Tag: Investment

Harnessing innovation in robotic-assisted surgery

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For nearly three decades, Intuitive has been developing innovative approaches in the field of minimally-invasive care. We are guided by the belief that minimally-invasive care can be life changing, that patient outcomes can be profoundly improved and that enhanced clinical outcomes can sustainably lower the total cost of comprehensive care.

Our focus is on helping customers in Europe and around the world achieve better outcomes, better surgeon and care team experiences, better patient experiences and lower cost of care. Positive impact in these areas requires a holistic effort that includes not only leading-edge, integrated systems and software, but also an ecosystem of education and support that extends across the patient care pathway and the broader health care system.

What is robotic-assisted surgery?

27 years ago, Intuitive launched the da Vinci robotic-assisted surgical system, transforming the field of minimally-invasive surgery.

Robotic-assisted surgery is a form of minimally-invasive surgery performed by a surgeon using a computer-assisted system to operate through small incisions using tiny, wristed instruments. Robotic-assisted surgical systems do not perform surgery on their own and they do not replace surgeons. Surgeons completely control da Vinci robotic-assisted surgical systems, while seated at an ergonomic console that uses high-definition, 3D vision to magnify the patient’s anatomy. The surgical system translates the surgeon’s hand movements in real time to bend and rotate the instruments with greater flexibility, precision and range of motion than the human hand. This approach can augment a surgeon’s skills and capabilities while allowing them to continue to apply their judgment and experience.

To date, more than 12 million da Vinci robotic-assisted surgical procedures have been performed worldwide — including more than 1.2 million in Europe — across a range of procedures including urology, gynecology, colorectal, thoracic, general surgery and more.

Robotic-assisted surgery is a form of minimally-invasive surgery performed by a surgeon using a computer-assisted system to operate through small incisions using tiny, wristed instruments.

A growing body of research, including more than 34,000 peer-reviewed studies, suggests that minimally-invasive, robotic-assisted surgery can offer patients benefits in many cases, depending on the procedure, including one or more of these benefits: less blood loss, fewer complications, shorter hospital stays, and less chance of hospital readmission.[i]

The added value of robotic-assisted surgery for European health care systems

Since the first robotic-assisted da Vinci prostatectomy was performed in Germany nearly 20 years ago, more than 1,500 da Vinci systems have been installed in Europe, highlighting Europe’s strong demand for this innovative technology. But, while Europe has helped drive this technology forward, more can be done to help hospitals in Europe become world leaders in the 21st century.

Similar to health care systems around the world, Europe faces challenges including rising health care costs, a pressured workforce, aging populations and increasing burdens of disease. At the same time, patients across Europe are seeking equitable access to innovative, high-quality care.

Using our more than two decades of experience working with hospitals and health care systems across Europe, we strive to offer solutions to these multifaceted challenges that are aligned with our customers’ clinical and economic capabilities and goals. A key insight from our experience is that we must provide more than a “robotic-assisted surgical system”; we must be a “technology-enabled solutions partner and provider”. Robotic-assisted surgery as a modality can help drive better patient outcomes; robotic-assisted surgical programs as a key part of a hospital’s care pathway can help optimize the cost and efficiency and advance the delivery and quality of care.

As one example, we collaborate with hospitals to examine opportunities to sustainably increase throughput and introduce efficiencies that can allow them to treat more patients and reduce patient backlogs. Solutions that our customers have enacted as a result of these engagements include improving operating room set up time, scheduling optimization, standardizing pre-operative planning for care teams, and starting surgical days earlier. 

In all cases, we work to assure that any effort is seamlessly integrated into the workflows of our hospital customers and their broader patient care pathways, and that our success is defined and measured in alignment with their goals.

Training

Central to our holistic approach is our technology training, which is essential to maximize patient safety and a vital part of any successful robotic-assisted surgery program. Our four-phase training pathway combines skills and technology training with opportunities for health care professionals around the world to learn from their peers. Our robust training offerings include a combination of simulation, virtual learning, in-person observation and hands-on training, with high-quality tissue models and peer-to-peer mentoring, proctoring and advanced learning opportunities. The training tools and technologies we offer are informed by our unique understanding of best practices and can help users build their skills by targeting individualized areas for improvement.

We believe that our robust training programs are contributing to the development of the next-generation health care workforce.

Last year, we became the largest provider of robotic-assisted surgical technology training to have our full global training portfolio accredited by The Royal College of Surgeons. And, our industry-leading offerings are more available than ever across both virtual and in-person opportunities; we now have more than 25 training centers and partnerships across Europe.

Looking forward, we believe that our robust training programs are contributing to the development of the next-generation health care workforce and motivating existing surgical staff to stay within our health care systems. We will continue to evolve and innovate our training offerings by listening to and learning from surgeons and teams to identify the practices that lead to better results and hone our efforts to offer meaningful interoperative guidance.

Total cost to treat

While there is an upfront investment in robotic-assisted technology, the experience of hospitals across Europe shows that da Vinci systems can help realize a return on this investment. The benefits of minimally-invasive care — fewer complications and readmissions, less blood loss, less pain — help to avoid higher ‘downstream’ costs and resource use associated with traditional, or “open” surgery, which typically requires longer hospital stays and presents a greater risk of post-operative complications.[ii] Robotic-assisted approaches, like the da Vinci system, can therefore help to reduce the costs and resources associated with a complete patient journey, or ‘episode of care’.

An important indicator of the economic value of this cost avoidance can be found in hospitals’ investment decisions in recent years. Based on their own medical records, financial data, and unique reimbursement and cost structures, hospitals are increasingly choosing to commit to robotic-assisted technology. Our own data shows that the number of hospital Integrated Delivery Networks, or IDN’s, with more than seven da Vinci systems has increased by more than 150 percent in the past five years.[iii] We believe this demonstrates a trend from cautious adoption to standardization based on recognized value. This trend brings the benefits of minimally-invasive care to an increasingly larger number of users, helping to accelerate and compound the potential savings to the health care system over time.

A vision for 2030: a future of European health care excellence

The next European Commission term will almost reach the end of this decade, serving as a useful marker for us to imagine where Europe could be in health care delivery by 2030.

Looking ahead, it will be essential that policymakers create an environment where advancements in robotic-assisted tools and technology, digital health and patient-focused innovation can be seamlessly integrated in a way that prioritizes patient safety and facilitates equitable access to and adoption of innovative technology.

The infrastructure and tools needed for future success are already present. Europe can lead the way in creating this environment, in part by avoiding policies which inhibit this kind of integration and innovation through duplicative or conflicting regulatory structures. We look forward to contributing to an ambitious agenda to bring cutting-edge health care, training, and innovations to European patients and health care professionals.

This material may contain estimates and forecasts from which actual results may differ.

[i] Bhama, A. R., et al. (2016). “Comparison of Risk Factors for Unplanned Conversion from Laparoscopic and Robotic to Open Colorectal Surgery Using the Michigan Surgical Quality Collaborative (MSQC) Database.” Journal of Gastrointestinal Surgery: 1-8

Oh, D. S., et al. (2017). “Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy: Propensity-Matched Analysis of Recent Premier Data.” Annals of Thoracic Surgery 104(5): 1733-1740.

Ran, L., et al. (2014). “Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis.” PLoS ONE 9(9): e108361.

Speicher, P. J., et al. (2014). “Robotic Low Anterior Resection for Rectal Cancer: A National Perspective on Short-term Oncologic Outcomes.” Annals of Surgery.

Tam, M. S., et al. (2015). “A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery.” Surgical Endoscopy and Other Interventional Techniques.

Pilecki, M., et al. (2014). „National Multi-Institutional Comparison of 30-Day Postoperative Complication and Readmission Rates Between Open Retropubic Radical Prostatectomy and Robot-Assisted Laparoscopic Prostatectomy Using NSQIP (National Surgical Quality Improvement Program)“ Journal of Endourology, 430 – 436.

Tewari A, et al. “Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy,” Eur Urol. 2012 Feb 24.7.

