Reinventing Global Health Yann A. Meunier, MD

Main points
Definition of global health in the context of Africa 
Primary problems in quantity and quality in human resources confounded by the multiplicity of stakeholders
Lack of harmonization of partnership and funding channels and modalities are different for stakeholders
Lack of tracking of resources by governments
Weak point: no direct government oversight of the project: no political will and/or no mechanism to harmonize the projects
International programs often lack sustainability. Example: H3Africa Program (Human Heredity and Health in Africa) 
Competition for the same skilled workers to carry out international programs who are thus diverted from provided healthcare to local populations. It also participates in the brain drain (example: H3Africa)
No prioritization of the programs in the interest of home countries (medications, tests, equipment). Example in South Africa: patient genetic difference between California and Africa
Accountability: No separation between politics and judicial systems. As a result, there is no prosecution when waste or corruption occurs in many cases. Example: SASA conference
Successes: H3Africa with sickle cell and genetic diseases / Training of workers skilled in global health / Help in rural areas
To counter the brain drain, two examples: (1) Brain Circulation, (2) Carnegie Foundation (cross appointments)   
Rural areas. The situation has improved in the last decades but they are still underserved particularly regarding access and distribution. Moreover, facilities are underdeveloped, understaffed, and lack diagnostic tools. Example in Tanzania for the training of healthcare workers but it has plateaued. Priority: mother and children healthcare   
Collaboration between African countries: despite African Union’s efforts there is little collaboration. No continent-wide standards for healthcare
Current Ebola outbreak in Uganda (date: 10/3/2020)
Disproportion between funding and priorities: HIV/AIDS, TB, malaria are well funded at the expense of other diseases like neglected tropical diseases and chronic diseases
Deciders for best ROI: African governments but external players like the Bill Gates foundation have their own projects. 
Political consequences if programs fail: no mechanism holding anybody accountable
Influence of academia on decision-makers. Difficulty in developing policies to advise governments. They have problems on their own: insufficient funding, low salaries, lack of academic freedom, nepotism and lack of competent leaders and staff, lack of equal access to academic institutions
High cost of tuition deprives African countries of bright students
Advice for people wanting to get involved in global health in Africa: 
     - Despite of challenges, follow your heart
     - Work in rural settings. Personal examples (1) in Tanzania, (2)        McMaster University, (3) Distributed medical education
Advice to fix what is not working in global health in Africa: (1) Training level: Expand distributed medical education nationally or internationally in Africa, (2) More collaboration between academic institutions promoting global health creating guidelines
Good example of a successful program that can be scaled: In Tanzania a training program initiated by a foundation in the Netherlands and taken by the Fogarty foundation 
Good example of program successful for sustainability: Nutritional program started by Oxfam against kwashiorkor and marasmus
Example of good collaboration between anglophone and francophone countries: Rwanda and Uganda and DRC (Democratic Republic of Congo) regarding Ebola
BIO
Dr. Kapalanga is a physician-scientist and educator who received his medical education from Yale University, the state university of New York, queen’s university and the university of Guelph. 
He is currently professor of paediatrics at the Schulich school of medicine and dentistry and the South Western Ontario academic health network - knowledge translation group, Canad

Main points
Speaker introduction (international experience and expertise / pharmaceutical industry and corporate background) 
Presentation goals (road map for reaching maximum efficiency and efficacy in providing healthcare across the globe / providing food for thought to frame issues)
Global and healthcare challenges: The African example
The Clinton foundation as an example of unreliable funding
One requirement to face multiple challenges: Prioritization
Analogy: Medical emergency department
Triage process
Criterion #1 for global health: ROI with several dimensions (medical, financial, societal, political, moral, and personal)
First concrete example: Acute vs chronic disease (tetanus vs HIV/AIDS)
HIV/AIDS situation description
HIV/AIDS age distribution
HIV/AIDS treatment yearly cost (for life)
Maternal and neonatal tetanus situation description
2022 study: Vaccination coverage of mothers in East Africa 
The financial calculus 
The question: Why is the choice not made in favor of the tetanus vaccination?
