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Global Health Matters
The Inside Track: Lemons, 3G and Dreams
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Can global health serve an increasingly fragmented world? That’s the question Garry Aslanyan asks co-hosts Catherine Kyobutungi and Ricardo Baptista Leite in the latest installment of “The Inside Track.” And this time, the trio is joined by special guest Tenu Avafia, Deputy Executive Director of Unitaid. Their conversation spans AI governance, geopolitics, and access to health. From the mismatch between how AI is built and who it's built for, to the normalization of hate eroding global solidarity, to the rise of regional institutions like Africa CDC and the African Medicines Agency — this episode maps a global health landscape genuinely at a crossroads.
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I would say Lemon's 3G and Dreams. How is that? Welcome to the Insight Track, a series from the Global Health Matters podcast. In this series, we step inside the conversations shaping global health, the debates, the dilemmas, and the decisions that don't always make the headlines. Each episode features two recurring expert pandas, Katherine Shabotunghi and Ricardo Battista Leite, offering informed independent analysis grounded in lived experience. Consider this your invitation to the inside. Okay, hi everyone. Welcome to the Inside Track with another episode just about to roll. So hi Ricardo, how are you today?
SPEAKER_03All good, Gary. How are you?
SPEAKER_04I'm good, thank you. So Catherine is coming or not, we'll see. Uh hopefully soon. But we the big surprise today is we have a guest, uh Tenu Avafia. Tenu, say hi.
SPEAKER_02Hi. Hi to Gary. Hi, Ricardo, hi everybody. And thanks so much for having me. I'm thrilled to be here. I'll also tell you, this is my first podcast. And when I told my daughters this morning, they were super excited.
SPEAKER_04Uh-huh. Okay. So for the first one, we will be nice. Um the rest I can't guarantee, but uh be assured that this one will be you'll be okay at the end.
SPEAKER_02Excellent.
SPEAKER_04Okay, the reason we have Tenu today, uh you'll find out in a second when we look at the topic we're going to cover today. But just to introduce Tenu, um, he is a leading global health and access to medicines expert, known for his work on intellectual property, trade, policy, equitable access. He's currently the deputy executive director of Unitaid. So really brings a lot of good experience on the topic we're going to talk about very soon. So welcome again, Teno.
SPEAKER_02Thanks so much for having me, Gary, and thanks for the very generous introduction.
SPEAKER_04Great. So, Teno, you'll find out very soon that something will happen after this episode, big, because what we just learned with Insight Track, Ricardo will attest, is that it's really starting to feel downright clairvoyant. Ricardo, don't you think? I agree with you. We asked We asked whether the world was prepared for the next pandemic. Then almost on a queue, we had the declaration of the Ebola outbreak and the concern of public health uh with all of that at the moment. So that's interesting, don't you think? Yeah. And then we talked about waping. Same happened with that. WHO had some things to say about regulating waping. I think we're getting there.
SPEAKER_03Aaron Ross Powell I think we need to start talking about what happens from a health perspective when you win the lottery. See if we get lucky.
SPEAKER_04I'm all for that. Yes. But I'm not kidding. I think it's really interesting that every time we lift a topic uh on the radar, the world kind of responds. So let's uh have a uh look at what we have at hand today. So today we're trying to look at a question uh that is quite big, but we'll try to compatize it. Global health and health in general is at a crossroads. And can our existing systems really serve uh this increasingly uh fragmented uh in this increasingly fragmented world and what really awaits for us? Um we'll look at from Ricardo from your side, and then we'll come back to Tenu uh as well. Um, the reason he's here to bring some realities of access financing and equity issues around the system. So governments are looking a lot more inward, but they're not spending too much uh on health. It's not like everyone put their monies into the health sector. Uh, there seems to be um a lot of structural kind of changes uh on the horizon. Um not a lot of money on donor sides. Um, you know, there are some philosophical changes, uh, how really health and global health are organized. And of course, um we kind of also have the technology, right? So uh maybe we can start by maybe answering the um one of the questions with the all of that going on and innovations coming, how can we make these innovations more affordable, or how will they actually be introduced, or will they be? Ricardo, can I start with you?