Carbonell, A. M., et al. (2017). “Reducing Length of Stay Using a Robotic-Assisted Approach for Retromuscular Ventral Hernia Repair: A Comparative Analysis from the Americas Hernia Society Quality Collaborative,” Annals of Thoracic Surgery.

Lim, P. C., et al. (2016). “Multicenter analysis comparing robotic, open, laparoscopic, and vaginal hysterectomies performed by high-volume surgeons for benign indications,” International Journal of Gynecology and Obstetrics.

O’Neill, Michelle, et al. “Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis,” Archives of gynecology and obstetrics 287.5 (2013): 907-918.

Geppert B, Lönnerfors C, Persson J. “Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.”  Acta Obstet Gynecol Scand. 90.11 (2011): 1210-1217. doi: 10.1111/j.1600-0412.2011.01253.x. Epub.

[ii] Id.

[iii] Intuitive internal data measuring from year end 2017 to year end 2022.



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Beyond forgetfulness: Why we must act on Alzheimer’s disease now

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In the face of an increasingly aging population, today’s reality reveals a harsh truth: health systems in the EU and beyond are ill-equipped to provide early and timely diagnosis of Alzheimer’s disease and embrace innovative treatments that could help to preserve memory and, with it, independence.  

Recent advances suggest that timely intervention may hold the promise to slow the memory decline in Alzheimer’s disease, making early diagnosis more critical than ever before. Yet without the necessary health care infrastructure in place to diagnose and provide treatment, we risk missing the crucial early window and the opportunity to delay — and hopefully in the near future prevent — distressing symptoms for patients and heartbreaking experiences for families.  

The EU and its member countries have the opportunity to be remembered for leading in this space by increasing funding for research, improving health care infrastructure to support accurate diagnosis and timely intervention, and enhancing support services at a national and regional level. The forthcoming European Parliament elections in June 2024 are the ideal moments to make that pledge. For individuals, families and health care systems, Alzheimer’s disease is a ticking time bomb unless we invest in our future health today.  

The EU is not prepared for Alzheimer’s disease  

In Europe, approximately 7 million people are affected by Alzheimer’s disease, a number set to double to 14 million by 2050.1 On top of the physical and emotional distress this will cause, there are direct financial and social implications on families and communities, with Alzheimer’s costs expected to reach a staggering €250 billion by 20302 — bigger than the GDP of Portugal3 — placing an additional and substantial weight on global health care systems that are already struggling under cost and capacity burdens.4 

Timely diagnosis stands as a cornerstone in determining the appropriate treatment for patients.

That’s why MEP Deirdre Clune is leading the call for a European Parliament hearing to discuss a focused EU strategy on dementia and Alzheimer’s disease. “Timely diagnosis stands as a cornerstone in determining the appropriate treatment for patients,” argues Clune. “Therefore, the EU must create a strategic framework which lays out clear recommendations for national governments and recognises the toll of dementia and Alzheimer’s disease on societies across Europe, encourage innovation and take on board best practices to develop effective and efficient approaches. Together, with a unified approach and firm commitment, the EU can pave the way for better Alzheimer’s care.”

In the next EU political mandate, policymakers must answer the call by developing a comprehensive EU Beating Dementia Plan that specifically addresses the unique challenges posed by Alzheimer’s disease and building on established coordinated action plans for other significant health burdens, such as the EU Beating Cancer Plan. The European Brain Council and EFPIA’s, RETHINKING Alzheimer’s disease White Paper is a useful resource, calling for policymakers to rethink Alzheimer’s and offering policy recommendations to make tangible changes to improve the lives of people living with the disease.  

EU member countries must commit to investing in diagnostic infrastructure, technology and integrated care that can help to detect Alzheimer’s disease at an early stage and ensure timely intervention resulting in the preservation of memory and, thereof, independent living and normal social functioning.  

Laying the foundations at national level  

While action is certainly needed at the EU level, huge opportunity lies at the national and regional levels. Each member country has the chance to apply well-funded national dementia plans that tailor their strategies and responses to address the distinct needs of their populations, making a real and meaningful impact on the people and health systems in their country.  

Inspiration stems from Italy, which recently launched its Parliamentary Intergroup for Neuroscience and Alzheimer’s, dedicating its efforts to raising awareness, fostering discussions among national and regional institutions, promoting clinician and patient involvement, supporting novel research, implementing new diagnostic models, and strengthening patient access to care. 

Italian MP Annarita Patriarca, co-host of the Parliamentary Intergroup, affirms: “Primary responsibility of a member state is to ensure to all citizens the greatest standards of diagnosis and access to treatment and care. Thus, it is necessary to put in place a strong collaboration between the public and private sector to strengthen investments in neurological diseases. Improving patients’ diagnostic and care pathways, especially in a disease area like AD with such a high unmet medical need and societal impact will be the core focus of the intergroup.” 

Additionally, during the Alzheimer’s and Neuroscience Conference: a priority for the country in July, members of the Italian Parliament importantly put forward legislative and regulatory solutions to ensure an early and accurate diagnosis. 

Leading the conversation on the international stage   

Amid the growing burden of Alzheimer’s disease globally, this is a moment for policymakers to hold each other accountable. Member countries are uniquely placed to do this within the EU but also across the wider health care ecosystem, calling on countries and leaders to honor prior commitments that prioritized investment in relieving major health burdens, including Alzheimer’s.  

Encouragingly, the May G7 Hiroshima Leaders’ Communiqué specifically recognized and supported dementia as a freestanding issue, breaking away from the typical categorization with NCDs. Moreover, the G7 health ministers published a joint Communiqué spotlighting the priority to “enhance early detection, diagnosis and interventions, including developing care pathways and capability and capacity building of health and primary care providers by strengthening primary health care (PHC)”.  

These promising steps mean that Alzheimer’s disease is beginning to gain the recognition it deserves but also acts as a line in the sand to ensure complacency doesn’t creep in. Collectively, EU countries must assume a leading voice within the international fora, ensuring that Alzheimer’s disease remains a global health care priority and receives the investment it warrants. 

Time to commit to action in Alzheimer’s disease  

September marks World Alzheimer’s Month, and its theme Never Too Early, Never Too Late, reiterates the importance of early diagnosis. It presents a valuable foundation to initiate discussions on country- and regional-level strategies to drive and strengthen diagnostic infrastructure and services for the prevention, diagnosis, case management, monitoring and treatment of Alzheimer’s disease. 

Unless we act now, a generation of people will be forgotten as they begin to lose their memories.

“Unless we act now, a generation of people will be forgotten as they begin to lose their memories,” shares Frédéric Destrebecq, executive director of The European Brain Council. “By recognizing the urgency of the situation and making concerted investments, we can forge a path toward a more compassionate, empowered future for individuals, families and communities impacted by Alzheimer’s, and remember all those who’ve been lost to this devastating disease.”

It is never too early, never too late, to be remembered for taking action against this debilitating disease.  

References:  

1 – Jones RW, Mackell J, Berthet K, Knox S. Assessing attitudes and behaviours surrounding Alzheimer’s disease in Europe: key findings of the Important Perspectives on Alzheimer’s Care and Treatment (IMPACT) survey. The journal of nutrition, health & aging. 2010 Aug;14:525-30.  

2 – Cimler R, Maresova P, Kuhnova J, Kuca K. Predictions of Alzheimer’s disease treatment and care costs in European countries. PLoS One. 2019;14(1):e0210958. Published 2019 Jan 25. doi:10.1371/journal.pone.0210958 

3 – Published by Statista Research Department, 20 J. GDP of European countries 2022. Statista. June 20, 2023. Accessed August 1, 2023. https://www.statista.com/statistics/685925/gdp-of-european-countries/. 

4 – The Economist. Why health-care services are in chaos everywhere. Available at:  https://www.economist.com/finance-and-economics/2023/01/15/why-health-care-services-are-in-chaos-everywhere. Accessed: July 2023.  



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Are small nations welcome at the EU’s industrial policy table?

