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Katie Hamilton

The Economic Burden of Neglected Tropical Diseases: What Trachoma Can Teach Us

This blog, the final in a 3-part series written by Costello Medical Consulting, focuses on the estimated economic burden of trachoma. This neglected tropical disease (NTD), caused by repeated bacterial infection of the eye, is estimated to leave one person blind every 15 minutes. International work highlighting the importance of tackling this infectious disease has led to adoption of a simple yet effective control strategy, which reduces the prevalence of trachoma by treating those affected and reducing transmission by improving sanitation. Here, we discuss the potential of this intervention tactic to not only decrease the prevalence of trachoma, but to also provide benefits that help reduce the global burden of other NTDs.

Trachoma is one of the top ten most common blinding diseases [1] and the leading cause of preventable blindness worldwide [2]. One person is left with severe sight loss every four minutes due to the damage caused by trachoma infection; four people are blinded by the disease every hour [3]. Endemic in more than 50 countries worldwide [1], trachoma has been classified by the World Health Organisation (WHO) as one of 17 neglected tropical diseases (NTDs). Its cause is infection of the eye surface by the bacteria 

 [1]. Recurrent infection leads to painful in-turning of the eyelashes (trichiasis), which, if left untreated, scratch and subsequently scar the eyeball, resulting in the cornea becoming opaque and, ultimately, blindness [1,4]. The bacteria are readily transmitted through infected discharge – therefore the disease can be spread through shared items such as towels, as well as by eye-seeking flies [4]. People that live in crowded conditions and with poor sanitation are particularly susceptible to the spread of trachoma [5]. This means that the disease burden, in terms of human suffering and reduced quality of life for those infected, their families and wider communities, is shouldered by some of the world’s poorest populations [2].

In addition to prevalence and impact on quality of life, the burden of a disease can also be measured in terms of monetary losses, referred to as economic burden of a disease. Estimating the economic burden of different diseases is useful when resources and funding for health interventions are limited, as it allows the cost-effectiveness of proposed control strategies to be evaluated in monetary terms.

To understand the economic burden of NTDs, we searched the key sources of health-related publications, including PubMed, the WHO and Cochrane websites, using a combination of disease-related and economy-related search terms. Disease-related search terms included all of the 17 NTDs, as defined by the WHO [6], and economy-related search terms such as ‘burden’, ‘cost’ and ‘employment’. Diseases with inexpensive treatments that affect the largest populations were prioritised. In total, we found 282 articles reporting on the economic burden of NTDs in developing countries, which we then divided by disease area. The 12 resulting articles on trachoma were used as basis for this review.

A number of studies presented estimates of the occurrence of trachoma at various scales - individual countries, continents and worldwide. One study estimated that, globally, trachoma is the cause of blindness in 1.3 million people and trichiasis in a further 8.2 million [1]. It is thought that 110 million people live in areas where trachoma is endemic [2], including Pakistan, Senegal, Nepal and Fiji [3], and are therefore at risk of contracting the disease. Within these endemic areas, 4.6 million people already suffer with late-stage-trachoma and will require surgery to prevent blindness. Worryingly, a further 210 million people currently live in areas where trachoma is suspected, but not confirmed [2].

Some of these studies converted the disease prevalence into health burden, measured in disability-adjusted or handicap-adjusted life years (DALYs, which are a measure of healthy life-years lost due to disability and mortality; or HALYs, which are a measure of years lived in a handicapped state and mortality); others used the prevalence data to calculate the economic burden of trachoma. The global estimate of the health burden of trachoma was 80 million HALYs [7]; the estimated economic burden was $2.9 billion [8]. The geographic distribution of trachoma infection is very patchy, with 80% of the global burden concentrated in only 14 countries [2], and 97% of the burden of Latin America and the Caribbean found in Brazil alone [9]. Perhaps unsurprisingly, NTDs have been shown to have particularly high prevalence in conflict and post-conflict countries, for example trachoma in Sudan, Mali and Niger [10].