SPEAKER_03Yeah, absolutely. Very important topics. And um you know, the framing you gave is is absolutely true. Um and people tend to actually reduce it to donor fatigue. I think it's it's much more than that. I think we can think about a triple shift in a way. One, there is fiscal stress uh due to domestic policies. Um there's more and more demand uh from constituents to solve problems at home, let's say it in simplistic terms. Um there's also that also leads to a certain sense of nationalism, uh, the inwardness that you were describing, um, which of course is affected by a lot of populist rhetoric that is uh around, and but it's deeply influencing a lot of what we're seeing. But also there's a deeper philosophical questioning, I would say, of the solidarity-based global health model that we've been uh going through and and building over the last decades. And, you know, everybody attributes the the shift to the US exiting uh in a way from this context. I would say what we're seeing is that it's not just the US that is stepping away. Perhaps the US gave others the very much wanted excuse they needed to be able to start cutting, which makes me think that we may be dealing with something much more structural and concerning because it goes to show that people were not giving aid out of their own belief, but because they felt pressure from their peers and other countries to do so. And you know, the numbers from the OECD are clear. ODA dropped 6.1% in 2024, 23% in uh 2025. And so there are many issues we have to address. I'm going straight to your question around technology. Uh, I believe technology can be part of the solution. On one hand, um, we can make sure that we are reducing our dependency on old models that were extremely expensive in terms of implementation, to be able to leverage the power of AI and other technologies, to find new ways of delivering health and care across the globe. Uh, that I think is probably the biggest promise if you think of low resource settings, to be able not to repeat models of the broken disease health systems of the richer world, but actually to rethink health altogether and to use the power of AI to get there. But that means that, as you were mentioning, the issue of equity has to be core. The problem is historically, we have seen that equity typically shows up in the conversation after the technology is put into the market, where people say, oh, this is fantastic. How do we make sure that people in low and middle income countries get access? And that typically is a missed opportunity. It takes much longer to address the challenge, and you won't be able to make sure that everyone gets access to the innovation that can lead to improvement of health outcomes in a timely fashion. There's a book called Power and Progress that I enjoy very much because it looks at the history of the last 1,000 years of the history of technology. Every time a new technology comes into the market, the owners of the technology historically have said that their innovation is going to save the world. It's going to make life better for everyone. But in reality, in most cases, it has led to a concentration of wealth and power. The exceptions to that are when, at the beginning of the technological revolution at hand, those that are in the forefront, be it from the policy side or the innovator side, by intention, were capable of designing a production, a development and production and deployment model of that technology that had equity at its core. It was designing the technology to make sure that the innovation reached everyone who needed it everywhere where it was needed as fundamental for the success to ensure equity from the get-go. And so I think this is an opportunity for all of us to rethink our ways of working, the way innovators are working, the way governments are working, and the way we're developing policy and even civil society should be advocating for a major shift where we're capable of not firewalling everyone from speaking from each other, but actually working closer together and finding models that accelerate innovation, but accelerate in a way that makes sure that people who need the access to that innovation are the ones that are the first to get it.
SPEAKER_04Thanks for that, Ricardo. Um Catherine, hi. Uh good you joined us. Uh so you see we have a guest today to give us a bit more uh depth into this discussion.
SPEAKER_01Hello. Hi, Catherine. Lovely to meet you. Nice to meet you too.
SPEAKER_04So uh Catherine, uh, you just heard uh part of what Ricardo said around where we are in this situation, how we're going to ensure that the innovation coming in is affordable and really the systems are ready and we can actually deliver on the goals we have. What's your views on this?
