United Nations High-Level Meeting on Tuberculosis: Importance of drug quality

At the end of next month, the inaugural United Nations (UN) High-Level meeting on Tuberculosis (TB) will take place in New York to discuss the future of the bout against the devastating yet elusive disease. As TB remains the largest infectious disease torturer in today’s society taking the lives of 4500 humans each day, the theme of this occurrence is “United to end Tuberculosis: an urgent global response to a global panic”. This unparalleled step undertaken by governments throughout the world along with those allies engaged in ending Tuberculosis will address an assortment of issues at this meeting. Although the exact agenda has yet to be revealed, the resolution to host this single day meeting mentioned the following items could be discussed:

  • Adequate funding for novel diagnostic testing, medications, and vaccinations
  • Multi-Drug Resistant Tuberculosis (MDR-TB)
  • Responsibility for multisectoral collaboration within nation states, regions, and the globe
  • Universal health care coverage and ensuring tuberculosis coverage is included

Each of these items – ranging from the use of prophylactic low dose isoniazid therapy to equal distribution of the recently designed TB diagnostic test Xpert MTB/RIF – are crucial in accomplishing the END TB strategy laid out by the World Health Organization. However, after looking over these action items for the meeting, Tuberculosis drug quality seems to absent.

As health care professionals across the globe continue to treat TB on a patient specific basis, certain untreated cases occur that puzzle even those who have treated the disease for years. The reasoning behind treatment failure? Adherence to medication or drug resistance are often the first assumed thoughts those sharing their patient’s fate may have. Yet, the actual medicine with its various active and inactive ingredients is often not called into question.

Towards the end of last year, the World Health Organization released an alarming figure concerning drug quality in low to middle income countries. In the report released to the public, WHO stated that approximately 10% of medications are counterfeit in these areas of the world – which happen to be the areas where Tuberculosis and other infectious diseases take their largest toll. In addition, WHO added that this percentage is most likely only a small part of the number of humans truly affected by counterfeit medications. To provide clarification, WHO considers counterfeit medications to be unapproved by regulators, unable to meet quality standards, or purposefully misrepresented active or inactive ingredients in the medication. In addition to this report by WHO, the National Institutes of Health (NIH) published a report outlining in 2015 that 9% to 41% of anti-tuberculosis and other infectious disease medications failed to meet the standards sought in specific studies.

It is vital for the global health community to obtain an effective vaccine to prevent pulmonary tuberculosis, to have a rapid yet specific TB diagnostic test, to create a strategy for various sectors of a nation state to work together in ending TB, and novel agents to treat the most severe cases of MDR-TB. Individuals in rural Kampot, Cambodia, inmates in the Russian prison system, or those residing in the slums of Bangalore, India often can be restored to health through the means that have been available for the last half a century. The RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) regime has proven its success in treating non-resistant tuberculosis – so long as each of the medications are of appropriate quality. However, The Lancet released a report in January 2017 that found that 8.9% of Indian rifampicin products were of inadequate quality in a country that is burdened with the highest prevalence of tuberculosis across the globe. Moreover, WHO revealed that 28.3% of rifampicin containing medications found in the Russian Federation in 2011 failed to meet predetermined specifications for proper quality – a country known to have one of the highest MDR-TB burdens in the world. With the aforementioned statistics released by the WHO, The Lancet, and NIH, a renewed emphasis needs to be placed on ensuring the quality of each and every tuberculosis medication that reaches a human being. The possibility of one in ten (or more) TB medications being counterfeit will continue to lead to failed treatment regimes, inappropriate use of resources, and spread of MDR-TB even if innovative technology is developed.

