Global Health News Last Week

Note: I apologize for the hiatus in the news round-up; I went to a major conference for work in April and was very busy with preparations and then wrap-up afterwards.

April 25 was World Malaria Day. According to the WHO, world malaria deaths have fallen 20% from 2000 to 2009.

The Global Health Hub has developed a really nifty global health timeline. It is interactive and open – meaning it can be edited by anyone.

POLICY

RESEARCH

  • Scientists have isolated the tuberculosis enzyme that destroys lung tissue, MMP-1. The discovery could speed up the search for treatments, as current regimens do not prevent the lung damage caused by TB infection.
  • Results from a recent study indicate that advances in antiretroviral therapy over the last 15 years have considerably improved outcomes for children with HIV who are entering adolescence and young adulthood.

DISEASES AND DISASTERS

  • Aging populations on Japan’s northeast coast are struggling to recover from last month’s devastating earthquake and tsunami, and health officials are concerned about increased incidence of pneumonia, influenza, respiratory illenss, and blood clots in the legs of older individuals.
  • The first WHO Global Status Report on Non-communicable Diseases found that these diseases are the leading cause of death worldwide.

Global Health News Last Week

POLICY

  • Assistant Senate Majority Leader Richard Durbin (D-IL) and Senator Bob Corker (R-TN) introduced the Water for the World Act of 2011, a bill in the Senate which will make providing safe and clean drinking water around the world a priority for US foreign aid.
  • More than 60 world nutrition experts met at WHO headquarters last week to revise guidelines and to identify solutions to tackle the growing problems of both malnutrition and obesity around the world.
  • Ministers of health and other high-level health officials from throughout the Americas called for a series of actions to reduce the toll of chronic noncommunicable diseases, in a declaration issued last week in Mexico City.
  • The Global Fund announced that former President of Botswana Festus Mogae and former U.S. Health and Human Services Secretary Michael O. Leavitt have agreed to lead a high-level panel of experts that will conduct an independent and thorough review of the Global Fund’s financial safeguards.
  • UN agencies are concerned that reduced donor funding due to the recession, combined with free trade agreements, will reduce the availability of low-cost HIV medications in developing countries.
  • The United Nations General Assembly will convene a high-level meeting in September this year to discuss the financial burden caused by non-communicable diseases (NCD) on countries.

RESEARCH

  • A study done is Malawi by the World Bank attracted attention (and criticism) from Businessweek. Young women were given to stay in school and deter them from accepting money and gifts from “sugar daddies” in exchange for sex. The study found that HIV infection rates were 60% among schoolgirls who received cash compared to those who received nothing.
  • A recent review of malaria treatment clinical trial results, published in the Chochrane Library, shows that artesunate was more effective that quinine at treating severe malaria.
  • A personalized text messaging reminder service significantly boosted antiretroviral (ARV) adherence over a six-week period compared with a standard beeper reminder system, according to a study published in the March issue of AIDS Patient Care and STDs.
  • About 600 people gathered at the Global Health Metrics and Evaluation conference in Seattle to discuss issues surrounding the evaluation of effectiveness of health programs.

PROGRAMS

  • Global health blogger Alanna Shaikh discusses how micro-credit and the Green Revolution, two of international development’s biggest successes, are being re-evaluated.
  • The Nepalese government is planning launch a large vaccination campaign against elephantiasis in 40 high-risk districts.
  • Dubai’s Ministry of Health introduced Pneumococcal Conjugate Vaccine PCV13, a vaccine that protects young children from the worst effects of illnesses including pneumonia, blood infections and meningitis.
  • The National Influenza Center of the Chinese Center for Disease Control and Prevention has been designated as a World Health Organization Collaborating Centre for Reference and Research on Influenza, making China the first developing country to house such an institution.

DISEASES AND DISASTERS

  • Europe is concerned by the growing incidence of drug-resistant TB, particularly in children.
  • The world continues to follow the aftermath of the earthquake and tsunami in Japan, including the unfolding situation at the Fukushima Dai-ichi nuclear power plant. The WHO has assured that there is no danger to individuals being exposed to radiation in nearby nations (e.g. China).
  • As if Haiti needed any more bad news, a study published in the Lancet says that the UN estimate of 400,000 cholera cases in Haiti this year is nearly half of what the real projection should be for the recovering nation. Meanwhile, health officials in Lagos have called on residents to observe high standards of personal and environmental hygiene and have designated emergency numbers to call in case of suspected cases; the Ghana Health Service has set up cholera centers in Accra to deal with the outbreak there; and the interim federal government of Somalia on Tuesday denied reports of an outbreak of cholera in the country, responding to an Associated Press story over the weekend that Somali doctors had reported that more than 20 people had died from the disease.
  • In the February 2011 issue of PLoS Neglected Tropical Disease Journal, contributing editor Serap Aksoy discussed the triumphs behind the control of human African trypanosomiasis, or African Sleeping Sickness.
  • Although women get diagnosed for tuberculosis (TB) later than men, treatment outcomes among women are better than men with higher TB treatment success rate and lower default (drop-out) rate in the female patients. The finding was announced at a meeting on TB and women in New Delhi, India.
  • While the total number of newly reported HIV positive people and AIDS patients are still low in Japan compared with other countries, the number of newly HIV-infected people in Japan has doubled in the past decade due to public complacency and lower awareness.

Drug Wars: What does a free trade agreement between India and the EU mean for generics?