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It is not just about the money, it is about what each country — no matter its size — can bring to the table, Marius Stasiukaitis writes.

The Green Industrial Plan, comprehensive as it might be, falls short of an industrial policy that would work equally well across the entire European Union. 

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Instead, new policies set broad rules, leaving the actual industrial development strategy in the purview of individual member states. 

While bolstering industry in manufacturing hotspots, this approach might significantly distort the market in ways that do a disservice not just to businesses but to the “green” part of the plan itself.

The EU’s industrial policy should not turn into a subsidy race

A new era of competition is unfolding for investments in strategically vital sectors across the world. 

Last year, the United States enacted the Inflation Reduction Act and Chips Act, introducing generous subsidies to incentivize investments in green technologies and semiconductors. 

In February 2023, the EU followed with the Green Industrial Plan, which relaxed state aid rules for member states, granting them the ability to match subsidies offered in other regions around the globe.

While the intention is likely to prove to be a net positive for the EU, reducing the EU’s industrial policy’s role to a rule set for a subsidy race between member states could prove to be costly. 

For smaller economies, it might be a particularly difficult challenge. This has the potential to undermine Europe’s green transition and weaken its competitiveness, losing prospective investment opportunities in the long run.

This could also imperil the bloc’s cohesion policy

We have already seen the EU’s leading economies roll out the red carpet for major investors, backing their invitation with impressive sums. 

For example, recent media reports have revealed that the German government provided Intel with €10 billion in subsidies to establish a €30bn chip plant within its territory.

Whereas France announced that it has received EU authorisation to grant €1.5bn in subsidies to a €5.2bn electric vehicle battery factory.

These announcements come at a time when many EU countries are facing rising borrowing costs, which could further complicate their efforts to secure significant additional funding for their industrial development. 

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The government deficit-to-GDP ratio in the eurozone stood at 3.6% in 2022 and might increase even further in 2023. 

It is also a matter of relative cost. For smaller countries such as the Baltic States or Slovenia, the size of the subsidy that Germany granted to Intel alone would exceed 10% of their GDP. 

No matter what they choose to do regarding upgrading their infrastructure, a subsidy in the billions would most likely trump that. 

In this scenario, the EU’s cohesion policy might also be jeopardised, as large countries will stronghold their position in tomorrow’s industries.

A paradigm shift could make the EU more competitive

Most importantly, this approach will likely undermine Europe’s green transition, making the process more costly. 

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A policy that favours larger countries with greater financial resources raises the risk of significant market distortions, diverting investments from locations in the EU where their lasting competitive advantages would be most viable.

The EU’s industrial policy is more likely to succeed if it utilises the distinct strengths held by its member states. 

This would require a paradigm shift in the EU’s approach, moving beyond merely relaxing state aid rules and towards implementing a shared industrial development strategy and financing at the EU level. 

However, it is a worthwhile step as this shift would make the EU more competitive on the global stage, capitalising on the strengths of its member-states that already have a long track record in attracting foreign direct investment.

Small advanced economies, such as the Baltic States or Nordic countries, hold the potential to propel the growth of green industries in the EU. 

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In contrast to the larger economies within the EU, they offer a more enticing business environment, showcase remarkable openness to foreign direct investment, boast ambitious renewable energy targets, and demonstrate a greater ability to adapt to the demands of future industries.

Smaller countries can also have ambitious plans

For instance, since the 1990s, Ireland has emerged as the premier EU destination for foreign direct investment, alluring multinational corporations across various sectors such as semiconductors, life sciences and digital technologies, despite its small size. 

This is attributed to its favourable business environment, skilled workforce, and strategic location.

Furthermore, in recent times, several other nations have joined the league. According to the 2023 Greenfield FDI Performance Index, Portugal and Lithuania have remarkably attracted about six times more investment projects than the size of their economy would predict, positioning them as leading overachievers within the EU.

Notably, small advanced economies that have been focusing on attracting foreign direct investment to fuel their growth also have successfully put all the essential building blocks in place. 

For example, the Baltic States, along with Denmark and Ireland, are ranked highest in the EU for their business environment in the Economic Freedom Ranking. 

Renewable energy could provide another compelling reason why smaller countries in Southern or Northern Europe are strategically positioned to drive the growth of green industries. Nordic countries are already global leaders in renewable energy production, and the surplus of clean energy was crucial to the success of Northvolt’s first battery factory in Sweden. 

The Baltic States also have ambitious plans; for instance, Lithuania aims to meet 90% of its energy demand through local production of renewable energy by the end of this decade. 

As the issue of energy independence is vital for countries on the eastern border of the EU, we are likely to see an acceleration of their green transition.

It’s not about the size — it’s about what you can bring to the table

The success of the EU’s industrial policy and green transformation could hinge on the smaller countries within the EU. Some of these countries have already mastered the fundamentals of future economy — adaptability and flexibility. 

This makes them ideal hubs for sandboxes or emerging industries with rapidly evolving technology. 

And while financial incentives will retain strong appeal, they will not be able to replace the agility of the smaller European states, crucial for securing Europe’s competitiveness. 

In other words, it is not just about the money, it is about what each country — no matter its size — can bring to the table.

Marius Stasiukaitis is the Head of Strategy at Invest Lithuania, a non-profit investment promotion agency founded in 2010 by the Ministry of Economy of the Republic of Lithuania.

At Euronews, we believe all views matter. Contact us at [email protected] to send pitches or submissions and be part of the conversation.

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Labs: the (overlooked) building block of Universal Health Coverage

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Hepatitis C (HCV) — a potentially life-threatening virus that infects 1.5 million new people around the world every year — is highly treatable if diagnosed early.[1]

Unfortunately,  access to quality screening is far from universal. Countries like Egypt — one of the countries with the highest prevalence of HCV in the world — demonstrate the impact screening can have. In 2015, HCV was prevalent in an estimated 7 percent of the country’s population and accounted for 7.6 percent of the country’s mortality, presenting a significant health care and societal burden.[2]

But since then, Egypt has turned a corner. In 2018, the Egyptian Ministry of Health and Population launched a massive nationwide HCV screening and treatment campaign as part of its 2014-2018 HCV action plan.[3] The campaign’s results were inspiring: by July 2020, Egypt had screened more than 60 million people[3] and treated 4 million residents.[2] Today, Egypt is set to be the world’s first country to eliminate HCV within its borders.[2]

The results of Egypt’s HCV screening program speak to diagnostics’ power in contributing to improved health outcomes around the world. Among the essential components of any health system is the capacity for prevention, which includes timely screening and detection. But a preventive approach based on timely diagnosis won’t work without the right infrastructure in place.

Strong laboratories as a cornerstone of building better health care

Matt Sause, CEO Roche Diagnostics | via Roche

The World Health Organization (WHO) highlights the critical role well-functioning laboratory services play in health systems with good reason.[4] Around the world, clinicians increasingly rely on  laboratory tests for diagnostic and treatment decisions. These tests help them make more informed decisions that result in better care and potentially improved outcomes for patients.

The challenges facing labs today — and tomorrow

Two key challenges facing laboratory systems today are underfunding and insufficient resources. Despite their central importance, laboratories struggle to garner the political and financial support they need to be as effective as possible. For example, it’s estimated that while lab results drive approximately 70 percent of clinical decision making, laboratories make up only 5 percent of hospital costs.[5]

After all, it’s the health care systems with strong, resilient labs that will be best placed to manage future pandemics and ever-growing health threats like heart disease and dementia.

What’s needed is a political commitment to provide everyone with access to accurate and timely diagnosis that paves the way to effective treatment and health. And putting this commitment into practice can only be achieved and sustained through coordinated multistakeholder efforts and public—private partnerships. This is not just a worthwhile investment for patients, but also the wider health care system in the long run. After all, it’s the health care systems with strong, resilient labs that will be best placed to manage future pandemics and ever-growing health threats like heart disease and dementia.

