Author: Disease Detective

After 30 years, @WHO finally begins pushing single-use syringes

by Disease Detective, posted in HIV/AIDS

Yesterday, the WHO officially updated its injection safety recommendations to call for the widespread adoption of single-use syringes, as well as a reduction in unnecessary injections (e.g., administering medications orally if they do not need to be injected):

A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with hepatitis B virus, up to 315 000 with hepatitis C virus and as many as 33 800 with HIV through an unsafe injection. New WHO injection safety guidelines and policy released today provide detailed recommendations highlighting the value of safety features for syringes, including devices that protect health workers against accidental needle injury and consequent exposure to infection.
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Transmission of infection through an unsafe injection occurs all over the world. For example, a 2007 hepatitis C outbreak in the state of Nevada, United States of America, was traced to the practices of a single physician who injected an anaesthetic to a patient who had hepatitis C. The doctor then used the same syringe to withdraw additional doses of the anaesthetic from the same vial – which had become contaminated with hepatitis C virus – and gave injections to a number of other patients. In Cambodia, a group of more than 200 children and adults living near the country’s second largest city, Battambang, tested positive for HIV in December 2014. The outbreak has been since been attributed to unsafe injection practices.
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WHO is urging countries to transition, by 2020, to the exclusive use of the new “smart” syringes, except in a few circumstances in which a syringe that blocks after a single use would interfere with the procedure. One example is when a person is on an intravenous pump that uses a syringe.

Setting aside my horror that repeat use of non-sterile needles in still a thing in healthcare facilities here in the US, I saw this as a positive move on WHO’s part and assumed that the “smart” syringe referred to in the press release and several headlines was something only recently developed. After all, injection drug use has been the primary driver of HIV and hepatitis infections in Eastern Europe and Central Asia for years, and it is a significant component of the epidemics in southeast Asia and China’s Yunnan province as well.

Imagine my chagrin when I came across this piece from the Guardian‘s Global development professionals network. It tells the story of Marc Koska, the British inventor of the K1 single-use syringe, who has apparently been trying – unsuccessfully – to get the global health community to jump on this bandwagon…for 30 years.

Using existing technology Koska came up with a syringe that falls apart after one use, and sold his first one in 1997. Even though he’s sold more than 4 billion auto-disable syringes since, he has been repeatedly frustrated in his attempts to make the world aware of the problem caused by reusable syringes. “It’s been a very frustrating journey. Thirty years to get WHO turned around. Thirty years to get the manufacturers turned around. You’ve got too many parts to expect it to be a three year journey.”

“There is a very basic reason why it hasn’t happened and that is because the manufacturers haven’t had a market,” he argues. “If the manufacturers could sell a product and it was identified where they were going to sell it and who was going to pay for it, they would make it.
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“Today, [WHO Director Margaret] Chan is a hero, but I think the next chapter might be just as challenging as the first bit,” he says.

“My gut feeling is that the ministries of health will be most resistant, because they’ve been saying for so long that they don’t have a problem of reuse in their countries. They’re never going to say that ‘we’ve got a terrible problem with hepatitis C because I can’t be bothered to buy enough syringes’. So now ministers have got to change their position and say, from Tuesday, we’re only going to buy auto-disable syringes.”

The frustrations of market forces blocking the development or widespread adoption of critically-needed global health resources is an old hat to most in the field, but this seems particularly egregious…WHO really should have caught on much sooner.

Lancet reminds us to include health in #humanrights analysis

by Disease Detective, posted in APHA IH Section

This should go without saying, but it is always nice when a respected, high-impact journal reminds us that health should be a central consideration in every human rights discussion and “necessary component of resilient human security.” In its most recent issue, British health journal Lancet published an editorial on HRW’s World Report 2015, lauding it for drawing attention to health-related human rights failures around the world while expressing disappointment that it “did not identify health as a core element in its analysis”:

In his opening essay, HRW’s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence. But when one delves deeper, there is a hidden story that often does not make the headlines. That story is the health dimension of human rights. Viewed through the lens of health, the report contains several compelling and disturbing themes.

The editorial noted numerous examples in the report of attacks on healthcare facilities, both in conflict zones and in the areas of West Africa struck by the Ebola outbreak, as well as spotlights on gender-based violence, a dearth of mental health services, targeted killings and persecution of health workers, and inadequate access to palliative care. While the report contains valuable analysis, the editorial contends that it does not go far enough in incorporating health as a human rights foundation:

This latest HRW report is an important call to arms to protect health as a fundamental human right. It is a pity that HRW did not identify health as a core element in its analysis, not only as part of a comprehensive package of human rights protections but also as a necessary component of resilient human security. Their analysis should prompt all governments and international health organisations to reflect carefully on their actions to make health a core responsibility and right of all citizens.

Agreed.

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

Media Wars: #Ferguson, American Hypocrisy and a Hint of Spring

by Disease Detective, posted in Human Rights, Information and Social Media

This was originally posted on my professional blog.

America has experienced an ugly spotlight reversal with the eruption of popular discontent into violence in its own backyard. Just a few weeks ago, international media was buzzing with reports of ISIS steamrolling the Iraqi military and Russian-supported separatists in Ukraine shooting down passenger airlines. Now, the US squirms uncomfortably under international scrutiny of Ferguson, Missouri, where the shooting of a young black man by a white police officer has once again raised the specter of racism and police brutality.

