Covid-19 e a diplomacia da saúde no BRICS: um estudo à luz da saúde global / Covid-19 and health diplomacy at BRICS: a study in the light of global health

Introdução: A Covid-19 representa o maior desafio do século XXI e o bloco econômico BRICS se destacou na produção de vacinas e assumiu o compromisso de sua distribuição equânime e a priorização do acesso pelos países periféricos, que são os mais vulneráveis. Durante os dois primeiros anos da pandemia (2020 e 2021), a China assumiu publicamente o desafio de tornar a vacina um bem público global, mas a diplomacia da vacina disputou espaço com os interesses econômicos das nações mais poderosas. Objetivo: Estudar a diplomacia do BRICS no mundo Covid-19, sua contribuição para a imunização global, em especial dos países do sul global, e seu posicionamento a respeito da implementação dos Objetivos do Desenvolvimento Sustentável. Metodologia: pesquisa de dados, documental e bibliográfica em livros, artigos científicos, jornalísticos e relatórios institucionais; pesquisa em websites que tratam sobre os temas de interesse do estudo. Resultados: No Brasil, a Fundação Oswaldo Cruz - Fiocruz conquistou autonomia para produzir a vacina AstraZeneca e o Instituto Butantã contribuiu eficazmente para a produção da CoronaVac, atuações que garantiram à população receber duas doses da vacina, mais duas doses de reforço. A Rússia criou a Sputnik V, mas não obteve sua aprovação pela Agência Europeia de Medicamentos, o que comprometeu a credibilidade do país para produzir e exportar vacinas Covid-19. O sistema de saúde da Índia, Ayushman Bharat, em processo de implementação, foi fortemente demandado no período crítico da pandemia, mas o país permanece ampliando investimentos em vacinas e medicamentos. A China foi quem mais produziu vacinas Covid-19, vendeu e doou milhões de doses, mas a diplomacia da vacina não exerceu a solidariedade tantas vezes declarada e o país mantém seus interesses econômicos preservados enquanto o desafio da equidade na imunização permanece no sul global. O governo da África do Sul enfrenta o descrédito da população no poder imunizante da vacina e lida com a necessidade de ampliar o sistema público de saúde. O BRICS demonstra interesse na implementação dos ODS para prevenir contra novos patógenos de potencial pandêmico, mas as realizações são tímidas quando analisadas a partir das declarações nas reuniões de cúpula. Conclusão: A Covid-19 se mostrou um problema de saúde global de enorme complexidade e o desafio da solidariedade assumido pelo BRICS, que deveria acontecer pela distribuição de vacinas, pelo compartilhamento de tecnologias e pelo empoderamento econômico dos países periféricos, não se concretizou, o que fez aumentarem a insegurança internacional e as desigualdades entre pobres e ricos. A implementação dos ODS é o melhor caminho para lidar com os desafios do mundo Covid-19, pois a Agenda 2030 contempla os grandes problemas globais, fortemente explicitados pela pandemia, mas os países do norte global priorizam a reconstrução econômica em detrimento da solidariedade com os países do sul global. A visão de desenvolvimento, em geral, permanece desassociada da proteção e preservação ambiental, o que poderá resultar em agravamento da sindemia em curso.

Introduction: Covid-19 represents the greatest challenge of the 21st century and the BRICS economic bloc stood out in the production of vaccines and has committed to its equitable distribution and prioritization of access by peripheral countries, which are the most vulnerable. During the first two years of the pandemic (2020 and 2021), China publicly took on the challenge of making the vaccine a global public good, but vaccine diplomacy disputed space with the economic interests of the most powerful nations. Objective: To study BRICS diplomacy in the Covid-19 world, its contribution to global immunization, especially in the countries of the global south, and its position on the implementation of the Sustainable Development Goals. Methodology: Data and documents reasearch; literature search in books, scientific and press articles, institutional reports and sites dealing with the topics of interest to the study. Results: In Brazil, the Oswaldo Cruz Foundation - Fiocruz gained autonomy to produce the AstraZeneca vaccine and the Butantã Institute contributed effectively to the production of CoronaVac, actions that ensured the population received two doses of the vaccine, plus two booster doses. Russia created Sputnik V but did not obtain its approval by the European Medicines Agency, which compromised the country's credibility to produce and export Covid-19 vaccines. India's health system, Ayushman Bharat, in the process of being implemented, was heavily demanded during the critical period of the pandemic, but the country continues to expand investments in vaccines and medicines. China has produced covid-19 vaccines the most, sold and donated millions of doses, but vaccine diplomacy has not exercised solidarity so often declared and the country keeps its economic interests preserved while the challenge of equity in immunization remains in the global south. The Government of South Africa faces the discredit of the population in the immunizing power of the vaccine and deals with the need to expand the public health system. BRICS shows interest in implementing the SDGs to prevent new pathogens of pandemic potential, but achievements are timid when analyzed from the statements at the summit meetings. Conclusion: Covid-19 proved to be a global health problem of enormous complexity and the challenge of solidarity assumed by BRICS, which should happen through the distribution of vaccines, the sharing of technologies and the economic empowerment of peripheral countries, did not materialize, which increased international insecurity and inequalities between the poor and rich. The implementation of the SDGs is the best way to address the challenges of the Covid-19 world, as the 2030 Agenda addresses the major global problems, strongly explained by the pandemic, but the countries of the global north prioritize economic reconstruction over solidarity with the countries of the global south. The vision of development, in general, remains disassociated from environmental protection and preservation, which may result in worsening of the ongoing sindemia.

¿Por qué una semana de la salud internacional? Mesa de apertura

La Semana de la Salud internacional se estructura en tres ejes de abordaje como punto de inicio y organización general, que a su vez dialogan con subejes y temas particulares: -Naciones, Estados y Pueblos unidos; -Política exterior y política doméstica: Argentinos y Argentinas en el frente exterior; -Geopolítica y diplomacia en salud. En la mesa de apertura dialogan el Ministro de Salud de la Provincia de Buenos Aires, Argentina, Nicolás Kreplak, la Vicerrectora de la UNPaz.,Silvia Storino, el Director del Departamento de Ciencias de la Salud y el Deporte de la UNPaz, Leonel Tesler, y el Director de la Escuela de Gobierno en Salud Floreal Ferrara, Mario Rovere. La Semana de la Salud internacional se propone como un espacio de análisis, intervención e investigación que provea sentido a las prácticas de gobierno y permita analizar el lugar de la Provincia de Buenos Aires en el mundo y desde dónde la Provincia invita al mundo a pensar en clave de Salud Internacional. Es organizada por la Diplomatura en Salud Internacional, una herramienta para la soberanía sanitaria de la Universidad Nacional de José C. Paz y la Escuela de Gobierno en Salud Floreal Ferrara de la Provincia de Buenos Aires. En la mesa de apertura se incluye un homenaje a Juan César García, referente del movimiento de medicina social.