Generally, estimates of the burden of trachoma vary considerably between different reports [1], most likely due to the fact that prevalence figures are not consistent between studies; and there seems to be no standard conversion method to generate estimates of human or economic burden. Accurate estimates of disease burden are therefore difficult to generate. However, even if not completely accurate, estimating the disease burden is undoubtedly useful, as it allows assessment of the cost-effectiveness of disease control or elimination strategies and provides decision makers with additional information to help prioritise healthcare interventions.

An innovative strategy which targets trachoma from both a medical and a socioeconomic angle [11], ‘The SAFE Strategy’ (

nvironmental change), is endorsed by the World Health Foundation [3]. The potential of SAFE has been demonstrated in Morocco, where the prevalence of trachoma has been reduced by 75% since its implementation in the late 1990s, and complete elimination of the disease has been achieved in some provinces [11]. This is by no means an isolated case - a further 9 countries, including Ghana, Vietnam and The Gambia, have reported meeting their targets towards the elimination of blinding trachoma [3]. The total cost of implementing the SAFE strategy in all remaining known endemic countries is estimated to be $430-$748 million [3], which is less than a third of the estimated overall economic burden of trachoma.

An alliance of interested parties, led by the WHO, has set the target of the 

 elimination of trachoma for 2020 (GET2020). Pfizer, a major pharmaceutical company, has committed to help. They have donated over 225 million doses of azithromycin (an antibiotic) to date [12], allowing the treatment to cure or prevent trachoma for 48.8 million people [13]. However a 2012 review suggested that lack of funding may still be a barrier to achieving the GET2020 goal [14]. Interestingly, the authors of this review estimated that diverting just 10% of the funding allocated to the treatment of the ‘Big Three’ diseases (tuberculosis, HIV and malaria) to NTDs would allow the achievement of the GET2020 goal [14].

As the occurrence of NTDs is so often linked to the living conditions in poor rural communities, it is likely that any healthcare interventions introduced will contribute to the decrease of more than one disease simultaneously. For example, it has been suggested that the framework set up to provide treatment for onchocerciasis (another NTD, which also causes blindness) can also be used to distribute azithromycin, or any other drug [11]. Therefore, if NTDs are considered individually, the effectiveness calculated for interventions may well be underestimated. In many cases, it will be more appropriate to consider the reduction of the burden of 

 diseases when calculating the cost-effectiveness of a single intervention strategy.

Overall, it is clear that NTDs, such as trachoma, cause immense human suffering and remain a serious impediment to poverty reduction and overall socioeconomic development [15]. Our research into trachoma, as well as onchocerciasis and cysticercosis [16, 17], has shown that these NTDs each impose a significant economic as well as health burden on affected communities. Although there has been much progress in tackling this global problem by introducing control measures, such as SAFE, continued strategic investment is necessary if the targets for the reduction and eradication of these diseases are to be met.

By Katie Hamilton and Julia Bardos, working pro bono on behalf of 

, with a wider team at Costello Medical Consulting

1. Burton M and Mabey D. The Global Burden of Trachoma: A Review. PLoS Negl Trop Dis. 2009;3(10):e460 2. International Trachoma Initiative: Trachoma Overview. 

http://trachoma.org/world%E2%80%99s-leading-cause-preventable-blindness

 3. International Coalition for Trachoma Control (ICTC): The End In Sight-2020 INSight 4. WHO: Prevention of Blindness and Visual Impairment-Priority Eye Diseases. 

http://www.who.int/blindness/causes/priority/en/index2.html

http://www.who.int/neglected_diseases/diseases/en/

 7. Evans T and Ranson M. The Global Burden of Trachomatous Visual Impairment: II. Assessing Burden. Int Ophthamol. 1995-1996;19(5):271-80 8. Frick K, Basilion E, Hanson C and Colchero M. Estimating the Burden and Economic Impact of Trachomatous Visual Loss. Ophthalmic Epidemiol. 2003;10(2):121-32 9. Hotez P, Bottazzi M, Franco-Paredes C et al. The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination. PLoS Negl Trop Dis. 2008;2(9):e300 10. Hotez P. The Neglected Tropical Diseases and Their Devastating Health and Economic Impact on the Member Nations of the Organisations of the Islamic Conference. PLoS Negl Trop Dis. 2009;3(10):e539 11. Jamison D, Breman J, Measham A, et al. Priorities in Health. The World Bank, 2006. 12. ICTC: GET2020 