In order to combat counterfeit medications on a global level, the World Health Organization developed a reporting system for the interconnectedness of the medication market. The Global Surveillance and Reporting System (GSRS), that all WHO members are eligible to contribute to, aims at collecting data on falsified medications, vaccines and other medical equipment to address real-time situations and prevent further harm. With this reporting arrangement in place, the WHO has reacted and thwarted mortality and morbidity associated with counterfeit medications – including the contaminated cough medication supply that led to 60 deaths in Pakistan and a number of individuals treated with an antidote in Paraguay in 2013. On top of the GSRS, WHO has implemented Good Manufacturing Practices (GMP) that each manufacturer should achieve in order to be certified by WHO; thus, providing a reliable source of medications that nation states can purchase from. Although these initiatives have brought about encouraging results along with halting global medication emergencies, there are still barriers that accompany these programs. The technical training, technology, and adequate staffing to properly identify and report through the GSRS is often difficult to obtain in the developing world while GMPs are often misapplied and have inadequate supervision. The root cause is the long-term development of countries’ public health systems – of which continuing problems with counterfeit medications remains deficiently addressed. A county’s public health care system is the vital organ to ensuring quality medications through these mechanisms that WHO has created and employed. An underutilized and under resourced public health care system leads a budding yet unregulated private market – unable to ensure proper treatment for those seeking it.

Since the United Nations declared this a high-level meeting, meaning all heads of member states are encouraged to participate in the highest level possible, this venue provides the ideal opportunity to recommit to guaranteeing TB drug quality. The sustained empowerment of the public health care systems for those countries tirelessly battling tuberculosis will be a step forward into truly ending this devastating disease. Each health care professional spanning the globe has a responsibility to accompany these governments, colleagues, and fellow humans by investing their time, resources, and talents to develop procedures and systems to ensure effective drug quality.

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Global Health Weekly News Round-Up

Politics and Policies:

  • Swaziland has launched a new national framework to eliminate new HIV infections among children by 2015 and keep their mothers alive.
  • According to a report Pakistani politicians have pledged for health and education of their people.
  • A Texas Senate bill would revise the state’s end-of-life procedure.
  • Bloomberg’s campaign might close off the remaining means of access to cheap cigarettes and little cigars which make it easier for teenagers to experiment with smoking and progress to smoking regularly.

Programs:

  • World Bank has approved a concessionary loan of US $200 million to Sri Lanka to further enhance the quality of the health sector service.
  • §  Britain is going to launch a £179 million five-year healthcare program in the Democratic Republic of Congo which aims to reach about six million people.
  • The Food and Drug Administration (FDA) is planning to clamp down on the sale of non-iodized salt.
  • UNICEF has increased its support from four to ten districts in the Upper East region in Ghana to implement a 5 year child survival program known as the Essential Newborn Care (ENC).
  • A regional health agency has been launched in Kigali, Rwanda, East Africa aiming to facilitate and improve regional health sectors.
  • US AIDS agencies have begun their five-year effort with Malawi’s government to improve health care services for HIV/AIDS virus infected people.
  • Irish aids program helping African people suffering from HIV/ AIDS.
  • Niger’s first lady commits to stopping new HIV infections in children.

Research:

  • According to a study done by the scientists at Queen’s University, the risk of getting head and neck cancer can be reduced by 22% by taking a weekly or even monthly dose of over-the counter aspirin.
  • A study shows that climate change can worsen the public health threat of diarrheal disease in Botswana.
  • According to a global health study HIV/ AIDS and tuberculosis are two top killers among the people of Russia.
  • A study on a disease- konzo- indicate that its physical effects on body is accompanied by impairment of children’s memory, problem solving capability and their cognitive functions.
  • Scientists in United Kingdom have been successful in making a vaccine for foot-and-mouth disease. Since it is not made from live virus, its production will require no special containment.
  • United Nations analyst says that Tanzania might achieve millennium goal on maternal health.
  • Kenya Aids Research Coordinating Mechanism chairperson has called for teamwork in HIV/Aids research.
  • According to a study early detection of bowl cancer can help to prevent cancer. They say that those who participated in the screening program were the people who were the most easiest to treat.
  • A study says that a ‘new diagnostic test may be safe and easy screening method that could improve the prognosis of patients with pancreatic cancer through early detection’.
  • Study shows that obesity makes a person to exercise less.
  • According to a study elderly people who have many social interactions may live longer than those who are more socially isolated.
  • According to a NIH study pregnant women who experienced financial, emotional or other personal stress in the year before their delivery had an increased chance of having stillbirth.
  • A study by U.S. Centers for Disease Control and Prevention many mothers in U.S. start infants on solid foods earlier than experts recommend.
  • A study done by the scientists at Boston School of Public Health finds a link between childhood abuse and fibroids.
  • Researchers at Boston University School of Medicine say that improving levels of vitamin D in the blood via supplementation could help to fight disease by affecting gene expression and boosting the immune system.
  • Italian scientists say that people who suffer from migraines are more likely to have brain abnormalities at birth and some develop them over the course of time.