SPEAKER_01Um unfortunately my views are not optimistic. Um and in a way, for me it's uh the moment where we are I think is reflects two things. One is that um you know, just as health, just as um human health is a function of, you know, factors outside the health sector, I think global health is also a function of factors outside global health and whoever the global health players are. So we're in a a a a time in history where I th I think we see a culmination of things which have been left unchecked, but which are not entirely within the control of global health players. And so global health is like a victim of these things that have been happening in the world. So it's the politics have finally come together, um, it's the cultural things have finally come together, technology in both good and bad way has finally come together. So global health is like caught up in this um turmoil that is going on in the world generally, and it's a world that is increasingly um uh difficult actually to witness in terms of where we are as human beings. So I think uh that's how that's how that's why I want to situate this what we see in global health. And so from that perspective, we have a world where increasingly hate has been normalized. We've normalized hate, we've normalized things that we thought were not normal, we've normalized things that were not acceptable. There's now a whole narrative about empathy being a bad thing. That is where we are as a people. So from that perspective, I that's where that's why I'm not optimistic that technology is going to solve the problems that it should solve or will solve uh or could solve from where I sit, from the uh sitting in the um in the African continent. And there are different reasons for that. That the African ecosystem, for reasons that perhaps were maybe unintentional or maybe perhaps intentional to some extent, has a very, very weak ecosystem to support technological development and adoption and and use. Whether it is from an infrastructure perspective, whether it is from um literacy perspective, technological literacy. And then of course now these other factors are coming in. So we're we are in an environment, I'll just give one example. There's a study which has been done about uh mobile phone technology. You know, you hear all these studies, maybe mobile phone ownership is very high. But in some countries, the ownership of 3G phones is like 20% 3G. In other parts of the world, we had four 4G, other parts we are at 5G, but 20% ownership of 3G technology. So when you think about it, the majority of people who own phones own worse than 3G. So when it when you think about mobile phone and its transformative impact as a technology, it means that a huge chunk of the population in this country is excluded from this. And then there's that part of ownership, and then there's use and connectivity. And there are countries where, for instance, electricity that can be used to charge phones so people can access mobile phone technology, you know, people don't have electricity. So there's huge infrastructural challenges around technology, technological adoption. So many many times when you see these conversations about AI and uptake and AI AI is going to solve this problem, and then you go back to a country which has, I don't know, 80% of the population not connected to electricity grid, and they depend on very unreliable sources of power to charge their 2G phones. Okay, so AI is a dream. I don't think it's going to happen. So there's there's there are those things that I, as I said, I'm not very optimistic because we are looking at global health and sort of pulling it out of the bigger structural problems, whether it's politics, whether it is um economics, you know, if you are in a refugee camp in South Sudan or in a refugee camp in Congo, all these things are dreams. And those are challenges that the African continent is still grappling with. And so, in a way, there are things technology could do and might and will do, perhaps, but they'll be they'll be incremental. They I don't think technology will have the transformative impact it could potentially have unless we address these other issues. So we've been part of conversations about where do we start because there's this whole thing about the digital transformation, where do you start? I don't think the starting point is to have digital transformation transformation of technologies for Africa. The beginning point is infrastructure, basic infrastructure, things like electricity, things like roads, things like internet connectivity. That those are like really, really basics. And so the balance, when you think about the balance, I don't think anybody is going to invest in electricity for the uptake of AI. We are still going to push these technologies that in ultimately probably benefit other parts of the world. Uh because the the the underlying infrastructure is not enabling for Africans to benefit from them. So yeah, um, I'm not very optimistic because I don't think we're doing the right things.
SPEAKER_04Okay. Well, that's good because you grounded us in reality. Thanks for that, uh Catherine. Let's hear from Tennu. Teno, uh, what do you think from where you are, what you see uh in terms of um innovations, how they might be financed, how can this be really addressed, and maybe even see how you can put that into perspective of what you heard from both Catherine and Ricardo so far.
SPEAKER_02Uh thanks very much uh for the question, Gary. And let me start by just agreeing with what both uh Ricardo and Catherine said. Uh I do believe that what we're seeing in the global health sector is a subset of a much larger geopolitical shift uh across international development, humanitarian assistance, where the model that has been, you can call it an ecosystem that evolved or an architecture that was constructed, uh, may have lived past itself by date. And from the health perspective, we started to see the corrections once the acute phase of the COVID-19 response was over. But the last two years have drastically accelerated that shift. Uh, and now there is a crisis about the sustainability of uh of the model. So from our perspective uh at Unitaid, for over the last 18 months, we've been focusing on three things. Integration as a priority, sustainability, and efficiency. Integration, because that in a way is the same direction that the countries and the communities we serve say that the model has to move. If we have less funding at the multilateral level for these large vertical funds that are disease or condition specific, then it's time to integrate services in a way that uh when a patient goes to a primary healthcare center, they're screened for NCDs, they get some uh reproductive uh health um advice, the child is seen, as well as their monthly medication for whatever chronic uh conditions they have. Uh the second piece of that has to be efficiency, because if there's less money in the system, then we have to, I don't like the phrase, but we have to do more with less. Uh and so that means making every dollar, every yen, every quacha, every rand count uh more and go further. And that's where United uh I think invests most of its energy. And then the third piece is uh sustainability. So making sure that the responses we craft are owned by governments, because ultimately the scale-up partners, the duty bearers, are governments. And so if we can build systems, co-construct them in a way that they're owned by the governments and the people we're serving, then there's a much higher likelihood that when there is a donor correction or a multilateral health correction, that something is left behind that's sustainable. Uh on the efficiency side, um the irony of it all is that I think we're on the cusp of a number of serious scientific breakthroughs. And the challenge is going to be to try and translate those breakthroughs in a way that can be afforded by individuals as well as by systems. Uh, one example of uh the work that we've been doing in partnership with many organizations has been access to Lena CapriVia, which, as you know, is uh a game-changing um health tool, twice a year injection to prevent HIV. Now, when this product was initially released, it was it cost as much as $28,000 in the US for a year. Uh, but thanks to Gilead licensing its product uh to six generic manufacturers, one of whom United and partners concluded an agreement with, uh, we now have a commitment from a generic manufacturer to produce this for $40 per year per person. And so that's a type of fiscal space that could be created for national health governments or national health budgets if we're able to make these leaps in efficiency.