Media briefing on COVID-19 - 09/04/2021​

00:01:25 CL Hello and good day to wherever you are joining us from today. It is Friday 9th April 2021. My name is Christian Lindmeier and I'm welcoming you to today's global COVID-19 press conference. Our special guest today is Dr Seth Berkley, Chief Executive Officer of GAVI. Simultaneous interoperation is provided again in the six official UN languages, Arabic, Chinese, French, English, Spanish and Russian as well as Portuguese and Hindi. Let me introduce the participants. Present in the room are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director for WHO's Health Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead on COVID-19, Dr Bruce Aylward, Special Advisor to the Director-General and the lead on the ACT Accelerator and last but not least Dr Rogerio Gaspar, Director for Regulation and Pre-Qualification. With this let me hand over to the Director-General for the opening remarks. TAG Thank you. Thank you, Christian. Good morning, good afternoon and good evening. As you know, at the beginning of the year we issued a call for vaccination to begin in all countries within the first 100 days of the year. Tomorrow is day 100. Out of 220 countries and economies 194 have now started vaccination and 26 have not. 00:03:07 Of those seven have received vaccines and could start and a further five countries should receive their vaccines in the coming days. That leaves 14 countries who have not yet begun vaccination for a range of reasons. Some have not requested vaccines through COVAX, some are not yet ready and some plan to start in the coming weeks and months COVAX has now delivered more than 38 million doses of vaccine to more than 100 countries and economies in the past six weeks. We're encouraged that almost all countries who want to start have now started. However I emphasise the word start. Most countries do not have anywhere near enough vaccines to cover all health workers or all at-risk groups never mind the rest of their populations. There remains a shocking imbalance in the global distribution of vaccines. More than 700 million vaccine doses have been administered globally but over 87% have gone to high-income or upper-middle-income countries while low-income countries have received just 0.2%. 00:04:28 On average in high-income countries almost one in four people have received a vaccine. In low-income countries it's one in more than 500. Let me repeat that; one in four versus one in 500. COVAX had been expecting to distribute almost 100 million doses by the end of March but due to a marked reduction in supply we have only been able to distribute 38 million doses. We hope to be able to catch up during April and May. COVAX works. It's a strong mechanism that can distribute vaccines faster and more efficiently than any other mechanism. The problem is not getting vaccines out of COVAX; the problem is getting them in. We understand that some countries and companies plan to do their own bilateral vaccine donations, bypassing COVAX for their own political or commercial reasons. These bilateral arrangements run the risk of fanning the flames of vaccine inequity. This is a time for partnership, not patronage. Scarcity of supply is driving vaccine nationalism and vaccine diplomacy so GAVI, WHO, CEPI and other COVAX partners are working on several options for accelerating production and supply. 00:06:06 We are in ongoing discussions with the Government of India about the supply of vaccines from the Serum Institute of India. We're working to accelerate the release and roll-out of vaccine from SK Bio in the Republic of Korea. We're trying to expedite the delivery of the J&J vaccine. We're continuing to seek donations of doses from countries who have enough to cover their entire populations several times over, not in several months' time but now. Were expediting the review of more vaccines including from Sinopharm, Sinovac and Gamaleya and we are in discussions with several countries as we seek to expand global manufacturing capacity. It is stunning to think that less than a year after the ACT Accelerator was launched vaccines have been approved and vaccination has started in almost all countries. None of this would have been possible without our partners in COVAX including GAVI. 00:07:16 Today I'm delighted to welcome my friend, Dr Seth Berkley, the Chief Executive Officer of GAVI. Seth, thank you so much to you and your team for everything you have done and everything you continue to do. Thank you so much for your leadership. Seth, the floor is yours. SB Thank you, Dr Tedros, for your kind invitation to join you in this important moment and I'd like to think, if we think of 2020 as the year of the pandemic we aspire to make 2021 the year that vaccines gave us hope. Of course as the ACT Accelerator always says, we need to make sure we have a comprehensive response and we fully agree with that. We need obviously diagnostics, treatments as well as other non-pharmacologic interventions but of course what we hope is that vaccines will change the dynamic of this illness. So we're on our path towards fulfilling the vision of rapid access to participants. You've mentioned more than 100 economies; actually I think today we're at 105 economies in the six weeks. We began the ex-India COVAX deliveries in the first days of the year and these are being used, as you said, to protect healthcare workers, the elderly and other risk groups. 00:08:54 So this is an important milestone but of course we still have an enormous amount of work ahead of us as we seek to deliver at least two billion doses this year which includes securing access and funding for 1.8 billion doses on behalf of the 92 lower-income economies eligible to be supported by the GAVI/COVAX advance market commitment. Our emphasis now is, as you say, on finishing the countries that do not have access now but most importantly scaling up the volumes to meet those at highest risk. To do this we need continued support from governments and manufacturers because every time a bilateral deal gets done around the COVAX facility it means fewer doses for COVAX and for equitable distribution. In the second half of the year we will see more suppliers come online and we'll be able to benefit from expanded production capacity at manufacturers that already are supplying to us. But again it's critical that we have solidarity at work because what we're now beginning to see are supply constraints not just of vaccines but also of the goods that go into making vaccines; the filters, the bags that are necessary, the media. 00:10:26 So one of the challenges is how we make sure we optimise supply for all of the manufacturers so that we can continue this unprecedented scale-up of vaccines. We're also talking to a number of high-income countries about sharing their surplus doses. We believe that this will be an important source of vaccines for COVAX in 2021. Lastly we expect that lower-income countries will be able to buy additional vaccine doses through cost-sharing mechanisms we are developing where they can purchase vaccines through COVAX funded by multilateral development banks, therefore lifting the levels of protection further. Of course we don't yet know exactly what 2022 is going to bring; will we need new vaccines which are going to replace the existing vaccines, will we need booster doses just because of immunity waning or will we need vaccines that are specifically targeted at some of the variants? These are scientific questions that continue to need to be getting attention. The country demand for COVID-19 vaccines has increased significantly in light of the new variants and achieving greater population coverage to slow down the appearance of a variant means the need for additional financing has become even more urgent. 00:11:56 In order to achieve this goal and building on the contributions made by donors so far GAVI will be seeking at least two billion in additional funding for the AMC in 2021 at the virtual investment opportunity event next week hosted by the United States. So in summary we look forward to continuing this very important work with our partners in this unprecedented shared global endeavour, WHO, CEPI, UNICEF, PAHO, manufacturers, governments, civil society and the many others that form the effort to make sure that no-one is left behind and that we can end the acute stage of this pandemic as one world protected. Thank you. TAG Thank you. Thank you so much, Seth, for your leadership and partnership. I look forward to continuing to work with you to achieve our vision of vaccines for all. Even as we work to expand access to vaccines we're continuing to keep a close eye on vaccine safety. Earlier this week the European Medicines Agency and the Medicines and Other Health Products Agency from the United Kingdom said that unusual blood clots with low blood platelets should be listed as very rare side-effects of the AstraZeneca COVID-19 vaccine. 00:13:25 The COVID-19 subcommittee of the WHO global advisory committee on vaccine safety has reviewed available information from Europe and other regions and has said that a causal relationship between the vaccine and the occurrence of blood clots with low platelets is plausible but more investigation is required. WHO, EMA and MHRA continue to recommend that the benefits of the vaccine outweigh the risk of these very rare side-effects. All vaccines and medicines carry a risk of side-effects. In this case the risks of severe disease and death from COVID-19 are many times higher than the very small risks related to the vaccine and we continue to appeal to all people to please be careful. Vaccines are giving us light at the end of the tunnel but we are not there yet and vaccines are only one of the many tools we have to prevent infections and save lives. The right approach is a comprehensive approach. We must all continue to protect ourselves and those around us by making the right choices. We all have responsibilities as individuals and leaders in ending this pandemic. Christian, back to you. 00:14:57 CL Thank you very much, Dr Tedros, and thank you very much, Dr Berkley. With this I'll open the floor and remind everybody, in order to get into the queue please push the raise your hand icon on the screen. We'll move to Stephanie Nebahe from Reuters. Stephanie, the floor is yours. ST Thanks very much, Christian. I wondered whether either Seth or someone else from the WHO perhaps can comment on the supply situation a bit more about AstraZeneca, whether given that some countries like Australia and Hong Kong have stepped back from AstraZeneca; are there talks going on with for instance the Serum Institute or AstraZeneca directly about getting more supplies for the COVAX programme, please? CL Thank you very much, Stephanie. Yes, I'll ask Dr Berkley to comment, please. 00:16:05 SB Thank you, Stephanie. The challenge we had of course is that when we first began negotiations with AstraZeneca we ended up receiving doses from two different groups; one, the parent company which had multiple supply chains associated with it and second the Serum Institute of India. What's happened of course is a confluence of events. One has been the rapid scale-up of vaccines so the parent corporation has had a novel supply chain that has been a little slow to get off the ground. We ended up with some delays moving forward, getting regulatory approvals, getting quality assurance, quality control work down in a rapid period of time. But that has really picked up and we've seen over the last couple of weeks increasing movement of doses and we expect those to really be back to the pace we had originally planned very shortly. On the Serum Institute of India, as you know India is suffering a very severe wave of disease right now and as a result it has made an effort to increase its vaccinations and as a result the doses that had been commercially acquired from India have not been available. Those have been kept domestically and that has meant that we've had a slow-down. We've notified all of the countries involved and we hope that supply is going to improve over time. 00:17:43 We do understand that countries have different choices for vaccines and countries understand that they are going to prioritise one vaccine or another that may free up doses and of course in doing that we will try to make sure that those doses are made available without delay if countries are willing to make that happen. We are in discussions with many countries to look at this as a potential possibility moving forward. CL Thank you so much, Dr Berkley. Let me now come to Toni Waterman from CGTN. Tony, please unmute yourself. TO Thank you very much for taking my question. I was just wondering if we could have an update on the evaluation of the Sinopharm and Sinovac vaccines; is a decision for the emergency use listing still expected at the end of April, could it come sooner and if both of those vaccines do receive the green light will they be added to the COVAX facility? I believe both of them put in applications in January. Are there any talks for as supply deal underway at the moment? Thank you. 00:18:56 CL Thank you very much, Toni. I'll hand to Dr Rogerio Gaspar, Director for Regulation and Pre-Qualification. RG A very simple answer concerning Sinopharm and Sinovac; they are in the final stages of evaluation. A number of questions have already been answered and we have convened the technical advisory group for vaccine assessment for 26th April. We expect that at least one of the two could make the time for that committee, to be discussed there. If one of those cannot make it for 26th April we are planning also to have another technical advisory group in the week of May 3rd so between the two weeks we expect that the final decision will be reached on the two vaccines. CL Thank you very much, Dr Gaspar. We now hand to Jamil Chad from Estado de Sao Paolo. Sorry, Dr Aylward, please. BA I think Seth might want to come in on the second part of that question about the utility [?] of these products for the COVAX facility. I think, as we've said in previous communications - let's take advantage of Seth being with us - through the COVAX facility we are trying to ensure all vaccines are assessed irrespective of where they're made, where they're produced. We want to have as broad a portfolio as possible and indeed have been in discussions with a broad range of manufacturers including from China and elsewhere in the course of setting up the facility but perhaps Seth would like to speak to this issue as well. SB Yes, just to add to what Bruce said, of course he's absolutely right; we are looking at any product. Of course what we require first is that they are proven to be safe and efficacious and that they do that through a stringent regulatory authority or through WHO pre-qualification or emergency use listing. But the second issue that we will be looking at of course is that the portfolio is well-balanced and that there is cost-effectiveness of the product. So there are a number of other steps that will be involved but we are in discussions with all of the manufacturers that have vaccines out now and will continue to do that until we determine that it makes sense to go ahead and purchase for the facility or not. CL Thank you very much all for your answers. That was Dr Seth Berkley and before that Dr Bruce Aylward. Apologies for trying to cut the answers short. Now let's move to Jamil Chad from Estado Sao Paolo. Jamil, please unmute yourself. 