World Health OrganizationSimilar to malaria in that it is transferred via mosquitos, yellow fever has killed millions and wiped out entire colonies and regions. This disease causes

B A C K G R O U N D G U I D E

V M U N 2 0 1 8

World Health Organization

Vancouver Model United Nations The 17th Annual Session | January 19 - 21, 2018

Dear Delegates, My name is Brandon Zhou and it is my distinct pleasure to be directing the World Health Organization (WHO) at VMUN 2018. I am currently in Grade 12 at St. George’s School and have been involved in MUN for several years. Model United Nations has shaped my perspective of the world, allowing for critical analysis of international issues and current events. Outside of MUN I am involved in volunteering, debate, and music. Being a General Assembly, the WHO will provide delegates with the experience of working and collaborating with a large group of like-minded individuals. My goal is not only to make this committee relevant to the events that take place in the world today, but also to deliver a committee that inspires stimulating and realistic debate. The two topics I have chosen this year present delegates with a multi-faceted outlook on health and medical services around the world: On the Ground Intervention During Medical Epidemics, and Black Market Medicine. These two topics capture health in both developed and developing countries, allowing all delegates to bring their own perspective into the issues at hand. I sincerely hope that you will enjoy your journey through these topics and are well equipped for the upcoming conference. I am excited to see you all in January and look forward to getting to know all the delegates whether it will be your first or fifth conference. If you have any questions, please do not hesitate to contact me, or speak with any of the Dais. Welcome to the WHO at VMUN 2018! Best of Luck, Brandon Zhou WHO Director

Ken Hong Secretary-General

Callum Shepard Chief of Staff

Jerry Jiao

Director-General

Andrew Wei Director of Logistics

Jadine Ngan USG General Assemblies

Eric Zhang

USG Specialized Agencies

Dillon Ramlochun USG Conference

Angelina Zhang

USG Delegate Affairs

Jerry Xu USG Delegate Affairs

Alan Chen

USG Finance

Meghna Lohia USG IT

Position Paper Policy

What is a Position Paper? A position paper is a brief overview of a country’s stance on the topics being discussed by a particular committee. Though there is no specific format the position paper must follow, it should include a description of your positions your country holds on the issues on the agenda, relevant actions that your country has taken, and potential solutions that your country would support. At Vancouver Model United Nations, delegates should write a position paper for each of the committee’s topics. Each position paper should not exceed one page, and should all be combined into a single document per delegate.

Formatting Position papers should: — Include the name of the delegate, his/her country, and the committee — Be in a standard font (e.g. Times New Roman) with a 12-point font size and 1-inch document margins — Not include illustrations, diagrams, decorations, national symbols, watermarks, or page borders — Include citations and a bibliography, in any format, giving due credit to the sources used in research (not included in the 1-page limit) Due Dates and Submission Procedure Position papers for this committee are highly recommended. To be eligible for an award, you must submit a position paper. The submission deadline is January 7th, 2018. Once your position paper is complete, please save the file as your last name, your first name and send it as an attachment in an email, to your committee’s email address, with the subject heading as your last name, your first name — Position Paper. Please do not add any other attachments to the email or write anything else in the body. Both your position papers should be combined into a single PDF or Word document file; position papers submitted in another format will not be accepted. The email address for this committee is [email protected].

Vancouver Model United Nations 2018 4

On the Ground Intervention During Epidemics ......................................................................... 7

Overview .................................................................................................................................................. 7

Timeline ................................................................................................................................................... 7

Historical Analysis ................................................................................................................................. 8

Tuberculosis ........................................................................................................................................................8

Yellow Fever........................................................................................................................................................8

Smallpox ..............................................................................................................................................................8

1918 Influenza Pandemic ..................................................................................................................................8

Ebola Virus in West Africa ...............................................................................................................................9

2009 Influenza Pandemic ............................................................................................................................... 10

Past UN/International Involvement .................................................................................................. 10

Role of the World Health Organization ....................................................................................................... 10

Sustainable Development Goal 3 .................................................................................................................. 11

International Health Regulations (IHR) 2005 ............................................................................................. 11

Global Outbreak Alert and Response Network (GOARN) ....................................................................... 11

International Coordinating Group (ICG) on Vaccine Provision ............................................................. 12

Other United Nations Bodies ........................................................................................................................ 12

Current Situation .................................................................................................................................. 12

Outbreak Control Mechanisms ..................................................................................................................... 12

Situation in Developing Countries ............................................................................................................... 12

Timeframe of Implementation of Vaccines ................................................................................................ 13

Scrutiny of Humanitarian Health Interventions ........................................................................................ 13

Humanitarian Intervention for Refugees .................................................................................................... 13

Control of Cholera Epidemics ....................................................................................................................... 14

Detection and Prevention of Malaria ........................................................................................................... 14

Case Study: Southeast Asia ............................................................................................................................ 14

Case Study: Sri Lanka ..................................................................................................................................... 14

Possible Solutions/Controversies ....................................................................................................... 15

Technological Solutions ................................................................................................................................. 15


Preventative Health Care ............................................................................................................................... 15

Community-Level Interventions .................................................................................................................. 15

Recognition of Outbreaks .............................................................................................................................. 16

Controversies of Health Interventions ......................................................................................................... 16

Proliferation of Vaccines and Medication ................................................................................................... 16

Outbreak Response Development ................................................................................................................ 17

Economic Issues with Current Interventions.............................................................................................. 17

Social Impacts of Interventions ..................................................................................................................... 17

Access to Basic Necessities ............................................................................................................................. 17

Use of Foreign Aid and Corruption ............................................................................................................. 17

Bloc Positions ........................................................................................................................................ 17

Countries with Strong Healthcare Systems ................................................................................................. 18

Countries Experiencing Epidemics .............................................................................................................. 18

Developing Countries and Countries in Poverty ........................................................................................ 18

Discussion Questions ........................................................................................................................... 18

Additional Resources ........................................................................................................................... 19

Bibliography .......................................................................................................................................... 20

Medical Black Markets ................................................................................................................ 23

Overview ................................................................................................................................................ 23

Timeline ................................................................................................................................................. 23

Past UN/International Involvement .................................................................................................. 24

Counterfeit/Black Market Drugs .................................................................................................................. 24

Methadone ....................................................................................................................................................... 24

Aleppo, Syria .................................................................................................................................................... 24

Iraq .................................................................................................................................................................... 24

SDG 3 ................................................................................................................................................................ 25

Current Situation .................................................................................................................................. 25

Organ Trade ..................................................................................................................................................... 25

Systemic Barriers ............................................................................................................................................. 25


Medical Records .............................................................................................................................................. 25

Case Study: Venezuela .................................................................................................................................... 26

Case Study: Canadian Black Market Clinics................................................................................................ 26

Case Study: China ........................................................................................................................................... 27

Case Study: Central and Eastern Europe ..................................................................................................... 27

Possible Solutions and Controversies ................................................................................................ 27

Technological Improvements ........................................................................................................................ 27

Ensuring Access to Medical Infrastructure ................................................................................................. 27

Prevention of Black Markets ......................................................................................................................... 28

Bloc Positions ........................................................................................................................................ 28

Countries that Lack Regulatory Resources .................................................................................................. 29

Countries Suffering from Overloaded Medical System ............................................................................. 29

Countries in Turmoil ...................................................................................................................................... 29

Countries with Forms of Universal Health Care ........................................................................................ 29

Discussion Questions ........................................................................................................................... 29

Additional Resources ........................................................................................................................... 30

Bibliography .......................................................................................................................................... 31


On the Ground Intervention During Epidemics

Overview

With an increase in epidemics and widespread diseases in both rural and urban areas, the World Health Organization must find an adequate way to deal with the problem, whether directly or indirectly. Often multi-lateral projects with the involvement of diverse member states, on the ground intervention during epidemics are becoming more challenging to manage logistically as the magnitude of outbreaks increase. The process of alerting other countries to infectious diseases and other outbreaks is in a state of constant improvement, but international cooperation is vital for continued success.

