The Daily Impact: Report warns of US global health funding decline

March 28, 2014

A new Global Health Technologies Coalition report says while big budget battles in Washington may be over for now, adequate funding to fight HIV, TB, malaria and other diseases may still be at risk. From VOA:

Coalition Director Kaitlin Christenson praises the improved atmosphere between Democrats and Republicans. She called the ceasefire in budget debates on Capitol Hill “good news.”

“We’re pleased to see that for the first time in several years Congress is able to move forward with a budget that went through the relatively normal process. And we’re pleased to see that in many areas numbers for global health specifically were held strong,” she said.

The federal budget had gone though – what’s called – sequestration.  It required mandatory across-the-board cuts for all agencies if Congress failed to make its own spending cuts. In recent years, the legislative body could not reach agreement, so all agencies took a big hit in spending.

Christenson said while the climate has improved, there are no guarantees of agreement for the next fiscal year beginning in October.

“Going into negotiations for FY-15 we do have some concerns and are hoping that Congress will – as it takes the president’s budget request – bring numbers back up for agencies like the NIH [National Institutes of Health], like global health programs at the State Department and at USAID.”

She said the National Institutes of Health and the U.S. Agency for International Development play a critical role in researching and developing health-related products, simply known as R&D.

With USAID and the State Department, in particular, we saw that funding levels were for the most part decreased across all conditions and disease areas based on the levels that were approved by Congress for the FY-14 budget agreement.

It’s a similar situation for the National Institutes of Health.

Christenson said, “With the NIH, the president’s request for FY-15 was still lower than the request that came in in 2014. It’s a slight increase over what we saw passed by Congress, but the budget request coming from the administration has actually decreased. There’s critical research happening at the NIH that helps us understand how these diseases take place – and helps propel the development of new products that are desperately needed.”

Before sequestration began in March of last year, many research projects were underway. Many millions of dollars had already been spent on them. When the cuts took hold, the projects simply shut down.

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What are the Best Buys in Global Health for 2014?

IMG_5641For this issue of Impact magazine, Devex, Merck for Mothers and PATH joined PSI and a team of experts to uncover some of global health’s best investments. The answers were as complicated as they were interesting.

Inspired by a Devex survey of more than 1,000 health experts working in a variety of settings around the globe, we set out to identify global health trends, as well as barriers and solutions to scaling up promising interventions.

Our research suggests that as important as new technologies are for tackling entrenched and emerging health challenges, it is even more important to strengthen health systems in the developing world and build local capacity there. After all, it’s people who implement the innovations and health systems which drive impact.

 

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The Daily Impact: Global effort stumbles in Malaria Fight

March 27, 2014

A new report in CNN describes how resistance to artemisinin is cause for concern regarding the global effort to control malaria.  An excerpt:

Malaria is the work of the single-celled Plasmodium parasites, and Plasmodium falciparum chief among them. They spread between people through the bites of mosquitoes, invading first the liver, then the red blood cells. The first symptoms are generic and flu-like: fever, headache, sweats and chills, vomiting. At that point, the immune system usually curtails the infection. But if the parasites spread to the kidneys, lungs and brain, things go downhill quickly. Organs start failing. Infected red blood cells clog the brain’s blood vessels, depriving it of oxygen and leading to seizures, unconsciousness and death.

When Nosten first arrived in Southeast Asia almost 30 years ago, malaria was the biggest killer in the region. Artemisinin changed everything. Spectacularly fast and effective, the drug arrived on the scene in 1994, when options for treating malaria were running out. Since then, “cases have just gone down, down, down,” says Nosten. “I’ve never seen so few in the rainy season — a few hundred this year compared to tens of thousands before.”

But he has no time for celebration. Artemisinin used to clear P. falciparum in a day; now, it can take several. The parasite has started to become resistant. The wonder drug is failing. It is the latest reprise of a decades-long theme: we attack malaria with a new drug, it mounts an evolutionary riposte.

Back in his office, Nosten pulls up a map showing the current whereabouts of the resistant parasites. Three colored bands highlight the borders between Cambodia and Vietnam, Cambodia and Thailand, and Thailand and Myanmar (Burma). Borders. Bold lines on maps, but invisible in reality. A river that can be crossed in a rickety boat is no barrier to a parasite that rides in the salivary glands of mosquitoes or the red blood cells of humans.

History tells us what happens next. Over the last century, almost every frontline antimalarial drug — chloroquine, sulfadoxine, pyrimethamine – has become obsolete because of defiant parasites that emerged from western Cambodia. From this cradle of resistance, the parasites gradually spread west to Africa, causing the deaths of millions. Malaria already kills around 660,000 people every year, and most of them are African kids.

If artemisinin resistance reached that continent, it would be catastrophic, especially since there are no good replacement drugs on the immediate horizon.

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The Daily Impact: Air Pollution Claims 7 Million Lives a Year – WHO

March 26, 2014

The WHO released a new report estimating that 7 million people die each year due to air pollution. From the AP:

The agency said air pollution is the cause of about one in eight deaths and has now become the single biggest environmental health risk.

“We all have to breathe, which makes pollution very hard to avoid,” said Frank Kelly, director of the environmental research group at King’s College London, who was not part of the WHO report.

One of the main risks of pollution is that tiny particles can get deep into the lungs, causing irritation. Scientists also suspect air pollution may be to blame for inflammation in the heart, leading to chronic problems or a heart attack.

WHO estimated that there were about 4.3 million deaths in 2012 caused by indoor air pollution, mostly people cooking inside using wood and coal stoves in Asia. WHO said there were about 3.7 million deaths from outdoor air pollution in 2012, of which nearly 90 percent were in developing countries.

