Global News Round Up

Politics & Policies

Microsoft founder and philanthropist Bill Gates, who’s in D.C. this week to meet with administration officials and members of Congress, told Axios he hopes the U.S.’ souring relationships with Europe and China — sparked by the Trump administration’s tariffs — won’t hurt long-term global health or climate change goals.

Stereotypes that migrants are disease carriers who present a risk to public health and are a burden on services are some of the most prevalent and harmful myths about migration.

Pakistan’s expulsion of 18 international aid agencies will hurt 11 million aid recipients in a South Asian nation grappling with perilously low standards of education and healthcare.

Programs, Grants & Awards

Each year, in June and November, the Global Health Center at Children’s Hospital of Philadelphia facilitates educational exchanges in the Dominican Republic (DR) through the Global Health Allies Program.  The program is open to all benefits-eligible CHOP employees who have been employed at CHOP for at least 18 months at the time of the trip.  Approximately six people whose expertise fits with the particular needs of each exchange are chosen following a formal application and interview process.

Students from the Clinton, Janesville Craig, Janesville Parker, Marshall, Milton, Portage and Sun Prairie high schools spent the day at “Opening Doors to the World,” the sixth annual High School Global Public Health Day at UW-Madison.

Research

For most people who take statins to lower cholesterol, the risk of side effects is low compared to the benefits, according to a recent scientific statement.

Diseases & Disasters

U.S. Navy sends hospital ship to Colombia to treat Venezuelan migrants.

The UN appealed Tuesday for $4 billion to cover humanitarian needs in Yemen in 2019 – its largest country appeal ever – and announced its first appeal related to Venezuela, calling for $738 million to help those who have fled the country’s economic meltdown and health crisis.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) confirmed that in September of 2018, first ladies from both China and Africa have committed to advocate and prevent HIV/AIDS among adolescents, creating a joint initiative that emphasizes a three-year health promotion and HIV-prevention advocacy program.

Newly released data by the US President’s Emergency Plan for Aids Relief (Pepfar) shows it is this community-centered approach that has helped Namibia exceed some of the 90-90-90 targets set by UNAids in 2014.

Decades after polio was eradicated from Papua New Guinea, the crippling and sometimes deadly disease has returned, leaving doctors scrambling to revive long-lapsed vaccination programmes.

A drug that protects children in wealthy countries against painful and sometimes lethal bouts of sickle-cell disease has been proven safe for use in Africa, where the condition is far more common, scientists reported on Saturday.

The Ebola outbreak in the Democratic Republic of the Congo (DRC) is quickly becoming an international concern.  With 489 people diagnosed with the disease and 289 deaths, it is already the second largest Ebola outbreak in history (although still dwarfed by the 2014 West Africa outbreak). While the DRC has a good track record of responding to these outbreaks, the ongoing military conflict in the country is making the response much more difficult.

Technology

Tanzania is the first confirmed country in Africa to achieve a well-functioning, regulatory system for medical products according to the World Health Organization (WHO).

A chatbot is a computer program that automatically replies to user messages based on a decision tree or artificial intelligence algorithm. Increasingly, chatbots are being used to give technology a more human face and make data more accessible to people.

Researchers from the Loyola University Chicago Stritch School of Medicine have generated six antibodies that could be used to test for and potentially treat the Zika virus.  To date, the mosquito-borne disease has afflicted more than 1.5 million people worldwide, but there is no effective vaccine or drug available for treatment. It is most dangerous during pregnancy, which can result in miscarriages, stillbirths, or congenital disabilities.

An inexpensive, easy-to-use blood test could dramatically alter how sickle cell disease is diagnosed in Africa, where the often-undiagnosed disease is a leading cause of childhood mortality, according to a manufacturer-sponsored study presented here.

Environmental Health

Britain is bidding to host the UN climate change conference in 2020, the biggest since the Paris agreement was signed in 2015, as part of the government’s aim to be seen as a green leader.

Equity & Disparities

Uterine cancer is killing more women, and black women are disproportionately burdened by the disease, a new report from the Centers for Disease Control and Prevention shows.

Women, Maternal, Neonatal & Children’s Health

Malaria quickly kills toddlers.  But rapid diagnostic tests, a new suppository drug and  bicycle ambulances can buy enough time to get stricken children to hospitals.

Advertisements

The Developing World & Non-Communicable Diseases: A Pandemic of Drug Shortages & Inequitable Access

Throughout the developing world, health demographics are rapidly shifting from communicable diseases to non-communicable diseases (NCDs) due to urbanization, lifestyle changes, and introduction of processed food. Although still retaining a significant portion of their communicable disease burden like tuberculosis and malaria, the prevalence of hypertension, diabetes, and cancer in developing countries has increased dramatically and is expected to cause every 7 out of 10 deaths by 2020. With the rise of these health ailments, the global health community has highlighted the importance and severity of these diseases through UN High-level meetings, incorporating relevant indicators in the Sustainable Development Goals (SDG’s), and forming interagency coalitions within countries to address the barriers of NCD prevention and treatment. However, NCD medication supplies have remained an underappreciated barrier that humans affected by global health inequalities confront each day. The complications of drug supplies range from common medications being out of stock to not having a vital class of medications available at the health facility. The medication shortages that plague developing nation states often have a more pronounced effect on underserved populations – essentially causing an impossible barrier to treating their chronic condition and preventing morbidity/mortality.