00:21:50 JA Yes, Christian. Can you hear me? CL Very well. JA Dr Tedros, good afternoon. My question is about Brazil. At least one region in the country has more deaths than births at the moment, more than 4,000 deaths per day. My question to you is, if the Federal Government is not responding adequately are you ready to go and talk straight to governors and mayors as well in order to get basically actions following science and whatever recommendation you have? Are you ready to bypass in a way the Federal Government and talk straight to governors and mayors? Thank you very much. CL Dr Tedros, please. TAG Thank you very much. We're speaking to the Federal Government and the latest was last Saturday actually with the newly-appointed Minister of Health. Also we have discussed with other officials at the Federal level so that's, I hope, going to help with moving forward in our partnership. Thank you. 00:23:10 CL Dr Ryan to add. MR Just to ad, as part of our normal technical cooperation with Brazil our country office and our colleagues in PAHO very often work directly on technical and operational support at the state level and in fact we have a number of technical teams working at subnational level but obviously our political engagement remains with the Federal Government, which is appropriate for us as an organisation. CL Thank you so much for these answers. Now we move to Robin Mia from AFP. Robin, please unmute yourself. RO Thank you. France announced today that people under the age of 55 who've received a first dose of the AstraZeneca vaccine can switch to another vaccine for their second dose. On the mixing and matching between vaccines, in February when SAGE issued its recommendations on AstraZeneca there was no data at that point on which it could recommend either way on mixing and matching. 00:24:17 Are there any early indications from any data so far since then and could mixing vaccines eventually prove beneficial, especially between different types of vaccine? Thank you. CL Thank you, Robin, for this. Let me ask Dr Gaspar. RG Let me be very clear about that; there is no available data to recommend that at this moment in time so that's the only answer I can give right now. CL Thank you for a crisp clarification. Now we move to John Zaracostas from the Lancet. John, please unmute yourself. JO Good afternoon. My question is to Dr Berkley. I was wondering; sir, you just mentioned... CL John, you seem to have pressed your mute button or we lost you. Try again, please. JO Can you hear me? CL Yes, please go ahead. JO Good. My question is to Dr Berkley. You mentioned that you have expectations to have an increase in production in the second half of this year. Can you give us a bird's eye view of how much anticipated increase you are looking at given your close talks with producers? Thank you. 00:25:39 CL Thank you very much. Dr Berkley. SB Thank you for the question. We try to be as transparent as possible even despite the changes that are occurring and the challenging supply situation so on our website are published forecasts for what we expect to be happening and those get adjusted regularly when there's a material change. The original plan was for about a quarter of the doses to be done in the first half of the year and three-quarters in the second half of the year. With scale-up I suspect that those ratios will shift perhaps a little bit more; it might be to go to 20% and 80% but our goal is still to try to get to 2.3 billion doses by the end of 2021, assuming that there are not any major supply disruptions with any of the manufacturers but please check on the website for further information. CL Thank you very much, Dr Berkley. We'll move to Catherine Fiancan from France 24. Catherine, please unmute yourself. CA Thank you, Christian. Good afternoon to all of you. In fact my question is a kind of follow-up of John's question. You spoke about the broad portfolio of vaccines that you have but I would like to know if you have plans to increase the manufacturing capacity and that means having more manufacturers; is there any existing plan for that in order to give access for everyone to vaccines? Thank you. CL Dr Berkley. SB Thanks for that question. The answer is we are planning to increase the number of products. We're at seven products now. We hope to get somewhere between ten and 15 products but we also hope to expand production both in numbers of sites as well as in the volumes those sites can produce. There is a COVAX manufacturing taskforce that is looking at technology transfer, is looking at how to expand production but as I mentioned in my opening remarks, right now one of the worries is limitations in supplies. The world usually has about 3.5 billion doses of vaccine a year. When you add flu in that jumps to about five billion and the hope this year is to add another ten billion, perhaps even as high as 12, 14 billion doses, which would be a quadrupling of capacity. 00:28:35 So of course we're looking at every potential possible place that can do manufacturing and scale-up in a reasonable time frame. Of course building new plants is not something that can be done in that time frame. We do hope that as some of the countries now that are expanding their use of vaccines are able to saturate those of use [?] that they will start making vaccines available and those supply chains and vaccine facilities will become available for the global community as well. CL Thank you very much, Dr Berkley. Let me move to Gabriela Sotomayor from Progreso. Gabriela, unmute yourself, please. GA Thank you, Christian, thank you very much for taking my question. It's a follow-up on the Brazil situation. I understand this concept of equity in vaccination but Brazil is going through such a big emergency; it's terrible what is happening there. So is WHO thinking about scaling up vaccination for Brazilians or sending more vaccines there or something to help this country? Thank you. 00:30:04 CL Dr Bruce Aylward, please. BA Thank you very much, Gabriela. Indeed the situation is very, very concerning, what's happening in Brazil and as you heard from the top of this organisation, the Director-General himself is directly involved with trying to look at what advice we can provide, what support we can provide also through our regional office. In terms of vaccines the bottom line is, as you've heard from the Director-General in his comments and also Dr Berkley in his comments, there simply is not the vaccine right now, certainly available through COVAX, to be able to try and help further reduce the risk to the people who are trying to deliver services during the outbreak there and also the older populations at risk of serious disease. The other thing to bear in mind - and I think Mike emphasised this in comments the other day and perhaps earlier today - is that the crucial thing to be doing right now are those proven steps that we know will slow down this virus in so many settings; that rapid identification of the cases, that immediate isolation, the quarantining of the people at risk. 00:31:21 I know we've been saying it for a long time but that is what most rapidly slows down the spread of this virus. Remember, even by the time you get vaccines into a country, by the time you get them into people and you're getting into a relatively small proportion of the people, that will have a small effect in limiting the risk to some people. But what you're dealing with here is a raging inferno of an outbreak and that requires population-level action in the rapid identification, isolation, quarantine because you have to approach this at that scale to slow this thing down. So while indeed the vaccines that are available and are being used to protect the essential workers are so crucial and the older population, certainly through the COVAX facility - as we've said, it's a moot point right now in terms of being able to get additional supply there. 00:32:16 But the crucial thing is those measures can be applied at a massive scale that can slow this thing down. CL Thank you very much, Dr Aylward. Dr Van Kerkhove, please. MK Just quickly to come in on this because I do want to emphasise the comprehensive nature of the approach that we've been articulating since the beginning of this pandemic. We need to stop thinking of this as one measure or another or one measure over another. It's all of these measures together at an individual level, at community levels, supported by leaders, supported by governments. It isn't one measure alone that is going to end this pandemic. Vaccines and vaccination are another incredibly powerful tool but they will not end this pandemic. What will end this pandemic is a comprehensive approach of everyone playing their part and being supported in being able to play their part. The trajectory of this pandemic around the world is going in the wrong direction. We have had six weeks in a row where there are increases in cases. Deaths are increasing as well and we have tools right now that could prevent infections and can save lives. So we need to find reasons why measures aren't in place, whether these are policies or whether these are barriers to individuals carrying them out and find solutions to actually get these in place. 00:33:36 It is about doing it all. WHO has issued guidance, we're working with partners and member states on all modes of transmission, around all different aspects of ways that you can keep yourself safe and your family safe. It's about your individual-level measures of the distancing and the masks, avoiding crowded spaces, working from home if you can, also making sure that there's good, supportive clinical care and that health workers are protected with the right personal protective equipment as well as being protected with the vaccines, with safe and effective vaccines that are rolling out around the world. While we are waiting for production to increase and taking steps to increase that production countries are ready to implement and they need the vaccines in hand so that they can implement vaccination for those that are most at risk. 00:34:23 But in the meantime we have to keep staying the course and doing everything that we can. We just really need to stop saying it's vaccine only. It's vaccine and, and there're a lot of things that all of us can do right now. CL Dr Tedros, please. TAG Yes, I fully agree with what has been said by Bruce and Maria. The only thing I'd like to add is in our discussions with officials including the Minister one area of discussion was how we can boost Brazil's local production for vaccines. We're partnering on that and I think local production would also help in boosting the volume of production of COVID vaccines. Brazil has some capacity and it will be a matter of boosting that and we will continue to support that. CL Thank you very much, Dr Tedros and all. We seem to be coming to our last question and that will go to Aswin Baswinger from Observer Times India. Aswin, please unmute yourself. AS Thank you for considering my question. My question is, is it necessary to have a charge on number of citizens' vaccination of individual countries along with its contribution to WHO's COVAX vaccination? In India the state of Maharashtra have the [Unclear] Institute for training, research and testing which has performed a pivotal role in polio vaccination in India. 00:36:08 Why has the Government of India kept such distribution out of production in order to fulfil COVID-19 vaccination demands for domestic and international vaccine supply? Can WHO intervene and suggest to the Government of India to get production of COVID-19 vaccines through the [Unclear] Institute? Thank you. CL Thank you very much, Aswin. Let me hand to Dr Aylward. BA Thank you, Christian. I'm afraid I didn't quite follow the first part of the question but I think it was about understanding what vaccines are being used where. Certainly that information is available on the COVAX website, on the WHO website and also on the UNICEF website. We try to ensure as much transparency as possible certainly in terms of the vaccines that are being used through the COVAX facility and how many doses from SII, how many doses of AstraZeneca vaccines, etc, and then even which countries these are being allocated to. 00:37:12 A core principle of the COVAX facility has been that all participants and indeed anyone in the world can have visibility on what's happening where so there's a lot of work in that regard. With respect to optimising the use of available production capacity to be expanding vaccine production globally, every single country right now is looking at their options in that regard and in discussions. I think there's no country that's got as much experience in this regard as India does. Of course there's a wide range of producers, a number of whom are already engaged in, if not production of COVID vaccines that are licensed already they're already looking at the development of such products. I do know as well that we've been working closely with the Ministries in the Government that are responsible for supporting the production of medical products and they have been working very hard with the institutions throughout India and potential producers who may be able to scale up production. So I think around the world we're seeing a common commitment, interest of governments to promote as much production as possible through as many sites as possible. 00:38:37 From the WHO side, as Seth alluded to earlier, we're establishing now within COVAX a COVAX taskforce that will be focused to really bring even more attention to this issue of expanding production. WHO and CEPI along with GAVI will be leading up this effort to try and ensure that if there is under-utilised capacity anywhere that does need support from any one of these agencies we will do anything possible to help further expand production capacity globally. CL Thank you very much, Dr Aylward. With this we've come to the end of our briefing today and I will ask Dr Seth Berkley for any closing remarks. Thank you very much. SB Thank you. I just wanted to come in on that last question because I think in that question - again I had a hard time hearing it as well - I think he mentioned the issue of polio vaccines and I want to emphasise one of the important priorities during all of this is to continue the use of routine vaccines and to make sure that we continue to produce the vaccines that we need to avoid other infectious diseases. 00:39:53 Because the worst-case scenario would be epidemics of other diseases that would further strain the health systems and make it really impossible to get control over COVID so I think it's very important that we get that balance right. At the current time we are seeing manufacturers continue to produce the vaccines we need for the routine vaccines and even those that are necessary for other epidemic infectious diseases that we are seeing of course simultaneously, whether they be Ebola, yellow fever, cholera. Those productions need to go on and continue to make sure there is provision of these vaccines to try to keep the world as free of infectious diseases as we can during this very difficult time. Again thank you; it's a real pleasure to be with my colleagues at WHO and working together on this problem and we look forward to our continued partnership. CL Thank you very much, Dr Berkley and thank you of course for joining us today. Before I hand to Dr Tedros for the final remarks, as usual the audio files will be posted right after the press conference today and the full transcript will be available tomorrow morning on our website. For any other follow-ups please contact mediaenquiries@who.int. Dr Tedros, the floor is yours. TAG Thank you. Thank you so much, Seth, for joining us today and again for your leadership. I would also like to thank the colleagues from the media for joining us today. Bon week-end. See you next week. Bye. 00:41:38

