World Health Organization
Today marks yet another moment in the “holidays without greeting cards” series: World Tuberculosis Day. Each year, there are 9 million new cases of TB and close to 2 million people die from the disease. An estimated 10 percent of people with TB also are co-infected with HIV, further compounding the diseases’ burden. Dr. Paul Nunn, a self-described “physician-turned-bureaucrat,” is responsible for coordinating TB control efforts throughout the WHO system — took some time to talk with me about his work on TB. I’ve taken the liberty of paraphrasing some of his answers below:
Today is World TB Day. What does that mean to you?
Travel! [Ed note: Dr. Nunn was off to mark World TB day with a speech at the Swiss Anti-Tuberculosis Association]. Besides that, I see it as a key advocacy moment to drive awareness of TB, highlight the progress we’ve made, and motivate the global community to do more on TB.
What sort of progress have we made on TB in the last decade?
There are still more than 9 million cases per year, but we have made significant progress. The incidence rate of TB flattened in 2004, and it has fallen (albeit fractionally) in the years since, in part thanks to the DOTS strategy. We’ve also significantly decreased the prevalence (total number of cases at any given time) and mortality from TB overall.
(more…)
This month, we’ll be featuring blog posts that help illustrate how the Global Fund affects programs that fight AIDS, tuberculosis and malaria around the world. In this article, Dr. Joia Mukherjee of Partners in Health (PIH), who participated in our ONE Haiti conference call in January, highlights the partnership between the Fund and PIH.
It is hard to believe that it has been ten years since all 191 United Nations member states agreed to achieve the Millennium Development Goals (MDGs).
Yet the lack of progress on the final one — a global partnership for development — has hampered the achievement of all others. The one shining light in such a partnership for global development is the Global Fund to Fight AIDS, TB and Malaria.
The Global Fund was partly established by activists in the developed and developing world, otherwise known as the “global North and South.” Many of these activists were living with HIV and wanted to start an organization that could help achieve universal HIV/AIDS treatment.
The Fund is a novel mechanism; it is a multilateral fund, independent of the United Nations and financed by donors from the government and private sector. Its structure has allowed even some of the poorest countries to expand treatment for HIV, tuberculosis and malaria as a basic right for free, largely through the public sector, with support from non-government organizations and the private sector.
The Fund has put more money into the public health sector than any previous initiative, and a consortium convened by the World Health Organization documented the positive synergies that this money has had not just on MDG 6 — combating AIDS, malaria and other diseases — but the health sector in general.
My organization, PIH, has been working to provide health care and improve the social determinants of health for the destitute for more than 20 years. As one of the recipients of first-round Global Fund monies in Haiti, we set out to build public sector health systems and tackle poverty as a critical component to our HIV response.
This work, supported by the Global Fund since its inception, has resulted in the rehabilitation and revitalization of 52 public facilities in ten countries around the globe. The public sector-NGO community partnership that has developed in the course of this work is poised to meet 4 and 5, the other health-related MDGs as well.
As the 2010 MDG summit approaches and the challenges to achieve the MDGs are addressed, it is critical to note the importance that dedicated funding for MDG 6 has had not only in achieving the right to HIV, TB and malaria treatment, but in improving the systems to deliver health care around the world.
Photo credit: Bill and Melinda Gates FoundationWe’ve dedicated a lot of space on this blog to rotavirus — a disease that is the most common form of childhood diarrhea.
Diarrhea is something we often think of as gross or annoying, but it’s easy to forget that diarrhea is deadly, causing nearly 500,000 deaths each year primarily in Asia and Africa.
We’ve also dedicated a lot of blog posts to the GAVI Alliance, because among other things, they’ve been a driving force behind an effort to accelerate access to a vaccine for rotavirus to children in the developing world, alongside partners like Merck, GlaxoSmithKline, PATH, the WHO and the CDC.
But developing a new vaccine for resource-limited settings is a challenging process that takes years of hard work and a lot of money — and it’s a process that’s certainly not guaranteed to work. Which is why today we’re celebrating big news out of medical journal The Lancet: two sets of clinical trials in Asia and Africa showed that new rotavirus vaccines can significantly reduce child deaths.
The Asian trial took place in Bangladesh and Vietnam, testing the efficacy of the vaccine (essentially, how well it protects against disease) in more than 2,000 infants. The study showed that the vaccine had 48.3 percent efficacy against severe disease. When combined with other efforts to improve child survival — oral rehydration salts, zinc, exclusive breastfeeding and improved hygiene and sanitation — diarrheal deaths could be reduced even more.
The African trial, which took place in Ghana, Kenya and Mali, also demonstrated that the rotavirus vaccine offered significant protection for young children. In fact, vaccination reduced severe cases of rotavirus by 64 percent in the first year of life. These findings were consistent with those from a previous study conducted in Malawi and South Africa.
While the percentages from the studies may not seem overwhelmingly high (We’re using a vaccine that works only half to 60 percent of the time?), the vaccine actually represents a critical tool that will help control one of the major killers of children around the world. Even with these lower efficacy rates, we have to remember that the rotavirus vaccines will still have a huge impact on reducing severe disease in Africa and Asia because so many more children are dealing with disease there than in the United States or Europe.
But how well a vaccine prevents against disease doesn’t tell the whole story, either, because the health care systems in the developed and developing world are vastly different. If a child gets diarrhea in the U.S., a parent can easily access medicines to treat him or her and — in worst case scenarios — take their child to the hospital for emergency care. But because medicines and health facilities are tough to access in much of the developing world, rotavirus vaccination can be a child’s only chance at survival against diarrhea in Africa and Asia.
