Top Five Global Medication-related Controversies in 2019

The onslaught of biomedical interventions has allowed healthcare professionals globally to provide more effective & efficient treatment. Medications, in particular, have equipped healthcare systems with chemical entities to combat infectious diseases, manage chronic disease states, and provide targeted oncology therapy. However, these synthetic agents are not without controversy or significant glitches. Despite the intention to do no harm, humanity is often burdened with the negative consequences of the biomedical age. As the global health community reflects on this past year, there is substantial insight to be gained by reviewing these controversies that occurred in 2019. The following five issues encompass a few of the biomedical controversies in 2019, so that internationally, our fragile species can learn and grow to further improve the lives around the globe. 

#1: Global Drug Deaths – Opioid Pandemic 

In June of 2019, the United Nations Office on Drugs and Crime (UNODC) released the 2017 World Drug Report that highlighted the reach drug addiction has on humanity. The UNODC found that 35 million individuals were suffering from drug use disorders and required addiction treatment services. This is a 30% rise from near the end of the last decade. Of the deaths that occurred due to drug use disorders, 2/3rds were attributed to opioids alone which include both heroin and legal pain relievers. An increase of opioid use in Africa, Asia, Europe, and North America in concert with the single largest yearly production of cocaine – 2000 tons – are thought to explain this rise in opioid deaths. In addition, this study discovered that parts of West, Central, and North Africa have been flooded with tramadol leading to this opioid’s abuse and the increase in global figures. 

Unfortunately, this study noted that only one in every seven people are receiving effective treatment for their drug-use disorder. Evidence-based interventions are either completely unavailable in their area of inhabitation or inaccessible due to cost, distance, stigma, or saturation of available treatment centers. This report concludes by encouraging nation states and the global community to increase their efforts and funding to providing this vital care to each patient seeking these services. 

#2: Medication Recall – Zantac 

GlaxoSmithKline (GSK), a UK based pharmaceutical industry, issued an October 2019 statement that informed the public on a recall of a common medication to treat peptic ulcer disease (PUD) – Zantac, also known & sold by its generic name ranitidine. The impurity N-nitrosodimethylamine (NDMA) was found in unacceptable limits as this chemical is known to be a potential carcinogen. All prescription dosage forms were recalled which included tables, syrups, and injections, and changes in the manufacturing process are thought to have caused this increased level. This recall follows the 2018 recall of the class of anti-hypertensive agents called angiotensin II receptor blockers (ARB) that were adulterated with the same unacceptable limits of NDMA. 

#3: The Resurrection of Biogen’s Alzheimer’s Medication 

In March of 2019, the pharmaceutical industry Biogen announced that it was terminating its phase three clinical trial of a novel entity in the treatment of Alzheimer’s Disease. The termination of the monoclonal antibody, aducanumab, was due to no significant statistical differences between the treatment and placebo study arms. Aducanumab targets beta-amyloid plaque which has been the substiantal focus in Alzheimer’s treatment throughout the last several years. The preliminary results released by Biogen shocked the Alzheimer’s medical community, as this treatment showed so much promise in early stage trials. It was also the last potential target in this medication class, forcing many to believe a novel treatment modality would need to be pursued. 

However after a retrospective analysis of the complete data, Biogen reversed its decision in October 2019 and restarted their phase three clinical trials. The company stated that the researchers, initially worried about brain swelling and other side effects, increased the dose of aducanumab late in the study. This increased dosage showed increased effectiveness, 25% reduction in the rate of decline compared to placebo, when the researchers conducted the analysis after the initial cancellation. This increased dosage is still marred in controversy as two different trials, EMERGE & ENGAGE, both utilized the high dose regimen with the EMERGE participants seeing the aforementioned positive results while the ENGAGE participants actually seeing an increase in their cognitive decline. Biogen will file approval for the US Food and Drug Administration (FDA) early in 2020, but experts are split on whether it will be approved or will require additional trial data. Regardless of the decision by the FDA, the success of aducanumab will shape the future of Alzheimer’s treatment and research. 

#4: A halt to Pediatric HIV Structural Violence: Quadrimune

Cipla, a generic manufacturing company based out of India, announced in late 2019 that they were going to start production of an antiretroviral pediatric formulation for just $1 per day. Quadriume, which contains ritonavir, lopinavir, abacavir and lamivudine, is strawberry flavored to increase the adherence rates for young children afflicted with this infectious disease. Before the availability of this formulation, UNAIDS estimated that globally 50% of the 160,000 children infected with HIV die each year before the age of two largely from access issues and inability to tolerate the older formulations. The older formulations had tolerance problems such as a metallic taste and need for refrigeration while also encountering HIV resistance. The western world’s pharmaceutical industries has continued to turn a blind eye to this population of humanity for the sake of profits, while Cipla has been undertaking pragmatic approaches to HIV care for several years. Cipla hopes to receive FDA approval followed shortly by the World Health Organization (WHO) approval in May 2020 while Doctors Without Borders has already started clinical trials in Uganda to receive support from African health leaders. 

