International
World Health Organization
Uniting to fight neglected tropical diseases
This Monday at 11 am GMT you can watch a historic live event that demonstrates how building partnerships between aid agencies and pharmaceutical companies can make big differences in health and development for millions of people living in the world’s poorest countries. World experts including Bill Gates and Dr Margaret Chan (Director of the World Health Organisation) will be taking part in a live webcast from London to discuss neglected tropical diseases (NTDs) – diseases which effect 1 billion poor people around the world.
You can watch the event on this page, and follow the buzz online using #NTD, #NTDs and #partnership hashtags. We will also be tweeting updates on the @ONEcampaign account.
Over the past week there have been a number of events celebrating the progress that’s being made towards saving lives – Bill Gates has published his annual letter and defended aid spending during difficult times at the European Parliament, and the Global Fund has celebrated 10 years of saving over 7.7 million lives.
But there’s still much more to do, the partners speaking at this event aim to combat NTDs and drive progress toward the World Health Organization’s goals for control or elimination by 2020.
The event will feature:
- Dr. Margaret Chan, Director-General, World Health Organization
- CEOs of Nine Leading Pharmaceutical Companies
- Bill Gates, Co-Chair, Bill & Melinda Gates Foundation
- Senior Government Officials from Tanzania, Mozambique, Brazil and Zanzibar
- Stephen O’Brien, Parliamentary Under-Secretary of State, UK Department for International Development
- Dr. Bernard Pécoul, Executive Director, Drugs for Neglected Diseases initiative
- Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health, US Agency for International Development
- Dr. Caroline Anstey, Managing Director, World Bank
- Moderated by: Riz Khan, Al Jazeera English
We have the opportunity to help the more than one billion people affected by NTDs lead healthier, more productive lives. And by working collaboratively, we can achieve more together than any one of us could on our own.
For more about neglected tropical diseases check out http://www.unitingtocombatntds.org
Q&A: Dr. Paul Nunn of the WHO talks tuberculosis
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.
Millennium Development Goal 6 set the target of reversing and reducing the incidence of TB along with AIDS, malaria, and other diseases — and for TB that has been achieved. The Stop TB Partnership also set additional goals by 2015: that we would halve the prevalence rate and mortality relative to 1990. It looks like we’re almost there on prevalence rate and may just barely achieve the mortality reduction treatment — although not for Africa specifically.
What work still needs to be done on TB? Where are we having the most difficulty, and what steps are in place to achieve progress?
The achievement of MDG 6 for TB is tempered by the fact that the absolute number of people getting TB continues to rise due to the rising overall world population. Africa also lags far behind many other regions when it comes to TB. The big challenge there is that HIV drives the TB epidemic, and the quality of health services overall is poor. We need to ensure that efforts to fight HIV in both prevention and treatment also take on TB. TB patients tend to be ignored — in part because TB is highly infectious in social settings, and thus stigmatizing — but it’s important that services for HIV and TB are integrated to reach those who are vulnerable and missed in the health system.
MDR-TB and XDR-TB are serious and growing threats to TB control. It’s estimated that there were 440,000 cases of MDR-TB last year, of which 67 percent were identified by the health care system; of those identified, we only managed to treat 30,475 cases (the WHO launched a new report on the topic this week). 69 countries have reported at least 1 case of XDR-TB through 2010, as well. Still, 95 percent of TB remains treatable with existing drugs—and that needs to be the primary focus.
Current tools to diagnose and prevent TB are outdated, but hope is on the horizon. A new diagnostic test Xpert (see our blog about it here) can tell within a few hours if someone has TB and whether the TB is multi-drug resistant. It’s already being used extensively in parts of the world, and we’re hoping to roll it out even further in the coming years, including through the Global Fund’s next round of grants. The currently existing TB vaccine, BCG, works to prevent the worst forms of childhood TB, but is too risky for many with compromised immune systems, including many who are HIV positive. New vaccines are still in the research phase; it’s likely we will go another 10 years before we see a new TB vaccine delivered to patients, yet it’s still an important future tool. Lastly, a few new drugs are nearly certified which, in 3-5 years, could be used to cure TB patients in high burden countries, especially those with MDR-TB.
Who are key partners working on TB around the world?
The Global Fund is key—it’s probably our most important partner—providing countries with financial support to do the work they need to do on TB. We also work closely with countries themselves, particularly those with high disease burdens. Technical agencies from many European capitals are strong partners, as well as the Gates Foundation and USAID, among others.
What messages about TB can advocates use that are the most compelling?
New rotavirus vaccines significantly reduce child deaths
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 World Health Organization and the Centers for Disease Control and Prevention in the United States.
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 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% 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% 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% 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 Europe or North America, 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!
