Global Health News Round-Up

The Communications Committee is working to revive the global health news round-up, which has been a popular feature in the past. Stay tuned!

WHO has released its latest situation report on Zika virus. The Director-General has announced that the cluster of microcephaly and other neurologic disorders in Brazil is a Public Health Emergency of International Concern. Experts also agreed that there is an urgent need for coordinated international efforts to understand the relationship between Zika virus and such neurologic disorders.

Nearly 25% of the South Sudanese population face food insecurity and in need of food assistance. This is particularly worrisome because this increase in hunger has occurred during the post-harvest season, a time when the country has traditionally been food secure.

A recent article in Health Affairs assessed the return on investment from childhood immunization programs to prevent diseases associated with 10 antigens in low- and middle- income countries. Their study shows that net gains were greater than costs across all 10 antigens.

Dr. Paul Farmer and 16 others who comprise the Commission on a Global Health Risk Framework for the Future have said in their 130-page report that pandemics are inevitable and that a key solution is investing in the countries’ health systems.

An analysis of the data from the Global Burden of Disease 2013 Study published in JAMA Pediatrics showed that “road injuries were the leading cause of death among adolescents globally.” Road traffic injuries killed nearly 115,000 young people, compared with ~76,000 deaths due to HIV/AIDS.

Zika virus: An emerging threat

by Abbhirami Rajagopal

Zika virus was originally reported in 1952 in the Transactions of Royal Society of Tropical Medicine and Hygiene. The original study involved placing a Rhesus monkey in a cage in the ZIka forest in Uganda. The monkey subsequently developed a fever and the researchers were identified a transmissible agent from its serum, and called it the ZIka virus. The virus belongs to the Flaviviridae virus family, related to dengue, yellow fever and West Nile virus, and it is transmitted by the day-time active mosquitoes, such as those of the genus Aedes.

CDC estimates that “about 1 in 5 people infected with Zika will get sick and for those who get sick, the illness is usually mild. The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin 2 to 7 days after being bitten by an infected mosquito.”

Currently, the virus has spread to nearly 23 countries, with countries like Colombia reporting that they have about 20,000 confirmed cases that include ~2000 pregnant women. Pregnant women are the focus of this epidemic, as recent studies showed a link between Zika virus infection and microcephaly, a devastating birth defect that results in smaller brain size. CDC has issued travel warnings for nearly 25 countries, and several South American countries are strongly urging women to not get pregnant.

WHO recently declared Zika virus a global health emergency with the potential for infecting nearly 4 million people. In the US there have been 36 cases including 4 pregnant women and in Houston, where I live and work, thus far seven cases have been reported. All cases in the US are travel-related and not due to local transmission.

There is real concern at the alarming rise in the number of infected individuals. The other potential cause for worry might be the summer Olympics in Rio De Janeiro in a few months. Brazil has stepped up its surveillance program and the hope is that the cooler, drier climate will control the mosquito population.

President Obama has called on U.S. health officials and scientists to examine the link with microcephaly and rapid development and testing of vaccines for Zika virus.

While we wait, protect yourself from mosquito bites and if you are traveling make sure to check the CDC ZIka Virus page.

APHA (@PublicHealth) late-breaker policy on HIV testing for immigrants posted

Note: This was cross-posted to my own blog.

As I mentioned in my recap of the 2015 APHA Annual Meeting, I authored a late-breaker policy, “Opposition to Policies Requiring a Negative HIV Test as a Condition of Employment for Foreign Nationals,” that was put forth by the IH Section and passed by the Governing Council with overwhelming support. That policy has now been finalized and posted to APHA’s Policy Statement Database. You can read the full text of the policy here.

According to APHA Joint Policy Committee (JPC) guidelines,

Approved late-breaker policy statements will be considered valid, but interim for one year. Late-breaker policy statement authors will need to revise, update, and resubmit their policy statements to the standard proposed policy statement review process…Late-breaker policy statements will be subject to full review and reaffirmation in the next annual policy development cycle. If the late-breaker is not resubmitted, it will expire after one year.

I am working with the Section’s Policy/Advocacy Committee to develop a standard policy proposal as a follow-up to the late-breaker, which will be submitted for consideration at this year’s Annual Meeting in Denver.