Another challenge is the health care workforce. Effective use of diagnostics requires qualified people to drive it, with expertise in pathology and laboratory medicine. Yet the world currently faces a laboratory staffing shortage. For diagnostics in particular, baccalaureate degree programs in laboratory science have previously been on the ‘endangered list’ of allied health professions.[6] In the end, inadequately trained staff, frequent turnover and scheduling problems all make quality lab results more difficult to guarantee.

This UHC ambition is only possible when backed by a network of strong laboratories that help ensure individuals can access high-quality diagnostics services without financial burden in all health care systems.

And that’s not all: inadequate infrastructure and staffing shortages are more present in low-income, rural communities, which exacerbate the broader diagnostics gap troubling global health care today. Many low-income countries lack an integrated laboratory network that can fully provide high-quality, accessible and efficient laboratory testing services for the entire population. In fact, a commission convened by The Lancet concluded that 81 percent of these populations have little or no access to diagnostics.[7]

The path to Universal Health Coverage

Put simply, innovative diagnostics are only meaningful if they reach people where and when they’re needed. Advancing this equity is at the heart of the WHO’s vision for Universal Health Coverage (UHC) by 2030. The goal? To guarantee all people have access to high-quality services for their health and the health of their families and communities, without facing financial hardship.

This UHC ambition is only possible when backed by a network of strong laboratories that help ensure individuals can access high-quality diagnostics services without financial burden in all health care systems. To do this, UHC should explicitly include diagnostics services. Financially, it’s savings from screening, early diagnosis and targeted treatment that make UHC feasible. Health care systems will have to undergo a systemic shift from focusing on treatment to focusing on prevention. And that’s just not possible when clinicians don’t have access to fast, accurate and cost-efficient lab results to inform their clinical decision-making. Policies and regulations that safeguard UHC goals of access and health equity are essential to make progress toward UHC.[8] The Saving Access to Laboratory Services Act (SALSA), in the United States, is an example of how national policies can help to ensure sustainable laboratory networks and contribute to equitable access to essential healthcare.

Stronger labs can not only help health care systems make savings in the routine management of population health; investing in them also helps to reduce costs and prepare in advance for any future public health crises.

This year has already seen encouraging progress toward achieving UHC through enhanced diagnostics capacity. The adoption of the resolution on strengthening diagnostics capacity at the World Health Assembly in May was an important signal of growing international political support for diagnostics. It was also a call to action. The next step for this month’s United Nations General Assembly and Sustainable Development Goals (SDG) Summit is channeling political support for diagnostics into the development of an action-oriented declaration.

To put us closer to UHC, this declaration should commit to ensuring that national health plans include access to timely detection and prevention. That starts with supporting laboratory systems and establishing National Essential Diagnostics Lists that identify the most critical diagnostic tests to help diagnose patients quickly and accurately so that they can receive needed treatment. At Roche, we’re advocating that governments, industry, civil society and other policy stakeholders will come together around concrete plans and shared resources that strengthen diagnostics and the lab infrastructure that makes them effective. In line with our commitment to increase patient access to important diagnostic solutions by 2030, we plan to do our part.

[1] Hepatitis C. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accessed 22.08.2023)

[2] Egypt’s Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study. Hassanin, A. et al. Available at:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087425/ (Accessed 22.08.2023)

[3] Hepatitis C in Egypt – Past, Present, and Future. Roche Diagnostics. Available at: https://diagnostics.roche.com/global/en/article-listing/egypt-s-road-to-eliminating-hepatitis-c-virus-infection—a-stor.html (Accessed 22.08.2023)

[4] Monitoring the Building Blocks of Health Systems. World Health Organization. Available at: https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf (Accessed 14.07.2023)

[5] The Cost-effective Laboratory: Implementation of Economic Evaluation of Laboratory Testing. Bogavac-Stanojevic N. & Jelic-Ivanovic Z. J Med Biochem. Volume 36, Issue 3, 238 – 242. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287218/

[6] Ensuring Quality Cancer Care through the Oncology Workforce: Sustaining Care in the 21st Century: Workshop Summary. National Academy of Sciences. Available at: https://www.ncbi.nlm.nih.gov/books/NBK215247/ (Accessed 14.07.2023)

[7] Essential diagnostics: mind the gap. The Lancet Global Health. Available at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00467-8/fulltext (Accessed 14.07.2023)

[8] Private Sector Commitments To Universal Health Coverage. UHC Private Sector Constituency 2023 Statement. https://www.uhc2030.org/fileadmin/uploads/UHC2030_Private_Sector_Commitments_Statement_April2023.pdf (Accessed 29.08.2023)



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BRICS hypocrisy on offshore reform

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Andrea Binder is a Freigeist fellow and research group leader at the Otto Suhr Institute of Political Science at Freie Universität Berlin and the author of “Offshore Finance and State Power.” Ricardo Soares de Oliveira is professor of the International Politics of Africa at Oxford University and is currently writing a monograph titled “Africa Offshore.”

Of all the challenges in global governance discussed at the latest BRICS summit in Johannesburg, the role of offshore financial centers should have loomed large. Instead, the issue barely got a noncommittal half paragraph on page eight of the summit’s 26-page declaration.

In an example of breathtaking hypocrisy, BRICS countries rail against the global financial architecture but offer no collective action on offshore banking, and they also continue to be among its major users themselves.

Data leaks such as the Pandora Papers and Panama Papers have shown just how vast amounts of cash end up in jurisdictions that cater to wealthy nonresidents by offering secrecy, asset protection and tax exemption. And according to economist Gabriel Zucman $7.8 trillion — or about 8 percent of global wealth (and 40 percent of corporate profits) — are currently hidden in such tax havens.

What’s interesting is that a considerable share of this originates from BRICS and other developing countries. The U.N. Conference on Trade and Development, for instance, estimates that $88.6 billion leave Africa every year in the form of illicit capital flight, much of it ending up offshore.

The fact that this offshore world is underpinned by the interests of the rich world and also a majorly exacerbates global inequality should fire up BRICS countries.

And certainly, they are quite vocal in denouncing the role of offshore finance: In the 2020 Moscow Summit declaration, for instance, BRICS member countries reiterated their “commitment to combating illicit financial flows, money laundering and financing of terrorism and to closely cooperating within the Financial Action Task Force (FATF) and the FATF-style regional bodies […], as well as other multilateral, regional and bilateral fora.” They have also rightly called out the West for setting up these mechanisms decades ago.

In practice, however, whatever global multilateral action is currently being taken is at the level of the G7 and the Organisation for Economic Co-operation and Development — even if these ambivalent reforms are often protective of the West’s offshore interests. BRICS countries, meanwhile, do almost nothing, despite being the largest global source of capital flight, according to a 2014 report by Global Financial Integrity.

And this lack of multilateral action perfectly aligns with the way individual BRICS countries have engaged with the offshore world thus far.

Brazil currently stands as the world’s second largest borrower from offshore financial markets. India long accepted a double-taxation agreement with Mauritius, which enabled significant foreign direct investment and tax avoidance by the wealthy until 2016. The country also created of an offshore financial center in Gujarat. Meanwhile, Russia’s hydrocarbons are traded through opaque offshore jurisdictions, and its elites have notoriously thrived in such systems. Then, there’s perhaps the most significant — and counterintuitive — stakeholder in the offshore world, which is China. Its state-owned enterprises are major users of jurisdictions like the British Virgin Islands, where they register secretive subsidiaries.

In short, BRICS countries are just as implicated in the offshore world as the Western economies they lambast. The reality is that their governments and political elites both benefit from and need the offshore financial world — and there are four reasons for this:

First, these countries engage in institutional arbitrage by accessing more efficient institutions — and, sometimes, institutions that don’t exist domestically, like credible contracts or a non-political judiciary — offshore.

They also seek access to cheaper and less constrained financing in offshore money markets, where they get access to the U.S. dollar and international investors that are unavailable onshore.

Heavily hit by sanctions — as in the case of Russia since 2022 — the offshore world is also a lifeline for BRICS countries, allowing for the circumvention of punitive measures.