http://www.trachomacoalition.org/about-us/get-2020

 13. WHO: Global Health Observatory: Trachoma Situation and Trends 

http://www.who.int/gho/neglected_diseases/trachoma/en/

 14. Fenwick A. The Global Burden of Neglected Tropical Diseases. Public Health. 2012;126(3):233-6 15. WHO: Neglected Tropical Diseases. 

http://www.who.int/neglected_diseases/about/en/

 16. The Economic Impact of Cysticercosis (Blog). 

https://www.givingwhatwecan.org/blog/2013-12-17/the-economic-impact-of-cysticercosis

 17. The Economic Impact of Cysticercosis (Blog). 

Francesca Day

How I Started Taking Charity Seriously

I've always liked to think of myself as I nice person. I helped my friends with their homework. I volunteered at a homeless shelter. I gave money to charity. Surely I was as ethical as it was possible to be? I have always believed that all of us are fundamentally equal - surely we all believe that! We all have the same right to freedom, health and education. Because of this conviction, I gave money to charities that helped those living in extreme poverty. All was right and proper, and I enjoyed my privileged life relatively untroubled by guilt. I was part of the solution, after all.

A few months ago, I started thinking about things differently. Did I really believe that a child in Ethiopia dying of malaria was equal to me and my friends? Of course I did - any other position would be awful. Was I acting like it? Absolutely not. If I really believed that child was my equal, I would be doing everything I could to help them and others living in such suffering. Not donating a small amount of money to a randomly chosen charity then forgetting about them.

This realisation took a while to sink in. I didn't want to change my lifestyle or admit that I had been so wrong. I made a lot of excuses to myself. I'm only a poor student, what can I do? There are richer people who don't give anything to charity at all! I'm already doing my bit. In the end, none of these excuses convinced me. I had the power to help so many more people in such desperate need at very little cost to myself. How could I justify not using it for a second longer? I came to the conclusion that if I was as "nice" as I claimed to be I needed to give more to charity. Much more. And I needed to think hard about which charities would help the most people with my donations, not just choose one based on an advert I saw in the Big Issue.

There is a community of people who have reached the same conclusion - Giving What We Can. 

 to give at least 10% of our income to the organizations we think will use it most effectively to help people living in the developing world. By today's standards, giving this much as a "normal" person (i.e. not a millionaire) is almost unheard of. But there is no escaping our duty to those born into extreme poverty. I hope that, through the work of Giving What We Can and similar organisations, more and more people will start to give more and give more effectively. I hope that we could be the generation to end global poverty.

Pledging to give 10% might be the most important decision I will make in my life. Whatever else happens, I will save and elevate countless lives - the lives of those who most need my help. That's worth giving up a few lattes.

This article originally appeared on Huffington Post UK on 10 February 2014.

Giving What We Can

Donating vs. Investing

An important question for those of us who intend to do good by donating to the most effective causes is whether we should donate now, or whether we should first invest our money with the intention of donating more (the invested money plus the returns accrued in the meantime) later. This is an overview of the most important considerations. We also have an older report on this topic 

The most obvious reason for delaying donations is that you can expect the invested amount of money to grow (exponentially) over time.

For example, assuming an average rate of return of 5%, you could turn every dollar you donate today into 10 dollars you could donate in 50 years’ time, which would mean (assuming the same donation opportunities are still around in the foreseeable future) that you could have more than 10 times as much impact with the money you save today.

2) Getting better at identifying the best interventions

A further consideration in favour of delaying one’s donations is the prospect of an improvement in one’s ability to identify the best donation opportunities.

In this context, we must bear in mind that cost-effectiveness research is in its infancy. GiveWell and Giving What We Can, the main cost-effectiveness evaluators out there, were created as recently as 2006 and 2009 respectively, and Giving What We Can has only started hiring paid staff in the summer of 2012. Accordingly, it is only reasonable to expect that GiveWell and Giving What We Can will get better at identifying the best interventions.

