Kaiser Daily Global Health Policy Report
Friday, November 6, 2009
The H1N1 (swine flu) virus is now the dominant flu strain worldwide, the WHO reported Thursday, with the virus accounting for up to 70 percent of the flu viruses sampled in some countries, the Associated Press reports. "We remain quite concerned about the patterns that we're seeing," Keiji Fukuda, the WHO's special adviser on pandemic influenza to the director-general, said during a press briefing. However, "[Fukuda] said the swine flu virus appeared to be fairly stable, and that samples from around the world remained very similar to when the virus was first identified in April," the news service writes (Cheng, 11/5).
During the press conference, Fukuda spoke of a growing body of evidence from ongoing H1N1 vaccination campaigns in 20 countries that demonstrates the safety and effectiveness of the H1N1 vaccine, the Canadian Press reports. "We now have good evidence, based on many people receiving the vaccines, that we have no picture of unusual side-effects emerging," Fukuda said. "And the side-effects which are expected – such as a painful injection or perhaps some swelling at the injection site – these are occurring at rates which are expected and usually seen with seasonal influenza vaccine. So the picture right now looks quite good in terms of the safety," he added (Branswell, 11/5).
"[Fukuda] complained … that the agency has yet to receive most of the 200 million doses of vaccine that were to be donated by 11 countries," according to the Los Angeles Times' blog, "Booster Shots." "Delays in production of the vaccine have led to shortages, and most countries, like the United States, have chosen to vaccinate their high-priority groups before making good on their pledges" (Maugh, 11/5).
Fukuda "warned the public not to treat the virus like just another flu," pointing to the severe symptoms the virus causes in young people and H1N1's ability to flourish in the summer months, CNN reports. He pointed to regions where H1N1 activity was on the rise, including Europe and Central and Western Asia (11/5).
"We anticipate seeing continued or increased activity during the winter period in the northern hemisphere," Fukuda said, Reuters reports. "This also means that we expect to see continued reports of serious cases and deaths." To date, at least 5,712 people worldwide have died from H1N1, according to the WHO (Nebehay, 11/5).
New York Times Examines Antiviral Peramivir
The New York Times examines the experimental antiviral, peramivir, which is delivered "intravenously, making it usable by hospitalized patients who are too ill to take two approved flu drugs that work against the virus in similar ways – Tamiflu by Roche, which is typically given as a pill, or Relenza from GlaxoSmithKline, which is inhaled." The U.S. government on Thursday ordered 10,000 "treatment courses of peramivir" to be added to the national stockpile.
Though peramivir has yet to receive FDA approval, it recently "granted authority for the drug to be used in emergencies for patients hospitalized with H1N1 flu who cannot take or do not benefit from Tamiflu or Relenza," the newspaper writes. "Of the 32 patients who received the drug that way, 29 were still alive, BioCryst said in late October," according to the New York Times.
"Although there are still questions about peramivir’s true effectiveness, some critics say the government moved too slowly to make the drug available, and that even now, access is too restricted. For each patient, doctors must call an 800 number or fill out a form on a Web site run by the Centers for Disease Control and Prevention. The drug is then sent overnight from a central stockpile," the newspaper writes.
"If you have a critically ill patient, to delay therapy, it’s just incomprehensible to me," said Richard Whitley, the president of the Infectious Diseases Society of America, who encouraged the distribution of the drug so that hospitals could have it on hand (Pollack, 11/5).
"AIDS drugs should be given to all who need them to reduce new infections, the World Health Organization said," following a three-day meeting on the topic of using antiretroviral therapy (ART) to help prevent the spread of HIV, Bloomberg reports. "Providing more antiretroviral drugs 'will achieve a significant transmission benefit,' Teguest Guerma, interim director of the WHO’s AIDS department, said … 'In the past, there has been a false dichotomy between prevention and treatment. …'That is really what has been corrected. Prevention and treatment are two faces of the same coin'" (Bennett, 11/5).
