Person:

Bloom, Barry

The article discusses the changing quality of global health institutions. It cites the factors that affect the change including variety of civil society, nongovernmental organizations, and private firms, changing relationships of health ministries, and new partnership of organizations. It also mentions that the global-level transformation is the biggest challenge of the global health institutions.

The global health system is in a period of rapid transition, with an upsurge of funds and greater political recognition, a broader range of health challenges, many new actors, and the rules, norms and expectations that govern them in flux. The traditional actors on the global health stage—most notably national health ministries, the World Health Organization (WHO) and a relatively small group of national medical research agencies and foundations funding global health research—are now being joined (and sometimes challenged) by a variety of newer actors: civil society and nongovernmental organizations, private firms, and private philanthropists, and an ever-growing presence in the global health policy arena of low- and middle-income countries, such as Kenya, Mexico, Brazil, China, India, Thailand, and South Africa. We present here a series of four papers on one dimension of the global health transition: its changing institutional arrangements. We define institutional arrangements broadly to include both the actors (individuals and/or organizations) that exert influence in global health and the norms and expectations that govern the relationships among them. We focused on three central questions regarding the global health system: (1) What functions must an effective global health system accomplish? (2) What kind of institutional arrangements can better govern the growing and diverse set of actors in the system to ensure that those functions are performed? (3) What lessons can be extracted from analysis of historical experience with malaria to inform future efforts to address them and the coming wave of new health challenges?

If accidentally released, mammalian-transmissible influenza A/H5N1 viruses could pose a greater threat to public health than possibly any other infectious agent currently under study in laboratories, because of such viruses' likely combination of transmissibility and virulence to humans. We advocate explicit risk-benefit assessments before work on such pathogens is permitted or funded, improvement of biosafety practices and enforcement, and harmonization of criteria for permitting such experiments across government agencies, as well as internationally. Such potential pandemic pathogens, as they have been called, jeopardize not only laboratory workers and their contacts, but also the wider population, who should be involved in assessments of when such risks are acceptable in the service of scientific knowledge that may itself bear major public health benefits.

Experience with influenza has shown that predictions of virus phenotype or fitness from nucleotide sequence are imperfect and that predicting the timing and course of evolution is extremely difficult. Such uncertainty means that the risk of experiments with mammalian-transmissible, possibly highly virulent influenza viruses remains high even if some aspects of their laboratory biology are reassuring; it also implies limitations on the ability of laboratory observations to guide interpretation of surveillance of strains in the field. Thus, we propose that future experiments with virulent pathogens whose accidental or deliberate release could lead to extensive spread in human populations should be limited by explicit risk-benefit considerations.