Conclusion
Fear: Resurgence of historical diseases with COVID-19 is in the news (TB, cholera, polio, HIV/AIDS, malaria)  
Second concrete example: Prevention vs cure (the tetanus example)
Conditions for success (avoiding bureaucracy and making the hard choices)
Solutions

Priority #1: Good health
Three values (equity / solidarity / liberty)
One need: One accepted and respected leadership
One urgency: A general political consensus
Two sub-priorities: Nutrition and education
One must: Erasing the African debt
Three strategies: A new and serial approach / Thinking locally and acting globally / Consolidating global health 

Six suggestions: Mergers, coordinating superstructure, drastic limitation of face to face international conferences and congresses, the right to interfere in countries for healthcare reasons (particularly transmissible diseases) and the creation of global health blue helmet brigades, having poverty as the #1 risk factor for many diseases)
The past and the future
Food for thought
Vision
Conclusion
BIO
Dr. Yann Meunier is an international and multifaceted healthcare professional and a pioneer in academia, healthcare provision (in clinical settings and public health programs), research, and business. 
During his education,
He studied medicine at Paris V University (France), the Federal University of Rio de Janeiro (Brazil) and The George Washington University (USA). He holds specialty degrees in emergency medicine (Paris XII University), and tropical diseases (Paris VI University), a certificate from the ECFMG, a certificate from Harvard University in internal medicine and two certificates from Stanford University in communication. 
During his career,
In Academia
He was Assistant Professor in Tropical Diseases and Public Health (Paris VI University), Adjunct Assistant Professor of Medicine (The George Washington University); Lecturer (The George Washington University Center for International Health), Director (Stanford Health Promotion Network), Manager in Health Promotion (Stanford Health Improvement Program), Mentor (Stanford Medscholars Research Fellowship Program), and Instructor (Stanford Health Improvement Program)
He is widely published in the international medical literature and is the author or co-author of nine books on global health and tropical diseases (Oxford University Press and Springer published two).
As Healthcare Provider
Clinically
He was (1) Private General Practitioner in France, Singapore (only European Private General Practitioner in the country), New Caledonia (first and only Private General Practitioner on the island of Lifou), and Nigeria (only European Private General Practitioner in Lagos), (2) Tropical Diseases Consultant (at the Pitie-Salpetriere hospital in Paris, France), (3) Chief Medical Officer for Chevron Oil Co. in Papua New Guinea (PNG), (4) Corporate Physician in Cameroon (for Cellucam), Nigeria (for Spie-Batignolles and Schlumberger), and China (for EDF), (5) he

COVID-19 has underlined the current poor state of global health. In this podcast, I have tried to identify the underlying problems that were evidenced, at least in part, by the root causes of the pandemic. My remarks were largely based on my published book “Pandemics: Prescription for Prediction and Prevention”*, especially its Chapter 18. 
To summarize:
We live in an unruly, not easily managed world of ~ 8 billion people that is constantly growing. Notwithstanding the plethora of international, regional, national, and other organizations, there are glaring inequities among nations, principally between developed and poor ones. In particular, within the context of COVID-19, the prime organization among them, the World Health Organization (WHO), has been dilatory, at times issuing contradictory recommendations, and deferring to those powerful nations that fund it most (in this instance, China). 
In this context, humanity has again proven to have a short memory of past epidemics/pandemics, not having even clearly identified what are their root causes. It is therefore no wonder that these events will continue to haunt us till the end of times ... unless we are able to devise appropriate strategies for predicting/preventing them such as the one I have proposed. For this purpose, I have identified ten important measures:
Highlight global health security;
Create and strengthen necessary mechanisms; 
Promote multidisciplinary engagement;
Strengthen multisectoral coordination;
Emphasize the importance of financial preparedness;
Improve early warning and detection;
Collect and share data in a timely manner;
Conduct laboratory testing;
Develop joint outbreak response capacities; and
Take appropriate science-based actions.