Last month on November 20thThe Lancet Diabetes & Endocrinology revealed predictions in the year 2030 regarding the world’s insulin supply that stunned health care professionals around the globe. From data gathered recently, the number of individuals diagnosed with Type 2 diabetes is estimated at 405 million people. Although some patients can be treated with oral or injectable diabetic medications like metformin or GLP1 inhibitors, there are approximately 63 million people on earth today that require the use of insulin to manage their diabetes. However, only 30 million individuals use insulin due to availability, affordability, and inequitable access to this essential class of medications. Although these numbers provide a clear indication of the necessity for change in regards to access to insulin globally, the scientists at Stanford that conducted the aforementioned study in The Lancet predicted that the number of individuals diagnosed with Type 2 diabetes will increase to 510 million in 2030 – 79 million of those will need insulin to proper manage their health disorder with only 38 million having equitable access to insulin. These statistics exhibit that, in 13 years, less than half of the people on this planet will be able to access insulin, a medication developed 97 years ago. Though over half of the world’s diagnosed Type 2 diabetics will reside in China, India, or the United States, the study continued and stated that the insulin supply shortage will distress those inhabiting Africa and Asia most significantly. The reasons formulated to explain this health disparity include the fact that three pharmaceutical industries control almost 100% of insulin being manufactured in the world, the complexity of insulin which is a hormone produced by living cells, and generic companies’ lack of interest in producing a biosimilar at an equitable price.   

Cardiovascular diseases (CVDs) pose an implausible health burden on the global society with 30% of all deaths worldwide being attributed to these ailments. Of this mortality caused by CVDs, it is estimated that 80% occurs in the developing world with projections suggesting a steady increase in this percentage. However, with equitable access to cardiovascular medications, approximately 75% of recurrent CVDs can be prevented causing a decrease in both mortality and morbidity for humanity. To determine the access to common cardiovascular medications like atenolol, captopril, hydrochlorothiazide, losartan, and nifedipine, the BMC Cardiovascular Disorders journal published findings in 2010 of a survey within 36 countries. The findings revealed that the drug shortages transcended more complex medications like insulin and affected the access of medications that are considered ubiquitous in the developed world. The analyzed data revealed that of the abovementioned medications in the 36 countries, only 26.3% was available in the public sector and 57.3% in the private sector. The study also stated that in several nations, the wages earned within one working day was insufficient to meet the cost of one day of purchasing treatment. When considering situations where monotherapy is inappropriate, this finding would disclose that treatment would be particularly unaffordable.

When considering access to NCD medications generally, wealth has been a substantial determinant of inequitable access to treatment of hypertension, asthma, cancer, and others classified as NCDs. In many low-income to middle-income countries (LMICs), a wealth gradient has even been observed. In order to gather information to disprove or support this theory, the BMJ Global Health Journal published a study conducted in Kenya in August 2018. The study administered surveys to patients prescribed hypertension, diabetes, and asthma medications and collected data on those medications available at their home, including location and cost of the service. When analyzing the data, the results clearly indicated a wealth gradient for each of the three diseases included in the study in terms of access. As household income increases, so does the likelihood that a family has an opportunity to obtain proper medication. In addition, the results showed that poorer patients had to travel further to obtain treatment than those with a higher income. Finally, and most meaningfully, poorer patients paid more for their medications than their fellow humans inhabiting other parts of the country.  

These global health inequalities are unjustifiable in a global society where the quantity and quality of medications on the market is incredible. The drug shortages and inequitable access differ between the developed world and developing world, but also by socioeconomic stratifications within countries themselves. In order to provide compassionate care to every human suffering from any of these ailments, governments need to begin initiatives to make insulin, losartan, albuterol, and every vital NCD medication available to every citizen in their country. Heads of states, pharmaceutical industries, ministries of health, and health care professionals need to accompany their citizens and patients with a health mindset moving away from health as a commodity to health as a right. Most urgently, universal health care coverage needs to be at the forefront of every national health agenda to properly address this pandemic of drug shortages and inequitable access.

Mark your calendar for WORLD AIDS DAY – December 1st!

The first global health day ever recognized, World AIDS Day, is observed on December 1st every year. This day is an opportunity for people all over the globe to support those living with HIV, support the fight and research against HIV, and remember those who have died because of AIDS-related illnesses.

Since the beginning of the AIDS epidemic in the 1980’s, over 70 million people have acquired the infection and an estimated half have died from AIDS related complications. Today, there are over 37 million across the globe that live with the disease. Twenty-two million of the 37 million are currently on treatment.