In fact, we already know of charities that may conceivably turn out to be more effective than AMF but need further investigation, such as the advocacy charity RESULTS.

3) New donation opportunities in the future

Waiting with our donations may be a good idea not only because we don’t know what the most cost-effective interventions are of those presently available, but also because the best donation opportunities may still be waiting to be created.

To take a concrete example, according to DCP2, promoting hand washing with soap was one of the best interventions they investigated. But at the moment it is not clear that there is a particular charity that implements this sort of intervention in a way that makes it an effective donation opportunity. However, such a charity could conceivably be established in the future and would be an excellent option for your donations.

Holding back a large sum of temporarily invested money that you can use for altruistic purposes when you wish to also allows you to create incentives for desirable action on behalf of potential recipients of these funds.

To some extent, meta-charities like GiveWell are already in a similar position. For instance, GiveWell’s ability to direct a considerable quantity of donations by changing its recommendations puts it in a strong position to demand evidence about their cost-effectiveness from charities. This in turn leaves all of us in a better position when we come to decide where to donate. Similar effects could be achieved through the creation of a large “effective altruism fund” by those who decide to invest for now (with the aim of donating later).

Such a fund could also incentivise the creation of new organisations (e.g., to use the example above, a new charity dedicated to hand washing) and thereby open up a promising donation opportunity that would otherwise not have existed at all.

5) The potential benefits of being able to make “lumpy” donations

Whilst it is plausible that typically, the benefits each dollar given to a charity generates diminishes marginally (given that the charity, if rational, spends the “first” dollars it receives from you on what it considers most important, and “later” dollars on measures it considers a bit less important), there are conceivable scenarios in which you can do considerably more good once your donation reaches a certain critical magnitude.

For instance, you could imagine a case in which an organisation considers extending its operations to a new region where the intervention they implement would be exceedingly effective, but in which this very promising project could only get off the ground if they received a certain critical sum of donations

In that case, it may be that if you had invested rather than donated your money over several years prior to this, or if you were even part of a group of smart donors who invested their money in the previous years, you could choose to provide this critical amount of donations, whereas had you donated rather than invested in previous years, you could only make a much smaller, subcritical and thereby much less effective donation.

6) Predictably higher taxable income in the future

There is further reason to delay one’s donations in the special case in which one can foresee that one will fall in a higher tax-bracket in the future and thereby predictably receive greater tax deductions on one’s delayed donations. Students are typically faced with this situation.

Interestingly, just as the returns on your investment would compound over time, donating to a charity now may also yield compounding benefits.

In the case of donations to global poverty charities, the benefits that accrue to those immediately helped by a particular intervention (e.g. those freed from intestinal worms by one’s donation to a deworming charity) also compound at a social rate of return. The idea here is that the direct benefits of the intervention (e.g. improvement of an individual’s health) lead to societal knock-on benefits that compound over time (e.g. increased productivity and likelihood to reproduce, which may themselves have beneficial economic and non-economic spill-over effects on the rest of society).

A further compounding effect of donations in general is that your donations (if made in the right way) may attract further donations by other donors. For example, in GiveWell’s post on the Giving Now vs. Giving Later problem, they stress that more donations made through GiveWell’s website support the organisation’s success, allowing it to move more money to highly effective charities in the future.

2) The best donation opportunities disappear

A further consideration in favour of giving now is that the best opportunities to do good through our donations might cease to exist in the future.

On the positive side of things, the best opportunities in a given area might firstly cease to exist because the main problems in that area have been solved. For instance, it is plausible that in fifty years’ time, global poverty will be much less of a problem than it is today, and that consequently, there will be far fewer excellent projects to fund.

Secondly, even during the time in which global poverty is still roughly as big a problem as it is today, it may (hopefully!) happen that other donors become more rational in their giving, or simply give more, and thereby reap much of the “low-hanging fruit”. In fact, we can already observe this latter effect happening today. For example VillageReach, GiveWell’s former top-rated charity, received over $2 Million as a result of GiveWell’s recommendation and it now looks as though it no longer has room for more funding.