#5: Samoa’s Measles Outbreak: Ill-prepared Vaccines 

The island nation of Samoa announced in December 2019 that 53 individuals, 48 being children under the age of five, have died due to large measles outbreak. In total, approximately 4000 measles cases have been reported in a population of 200,000. Throughout the country, public gatherings have been banned and schools/universities has been closed. Although experts believe the myth of autism being caused by vaccines have led to decreased vaccination rates (31% among young children), there may be a more significant reason for distrust in vaccinations. In July 2018, two nurses in Samoa mistakenly reconstituted the Measles, Mumps, Rubella (MMR) vaccine with a muscle relaxer instead of distilled water. This led to two infant deaths, five years in prison for the nurses, and a plethora of misinformation spread to the island’s inhabitations. This Samoan outbreak reflects a trend across the globe with a quadrupled amount of measles cases in the first three months of 2019 compared to the same time frame in 2018. 

A Promising Outlook: 2020

Despite these biomedical obstructions to a healthier global society in 2019, 2020 promises great advancements in the way humanity’s well-being is cared for. With the perspectives gained from this past year, the following health innovations are due to be initiated to achieve equitable healthcare for all: 

  • A novel class of migraine medications, oral calcitonin gene-related peptide receptor antagonists, is due to have its first agent approved in 2020. Ubrogepant, manufactured by Allergan, will offer an effective therapy for those who cannot tolerate the current gold standard migraine agents – triptans. 
  • The future of the fight against HIV will be equipped with a once-monthly injection of antiretroviral therapy in 2020. The combination therapy of cabotegravir/rilpivirine (Cabenuva) produced by ViiV Healthcare has shown to be as effective as current once daily therapy options. 
  • The eradication of malaria will discover if a vaccine candidate could add to its arsenal of biomedical interventions. Sanaria has developed the PfSPZ vaccine, and will conduct phase three clinical trials in Bioko, Equatorial Guinea in 2020. This new candidate has, thus far, shown to have a more protective effect (48.3%) than the currently approved RTS,S vaccine. 

Sustainable health through social enterprise

After five years of working towards the Sustainable Development Goals (SDGs) the global health community still has a long way to go to achieve health related goals by 2030. To improve health and well-being for all global health organizations need to reflect on the successes and challenges to date, as well as reflect on how to make programs more sustainable. One way to create and maintain sustainable health programs is through the social enterprise model.

Social enterprises are for-profit organizations that utilize business practices and the marketplace to advance social justice and development. To be defined as a social enterprise a program must address a social need, generate income mainly through commercial activities and primarily focus on the common good. Types of social enterprises include: one, opportunity employment – organizations that provide jobs to those with barriers to mainstream employment (i.e. Goodwill); two, transformative products or services – creating social or environmental impact through innovative products or services (i.e., World Bicycle Relief, Grameen Bank); and three, donate back – organizations that donate a portion of profits or goods to meet social needs (i.e. TOMS).

Global Health and Social Enterprise

There are several examples of successful global health social enterprises that can be leveraged to create new, or modify existing, programs. In some low-income countries the social enterprise model has been used to strengthen and empower the nurse and midwife workforce. In other examples, Unite for Sight, a non-profit organization working to deliver eye care to low-income countries, partners with clinics all over the world and engages with social entrepreneurs to increase patient access to vision care; and Dispensary of Hope, utilizes the donate back social enterprise model to provide free medications from pharmaceutical companies to health clinics all over the world.

Another successful social enterprise working to solve a global health problem is Days for Girls International. While on a trip to Kenya in 2008 founder Celeste Mergens discovered girls having their periods were sent to their rooms for days, sometimes going without food, and were forced to sit on cardboard until they stopped menstruating. Days for Girls set out to address this issue by designing a washable, long-lasting pad since many of the women and girls without access to menstruation products also lack access to sanitation and safe disposal of pads. 

To date Days for Girls has reached over 1 million women and girls in 125 countries with their Days for Girls Kits (DfG Kits). The Days for Girls Social Enterprise Program trains local women to produce and sell DfG Kits, as well as provide women with menstrual health education. According to the Days for Girls 2018 report, 81% of participants in the social enterprise program reported earning an income, and overall the program has created jobs and increased women’s confidence and ability to become business leaders in their communities.  

