121 e-Letters

  • Letter to the editor: “Conference equity in global health: are online conferences a solution?"

    Lotta Velin1,2, Ulrick Sidney Kanmounye1,3, Michelle Nyah Joseph1,4

    1. Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
    2. WHO Collaborating Center for Surgery and Public Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
    3. Department of Neurosurgery, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic of the)
    4. Warwick Clinical Trials Unit, Warwick Medical School, Coventry, West Midlands, UK

    Correspondence to: Dr Michelle Nyah Joseph; Michelle_Joseph@hms.harvard.edu

    We want to congratulate Phan et al. on their thoughtful analysis of our article “Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences” (1). Phan et al. are addressing inequities in global health conferences. This is evidenced by their inspiring work with transitioning the Global Women’s Research Conference (GLOW) from a physical to an online event. It is clear from Phan et al. recount that the transition helped increase access and equity to a major global health conference. We agree with the authors that such a strategy can help address many of the barriers we identified in our systematic review.

    Prior to 2019, some global health events offered an online component; however, none of the major global health conferences hel...

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  • Using early BCG vaccination to reduce mortality among low-birthweight neonates

    In this systematic review and meta-analysis of evidence-based interventions to reduce mortality among preterm and low birthweight (LBW) neonates in low-income and middle-income countries, the implementation of four effective interventions in current WHO guidelines is encouraged: cord and skin cleansing with chlorhexidine, community kangaroo mother care, home-based new-born care and early Bacille Calmette-Guérin (BCG) vaccination.

    Regarding BCG vaccination, the authors identified two randomised controlled trials (RCTs) of BCG-Denmark vs. no-BCG to LBW neonates and estimated that providing early BCG reduces neonatal mortality by 36% (14% to 52%). In addition to the two trials, a small RCT of BCG-Denmark to LBW neonates reported an effect estimate of 0.28 (0.06 to 1.37).[1] In a combined analysis of the three datasets, providing early BCG-Denmark to LBW neonates at hospital discharge was associated with a 38% (17% to 54%) reduction in neonatal mortality.[2] Also, a recent Ugandan RCT of BCG-Denmark vs. no-BCG[3] found BCG-Denmark associated with fewer early-life infections, particularly for LBW, further strengthening the argument for using BCG-Denmark as an evidence-based intervention for LBW neonates.

    Many manufacturers produce BCG world-wide, and the genetically different BCG strains might not have the same effects on all-cause mortality. For example, two RCTs conducted in India evaluated the effects of providing BCG-Russia vs. no-BCG to a cohort of neonates...

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  • Conference equity in global health: are online conferences a solution?

    We congratulate the authors on their systematic review of conference equity in global health (1) and agree that this is a key step towards decolonising global health research. Their review identifies barriers and facilitators impacting attendance from low-and-middle-income countries (LMICs). The authors have identified many solutions to improve the equity of conferences but did not mention online conferences. These have rapidly become the norm during the COVID-19 pandemic and could offer a feasible solution. (2)

    The global pandemic forced the Global Women’s Research Society (GLOW) society conference to go online for the first time and it had dramatic impacts on the reach of the conference. We have run the annual UK-based GLOW conferences in global reproductive, maternal and new-born health since 2012, with a typical attendance of 70-140. In 2020, however, the pandemic forced us to pivot to an online conference. We fundraised £25,700 to provide the online platform and recordings, allowing free attendance for anyone from around the world. As a result, over 1300 people from 70 countries registered, with up to 1076 live views at one time. This works out at just £20 per registrant. During 2 days of the conference, there were a total of 3347 views, with 546 of those from LMICs. Additionally, there have been nearly 500 views of the videos on the YouTube channel since the September conference. We estimate costs of over £1,000,000 if all registrants and presenters had attend...

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  • The success of malaria digital dashboard is linked with development of basic health care infrastructure in rural/tribal areas

    We read the commentary by Rahi, M. et al., with great interest, about the need of digitisation of malaria surveillance data and its integration on a single digital platform for malaria elimination in India1. There is no doubt that digitisation of malaria surveillance tools and data will help patients, clinician, researchers, policy makers alike and ultimately may contribute in malaria elimination, if implemented timely and efficiently. However, the proposition of digital dashboard for collection, integration and sharing of data on malaria, though important, but seems a little far-fetched conjecture at this moment as majority of malaria cases are reported from rural/tribal areas with sparsely distributed health care and telecommunication infrastructure. The top ten tribal dominated states with a population of 36 % contribute about 73 % of total malaria cases2. The strength of healthcare workforce is poor in rural/tribal areas of India in comparison to the WHO minimum threshold of 22.8 per 10 000 population3. Further, there is strong need to strengthen the power (electricity), telecommunication and transport infrastructure in rural/tribal areas. Such healthcare environment in tribal areas increases the reluctance among tribal people for the public health care system and leads them towards quacks, traditional healers and nearby private practitioners. Further, this digital drive of healthcare system would require additional human resource, periodical training and digital infr...

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  • In reply to Pimenta

    Many thanks to Dominic Pimenta for the interesting comment. I respect Pimenta’s well-intentioned activism during the COVID-19 crisis, but here he polarizes the discussion between two schools of thought by using a strawman argument, i.e. that one of the two schools wants to promote high community transmission. Such strawman arguments are prevalent in social media and the blogosphere, but they do not serve scientific discourse for resolution of major questions. I have signed neither the Great Barrington Declaration nor the John Snow Memorandum, so I cannot become an insider apologist for either (1). However, my reading of both documents suggests that neither of them advocates to promote high community transmission. If they do, this is certainly not what I would personally advocate.