Principais elementos / Coleção COVID-19 / Main Elements / COVID-19 Collection

A Coleção COVID-19 persegue o desafio de apresentar questões relevantes para o debate e o aprendizado acerca da crise sanitária pandêmica, que assola todo o planeta, desde dezembro de 2019. No Volume 1 ­ Principais Elementos ­ estão reunidas diferentes interpretações sobre conteúdo fundamental que se relacionada com a pandemia e seu controle. As posições que referem o desenvolvimento humano, as desigualdades econômicas, os alicerces democráticos, a participação e a relação entre os poderes instituídos são apresentadas previamente àquelas mais específicas do controle das pandemias. A relevância está na apresentação de dados, posicionamentos e interpretações acerca das manifestações do judiciário, legislativo e executivo. Os textos que dizem respeito ao Sistema Único de Saúde (SUS), dão ênfase à atuação dos conselhos representativos da gestão dos entes subnacionais, à força e importância da vigilância em saúde ­ quer em tempos de rotina, quer na excepcionalidade ­, às intervenções em prol dos pacientes, sua segurança e avaliação. A reflexão sobre a dor incomensurável pelas vidas perdidas foi apresentada pelo relato de iniciativa da sociedade civil, enquanto estudos e perspectivas relacionados à imunidade e a imunização foram apresentados por especialistas. O volume se encerra ao debater as expectativas de incremento na participação social e na diplomacia como forma de conferir desenvolvimento e sustentabilidade aos sistemas universais de saúde. Todos os textos, da lavra de estudiosos, profissionais e gestores experientes, foram mantidos integralmente conforme apresentados, ainda que porventura apresentem divergências quanto às posições oficiais do Conass. Possuem o condão de registrar fatos e evidências, por pontos de vista de profissionais de vários campos do saber e, em que pese refletirem o momento histórico vivenciado até novembro de 2020, contribuirão notadamente para a compreensão e a análise da crise sanitária mais severa do último século.

