden">PHM: cholera incidence 'an indicator of the crisis of neoliberal globalisation'</span>
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<h1 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Cholera: neglected disease of poverty</h1>
<h2 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">PHM: cholera incidence an indicator of the crisis of neoliberal globalisation</h2>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">In May 2018, following the publication of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=76ba295625&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Global Task Force Roadmap</a>, WHA71 adopted <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=26ff7d581f&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHA71.4</a> on Cholera prevention and control.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">WHO's Executive Board, meeting from 3 Feb in Geneva will review a report (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fcdc6567ef&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/20</a>) on the global cholera situation and progress in recent efforts made in cholera prevention and control. A more detailed update is provided in <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c0615e45c8&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WER 94(48), 961</a>. See <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4495e7e355&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM comment</a> for more links and comment.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=41f2b6ab51&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHA71.4</a> affirms that “the prevention and control of cholera require a coordinated and multisectoral approach that includes access to appropriate health care, early case management, access to safe water, sanitation, education, health literacy and improved hygiene behaviours, with adjunct use of oral cholera vaccines, strengthened surveillance and information sharing, strengthened laboratory capacity and community involvement, including action on the social determinants of health”.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">In its more detailed cholera report in <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e3907332e3&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WER 94(48), 961</a> WHO notes that “The epidemiological accounting is, however, skewed by the lack of full reporting from other high-burden countries in Asia. Bangladesh acknowledged cholera as a major public health threat by reporting cases to WHO in 2018 for the first time since 1997, although these were only confirmed cases from sentinel sites. India has continued its practice of reporting cases, primarily from West Bengal, but, again, only confirmed cases in a limited geographical area. In these 2 countries, however, with a total population of nearly 1.5 billion and heavily endemic for cholera, the true number of cases is understood to be substantially far higher.” India reported 697 cases in 2018 and no deaths. It seems likely that weak surveillance and reporting may well be associated with lower public health priority, delays in diagnosis and higher case fatality rates. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The Secretariat report on cholera in 2011 (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c43d40a7c2&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">A64/18</a>) commented that “Under-reporting may also occur because of concerns over possible sanctions on travel and trade. Sanctions have been shown not to contribute to the efficient control of cholera.”</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Vaccination</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">It appears that mass vaccination at an early stage of outbreaks has contributed to the decline in cases and deaths observed in 2018 (not including Yemen). </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">EB146/20 comments that, “Oral cholera vaccine is just one tool in a large toolbox that includes sustainable water, sanitation and hygiene solutions, but it serves as a critical bridge to such longer-term efforts.”</p>
<h3 dir="ltr" style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Water, sanitation and hygiene (WASH) infrastructure </h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">EB146/20 does not report much progress in WASH infrastructure. WHO’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1a0b79f7dc&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">SDGs report for 2018</a> advises that:</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><i>Unsafe drinking water, unsafe sanitation and lack of hygiene also remain important causes of death, with an estimated 870 000 associated deaths occurring in 2016. The WHO African Region suffered a disproportionate burden from such deaths, with a mortality rate four times the global rate. Available data from fewer than 100 countries indicate that safely managed drinking-water services - that is, located on premises, available when needed and free from contamination - were enjoyed by only 71% of the global population (5.2 billion people) in 2015, whereas safely managed sanitation services - with excreta safely disposed of in situ or treated off site - were available to only 39% of the global population (2.9 billion people).</i></p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">One of the greatest challenges in most of the cholera burdened countries in sub-Saharan Africa is the management of waste. The high rural urban migration results in most large unplanned settlements without safe drinking water or provision for the disposal of faecal waste. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Economic denialism</h3>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=6400c121c4&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/20</a> remarks that cholera “remains a global threat to public health and an indicator of inequity and lack of social development”.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">What is not mentioned is that economic inequality is increasing globally. Population displacement (through the impoverishment of small farmers, unemployment in cities and towns, xenophobia and global warming) is contributing to the growth of informal settlements without decent WASH infrastructure. Fiscal austerity (impacting on public infrastructure investment) is being imposed (or self-imposed) on more and more countries.</p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">New technologies, such as improved diagnostics and new vaccines, can make a marginal difference but in the context of a global economic regime which drives inequality, austerity and displacement (neoliberal transnational capitalism) it is unlikely that cholera will be eliminated any time soon. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">PHM calls upon member state representatives to acknowledge the continuing disease burden of cholera as an indicator of the crisis of neoliberal globalisation. The roadmap for cholera control must contextualise the challenge of cholera in relation to this crisis. </p>
<p dir="ltr" style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">If UNDP (see <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a607378655&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">HDR 2019</a>) is able to name elite power as a barrier to equity so should WHO!</p>
<h3 dir="ltr" style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">More</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">For further links and more detailed comment on the Cervical Cancer item on the WHO Executive Board agenda see the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a0748ed8b6&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM comment</a> on this item.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The full agenda for the EB can be accessed through the WHO Tracker at <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=1abcf64046&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">who-track.phmovement.org/eb146</a>, including PHM comments on most items.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">To provide feedback on this commentary please write to <a href="mailto:editor@phmovement.org" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">editor@phmovement.org</a>.</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Spread the word</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The WHO Tracker and PHM item commentaries are produced through WHO Watch which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=aea9ca02b6&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52567e81a7&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=9a396de650&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The purpose of WHO Watch is to contribute to democratising global health governance, through new alliances and new information flows.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">You can help by forwarding our updates, including on social media, and by inviting others to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4c79ce417e&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe to the WHO Watch Newsletter</a> and follow us on @PHMglobal and @WorldHealthWatch.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Update Reports from previous WHO governing body meetings and earlier Item Alerts regarding EB146 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f2029b490e&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>.</p></td></tr></tbody></table></td></tr></tbody></table></td></tr><tr><td id="m_8946635426073001355templateFooter" style="background:#fafafa none no-repeat center/cover;background-color:#fafafa;background-image:none;background-repeat:no-repeat;background-position:center;background-size:cover;border-top:0;border-bottom:0;padding-top:9px;padding-bottom:9px" valign="top"><br></td></tr></tbody></table></td></tr></tbody></table></center></div>
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