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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Review: “EXPOSED” Film Series by Aeras

EXPOSED: The Race Against Tuberculosis (video review)

This post was written together with Niniola Soleye.

EXPOSED: The Race Against Tuberculosis is a series of four short films (about ten minutes each) about the global epidemic of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). The series was produced by Aeras, a biotech company working toward a tuberculosis vaccine. It features personal stories from patients, as well as commentary from physicians, researchers, policymakers, and experts around the world.

The global health community has seen TB morph from a death sentence to a treatable disease with antibiotics to an increasingly drug-resistant (and persistent) monster – thus completing the cycle and essentially bringing it back to a death sentence in the case of XDR-TB. Even more terrifying is the emergence of totally drug-resistant TB (that’s TDR-TB) in Iran, India, and Western Europe.

From testing and treatment costs to lost wages and productivity costs, TB, especially DR-TB, is also a very expensive disease. The first video, which features a woman from Tennessee, really drives the point home. She went on a short mission trip with her church to South Africa, where she contracted a strain of TB that was resistant to seven drugs, and wound up in isolation for two years. The total treatment course cost the health department over $1 million – a case in point of how the uninformed desire to “do something” can do more harm than good.

The purpose of the video series, in addition to raising awareness about drug-resistant tuberculosis, is to build support for Aeras’s mission to develop a TB vaccine. Currently, there is no effective vaccine against the most infectious form of tuberculosis, pulmonary TB. The BCG vaccine which was developed 90 years ago does not prevent the majority of TB cases. While the movies play to the emotional side to a certain extent, and I wasn’t crazy about the fact that they opened the series with a profile of a Westerner who “just wanted to help,” I felt that the series did an overall good job of giving voice to individuals in the developing world who are most immediately affected by the disease – both a survivor of treatment and a woman who is volunteering in a clinical trial for a vaccine candidate.

You can watch the films here.

IH News Global Health Weekly News Round-Up

  • May 31 was observed as World anti-tobacco day by the World Health Organization.
  • The Fitness Industry Council Canada has announced June 1 as National Health and Fitness Day.

Politics and Policies:

  • The Republic of Congo has passed a law that prohibits the purchase, consumption and possession of tobacco for minors, pregnant women and mentally ill. The advising and any kind of promotion of tobacco are also prohibited in the country. Smoking is prohibited in public places.
  • According to the World Health Organization On June 10th Ethiopia is launching an emergency mass-vaccination campaign against yellow fever.
  • According to the Ghana’s Minister of Health, the country is committed to ban all forms of tobacco advertisements and promotions.
  • Smoking in presence of children equaled to physical violence in Latvia.
  • Russia’s smoking ban came into effect on Saturday. It involves no smoking in public places and curbing cigarette advertising and sales.

Programs:

  • The World Health Organization (WHO) in Gambia is launching polio campaign to vaccinate 400,000 children under five years.
  • The Ministry of Finance of Lesotho has signed two agreements totaling $17 million with the Global Fund to fight against HIV/AIDS, tuberculosis and malaria.
  • Professionals for Humanity International (PROFOH) have announced its third free medical screening in this year in Nigeria.
  • After the discovery of polio this week, United Nations emergency team rushes to vaccinate 424,000 people living in a refugee camp in Kenya.
  • Zimbabwe is going to conduct its first national tuberculosis prevalence survey with an objective to determine the national prevalence of bacteriologically-confirmed pulmonary TB among people aged 15 and over.
  • Rotary India extends its help to Pakistan in its polio vaccination drive.
  • The World Health Organization is calling on the countries to ban advertising about the tobacco products.

 Research:

  • Improvement of maternal health and reduction in child mortality in some countries was highlighted in a recently released report ‘Accountability for Maternal, newborn and Child Survival ‘.
  • According to the director of the National Institute of Combat of HIV (INLS), the prevalence of HIV in Angola has not changed since 1997.
  • According to the researchers patients who have developed oral cancer due to HPV can have sex with their spouses or long term partners.
  • According to a study done by the researchers at the Institute for Clinical Evaluative Sciences, rates of diabetes have jumped 15 fold within a decade for the Chinese Canadians.
  • A systemic review confirms that the licensed medicines for smoking cessation are successful in assisting people to quit smoking.
  • Scientists are using new optics-based single virus detecting methods for determining the exact viral load of a sample by counting individual virus sample.
  • New malaria vaccine developed by the team Japanese researchers has cut the infection rates by 72%.
  • A study conducted in over 13 hospitals in Indonesia, Singapore, Thailand and Vietnam shows that doubling Tamiflu vaccine dose does not help in severe flu.
  • Results of a study warn development of resistance to drug used in treatment of H7N9 virus.
  • A group of scientists discover how a single gene mutation helps brain cancer cells to survive and drive tumor growth.
  • According to the United Nations scientists, Fukushima No.1 nuclear plant has very low radiation doses and there is no increased risk of cancer on local residents.
  • According to the experts nearly one-sixth of young adults in Sri Lanka are overweight. Lack of nutrition education and food culture of the country are reasons for this problem.
  • A study states that particular combination of bacteria in the human digestive system can identify patients who have or are likely to develop Type 2 diabetes.
  • A study shows that the Coenzyme Q10 cuts the mortality rate by half in heart failure patients.
  • Report released by EU says that several new health risks are emerging from new chemicals, products and changing lifestyle patterns. It is important to address these issues all together.
  • According to a study fizzy drinks do harm to the teeth as drugs.
  • New vaccine for lung cancer has been developed by the scientists of Argentina and Cuba. It activates the body’s immune system to promote its destruction.