The International Health Regulations (2005) provide a framework for the epidemic alert system, looking specifically at disease surveillance, notification, and the reporting of public health events. This process involves the verification of such occurrences and risk assessments of epidemics. In addition to determining whether the event constitutes a public health emergency, there will oftentimes be a coordination of international response and action toward the crisis. These types of intervention during epidemics can take multiple forms depending on the country and situation. In some cases, more developed countries are able to work on the development of vaccines and other drugs to stem the transmission of diseases.

Alternatively, doctors and other medical professionals can join task forces that are dedicated to directly helping people in the afflicted country or countries. Working with either the World Health Organization or other non-governmental organizations such as Doctors Without Borders (MSF), these doctors operate internationally to take care of patients, record first-hand information, and conduct research and experiments. This international team also has the opportunity to connect and share with local doctors in their work to cure the patients. Coming with certain benefits and drawbacks, these two vastly different approaches marry to create a sustainable response plan. However, with the obvious dangers of on the ground intervention, certain problems or situations arise that put these medical professionals in dangerous situations.

In a broader sense, the ramifications of diseases and epidemics are widespread and evident; this means that all countries must take clear steps toward the prevention, recognition, and control of such situations. Such medical emergencies can impact a wide range of citizens within the country and can spread to neighbouring states. This is especially dangerous in an increasingly globalized and connected world. This topic will deal with the management of epidemics and their surveillance. These public health risks are then researched and cured with the help of both direct intervention and indirect aid. Looking more closely at past response plans and solutions, a more robust and cohesive resolution can be developed to solve the inevitable outbreaks that will occur in the future.

Timeline

1334 — Originating in China, the Great Plague of London spreads along trade routes eventually killing 25 million people in Europe.

1918 — The Spanish Flu pandemic kills between 50 and 90 million people around the world.

1952 — Jonas Salk develops the first polio vaccines which are shown to be effective against multiple types of the polio virus. Cases gradually fell through the 1950s.


1984 — Scientists find that the human immunodeficiency virus (HIV) as the cause of AIDS.

1994 — Polio is eliminated in the Americas.

2003 — Severe acute respiratory syndrome is first identified in China and in a span of seven months spread to 7,000 cases.

2009 — The H1N1 virus, a type of swine flu caused by the type A influenza virus, kills over 575,000 people.

2010 — An outbreak of cholera, believed to be brought by Nepalese rescuers, kills 10,000 people in Haiti which prevented efforts to rebuild after an earthquake.

2014 — The Ebola epidemic hits West Africa, recorded as the largest Ebola outbreak killing more than 11,300 people.

2016 — A state of public health emergency is declared over the Zika virus which is predicted to infect more than 3 million people throughout the Americas and the rest of the world.

Historical Analysis

Tuberculosis Arguably the deadliest epidemic, tuberculosis has been found throughout humankind from the lungs of mummies in ancient Egypt to today. This disease manifests in the lungs causing internal weakness, chest pains, and coughing fits. In the 19th century, tuberculosis caused the death of a quarter of the adult population in Europe. Even today, it affects nearly 8 million people, mainly in developing countries, resulting in the death of 2 million annually.1 The distribution of vaccines in developing countries has fallen behind that of developed nations.

Yellow Fever Similar to malaria in that it is transferred via mosquitos, yellow fever has killed millions and wiped out entire colonies and regions. This disease causes internal bleeding and liver failure which is marked by the yellowing of the skin. The most famous Yellow Fever epidemic happened in 1793 in Philadelphia, PA when 4,000 people died in only four months. Many cases of yellow fever still exist today; it causes 30,000 deaths globally.2

Smallpox Although most notably present in Native American populations of the 16th century, cases of smallpox have continued even in the last few decades. An epidemic killed nearly 90 million Native Americans in North America, with symptoms such as aches, fevers, and rashes. While a vaccine was created in 1796, the most recent breakout of this disease was in the late 1960s when two million people were killed.3

1918 Influenza Pandemic While influenza pandemics have occurred intermittently over the course of the last few decades, the 1918 pandemic resulted in unexpected mortality rates: around 500,000-675,000 deaths in the United States alone and

1 http://www.healthcarebusinesstech.com/the-10-deadliest-epidemics-in-history/ 2 Ibid. 3 Ibid.


50-100 million deaths globally.4 The spread of the H5N1 avian influenza caused public concern and efforts by national governments to plan for its prevention and treatment.

Noting that antiviral medications and vaccines could not be made readily available and effective for the treatment of the particular strain of influenza, health authorities suggested the use of non-pharmaceutical interventions (NPIs). Examples of such interventions include the closing of schools and other public facilities, quarantine of infected households, and bans on public gatherings. Mainly utilized in American cities, it did not prove to be very effective in preventing the disease. However, analysis of these preventative measures has shown that if they were implemented earlier and more intensely, the spread and death rate of influenza could have been reduced.5

Ebola Virus in West Africa The Ebola virus disease (EVD), previously known as the Ebola hemorrhagic fever, is a severe and often fatal illness in humans, spread via wild animals and from other humans. This disease was first discovered in 1976 in 2 outbreaks in South Sudan and the Democratic Republic of Congo.6 Onward from 1976, there have been 23 known outbreaks in equatorial Africa.7 Since this condition was found, the 2014-2016 outbreak in West Africa has been the largest yet, reaching from Guinea to Sierra Leone and Liberia.

Exhibiting symptoms such as vomiting, impaired kidney and liver function, and internal and external bleeding, Ebola can be difficult to diagnose and can be mistaken for other infectious diseases such as malaria and meningitis. The treatment for this disease can be in the form of supportive care-rehydration which improves survival, although there is no proven treatment available yet. However, strong preventative and control measures can be taken by both citizens and medical professionals in order to limit the range of outbreaks. Outbreak control relies on a variety of intervention measures including case management, surveillance, and social mobilization. Community engagement has been vital to the prevention of infections and protective measures in past outbreaks. There are several factors to consider: reducing the risk of wildlife-to-human transmission by limiting consumption and handling of infected organisms, reducing the risk of human-to-human transmission through sanitary measures, and ensuring the safe burial of the infected dead.8

Some of the more effective measures used in the 2013 outbreak include the quick detection and isolation of affected individuals and communities. Also, the expansion of Ebola treatment centres in Liberia and Sierra Leone were important in developing safe zones from the disease.9 The epidemic reached peak incidence in September 2014 although cases continued to develop afterwards. The outbreaks were finally declared over in Liberia, Sierra Leone, and Guinea on May 9, November 7, and December 28 of 2015 respectively. Even today, when international medical teams and organizations have plenty of experience in dealing with EVD, it cannot be accurately predicted in the long-run. In the meantime, there is a large focus on infection control, early detection and diagnosis, and survivor support services, in addition to primary health care services.