And finally, BRICS elites frequently use such facilities for their own personal purposes, including hiding illicit money and assets.

Thus, closing these discretionary offshore avenues may well have implications for their personal survival — or the survival of their regimes.

This is why multilateral action from BRICS members remains rhetorical at best. And unilaterally, they either do nothing, or selectively implement anti-offshore measures as political tools of regime consolidation and to punish rivals. While continuing to criticize the West, they also voice few qualms regarding the thriving offshore roles of Hong Kong, the United Arab Emirates or Singapore.

The latest summit declaration’s vague language of “international cooperation” and “mutual legal assistance” simply highlighted all this once more, and it even eschewed the previous declaration’s references to the FATF or anything smacking of coordination with the West.

And while de-dollarization was again bandied about, BRICS countries remain keen on access to offshore dollars. Moreover, several of the bloc’s newly admitted states have deeply problematic records when it comes to money laundering and illicit financial flows. This is especially true of the UAE — an aggressively growing offshore financial center with dense layers of secrecy, and which the FATF placed on its “grey list” due to “strategic deficiencies” in its efforts to counter money laundering.

Given all this, what are the chances of BRICS-initiated reform in this area? Realistically, the only reason they would take action is because they care about their own regime stability. Though offshore mechanisms may seem like useful short-term levers, their long-term impact is likely to have troubling consequences for their economies. In time, offshore finance supercharges inequality and begets financial instability, which can lead to the toppling of regimes. Brazil experienced this first-hand in the 1982 financial crisis, which had a significant offshore component.

Of course, Russia’s dependence on offshore financial facilities to circumvent sanctions means it can be written off as reformer. But one would hope that some of the others might belatedly come to see an enlightened self-interest in going beyond their rhetoric.

For now, however, even this seems highly unlikely as, in the immediate future, the availability of offshore services continues to come in handy, while their negative impact on domestic inequality remain largely hidden from public view.

Besides, fighting domestic inequality isn’t really a major concern for many of these governments anyway.



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‘Own what the Mother of All Bubbles crowd doesn’t.’ This market strategist expects stagflation and is investing for it now.

Post By Stock , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

There’s always a bull market somewhere — if you can find it.

Keith McCullough encourages investors to join him in the hunt. You’ll need to be agnostic and open-minded, the CEO of investment service Hedgeye Risk Management says. If you’re wedded just to U.S. stocks, or the market’s latest darlings, you’re setting yourself up for disappointment — particularly in the hostile environment McCullough sees coming.

This coming challenge for U.S. stock investors, in a word, is stagflation, McCullough says. Stagflation — higher inflation plus slow- or no economic growth — is hardly a bullish outlook for stocks, but McCullough’s investment process looks for opportunties wherever they may be. Right now that’s led him to put money into health care, gold, Japan, India, Brazil and energy stocks, among others.

In this recent interview, which has been edited for length and clarity, McCullough takes the Federal Reserve and Chair Jerome Powell to the woodshed, offers a warning about the potential fallout from Powell’s upcoming speech at Jackson Hole, Wyo., and implores investors to discount happy talk and always watch what they do, not what they say.

MarketWatch: When we spoke in late May, you criticized the Federal Reserve for being obtuse and myopic in its response to inflation and, later, to the threat of recession. Has the Fed done anything since to give you more confidence?

McCullough: The Fed forecast of the probability of recession should be trusted as much as their “transitory” inflation forecast or a parlor game. People should not have confidence in the Fed’s forecast. The “no-landing” or “soft-landing” thesis is looking backwards. The Fed is grossly underestimating the future, doing what they always do, in looking at the recent past.

Their policy is wed to what they say. They claim they’re not going to cut interest rates until they get to their target. But any hint of the Fed arresting the tightening gives you more inflation. So there’s this perverse relationship where the Fed is the catalyst to bring back the inflation they’ve spent so much time fighting. 

Read: ‘The Fed is way late and they’ve already screwed it up.’ This stock strategist is banking on gold, silver and Treasurys to weather a recession.

MarketWatch: U.S. Inflation has come down quite signficantly over the past year. Doesn’t that show the Fed is well on the way to achieving its 2% target?

McCullough: A lot of people are peacocking and declaring victory over inflation when we’re about to have reflation that sticks. We have inflation heading back towards 3.5% and staying there.

Our inflation forecast is that it’s set to reaccelerate in the next two inflation reports, which will lead to another rate hike in September. The Fed’s view is that until they get to the 2% target they’re not done. A lot of people are really confident because inflation went from 9% to 3% that it’s getting closer to 2%, therefore the Fed is done. Given what Fed Chair Jerome Powell said, the next two inflation reports are critical in determining whether we hike rates in September. I think maybe even one in November. This is a major catalyst for the next leg down in the equity market.

The Fed is going to see inflation go higher, and they’ve already articulated to Wall Street that no matter what happens, that should constitute a rate hike. That’s a policy mistake. They’re going to continue to tighten into a slowdown. When the Fed tightens into a slowdown, things blow up.

MarketWatch: By “things blow up,” you mean the stock market.

McCullough: I don’t think the Fed cuts interest rates until the stock market crashes. The Fed is going to be tightening when the U.S. economy and corporate profits are at a low point, going into the fourth quarter. It’s not dissimilar from 1987 where all of a sudden a market that looked fine got annihilated in very short order. There are a lot of similarities to 1987 now; the market’s quick start in January, people in love with stocks. That’s a catalyst for the stock market to crash.

When the Fed has an inconvenient rule, particularly for the U.S. stock market, they just move the goal posts or change the rule. If they actually started to cut interest rates, inflation would go up faster. This is exactly what happened in the 1970s and what Powell explains is the risk of going dovish too soon – that he becomes [much-criticized former Fed chair] Arthur Burns. That’s why you had rolling recessions in the 1970s; the Fed would go dovish, devalue the U.S. dollar
DX00,
-0.21%,
and the cost of living for Americans would reflate to levels that are prohibitive.

People can’t afford reflation at the gas pump, or in their health care. It’ll be fascinating to see how Powell pivots from fighting for the people to bailing out Wall Street from another stock market crash, which will therein create the next reflation.

“ ‘The Federal Reserve has set the table for a major event in the U.S. stock market and the credit market.’”

MarketWatch: Speaking of a Powell pivot, the Fed chair speaks at Jackson Hole this week. Last year he put markets on notice for rate hikes. What do you think he’ll say this time?

Powell’s going to see inflation accelerating. I think Jackson Hole is going to be a hawkish meeting. That might be the trigger for the stock market.

Take the bond market’s word for it.  The bond market is saying the Fed is going to remain tight and seriously consider another rate hike in September. The reasons why markets crash in October during recession is that the fourth quarter is when companies realize that there’s no soft landing and they need to guide down.

The Federal Reserve has set the table for a major event in the U.S. stock market and the credit market. We’re short high-yield and junk bonds through two ETFs: iShares iBoxx $ High Yield Corporate Bond
HYG
and SPDR Bloomberg High Yield Bond
JNK.
 On the equity side the best thing is to short the cyclicals; I would short the Russell 2000
RUT.

MarketWatch: What’s your advice to stock investors right now about how to reposition their portfolios?

McCullough: Own what the “Mother of All Bubbles” crowd doesn’t. The things we’re most bullish on include gold
GC00,
+0.21%.
 The Fed is going to keep short term rates high and both the 10 year and 30 year go lower. Gold trades with real interest rates. I think gold can go a lot higher, towards 2,150. Our ETF for gold is SPDR Gold Shares
GLD.

Also, you can be long equities and not take on the heart-attack risk that is the U.S. stock market. I’m long Japanese equities — ETFs for this include iShares MSCI Japan
EWJ
and iShares MSCI Japan Small-Cap
SCJ.

We’re long India with iShares MSCI India
INDA
and iShares MSCI India Small-Cap
SMIN.
Both Japan and India are accelerating economically. Were also long Brazil iShares MSCI Brazil
EWZ,
which is weighted to energy. We are bullish on energy. 