SPEAKER_04And um maybe um since you've really really put this into a little bit more uh technical terms in terms of what might be coming, maybe Ricardo and Catherine, how do you think the system and the global health all of this arrangement will look like in ten years?
SPEAKER_01Yes, I could go fast. I I think I'll I'll talk about what my vision of systems would be. And um, you know, based on the conversations that are happening today and based on you know, several uh reform and reimagining uh processes, I think there's some emerging themes that are encouraging. And those themes are around things like sovereignty, things like ownership, things like um maybe impact forcast. There are some there are some good things that are emerging from these conversations. And um my hope is that on both sides, at the country level and also at the external level of the the different actors that shape global health, that these are taken seriously. And if they are, then we might start we we might we might we might start seeing some shifts. And some of the shifts will be short term. For instance, if there's um an agreement that countries need to set their own priorities and the right systems are put in place around that, then of course we start seeing how global health is perceived and how what global health does, and maybe a different focus on how global health should be practiced. And of course, that percolates into What countries do. So my my vision is waking up five years from now and we finally see that every single African country, I won't talk about other regions, can isn't has the ability to articulate what their priorities are, and the global health architecture is responsive to those priorities. Not that countries are responding to priorities set by the global health architecture. For me, that too is that is the vision I have of the world. And I think that could move outside health to other sectors. That countries are allowed the room to breathe and say these are the problems we face, and therefore this is the kind of help we want. And this is how we are going to solve them, help us solve them our way and this way. And of course, that's a that's a dream to some extent because the structures to allow countries, first of all, set their own priorities and solve their own priorities, I think are not are not very strong. But five years is maybe a good time to start building those structures. Because again, at the end of the day, in a way, when you're in health, you see health as this thing that everybody should be um should give maximum attention, but countries don't see health that way. Politicians don't see health that way. And if countries are allowed to set their own priorities, maybe they'll say, let's let's build an electricity network to support healthcare. Or maybe let's build electricity network to allow us to harness the technological innovations around AI, rather than maybe let's push AI and trying to push it to the system that is not going to accept it because the system is not fit for purpose. Maybe they'll say let's build roads to deal with maternal mortality, no other than let's deal with maternal mortality as these abstract concepts that has no connection with roads and with uh incomes and with uh you know aquaculture. So if we if we allow countries to take their own priorities and we maybe conceptualize health much broader than something which is a function of sectors outside the health sector, maybe we'll start seeing some progress. But I think practically my vision is a world where every single country has the power and the um the space to decide what is important for them. And then whoever wants to help those countries responds to what the country articulates as its problems. Currently that's not the case. Countries are running after problems because these problems have been deemed very important by the global quote unquote community, and they can't escape this this sort of trap of dealing with global problems. These are important problems, but countries, if they had a choice, they probably deal with their health and other development issues differently. So that's my vision.
SPEAKER_00Um sovereignty like to be defined and operationalized. Yeah. Okay. Uh Ricardo?