Diseases and Disasters:

  • According to the reports about two people have died due to infection of a new strain of Avian flu in China.
  • UNICEF warns that 2 million children in Central African Republic are without basic supplies.
  • United Nations has been forced to delay desperately-needed food-aid to nearly 300,000 people in Guinea Bissau as it has so far received no donations to support its operation.
  • According to the United Nations reports about 240,000 Pakistani children have missed their UN sponsored polio vaccinations due to the security concerns in the country’s tribal regions.
  • According to the reports, skin lightening is popular among the females in Senegal despite of health concerns over the product.
  • Reports show that the public health centers in Tanzania do not have enough medicine and hospital supplies.
  • Clusters of vancomycin resistant enterococci cases in Kowloon Central Cluster (KCC), in Queen Elizabeth Hospital, Hong Kong have been reported.
  •  Visitors urged to stay away from Beaumount Hospital Dublin due to flu outbreak, according to the reports.
  • The health officials of Australia have become alarmed after the report of first death from XDR-TB- drug resistant tuberculosis.
  • According to the reports, more than 7,000 people might have been exposed to HIV and or hepatitis in Oklahoma dentist’s office.

 

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • Egypt will carry out vaccination campaign in parts of Cairo after polio virus was found in sewer.
  • The United Kingdom’s Advisory Council on the Misuse of Drugs (ACMD) has rejected calls to ban the herbal stimulant, khat.
  • Minister of Finance of Kyrgystan has announced a Russian grant of $25 million to be directed to health and education in Kyrgyzstan.

Programs:

  • To support veteran’s mental health in Kent and Medway, National Health Service (NHS) invests £150,000.
  • The National Institutes of Health (NIH) is in a process of stopping its researches involving the chimpanzees.
  • UNESCO has released a booklet that promotes improved links between gender, HIV and education.
  • The First lady opened Sh6 Billion health center– the AIDS Healthcare Foundation (AHF) in Lukaya, Uganda.
  • Two projects in the health and education fields have been funded by British Gas Tunisia. It will provide health services to 20 thousand locals.
  • A HIV gender assessment tool has been designed by the United Nations Program on HIV/AIDS (UNAIDS) to assess the cause of women vulnerability to contracting HIV.
  • About N$67,720 donation has been received by the Cancer Association of Nambia (CAN) from Quality Tyres Nambia. This money will be used for the prostate cancer treatment of the people.
  • The United Nations Children’s Education Fund (UNICEF) has called on the international community to contribute nearly $1.4 billion to address to the urgent needs of the children in 45 countries including a need to strengthen the capacity of partners in the field of health and nutrition.
  • The UNICEF, EU and Uzbekistan are together implementing a project to protect health of mother and child.
  • The United States Agency for International Development (USAID) and Batey Relief Alliance have together launched a food assistance program for people living in extreme poverty in the Dominican Republic.

Research:

  • New researches on bird flu is about to begin.
  • According to a study published in the British Health Journal, women’s views on over diagnosis in breast cancer screening vary. The highest estimates made some women (50%) perceive need for more careful personal decision making about screening. While lower and intermediate estimates had limited impact on attitudes and intentions related to screening.
  • According to a study published in PLoS ONE, scientists in Benin have developed a new technique to detect malaria parasites in mosquito vectors. It could help to estimate malaria transmission intensity in different settings.
  • According to a study published in the Lancet folic acid supplements are unlikely to substantially increase or decrease overall cancer risk.
  • The monitoring data by the Food Security and Nutrition Analysis Unit (FSNAU) published by the UN Office for Coordination of Humanitarian Affairs (OCHA) suggest that number of people facing food insecurity will reduce.
  • According to a meta-analysis published in British Medical Journal, there is no link between consumption of eggs and increased risk of heart disease or stroke.
  • A recently published international study states that the children were most hit by 2009 bird flu. About 47% of those aged between five to 19 developed symptoms as compared to only 11% of people aged 65 or older.
  • A study published in New England Journal of Medicine states that female smokers were 25.7 times more likely to die from lung cancer than those who never smoked.
  • According to a study published in the journal Nutrition Research , a natural extract from the roots of Japanese mushrooms can boost the effectiveness of the flu shot.
  • Micro blogging site Twitter has been used by the researchers and computer scientists of the John Hopkins University to track the cases of influenza across the United States. This system was tested by the researchers at the Baltimore University by comparing these results with the data obtained from the Centers of Disease Control and Prevention (CDC).
  • After five years of studying the workings of the mutant form of the p53 gene, scientists from the National Cancer Center Singapore (NCCS) have discovered the workings of this gene that has been hindering treatment response in cancer patients.
  • According to a study published in Annals of the Rheumatic Diseases people who take immunosuppressive drugs to treat lupus do not necessary increase their cancer risk.
  • A study published in Nutrition Journal, a mixture of B vitamins, fish oils and plant sterols show a promise in boosting heart health by improving the lipid profile of young people with high cholesterol.

Diseases & Disasters:

  • A wave of spiritual human killings has been reported in Camroon.
  • Chinese mine pumps chrome (poisonous chemical) into Ngezi river in Zimbabwe.
  • The United States Department of Agriculture (USDA) has announced a recalled ready-to-eat port product by Houston’s Stallings Head Cheese Co. Inc.
  • Global Virus Network has released a statement on 2012-2013 U.S. Flu epidemic.
  • The World Health Organization said in a joint statement with the Cambodian health ministry that two Cambodians have died from bird flu contracted while preparing infected chicken.
  • According to U.S. health officials a new strain of stomach virus outbreaks has occurred in this flu season.
  • The European Center for Disease Prevention and Control in Brussels has reported an increasing trend of influenza transmission.
  • The Medical Products Agency of Sweden (MPA) opened an inquiry into vaccinations for H1N1 (Pandemrix) made by GlaxoSmithKline, suspected for provoking narcolepsy.
  • The Michigan departments of Community Health and Agriculture and Rural Development are investigating the causes of Salmonella outbreak.
  • Health authorities in the Brazilian city of Campo Grande are fighting a dengue fever epidemic.
  • French authorities fear drug-resistant tuberculosis from Eastern Europe.

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • Burundi is introducing the second dose of measles vaccine in its vaccination campaign in order to strengthen its efforts to fight preventable diseases.
  • China has stated that it will assist Cameroon in its fight against malaria as well as to strengthen health policies.
  • Angola parliament approves main lines of 2013 budget bill. A third of it will be spent on education, health, social welfare and housing.
  • African government’s will implement a health scorecard to reduce child deaths. This monitoring system publicly collects and reports health data.
  • Ghana is planning to establish its Health Insurance Learning Center to provide expertise and training on health insurance to many countries and institutions across the world.
  • China plans emergency measures to control Beijing air pollution. The rules will formalize previous ad-hoc measures including shutting down factories, cutting back on burning coal and taking certain vehicle classes off the roads on days when pollution hits unacceptable levels.
  • Negotiations on the Minamata Convention on Mercury (in Switzerland) among the delegates of 140 United Nations member states state that mercury added products like batteries, switches, thermometers etc. may not be manufactured, imported or exported no later than 2020. Mercury-added dental amalgams are also to be phased out. But certain mercury-added products are to be exempted from ban- like products for military and civil protection, products used in religious practices and some vaccines (with thimerosal) etc.
  • The Food and Drug Administration (FDA) has approved a new type of flu vaccine which is made with a process that does not require the virus to be grown in chicken eggs. This will make it available weeks earlier in the event of a pandemic.