Major congratulations are due to all who have worked on rotavirus vaccine development and studies to date, and an additional debt of gratitude is owed to the parents who volunteered their children for the trials. We’re thrilled at the news and for what it means for the health of children and families across the developing world. We’ll keep you posted with more on the vaccine and efforts to deliver it in the field in the coming months!
We must do better against malaria, says President – Following this week’s African Union summit, Tanzanian President, Jakaya Mrisho Kikwete, asserts that leaders must do more to eliminate all preventable malaria deaths, starting with the goal of reaching universal mosquito-net coverage by the end of this year. (The Guardian)
New TB test must reach more people, says WHO – A new diagnostic tool that reduces to two hours the time needed to detect drug-resistant tuberculosis must be made available to populations vulnerable to the disease, a World Health Organization expert said. “These tools are very expensive, but the scale up should be carefully planned,” said one WHO adviser. (Reuters)
Millions awarded for TB and HIV/AIDS fight in Uganda – The Elizabeth Glaser Pediatric AIDS Foundation has been awarded $38 million by USAID to provide integrated TB and HIV/AIDS services in the southwest region of Uganda. The new program seeks to support health service delivery at the district level to provide comprehensive services in the region.” (Rosebell Kagumire, The Independent)
African leaders must focus on maternal health – Ex-Irish president Mary Robinson urged African leaders to boost support for maternal health, during a visit to Sierra Leone where mortality rates are among the highest in the world. “If the African Union succeeds in fulfilling its commitment to maternal health, it will benefit the economies of countries to have healthy populations,” she said. (AFP)
Flower power in Kenya – Slate explores the burgeoning flower industry in Kenya’s Rift Valley, where ambitious plans of turning the country into a global powerhouse are blooming into reality. Though environmentalists may disagree with some of the growing methods, one farmer asserts, “We are branding ourselves as a flower-growing country.” (Alexis Okeowo, Slate)
Last week, senior health officials from 193 Member States of the WHO gathered in Geneva to participate in the 63rd World Health Assembly. There—as in every other year—they reviewed the WHO’s work, set new goals, and assigned new tasks. Highlights and topics from the week included:
Opening remarks from WHO Director-General Dr. Margaret Chan
- She noted the impressive successes achieved through investments in global health including the drop in under-five child deaths to below 9 million, the increase in the number of people receiving antiretroviral therapy for AIDS to more than 4 million, early signs that tuberculosis and malaria cases are declining, and the value of vaccines which currently prevent an estimated 2 to 3 million deaths each year
- She relayed the urgency in the homestretch for reaching MDGs, especially for the world’s poorest
- She urged participants to scale up delivery of interventions, while also strengthening fundamental capacities needed to do so.
Case studies from country representatives on MDGs 4, 5, and 6
Noting the impact of the financial crisis on health, participants emphasized the importance of sustaining investments in health. Speakers highlighted the need for better coordination of funding mechanisms, global financing alignment with local priorities and national health plans, and mutual accountability for both the donors and the recipient governments.
Participants also noted the importance of:
- strengthening health systems, including the quality and quantity of health care workers;
- focusing on primary health care and integrated delivery;
- strengthening the aid architecture to improve effectiveness and national ownership in the development agenda; and
- making use of innovations including information communication technology in addressing MDGs.
Pneumonia
Member States adopted a resolution on the treatment and prevention of pneumonia–the number one killer of children under five years globally. The resolution makes it clear that intensified efforts to address pneumonia are imperative if the achievement of MDG 4 is to be achieved. The resolution also provides critical momentum to a broader effort to deliver vaccines and immunizations across the developing world, particularly in the lead up to the G8 Summit in Canada this summer which will be focused on maternal and child health.
Polio
Member States welcomed the new Global Polio Eradication Initiative Strategic Plan 2010-2012. The new Plan addresses the barriers to eradicating polio from the remaining few areas which had not yet stopped the disease, using a combination of new area- and population-specific approaches to reach chronically missed children using an effective new oral polio vaccine. The delegates expressed serious concern that insufficient financing for the new Plan will inhibit its full implementation, as $1.3 billion is still needed for the period 2010-2012. The dangers of not completing the job of polio eradication are underscored by the confirmation in April of a large new polio outbreak following an importation into Tajikistan (in a region which had been certified as polio-free in 2002).
The WHO just released its 2010 report on multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) surveillance and response, providing the latest information on the status of this global epidemic.
The alarming news from this report is that in some areas of the world, one in four people who were infected with tuberculosis became ill with a form of the disease that can no longer be treated with standard drug regimens. A region in Russia reported that 28% of those diagnosed with TB had the multidrug-resistant form – the highest level ever reported to WHO.
As background, multidrug-resistant tuberculosis (MDR-TB) is difficult and expensive to treat, frequently failing to respond to standard first-line drugs. Extensively drug-resistant tuberculosis (XDR-TB) is a deadlier strain, resistant to even more of the existing tuberculosis treatment.
Of the estimated 9.4 million new TB cases in 2008, approximately 440,000 were MDR-TB, and a third of those infected with this form died. It is estimated that 69,000 cases of MDR-TB occurred in Africa, with the vast majority going undiagnosed due partly to limited labratory capacity. There are no official estimated on the number of XDR-TB cases, but the WHO still suggests it may be around 25,000 annually with most cases being fatal. 58 countries have reported at least one case of XDR-TB since 2006.
Strong tuberculosis programs can have a significant impact on reducing MDR-TB rates, as seen in countries like Estonia, Latvia, the U.S. and China, Hong Kong Special Administrative Region. Additionally, new technologies that can cut the diagnosis time to two days from up to four months, offer hope in the fight against TB.
As we observe World TB Day 2010, it’s important to reflect on the progress being made in combating this disease (36 million people have been cured of tuberculosis in the last fifteen years), while acknowledging the challenges that remain, particularly in the growing area of drug resistance.
You can download the full report here.