SPEAKER_03Well, I think listening to Catherine and Denue, I I I think that looking 10 years down the road, I would really like um innovators to also have a different mindset, which of course should be stemmed from the views of who are of the people who are on the ground, as as Catherine mentioned, be it governments, be it citizens. Uh governments typically only represent part of the view of the population. That's why I'm a strong believer of the power of parliaments, uh, which hopefully can bring in different views, even from minorities. And I think it's important that when we design innovations, and I think AI is a very good example of that, we should stop building them for a world that only a few privileged people will have access. And so when we talk about the governance of AI and the development of AI 10 years down the road, it has to be thinking, what is the reality of context? As Catherine was saying, if you don't have broadband connection and internet, do you have to integrate that into the innovation cycle? And that is not being done. What we're seeing now is most major companies are spending billions and billions on building larger and larger AI models and then trying to shove it down our throats. And so what we need is to move towards models that are smaller, more specific, less dependent on energy, less dependent on broadband connection that can be used in rural parts of Africa, Latin America, Southeast Asia with the same efficiency as they would be used in high-income settings. Yet the mindset of the innovators is also not there. So I think we have a mismatch that I'd like to see over the next decade to be closed and to see that gap closed. And, you know, some years ago I came up with this thing I call the five commandments for managing health. And basically commandments normally tell you what not to do. This is what you should do. And so basically, if if you're not doing one of these five things when you're managing a health system, you should question yourself, why am I doing this? And so the first one is if you're dealing with something that is preventable, prevent it. If it's curable, cure it. If it's um if it's not preventable or curable and the chronic condition, make sure you're managing it properly. And make sure you're doing everything you're doing, including end-of-life care and dealing with chronic pain with compassion and with a humane perspective. And the fifth commandment is try to put uh a lens of uh efficiency in terms of cost-benefit ratio in everything you do. The thing is, 20 to 30% of everything we do in healthcare globally does not contribute in any way to improving health outcomes. 0% to health outcomes. We're talking about hundreds of millions of US dollars that are spent. We're always saying there's not enough money, but we're wasting money in doing things in the way our health systems have been built. I would like the future, 10 years from now, where we have uh a model where governments, civil society, academia, and innovators all have human dignity at the forefront of the way they develop their technologies, the way they develop policies, the way they implement that, and making sure then that we are doing so in a way that aligns with the economic incentives that have to be put in place if we want long-term sustainability. And so it's that mindset shift that I think this current crisis we are going through, I hope, will lead us to. But it really depends on the leaders of today to get us there. Okay.
SPEAKER_01Sorry, if I if I could jump in, Gabby, um, on Ricardo's point about um, you know, involving users of technology and shepherds of technology. I was at I was at an event this week and um it was about scaling impact of innovations. And there was a very insightful, I would say, thinking around what you scale. And one one thing I learned from this event was that actually what should what should what should what should be scaled should be a function of what the potential users and beneficiaries think is valuable and useful for them. So as scientists, we can do science that says this thing can work, but it doesn't mean what can work from a scientist's perspective should be scaled. What should be scaled should be guided but by the values of the potential users. And in my mind, I was like, okay, AI, where were where were the users in these conversations about what should be scaled around that? And it was quite, it was quite eye-opening that um ethics, accountability, sustainability, all these considerations should be should guide what is scaled, not just science. So just because something can work doesn't mean it should be scaled. And I think I I wanted to sort of reinforce Ricardo's point about how we bring in the voices, uh, whether it is government or parliament or you know communities that are supposed to use whatever innovation or technology we're supposed to benefit from. Yeah, that's what I wanted to add.
SPEAKER_04Okay, great. Um, I'm gonna give you a last word to bring us a little bit into the conclusion of this, and really hoping you can do that. And someone said, leaders of tomorrow, I think that's you. So um tell us where are we with this and what you think will enable some of this to be less uh more out more hopeful, let's put it that way.
SPEAKER_02Now thanks for the question. And I do think we're at an important uh inflection point. Not one of our choosing, but uh in a crisis also comes an opportunity. And I'm encouraged to see the level of um ownership of assertion of uh health sovereignty and also asserting that country set priorities uh should then drive global health responses. And if we can make that shift, I think that will be a very important one. Hopefully, it also means that um national governments are are more committed to domestically funding their health responses because that will clearly be needed. The other thing that encourages me, the other development has been the growth of, I think, robust regional institutions. Uh Africa CDC came about after the Ebola outbreak of 2013 to 2015 and see the institution it is now in the space of 10 years. That is important progress. The African Medicines Agency, I think, has the capacity to also play a vital role in facilitating access on a regional level for uh health innovations. So we need to continue to support uh these initiatives. Uh the third thing I think I'm seeing more of that I'm encouraged by is less of a disconnect between the innovators and those who access the health innovations. And if we can continue to bridge that gap so that access is not an afterthought, but rather something that is thought of. And I think Catherine, you alluded to this as well. The users of the technology should be consulted during the innovation process. Otherwise, there'll be a disconnect between the product that emerges from the pipeline and then the users and the utility that they have for that product. And then the last point will be around uh financing, because the reality is that we will have less funding and financing for the next several years to come. And so, how do we unlock innovative financing opportunities to help to propel those national disease responses? It's a journey we have just started at Unitaid. As you know, we're born off the idea of an airline ticket levy, and that is an idea that seems to be coming back into circulation, which is good. Uh, but more than that, we're working much more systematically with uh philanthropy, who see themselves as a part of the solution for the next 10 years. Most importantly, we would like to use our grant funding to unlock concessional financing so that businesses, whether it's small and medium enterprises, small and medium sector enterprises who are in the pharmaceutical manufacturing industry, are able to get access to much more preferential interest from commercial or non-commercial lenders. So, the idea is to, for every grant we make, unlock five to six dollars of concessional financing so that manufacturers actually have the capital they need to be able to establish their facilities. So if we can make some lemonade from the lemon that uh was presented to us, then I do have reason or cause for optimism in the years ahead.