Programs:

  • In order to prevent, strengthen, and mobilize the society on HIV/AIDS risks, a project “Proactive” was presented in Angola by the Population Services International (PSI). It will target prostitutes, lorry drivers and gays.
  • In collaboration with UNAIDS, Tango organized a two-day workshop on combating stigma and discrimination in HIV/AIDS for Civil Society Organizations.
  • To provide treatment to the needy heart patients mainly children and elderly, the Emirates Heart Group has launched humanitarian missions in Sudan, Egypt and Bosnia.
  • Guinea worm eradication program is coming to its completion. The reports show that the cases of the parasitic disease were reduced by nearly half in 2012.
  • For increasing awareness on road traffic safety the Riders for Health-the Gambia (RFH) and the British High Commission have established a Training-cum Resource Center in Gambia.

Research:

  • According to a study done by the researchers of UK, US and Germany, eating with seven servings a day is linked to peak mental well-being.
  • A study states that the HIV infection rate has declined among the pregnant females in the Republic of Congo from 3.4 percent in 2009 to 2.8 percent in 2012.
  • According to the World Health Organization, the cases of measles have fallen by 75 percent since 2000 but the rate of vaccination is still quite low to progress towards its complete eradication.
  • A study states that the HIV infection rate has declined among the pregnant females in the Republic of Congo from 3.4 percent in 2009 to 2.8 percent in 2012.
  • A report states that the Somali women living in Minnesota for 20 years or more have their cultural traditions about pregnancy and birth. They continue to resist cesarean sections, prenatal care and family planning.
  • A study published in PloS One states that South Africa pays a high cost to treat both drug-resistant and drug-sensitive tuberculosis. It states that drug resistant tuberculosis in South Africa consumed about 32% of the total estimated 2011 national TB budget of $218 million.
  • A simple radiographic scoring system has been suggested as it is found to reliably rule out active pulmonary tuberculosis in smear negative HIV – uninfected patients. It will potentially reduce the need for further testing in high burden settings.
  • A study published in the New England Journal of Medicine states that a 48-week course of antiretroviral medication taken in early stages of HIV infection slows the damage to immune system and delays the need for long term treatment.
  • According to a study bats are reservoirs for Ebola virus in Bangladesh.
  • Studies have shown that the cactus fruit could treat diabetes, help to lower cholesterol and have high levels of vitamin C.
  • A study published in Plos One states that majority of the high risk population in a setting in rural China have been diagnosed with a Cardiovascular Disease related disease. Majority of them did not take any cardiovascular disease drugs and very few of them took some drugs to prevent the diseases.
  • A study done in University of Gothenburg, Sweden, states that amputations among people with diabetes can be reduced by 50%. They stated that simple interventions like shoe inserts, podiatry, regular check-ups and other simple interventions can help to reduce it.
  • A new infection caused by ticks similar to Lyme disease has been found in 18 people in southern New England and upstate New York. According to the study published in the New England Journal of Medicine, this sickness could be infecting more than 4,300 Americans a year with flu-like symptoms and relapsing fevers.
  • According to a study vitamin D3 supplements are as effective as influenza vaccine. The study published in the American Journal of Clinical Nutrition states that those school children who took vitamin D3 supplements were 64 % less likely to contract seasonal influenza A viral infection.

Diseases and Disasters:

  • A recently introduced five-in-one vaccine against diphtheria, pneumonia, tetanus, hepatitis B and Hib meningitis have raised health concerns among the doctors in India.
  • The Public Health Laboratory Services Branch (PHLSB) of the Center for Health Protection (CHP) of the Department of Health Hong Kong, has confirmed a case of New Delhi metallo-β – lacatamase-1 (NDM-1) Carbapenemase-producing Enterobacteriaceae in a 26 year old female.
  • The Department of Health (Hong Kong) has released a warning on a oral product named ‘Chashoot’. They say that it may contain undeclared Western drug ingredients that are dangerous to health.

