Dear Sir,

Although I agree with the general basis of your arguments, I would like to raise two points that I consider to be relevant for the discussion.

(i) The use of MSCI index to define the relevant emerging market economies. This index is an equity index, designed to help investment strategies. How this relates to the issues of NTD and global responsibilities and capabilities is unclear. Moreover, the very purpose of the index tends to neglect countries that pursue economical policies based on heavier state regulations. A few countries that would be relevant to the discussion are Argentina, Venezuela, Vietnam, Pakistan and Iran. It is also difficult to list Poland and Hungary and not, say, Greece or Portugal or still Ireland.

(ii) The list in "Box 2", about "who should do what" seems based on arbitrary and disputable criteria. Let us focus on two of the guidelines:

(ii.a) "China to support NTDs in sub-Saharian Africa" . The Chinese external policy has indeed devoted attention to cooperation with Africa. However, their approach is mainly based on obtaining short-term economic gains and granting access to energy resources. Although this can lead to localized economic blooms, their benefits rarely spread through the society. As NTD are mainly related to the poorer and to rural areas, it is unlikely that Chinese cooperation in its present form will promote long-term solutions to health issues. Pledging for Chinese to take responsibility for sub-Saharan countries is at the same time asking them to do a favor - sounding somewhat naive - and taking for granted that the region is to be seen as a Chinese influence region.

The soft power approach of India and Brazil ( two of the other BRICS, Russia being hardly concerned with NTDs) seems to be much more adequate to promote a long-time knowledge transfer on health issues. External policies of those countries are less short-term planned and aim at influence rather then obtaining accountable economic gains. Development of cooperation to create local scientific communities, as promoted by the Brazilian government, is much more effective to spread benefits of public health to poorer. Increasing the local autonomy to deal with public health issues, identifying cultural and societal barriers and devising adapted public health awareness programs are topics that would be greatly favored by cooperation based on dialogue, rather than standard "cooperation packages". Finally, India and Brazil are liberal democracies, a point not to be overlooked when defining "who should do what".

(ii.b) "Gulf Nations to support NTDs in poor OIC countries". Taking religion a defining factor for global responsibilities is hardly sustainable. Islamism can be so differently anchored in societies a diverse as Suriname, Albania, Uzbekistan and Niger - all relatively poor OIC countries - that taking it as pivotal to determine NTDs related policies is likely to de ineffective.

The idea that Gulf Nations - because they are at the same time Islamist and in possession of considerable amount of money -- should necessarily back other Islamic countries oversees the fact that this would be probably combined with political proselytism of religion-based monarchies. Together with sharia-inspired laws, this could induce public health policies discriminating persons by gender, ethnicity and religion, in opposition to most guidelines promoted by, e.g., WHO.


In summary, a "post-American World" is to be welcomed as promoting multilateralism in health issues, NTDs in particular. However, postulating regions of influence from "ideés reçus" on the global geopolitical scenario is, in my opinion, a too naive approach. Global and regional forums, with decision makers and public health scientists involved, could indicate routes for policies and financial schemes better suited for the needs of the poorer nations and their people.