4 Ibid. 5 Ibid. 6 http://www.who.int/mediacentre/factsheets/fs103/en/ 7 http://www.nejm.org/doi/full/10.1056/NEJMsr1513109#t=article 8 http://www.who.int/mediacentre/factsheets/fs103/en/ 9 http://www.nejm.org/doi/full/10.1056/NEJMsr1513109#t=article


2009 Influenza Pandemic In more recent years, such as during the 2009 Influenza pandemic in North America, a series of steps were taken to monitor and control the spread of diseases. Mathematical models have been used in pre-pandemic planning. By planning assumptions and modelling the trajectory of the diseases, the number of infected and fatal cases could be preliminarily determined and the impacts of such a disease could be controlled. In 2009, the influenza modelling community worked extensively with public health agencies and ministries of health in order to help quantify the transmission and assess the characteristics of the pandemic.10 This model was integral in targeted interventions on certain members of the population given the limited supply of antivirals and vaccines. Based upon scientists’ models, interventions were taken by national governments, such as closing schools and increased health awareness.

In light of these events, countries have improved their public health interventions and pandemic modelling capacities. Better coordination must be achieved between different organizations and governments so that a complete approach can be taken. There were also difficulties in data collection especially in more rural and developing areas of the world. Such improvements must be made to further each country’s capacity to track and implement disease protection.

Past UN/International Involvement

Role of the World Health Organization Beyond the traditional political and economic goals of the United Nations, it has been very involved in promoting and protecting good health worldwide. Founded on April 7, 1948, a date now known as World Health Day, the World Health Organization (WHO) has been vital in ensuring health awareness throughout the world. At its establishment, its main priorities included malaria, women’s and children’s health, tuberculosis, venereal disease, nutrition, and environmental pollution. Today, its agenda has been expanded to include newer diseases such as HIV/AIDS, cancer, Ebola, and the Zika viruses. 11 WHO has been successful in the discovery and distribution of various vaccines for Polio, Smallpox, and Tuberculosis. In response to the 2014 Ebola outbreak in West Africa, WHO engaged in an unprecedented response, deploying thousands of experts and medical equipment, coordinating medical teams, and building mobile treatment and research centres.

While working with other organs of the United Nations and other non-governmental organizations, the Department of Emergency and Humanitarian Action addresses ten core health issues. The WHO works to assess the health risk of epidemics in certain regions and protect physical and mental health. It coordinates the works of different organizations to prioritize the control of preventable causes of illness and death through nutritional surveillance. Noting the situation of those who may be especially vulnerable to disease, such as children, the elderly, and the pregnant, it helps ensure access to preventative and curative care and management environmental health risks. In the aftermath of medical emergencies, it helps encourage the development of healthcare systems and helps make them more resilient in the future. The WHO Disease Outbreak News and Weekly Epidemiological Record (WER) provides countries and other organizations with information regarding cases and outbreak of disease of public health importance under the International Health Regulations.12

10 http://www.who.int/bulletin/volumes/90/4/11-097949/en/ 11 http://www.un.org/en/sections/issues-depth/health/ 12 http://www.who.int/csr/alertresponse/infomanagement/en/


During humanitarian emergencies, the World Health Organization helps reduce mortality rates in areas affected by conflict, natural disasters, and food insecurity. It focuses on three areas of work: field epidemiology, training, and publication of technical standards, guidelines, and tools.13

Sustainable Development Goal 3 The United Nations’ third Sustainable Development Goal is to “ensure healthy lives and promote well-being for all at all ages.”14 Within this goal, the UN has established several targets by 2030 in the area of epidemics and their intervention:

End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases,

Reduce by one-third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being,

Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries and provide access to affordable essential medicines and vaccines.15

International Health Regulations (IHR) 2005 In order to properly fulfill their role, the World Health Organization developed a system to track the evolution of diseases, alert countries when necessary, share expertise, and prepare a response to protect citizens. Thus, the International Health Regulations was put into place to prevent, protect against, and control and provide a public health response to the spread of such infectious diseases.16 This framework offers an epidemic alert mechanism and helps control emergencies by solidifying public health security. Specifically, the IHR (2005) notifies countries of health risks and confirms public health events for the World Health Organization. It also collects data and other pertinent information regarding the development and proliferation of diseases. Member countries, all 196 of which participating in this binding agreement, are required to report the progress of epidemics and public health events to WHO.17 Continuing onward, in May 2015, a mandate was developed for the IHR to participate in the prevention and operation response to the Ebola outbreak and recommend steps to improve the functioning and transparency of epidemic response plans in the future.18

Global Outbreak Alert and Response Network (GOARN) The GOARN system ensures that a robust response operation is mounted during times of epidemics. This organization is a collaboration of different institutions and networks around the world that pool together their expertise and resources to identify, confirm, and respond to outbreaks.19 Using resources from this network, the World Health Organization also assists in the coordination of a response to pandemics.

13 http://www.who.int/mediacentre/factsheets/fs090/en/ 14 http://www.un.org/sustainabledevelopment/health/ 15 http://www.un.org/sustainabledevelopment/health/ 16 http://www.who.int/csr/alertresponse/en/ 17 http://www.who.int/topics/international_health_regulations/en/ 18 http://www.who.int/ihr/review-committee-2016/en/ 19 http://www.who.int/ihr/alert_and_response/outbreak-network/en/


International Coordinating Group (ICG) on Vaccine Provision The ICG, established in 1997, serves as a means of providing vaccines and antibiotics to those in need during outbreaks. This group helps coordinate the cooperation of different parties to ensure that countries are prepared to respond. Primarily, the ICG helps forecast vaccine stocks, negotiate vaccine prices, and evaluate the protocols for managing diseases. Integral in a variety of different situations, the ICG has been instrumental in delivering vaccines during outbreaks of meningitis, yellow fever, and cholera.20

Other United Nations Bodies In addition to the World Health Organization, several other United Nations bodies are also working to deliver humanitarian aid and other forms of intervention prior to, during, and in the aftermath of outbreaks. The Office for the Coordination of Humanitarian Affairs (OCHA) has an emergency relief system that provides basic necessities to those in need. Furthermore, the World Food Programme (WFP) and United Nations Children’s Fund (UNICEF) has been working to improve the rights of the child and food transport issues, especially during epidemics.

Current Situation

Outbreak Control Mechanisms One of the most important parts of the World Health Organization’s outbreak response is event verification to determine the scope and severity of the epidemic. Several criteria are used to determine whether a disease is a cause for international concern. They include the spread of the disease, impact on local health, and possibility for interference with international travel or trade. 21 The Global Alert and Response team works to assess situations by recording key information regarding each potential pandemic. The Alert and Response Operations Centre in Geneva is responsible for responding to scenarios that require verification and containment.

Several steps are taken throughout the development of epidemics: prevention, surveillance, and control. 22 Prevention takes place in the form of shelter, water, nutrition, and vaccination. Also, sanitation and vectors must be monitored to create an environment that is safe for individuals. From a community standpoint, health education and community participation are vital for the recognition and prevention of diseases. Furthermore, the collection of data and identification of responsible persons is necessary to track and control outbreaks. The outbreak control plan consists of the appropriate response to the disease after it has been confirmed.