Vaccines: Making a best-buy better
This entry in our series on “Vaccines: The Next 10 Years” comes from Dr. Margaret Chan, Director-General of the World Health Organization:
In January, the Bill and Melinda Gates Foundation pledged $10 billion over the next decade to help deliver existing vaccines and develop new ones. This commitment, which launches the Decade of Vaccines, gives an unprecedented boost to an area of public health that is already on a winning streak.
Vaccines are one of the best life-saving buys on offer. Each year, immunization programmes prevent an estimated 2 to 3 million deaths. No other public health intervention reduces illness and deaths, on such a scale, in such a safe and cost-effective way.
Progress since the start of this century has been stunning. For the first time in nearly 6 decades, immunization programmes helped push the worldwide number of young-child deaths below the 10-million mark. As the decade progressed, the number dipped again to below 9 million. Ambitious targets for reducing deaths from measles, one of the most contagious childhood killers known, have been surpassed, with Africa leading the way.
We can pinpoint some reasons for this success: an international drive to reach time-bound health goals, the commitment of governments in the developing world, new financial instruments, and several new partnerships, like the Measles Initiative and the GAVI Alliance.
GAVI, which was launched at the start of this century by a grant from the Bill and Melinda Gates Foundation, was founded on the principle of fairness. Poverty or the place where a child is born should not influence access to life-saving vaccines, including the newer and more expensive ones. Every child deserves the best that science can offer. In its brief ten-year history, GAVI has reached 257 million additional children with new and underused vaccines.
Still, as we begin this Decade of Vaccines, more children need to be reached – with the best that science can offer. New vaccines that protect children from pneumonia and diarrhoea, the two biggest killers of young children, need to be more widely introduced. Information systems in developing countries need to improve so that we can measure progress and target resources more wisely. Incentives need to be found to stimulate R&D for badly needed new vaccines that are unlikely to make a profit. To ensure continuing expansion of coverage, production needs to increase and prices need to go down. Immunization programmes are already delivering other interventions that promote child survival, and this value-added approach should likewise expand.
WHO is active in all these areas. As just one example, our programme for the pre-qualification of vaccines is helping vaccine manufacturers in the developing world become internationally competitive. As a result, supplies are more plentiful and reliable, and competition is driving prices down, with no compromise of safety or quality.
Above all, we need to encourage all partners – from foundations and ministries of health to grassroots workers – to keep up the good work. At a time when the world seems overwhelmed by bad news, I am constantly inspired by the good will, generosity, and creativity that are driving efforts to improve child survival. My heartfelt thanks to all.
36 Million Cured of TB
The 2009 WHO Global Tuberculosis Update was launched earlier this month, providing the latest information on the state of the epidemic around the world. The report shows that in the last 15 years, 36 million people have been cured of tuberculosis, and eight million cases have been prevented. This progress attests to the effectiveness of the Stop TB Strategy and DOTS in the fight against tuberculosis.
During the latest 12-month reporting period, 2.3 million infectious patients were cured, more than ever before in that time frame. Still, not enough people are accessing the treatment they need, and about 1.8 million people died of tuberculosis in 2008.
There were an estimated 9.27 million incident cases of TB in 2007 (of which, 15% percent were among individuals who were also HIV-positive), a slight increase from 9.24 million in 2006. However, while the total number of TB cases is up due to population growth, the number of cases per capita is actually down 1%.
The report shows further progress in addressing the deadly combination of TB and HIV. TB remains the leading cause of death for those with HIV, but testing TB patients for HIV is on the rise, and more patients are receiving appropriate treatment.
The report also notes that there has been little progress in stopping multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB), an even more dangerous and resistant to treatment form of TB.
To learn more, you can read the full report, as well as the WHO’s press release.
Watch Global Pneumonia Summit Live Right Now
Today is World Pneumonia Day and you can watch the Global Pneumonia Summit live right now.
Child advocates from around the world are gathering in New York City to hear the latest on how we can raise the profile of child pneumonia and get policymakers everywhere to act.
Speakers include:
- Professor Jeffrey Sachs, Director of The Earth Institute at Columbia University and Special Advisor to the United Nations’ Secretary-General
- Singer-songwriter and UNICEF Goodwill Ambassador Angélique Kidjo
- ABC News’ senior health and medical editor Dr. Richard Besser
- WHO and UNICEF present a new report, the Global Action Plan for the Prevention and Control of Pneumonia, which provides a road map for preventing and treat child pneumonia in the world’s poorest countries.
- And leading global health experts, philanthropists, faith-based leaders, corporate representatives and child advocates to begin to change the way the world responds to the #1 killer of children—pneumonia.
WHO says all children should receive a vaccine to prevent diarrhea
The World Health Organization’s expert advisory panel on immunizations announced today that all children should receive a vaccine that can prevent a severe type of diarrhea and vomiting caused by the rotavirus.
Every year, 600,000 children die from severe diarrhea caused by rotavirus around the world. Although most of these deaths occur in developing countries, rotavirus also afflicts children in the developed world. In the United States, 55,000 children are hospitalized because of rotavirus infections every year.
