Response to Lancet Editorial

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Press Release: Lancet Editorial Misinterprets Key WHO Data

The US Global AIDS Plan

June 19, 2009

PRESS RELEASE
Contact: Asia Russell, +1-267-4752645 or asia@healthgap.org

HEALTH EXPERTS TO MEDIA AND POLICY MAKERS:
Lancet Editorial Misinterprets Key WHO Data

New York: The World Health Organization (WHO) is releasing data in the coming days that demonstrate the impact of “global health initiatives” such as the Global Fund to fight AIDS, Tuberculosis, and Malaria, the U.S. PEPFAR program, and GAVI on health systems in developing countries.

Preliminary data was included in a 36-page article will be published in the June 20 issue of The Lancet; more detailed and up-to-date, multi-country studies are being presented in Venice at a WHO meeting 22-23 June. Many health experts, however, are baffled by the misinterpretation of that data by the very journal in which some of these preliminary data were published.

Overall, the results of the “Maximizing Positive Synergies Project,”-a project bridging people accessing healthcare in the poorest parts of the world, frontline implementers, academics and policy makers-reveal ambitious scale-up of interventions that have likely saved millions of lives, from increased coverage of malaria prevention efforts to immunization interventions, to aggressive scale up of AIDS treatment. There are also promising signs of positive benefits to broader health systems. The project will make policy recommendations about how GHI funded programs can maximize the positive benefits to health systems overall and reduce the occurrence of unintended negative effects.

The Lancet editorial accompanying the piece, which will also be published June 20, however, seems to conflate lack of conclusive data with some negative results. The editorial suggests that the failure of the GHIs to solve every development problem that exists, including poverty-related disease burden, pre-existing weak health systems, and governments' weak capacity means that GHIs are not effective. In other areas, experts were confused as the Lancet editorial has simply made statements at odds with the data presented.

“The Lancet editorial misrepresents basic data—if policy makers simply read this editorial it would suggest a course of action not borne out by evidence,” said Dr. Jen Cohn, Director of the University of Pennsylvania's Global Health Equities Program, who worked with grassroots civil society organizations in Kenya, interviewing hundreds of patients, health care workers and civil society implementers as part of the project. "This editorial seems out of touch with people on the ground who have benefitted from the resources of GHIs and who are advocating to improve the positive health systems effects of these programs." Dr. Cohn continued.

For example, the editorial states that GHIs are causing “steepening inequalities in health services,” when the article states: “Data show an overall trend of improved equity in access and outcomes for GHI-targeted interventions" and goes on to explore the causes for this positive effect on equity. "Editorial perspective is by definition somewhat subjective," said Dr. Cohn. "But editorial perspective that contradicts much of the assembled evidence--that's concerning."

Health experts are calling for a retraction or correction of The Lancet's editorial to ensure that readers are not misguided. They also urge a close reading of the wealth of underlying data that supports smarter and expanded programming to fight priority diseases while simultaneously strengthening underlying health systems.

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