MarketWatch: Clearly accelerating inflation and slowing economic growth is an unhealthy combination for both investors and consumers.

McCullough: What I’m looking for, with inflation reaccelerating, is stagflation.

Stagflation pays the rich and punishes the poor. You want to be the landlord. The prices of things people own are going to go up, and the prices of things you need to live are also going to go up. So for example, we are long energy, uranium and timber as stagflation plays. ETFs we’re using for that include Energy Select Sector SPDR
XLE,
Global X Uranium
URA,
and iShares Global Timber & Forestry
WOOD.

One positive thing that happens from stagflation is that because it’s so hard to find real consumption growth, there’s a premium on the growth you can find.

If there is something that actually accelerates, then those stocks will work, which puts a nice premium on stock picking. You can be long anything that is accelerating because so many things are decelerating. So avoid U.S. consumer, retailers, industrials and financials, which are all decelerating. Health care is our favorite sector, which we own through the ETFs Simplify Health Care
PINK
and SPDR S&P Health Care Equipment
XHE.

Instead, people are betting we’re going to go back to some crazy AI-led growth environment. Now everyone thinks everything is AI and rainbows and puppy dogs. I’m old enough to remember we were in a banking crisis in March. From an intermediate- to longer-term perspective, I don’t know why you wouldn’t want to protect yourself until this inflation cycle plays out.

Also read: Jackson Hole: Fed’s Powell could join rather than fight bond vigilantes as yields surge

More: Will August’s stock-market stumble turn into a rout? Here’s what to watch, says Fundstrat’s Tom Lee.

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#Mother #Bubbles #crowd #doesnt #market #strategist #expects #stagflation #investing

You can still run with the stock market’s bulls, but watch the exits

Post By Stock , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

The stock market, as measured by the S&P 500 Index
SPX,
-0.64%
), has been moving upward. The U.S. benchmark index is essentially crawling up the higher “modified Bollinger Bands” (mBB), which is a bit of an overbought condition, but not a sell signal.

The next major resistance appears to be in the 4650 area, which at one time seemed far away but is now within range. There is minor support at 4527 (last week’s lows), with stronger support below that, at 4440, 4385, 4330 and 4200. Given the strong upward momentum of the market, a couple of those could be violated without giving the bull market any problem, but a fall below 4330 would be a game changer.

The S&P 500 has recently closed above the +4σ mBB, which sets up a “classic” sell signal. That “classic” signal was generated on Thursday when SPX closed below the +3σ Band — 4560. But we do not trade the “classic” signals, preferring to wait for the further confirmation of a McMillan Volatility Band (MVB) signal. Just because a “classic” sell signal has occurred does not mean that a MVB sell signal will automatically follow. We will keep you up to date on these developments weekly.

Equity-only put-call ratios have continued to edge lower as stocks have risen. This means that the put-call ratios are still on buy signals, but they are in deeply overbought territory because they are so low on their charts. The computer programs that we use to analyze these charts are once again warning of a sell signal, but we prefer to wait until we can visibly see the ratios begin to rise before taking on any negative position based on these ratios. Despite the fact that these ratios are at lows for the last year or so, it should be noted that they were much lower all during the 2021, as that bull market was pressing forward, and eventually gave way to a bear market.

Market breadth has been generally positive. Both breadth oscillators are on buy signals and are in overbought territory. They could withstand a day or two of negative breadth and still remain on those buy signals. Perhaps more importantly, cumulative volume breadth (CVB) is approaching what could be a major buy signal. If CVB makes a new all-time high, then SPX will follow. CVB is within just a small distance of its all-time high and could attain that today. Doing so would mean that an upside target of 4800+ would be in force for SPX.

New Highs on the NYSE continue to dominate New Lows, so this indicator remains strongly positive for stocks.

VIX
VIX,
+9.25%
is languishing between 13 and 14. As long as this continues, stocks can rise. The only time problems would surface would be if VIX spurted higher. So far, that hasn’t happened. It appears that “big money” still has some fear of this market, so they are buying SPX puts, keeping VIX a bit elevated. It should also be noted that VIX normally makes its annual low in July and begins to rise in August. So that is a potentially negative seasonal factor on the horizon.

The construct of volatility derivatives remains bullish for stocks, since the term structures of both the VIX futures and of the CBOE Volatility Indices continue to slope upwards.

Overall, we are maintaining our “core” bullish position because of the bullish SPX chart. We are raising trailing stops and rolling deeply in-the-money calls upward as we go along. Eventually, we will trade other confirmed signals around that “core” position.

New recommendation: Potential CVB buy signal

We made this recommendation last week and recommended using the cumulative total of daily NYSE advancing volume minus declining volume as a guide. That cumulative total did reach our projected value as of July 26. In reality, the “stocks only” CVB ended just shy of a new all-time high. We are going ahead with the recommendation, since the way that we stated it last week did generate the buy signal.

Buy 4 SPY Sept (29th) 480 calls: Since CVB reached a new all-time high, we are going to buy SPY
SPY,
-0.66%
calls with a striking price equal to SPY’s all-time high. We will hold without a stop initially.

New Recommendation: Emerging markets ETF (EEM)

There has been a high-level buy signal generated from the weighted put-call ratio for the Emerging Markets ETF
EEM,
-1.23%.
Put buying has been extremely strong for more than a month and is now is abating. This has generated the buy signal.

Buy 5 EEM Oct (20th) 41 calls in line with the market

We will hold these calls as long as the EEM weighted put-call ratio remains on a buy signal.

Follow-up action: 

We are using a “standard” rolling procedure for our SPY spreads: in any vertical bull or bear spread, if the underlying hits the short strike, then roll the entire spread. That would be roll up in the case of a call bull spread, or roll down in the case of a bear put spread. Stay in the same expiration and keep the distance between the strikes the same unless otherwise instructed. 

Long 800 KOPN: 
KOPN,
-4.76%
The stop remains at 1.70.

Long 2 SPY Aug (4th) 453 calls: This is our “core” bullish position. The calls have been rolled up three times. Stop out of this trade if SPX closes below 4330. Roll up every time your long SPY option is at least 6 points in-the-money.

Long 1 SPY Aug (4th) 453 call: Bought in line with the “New Highs vs. New Lows” buy signal. The calls have been rolled up three times. Stop out of this trade if, on the NYSE, New Lows outnumber New Highs for two consecutive days. Roll up every time your long SPY option is at least 6 points in-the-money.

Long 2 PFG Aug (18th) 80 calls: This position has been was rolled up twice. We will hold this PFG
PFG,
-1.07%
position as long as the weighted put-call ratio remains on a buy signal.

Long 10 VTRS
VTRS,
-1.43%
August (18th) 10 calls: The stop remains at 10.15. 

Long 5 CCL
CCL,
+3.23%
Aug (18th) 17 calls: Raise the stop to 17.10.

Long 2 PRU
PRU,
-0.46%
Aug (18th) 87.5 calls: We will continue to hold these calls as long as the weighted put-call ratio remains on a buy signal.

Long 8 CRON
CRON,
-1.66%
Aug (18th) 2 calls: Hold these calls without a stop while takeover rumors play out.

Long 6 ORIC
ORIC,
-9.06%
Aug (18th) 7.5 calls: The stop remains at 7.40.

Long 2 EW
EW,
-9.78%
Aug (18th) 95 puts: Continue to hold these puts as long as the weighted put-call ratio remains on a sell signal.

All stops are mental closing stops unless otherwise noted.

Lawrence G. McMillan is president of McMillan Analysis, a registered investment and commodity trading advisor. McMillan may hold positions in securities recommended in this report, both personally and in client accounts. He is an experienced trader and money manager and is the author of the best-selling book, Options as a Strategic Investment. www.optionstrategist.com

©McMillan Analysis Corporation is registered with the SEC as an investment advisor and with the CFTC as a commodity trading advisor. The information in this newsletter has been carefully compiled from sources believed to be reliable, but accuracy and completeness are not guaranteed. The officers or directors of McMillan Analysis Corporation, or accounts managed by such persons may have positions in the securities recommended in the advisory. 