Research to determine whether the rotavirus vaccine is safe and effective in countries with high child mortality has proven successful: cases of severe diarrhea were reduced after administration of the vaccine. Funded by the GAVI Alliance, and conducted by PATH, WHO, and GlaxoSmithKline, as well as many research institutions in South Africa and Malawi, this research “clears the way for vaccines that will protect children in the developing world from one of the most deadly diseases they face,” said Dr. Tachi Yamada, President of the Global Health Program at the Bill and Melinda Gates Foundation.
As one of the diseases that causes the greatest number of deaths and illness in the developing world but receives little attention and resources, the prevention and treatment of diarrheal diseases is a priority area for the Bill and Melinda Gates Foundation. Their work involves funding research to determine the causes of diarrheal disease in developing countries, supporting the development of a vaccine, including the rotavirus vaccine, and efforts to develop medicines and other treatments for diarrheal disease.
Delivering the rotavirus vaccine with a package of other essential interventions including improving water and sanitation to children in need in Africa and Asia will be critical for reducing child mortality.
-Lisa Fleisher
Back to the Basics
Government ministers and global health advocates from across the world are making their way to Almaty, Kazakhstan this week to focus on primary health care. The summit marks the 30th anniversary of the Alma-Ata Conference, which took place in the Kazakhstani city before the collapse of the USSR.
In the years since 1978, Alma-Ata has become somewhat of a hallmark and source of nostalgia in global health circles. The conference was the first of its kind to put the concept of health equity on the international agenda. Aiming to launch a campaign for health for all, attendees laid out their vision of primary health care. Identifying health as a fundamental human right, they argued that health care should not only be universal and affordable, but should be delivered in collaboration with local citizens in a way that is appropriate to the context.
These tenets were laid out in the Alma-Ata Declaration, which gave countries and international organizations a target date of 2000 for implementation.
Thirty years later the ideals of Alma Ata are far from being realized. Here at ONE, we know the stats on the global health deficit all too well: over 9 million children die before their fifth birthday every year from preventable, treatable causes; half a million mothers die every year during childbirth. While many at the time branded Alma-Ata and utopian, in retrospect its failure was more a result of unforeseen social and economic challenges that shaped the global health landscape of the 1980s and 1990s. WHO Director-General, Dr. Margaret Chan, speaks to this in a recent article featured in the Lancet:
Nor could the visionary thinkers in 1978 have foreseen world events: an oil crisis, a global recession, and the introduction, by development banks, of structural adjustment programs that shifted national budgets away from the social services, including health…The emergence of HIV/AIDS, the associated resurgence of tuberculosis, and an increase in malaria cases moved the focus of international public health away from broad-based programs and towards the urgent management of high-mortality emergencies.
WHO Warns that Climate Change May Worsen Health Crises
In commemoration of World Health Day, Dr. Margaret Chan, the director of the World Health Organization, warned that climate change stands to exacerbate health crises in the world’s poorest communities.
Reuters reported:
WHO Director-General Margaret Chan said that new patterns of global rainfall, droughts and storms could accelerate the spread of diseases such as malaria and dengue fever in some regions, creating serious problems for poor nations.
“The climate change-sensitive diseases and conditions are already creating huge burdens in many countries… The impact of climate change can act as an amplifier,” she told a news conference in Geneva, where the United Nations agency is based.Confronting the health challenges from global warming will require concerted efforts to forecast changing weather patterns, fight mosquitoes and other disease-spreading bugs, distribute vaccinations and boost medical coverage, Chan said.
In sub-Saharan Africa, projections indicate that changing climate patterns will have serious implications on agricultural productivity, water availability and human health.
-The areas suitable for agriculture, the length of growing seasons and the yield potential of food staples are all projected to decline- some African countries could see agricultural yields decrease by 50% by 2050 and crop net revenues could fall by as much as 90% by 2100.
-Rising temperatures can alter runoff patterns and increase water evaporation rates, which can severely reduce the availability of water. By 2020, an additional 75-250 million people in Africa are projected to be exposed to increased water stress due to climate change.
-Previously malaria-free highland areas in Ethiopia, Kenya, Rwanda and Burundi could experience modest incursions of malaria by the 2050s, with conditions for transmission becoming highly suitable by the 2080s. In total, an additional 260-320 million people worldwide could be living in malaria infested areas by 2080.
While these trends and events can not be attributed solely to climate change, they are the types of challenges that will become more frequent and intense with increasing climate variation.
Read about World Health Day 2008: Protecting Health from Climate Change
Read more about how climate change will impact sub-Saharan Africa.
-Nora Coghlan
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The International ONE Blog is a daily log of the anti-poverty movement. The site is operated by ONE staff, with guest contributions from ONE volunteers, members and allies.
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TAGS: Bill and Melinda Gates Foundation, Bill Gates, Neglected Tropical Diseases, World Health Organization