SPEAKER_04Okay, so uh let's wrap this part up. I would say lemons, 3G and dreams. How is that?
SPEAKER_03I think it's an optimistic take, which is good.
SPEAKER_043G lemonade. Thank you. So now yes, 3G lemonade, that could also be. Thank you. Uh so uh we're moving to our next section, which is clipping. And uh, Tenu, I hope that you can also contribute, even this being your first appearance, guest appearance here. Today's clipping is actually a letter with a lot of good information. It's from the uh JAMA Journal of American Medical Association, Pediatrics, and it's behind a free subscription, so it's accessible for our listeners if you want to go look at it. And it's uh titled Paternal Mortality During Early Childhood. And we want your take on the article and its repercussions in what it means. I'll just read one quote from the letter. Paternal mortality is more than a male health issue, it's also a family and public health crisis. So um why don't you discuss? Me?
SPEAKER_03Okay. All right. Um well for this is a very personal topic for me because my father lost his dad at the age of seven. Uh he was uh you know three generations before me, were born in Angola. And um my my grandfather, who I never met, um was a commercial pilot who was shot down in um by accident um in the midst of the Civil War, uh, despite not being military. And so that led to my father's family. Uh he was seven, as I said. They had to relocate to a town near Luanda, to the capital, where they had some family structure. And in my father's case, I mean, he fortunately he's well today. Um, and looking back and reading the literature uh ahead of this uh podcast when it was shared with us, it made me think what contributed to the positive outcome in this case. And I think it was a multifactorial issue was the fact that despite the financial burden uh of losing a father in that time and age, particularly. Um, of course, my grandmother uh started to have to work in a different way. There was family support, the town he was in, and I think this speaks to, you know, it takes a village to raise a child, and very much in the African spirit, he he was very lucky to be in a town of a that was a true community. And and so, and he was also integrated into a very high-end school at no cost because they were sensitive to his personal situation. And uh it was a Marion College that I actually got to visit with my dad just recently, for and it was the first time in 50 years that he went there, and it was quite emotional, as you can imagine. He was lucky looking at the literature, because in many cases um that that's not the story. Uh, we see that typically losing a father does lead to higher premature mortality, higher mental health issues, and suicide, and so forth. And it may feel counterintuitive to talk about this and even to talk about men's health, because women have been historically discriminated in every front. And so the social discrimination factor sometimes puts us in a situation where it makes us difficult to even address men's health as an area that has been not prioritized uh sufficiently. And I would I would maybe argue that the issue is not one against the other, uh, but there is a need to understand that there are gender-specific needs that health systems today uh need to continue to invest in. So when we talk about um even maternal health, despite it was mentioned that uh it has been prioritized. The truth is many parts of the world, it's still not the case. We need to ground it, as Catherine was saying in the previous segment, into reality. Uh, you know, reproductive health and rights, when we talk about gender-based violence, uh, underdiagnosis of several uh women's health conditions today, multiple women's health uh cancers are completely ignored by the health system when we think about prevention and screening, um, and even the issue of caregiving uh burdens. This is something that is highly underestimated. And the truth is, the the idea is that men die earlier than women, uh, but the truth is women live with severe disability and less life, healthy life years, uh, and very much because they typically historically have put everyone's interests ahead of their own with tremendous consequences on their health and well-being down the road. So there are specificities of women's health that we cannot ignore. But when we talk about men, the issue of premature mortality, particularly cardiovascular, uh, when we talk about clearly having higher prevalence of suicide rates among men, occupational risks, um, the fact that many have reluctance to seek care, much more higher cases of prevalence, case of cases of substance abuse, of social isolation and mental health issues goes to show that we need to have that gender lens, if you will, when talking about health system resilience and building health systems. And I think the article that we shared today uh demonstrates that. And going back to the initial topic of losing a father at a very tender age and the tremendous negative consequences that that can represent for a child in their life cycle, um, there are multiple factors that play in, of course, social factors, uh, financial factors, economic factors. And so to address that, you need to proactively take all of that into account and not simply suppose that everything is going to be okay, because in the majority of cases that will not be the case.