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Blockaded on all fronts: Poland and Hungary threaten to cut Ukraine’s export route to the West

Post By Politics , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

As Russia once again bombards and blockades Ukraine’s Black Sea ports — through which the country exports its vast agricultural produce — Poland and Hungary threaten to cut off the country’s western exit routes.

Poland will unilaterally block trade with Ukraine if the European Commission fails to extend temporary restrictions on grain imports at least until the end of the year, Prime Minister Mateusz Morawiecki told a meeting of agriculture ministers from five Eastern EU countries in Warsaw on Wednesday.

“I want to make it clear,” Morawiecki told reporters, “we will not open our border. Either the European Commission will agree to jointly work out regulations that will extend this ban, or we will do it ourselves.”

Hungarian Agriculture Minister István Nagy echoed Morawiecki, saying his country would “protect Hungarian farmers with all its means.”

Days after killing a deal to allow Ukraine to export grain across the Black Sea, Moscow unleashed a wave of attacks on the Ukrainian ports of Odesa and Chornomorsk — two vital export facilities — damaging the infrastructure of global and Ukrainian traders and destroying 60,000 tons of grain.

The EU’s top diplomat, Josep Borell, called Russia’s escalating offensive “barbarian” on Thursday. “What we already know is that this is going to create a huge food crisis in the world,” he told reporters in Brussels, adding that EU countries needed to step up alternative export routes for Ukraine.

Ukraine is one of the world’s biggest exporters of corn, wheat and other grains. Following Russia’s invasion and blockade of its Black Sea ports last year, the EU set up land export routes through its territory.

In the year since, export corridors set up by the EU called ‘solidarity lanes’ have carried about 60 percent of Ukraine’s exports — mostly along the Danube to the Romanian port of Constanța. The remaining 40 percent has trickled through the country’s own ports under the now-defunct Black Sea Grain Initiative brokered by the U.N. and Turkey.

But the opening of the overland routes also led to an unprecedented influx of cheap Ukrainian grain into neighboring EU countries — Romania, Poland, Hungary, Bulgaria and Slovakia — which was bought and resold by local traders instead of being exported further afield. The glut has put the solidarity of the bloc’s Eastern members with Ukraine in its war of defense sorely to the test.

With an election looming this fall, Poland sought to appease local farmers — a vital constituency for the right-wing government — by closing its border this spring to Ukrainian imports. Hungary, Slovakia and Bulgaria followed suit while Romania, which didn’t impose its own restrictions, joined the four in calling for restrictions at EU level.

In May, the five countries struck a deal with the Commission to drop their unilateral measures in exchange for €100 million in EU funding and assurances that Ukrainian shipments would only pass through the five countries on their way to other destinations. 

It’s these restrictions, which will expire on September 15, that the five countries want extended.

Other EU countries have criticized the Commission’s leniency towards the five Eastern troublemakers, saying the compromise undermined the integrity of the bloc’s internal market.

Open the borders

Borrell said that, instead of restricting trade, the EU should respond to Russia’s Black Sea escalation by opening its borders further.

“If the sea route is closed, we will have to increase the capacity of exporting Ukrainian grain through our ports, which means a bigger effort for the Ukrainian neighbors,” he said before a meeting of EU foreign ministers.

“They will have to contribute more, opening the borders and facilitating transport in order to take the grain of Ukraine from the Black Sea ports. This will require from Member States more engagement. We have done a lot, we have to do more.”

Separately on Thursday, Ukrainian Foreign Minister Dmytro Kuleba called on the EU to make “maximum efforts” to facilitate grain exports from the country.

“While Russia destroys the Grain Initiative, attacks Ukrainian ports and tries to make money on rising food prices, Ukraine and the European Union should make maximum efforts to simplify food exports from Ukraine, particularly by increasing the capacity of alternative transport corridors ‘Solidarity Lanes’ as much as possible,” he said.

During Wednesday’s meeting in Warsaw, agriculture ministers from the five EU countries signed a declaration calling on Brussels to extend and expand the trade restrictions, amid concerns that Russia’s renewed Black Sea blockade could further pressure their domestic markets.

Only Poland and Hungary threatened to take unilateral action if the restrictions were lifted.

Premature

Despite the threat, a senior Commission official said on Thursday it was “premature” to say whether there was a need to extend the restrictions beyond the September 15 deadline.

In recent months, officials have stepped up surveillance and customs checks, and Romania and other countries have significantly increased investment in infrastructure and investment to facilitate the transit of grain through their countries and to other markets, the Commission official said.

But in the year since the land-based export routes were opened, Poland has taken no major steps to improve its own infrastructure or the capacity of its Baltic ports. Analysts say it is unlikely the country will be able to repeat the feat come this summer’s harvest. The Polish government has repeatedly blamed Brussels for not providing enough help.

Despite the ongoing trade dispute, officials in Kyiv have been careful not to openly criticize their counterparts in Warsaw.

That’s because Poland has played a leading role in supporting Ukraine since the war broke out, acting as the main transit point for Western weapons and sending plenty of its own. It has also taken in millions of Ukrainian refugees.

“We highly appreciate all the work done so far within the solidarity lanes by the European Commission and neighboring member states,” Ukraine’s ambassador to the EU, Vsevolod Chentsov, told POLITICO.

Still, he added: “Statements by some member states of the need to extend the ban on the export of Ukrainian agrarian production [cause] serious concerns.” Without naming Poland he said that this “politicizes” the practical reality of what is a logistical challenge “jeopardizes the effectiveness of the solidarity lanes.”

Jacopo Barigazzi contributed reporting



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Players took unpaid leave and played on unsafe pitches en route to World Cup, report finds

Post By World , , , , , , , , , , , , , ,

The global players’ union FIFPro has called on FIFA and its six member confederations to drastically improve the conditions, compensation and medical care for all players competing in future Women’s World Cup qualifiers after a new report found myriad problems with the path towards the 2023 tournament.

Compiled over a two-year period, the inaugural report surveyed 362 players who took part in World Cup qualifiers, focusing on both the global perspective as well as the specific contexts of each confederation: the OFC (Oceania), AFC (Asia), CAF (Africa), UEFA (Europe), CONMEBOL (South America), and CONCACAF (North & Central America and the Caribbean).

Through anonymised online and in-person surveys, they were asked about various aspects of their experiences including travel and accommodation, pre-tournament health checks, pitch quality, recovery facilities, food, mental health support, match scheduling and payment.

The report found various qualifying paths fell short of minimum standards in many categories, with “multiple inconsistencies in the scheduling, duration, format and conditions between tournaments”. 

Sixty-six per cent of respondents said they had to take unpaid leave from other jobs in order to participate in their respective confederation competitions, which also double as qualifying pathways for World Cups and Olympic Games, with almost one-third saying they had not been paid to play at all.

Only 40 per cent of those surveyed said they viewed themselves as “professional” players, defined by FIFA as anyone who has a written contract with a club and is paid more for football than the expenses they incur.

Thirty-five per cent of players identified as amateur, 16 per cent as semi-professional, while nine were uncertain of their status.

In every confederation, match payment and prize money were two of the biggest issues of the qualifying phases, with the vast majority of respondents saying payment needed significant improvement.

Last week, players from the World Cup-bound Jamaican women’s national team posted public statements saying a lack of investment had led to abandoned camps and missed compensation.

“We are not financially supported enough,” said an anonymous UEFA player.

“Some of our girls had to take unpaid vacation at work and it wasn’t sure if they can even attend the tournament.”

Over half the players surveyed were not provided with pre-tournament medical checks, while 70 per cent were not given ECG heart-health checks.

“Any stat that is below 100 per cent in terms of access to important medical checks is completely unacceptable,” said Sarah Gregorious, director of global policy and strategic relations for women’s football at FIFPro.