Situation in Developing Countries In many developing countries, health care interventions are underutilized and not as effective as they are in many developed countries, mostly due to wealth disparities. Those who are in poverty in developing countries lack a basic level and access to care that would grant them security and safety during times of epidemics. Different perspectives demonstrate the two sides of this problem. For many of the governments of developing countries, quality health care cannot be provided and delivered due to various problems, mainly corruption and lack of incentive. However, demand-side barriers also exist where citizens do not access and use such resource provided

20 http://www.who.int/csr/disease/icg/en/ 21 http://www.who.int/csr/alertresponse/verification/en/ 22 http://apps.who.int/iris/bitstream/10665/96340/1/9241546166_eng.pdf


to them.23 During outbreaks, this means that individuals are not able to get the care that would help them. But also, they are unable to access preventative treatments that would have stopped the spread of the disease.

Evidence shows that millions of people end up suffering and dying, as a result of ineffective health care interventions, from three diseases: diarrhoea, pneumonia, and malaria. These diseases are responsible for 52% of child deaths globally.24 People die from these diseases despite there being clear prevention and treatment available. In Bolivia, a study found that 23% of fatally ill children were not taken for treatment even when it was available.25 In fact, this access to healthcare is not extremely expensive in some cases. For example, one-half of avoidable child fatalities in sub-Saharan Africa could be avoided through home-delivered interventions.

On the other hand, interventions are not provided at all, usually due to a lack of resources. A large gap exists in many developing countries between the amount of capital spent on healthcare compared to the amount required to provide adequate resources for citizens. Even when such health care is available, the quality is significantly lower.

Timeframe of Implementation of Vaccines Another issue with the implementation of vaccines is the long gestation period associated with the development of the vaccine. In fact, the research and development portion of vaccine development requires analysis of the vaccine on three different fronts: availability, affordability, and adoption. On average, it takes a vaccine ten years to go from the “Regulatory Approval” stage to the “Comprehensive WHO Recommendation” milestone where the vaccine has support for international-level adoption.26

Scrutiny of Humanitarian Health Interventions Even with the recent accumulation of knowledge on public health interventions during times of outbreaks and epidemics, there has been a lack of scrutiny on the quality and spending of aid provided. In addition, the documentation of such interventions for analysis has been limited.27 As such, this raises the question of whether all actors are held accountable during the process of implementation for each intervention. While large sums of money are spent on interventions and humanitarian assistance, 2 billion in 1990 and 5.5 billion by 2000, the true impact of the capital used cannot be clearly measured.28 Currently, the method of quantifying such positive impact is done by either comparing the situation with and without the aid or comparing the ‘before’ and ‘after.’ Both these approaches have their drawbacks, such as the impossibility of comparing certain scenarios and inability to measure chain reactions.

Humanitarian Intervention for Refugees Dating from the 1970s and 1980s, the main form of humanitarian assistance took form in the provision of health care services for refugees and other displaced peoples. These people had a higher mortality rate due to epidemics, malnutrition, and lack of access to medical care.29 However in places with a lack of stable government or where the government is burdened with other social and political issues, humanitarian actors have limited reach and ability to support national health systems and coordinate with other international organizations. While funds

23 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007001200003 24 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007001200003 25 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007001200003 26 https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-683 27 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544941/ 28 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544941/ 29 CS C1


are well-provided in many cases, the chronic nature of non-communicable diseases, which are common in such populations, requires more sustainable use and effective planning.

Control of Cholera Epidemics Epidemics of cholera have emerged around the globe from Haiti to Iran. In 2005, beginning in the city of Qom, Iran, more than 1100 registered cases of cholera were found to affect many provinces. Noticed and reported quickly, local health authorities led efforts for community awareness and stricter controls on local food and raw vegetable markets. This epidemic was controlled in a matter of weeks and stopped after four months.30 Elsewhere, in Haiti, although the nation was cholera-free for decades, it was brought back after the earthquake by United Nations stabilizing forces. Unlike Iran, this epidemic took much longer to control due to the poor quality of drinking water and poor hygiene. The most successful interventions in this case, especially concerning non-communicable diseases, come in the form of information for the population and empowerment of food supplies.

In other countries, cholera outbreaks are much more frequent, for instance, Kenya, which follows a five to seven-year cycle. In fact, since December 2014, Kenya has experienced a cumulative total of 17,597 cases.31 As a result, WHO recommends improving local health facilities so that epidemics are detected earlier and multi-sectoral approaches can be coordinated.

Detection and Prevention of Malaria Instead of being consumption and nutrition based, malaria is transmitted via the environment. This presents a different set of challenges for organizations focused on interventions. Malaria epidemics may be caused by climate anomalies, such as periods of rainfall, temperature fluctuations, and drought and famine. Out of the 620,000 severe cases of malaria annually, up to 155,000-310,000 may result in death.32 Mainly spread through mosquito bites, preventative steps can usually be taken. However, these interventions can be ineffective, costly, and depend on the accuracy of climate predictions. Interventions for malaria usually take the form of indoor residual house spraying and insecticide-treated nets (ITNs).

Case Study: Southeast Asia Even with the recent economic growth and development, many countries in the South-East Asia region are susceptible to communicable diseases. Many of such countries are affected by human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), tuberculosis (TB), malaria, influenza, and cholera. Many countries and non-governmental organizations have contributed to the eradication of these diseases through vaccination. However, countries such as India, Indonesia, and Myanmar have not achieved full coverage of their population.33

Case Study: Sri Lanka In Sri Lanka, dengue fever remains an epidemic, with 80,732 reported cases and 215 deaths.34 This outbreak takes place after heavy rains and flooding in many regions of Sri Lanka. Rain-soaked garbage and standing water pools create breeding grounds for mosquito larvae, causing cases of dengue fever in both urban and rural populations.

30 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872598/ 31 http://www.who.int/csr/don/21-july-2017-cholera-kenya/en/ 32 https://www.ncbi.nlm.nih.gov/books/NBK3739/ 33 http://www.who.int/bulletin/volumes/88/3/09-065540/en/ 34 http://www.who.int/csr/don/19-july-2017-dengue-sri-lanka/en/


The World Health Organization has been supportive of interventions taken in these areas by providing resources to healthcare facilities, implementing vector control activities, and mobilizing the community for garbage disposal.35 From a management point of view, WHO has also supported the Sri Lankan Ministry of Health by updating their triage protocol, guiding local task forces, and preparing strategic plans to control the current outbreak and prevent future situations.

Possible Solutions/Controversies

Technological Solutions As we head into the 21st century, technology has provided organizations with the tools that allow for quicker communication and more efficient control of outbreaks. With mobile phones becoming more prevalent even in rural communities, text messaging has become an opportunity for organizations to reach out to large populations and spread informative messages highlighting the symptoms and other pertinent information for certain diseases. It also serves as an easy point of communication for community initiatives. This has been successful in the past with the Text to Change project used during the Sierra Leonean Ebola epidemic.36 Computers have also been used as training devices, with the growing connectivity of the world being utilized to unite medical professionals worldwide and allow for communication between different organizations and people. Finally, real-time monitoring and tracking of diseases can drastically change the way data is examined and allow for more effective targeted control measures. Naturally, there will be difficulties in areas where modern technology remains scarce; the high costs of implementing and maintaining a system of mobile phones and internet can be a restriction. The use of technology can make systems vulnerable to external misuse such as hackings and can also be a source of miscommunication.