Obviously, the incident itself is complicated. Eyewitnesses – who have given conflicting testimonies – are the only window into what happened, since there was no dashboard camera. The initial description of Michael Brown, the victim of the shooting, as a “gentle giant” about to start college clashed with video footage of him stealing a box of cigarillos from a convenience store. Commentators have drawn parallels with the case of Trayvon Martin, whose mother has now reached out to Brown’s mother. Peaceful protests have given way to violence and looting, reporters have been arrested, and witnesses have complained of excessive use of force by the police.

Social media, which played a major role in bringing media attention to Ferguson in the first place, has played host to the battleground of ideological responses to the incident. The primary complaint from conservatives is that the uprising in Ferguson, and the underlying racial tensions it has exposed, don’t deserve our consideration because some of the protesters have been looting and vandalizing stores…

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…including a few gems that actually blame the community for the excessive force used against it.

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Meanwhile, people used the Twitter hastag #IfTheyGunnedMeDown to spar over which photos of Brown were used by traditional media (wearing a cap and gown vs. striking a “thug” pose) and post their own side-by-side pictures. Still others are expressing frustration at the fact that the vandalism and looting has been used as a straw man to distract from ongoing widespread racial profiling and policy brutality against blacks, including one refreshingly blunt protester at a rally in DC:

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What has been the most interesting to me is the global shock and horror at the incident and resulting fallout. The international community sees what many Americans are apparently missing: that the protests and unrest in Ferguson are the manifestation of a minority group sick of being oppressed and ignored. The UN High Commissioner for Human Rights drew parallels to South African apartheid, while several countries have been using the situation to take shots at America’s own human rights record when we so often criticize other countries. One might expect Iran and Russia troll the US over civil unrest, but as one friend of mine pointed out on Facebook, “When Egypt calls you out for human rights abuses, YOU’RE DOING IT WRONG.”

American police brutality, and the unwillingness of many police departments to be held accountable for their actions, have also been focal points. What happened to Michael Brown will unfortunately always be shrouded in mystery, since the Ferguson police department apparently prioritizes riot gear and tear gas over cameras for officers or police cruisers. They also seemed to have forgotten the meaning of “free press,” as they arrested and harassed several reporters who were trying to cover the protests. Interestingly, Obama was quick to condemn the bullying of journalists “here in the United States of America,” despite his own administration’s secrecy and aggression toward the press, including prosecuting a journalist who refused to identify the source of an intelligence leak.

Indeed, many observers have been quick to point out America’s hypocrisy at fingering human rights abuses outside our own borders when we have threads of discontent, similar to those found in the Arab Spring and other global protest movements, woven throughout our own society. A lovely little piece of satire from Vox portrays how American media might describe the events in Ferguson if they happened in another country.

When everything is said and done, America doesn’t look so much like a shining beacon of democracy and human rights – we just kinda look like everybody else.

Annual Meeting, Day 2: A Visit to the Hill, Refugees, and the Awards Dinner

by Disease Detective, posted in APHA IH Section

This morning I got a preview of what those of you who are signed up for Thursday’s Advocacy Day will experience.  Since I will not be able to stay in DC until Thursday, I decided to take some time while I was here to visit the office of my own Congressman, Representative Michael McCaul.  While the Congressman was not able to meet me himself, I spoke with DoD fellow Christian Lyons (who manages his foreign affairs portfolio) and made my case for global health funding.  While he was very polite and expressed support for my concerns, he was just as eager to raise some issues of his own, so be prepared to answer questions and be on your toes!

After a long walk back from Capitol Hill, I took my “passport” to the Public Health Expo, determined to put my name in for the drawing (go free registration for APHA12!).  Walking around the expo is a great way to scope out job opportunities, pick up stress balls, and get free smoothies.  For me, it is also a great way to get comfortable with meeting and talking to people.  If networking does not come naturally to you (it has always been awkward for me), the best way to get good at it is to practice.

In the afternoon, I attended a session on refugee health.  Those presentations were particularly interesting to me, as I have done some research and writing on the side related to displacement and refugee health issues.  We heard from researchers who work with refugee populations, as well as a very interesting presentation from a representative from Physicians for Human Rights.

At the IH Social this evening, members got together to chat, make connections, and reminisce as we honored this year’s section awardees.  Congratulations to all of this year’s award winners.  Pictures will follow soon!

Annual Meeting, Day 1: Meetings and Opening General Session

by Disease Detective, posted in APHA IH Section

The APHA Annual Meeting kicked off today with the Opening General Session, which featured Pamela Hyde, administrator of the Substance Abuse and Mental Health Services Association; Jonathan Jarvis, director of the National Parks Service; and former Senate Majority Leader Tom Daschle.  The session began with some very inspiring words from current APHA President Linda Rae Murray; however, I have to confess that I was less than impressed by the speeches – and somewhat baffled by the choices of Jarvis (not quite sure why national parks are relevant to public health) and Daschle (Obama’s first failed choice for Secretary of HHS).  That is just my personal opinion, though – many at the IH section’s first business meeting enjoyed the talks.

For some of us, however, the meeting began before the opening session.  Section members greeted and helped orient international attendees at our International Welcome Booth, which the Global Health Connections Committee is hosting for the third year in the a row.  The GHCC also held its annual meeting in the hour before the opening session.  We discussed our progress on the Global Health Expertise Directory and discussed ways to get involved in the section and make connections with other members.  After the opening session, the section held its first business meeting, where longtime members reconnected and new members learned about opportunities to get involved.

For many of us, one of the main highlights of the Annual Meeting is the wide array of scientific sections, which begin tomorrow – so get excited!  I have my own reason to be excited as well – although I cannot stay for the section’s very first Advocacy Day, I am going to my Congressman’s office to advocate for international aid funding!