I have also identified ten intertwined cardinal factors that are the root causes of pandemics that need to be simultaneously tackled and remedied:
Rapid growth of global human population;
Increased globalization;
Environmental degradation and destabilization of ecosystems;
Creation of new urban or agricultural ecosystems;
Economies of scale and monocultures in agriculture and dysfunctional agrifood systems;
Loss of land and ocean biodiversity;
Water scarcity;
Human-induced climate change;
Societal inequities; and
Irrational mass denialism of hard-won facts of science (vaccinations, antimicrobial overuse). 
Some of the above factors could be correlated with the United Nations (U.N.) Sustainable Development Goals (SDG). 
In the same book, I have offered a blueprint for a 6-level strategic pandemic prediction and prevention program that should herald the beginning of the end of pandemics: 
Creating of a new “World Environment Organization”;
Shifting the current health paradigm to a “One-World/One-ecoHealth paradigm” that will be grounded by a new “International Pandemic Treaty” and other international laws;
Involving international, intergovernmental, regional, and national health organizations;
Incorporating the “Global Human Virome Project”;
Actively developing models (epidemiological, climate-type) with their enabling technologies and databases: and
Folding-in the development of vaccines & therapeutics and the corresponding research. 
The value and success of the proposed approach will be gauged by four measures: 
Reducing causes of new infectious diseases;
Preventing outbreaks and epidemics from becoming pandemics;
Preparing for potential future pandemics that could not be prevented; and
Ensuring that the causing virus does not re-emerge thereafter (e.g., by sustaining itself in domestic animals).
Within that blueprint, I truly believe we can reach a stage where pandemics could at long last be predicted and prevented.
*Book (hard cover and paperback): Pandemics: Prescription for Prediction and Prevention: https://www.amazon.com/Pandemics-Prescription-Prediction-Alain-Fymat/dp/0228867215
BIO
Dr. Fymat is a medical-physical scientist and an educator. He is the current President/CEO and Profe

The US Healthcare system has slowly evolved over the past century through a combination of legislative efforts, need assessment by the private sector and pioneering efforts by a few dedicated and resourceful patient care givers. As such, morphing over the decades and at times having been shackled by political compromise, it is not surprising that with its evolution there would be some unintended consequences. At this stage, to help create a future healthcare delivery system which can facilitate the timely, efficient and appropriate access to healthcare for those most in need at a cost that is sustainable, one must proceed carefully lest we continue to apply layer upon layer of more ineffectual “band-aids” as has been previously done. Healthcare is complicated and so therefore is its delivery. As HL Mencken once warned, “For every complex problem there is a solution which is simple direct and wrong.” In this digital world in which we now live, do not surrender to the vicarious technological varlets: fax, voice mail, email, text, electronic health records and artificial intelligence, the very effective and personable interactions with your colleagues and your patients, including a carefully performed physical examination. The latter represents an important transactional moment between doctor and patient, “a laying on of healing hands” which helps foster the trust needed for relational continuity and effective cure. To those who would have you believe that technology will totally replace this interaction, I would have them remember the old girl scouting adage…. “Make new friends but keep the old, the one is silver, the other gold”… Further, please never forget, “No one cares how much you know until they know how much you care.” Remember, even an intellectual argument, including detailed statistical analyses can at first appear quite cogent, but upon more careful examination may be found to be fraught with erroneous assumptions and even faulty methodology. Be critical in your review of the literature. As Benjamin Desraeli, 19th century Prime Minister of England twice over quite perspicaciously once stated, “There are three kinds of lies; lies, damned lies and statistics.” When reviewing the literature, remember to fix your sights on the proper target. Albert Einstein once stated, “Not everything that can be counted counts and not everything worth counting can be counted,” words of wisdom when applied to healthcare.