Preventative Health Care In the United States, at the start of the 20th century, the leading causes of death were influenza, tuberculosis, and gastrointestinal infections. A century later, the infection rates for these diseases have dropped significantly due to the implementation of preventative health care. Through the adoption of healthy lifestyles such as physical activity, good nutrition, and the avoidance of tobacco, there has been a 93% reduction of diabetes and 81% reduction of heart attacks.37 It is important to realize that preventative health care campaigns are vital to stopping epidemics before they occur. Although useful in the prevention of diseases and outbreaks, there are limited benefits during times of epidemics.

Community-Level Interventions Interventions on a more personal and community level are necessary. since the root of many epidemics and the key to their solution are based on the actions of the community. In areas where medical systems are overwhelmed and unable to support the entire population, many of those who are ill are cared for at home.38 Among the many short-term initiatives include the strengthening the diagnostic capacities and the ability of countries to identify and control outbreaks. In the long run, more equitable distribution of resources should be achieved, government

35 http://www.who.int/csr/don/19-july-2017-dengue-sri-lanka/en/ 36https://www.weforum.org/agenda/2015/06/4-ways-technology-can-help-fight-future-epidemics/ 37 http://www.huffingtonpost.com/deepak-chopra/a-hidden-solution-to-amer_b_7664564.html 38 http://www.un.org/womenwatch/daw/csw/hivaids/Iwere.html


spending on social services should be encouraged, and community connections for the distribution of information should be fostered.

It is important to realize that the community is an important part of the health system and as a result, community understanding and knowledge regarding outbreaks is essential. At the grassroots level, door-to-door educational campaigns and resource collections can aid toward the control of infectious diseases.39 These initiatives can then be amplified by organizations and governments, but first, they must be established by the population. Community-level interventions can be controversial and may be ill-received by local communities due to past interactions. As a result, there should be a focus on both establishing new connections and mending previous relationships.

Recognition of Outbreaks The easiest way to control and minimize the spread of disease during epidemics is through early recognition and well-targeted interventions. As was shown during the Ebola outbreak of 2014, unlike the high number of those affected in countries like Liberia, the situation in Nigeria was much more controlled due to the early identification of the disease through tracking. This can be accomplished by encouraging communication between international bodies and various levels of government.

Secondarily, steps must be taken to minimize the possible adverse impacts of interventions on the population after the outbreak has been stemmed. By monitoring the impacts of health projects on the community and in governmental development, it can be ensured that even after an outbreak, the development of medical systems continues and the wellbeing of the population remains a priority for local governments.

Controversies of Health Interventions Despite the positive impacts of increased connectivity and benefits of health interventions, there is still a dilemma whether to continue with these actions. Each country’s sovereignty must be preserved throughout the process of intervention. This means that local health authorities must be part of the cooperative effort to stop outbreaks.40 Currently, many interventions are done with both local community and governments excluded from the process. In these cases, although the outbreak may initially be solved, the community ends up fearful and distrustful of these organizations, and the government lacks the skills and knowledge to respond to epidemics in the future.

Proliferation of Vaccines and Medication Access to vaccinations remains limited in many countries due to the seclusion of rural communities and lack of resources for development. So, even when vaccines are developed, they are not readily used due to the government’s inability to spread them to the population. On the other hand, in many developed countries, there are crises with the over-distribution of medications which leads to misuse and addictions. A healthy balance between these two extremes must be reached when dealing with medications, and this can only be done through careful monitoring and a robust system of distribution. Vaccinations and other medications remain expensive for both hospitals and individuals. In addition, there are also certain limitations toward their usage with evolving strains of diseases and the need to constantly develop new medications.

39http://globalhealth.thelancet.com/2015/06/05/take-it-community-and-stop-epidemics-where-they-start 40 https://www.cfr.org/backgrounder/dilemma-humanitarian-intervention


Outbreak Response Development Another improvement that can be made would be in the recognition of diseases and control. The development of a stronger database will help countries and local ministries of health in stopping outbreaks. Efforts should be made to outline not just methods of control but also preventative steps for the future. Often in cases where the non-governmental organizations step in to help prevent or stop an epidemic, the government will then lack the tools to intervene in medical emergencies in the future. Therefore, a better way to spread knowledge must be created so that government and other bodies can communicate with each other and share their data and knowledge. Naturally, certain countries would still be unable to or would not want to cooperate in such a way, citing political or ideological differences.

Economic Issues with Current Interventions From an economic perspective, the affordability of interventions remains a problem on a micro and macro scale. For governments, large-scale operations for control mechanisms are prohibitively costly, coupled with other associated costs for vaccinations and monitoring support. On the contrary, for individuals, low incomes in developing countries are a deterrence to getting medical support and purchasing vaccinations. The high prices prevent access to essential medical support and resources. Beyond lowering costs and increasing the quality of healthcare, another possibility would be extended health insurance coverage and price subsidies for both governments and citizens. These steps will help lower the barriers of distance.

Social Impacts of Interventions In many countries, the culture and gender issues that underlie the health interventions create an incentive for individuals to turn away from foreign aid and even local medical resources. Efforts must be made to overcome such barriers through integration and education of communities. By increasing the knowledge of the population, they would be able to make informed decisions that both prevent future outbreaks and increase the effectiveness of future interventions.

Access to Basic Necessities Food and water supplies are the cause of many outbreaks; thus, communities must be ensured these basic human rights. Improvements can be made to overcoming environmental and man-made problems that cause the tainting or destruction of these supplies. Solutions include the development of safeguards to preserve the state of food and water as well as protecting agricultural land and reservoirs. The hygiene and sanitation of medical facilities and communities must be maintained at a high standard. This can be done by increasing inspections and through localized education, among other solutions.

Use of Foreign Aid and Corruption Although plentiful in many cases, the issue is not acquiring foreign aid but rather monitoring the use of such funds. In developing countries where corruption is more rampant aid is often misused or misdirected, whether accidentally or intentionally. There should be oversight in the use of such aid to avoid the wasting or misappropriation of money.

Bloc Positions Ultimately, the goal of all countries is very similar in that they wish to continue to develop systems of health intervention to control current outbreaks and prevent future epidemics. However, countries will have different


perspectives on issues and methods of implementing interventions. It is also important to realize that countries may belong to more than one bloc.

Countries with Strong Healthcare Systems Countries in this bloc include many wealthier countries such as the United States, France, Germany, and Australia. These countries are willing to lend their expertise and participate in international efforts to intervene and stop outbreaks. They also contribute financially and help in the monitoring of epidemics and research of vaccinations. The problems they face are often different than developing countries, with issues such as cancer, heart disease, and addiction crises. With stronger healthcare facilities and development, they are able to contribute to the stopping of outbreaks in other countries. Often technologically advanced, these countries would continue to advocate and maintain the development of support networks and methods of communication around the world.