Today, an HIV diagnosis is not a death sentence. There are many different treatment and prevention options (such as PrEP) and services for those in vulnerable populations. Still, access to care and treatment remains a significant problem, especially in developing nations, and more needs to be done to address this issue and increase access. There is also still a general gap in awareness. This year’s theme is “Know Your Status” because one in four people with HIV are unaware that they have the disease. Unfortunately, this may be due to barriers to getting tested.

The WHO recommends the use of self-tests for HIV in areas where there is a lack in availability of HIV tests. This is where a person can collect their own specimen, typically oral fluid or blood, and perform the test in a private setting such as their home. Currently, 59 countries have started using HIV-self tests.  The largest HIV self testing programs have been implemented in six countries in south Africa by the WHO with help from international organizations such as Unitaid.

The UN has a target of diagnosing 90% of all people with HIV by year 2020 and the world has committed to ending AIDS by 2030. Self tests are a huge step in getting vulnerable populations and communities access to testing and knowing their status. Knowing your status and getting on antiviral treatment as soon as possible are the consequential steps to ending AIDS. However, it all begins with awareness and access to testing.

What are some ways YOU can spread awareness and recognition for World AIDS Day and contribute to the goals for 2020 and 2030?

  1. Rock the RED Ribbon to show everyone you support the movement – this symbol became part of the AIDS awareness movement in 1991 when New York artists created it. Fun Fact:  It was the first disease-awareness ribbon made and was later adopted by other health awareness causes, such as breast cancer awareness and mental health awareness.
  2. Print out #ROCKTHERIBBON posters or share them on social media to spread the message. Find these images here!
  3. DONATE to organizations that support AIDS research. Be sure to do your own research to make sure the organization’s mission aligns with your motivations.
  4. Volunteer at a World AIDS Day event near you!
  5. GET TESTED & KNOW YOUR STATUS!

IH Section’s Global Health Mentoring Program, Applications due 11/29!

Don’t forget to apply!

The Global Health Mentoring Program applications for mentors and mentees is still open. Applications and information on the program can be found here: https://aphaih.org/global-health-mentoring-program/

Mentee applications for this cohort (January 2019 to€“ September 2019) will be accepted until November 29, 2018 at 11:59 PM US Eastern Time.

Mentor applications have been extended! Applications are due on Thursday Dec 6th at 11:59 PM US Eastern Time.

African Field Epidemiology Network: My Experience Attending the 2018 AFENET Conference in Maputo, Mozambique

I attended the African Field Epidemiology Network (AFENET) from November 12th-16th in Maputo, Mozambique. It was a great opportunity to hear about the on-the-ground public health work being conducted in 31 countries on the African continent and efforts being made to build field epidemiology capacity. The theme of the conference was, “Building Resilient and Sustainable Public Health Systems in Africa Through Field Epidemiology Training.” My first session to participate in was the preconference workshop, “Orientation to International Outbreak Response with WHO and Global Outbreak Alert and Response Network (GOARN) in the African Region.” Participants spent a full day learning about how to become involved in international public health deployments through the AFENET network, working through complex exercises in groups, and assessing our individual readiness to deploy if needed. Attendees from Zambia, Guinea, Cameroon, Nigeria, Uganda, and many other countries were represented at this session.

There were also great plenary sessions. My top three sessions (of those I had the opportunity to attend) included: 1) Implementation Science in Public Health (presentation given by Dr. Echezona Ezeanolue), 2) Transforming Public Health Surveillance – Proactive Measures for Prevention Detection and Response (presentation given by Dr. Scott JN McNabb), and 3) North-South Collaboration for Public Health Workforce Development: The Case of Washington University & University of Zimbabwe (Dr. Janet Baseman, Dr. Notion Gombe and Audrey Hu). All of these sessions either resonated with me or challenged me to think outside the box to take needed risks as a public health professional.

Now, the real reason I had the opportunity to attend the AFENET conference was to provide support and technical assistance to the Zambia Field Epidemiology Training Program (Zambia FETP). Zambia FETP had 6 residents present a mixture of poster and oral presentations over the course of 5 days. Our residents shined not only in the scientific sessions but also when it came time to share about the nation of Zambia during the International Night that was held towards the end of the week. Overall, I learned that providing support also meant helping showcase a popular Zambian dance, assisting with handing out small gifts and pamphlets to colleagues from other countries, and participating in insightful conversations about what true mentorship looks like.

Some highlights of the conference included catching up with two of my fellow PHI/CDC Global Health Fellows, having breakfast with my mentor, being near the beach, building relationships with our residents, meeting our points of contacts from CDC Atlanta, connecting with the Nigerian FETP and, of course, networking with a diverse array of public health leaders from the African continent. There were a few challenges as well. I was sick for the first few days of the conference. There were many hiccups that occurred prior to the conference which led to me only being able to attend last minute. Finally, the theme of the conference made me reflect on gaps I see in epidemiology capacity when I consider situations like the current Ebola outbreak in the Democratic Republic of the Congo (DRC) and wonder what, if any, impact I may be able to make during my time here.

Sophia Anyatonwu, MPH, CPH, CIC
Epidemiologist
Global Epidemiology Fellow | PHI/CDC Global Health Fellowship Program