But WHO noted that many people are exposed to both indoor and outdoor air pollution. Due to this overlap, mortality attributed to the two sources cannot simply added together, hence WHO said it lowered the total estimate from around 8 million to 7 million deaths in 2012.

The new estimates are more than double previous figures and based mostly on modeling. The increase is partly due to better information about the health effects of pollution and improved detection methods. Last year, WHO’s cancer agency classified air pollution as a carcinogen, linking dirty air to lung and bladder cancer.

WHO’s report noted women had higher levels of exposure than men in developing countries.

“Poor women and children pay a heavy price from indoor air pollution since they spend more time at home breathing in smoke and soot from leaky coal and wood cook stoves,” Flavia Bustreo, WHO Assistant Director-General for family, women and children’s health, said in a statement.

Other experts said more research was needed to identify the deadliest components of pollution in order to target control measures more effectively.

“We don’t know if dust from the Sahara is as bad as diesel fuel or burning coal,” said Majid Ezzati, chair in global environmental health at Imperial College London.

Kelly said it was mostly up to governments to curb pollution levels, through measures like legislation, moving power stations away from big cities and providing cheap alternatives to indoor wood and coal stoves.

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Thoughts on Next Month’s Global Partnership Ministerial in Mexico City

The Mexico City meeting is part of a series that started in Rome in 2003. Subsequent meetings in Paris (2005), Accra (2008) and Busan (2011) created an ever-stronger set of principles related to the effectiveness of development interventions. As time has gone on, the donor profile at these meetings has receded as partner nations in the developing world began participating in large numbers and with growing intensity. The global development challenge will require better coordination among all constituencies and this forum more than any other has the potential to play that role.

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The Daily Impact: 1 million children infected with TB annually, says report

March 25, 2014

Roughly 1 million children, double the previous estimate, fall ill with tuberculosis every year, said a study that also gave the first tally of drug-resistant TB among the young. From AFP:

“Many cases of tuberculosis and multi-drug resistant tuberculosis disease are not being detected in children,” it said.

The team’s computer model, based on population data and previous studies, suggests 999,800 people aged under 15 fell sick with TB in 2010.

Around 40 percent of the cases were in Southeast Asia and 28 percent in Africa.

“Our estimate of the total number of new cases of childhood TB is twice that estimated by the WHO (World Health Organisation) in 2011, and three times the number of child TB cases notified globally each year,” said Ted Cohen from the Harvard School of Public Health.

The research, published in The Lancet, coincides with World TB Day, which places the spotlight on a disease that claims some 1.3 million lives each year.

The team estimated that nearly 32,000 children in 2010 had multi-drug resistant TB (MDR-TB), meaning the strain was impervious to frontline drugs isoniazid and rifampin and was thus harder and costlier to treat.

This is the first estimate of MDR-TB among children under 15, who constitute a quarter of the global population.

Children are at a higher risk of disease and death from MDR-TB, but react well to medication. They are harder to diagnose, partly because smaller children cannot cough up sputum samples needed for laboratory tests.

Reliable estimates are necessary for health authorities to assign resources for diagnosing and treating the infectious lung disease.

Commenting on the study, Ben Marais of the Marie Bashir Institute for Infectious Diseases and Biosecurity in Sydney, Australia, described it as the “most rigorous effort to date” to assess TB and MDR-TB incidence in children.

“Every effort should be made to reduce the massive case-detection gap and address the vast unmet need for diagnosis and treatment,” he said.

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The Daily Impact: Ebola strikes Guinea, killing more than 50

March 24, 2014

MSF has launched an emergency medical intervention following reports of the Ebola virus in southern Guinea, where an outbreak of hemorrhagic fever has left at least 59 people dead. From CNN:

Experts in the country had been unable to identify the disease, whose symptoms — diarrhea, vomiting and fever — were first observed last month.

Health Minister Remy Lamah said Saturday initial test results confirm the presence of a viral hemorrhagic fever, which according to the U.S. Centers for Disease Control and Prevention refers to a group of viruses that affect multiple organ systems in the body.

In a written statement, UNICEF said at least 59 out of 80 people who contracted Ebola have died. At least three of the victims were children.

“In Guinea, a country with a weak medical infrastructure, an outbreak like this can be devastating,” the UNICEF representative in Guinea, Dr. Mohamed Ag Ayoya, said in the statement.

UNICEF has prepositioned supplies and stepped up communication on the ground to sensitize medical staff and local populations on how to avoid contracting the illness, Agoya added.

The Guinean Health Ministry warned that the disease is mainly spread from infected people, from objects belonging to ill or dead people, and by the consumption of meat from animals in the bush.

So far, most of the cases have been in the forest area of southern Guinea, and health officials say they are offering free treatment for all patients.

They’ve urged people to stay calm, wash their hands and report all cases to authorities.

The international medical charity Medecins Sans Frontieres announced on Saturday it was reinforcing its medical and logistics teams in Guinea in response to the epidemic.

It is also flying in 33 tons of medicines and equipment and setting up isolation units in the three affected areas in the country.

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Let’s go the distance: Investing in partnerships for a healthier future

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By Karl Hofmann, President & CEO, PSI; Steve Davis, President & CEO, PATH; and Raj Kumar, president, Devex.

Knowing where to invest time, resources and funding to have the greatest impact in this complex environment can be difficult. To inform these decisions, Devex, in partnership with PSI and PATH, conducted a survey to highlight smart investments in global health. We surveyed nearly 1,500 experts working in global health to learn what they think are the smartest investments — or “best buys” — to achieve our public health goals.

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