Countries Experiencing Epidemics Countries in this bloc include Sri Lanka, Liberia, Bolivia, and Haiti. Currently experiencing outbreaks, they are looking toward other countries for help in controlling and preventing these epidemics through both on-the-ground management and guidance to prevent future situations. Often times, these countries may also be inexperienced with dealing with outbreaks and face the corruption of government officials. They lack the resources to adequately deal with the outbreak and need interventions in order to control the spread of the disease. However, they also seek to reduce any disruptions of interventions on local communities and their economy. These countries also see the importance of developing and transferring knowledge between countries in order to come to a more informed future. In these countries – for example, those affected by the Ebola virus – there may continue to be a social stigma against cooperation with international bodies. This bloc works toward a higher degree of cooperation with local communities.

Developing Countries and Countries in Poverty Countries in this bloc include many African and Southeast Asian countries that are still in a developmental phase regarding their countries' healthcare systems. Other countries may be those who are in poverty, both on a government and individual scale. Although not at immediate risk of outbreaks, they seek to put in preventative measures that will safeguard their populations in the future. They may also have poor living conditions and communities and lack access to basic necessities making them susceptible to disease. Countries in poverty require the help of other nations to use resources provided to them sustainably. This bloc also faces aspects of the refugee crisis and the impact of displaced peoples. It is important to keep in mind the unique needs of this group of people when creating a solution.

Discussion Questions 1. What improvements can be made on the current methods of interventions during crises to limit their

disruptions on local communities and governments?

2. Regarding current outbreaks, what steps can be taken to ensure that they are properly managed and cases are kept to a minimum? What preventative measures can be imposed to avoid future outbreaks?

3. How can the use of aid be regulated and corruption be minimized to ensure its sustainability?


4. What work can be completed on a community level and how can a meaningful relationship be created between communities and international bodies?

5. How can the connectivity of different countries and organizations be guaranteed so that knowledge and data concerning outbreaks and epidemics is distributed to all parties? What role does technology play in this?

6. What steps need to be taken to improve access to basic necessities and medical facilities? How will individuals and governments have the financial means to acquire such resources?

7. How can distribution and access to vaccines be improved especially for rural populations? What can be done to expedite the timeframe for vaccines?

Additional Resources WHO Emergency Preparedness and Response Guidelines

http://www.who.int/csr/alertresponse/en/ Access to Healthcare in Developing Countries

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2007001200003

Health Interventions in Developing Countries

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-683

Lessons Learned from Past Cholera Epidemics and Interventions

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872598/ Role of Technology in Future Epidemics

https://www.weforum.org/agenda/2015/06/4-ways-technology-can-help-fight-future-epidemics/

Importance of Interventions in Ebola Outbreaks

https://asunow.asu.edu/content/rapid-interventions-key-preventing-ebola-outbreak

Interventions on a Community Level

http://globalhealth.thelancet.com/2015/06/05/take-it-community-and-stop-epidemics-where-they-start


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Medical Black Markets

Overview

Heading into the 21st century, many developed and technologically advanced countries have the privilege of healthcare that is supported and regulated by the state; however, this is not the case in many countries. This topic will cover the development and progression of black markets in the medical field, looking at the underlying problems that create such a marketplace and the implications this has on the population. The ultimate goal of the international community should be not only to control such black markets but also to provide alternatives and resources for citizens to gain access to more robust and safer healthcare. The existence of black markets in the medical field occurs not only in gaining access to doctors and other medical professionals, but also illegal transactions can take place in exchanges of medicine, medical records, and much more.

Medical care is integral to our survival especially as much of the world is in poverty in the face of natural disasters. In many developing countries, access to medical facilities and medication is often scarce and can only be obtained through black markets and without government regulation. However, even in much more developed countries, similar situation take place in addition to other unique issues such as the counterfeiting of drugs and identity theft. Medical tourism and the organ trade are also important pieces to the puzzle as citizens travel from their home to another country in pursuit of treatment. This can prove not only to be detrimental to their native country but also to the destination country.

Timeline

1796 — Edward Jenner introduces the first successful vaccine for humans to prevent smallpox.

July 1948 — The United Kingdom launches one of the world’s first universal health care systems, called the National Health Service (NHS)

1997 — Medicine shortages in Cuba mark the beginning of years of decline in the medical field.

2004 — The trade of black market medicine is estimated to be worth $32 billion annually.41

2007 — The underground organ market in India is growing with 2000 Indians selling kidneys every year.42

2011 — The U.S. Food and Drug Administration sentences a Belgian national to 48 months in federal prison for selling misbranded and counterfeit drugs.43

2016 — The price of an appointment ticket for doctors in China reaches three times the face value.

December 2016 — All United Nations Member States agree to work toward achieving universal healthcare by 2030 as a part of their Sustainable Development Goals.44

41 http://www.bbc.co.uk/worldservice/specials/1718_pills/page4.shtml 42 http://www.dailymail.co.uk/news/article-3031784/Inside-illegal-hospitals-performing-thousands-black-market-organ-transplants-year-200-000-time.html 43 https://www.fda.gov/ICECI/CriminalInvestigations/ucm257945.htm 44 http://www.who.int/mediacentre/factsheets/fs395/en/


June 2017 — In the face of a humanitarian crisis, Venezuela suffers from an 85% shortage of medicine and 90% deficit in medical supplies.45

Past UN/International Involvement

Counterfeit/Black Market Drugs

Many international organizations, such as the International Narcotics Control Board (INCB), have been extensively involved in the tracking and control of unregulated medicines. The key to this current problem lies not just in the distribution of these medicines, but also their manufacturing. Backed by the United Nations, the INCB has been key in the implementation of UN drug control conventions and monitoring of unregulated sales of drugs in street markets and on the Internet.46

While much of what is done by the INCB involves the tracking and monitoring of such illicit drugs, its cooperation with the World Health Organization (WHO) and United Nations Office on Drugs and Crime (UNODC) has prevented the trafficking of drugs by helping nations understand the consequences. In the past, they have recommended the strengthening of drug laws and regulatory authorities in order to protect the lives of the patients who intentionally or unknowingly consume these medicines.

Methadone

In the face of addictive opioid drugs such as cocaine and heroin, the World Health Organization continues to advocate for substitution therapies such as methadone to reduce drug dependence and help victims return to their day-to-day routine.47 In India, the Narcotics Control Bureau has noted the leakage of pharmaceutical preparations of methadone onto the black market. Through a report, the WHO then recognized the need for supervision in the creation and development of these medications through increased regulation and the involvement of non-governmental organizations.

Aleppo, Syria

In Aleppo, Syria, the World Health Organization has been coordinating efforts to deliver shipments of medical equipment and medicines to healthcare providers. As a result of the civil war and conflict in that area, local production of medication has been reduced by 65-70%,48 causing a steep incline of medicine prices on the black market. This is especially true in rural areas, where access to healthcare is further restricted. In order to mitigate the high prices, manufacturers have responded by increasing the supply to lower costs and reduce the excess demand.