SPEAKER_04Okay. Catherine, what are your thoughts on this?
SPEAKER_01Um, I I actually struggled with this paper. And um I struggled with the central message um of the paper and whether the analysis actually supports the central message because for me it's it's almost like um it's like the opposite, because it says fatherhood is sort of protective. And then you're talking about paternal mortality. So I I struggled a little bit with that. But I think I think um I totally agree with Ricardo's um um points about why things are the way they are. And in a world where you're still you're still struggling maybe with the issue that has the greater impact, it's hard to see how to make a case for the one that maybe doesn't have as great an impact. And maybe maybe that's where the challenge is, because again, what gets studied gets done and gets programmed and gets studied again. So at some point in history, it was recognized that um a a woman's health is very important for herself but also for the family and for the, you know, for the for the child, whether it's during pregnancy or after, and especially in the early years of life. So it was determined, and then it became a thing that is constantly studied and and there are policies around it, and it's constantly studying, and there are policies around it. So there's a cycle that is self-reinforcing around why women's health issues are very prominent. And maybe the one thing that's it um that's this paper is saying is okay, maybe we need also to look at the other side. We could be missing other things that are not yet very clear because we've not really studied men's health as it relates to their families and all that. So there are some studies, but they're not as many. So I think it makes a good point from there. But um I think historically, one of the things that Ricardo said is because there's been this um uh you know, lack of inequity. I mean, there's been inequity generally, and there are all these social norms and structural things that put women at a disadvantage from very many perspectives. So it makes sense to give prominence to those. Um, but then um I think if this becomes like a new area of study and we get more and more information, at some point I think you can make the case for why we need maybe family health, something, everything put together rather than women's health and men's separately.
SPEAKER_00Right.
SPEAKER_01But at this point in time is very hard to see what is possible when you don't even have enough resources to deal with now the thing we understand very well and which we know for sure has this huge impact um, you know, on um on yeah, on the family and on children and women themselves. So an interesting paper, maybe the beginning of a new conversation, and maybe 10 years from now we have enough body of knowledge to start shaping things at global level at, you know, within countries and within families and within practice. Uh uh, but for now I think it's just an interesting piece of literature.
SPEAKER_04Okay. Penno, what were your thoughts when you read this uh short article?
SPEAKER_02Yeah, super interesting, I must say, and I also enjoyed both your responses. Um my take on it is that it's an underexplored area, and the whole point of science is to shine a light uh for us to perhaps get more awareness on things that were not on our radar, and I appreciated that about the paper. It certainly wasn't something I thought about from that perspective, paternal mortality and what that means for the outcomes of uh of young children. Right. I do think that it's very right that there is a big focus now on. Women's health, because if you look at the MDGs, the worst performing MDG, the one we struggled to make the most progress was uh maternal mortality. And if you look at SDG indicators as well, maternal mortality remains very stubborn. And that's why we are, you know, I'm very pleased to see us investing more and more in uh conditions that uh kill women, whether it's postpartum hemorrhage or pre-eclampsia or anemia. But I must say I had an encounter recently with a colleague who is around my age who told me that he'd been diagnosed with quite an aggressive form of prostate cancer. And he said, you know, it was not on my radar at all. And so that was quite a sobering reflection to say, you know what, as much as we are correct as an community or to be focusing on maternal health, maternal mortality, and and outcomes for children under five, let it not be at the cost of uh of others. So I I do like the idea of a holistic approach and this being an additional uh piece of uh of research and area where we try and understand more so that we can construct interventions that are synergistic and holistic with the health system.
SPEAKER_04Okay. Well, this is good, and this is what we do here. We try to pick something that will uh really uh trigger some thinking. So I think we've done that with this uh particular article. But let's go to our last sector section of our uh episode, and that's where we give kudos to a global health uh achievement event or something that's happening. I'm gonna ask Ricardo to go first.