OECD (Organization of Economic Cooperation & Development) https://www.oecd.org/health/health-statistics.htm World Index of Healthcare Innovation www.freopp.org/wihi/home
Kaiser Family Foundation Schaeffer Center for Health Policy 
Brookings Institute Center for Medicare & Medicaid Services Commonwealth Fund https://www.commonwealthfund.org/international-health-policy-center/system-stats
IMS Institute for Healthcare Information Global Medication Use in 2020 US Census Bureau https://www.census.gov/quickfacts/fact/table/US/PST045221 
American Hospital Association https://www.aha.org/statistics/fast-facts-us-hospitals
US Dept Health & Human Services Office of the Inspector General https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf / https://oig.hhs.gov/oei/reports/OEI-06-18-00400.pdf 
Association of America Medical Colleges https://www.aamc.org/data-reports/reporting-tools/report/tuition-and-studentfees-reports 
3M Clinical and Economic Research https://multimedia.3m.com/mws/media/2117913O/his-pm-cer-socioeconomicstatus-health-care-deliverysystem-performance-report-en-us.pdf 
American Association of Nurse Practitioners (AANP) https://www.aanp.org 
BIO
Dr. Zema has enjoyed a tenure of forty plus years in the healthcare arena on the “inside” as physician trainee; private practitioner; member of a hospital medical board; vice president of a physician independent practice association; board member of a physician holding company; pharmaceutical industry and malpractice legal consulta

Plus on détecte précocement un problème de santé en devenir, plus son traitement sera facile, voire seulement possible. C’est une évidence.
La médecine de plus en plus s’attache à chercher des « signaux faibles » qui permettent des diagnostics de plus en plus précoces. C’est le cas par exemple dans l’imagerie en utilisant de savants algorithmes. Mais c’est aussi le cas pour des choses aussi simples que de mesurer le taux d’hémoglobine glyquée à la recherche d’un diabète, de TSH à la recherche d’un dysfonctionnement de la thyroïde ou de PSA pour la prostate, voire une simple mesure de la tension artérielle. Bien d’autres examens sont possibles.
Proposer de faire un « bilan de santé » est une fausse promesse car nul ne peut prétendre dresser l’état de la santé d’une personne dans son entièreté. Ce que l’on peut faire est d’explorer le plus probable pour une personne en fonction de ses antécédents personnels et familiaux, et des signes cliniques qu’il présente. Également, on va chercher ce qui est le plus fréquent épidémiologiquement pour sa tranche d’âge ou son genre. Ainsi pourra-t-on approcher un « bilan médical » ciblé qui a le plus de chances d’être pertinent pour une personne donnée.
C’est pourquoi notre Centre Médical International propose des « bilans médicaux modulaires » attachés à une fonction (sommeil par exemple), ou à un organe (cœur par exemple), plusieurs modules pouvant être assemblés pour réaliser ce que d’autres appelleront un « bilan de santé ».
Mais ce n’est pas le tout de dépister, encore faut-il savoir que faire de ce que l’on a trouvé. Après un bilan, on ne se précipite pas toujours sur un traitement médical ou une opération. Surtout lorsque l’on a détecté des signaux faibles ; il suffit parfois juste de mettre en œuvre des mesures de prévention de l’aggravation. Ou alors au moins de mesures accompagnant des traitements qui peuvent en être plus légers.
Car c’est bien joli de faire un bilan pour détecter un sujet à considérer, mais qu’en fait-on ? L’important pour nous, ce sont les suites qu’on donne à un bilan. Certaines conduiront à un spécialiste pour approfondir une recherche parce qu’un résultat questionne. On entre dans la sphère médicale classique.
D’autres conclusions ne conduiront qu’à des recommandations d’hygiène de vie. Elles sont fondamentales. Les déterminants de la santé sont loin d’être entre les mains des seuls médecins. Ils sont avant tout entre les mains de chacun ou de sa destinée. Pour le patrimoine génétique ou les traces laissées de l’enfance, on ne peut que les subir. Pour les facteurs importants conditionnant la santé de tout un chacun comme les facteurs sociaux, économiques ou familiaux, tout comme l’environnement, on ne peut pas faire grand-chose. Il reste toutefois de nombreux domaines sur lesquels on peut agir pour influencer considérablement l’avenir de sa santé. Il s’agit pour l’essentiel de l’activité physique, de l’alimentation, du sommeil, du stress et des addictions à commencer par le tabac.