Diseases & Disasters:

  • Tornadoes hit Oklahoma again on 1st June. Death toll rises to 9.
  • A report issued by the Chinese Ministry of Land and Resources state that the ground water of China is poisoned. It did not address the severity and scope of this problem.
  • Death toll from bird flu has risen to 38 in China.
  • According to the reports of the United Nations, there is a suspected outbreak of Ebola fever in the north of the Democratic Republic of Congo.
  • According to the reports by Ghana Health Service, cholera outbreak hits greater Accra region.
  • The World Health Organization is concerned about the new strain of Coronavirus which has killed 55 of the confirmed cases.
  • A Starbucks in Hong Kong used water from the public restroom to brew coffee.
  • Pakistan is facing a severe measles epidemic. Since the start of 2013 about 239 deaths have been reported.
  • According to the Ministry of Health, Philippines, new cases of HIV infections recorded in the month of April were 388. It was 67 percent higher than those recorded in April 2012.
  • According to the reports Singapore is facing Dengue epidemic. More than 7,700 people are reported to be infected as of May 25.
  • Frozen berry and pomegranate mix has been reported to be linked to hepatitis A outbreak in five states in U.S.

IH News Global Health Weekly News Round-Up

  • The Ministry of Health and Social Welfare (Gambia) in collaboration with WHO UNICEF, Rotary International and other partners  observe  the week of May 2013 (from 24- 27) as National Immunization (NIDs) days against poliomyelitis.
  • May is skin Cancer Awareness Month.
  • May 19 was observed as National Asian & Pacific Islander HIV/AIDS Awareness Day.

Politics and Policies:

  • Kenya is the first country to protect girls against cervical cancer with GAVI- supported human papillomavirus (HPV) vaccines.
  • The government of Canada has announced its support in the fight against tuberculosis, malaria and HIV/AIDS.
  • India’s health ministry is tying itself in knots over the ban of drugs that are banned in some countries and some cases for some population segments.
  • The Illinois Senate has voted to approve the use of marijuana for medical purposes.

Programs:

  • Zambia- Zimbabwe Cross Border Malaria Initiative, a joint co-ordination launched by Zambia and Zimbabwe to control malaria and accelerate reduction of its transmission among the border communities.
  • Merck and Glaxo cut price of Human Papilloma Virus drug in the poorest countries. This cut is more than 95%.
  • Nigeria seeks support on guinea worm eradication.
  • Ghana Health Service has launched the country’s first online based health service which allows patients to engage with doctors online over minor ailments.
  • The Gambia and the World Health Organization (WHO) has launched a Comprehensive Tobacco Control formulation in Bakau.
  • India develops cheap vaccine (against Rotavirus) against major cause of diarrhea deaths in children.
  • The Child Division at the Ministry of Health and Population (MoHP) is working to introduce pneumococcal vaccine against pneumonia– major cause of death among children less than five years of age in the country.

 Research:

  • According to Cervical Cancer Crisis card that used data from official reports by the World Health Organization, Africa has the highest cervical cancer deaths.
  • According to the 2011 National HIV Indicator Survey, prevalence rates among the Ugandans between ages of 15 to 19 are rising.
  • The Annual State of the World’s Mothers report states that every year three million babies die within the first month of life.
  • A study published shows that HIV prevalence and late diagnosis of HIV infection is high among young women with sexual risk behavior in Beira, Mozambique.
  • According to a Global Mother’s Wellbeings ranking report, Ghana ranks 146th out of 176 countries.
  • According to the Maternal and Neonatal Tetanus Elimination Initiative partners, landmark has reached in fight against tetanus. It has been eliminated in over half of 59 priority countries.
  • According to a study, number of Australian parents with mental illness has increased by 3% every year from 1990 to 2005.
  • The findings of a study published in the World Allergy Organization Journal, children dwelling in commercial areas of New Delhi, India are most susceptible as compared to those living in other parts of the capital, to the respiratory ailments followed by industrial and residential areas.
  • A study shows that the paradoxical TB-IRIS frequently complicates HIV-TB therapy in India.
  • A paper published in The Lancet Oncology, say that if current trends in cancer among the people of Latin America and Caribbean continue, the region will see cancer cases soaring by third each year to reach 16.8 million in total by 2020.
  • According to a study health of the immigrants suffer as they live longer in the U.S.
  • According to a study, newer whooping cough vaccine is as protective as was thought to be.