Diplomacia da saúde e COVID-19: reflexões a meio caminho / Health diplomacy and COVID-19: reflections halfway

Organizada por Paulo Marchiori Buss e Luiz Eduardo Fonseca, coordenadores do Centro de Relações Internacionais em Saúde da Fiocruz, esta obra reúne as análises produzidas sobre as respostas do multilateralismo ao novo coronavírus. Dividida em três partes, a coletânea viabiliza o acesso do público a um panorama de ações internacionais promovidas para o enfrentamento da crise sanitária. A publicação engloba renomados pesquisadores das mais diversas áreas de saúde, diplomacia e relações internacionais, examinando as ações de órgãos e agências, como OMS, ONU e OCDE, além de iniciativas multilaterais, como G20 e países do BRICS. Os capítulos abordam ainda as respostas de diferentes países e regiões do mundo, incluindo Brasil, China, Estados Unidos, África, Oriente Médio, Europa, América Latina e Caribe, além de instituições financeiras internacionais,como FMI e Banco Mundial. Primeiro livro da série "Informação para Ação na Covid-19", que tem como objetivo reunir o conjunto de respostas, pesquisas e ações técnicas produzidas pela Fiocruz durante a pandemia causada pelo novo coronavírus. Publicada em coedição por Observatório Covid-19 Fiocruz e Editora Fiocruz, com apoio da Rede SciELO Livros, a série estará disponível exclusivamente em formato digital e acesso aberto.

Desafios e conflitos bioéticos da covid-19: contexto da saúde global / Covid-19 bioethical challenges and conflicts: global health context / Desafíos y conflictos bioéticos de la covid-19: contexto de salud global

Resumo A pandemia desencadeada pela covid-19, imersa em muitas incertezas, suscita uma série de conflitos éticos. O objetivo deste artigo é refletir sobre esses conflitos e sobre os distintos interesses envolvidos no atual cenário. O horizonte da análise crítica é a bioética global, e o foco do estudo é o Brasil, onde os problemas de saúde decorrentes da covid-19 não têm sido abordados de forma integrada à diplomacia internacional. No país, a oposição simplista entre saúde e economia tem servido de base para decisões estratégicas e medidas de contenção do vírus. No entanto, as variáveis a se considerar são múltiplas, e é necessário um balizador ético, como a responsabilidade dos agentes políticos quanto ao desfecho de suas decisões.

Abstract Characterized by extreme uncertainty, the Covid-19 outbreak raises important ethical conflicts. In this article, we reflect on these conflicts and the different interests involved in the current scenario. Our critical analysis is based on global bioethics, and focused on Brazil, where public health issues have not been properly integrated with international diplomacy. The simplistic opposition between health and economy has been used as a decision-making strategy and to establish measures to control the virus. However, there are several variables in this context, and an ethical guideline becomes necessary, especially for the decisions made by politicians in the country.

Resumen La pandemia desencadenada por la covid-19, inmersa en muchas incertidumbres, genera una serie de conflictos éticos. Este artículo tiene como objetivo contribuir para la reflexión sobre estos conflictos y sobre los distintos intereses implicados en el escenario actual. El horizonte del análisis crítico es la bioética global, y el estudio se concentra en Brasil, donde los problemas de salud derivados de la covid-19 no han sido abordados de forma integrada a la diplomacia internacional. En este país, la oposición simplista entre salud y economía ha servido de base para decisiones estratégicas y medidas de contención del virus. Sin embargo, múltiples son las variables que se deben tener en cuenta, y son necesarias referencias éticas, como la responsabilidad de los agentes políticos en cuanto al desenlace de sus decisiones.

"Diplomacia Científica": El rol del científico en el manejo de pandemias / Scientific Diplomacy: The role of the scientific in pandemics management / Diplomàcia Científica: el rol del científic en la gestió de pandèmies

Este artículo evalúa el papel de los científicos en el análisis y la gestión de los asuntos mundiales, en particular durante las crisis sanitarias como la actual pandemia de COVID-19. Las autoridades y la población requieren su asesoramiento basado en el conocimiento adquirido a través del proceso científico para comprender los problemas locales y globales, y facilitar la búsqueda de soluciones. La intervención de los expertos debe estar inscrita en principios éticos y deontológicos del conocimiento científico, y tener en cuenta una serie de aspectos sociales y económicos, para proporcionar respuestas que favorezcan el avance del conocimiento, el bienestar social y la mejora de la salud de las poblaciones

This article evaluates the role of scientists in the analysis and management of global affairs, in particular during health crises such as the current COVID-19 pandemic. Their advice based in the knowledge acquired through the scientific process is required by the authorities and the population to understand local and global issues and to facilitate the search for solutions. Experts' intervention must be inscribed on ethical and deontological principles of scientific knowledge, and take into account a series of social and economic aspects, to provide answers in favor of the advancement of knowledge, social well-being and the improvement of the health of populations

Aquest article avalua el paper dels científics en l'anàlisi I la gestió dels assumptes mundials, en particular durant les crisis sanitàries com l'actual pandèmia de COVID-19. Les autoritats I la població requereixen el seu assessorament basat en el coneixement adquirit a través del procés científic per comprendre els problemes locals I globals, I facilitar la recerca de solucions. La intervenció dels experts ha d'estar inscrita en principis ètics I deontològics del coneixement científic, I tenir en compte un seguit d'aspectes socials I econòmics per proporcionar respostes que afavoreixin l'avanç del coneixement, el benestar social I la millora de la salut de les poblacions

Coronavírus: Secretário de Relações Internacionais

Saiba mais em: http://saopaulo.sp.gov.br/coronavirus/

Cooperação internacional em saúde do Brasil na era do SUS / Brazilian international cooperation in health in the era of SUS

Resumo O artigo aborda a presença da saúde na diplomacia da saúde e na cooperação internacional do Brasil, desde o surgimento do Sistema Único de Saúde (SUS), com ênfase na cooperação Sul-Sul e em linha com as prioridades da cooperação técnica internacional do país desde então, que enfatiza as relações com países da América Latina e Caribe (ALC) e da Comunidade de Países de Língua Portuguesa (CPLP), particularmente com os Países Africanos de Língua Oficial Portuguesa (PALOP) e Timor Leste. Ressalta os papéis do Ministério da Saúde, por meio da Assessoria Internacional em Saúde (AISA) e da Fundação Oswaldo Cruz (Fiocruz), além da Agência Brasileira de Cooperação (ABC), do Ministério das Relações Exteriores, e da Organização Pan-Americana da Saúde (OPAS). Aponta o papel do Termo de Cooperação TC-41 como um dos principais instrumentos da viabilização da cooperação. Apresenta os casos das redes estruturantes dos sistemas de saúde, assim como as negociações paradigmáticas da Convenção-Quadro sobre Controle do Tabaco, do Acordo TRIPS e da criação da UNAIDS, nos quais o papel da diplomacia brasileira foi preponderante.

Abstract This paper addresses the role of health in Brazil's health diplomacy and international cooperation since the emergence of the Brazilian Unified Health System (SUS), focusing in particular on South-South cooperation, in line with the priorities of the country's international technical cooperation since its creation. It highlights the relationship with the Latin American and Caribbean Countries (LAC) and the Community of Portuguese Speaking Countries (CPLP), more specifically, with the Portuguese Speaking African Countries (PALOP) and East Timor. It emphasizes the roles of the Ministry of Health, through the International Advisory Working Group on Health (AISA) and the Oswaldo Cruz Foundation (Fiocruz), the Brazilian Cooperation Agency (ABC), the Ministry of Foreign Affairs, and the Pan American Health Organization (PAHO). The article points out that the TC-41 Co-operation Agreement is one of the main instruments for enabling cooperation. It presents the cases of the structuring networks of health systems, as well as the paradigmatic negotiations of the Framework Convention on Tobacco Control, the TRIPS Agreement and the establishment of UNITAIDS, in which Brazilian diplomacy had a predominant role.