“We just want to work with whoever wants to work with us, particularly FIFA and the confederations, to understand why that is the case and how that can be prevented, because that is certainly not something that should be acceptable to anybody.”

Almost 40 per cent of players surveyed did not have access to mental health support, while one-third of those surveyed said there was insufficient recovery time between games, which was exacerbated by the sub-standard quality of training and match pitches, particularly outside of Europe.

Sixty-six per cent said recovery and gym facilities were not of an elite standard or did not exist at all, making it more difficult to recover from games as well as from international travel, with 59 per cent saying they flew economy — even over long distances.

Another major issue highlighted was inconsistent match scheduling.

Only UEFA has a stand-alone World Cup qualifying process separate from their continental championship, which affords players more high-quality matches and opportunities for remuneration, while the other five confederations rely on a single tournament for multiple purposes.

Some of those tournaments — like the AFC Women’s Asian Cup, in which Australia participates — are shorter in length (the 2022 tournament ran for just 18 days), and also operate outside designated FIFA windows, forcing players to choose between playing for club or country, with the tight turn-around between games also heightening risk of injury and fatigue.

One-third of players said they did not have enough recovery time between matches, with 34 per cent saying that had one rest day or fewer between arriving in camp and playing a qualifying match. Further, 39 per cent said they had one day or fewer between the end of the international window and resuming training at their clubs.

FIFPro has used the report to call on FIFA to have greater control and oversight over World Cup qualifying pathways, highlighting the need to implement global standards for player conditions in international tournaments, as well as for each confederation to conduct stand-alone qualifying tournaments outside of their continental championships.

The lack of domestic player unions in many federations — particularly those from less privileged confederations such as Oceania and Africa — had made organising and collective bargaining difficult, but ABC understands one suggestion is to establish a confederation-wide union membership system so that players can still be protected even if they don’t have their own country-specific union.

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#Players #unpaid #leave #played #unsafe #pitches #route #World #Cup #report #finds

IBBC hosts well attended Conference at The Mansion House | Iraq Business News

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On June 16th IBBC hosted it’s best attended London Conference at The Mansion House yet, with over 280 delegates from Iraq, UK, and International European and Middle East countries.

With an overarching theme of ‘Iraq open to the world’ a wide range of panels discussed Iraq’s rapidly improving international position across economic indicators, political relationships, and security. Baroness Nicholson, IBBC President, welcomed delegates, The Lord Mayor spoke of London’s importance as a financial centre and Lord Ahmed (Minister of State for the Middle East, North Africa, South Asia, and United Nations) presented an upbeat outline of UK’s trading and political relationship with Iraq including significant increase in bilateral trade in the last year. Professor Hamid Khalaf Ahmed, Executive Director for the Higher Committee for Education Development in Iraq & Advisor to the Prime Minister, spoke on behalf of the Iraqi Prime Minster, to reiterate the determination of the GOI to see through its five priorities, including setting a budget and delivering on targets for corruption and infrastructure development, increase in public sector jobs and investment in education at all levels of Iraqi society. Dr Mohammed Shukri, Chairman, Kurdistan Board of Investment outlined a focus on diverse investment opportunities including agriculture, tech, and infrastructure in the KRG. Two prominent sponsors Mr Sardar Al Bebany, IBBC Executive Committee Member, CEO & Chairman, Sardar Group and Mr Amet Selman, CEO, AAA Holding Group offered their thanks to IBBC audience and outlined their commitment and importance to investing in their people and businesses in Iraq.

Three strong focus areas emerged from the conference, and were reflected in the panels along with other important topics:

Finance, chaired by Mr John Curtin, Ernst & Young Iraq, Included panellists Mr Haider F. Al-Shamaa, International Islamic Bank; Mr Tim Palmer, UK Export Finance; Mr Salahuddin Al-Hadeethi, Ministry of Finance; Dr Yasser Hassan, National Bank of Egypt; Mr Raed Hanna, Mutual Finance Ltd

Energy; Chaired by Mr Luay Al Khateeb, Centre on Global Energy Policy – Columbia U. With a keynote Address from: Mr Laith Al Shaher, Deputy Minister of Oil. Panellists included: Dr Abdulhamzah Hadi Abood, the Advisor from the Ministry of Electricity; Mr Laith Al Shaher, Ministry of Oil; Mr Andrew Wiper, Basrah Gas Company; Mr Mushhood Haider, Scotland Trade, and Investment; Mr Ali Al Janabi, Shell Iraq and UAE; Ms Sara Akbar, Oil Serv 

And keynote discussion on Iraq Open to the World.

Professor Frank Gunter opened the discussion with a keynote presentation of the key findings of his report ‘‘Seaports and Airports of Iraq: Rules Versus Infrastructure’ (see separate briefing here)

Chairman Mrs Hadeel Hasan Al Hadeel Al Hasan LLC led the discussion including, panellists: Professor Frank Gunter, Lehigh University; Mr Steve Alexander; Sardar Group; Mr Richard Cotton, AAA Holdings; Mr Hassan Heshmat, Hydro-C; H.E. Bader Mohammad Alawadi, Ambassador of the State of Kuwait.

Significant panels also included.

Education and skills roundtable; of acute importance due to the technical demands on Iraq’s expanding economy and the need to upgrade university courses and overseas scholarship support for 5,000 Iraqi students from the GOI, Chaired by Professor Mohammed Al Uzri (IBBC Health and Education Advisor) with Professor Hamid Khalaf Ahmed responding to questions and outlining the GOI plans for education with IBBCs University and skills members.

An emergent theme of growing importance is ‘Heritage’, as a business and culturally important sector, chaired by: Professor Mohammed Al Uzri, with Dr John McGinnis, The British Museum; with Prof Gamal Abdelmonem, Nottingham Trent University, Mr Ali Al Makhzomy, Bilweekend; Dr Rosalind Wade Haddon, British Institute for the Study of Iraq; Professor Chris Whitehead, Newcastle University.

During the day there were also a KRG roundtable discussions with Dr Mohammed Shukri and a full complement of KRG businesses and chambers of commerce, A Tech forum on ‘The digitisation of Iraq. Chaired by Ashley Goodall of IBBC, including Mr Saquib Ahmed, MD SAP Iraq; Mr Padraig O’Hannelly, Iraq Business News; Mr Mohsen Garcia, CEO 1001 Media; Mr Peter Chamberlin, Scott Logic, Ms Cynthia El Khoury, Mastercard Iraq; Mr Ali Al-Khairalla, Embassy of the Republic of Iraq (available to view here)

A special ceremony awarded The Rasmi Al Jabri Award (for Iraqi companies dedicated to best international practices and significant growth of Investment and turnover). This year the winners are AAA Holding and Mr Amet Selman for their work for successfully providing fertilizers to the Iraqi market in conjunction with the GOI and third-party agricultural groups. (Video link here). The conference was preceded by an ebullient reception for over 150 delegates the previous evening at the Institute of engineers, where Prof. Dr Sabih G. Khisaf (of Hyperloop Dubai) gave a talk on the importance of engineering and his work on the hyperloop and hosted by John Scott of IBBC.

Christophe Michels, MD of IBBC who chaired the conference commented ‘This is our 11th Iraq Day at The Mansion House and probably the most successful we have had yet. Iraq is rapidly developing, building on a stable budget, good security, political stability, and increasingly good relations with her neighbours. Now is the time for Iraq to truly embrace business and to cut down on outdated bureaucracy, regulations and the corruption going hand in hand with these. If this does not happen, the country risks missing out on all the new opportunities arising from finally opening to the world. As IBBC we are optimistic and will continue to lend our support to our Members and the wider Iraqi community’.

IBBC Spring Conference 2023 Sponsors:

Principal Sponsor: AAA Holding Group

Gold Sponsors: Sardar Group & Trade Bank of Iraq

Bronze Sponsors: Standard Chartered Bank & Hydro – C

To attend future events, including the Iraq SME conference, July 6th, and IBBC Autumn conference in Dubai, Dec 8th, please follow our website.

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