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • Medical Insurance bill has been passed by the lawmakers in Rwanda on Friday.
  • Chinese government has signed U.S. $35 million loan agreement with Rwanda which includes the projects for the improvement of health of people.
  • According to the Food and Health Bureau in Hong Kong, the country will not accept any bookings by pregnant non-local women for delivery in Hong Kong starting January1, 2013.
  • Sindh government (Pakistan) has ordered mandatory vaccination of children against measles virus.
  • In order to boost anti-AIDS program and prolong lives Brazil will track the numbers of HIV cases in the country.
  • New air pollution standards for industrial boilers have been issued by the Environmental Protection Agency (EPA).
  • Alabama (U.S.) to end isolation of inmates with H.I.V.

Programs:

  • The Bill & Melinda Gates Foundation is giving $5 million to the Johns Hopkins Bloomberg School of Public Health to promote use of oral cholera vaccine worldwide.
  • The World Health Organization (WHO) in collaboration with International Telecommunications union (ITU) has launched “mHeath” initiative to fight diseases in Africa.
  • $40mn health care city project by the UAE based Tasweek Real Estate Marketing and Development is estimated to be completed in 2 years and will be the largest health and tourist project in Morocco.
  • World Vision Rwanda has launched its global advocacy campaign “Child Health Now Campaign” aimed at reducing the preventable deaths of children who are under five years of age.
  • The World Health Organization (The WHO) offers review of key global public health issues- says the key public health milestones were reached in 2012.
  • Johnson & Johnson (JNJ)’s tablet Sirturo wins FDA approval to treat drug – resistant tuberculosis.
  • A free-to-play mobile game available on the App Store for iPhone, iPad and iPod touch (THRED) has been launched by Coca-Cola Company with (RED) to raise the awareness and funds for the fight to end mother-to-child transmission of HIV by 2015.

Research:

  • A study done in Britain revealed that the female students consume alcohol more than males.
  • A study done by the International Union against Tuberculosis and Lung Disease (The Union) states that to beat AIDS related deaths it is important to improve Tb-HIV collaborative services.
  • A study done by the United Nations (The UN) states that the Philippines has failed to curb the spread of HIV virus. It has reported a 25% increase in the incidence rate of this deadly infection among the adult’s ages 15-49 years from 2001- 2011.
  • A report released by the WHO states that infant mortality rate is high in Uganda. More than 7 million children below the age of five years died in 2011 alone.
  • Researchers from Australia and Britain have found a link between milk producing protein and aggressive breast cancer in females.
  • According to a recent study sleep apnea is as detrimental to heart health as diabetes. The researchers found that snoring could be a warning sign for OSA or even a sign that serious heart problems could be developing.
  • Dutch scientists state that junk food and genes can deliver colon cancer.
  • According to a journal Nature Genetics three uncommon genetic variants influence the production of insulin.
  • Scientists have sequenced the genome of a fungus called Pneumocystis jirovecii , laying the groundwork for new ways to treat a strain of pneumonia.
  • A study published in European Journal of Preventive Cardiology state that the lifestyle parameters are linked to cardiovascular disease.
  • A study published in Diabetes Care stated that women who experienced early menopause have a greater risk of type 2 diabetes.
  • A study reported in British Medically Journal suggests that gluten free diet helps to fight type 1 diabetes mellitus.

Diseases and Disasters:

  • According to the experts the outbreak of yellow fever in Sudan is among the worst faced by it in the past twenty years.
  • Shortage of typhoid vaccine in UK has led the doctors to warn travelers to developing countries in areas with poor sanitation.
  • The Center for Food Safety (CFS) of the Food and Environmental Hygiene Department Hong Kong has called on parents to refrain from feeding their babies with an infant formula imported from Japan.
  • According to the Palestinian health official outbreak of swine flu has killed nine people in the country.
  • Japan suspects norovirus outbreak in Yokohama hospital in southern Tokyo. The authorities say that the infection has killed four elderly people.
  • According to the Pakistani authorities, 33 people have been suspected to die due to consumption of a cough syrup.
  • The U.S. State Department has issued a revised travel advisory on the French-speaking Caribbean Community (CARICOM) country- Haiti about violent crime, infectious disease and poor medical facilities in Haiti.