    Pimenta draws a correlation from 10 observations on the data that I present on nursing home shielding factors (my Table 3) reaching the conclusion that precision shielding is impossible under high community transmission. This is a precarious exercise with rushed conclusions. These are ecological, whole-country data including only 4 observations with high community transmission. Drawing firm causal inferences from an ecological regression with effective sample size of n=4 is impossible. Sadly, over-confident, stretched causal inferences are common during the COVID-19 crisis. A similar look at the age-stratified data on Table 2 shows that shielding of the elderly was achieved in countries w...

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  • Unlikely to be useful for future policy decisions.

    I don't think this research is particularly useful for policy analysis.

    Any analysis of leader's age, marital status or whether they had children?
    These are also likely to effect rhetoric.

    The short time period of the analysis also casts doubts on the validity of the study and usefulness of any conclusions.

  • On equity in authorship. Response to Dmitris et al.

    Dear Dr Abimbola,

    We read with interest the article ‘How global is global health Research? A large-scale analysis of tends in authorship’ by Dimitris and colleagues published in BMJ Global Health January 2021.1 The authors’ research highlights the slow progress in proportion of studies with any, first, and, last authors affiliated with a low- or middle-income country (LMICs), particularly in first and last authorship. The authors welcome and have called for a thorough discussion about the implications of these findings, particularly in identifying the barriers and facilitators to diversity in authorship.

    Reflecting on our experience of international research in infectious diseases and antimicrobial resistance we present here some of the barriers we have faced together with the solutions which we have identified. Recognising however, that addressing this inequity requires broader inclusion and participation from academic institutions, scientific journals and funders, we propose remedial steps at every level which will require a different approach to scientific research funding and communication.

    There is a culture and hierarchy within academia which manifests itself in the authorship order. It is accepted that the first leads the writing and last author leads the research with all authors contributing to the final manuscript. There are of course the guidelines from the International Committee of medical Journal Editors which clearly stipulate the rol...

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  • A successful demonstration of why 'precision shielding' is impossible with high community transmission

    The article is predicated on the notion that “The ability to preferentially protect high-risk groups in COVID-19 is hotly debated.” This is a mischaracterisation of the debate. The ability to protect high-risk groups has never been questioned.
    The debate would be better characterised as the ability to focus non-pharmaceutical interventions solely on those most at risk of severe disease due to COVID-19, and removing restrictions and allowing widespread infection amongst the low risk groups. The debate has only ever been between those who advocated only applying NPIs to the highest risk cohorts ("focussed protection") and those that advocate that community wide measures are the only effective means to protect those at highest risk.
    The stated aim of this paper is to demonstrate whether ‘precision shielding’ was achieved in the first wave, and invents a metric to compare incidence and death in the high risk long-term care population vs the low risk younger population. The author uses seroprevalence data from the elderly and the young to estimate infection prevalence, but takes no account of the differing antibody response that would largely confound this approach.
    Using these metrics the author then goes on to ascribe a value judgement as “substantial shielding” or “substantial inverse protection.” Care homes and institutions are already known to be at risk environments for the spread of infectious disease, due to the close contact care work, the m...

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  • Letter to the Editor Regarding Global health education in UK medical schools: a review of undergraduate university curricula

    I congratulate the authors who successfully conducted a survey on the current provision of global health education (GHE) in United Kingdom (UK) medical schools.1 Their findings are in keeping with a recent cross-sectional study into the timetables of UK medical schools.2 In the methods section of the paper, the global health learning outcomes and competencies surveyed were listed. However, global surgery was neither surveyed nor discussed in this paper.

    This occurred despite global surgery being added as a mandatory learning objective to the national undergraduate curriculum in surgery by the Royal College of England in 2015.3 Post 2015, GHE studies2 and study protocols4 have typically strived to ensure that global surgery is assessed within their study designs. This is particularly important as global surgery often becomes the ‘neglected stepchild of global health’.5 It is easy to see why given that approximately two-thirds of UK medical courses are reported not to cover this topic within their core curriculum.2 It is not in the best interests of the population for a subject of such importance to be ignored by global health researchers and educational institutions.

    Therefore, whilst it is encouraging that a study has been done with the aim of identifying gaps in GHE teaching in UK medical schools, the study design in and of itself has resulted in the researchers missing gaps.2 This exemplifies the importance of having a diverse range of stakeholders involve...

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  • A commentary on Global Health Security Index-A guiding tool for preparing for the next pandemic

    Introduction and Brief Overview
    The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR [2005])1. The GHS Index takes into account countries’ capability to prevent, detect, and respond to public health emergencies while also assessing the robustness of the healthcare system in each country. This index is comprehensive since it has the ability to consider political and socioeconomic risks, as well as adherence to international norms, which can influence countries’ abilities to stop outbreaks1,2. The GHS Index has been the creation of Open Philanthropy Project, the Bill & Melinda Gates Foundation and the Robertson Foundation1.
    The GHS Index treats biosafety and biosecurity as critical components of global health security. As such, the tool includes numerous indicators measuring country capacities and accounts for differences in priorities between high income and low/middle income countries. The GHS index is based on 6 categories, 34 indicators, and 85 sub-indicators. The six categories comprise prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment5.
    This article describes the practical value of the GHS Index and also explains how the methodology of assigning country ranks and scores is helpful in aidin...

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