In response to this second point, one might worry why, if a given donation opportunity is going to disappear in the future because it will be taken care of by other rational donors, it is a good opportunity now. For in such a case, it might seem that you merely move the benefits of the donation (which would accrue independently of who made it) forward in time. (Of course, this may still have significant benefits due to compounding effects, although we would then be considering a different argument.)

Whilst this worry can be justified in particular cases, it will typically be rendered moot by the fact that when the best opportunities get "filled up" by other donors later on, different individuals will be helped from the ones we could help were we to donate to the intervention in question now. These latter individuals would then go unhelped if we didn’t donate now. As a result, by donating before a donation opportunity gets “filled up” by other smart donors, we are not just moving the benefits of those donations forward, but are actually generating additional benefits for additional ("earlier") people.

On the more pessimistic side of things, it is worth bearing in mind that if you choose to invest for now, you may also be detained from giving to effective causes later on e.g. because their investments are eliminated (perhaps as the result of collapse of the financial system). However, these risks should of course already be incorporated when evaluating the prospective return of your investment

3) Following through with your plan to donate

In contrast to investing now, which (at least on the default way of understanding this proposal) leaves open the possibility that you won’t donate your money later on despite sincerely intending to do so now (e.g. because you change your mind later on), donating now obviously allows you to ensure that you follow through with your altruistic plans to donate a significant proportion of your income at least up to the point at which a potential change of mind occurs. Donating now can be seen as a precommitment strategy like pledging

However, an attractive variant of the approach of investing for now with the aim of giving later that must be mentioned in this context is investing your money in a donor-advised fund (DAF).

Money that is paid into a DAF is tax-deducible, and donors can decide how the fund should invest and to which organisations the fund later distributes the money they have paid in. As investment in a DAF is irrevocable (in the sense that once the money is paid in, it can only be paid out to organisations that are officially recognised as charities and not to the donors themselves), it is an effective way (as effective as donating immediately) of “tying yourself to the mast” of using your money for altruistic purposes.

Unfortunately, it may happen that some of the most effective organisations in the future will not enjoy charity status (or at least not during the initial stages when donations to them are arguably particularly effective), and that as a result, you would have to forgo the possibility of donating to such causes were you to invest in a DAF.

This problem could be sidestep by investing, for example, in a fund other than a DAF, and legally binding yourself to donating the money in that fund either to a charity or to an organisation that is approved by an external body that can grant proposals for donations to non-charities. We are currently investigating the best ways of implementing this idea.

Clearly, the more people work together on solving poverty, the better we will be able to do in this area. As a result, when deciding whether to donate or invest with the intention of donating later, you may want to take into account the effect this decision has on your ability to convince others to join the fight against global poverty.

Donating rather than investing with the intention of giving later is arguably advantageous in this regard.

Firstly, investing money with the intention of donating it later may provoke the suspicion that you are really just keeping open the back-door of using the money for non-altruistic purposes later on in case you change your mind.

Secondly, if you were to invest without somehow binding yourself to donate the invested money later (e.g. by investing in a DAF), you would not count as fulfilling the Pledge to Give, and hence would hence forgo the benefits of being a “pledger”.

Although adopting a DAF-scheme, given the irrevocable nature of an investment in a DAF, would arguably overcome these problems, people may still find the idea of stockpiling money in order to do good very counterintuitive.

On the other hand, being able to explain the rationale behind giving to a DAF is a good opportunity to signal that you have very thoroughly considered how to have the most impact with one’s donations.

5) Does the reasoning in favour of investing lead to paradox?

Finally, it might appear that (provided certain background conditions, e.g. that the best giving opportunities are sufficiently unlikely to disappear during that year, the risk of not following through with your plan to donate sufficiently low etc., hold for the indefinite future) the reasoning behind investing rather than donating implies that you should defer donations indefinitely. But this is conclusion would be absurd, because no good would be done if you never actually donated your money, and hence the reasoning in favour of investing would have to be rejected.

