Correspondence
Currently the incidence of The Global Fund is in the middle
serotype 3 poliomyelitis remains
low in Pakistan and Afghanistan,
probably as a result of the availability
and use of bivalent OPV. The last
case of serotype 3 poliomyelitis
was on April 18, 2012, from Bara
tehsil of Khyber agency, and
serotype 3 poliovirus was last
isolated from sewage samples on
Oct 7, 2010 (Gadap town, Karachi).5
We conclude that to change strategy
to predominantly monovalent rather
than bivalent vaccine use would
undo the gains made in population
immunity against both serotypes and
risk a return to the large outbreaks
that plagued the programme before
the licensure of bivalent OPV.
I declare that I have no conflicts of interest.
Kath M O’Reilly, on behalf of all
authors
k.oreilly@imperial.ac.uk
Medical Research Council Centre for Outbreak
Analysis and Modelling, Department of Infectious
Disease Epidemiology, School of Public Health,
Imperial College London, London W2 1PG, UK
1 WHO. Progress towards poliomyelitis
eradication in India, January 2007–May 2009.
Wkly Epidemiol Rec 2009; 84: 281–87.
2 WHO. Progress towards eradicating
poliomyelitis in India, January 2009–October
2010. Wkly Epidemiol Rec 2010; 85: 497–503.
3 WHO. Progress towards eradicating
poliomyelitis: India, January 2010–September
2011. Wkly Epidemiol Rec 2011; 86: 501–07.
4 Sutter RW, John TJ, Jain H, et al.
Immunogenicity of bivalent types 1 and 3 oral
poliovirus vaccine: a randomised, double-blind,
controlled trial. Lancet 2010; 376: 1682–88
5 WHO. Polio this week in Pakistan. http://www.
polioeradication.org/Infectedcountries/
Pakistan.aspx (accessed Sept 18, 2012).
Global Fund at risk of
alienating civil society
Although I agree that the Global
Fund to Fight AIDS, Tuberculosis and
Malaria will need improved civil society
engagement over the coming months
(Sept 8, p 860),1 this is not just to help
secure sufficient funds—vital though
this is—but to help design and develop
a revitalised Global Fund that can
achieve its objective of bringing HIV,
tuberculosis, and malaria under control.
1646
Global health in the UK’s
of a crucial reform process. The
International HIV/AIDS Alliance,
along with thousands of other
community-based organisations
responding to the three diseases,
is seriously concerned that in this
period of transition the Global Fund
might be at risk of losing sight
of some of the Fund’s founding
principles on which future success is
dependent.
When the Global Fund was first
established in 2002, civil society
from both developed and developing
countries was embedded in its
structures and processes, from
representation on bodies that co-
ordinate the submission of countries’
proposals, to a dedicated engagement
team in the Geneva secretariat and a
governance structure that includes a
wide variety of constituencies, one of
which I represent.
Civil society engagement makes
the Global Fund very different from
other multilateral institutions, and
has allowed it to substantially alter
the trajectory of the three epidemics.
However, over the past few months,
some of the reforms that have taken
place in the name of creating a
less bureaucratic Fund with a more
flexible and strategic way of doing
business—such as the removal of a
dedicated civil society team—have
been detrimental in that they have
made civil society’s engagement
with the Secretariat more difficult.
As the reform process nears its
end, care must be taken not to let
these divisions grow. Communities
need to remain at the frontline
of an effective response to HIV,
tuberculosis, and malaria.
I represent developed-country non-governmental
organisations on the Board of the Global Fund to
Fight AIDS, Tuberculosis and Malaria. I am Executive
Director of the International HIV/AIDS Alliance.
Alvaro Bermejo
hphillips@aidsalliance.org
International HIV/AIDS Alliance, Hove BN3 1RE, UK
1 The Lancet. The future of the Global Fund.
Lancet 2012; 380: 860.
www.thelancet.com Vol 380 November 10, 2012
GP postgraduate
curriculum
Jennifer Hall and colleagues
(Aug 25, p 728)1 highlight an apparent
lack of global health content in UK
postgraduate curricula. The Curriculum
Development Committee of the UK’s
Royal College of General Practitioners
(RCGP) is currently exploring whether
more explicit language about global
health issues should appear in the GP
postgraduate curriculum.
The RCGP curriculum has grown
from strong international roots:
its core statement, Being a General
Practitioner,2 is based on the World
Organisation of National Colleges and
Academies European definition of
general practice.3 Some of the deeper
features of global health described
in the RCGP statement—such as
the tailoring of communication,
diagnosis, and management to
patients from different cultures—form
part of the person-centred, holistic
mindset that GPs routinely use. We
anticipate that, as our curriculum
evolves, the profile and understanding
of global health could be raised
through the provision of contextual
illustrations of these deeper features.
The RCGP’s proposal to enhance
and extend GP training4 also presents
opportunities for tomorrow’s GPs to
develop their understanding of global
health by leading improvements
in population health and services,
and reducing health inequalities.
Competencies should be defined
explicitly, and not simply use the
phrase “global health” as cover.
Hall and colleagues’ finding that
“all curricula contained numerous
generic competencies for which the
global health perspective could be
advantageous” implies that it might
be beneficial to explore whether the
“development of a small number of
core competencies common across
the curricula” could integrate with
existing cross-specialty initiatives,