When I was a junior in college, I had to give a presentation for my honors Molecular Genetics class. The hot topics that year were avian influenza and HIV. I had just been accepted into the School of Rural Public Health’s MPH program, so I decided to get in the HIV-line, but with a twist: rather than present a paper on the mechanism of infection or a mutant viral protein, I would pull the lens back and look at the disease from a public health standpoint. It was an eye-opener for a lot of my classmates, most of whom were biochemistry majors whose only exposure to HIV had been through pictures of Western blots in peer-reviewed journal articles. Some of the strongest reactions were to cost of care, especially drug prices: when I cited several drugs that entered the market at $25 (darunavir), $29 (tipranavir), or even $61 (efuvirtide) for one day’s dose in the U.S., eyes widened and jaws dropped across the room.

A round white pill.
Flickr, doug88888

The war on drug prices is a long-standing, bitter battle between the pharmaceutical industry and humanitarian groups and lobbyists, with governments and regulators perpetually caught in the middle. International health and humanitarian organizations argue that access to inexpensive medicines is vital to the survival of the poor who need them, and that Big Pharma is driven by greed and cares only for its profit margins. Pharmaceutical companies counter that intellectual property protection and patents encourage innovation and the development of newer and better drugs. The solution to this dilemma in developing countries, including India and many African nations, has been generics. India’s patent laws make it easy for regulators to deny drug patent applications, allowing Indian pharmaceutical companies to use the data from clinical trials already performed to get approval to produce cheap generic versions of patented medications. India is the world’s leading producer of inexpensive generic drugs – its pharmaceutical industry makes most of its money by producing generic versions of drugs patented by Western companies – which has earned its reputation as “the pharmacy of the developing world.” India supplies 80% of the medicines distributed by medical humanitarian organizations in poor countries; in particular, 93% of ARVs going to HIV patients in these countries are Indian-made.

The EU is currently negotiating a free-trade deal that may change all of this: in addition to agricultural tariffs and work visa agreements, Europe is trying to negotiate a period of exclusive access to pharmaceutical companies’ research and clinical trial data. No specific amount of time has been finalized, but without information from the clinical trials already conducted, generics manufacturers would have to conduct their own testing to register their products. Opponents of this provision fear that this will drive up the cost of generic medicines and make them unaffordable for the poor. Médicins sans Frontières (Doctors without Borders) has launched their “Europe! HANDS OFF our Medicine” campaign specifically against this component of the agreement. The WHO and the UN’s special rapporteur on the Right to Health Anand Grover are also concerned, and the Indian generic pharmaceutical industry is predicting a global health crisis if the trade agreements lead to production restrictions. The European Commission insists that the negotiations will not negatively impact India’s generics industry, but worries will persist until a draft of the agreement is released.

The ever-continuing debate underscores the need to find a balance between encouraging economic growth and innovation, and ensuring affordable access to medicines for those who need them. Though the start-to-finish cost of producing drugs can admittedly cost billions of dollars, the question of whether it justifies such high new value benchmarks has not yet been settled. The fact that so many millions wait in line for these drugs begs this ever-persistent question: what is the point of charging so much for drugs that so many need if so few can afford them?

Whoonga: South Africa’s New Crack

Question: What costs $3, contains AIDS medication and rat poison, and is smoked with marijuana?
Answer: One day’s dose of whoonga, South Africa’s latest, and most tragic, drug craze.

The word “whoonga” is more of an exclamation than an actual name. Invented in Durban, South Africa, this cream-colored powder is hustled by drug dealers who charge 20 rand ($3) for one day’s dose. This mixture of detergent, rat poison, and antiretrovirals (ARVs) is initially taken up as just another addition to a cheap array of recreational drugs for the unskilled and unemployed. For some, it helps them relax or get to sleep; for others, it makes them feel like the “the best person ever.” But this pleasant high soon turns nasty. The drug is extremely addictive, and users report cravings and withdrawal symptoms after the very first hit ranging from stomach cramps and night sweats to depressed heart and lung function. Addicts need several hits to make it through the day. What begins as a way to pass the time becomes an all-consuming habit that drives people to steal, commit crimes, or worse – steal or sell HIV medications.

South Africa has the highest HIV burden of any country in the world. As it finally begins to make meaningful progress against the disease, whoonga could not have come at a worse time. The South African government provides free ARVs to AIDS patients who qualify for economic assistance, and this has now become an unfortunate source of drug supply. Corrupt health workers and clinic staff are selling ARV medications on the whoonga market. AIDS patients have been robbed as they leave clinics with their pills. In some cases, they are selling their own medications to whoonga dealers. And now reports are emerging of desperate addicts intentionally trying to get infected when they can no longer support their habits through petty crime. The cruel irony of it all is that there is no evidence that the HIV medications actually do anything to create or enhance the high.

South African officials are aware of the problem, and so far, the drug has not spread outside of KwaZulu-Natal. However, the implications of the drug’s spread are frightening. What makes whoonga particularly insidious and difficult to combat is lack of information: many experiment with it without realizing what they are getting themselves into. One small organization, Project Whoonga, is confronting it head-on. Run by Vumani Gwala, this community-based support group is based in Kwadebeka, a large township outside of Durban, and has 45 addicts in recovery. While admirable, the organization needs all the help it can get in taking on this tragic menace. “This drug has turned our beloved township into a jungle,” laments Gwala. “Families with addicts live in constant fear of vigilantes that threaten to get rid of this crime using violence and families have gotten their homes burned down.”