Here it is firstly important to stress that the relevant conditions clearly won’t, assuming they hold at all, continue to hold even just for the foreseeable future. For example, the time window during which there are highly effective charities in the field of global poverty will lapse at the latest when global poverty is eliminated.

Secondly, whilst in cases like the highly idealised scenario in which donation opportunities never disappear, the risk of not following through with your plan to donate etc. raise some tricky technical issues, philosophers have studied these in some depth and appear to have come up with responses that can be used to successfully defend the reasoning behind investing now against this objection.

In essence, the crucial thing to realise in this context is that there can be cases in which there is no such thing as a best option, and this is the feature that makes cases like this paradoxical. In this case, whilst the later you give, the better (because the later you give, the more returns your investment will have accrued when you come to donate), it is not the case that the best option is to defer your donations indefinitely. The rational strategy to adopt in such cases, it appears, is to choose an arbitrary stopping point that lies a finite number of years into the future at which you stop investing and donate. However, as mentioned above, such paradoxical scenarios won’t obtain in practice. For those interested in this sort of technical issue, see Arntzenius et al. (2004).)

There is a particular way of donating now that is worth discussing in more detail in the context of the donating vs. investing issue, as it combines the benefits of giving now with many of the benefits associated with investing one’s money with the intention of donating later, namely that of donating to a “meta-charity”. (By “meta-charity”, I mean an organisation like GiveWell or the Disease Control Priorities Project (DCPP) that can redirect and/or generate future streams of donations by recommending causes to other donors and/or by building a community of people concerned with effective giving.)

A distinctive attractive feature of the idea of donating to a meta-charity stems from the fact that it is in some sense analogous to investing in a DAF. The idea behind investing in a DAF is (as explained above) that the money you pay into the DAF (on which you get a tax deduction) accumulates returns, and you can later decide to channel it into whatever you consider the best charity at that time.

Similarly, your donations to a meta-charity (on which you get a tax deduction, provided the meta-charity enjoys official charity-status), insofar as they help to make the meta-charity more successful, accumulate returns in the form of an increase in the future stream of donations which the meta-charity can channel into whatever it considers the best cause.

To the extent to which the donations the meta-charity in question can redirect lie in the future, giving to a meta-charity now would, much like investing in a DAF, seem to allow one to reap these informational benefits associated with donating later, i.e. the benefits due to the fact that we can expect to have better information concerning interventions’ cost-effectiveness in the future.

However, it is worth stressing that giving to a meta-charity allows one to reap these informational benefits to the extent to which i) the meta-charity is capable of assessing future information about the cost-effectiveness of different causes and ii) it is free to redirect donation streams in the light of such information.

Moreover, analogously to the case of donating to an ordinary first-order charity, there may be reasons to delay your donations to a meta-charity on the grounds that you have reason to expect that we will learn of much better meta-charities in the future that either already exist or are yet to be created. In addition, even if there isn’t a better (actual or potential) meta-organisation out there that we have so far overlooked, it appears very plausible that the next years will bring with them a great amount of valuable information about the relative merits of the different models different meta-organisations (e.g. GiveWell and Giving What We Can) implement.

It is worth noting, however, that growing a particular meta-charity now may be a very good way of generating additional resources of the new best meta-charity that is yet to be created/identified. For it may be that a promising meta-charity can direct a fraction of the donation streams it can affect to other meta-charities in the future, should the evidence mount that these are particularly cost-effective. If this fraction is sufficiently large, and your donation to the meta-charity now has a sufficiently significant effect on its future donation streams, giving to this meta-charity now may still be a better option than investing, even if you think that it is very likely that we will be able to identify better meta-charities in the future.

As we see strong arguments on both sides, the donating vs. investing issue is one we are planning to investigate in greater depth.

We think that the case that can be made (based, among others, on the considerations outlined above) for donating to meta-charities is sufficiently strong on the face of it that we have begun to work on assessing the cost-effectiveness of meta-charities and have a detailed analysis of DCP3 as a cause to give to.

Carolina Flores

Can you trade away health?