Traumatólogos militares españoles en Mauritania: otra forma de diplomacia de defensa / Spanish military traumatologists in Mauritania: another way of defence diplomacy

INTRODUCCIÓN: El papel de la Sanidad Militar en el ámbito de la diplomacia de defensa tiene muchas formas de entenderse y ponerse en práctica, entre ellas la utilización del recurso humano. Tras años de cooperación entre España y Mauritania, el Ministerio de Defensa ha comisionado a médicos militares españoles para realizar tareas de formación y asesoramiento a sus homólogos mauritanos. Este trabajo muestra la actividad de dos oficiales traumatólogos durante su estancia en el Hospital Militar de Nouakchott. Material y MÉTODOS: Estudio transversal, descriptivo y retrospectivo realizado en el periodo de tiempo comprendido entre los días 22 y 27 de mayo de 2017 en el que se recogen todas las actividades realizadas por dos oficiales médicos españoles durante su estancia en Mauritania y la actividad asistencial prestada por los mismos en el Sservicio de Cirugía Ortopédica y Traumatología del Hospital Militar de Nouakchott. RESULTADOS: Durante el tiempo de estudio, los oficiales médicos españoles participaron en cuatro jornadas laborales, en las cuales atendieron a 28 pacientes en consulta, realizaron 7 intervenciones de cirugía artroscópica de rodilla y participaron en 8 sesiones clínicas, además de otras laboras de representación oficial. CONCLUSIÓN: El empleo de médicos militares comisionados en países extranjeros ofrece una forma de diplomacia de defensa basada en un modelo reconocido, cuyo objetivo final es mejorar la estabilidad y la seguridad mundiales

INTRODUCTION: Bacillus anthracis is the most employed biological warfare agent in the world. However, in biological defense laboratories, many times it is convenient to use other bacteria similar to Bacillus anthracis but less dangerous or non-pathogenic. One of the main surrogates of Bacillus anthracis is Bacillus thuringiensis, due to its high homology with B. anthracis and its null pathogenicity for humans. OBJECTIVE: The objective of the present study is to develope and validate a real-time PCR for the rapid identification of Bacillus thuringiensis DNA, biological agent very often employed in the training of the Operative Units of CBRN sampling of the Armed Forces. METHODS: The identification of Bacillus thuringiensis has been performed by the amplification and detection with a hydrolysis probe of a 69 base pairs fragment of the cry1A gene, which is specific for this bacterium. After optimizing the amplification conditions by testing three different hybridization / extension temperatures, the validation of the new developed method was carried out. RESULTS: The new developed real-time PCR showed an efficiency of 93%, as well as a high linearity (regression coefficient R20.9993). The limit of detection at 95% probability was 13 genome equivalents per reaction. Both the inclusiveness and the exclusivity of the method were 100%. CONCLUSIONS: The molecular method developed at the Molecular Biology Laboratory of INTA allows the rapid identification of Bacillus thuringiensis DNA, surrogate of Bacillus anthracis, with a high analytical sensitivity and specificity

A importância da cooperação sul-sul em saúde no processo de implantação da Rede Latino-americana de Banco de Leite Humano / The importance of health cooperation in the implementation process of the Latin American Human Milk Bank Network / La importancia de la cooperación en salud en el proceso de implantación de la RedLatinoamericana de Banco de Leche Humana

Objetivo: Este estudo tem como objetivo analisar a importância do modelo de cooperação sul-sul para a implantação da Rede Latino-americana de Banco de Leite Humano e as ações desempenhadas pelo Brasil neste processo de implantação. Metodologia: Tratou-se de uma pesquisa com a utilização da análise bibliográfica e documental, para a compreensão da cooperação estruturante. Sendo realizada a busca nas bases de dados do SciELO, e LILACS, e no site da Rede Global de Banco de Leite da Fundação Oswaldo Cruz. Foram selecionados 10 artigos e cinco documentos oficiais. Resultados: Percebe-se que a trajetória de cooperação entre os países teve sua construção marcada por eventos e acordos, que permitiram a estruturação da Rede Global de Leite Humano, maior articuladora para o sucesso da política pública em amamentação no Brasil, enfrentando da mortalidade infantil, e afirmando o protagonismo feminino que movimenta todas as ações que cooperam para a redução da mortalidade infantil. Conclusão: A estratégia mantém um perfil solidário entre os países pactuados, pois o objetivo de redução da mortalidade é enfrentado como experiência exitosa

Objective: This study aims to analyze the importance of the South-South cooperation model for the implementation of the Latin American Network of Human Milk Bank and the actions carried out by Brazil in this implementation process. Methodology: It is a research with the use of bibliographical and documentary analysis, for the understanding of structuring cooperation. The search was carried out in the databases of Scielo, and LILACS, and in the website of the Global Network of Milk Bank of the Oswaldo Cruz Foundation. We selected 10 articles and five official documents. Results: It is noticed that the cooperation path between the countries was built by events and agreements, which allowed the structuring of the Global Network of Human Milk, the main articulator for the success of the public policy on breastfeeding in Brazil, facing infant mortality, and affirming the female protagonism that moves all actions that cooperate to reduce infant mortality. Conclusion: The strategy maintains a solidarity profile between the agreedments countries, because the objective of mortality decrease is confronting as a successful experience

Objetivo: Este estudio tiene como objetivo analizar la importancia del modelo de cooperación sur-sur para la implantación de la Red Latinoamericana de Banco de Leche Humana y las acciones desempeñadas por Brasil en este proceso de implantación. Metodología: Se trata de una investigación con la utilización del análisis bibliográfico y documental, para la comprensión de la cooperación estructurante. Se realizó la búsqueda en las bases de datos de Scielo, y LILACS, y en el sitio de la Red Global de Banco de Leche de la Fundación Oswaldo Cruz. Se seleccionaron 10 artículos y cinco documentos oficiales. Resultados: Se percibe que la trayectoria de cooperación entre los países tuvo su construcción marcada por eventos y acuerdos, que permitieron la estructuración de la Red Global de Leche Humana, mayor articuladora para el éxito de la política pública en lactancia en Brasil, enfrentándose a la mortalidad infantil, y afirmando el protagonismo femenino que mueve todas las acciones que cooperan para la reducción de la mortalidad infantil. Conclusión: La estrategia mantiene un solidario perfil entre los países pactados, porque el objetivo de reducir la mortalidad se enfrentado como una experiencia exitosa.

Coletânea discute aplicação da diplomacia em prol de uma saúde mais equitativa

O médico Paulo Marchiori Buss e o sociólogo Sebastián Tobar, respectivamente diretor e assessor do Centro de Relações Internacionais em Saúde (Cris/Fiocruz), organizaram a coletânea Diplomacia em Saúde e Saúde Global: perspectivas latino-americanas. Lançamento da Editora Fiocruz, o livro reúne 40 autores que discutem a presença da saúde na diplomacia com foco na América Latina e Caribe.

Diplomacia de la salud: fortalecimiento de las oficinas de relaciones internacionales de los ministerios de salud en las Américas

[RESUMEN]. La dimensión internacional de los determinantes sociales, económicos y ambientales de la salud y sus manifestaciones impulsa a los países a emprender cada vez más negociaciones entre sí y a participar activamente en la gobernanza de la salud global y en la gobernanza global por sus inequívocas relaciones con la salud. Los ministerios de salud necesitan personal capacitado para ello. En este informe se reflexiona sobre el fortalecimiento de esa función de los ministerios de salud por medio de procesos de capacitación en diplomacia de la salud y se analiza la experiencia del Programa de Fortalecimiento de la Cooperación para el Desarrollo Sanitario (CCHD), desarrollado por el Departamento de Relaciones Externas, Alianzas y Movilización de Recursos de la Organización Panamericana de la Salud (OPS) y el Centro de Relaciones Internacionales en Salud de la Fundación Oswaldo Cruz (CRIS/FIOCRUZ). Esta reflexión parte de los participantes y de los facilitadores y coordinadores del CCHD, y se basa en la construcción de los conceptos a partir de la experiencia como soporte de la reflexión para explicar la realidad y pensar en las concepciones y prácticas de los procesos de gobernanza en salud y cooperación de los ministerios de salud. Como la diplomacia de la salud es un concepto en construcción, las experiencias de capacitación en diplomacia de la salud deben promover la reflexión crítica y dar cuenta de la identidad a partir de las concepciones y prácticas de los actores involucrados en los procesos de gobernanza global y cooperación de los ministerios de salud. En este artículo también se identifican los requisitos y los procesos de formación de recursos humanos en diplomacia de la salud.