Untapped potential

 In the development world terms such as social enterprise and social entrepreneurship are often used, but not often defined. Social enterprises are businesses which maximize social good and financial return, while social entrepreneurship is about creating change agents by investing in the ideas of social entrepreneurs. While the latter is important it is equally, if not more important, for sustainable change in global health to invest in, create and support social enterprises that can provide in-country jobs and economic stability, as well as solve important health problems. 

As we head into 2020 and plan for achieving the SDGs in the next ten years, finding innovative ways to solve global health problems will be critical. Global health organizations need to capitalize on the success of current social enterprises, and partner with in-country social entrepreneurs in order to solve intertwined health and development issues. Creating sustainable change means moving beyond charity and finding ways for low-income countries to prosper; because in a global economy when low income countries thrive – everyone thrives.

 

 

 

 

 

 

 

 

 

 

 

 

 

Global Health and Diabetic Retinopathy-“Protect your vision: Steps for someone with Diabetes”

“Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.” -WHO (2018)

The prevalence of Diabetes has increased in low and middle-income countries. Diabetes increases the risk of a range of eye diseases, but the main cause of blindness associated with diabetes is diabetic retinopathy.

According to the World Health Organization (WHO), diabetic retinopathy causes blindness in almost 5 million people worldwide. As the leading cause of vision loss in working-age adults, diabetic eye disease thus represents a significant global socioeconomic and healthcare problem.

What is diabetic retinopathy and what causes it? 

Diabetic retinopathy is an eye condition caused by diabetes. It affects the small blood vessels and light sensitive tissues in the back of the eye (retina). This condition is primarily caused due to high blood sugar levels and if left untreated can lead to vision loss.

Am I at risk for vision problems? 

If you have any type of diabetes you can get diabetic retinopathy. This includes people with type 1, type 2, and gestational diabetes, which is diabetes that occurs during pregnancy. Your risk gets higher the longer you have diabetes. More than 2 in 5 Americans with diabetes have some stage of diabetic retinopathy. The good news is that you can lower your risk by controlling your diabetes!

When should I get an eye exam?

The best diagnostic for diabetic retinopathy is a dilated eye exam.

  • If you have diabetes, get a dilated eye exam once a year
  • If you have diabetes and become pregnant, get a dilated eye exam as soon as possible and ask your doctor if you will need more eye exams during your pregnancy

What can I do to prevent diabetic retinopathy?

Losing your vision to diabetic retinopathy is sometimes permanent, but can be prevented. Studies have shown that the best ways to prevent it are to:

  • Keep your blood sugar level close to normal (this also reduces getting kidney and nerve diseases)
  • Control any elevated blood pressure and cholesterol
  • Exercise regularly
  • Choose healthy foods
  • Follow your doctor’s instructions for taking any medications and ask questions about your health

Is there a treatment for diabetic retinopathy?

Yes. However, treatment for diabetic retinopathy is often delayed as symptoms are unnoticeable until the condition starts to progress, or when Diabetic Macular Edema (DME) occurs. DME is when blood vessels leak fluid into the back of the eye, causing swelling. In this case, eye exams would be needed more often, as it becomes more severe. People with more severe cases may need a dilated eye exam as often as every 2 to 4 months. It is important to know that early detection and treatment can reduce the risk of blindness on a global scale.

APHA 2019 Annual Conference: Recap

My name is Christa Cook and I am a Communications Committee Chair.

This year, I was able to attend the annual APHA conference for the first time! My schedule was packed full of sessions and meet-ups and it was all so worth it! I am an infectious disease epidemiologist, so my work is mainly focused on infection control and disease transmission, and I love it… but I’m also interested in other aspects of public health like chronic diseases and social and behavioral health. The conference allowed me to get a little taste of what’s going outside of my focused public health field. I highly recommend attending if your interests in public health are varied.

It’s also a great opportunity to network and meet other members of the sections or committees you’re involved in. I’ve been working with the International Health Section’s Communications Committee for over a year, and I was finally able to meet some of the people I’ve been talking to over the phone with at every month’s leadership call! I attended the business meeting for the section on Sunday and as each representative from committees gave their update, I was able to grasp just how much our section does. Here are a few highlights from each of the section’s committees:

  • The Policy and Advocacy Committee sponsored 3 policy statements, endorsed 2 policy statements, and reviewed/provided feedback to all 17 proposed policy statements.
  • The Communications Committee is now producing the section’s newsletter, the Section Connection. They continue to recruit bloggers for the section website and are active on all social media including Instagram, Facebook, and Twitter.
  • The Nominations Committee fielded a full slate of candidates for section leadership positions this spring. This year we elected Jirair Ratevosian, Samer Jabbour, and Rania Millerson as governing councilors. Carmyn Polk stepped up to run for secretary-elect, and will assume the secretary position in November 2021. Jay Nepal, Roberto Jorge Esteves and Ucheoma Nwaozuru were elected to the three open section councilor position. Caitlin Wolfe was elected to our section student liaison position. We hope you consider running for a position next year. The latest leadership roster is available here
  • The Membership Committee conducted an online membership survey in Spring and based on the feedback proposed a plan to more actively engage members.
  • The Global Health mentoring program saw an increase in the number of mentor/mentee pairings in 2019 compared to 2018. Applications for the 2020 cohort are now open.
  • The Program Committee created over 40 scientific sessions for this year’s annual meeting on emerging public health issues of international importance, including nine collaborative sessions with association components.