The TPP (Trans-Pacific Partnership), a trade deal under negotiation now, aims to enforce strong intellectual property laws in 12 countries in the Asia-Pacific region which may seriously affect health provision. The suggested laws will make access to generics harder and increase the price of treatment for those who can't afford it. This sets a negative precedent in negotiation and may cause a lot of damage to aid programmes, which often rely on affordable drugs to reach out to as many people as possible.

Amongst the measures of the TPP, the following might be particularly harmful:

. This means that pharmaceutical companies will be able to extend monopoly protection by obtaining patents for modifications of existing drugs, delaying access to generic drugs.

. Patents cannot be challenged until they have been granted. This delays access to medicines and makes it harder to challenge patents.

 Regulators can't use existing clinical data to give market approval to generic drugs. This allows pharmaceutical companies to keep prices high for longer.

All of this is expected to have a particularly dramatic effect in Vietnam, where 0.5% of the population is infected with HIV, Tuberculosis is on the rise, and malaria is prevalent. The country has relied on foreign aid and needs appropriate access to cheap medicines to provide treatment for these diseases. The TPP might jeopardize the chances of success of international aid programmes to the country, by making it much more expensive to provide healthcare. This is a pretty big problem in a country where 12% of the population still lives below the poverty line.

PhARMA - which represents large companies such as Pfizer and GlaxoSmithKline - has been lobbying the US government to make sure that the TPP goes ahead. It argues that intellectual property protections are not a problem compared to scarcity of hospitals and doctors. It also claims that strong patent protection offers an incentive for investments in areas that may benefit developing countries, such as drug delivery system suitable for high temperatures and humidity, and that it protects against the distribution of counterfeit products, which is a large problem in some areas.

The next round of negotiations on the 12-nation trade agreement backed by the US, is expected to take place next week in Singapore.

http://www.ft.com/cms/s/0/606fcb32-efc7-11e2-8229-00144feabdc0.html#axzz2t6MNKeTz

http://www.msfaccess.org/about-us/media-room/press-releases/trans-pacific-trade-talks-accelerate-vital-lifeline-affordable

http://www.bloomberg.com/news/2014-02-11/tpp-talks-on-artificial-timeframe-u-s-ambassador-wagar-says.html

Internship opportunities at Giving What We Can

We are currently looking for interns to join our Graduate Volunteer Scheme. This involves a period of several months' work in our Oxford-based office. Work will be varied, and prioritised by the most pressing needs in the six month plan. We are also taking applications for our two-week student development programme in September. All candidates would ideally be intelligent and hardworking, and motivated by the idea of contributing to our mission of inspiring donations to the most effective charities fighting extreme poverty.

Taking up a graduate volunteer position is a great way to gain experience for your future career as well as meet and work with a diverse range of fascinating and motivated people at the same time. There is a large amount of job flexibility, meaning that you can work on whatever is most useful and will develop your skills in a good way. It is also a great way to do good and make a positive impact.

See below for more information; details are also available on our 

Long-term internships on our Graduate Volunteer Scheme

We run a Graduate Volunteer Scheme on which you can intern with us for several months. We can often provide accommodation and expenses to ensure that you're not left out of pocket. As a Graduate Volunteer, there are lots of different areas to work on, and there's plenty of flexibility to adjust the role so it plays to your strengths and development aims. We make it our responsibility to ensure your time here allows you to grow as much as possible, as well as just being lots of fun! We're looking for hardworking individuals with a strong desire for personal development who are deeply interested in making the world a better place in an effective way.

The scheme has proved very popular with our current interns, with a stimulating and dedicated atmosphere in the office and a lively and welcoming community outside office hours. Perhaps the strongest evidence of this is that many have extended their stays repeatedly. Once you have applied, we are happy to connect you with a current intern to discuss what it's like to work with us. Read more about why it's great to work at CEA 

Your chances of being offered an internship are greatly increased if you can secure your own funding, for example through scholarships and fundraising.

. If you would be interested in interning with us, please 

https://docs.google.com/forms/d/1Nr-D7DEyDOhcPrsJl72lxdqULiboq8mkOi9kPSQkdXI/viewform

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