Big losses for Big Tobacco

By Abbhirami Rajagopal

Six million people die annually as a result of tobacco. Many governments have adopted the WHO framework for tobacco control and have since taken measures (policy changes, cessation programs, etc.) to reduce mortalities and morbidities that occur due to tobacco. Not surprisingly, big tobacco companies like Philip Morris International have pushed back against countries that have enacted stringent packaging laws.

In a much-awaited decision, Australia won an international legal battle to uphold its tobacco policies that include the plain packaging laws. Australia has enacted some of the toughest measures to reduce the harm caused by tobacco and plain packaging laws are among them. These laws are intended to prevent the tobacco companies from displaying their distinctive designs, colors or even their brand logos (companies can include their names and logos, but they cannot have flashy, enticing packaging). Instead, the companies would be required to use olive-green packs with health warnings and graphic color images that would cover nearly 75% of the front of the packs. The Plain Packaging Act passed by the Australian parliament became law in 2011 and, shortly thereafter, Hong Kong-based PMI sought legal action against Australia citing that, by stripping logos off the packs, these stringent laws violated the bilateral investment treaty between Australia and Hong Kong, thereby severely diminishing their brand value.

This is not the first time Philip Morris has dragged governments into legal battles over stricter anti-smoking and tobacco laws.

While global rate of lung cancer mortality was increasing between 1990 and 2013, owing to stricter anti-tobacco measures, Uruguay saw a 15% reduction in lung cancer mortality. PMI, a company whose revenues were nearly $80 billion in 2013, sued Uruguay, a small country of 3 million with a GDP of about $56 billion, in 2013. The lawsuit was brought to the International Center for Settlement of Investment Disputes (ICSID) in 2010 and the company is seeking $25 million in damages from Uruguay, once again, citing violation of bilateral investment treaty between Uruguay and Switzerland. The ICSID is expected to settle this case by arbitration.

The upholding of the anti-tobacco laws in Australia will hopefully set a precedent and allow countries to move forward with legitimate public health actions to curb the global tobacco epidemic without interference from tobacco companies.

Mary Anne Mercer featured in JHU Magazine

Our Section’s own Mary Anne Mercer was featured in the Winter edition of Johns Hopkins magazine! The piece tells the story of Dr. Mercer’s career in public health, with a particular focus on a program she developed in East Timor to decrease maternal mortality by combining a text-message alert service for pregnant women with a training program for midwives. The article is a slightly longer read, but here is an excerpt:

Back in Seattle, Mercer began writing SMS messages that could be sent to pregnant women, dispensing advice and reminders about how best to stay healthy. These were translated into Tetum, the most commonly spoken language in the country. HAI purchased smartphones to distribute to midwives, and Mercer flew out in January 2012 to oversee the first midwife training. The program was simple. When a woman came in for her first prenatal care visit, the midwife asked if she had a phone, and if she did, the midwife took her picture and some basic information: her name, her estimated due date, her phone number, the village in which she lived, and other pieces of identifying information. Then, twice a week, the woman began receiving messages appropriate for her stage of pregnancy. The first message read: “Congratulations on your pregnancy! You should be checked by the midwife at least 4 times at a health center to ensure a healthy pregnancy and healthy baby.” A first trimester message read, “During the [antenatal] visit the midwife will measure your blood pressure and feel your belly to see how your baby is growing and moving.” A message as the woman’s due date approached was, “The baby is getting bigger and may cause your back to hurt. You should stay active but try not to lift heavy things like water or other children.” The messages were meant in part to get women to think about having a midwife, now trained by HAI, present for the delivery. After birth, the messages continued for six weeks, with advice on postpartum and newborn care.

The program’s early results were so impressive that HAI and Catalpa International were asked to scale up the program into three new districts, with a tentative plan to expand to all of the country’s 13 districts in the next five years. In Manufahi, the number of deliveries in clinics rose by 70 percent, and total births assisted by a skilled attendant, whether at home or in a facility, increased by 32 percent. But Mercer is the first to take those numbers with a grain of salt. “There are a lot of complicated factors involved in evaluating whether the program works,” she says. The ultimate outcome they hope for, of course, is decreased maternal mortality. But those numbers are hard for HAI or the Timorese Ministry of Health to measure, given how expensive and difficult it is to gather them. So the key outcome measure remains whether the women use a midwife or doctor. In the most densely populated area with the largest number of midwifery staff—the places “close to the road,” as Mercer would have said in Nepal—the results were swift and impressive: more women came in for prenatal care visits, more women had their births attended by a skilled attendant, and more births occurred in a health facility.