Notre objet dans le podcast était d’en souligner l’importance et leur place dans la médecine moderne. En effet celle-ci s’efforcera de plus en plus de ne pas être réactive – à savoir attendre la maladie pour agir, mais prospective – à savoir anticiper et prévenir les risques pour ne pas avoir à en traiter les conséquences plus tard.
En ce sens, la prévention ne peut être utile que si elle rencontre le projet de santé d’une personne. Si un fumeur ne veut pas arrêter, un obèse ne pas arrêter de mal manger ou un sédentaire de rester devant sa télévision, une action préventive sur l’addiction, la nourriture ou l’activité physique sera inutile. Par contre, discuter avec son médecin de ses points faibles que l’on veut renforcer, et des moyens que l’on veut se donner pour am

Main points
Unequivocal support for vaccines (examples of tetanus and yellow fever)
Criteria for good vaccination
The degree of difficulty increases incrementally: (1) Against viruses, bacteria and parasites, and (2) For chronic diseases (examples: TB, HIV/AIDS, malaria)
Progress in empirical. Examples: Big for conjugated vaccines but small for adjuvants
Strong and fast immunity induced by a germ translated into very good vaccines (examples: tetanus, diphtheria)
Future: Molecular ecology of human-germ interaction
Problem of misinformation on the internet (examples: aluminum hydroxide, measles)
International vaccination requirements protect first and foremost a country not the individual
Mass vaccination and COVID-19
Speed of action to produce the vaccine was worrisome for some people
Live attenuated vaccine would have been “universal” and not variant-specific like with the spike protein but less efficient
The vaccine winner was the fastest and easiest to manufacture (1 week on the computer / Available in 6 months)
Nationalism, politics and capacity to conduct clinical trials and of production played a role in the choice of the technology
RNA vaccines have been known for years 
Variants are selected by immunity pressure coming from mass vaccination and immunity gained from infection (asymptomatic or not)
Possibility of the emergence of more virulent strains: Usually, in a pandemic the evolution is toward less pathogenic mutants 
Low mortality in Africa may be due to protective immune cross-reaction between the COVID-19 virus and coronaviruses causing seasonal rhinitis (4 different types)
The current vaccines protect much more against death and severe forms of the disease than infection
One should stop talking about antibodies
A “universal” vaccine would take 3 years to develop
There is a need for both vaccines and antiviral drugs
Malaria
5,800 parasitic molecules. Over 30 years, 20 have been studied. Only 5 in details
Usual approach: hypothesis verified by studies (examples: GPI-anchored and surface proteins). All the studies failed. In the global North they used models with rats. However, for example, malaria mortality is 0% in African tree rats but when a vaccine-candidate is studied in lab mice mortality is 100%. Similarly good results in animals do not translate into the same in humans 
Other approach based on reality and molecular ecology 
Vac4All studied 12 molecules that have shown no antigen variation
Vaccine results with children in Mali and Burkina Faso have been encouraging (good efficiency and good tolerance)
Immunogenicity has been increased with adjuvants
Trials have been almost completed in adults 
BIO
Dr. Druilhe is a physician, immunologist, parasitologist, inventor and entrepreneur. He started his research career at the Department of Tropical Medicine of the Pitie Salpetriere Hospital, where he initiated many first-of-a-kind malaria research experiments, including the first cultures of the pre-erythrocytic stages of the malaria parasites, characterization and cloning of P. falciparum liver stages antigens, and the investigation of natural immunity to malaria blood stages through passive transfer of African adult immunoglobulin in Thai individuals with malaria. 
For over 20 years (1987-2011), he led the Laboratoire de Parasitologie Bio-Medicale at the Institut Pasteur in Paris, France, where he pursued his scientific strategy of analysis of immunity to malaria in humans and where he and his team made major discoveries, identified novel mechanisms, not foreseen in animal models, and important molecules believed to be responsible for malaria immunity in humans.
His work covers the wide breadth of vaccine research and development, including involvement in the organization and conduct of 8 vaccine clinical trials. He has authored around 330 Scientific Publications and holds more than 23 patents on inventions.
His main scientific interests have been and remain the analysis of host-parasite immune i