Diseases & Disasters:

  • According to the reports Zambia is facing shortage of HIV medicines.
  • Heavy rains have caused flooding of both Nyamamba and Nyamugasani rivers in Uganda. It has caused heavy flooding which has displaced thousands of people.
  • Two cases of wild polio virus have been recorded in Tafa Local government area of Niger and Fagge in Kano respectively in Nigeria.
  • Reports have indicated that African mineworkers are at significant risk of becoming resistant to tuberculosis treatment.
  • Body of a man who died in an unnamed hospital as having suffered from Creutzfeld –Jakob disease has been identified by the L. Greenberg Forensic Institute at Abu Kabir.  According to the Health Ministry danger of being infected under normal conditions are negligible.
  • A travel alert has been issued for dengue fever in Thailand. About 33 deaths have been reported since April of this year, particularly in northeastern part of the country.
  • According to the reports more than 1200 new cases of measles have been reported this year. Health officials are scrambling to catch up and stop a growing this growing epidemic.

 

 

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • Somalia signs its new Healthcare Plan. It has moved away from the emergency-level health provision towards more mainstream national health systems.
  • Kenya’s President elect promises much needed free primary healthcare for the citizens and raising the financing from 6-15%
  • Five memorandums of understandings has been signed by Egypt with South Sudan in the healthcare, livestock and agriculture sectors.
  • Tanzania and Japan sign Sh802 million project grant. It will help Tanzania in various sectors including health, education and water supply.
  • Kansas, United States, doctors may be required to tell patients that abortion causes breast cancer.

Programs:

  • The World Bank will help Cameroon to build safety net system aimed at reducing poverty and vulnerability. Households will get training to improve their health.
  • Solar power in Africa helps people to grow nutritional vegetables and improve their basic needs including health.
  • The United Nations Population Fund (UNFPA) calls for more reproductive health resources.
  • UNAIDS and other health organizations support new TB and HIV initiative in Africa.  It will include a package worth more than US$120 million to be used to expedite this process.
  • South Sudan through its community health workers detect and treat tuberculosis. This strategy is helping to fight tuberculosis draws communities themselves to detect and treat cases of tuberculosis.
  • UC San Francisco receives $2 million from billionaire Li K-shing for transforming its medical care by integrating data from the human genome and disease research with information from patient’s records and environmental data.

 Research:

  • According to a study about 570 United Kingdom children start smoking every day. This has made the UK government to consider whether to introduce plain packaging for tobacco products.
  • According to a study published in the New England Journal of Medicine physiotherapy results are as good as knee surgery.
  • According to a study, as part of prevention of mother-to-child transmission of HIV virus, antiretroviral therapy has to be initiated before the last trimester of pregnancy to achieve an undetectable RNA plasma viral load before delivery.
  • A report of United Nation states that about four and a half billion people have access to toilet (as compared to six billion people who have access to mobile phones) of the world’s seven billion people.
  • Researchers are working to tackle obstacles to medical aid.
  • According to the World Health Organization and Global Fund Africa and Europe has not yet reached the millennium tuberculosis goal. They say that strains of tuberculosis with resistance to multiple drugs could spread widely.
  • According to a report by the UNICEF, about 66 million Nigerians are without portable water.  It is the leading cause of diseases and deaths especially among under five aged children.
  • Doctors have discovered a women’s mysterious bone condition due to drinking a pitcher of tea every day for past 17 years.
  • Reports indicate that only 28% of Ugandans have access to hand-washing facilities. Statistics from the Uganda Demographic and Household Survey show that 190,000 Ugandan children die every year due to diarrhea.
  • A report publish by the World Health organization (WHO), among South-East Asia Region, Indonesia has achieved an amazing 90% success rate for TB treatment.
  • Scientists from the John Hopkins University have developed a new innovative method known as Predicting Infectious Disease Scalable Model (PRISM) extracts relationships between clinical, meteorological, climatic and socio-political data in Peru and the Philippines.
  • According to a study flu sufferers can spread the virus by sneezing, while talking, breathing by at least 6 feet.
  • A new method to treat blinding cornea diseases in children is now available in Singapore.
  • According to a study breast cancer radiation therapy increases a women’s risk of suffering a heart attack or other heart problems.
  • A study indicates an increase in the number of parents who won’t vaccinate daughters against Human Papilloma Virus (HPV).
  • A study shows that parents seem to be increasingly worried about the vaccine’s safety.
  • Low-GI protein blends have been designed to be eaten about 30 minutes before meals to reduce satiety is being marketed by a Swedish form Indevex. It increases release of incretin hormone which can provoke insulin release before blood glucose levels due to meal consumption.
  • A research done by Lund University in Sweden shows that we can modify the function of genes through epigenetic changes that can take place over the course of time.
  • United States tuberculosis rates reach all-time low but resistance of bacteria is a continuous threat.
  • Researchers have indicated that menstrual blood cells can be used to treat heart failure patients.
  • Researchers say that females with ovarian cancer too often get insufficient treatment.

Diseases and Disasters:

  • Chinese Public call for tackling water pollution.
  • Reports indicate that about 40 patients have lost their lives in drug trials in Maharashtra, India.
  • According to a report released by the CDC, from early December, 2012 to mid-February 2013, the Salmonella Typhimurium outbreak linked to ground beef had sickened a total of 22 people.
  • Natives of United States call for increased HIV testing per Centers for Disease Control and Prevention (CDC) recommendations.