The full article is available here.

APHA’s Georges Benjamin writes a letter on health workers in Syria

APHA Executive Director Georges Benjamin has written a letter to the members of the UN Security Council to enforce a resolution to end attacks targeting health care workers in Syria. You can read the text below.

Dear United Nations Security Council members:

On behalf of the American Public Health Association, a diverse community of public health professionals who champion the health of all people and communities, I write to call on the United Nations Security Council to enforce resolution 2139 to put an end to the attacks on health workers and facilities in Syria.

In over four and a half years of conflict in Syria, nearly 700 health workers have been killed and more than 300 medical facilities have been attacked. According to well-documented reports, the Syrian government is responsible for over 90 percent of these assaults. The disruption of health services is being used as a weapon of war. This year, by the end of October, attacks on medical facilities in Syria had already surpassed the number of attacks for any other year since the conflict began in 2011.

The attacks have decimated the country’s health system. In Aleppo, only 10 hospitals remain of the 33 hospitals that were functioning in 2010. About 95 percent of doctors have been detained, killed or have fled leaving one doctor for every 7,000 residents. There are shortages of medicine and necessities such as clean water and electricity. Hospitals are overwhelmed with patients needing emergency care for conflict-related injuries and patients are dying from treatable conditions.

In February 2014, the United Nations Security Council unanimously passed resolution 2139 demanding that all parties immediately end all forms of violence. The resolution strongly condemned attacks on hospitals and demanded that all parties respect the principle of medical neutrality, and that medical personnel, facilities and transport must be respected and protected. Passing the resolution was a critical first step, but now almost two years have passed since it was adopted and the attacks have continued. We urge the Security Council to take immediate steps to ensure that the resolution translates into meaningful progress to protect health workers and their patients in Syria.


Georges C. Benjamin, MD
Executive Director

More HIV discrimination from the ROK government: Korea disqualifies students with HIV from receiving scholarships

A few regular readers might be familiar with the Korean government’s ongoing misrepresentation of its HIV-related immigration restrictions: while it continues to receive undeserved recognition from the UN for being a country free of HIV-related travel restrictions, it mandates HIV tests for native-speaking English teachers, EPS workers (manual laborers), and entertainment workers. Despite claims from KCDC and Korea’s ministry of foreign affairs that immigration restrictions have been lifted, one English teacher won a discrimination case with the UN CERD earlier this year, and another case is pending with the ICCPR. Our Section was even successful in pushing through a resolution on immigration restrictions tied to HIV status at this year’s APHA Annual Meeting that called Korea out specifically for its double-talk.

Now there more evidence of discrimination to add to the list. The Korean Government Scholarship Program, which provides funding and airfare for non-Koreans interested in pursuing post-graduate degrees at a Korean university, is open to a small number of foreign nationals each year and is actively advertised on Korean embassy websites and even featured on several university websites for current undergraduates who might be interested. The program “is designed to provide higher education in Korea for international students, with the aim of promoting international exchange in education, as well as mutual friendship amongst the participating countries,” and the payment includes tuition, airfare, a monthly allowance, a research allowance, relocation (settlement) allowance, a language training fee, dissertation printing costs, and medical insurance. Which sounds lovely, except:

Applicants must submit the Personal Medical Assessment (included in the application form) when he/she apply for this program, and when it’s orientation, an Official Medical Examination will be done by NIIED. A serious illness (For example, HIV, Drug, etc) will be the main cause of disqualification from the scholarship.

It is also worth noting that pregnancy can disqualify candidates as well.

The best part is that this information is not even hidden: a Google search on the above line pulls up dozens of results, and the restrictions on prominently featured on the websites of Korean embassies to the US, the UK, Australia, Malaysia, plus the Korean Education Center in New York, GWU’s Sigur Center for Asian Studies, and even Seoul National University (DOC), the most prestigious university in the country.