Iraq Meanwhile, the World Health Organization has been active in areas such as the Al Hadi City (Five Mile City) in Iraq to monitor and assist local authorities in their battle against black market medications.49 In a street market in this city, experts confirmed the sale of medicines at much lower prices compared to the pharmacy. These

45 https://www.usatoday.com/story/news/world/2017/06/22/venezuela-medical-shortages-doctors-health-care/103039928/ 46 http://www.un.org/apps/news/story.asp?NewsID=21789&Cr=drug&Cr1=#.WbohHjPMxsM 47 http://www.who.int/bulletin/volumes/86/3/08-010308/en/ 48 http://www.who.int/mediacentre/news/releases/2014/syrian-arab-republic-20140107/en/ 49 http://www.who.int/features/2003/iraq/briefings/thursday15/en/


medications are usually stolen or looted from health care centres. In the past, Iraqi authorities have patrolled the area and confiscated merchandise, but this has failed to stop the trade. Years after, there is even less regulation and monitoring of the illegal sale of medicines due to the police’s inability to monitor and control the situation.50 While the WHO cannot play a hands-on role on the ground, it has been able to work with local police and authorities in developing approaches that are accommodating and effective against drug vendors. Furthermore, they have coordinated donations from other organizations to strengthen the distribution process of medicines.

SDG 3

On a higher level, the United Nations’ third Sustainable Development Goal is to “ensure healthy lives and promote well-being for all at all ages.”51 More specifically, they plan to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” This shows their dedication to stopping black markets on a larger scale in efforts to improve global health.

Current Situation

Organ Trade From the perspective of a regulatory body, the shortage of organs is becoming a more pressing issue as the practice of organ transplantation becomes more frequent. With the number of donors decreasing while the requests from recipients continue to rise, there comes a point in which an alternative is necessary. In many organ-exporting countries, kidney and liver transplants are often performed without consent from executed prisoners in China to those in the underground organ market.52 For international governments, there has been a continued push to stem the international organ trade with encouragement from public media and local experts. Unfortunately, the lack of legal framework and enforcing mechanism proves to be a difficulty for these countries in their mission to control the black market.

Systemic Barriers The more pressing issue behind the increasing prevalence of black markets for medical care and medicine lies in the extreme costs and ineffectivity of medical systems around the world. While the demand and need for healthcare have grown in many countries, especially those with an increasingly aging population, the resources for them have not expanded to accommodate for this change.

Medical Records In the 21st century, cyber-criminals have been able to use medical records for healthcare and tax fraud. Hackers obtain medical records and sell them to other criminals on the Dark Web. According to the United States Department of Health and Human Services’ Office for Civil Rights, breaches of healthcare data from hospitals and other facilities affected more than 500 people in 2016 alone.53 The danger of medical records fraud comes from the personal information criminals receive, often containing full history and personal information about the patient. A key trend in these crimes is that they occur not solely on an individual basis, but rather the hacking

50 http://www.who.int/dg/speeches/2016/shanghai-health-promotion/en/ 51 http://www.un.org/sustainabledevelopment/health/ 52 http://www.who.int/bulletin/volumes/85/12/06-039370/en/ 53 https://www.cnbc.com/2016/03/10/dark-web-is-fertile-ground-for-stolen-medical-records.html


of a single facility can compromise many people.54 Therefore, it remains a vital goal for both national and international bodies to preserve the private nature of their data. The development of cybersecurity measures and increasingly mandatory disclosure of data compromises have aided in factors such as transparency and safety.55 By increasing authentication measures and implementing anti-hacking and virus mechanisms, these facilities are able to better prevent breaches.

Case Study: Venezuela

In Venezuela, the economic crisis has taken on a more humanitarian tone involving both food and medicine shortages, resulting in the development of black markets. Many patients who need prescriptions for medicines have been unable fill them at local pharmacies. Many healthcare workers believe that medicine is being smuggled into the country and brought to the black market where it can be sold at a higher price. This not only takes advantage of those in need but also reduces accessibility to those who may face life-threatening repercussions.56 Furthermore, these medicine shortages have hinted at larger problems with the system, including a sharp decline in the quality and safety of healthcare provided by hospitals. It has come to a point where some doctors have asked patients to purchase drugs that are made for animals.

These shortages of access to medication have also been followed by greater social problems such as distrust in the government, social unrest, and illegal behaviour. As medication has become such a scarce commodity, property and hate crimes have become more prevalent towards medical professionals. In 2016, reports by the Venezuelan Health Ministry and Human Rights Watch showed higher than usual infant and maternal mortality rates; one of the many symptoms of the greater extent of this problem. 57 There has also been a lack of transparency from the government on statistics related to the quality of healthcare received by citizens.

President Nicolas Maduro has requested the United Nations’ help in dealing with medicine shortages due to the flailing economy and drop in oil prices. The United Nations, in response, has reached out and met with Venezuelan representatives to help stabilize food and medicine prices in hopes of making them more affordable.

Case Study: Canadian Black Market Clinics

Meanwhile, similar problems with black markets exist in more developed countries such as Canada. Operating under a system of universal healthcare has caused a huge backlog in the system, with nonessential surgeries requiring a wait time of up to two years.58 This has caused many patients to resort to black market care. Much of this takes place in the neighbouring United States, where Canadians travel to private and illegal clinics to get their treatment. While price controls have been beneficial in keeping drugs affordable and improving the standardization of the healthcare system, loopholes have also forced citizens to turn to other illegal sources of care.59

54 https://www.csoonline.com/article/3152787/data-breach/black-market-medical-record-prices-drop-to-under-10-criminals-switch-to-ransomware.html 55 http://resources.infosecinstitute.com/hackers-selling-healthcare-data-in-the-black-market/#gref 56 http://www.cnn.com/2017/03/25/americas/venezuela-maduro-un/index.html 57 http://www.huffingtonpost.com/rafael-osao-cabrices/venezuela-drug-shortage_b_9154498.html 58 http://econlog.econlib.org/archives/2010/11/price_controls_1.html 59 https://www.city-journal.org/html/ugly-truth-about-canadian-health-care-13032.html


Case Study: China

In Beijing, China, a different problem presents itself. There, the black market exists indirectly due to the work of scalpers. Under the Chinese system, patients must line up at the hospital to be seen by a medical professional. Scalpers are able to sell appointments for up to three times the face value, often with the help of insiders at these hospitals.60 This type of illegal behaviour is designed to tackle the unreasonable wait lines imposed by the high demand. By detouring around the established system, this has created a black market artificially inflating prices for citizens. This has now limited access to healthcare for those in poverty and neglecting those who cannot afford the high prices. Even for routine checkups and procedures, citizens have to pay large sums of money disrupting their daily lives.

Case Study: Central and Eastern Europe

Due to the low wages and an overloaded healthcare system in Eastern European countries such as Poland and Slovakia, a pattern of informal payments has emerged. It has been found that these “gratitude payments” are common in several countries, with 28% of patients in Romania and 21% in Lithuania having given these gifts to doctors in exchange for shorter wait times.61 These bribes hint at the underlying issue that these hospitals are at capacity.

Possible Solutions and Controversies

Technological Improvements As identity theft and the black market for medical records remain prevalent, medical facilities must strive to defend against hackings by improving their security measures. The implementation of encryption and a data breach response plan will provide a clear basis of response when breaches do occur.62 Since hackings may sometimes but inevitable, the ability to do damage control and plan for a multi-step approach toward dealing with electronic vulnerabilities is essential to be pro-active in the current state. In cases where data breaches have occurred, it is important for facilities to own up to their failures.63 This transparency is vital to preventing similar situations in the future and dealing with the aftermath of identity theft. However, the improvement of technological procedures can often be expensive and cost prohibitive despite the clear positive outcomes.