[ABSTRACT]. Given the international dimensions of the social, economic, and environmental determinants of health and their manifestations, countries are increasingly negotiating with each other and actively participating in global health governance and global governance in general, which is unequivocally linked to health. This implies that health ministries need trained staff. This report is a reflection on how to strengthen this function in health ministries through training in health diplomacy. It analyzes the experience of the Program for Strengthening Cooperation for Health Development as part of Cooperation among Countries for Health Development (CCHD), developed by the Department of External Relations, Partnerships and Resource Mobilization of the Pan American Health Organization and the Center for International Relations in Health of the Oswaldo Cruz Foundation (CRS/FIOCRUZ). This analysis is based on feedback from participants and from facilitators and coordinators of CCHD, and it attempts to develop concepts stemming from their experiences, with the aim of explaining the current situation and reflect on the concepts and practices of health governance and cooperation between health ministries. Since health diplomacy is a concept still in construction, training experiences in health diplomacy should promote critical analysis and reflect identity, based on the conceptions and practices of stakeholders in the processes of global governance and cooperation between health ministries. This article also identifies the requirements and processes of human resources training in health diplomacy.

[RESUMO]. Diante da dimensão internacional dos determinantes sociais, econômicos e ambientais da saúde e das suas manifestações, os países cada vez mais negociam entre si e participam ativamente da governança da saúde global e da governança global em geral, que está incontestavelmente relacionada com a saúde. Os ministérios da Saúde precisam ter pessoal capacitado para exercer estas atividades. Este artigo examina como fortalecer esta função dos ministérios da Saúde por meio da capacitação em diplomacia da saúde e analisa a experiência obtida com o Programa de Fortalecimento da Cooperação para o Desenvolvimento da Saúde (CCHD), desenvolvido em conjunto pelo Departamento de Relações Externas, Parcerias e Captação de Recursos da Organização Pan-Americana da Saúde (OPAS) e Centro de Relações Internacionais em Saúde da Fundação Oswaldo Cruz (CRIS/FIOCRUZ). A análise parte da perspectiva dos participantes, facilitadores e coordenadores do CCHD e busca elaborar os conceitos a partir das experiências deles visando explicar a realidade atual e pensar nos conceitos e práticas dos processos de governança em saúde e cooperação dos ministérios da Saúde. Como a diplomacia da saúde é um conceito em evolução, as experiências de capacitação nesta área contribuem para estimular uma reflexão crítica e conferir identidade a partir de conceitos e práticas dos atores envolvidos nos processos de governança global e cooperação dos ministérios da Saúde. Também são abordados os requisitos e os processos de formação de recursos humanos em diplomacia da saúde.

The evolution of Vaccination Week in the Americas

[ABSTRACT]. This report covers the background and evolution of Vaccination Week in the Americas (VWA), an initiative that started as a coordinated response to a 2002 measles outbreak in Colombia and Venezuela, and evolved into the model for other regions and World Immunization Week (WIW). VWA focuses on the work of national immunization programs, with special efforts to reach the unreached. This paper offers examples of how countries have leveraged VWA to implement a diverse array of vaccination activities, strengthening overall health services by integrating with other preventive health interventions, and bolstering “Pan-Americanism” and health diplomacy. The opportunities offered by this global initiative were clearly demonstrated in April 2016 when the successful global switch from the trivalent oral polio vaccine to the bivalent vaccine was synchronized with WIW. Going forward, VWA and WIW can help close the gaps in access to immunization and other health services, contributing to achieve universal health coverage.

[RESUMEN]. Este informe incluye los antecedentes y la evolución de la Semana de Vacunación en las Américas, una iniciativa que comenzó como una respuesta coordinada a un brote de sarampión en Colombia y Venezuela en el 2002, y evolucionó hasta convertirse en modelo para otras regiones y para la Semana Mundial de la Inmunización. La Semana de Vacunación en las Américas se centra en el trabajo de los programas nacionales de inmunización, con esfuerzos especiales para llegar a las personas que todavía no estén cubiertas. En el presente trabajo se dan ejemplos de cómo los países han aprovechado la Semana de Vacunación para realizar diversas actividades relacionadas con la vacunación, fortalecer los servicios de salud en general mediante la integración con otras intervenciones preventivas y fomentar el “panamericanismo” y la diplomacia en torno a la salud. Las oportunidades que ofrece esta iniciativa mundial quedaron claramente evidenciadas en abril del 2016 con el éxito obtenido en la sustitución de la vacuna oral trivalente contra la poliomielitis por la vacuna bivalente, sincronizada con la Semana Mundial de la Inmunización. En el futuro, la Semana de Vacunación en las Américas y la Semana Mundial de Inmunización pueden ayudar a subsanar la brecha en el acceso a la inmunización y otros servicios de salud, y contribuir a alcanzar la cobertura universal de salud.

[RESUMO]. Este artigo narra os antecedentes e a evolução da Semana de Vacinação nas Américas (SVA), uma iniciativa que nasceu da resposta coordenada ao surto de sarampo na Colômbia e na Venezuela em 2002 e evoluiu como um modelo para as outras regiões e para a Semana Mundial da Imunização. A SVA põe ênfase no trabalho dos programas nacionais de vacinação e, principalmente, nos esforços para se alcançar quem ainda está inalcançado. São ilustrados exemplos de como os países têm aproveitado a SVA para implementar várias atividades de vacinação, fortalecendo os serviços de saúde em geral ao integrá-la a outras intervenções preventivas e reforçando o pan-americanismo e a diplomacia da saúde. As oportunidades criadas por esta iniciativa global ficaram bem evidentes em abril de 2016 com a bem-sucedida transição em nível mundial da vacina oral contra poliomielite trivalente à bivalente, em sincronia com a Semana Mundial da Imunização. Prosseguindo adiante, a SVA e a Semana Mundial da Imunização podem contribuir para sanar as lacunas no acesso à imunização e a outros serviços de saúde e alcançar a cobertura universal de saúde.

Protocolo clinico e terapêutico na assistência a gestantes e puérperas usuárias de substâncias psicoativas. Corintio Mariani Neto.

Protocolo Clinico e terapêutico na assistência a gestantes e puérperas usuárias de substancias psicoativas. Conv. Corintio Mariani Neto.

South-South cooperation in health: bringing in theory, politics, history, and social justice / A cooperação Sul-Sul em saúde: trazendo perspectivas teóricas, políticas, históricas e de justiça social / Cooperación Sur-Sur en salud: aportando perspectivas teóricas, políticas, históricas y de justicia social

Abstract: Since the mid-2000s, the practice of South-South cooperation in health (SSC) has attracted growing attention among policymakers, health and foreign affairs ministries, global health agencies, and scholars from a range of fields. But the South-South label elucidates little about the actual content of the cooperation and conflates the "where" with the "who, what, how, and why". While there have been some attempts to theorize global health diplomacy and South-South cooperation generally, these efforts do not sufficiently distinguish among the different kinds of practices and political values that fall under the South-South rubric, ranging from economic and geopolitical interests to social justice forms of solidarity. In the spirit of deepening theoretical, historical, and social justice analyses of SSC, this article: (1) critically revisits international relations theories that seek to explain SSC, exploring Marxian and other heterodox theories ignored in the mainstream literature; (2) traces the historical provenance of a variety of forms of SSC; and (3) introduces the concept of social justice-oriented South-South.