SPEAKER_03Yeah, and I appreciate that, as I'll have to sign off. Um but uh since it's my last intervention, Gary, um it's it's always a pleasure being here with you and Catherine, but I also want to highlight our special guest, uh Tenu. And we could actually do give kudos to Unitate for their amazing work uh when it comes to fostering innovation and making it accessible to those that need it the most. So thank you so much for joining us. The the I would like to actually um give kudos today to um uh an event that I to have an event that I participated in. I go to many AI-related events because of my role at Health AI, obviously, but this one was a bit different. It's called it was organized by the OECD and the Ministry of Health of Spain, and it was focusing on scaling responsible AI for health. And uh it took place uh just recently. Its mentor was uh the OECD's senior economist and head of digital health, Eric Sutherland, who really deserves kudos today, because it took a very different approach than what I normally see. It had a very serious conversation going beyond the hype, all of the things we were talking about today, and saying, okay, we need to make sure that the technology is developed and deployed responsibly, and that people who need it can benefit from it. Which means we need to have clarity on a vision of what that means in terms of regulations, in terms of governance, and in terms of what is expected from all of the different stakeholders. And to have governments and multilaterals and academia and innovators all in the same room. Um, I think it was a very good service from, as the economist calls the OECD, a club of uh mainly rich countries, um, to see that they had an effort of representation, even the Africa CDC was present, and to make it a very holistic and global conversation about something that I think uh is incredibly important to the future. There's going to be now some outcomes from that meeting that I'm hoping will help shape the conversations to come. And so that's my kudos for today.
SPEAKER_04Okay, great. And uh good luck with whatever you're doing next. Thank you, Ricardo. Let's hear kudos from Catherine.
SPEAKER_01Yes, um, my kudos are about Ebola and uh not the virus. I'm not I'm not I'm not stanking the virus. Um but that's in a very short time we have three vaccine candidates. I think um, or I think we are making progress when it comes to developing vaccine candidates for the Bondebujo strain that is currently um active in DRC and in Uganda. And that um in such a short time we are repurposing technology that helped us give the existing Ebola vaccine, but also the COVID vaccine. Um so University of Oxford is working on something using the adenovirus um vector, and then the International AIDS Vaccine Institute, which developed the first Ebola vaccine, is using the same technology they used, developed uh something for the product strain, and then Moderna is also using the Messenger RNA technology. I think this is unprecedented. For many years we got the first vaccine a few years back, and now we have three promising candidates that could be going for trial very soon. The first test could be in the next two to three months. And so I say kudos to science, but maybe kudos to scientists. And kudos to CEPI that made money available. And um, so I think it's it's a good a good development for global health.
SPEAKER_04Okay, great. Thank you, Catherine. And Teno, let's see how you do with this one. This is new to you.
SPEAKER_02It's new to me, and maybe before I do the kudos, I want to thank you, Gary, for having me, and thank you, Catherine, and Ricardo, in his absence, for being so gentle. Uh, my first podcast. It's been a real learning experience and pleasure. Uh, I couldn't agree more with uh Catherine's kudos, given just uh what we've been seeing around uh the Ebola outbreak. An additional kudos this week will be for something that's happening tomorrow, and that's because the president of South Africa, together with the Minister of Health, will be launching the rollout of Lena Kapavier in South Africa through the healthcare system, uh, which is a big deal considering how quickly this product came onto the market and how recently it was available even in high-income countries. And for me, it's a sign of what we're talking about sovereignty, country ownership, and leadership. And as we all know, because of South Africa's unique role in the age response, if South Africa succeeds, we succeed in the age response. So kudos to them and good luck to them.
SPEAKER_04So today's kudos I'm gonna give to Spain, uh the country of Spain. And it's really earned a moment uh on the spotlight. And uh just because it really engaged in global health in a very interesting way and emerged as a leader in discussing global health. Um, and perhaps that's because they've realized that you know, global health might be the geopolitical issue that might bring together a divided world that we live in today. So they were very active at the World Health Assembly and really putting some extra funding and all of that. So I think uh we need more uh countries to step in and uh really um get involved in the global health arena. And and interestingly, we talked about pandemics last time. Spain actually handled the uh huntavirus uh following all the IHR rules quite nicely, that really helped everyone to uh make sure that uh that outbreak didn't become anything that we didn't want to see at the global level. So, on that, uh let's uh thank everyone for today. We have uh we have a new uh guest kind of experiment that worked quite well. So thank you, Teno. Thank you, Katherine, and of course to Ricardo who has already left. Thanks so much. Thank you. To learn more about the topic discussed in this episode, visit the episode's webpage where you will find additional readings, show notes, and translations. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us wherever you get your podcast. Global Health Matters is produced by TDR, a United Nations co sponsored research program based at the World Health Organization. Thank you for listening.