Ensuring Access to Medical Infrastructure

Access to medical infrastructure can take two main forms: healthcare and medicine. Healthcare may come in the form of the services received by patients, for instance in the form of doctors and nurses. This can be done through dedicated access to education for doctors and professional development for nurses. Medicine is resource and ability to import medication and other technology necessary for to undergo medical procedures. The quality of healthcare and medicine can be improved through international cooperation and investment into research. However, this symptom is often not the main problem in countries that fail to provide healthcare to all citizens. This plan of a more universal and guaranteed form of healthcare, similar to those in Scandinavia, is an option often considered by scholars. However, the immediate drawback of this plan would be the lengthening wait times for treatment. In some ways, even if there is greater access to infrastructure, such as in many developed countries,

60 http://www.newsweek.com/china-hospitals-scalping-tickets-medical-care-death-dying-disease-beijing-446612 61 https://www.economist.com/news/europe/21647087-central-and-eastern-europe-low-paid-doctors-accept-bribes-and-patients-offer-them-patients-bearing 62 http://resources.infosecinstitute.com/hackers-selling-healthcare-data-in-the-black-market/#gref 63 https://securityintelligence.com/childrens-health-care-patient-records-and-black-market-identity-theft/


treatment voids still exist. One way to combat this is to ensure that enough facilities are created and to constantly monitor the supply of infrastructure to be sure that the demand is met.

In the field of medicine, the supply and affordability of medication are vital to ensuring access. By stabilizing the manufacturing prices of medication, a steady supply will relieve the market from upward pressure on prices. Price controls and government subsidies can aid in the further proliferation of medicines, but puts a larger strain on national budgets. Finally, the development of an Essential Medicines List can be extremely beneficial for countries who may lack direction in identifying and acquiring medication.64 Such a list would allow the cheaper and expedited production of certain drugs deemed necessary for medical facilities. As well, this would allow better distribution of medicines, resulting in a more accountable inventory.

By easing a burdened healthcare system, the need for a black market can be reduced. In most situations, a shortage of doctors exists, resulting in longer wait times and a lower quality of treatment. This can be overcome through enabling and encouraging the education and training of more medical professionals. The development of medical technology and construction of facilities will also aid in spreading out the demand for healthcare among a wider range of providers. However, there are cost and educational strains this may have on universities. As well, high costs are associated with the development of new infrastructure.

Prevention of Black Markets While the demand for a black market can be reduced, these illegal transactions should still be prevented. The main means of doing so involves increased regulation and greater action taken toward black markets. Such action could take the form of restrictions and jail time for those involved with black markets, including both vendors and buyers, although it is important to take into account the situation of those looking to engage with the black market. The cooperation of international and local governing and enforcement bodies will help eliminate the presence of black markets. Monitoring and tracking not only acts as a deterrence for those looking to commit crimes, but can also provide authorities with information regarding the current status of the situation. Stronger legal consequences for participation in black markets could be enacted but one would warn against the need for or utility of blanket solutions. It is still important go on a case-by-case basis as well as target large-scale operations instead of individual vendors. An alternate approach would focus on rehabilitation instead of punishment to ensure community participation and alleviate resentment. This modification of the legal process would look to involve the community through a solution-based approach that would look at the root of the problem and not simply the consequences.

Bloc Positions

It is important to note that black markets exist in multiple countries and that one nation can fall into multiple blocs. It is up to delegates to find the stance that is most beneficial for their country and adopt an approach that true to their experiences and needs. The goal of all the blocs is not only to fix the issues at hand, but also to tackle the underlying problems that cause the black markets to form. While each bloc in this committee has a unique focus, all aspects of the problem and the subsequent solutions will contribute to solving the central problem. Therefore, the pieces of this puzzle must fit together and delegates must work to together and accommodate one another in their journey to a healthy population.

64 http://www.who.int/medicines/areas/policy/AccesstoMedicinesIPP.pdf


Countries that Lack Regulatory Resources Countries in this bloc include developing countries, particularly South Africa and other sub-Saharan African nations. Although these countries generally want the best resources for their citizens, they may lack the regulatory resources and oversight in order to monitor and prevent the establishment of black markets. This result comes from corruption or inadequate capital in these countries. This bloc’s main priority is to push for international help in achieving a strong regulatory foundation as well as global cooperation in tackling the problem of black markets. This is especially important for countries in this bloc because they lack the resources to deal with the problem by themselves. They believe in targeting the root of the problem and seizing the means of production of medicines.

Countries Suffering from Overloaded Medical System Countries in this bloc include Eastern European countries, China, and Cuba. The primary motivation behind this group’s actions is to relieve the problem from its source: the overloaded medical systems. This problem manifests itself in the shortage of personnel as well as the subpar quality of their work. Countries in this bloc should focus on the lack of doctors by supporting and increasing training facilities for future generations. As well, they should encourage further research and stronger knowledge of the medical field by encouraging the creation of networks for doctors. On an economic level, this bloc realizes that the problem also lies in the wages paid to the doctors. However, beyond that, they also see the need to stop the corruption in their medical system. By ensuring accountability and promoting transparency within their medical facilities, these nations will be able to keep access to the medical system equitable and promote uniform access to all members of the population.

Countries in Turmoil Countries in this bloc include Venezuela, Colombia, and other countries involved in civil conflicts or humanitarian crises. These countries are all currently involved in some type of disruptive event that further prevents the government from fulfilling its role and obligation to the citizens. This complicates the distribution and access to healthcare, resulting in severe shortages of healthcare and medicines. The main objective for this bloc is to focus on obtaining these resources for their citizens in order to minimize the repercussions of social problems.

Countries with Forms of Universal Health Care Countries in this bloc include Sweden, Norway, Canada, and the United Kingdom. However, they also suffer the drawbacks of their own healthcare systems and have problems expediting the medical care to citizens. Often involving more developed countries, this bloc has the resources and capital to aid other countries and better monitor black markets to protect their citizens.

Discussion Questions

1. What steps should countries take to preserve the integrity of their health care process and reduce corruption?

2. What role do international organizations, corporate bodies, and other governments play in the process to eliminate black markets?

3. How will the confidentiality of patients be preserved in the face of hackers and malicious organizations?

4. How can access to medical infrastructure such as facilities and medicines be guaranteed for patients?


5. How do black markets manifest itself in different countries? What common solutions can be utilized? What should be unique?

Additional Resources

Black Market for Healthcare Data

http://www.npr.org/sections/alltechconsidered/2015/02/13/385901377/the-black-market-for-stolen-health-care-data

Origins of Healthcare Data Black Market

http://www.beckershospitalreview.com/healthcare-information-technology/5-facts-about-the-health-data-black-market.html

Appearance of Black Markets in Humanitarian Crises

https://www.hrw.org/report/2016/10/24/venezuelas-humanitarian-crisis/severe-medical-and-food-shortages-inadequate-and

Black Markets in Canadian Medical System

http://www.washingtontimes.com/news/2009/oct/5/canadas-black-market-clinics/

Situation in Central and Eastern Europe

https://www.economist.com/news/europe/21647087-central-and-eastern-europe-low-paid-doctors-accept-bribes-and-patients-offer-them-patients-bearing


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Documents

World Health OrganizationSimilar to malaria in that it is transferred via mosquitos, yellow fever has killed millions and wiped out entire colonies and regions. This disease causes