Resumo: Desde meados da primeira década do século XXI, a cooperação Sul-Sul em saúde (CSS) vem atraindo cada vez mais atenção entre gestores, ministérios da saúde e das relações exteriores, agências de saúde global, e pesquisadores de diversas disciplinas. Não obstante, o uso do termo "Sul-Sul" para caracterizar essa prática explica pouco sobre o conteúdo da cooperação, além de misturar o "onde?" com o "quem, quê, como e por quê?". Já houve algumas tentativas de teorizar a diplomacia da saúde global e a cooperação Sul-Sul geralmente, mas esses esforços têm sido insuficientes no sentido de distinguir as diversas práticas e valores políticos sob a rubrica Sul- Sul, desde os intereses econômicos e geopolíticos até a solidariedade e a justiça social. No espírito de aprofundar as análises políticas, teóricas, históricas, e de justiça social nas discussões sobre a CSS, o artigo: (1) revisita criticamente as teorias de relações internacionais que podem explicar a CSS, explorando teorias en la tradição Marxista e heterodoxas ignoradas na literatura convencional; (2) identifica as origens históricas das diferentes formas dessa cooperação; e (3) introduz o conceito da cooperação Sul-Sul orientada a la justiça social.

Resumen: Desde mediados de los años 2000, la práctica de la cooperación Sur-Sur en salud (CSS) ha recibido una creciente atención entre formuladores de políticas, ministerios de salud y de asuntos exteriores, organismos internacionales de salud y académicos provenientes de un gran abanico de campos científicos. Sin embargo, la denominación cooperación Sur-Sur poco dilucida acerca del contenido real de la cooperación y mezcla el "dónde" con el "quién, qué, cómo, y el por qué". A pesar de que han habido algunos intentos de teorizar sobre la diplomacia en la salud global y la cooperación Sur-Sur en general, estos esfuerzos no han identificado de manera suficiente los distintos tipos de prácticas y los diferentes valores políticos que caen en la rúbrica de CSS, y que incluyen desde los intereses económicos y geopolíticos hasta las formas de solidaridad fieles a la justicia social. Con el ánimo de ahondar en los análisis políticos, teóricos, históricos y de justicia social de la CSS, este artículo: (1) vuelve a examinar críticamente las teorías sobre las relaciones internacionales que intentan explicar la CSS, explorando teorías en la tradición Marxista y otras teorías heterodoxas, que han sido ignoradas en la literatura convencional; (2) rastrea los orígenes históricos de distintas formas de CSS; y (3) presenta el concepto de cooperación Sur-Sur orientada por la justicia social.

Diplomacia da saúde e cooperação Sul-Sul: as experiências da Unasul saúde e do Plano Estratégico de Cooperação em Saúde da Comunidade de Países de Língua Portuguesa (CPLP) / Health diplomacy and South-South cooperation: the experiences of Unasur health and the Strategic Plan for Cooperation in Health of the Community of Portuguese Speaking Countries (CPLP)

O artigo apresenta as principais características da cooperação internacional em saúde realizada recentemente em contextos regionais, que se inscrevem no âmbito da cooperação Sul-Sul. Tal cooperação se desenvolve particularmente entre países da América do Sul, no contexto da Unasul Saúde, e entre os Palop (Países Africanos de Língua Oficial Portuguesa), Timor Leste, Brasil e Portugal, no contexto do PECS/CPLP (Plano Estratégico de Cooperação em Saúde da Comunidade de Países de Língua Portuguesa).

O Instituto Sul-Americano de Governo em Saúde e a Cooperação Sul-Sul

A globalização ampliou a interdependência entre países e exige dosEstados nação adaptar suas políticas domésticas à realidade internacional, poiscada vez mais problemas internos não podem ser solucionados integralmentesem a cooperação com outras nações e outros agentes. Na saúde, esta novanoção de interdependência nas relações internacionais e necessidade decooperação entre atores ativos na política internacional são evidenciadas com ocrescente número de instituições, de regimes internacionais e de organizaçõesinternacionais criadas nas últimas décadas. Na América do Sul, em contexto demudanças políticas e governos democráticos, foi criada em 2008 a União deNações Sul-Americanas (Unasul). Reconhecendo o lugar de destaque que asaúde vem alcançando na política externa dos países e nas agendasinternacionais, o segundo conselho ministerial setorial a ser constituído peloschefes de Estado da Unasul foi o Conselho de Saúde Sul-Americano. Um dosprodutos mais concretos deste Conselho foi a criação do Instituto Sul-Americanode Governo em Saúde (Isags). Esta dissertação teve por objetivo examinar oprocesso de institucionalização do ISAGS no período de 2011 a 2015, analisara sua atuação a partir da perspectiva da cooperação Sul-Sul, e identificar osdesafios para sua sustentabilidade. Trata-se de um estudo de caso a partir deduas estratégias principais de coleta de dados e fontes de informação: análisedocumental e entrevistas com atores-chave. Foram realizadas 16 entrevistascom informantes-chave de nove dos doze países membros do Conselho deSaúde Sul-americano e analisados documentos deste conselho e do Isags...

Globalization has increased interdependence between countries and hasrequired nation states to adapt internal policies to international reality since, allthe time more, internal problems cannot be entirely resolved without cooperationwith other nations or actors. In the field of health, this new idea ofinterdependence in international relations and the need for cooperation betweenactive actors in international policies are demonstrated by the increasing numberof institutions, international regimes and international organizations created overthe past few decades. At the beginning of the 2000s, in a context of politicalchanges and democratic governments in South America, the Union of SouthAmerican Nations (Unasur) was created. In recognition of the important role thathealth had been gaining in external policies and international agendas of severalcountries, the second Ministerial Sectorial Council formed by the Heads of Stateof UNASUR was the South American Health Council. One of the most concreteoutcomes of this Council was the creation of the South American Institute ofGovernment in Health (ISAGS). This study aims to to examine the process ofinstitutionalization of ISAGS in the period from 2011 to 2015, Analyze itsperformance from the perspective of South-South cooperation, and identify thechallenges for its sustainability. This is a case study, which uses two mainstrategies for the choice of information sources and data collection: documentanalysis and interviews with key actors. Sixteen interviews were conducted withkey informants from nine of the twelve member countries of the South AmericanHealth Council and documents from this council and Isags were analyzed...

Diplomacia de la salud: fortalecimiento de las oficinas de relaciones internacionales de los ministerios de salud en las Américas / Health diplomacy: strengthening the international relations offices of health ministries of the Americas

La dimensión internacional de los determinantes sociales, económicos y ambientales de la salud y sus manifestaciones impulsa a los países a emprender cada vez más negociaciones entre sí y a participar activamente en la gobernanza de la salud global y en la gobernanza global por sus inequívocas relaciones con la salud. Los ministerios de salud necesitan personal capacitado para ello. En este informe se reflexiona sobre el fortalecimiento de esa función de los ministerios de salud por medio de procesos de capacitación en diplomacia de la salud y se analiza la experiencia del Programa de Fortalecimiento de la Cooperación para el Desarrollo Sanitario (CCHD), desarrollado por el Departamento de Relaciones Externas, Alianzas y Movilización de Recursos de la Organización Panamericana de la Salud (OPS) y el Centro de Relaciones Internacionales en Salud de la Fundación Oswaldo Cruz (CRIS/FIOCRUZ). Esta reflexión parte de los participantes y de los facilitadores y coordinadores del CCHD, y se basa en la construcción de los conceptos a partir de la experiencia como soporte de la reflexión para explicar la realidad y pensar en las concepciones y prácticas de los procesos de gobernanza en salud y cooperación de los ministerios de salud. Como la diplomacia de la salud es un concepto en construcción, las experiencias de capacitación en diplomacia de la salud deben promover la reflexión crítica y dar cuenta de la identidad a partir de las concepciones y prácticas de los actores involucrados en los procesos de gobernanza global y cooperación de los ministerios de salud. En este artículo también se identifican los requisitos y los procesos de formación de recursos humanos en diplomacia de la salud.