It was so inspiring to learn about the work that each of our committees does! I also was introduced to a few of the International Health section’s different working groups such as the breastfeeding working group, international abortion working group, and the climate health and working group. I wasn’t aware of these groups beforehand and found myself interested in learning more. I even connected one of the heads of the working group with a colleague at the conference because I knew her passion aligned with the group’s mission. 

APHA International Health Section’s Open House

After the business meeting, the section held their Open House. The Open House is an opportunity for all members to get to know the work the section does. This year our Assistant Social Media Manager, Jackie Bell, represented the Communications Committee. The format of the Open House was similar to speed dating where members and potential members would spend a few minutes at a table with each Committee and listen to what each Committee does and ask questions.

On top of attending the country’s largest gathering of public health professionals, you also get to explore a new city. This year, the conference was held in the wonderful and historical city of Philadelphia. I got to sneak away to see where the Declaration of Independence was signed as well as do a cheesy tourist bus ride to learn more about the other historical sites scattered around downtown! I learned SO much inside and outside of the walls of the conference center.

Annual Awards Ceremony and Networking Event

On Tuesday night, I was able to briefly attend the section’s annual Awards Ceremony and Networking event. During this event, section members are able to meet other section members as well as section leaders. It was a great opportunity to learn more about the wonderful global health work our members do. During that time, they also presented awards to people I’d consider to be global health heroes.  To learn more about this year’s awardees, click here.

To summarize the conference events, I’ve found some quick links for both attendees and those who were unable to attend this year. See below:

For attendees:

  • Check out pictures from the fun-filled week right here! Try to find yourself if you attended!
  • Did you attend and forget to file for continuing education credits? Check here for instructions on how to obtain your credits.
  • Did you learn the APHA dance and want to teach others at your workplace? Find the youtube video here!
  • Did you attend and want to share about the conference? Comment on the blog post below or find us on our social media platforms. We may spotlight your experience this month!

For those wanting a recap:

  • The theme of this year’s conference was “Creating the Healthiest Nation: For Science. For Action. For Health”. Read more about what that means in the link above.
  • Some of the best highlights from the conference can be found here on APHA TV! These quick clips can give you a taste of some of the biggest speakers that presented.
  • The annual meeting had many diverse workshops the Saturday before the conference. See a listing of the different options that were available this year here.
  • If you’re interested in reading other’s perspectives about sessions at the conference, check out the blog here. You can also cruise APHA’s social media channels to see what others retweeted or posted about the conference!
  • The conference also had a neat Social Media Lab! Check out the link to see what was available for attendees. This was super beneficial for those wanting to revamp their organization’s social media platforms to increase their public health presence. 
  • Still want more? You can purchase sessions like the opening, general and closing sessions from APHA Live. If you’re a member, it’s half price! 

I hope I’ve convinced you to attend next year’s event in San Francisco!

Congratulations to the 2019 APHA International Health Section Award Winners!

This year, we had a good pool of candidates for the various awards offered by our Section. Congratulations to our colleagues whose outstanding accomplishments in international health are being recognized by our Section this year.

1. Carl Taylor Lifetime Achievement Award in International Health — Dr. Russell Morgan

2. Mid-Career Achievement Award in International Health — Dr. Jirair Ratevosian

3. Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice – Dr.  MaryAnne Mercer

4. Distinguished Section Service Award – Ms. Jean Armas

The Awards Committee encourages all to nominate a colleague and/or be willing to be nominated next year. To find out more information about nominating a colleague or to view a list of past award winners, please visit the IH Section’s Awards webpage.

We would also like to congratulate this year’s top-scoring Early Career Professional abstract, Dr Bilikisu Reni Elewonibi. Dr Elewonibi presented her abstract, entitled “Pregnancy loss in Urban Tanzania: Patterns and Predictors,” at this year’s conference. Every year the IH section awards two $500 scholarships to top scoring abstracts submitted by IH Early Career Professionals. Don’t forget to submit your abstract to next year’s meeting in San Francisco!