The meeting provided the opportunity for health experts to "review scientific data available on the use of ART for prevention," examine "the implications of this approach for individuals and communities," and evaluate "human rights and ethical and public health implications" of such an approach, according to a UNAIDS press release. "UNAIDS strongly recommend[s] a comprehensive package of HIV prevention approaches and advocates for an evidence informed and human rights based approach to HIV prevention," according to the release (11/6).
The meeting came after a Lancet study "last year suggested the spread of HIV in hard-hit African nations could be cut by 95 percent in a decade if everyone was tested and those found to be infected were treated immediately," Bloomberg writes. Last week, researchers presented an article in Nature Precedings challenging the assumptions made in the Lancet study, according to Bloomberg. "Even under optimistic assumptions we find elimination to be unlikely," the researchers said in their paper. "Achieving a very high treatment rate would reduce transmission substantially, but not enough to achieve elimination."
"The so-called 'test and treat' strategy may involve millions more people getting treatment in nations already struggling to get drugs to those who need them," the news service writes. "At least 5 million people with HIV in poorer nations don’t have access to the medicines out of 9 million who need them, the WHO said in a Sept. 30 report" (11/5).
President Barack Obama met with Botswana's president, Ian Khama, on Thursday to discuss issues facing the country, including the spread of HIV/AIDS in Africa, Bloomberg reports (Johnston, 11/5).
"Although Botswana is not a large country, it is truly one of the extraordinary success stories in Africa," Obama said, according to a White House transcript of Obama's statements to reporters following the meeting. "President Khama … has been showing his own extraordinary leadership in helping to move his country forward on a range of issues, from how to deal with the HIV/AIDS crisis to addressing economic development to dealing with some of the regional problems that exist" (11/5).
Bloomberg writes that Botswana has the second highest HIV prevalence in the world with nearly "one in four people between the ages of 15 and 49" HIV-positive, according to UNAIDS (11/5).
Chinese scientists have been working on enhancing "the rare sweet wormwood shrub, from which artemisinin – the best drug to fight malaria – is derived" in an effort to fight malaria "not on its own soil, where the deadly disease has been sharply pruned back, but in Africa, where it still kills one child every 30 seconds," Reuters reports. According to the news service, "China pledged to help Africa fight malaria at the triennial Forum on China and Africa Cooperation (FOCAC) in 2006 and has since set up 30 anti-malaria and prevention units. The next FOCAC meeting is in Egypt on Nov. 8-9."
Joseph Cheng, a professor at City University in Hong Kong, said China's influence could be expanded by its efforts to eradicate malaria in developing countries. "China is exploring cost effective ways to help the Third World and is interested in making distinct contributions," he said.
"Tanzania, Kenya and Nigeria have begun farming hybrids of the sweet wormwood shrub with Chinese and Vietnamese ancestry, said Li Guoqiao at the Tropical Medicine Institute. ... Asked if China would export the high-yielding Artemisia annua to Africa, Li said: 'We want to grow them in China and whatever we export depends on bilateral relationships,'" Reuters writes.
The article includes information about China's "mass drug administration" exercise on the "island of Moheli, which belongs to the Comoros group of islands at the northern mouth of the Mozambique Channel." Reuters writes, "The results were startling. While the parasite carrier rate in Moheli ranged from 5 to 94 percent from village to village before the exercise, that fell to 1 percent or less from January 2008 and has stayed around that figure since" (Lyn, 11/5).
Three quarters of people in South Sudan, which has a population of 8 million, do not have access to health care, and 10 percent of children there and in Darfur die before the age of 1, Mohammad Abdur Rab, the WHO's representative to Sudan, said Thursday, Reuters/ABC News reports.
Violence in different parts of the country are exacerbating health conditions, according to the article. In western Darfur, 15 percent of children are malnourished, Abdur Rab said, adding that diseases such as, diarrhea, malaria and meningitis were common. In the southern part of the country, more than 2,000 women die per every 100,000 live births, he said. "'These figures are among the highest in the world,' Abdur Rab said, faulting a 'huge dearth of skilled manpower in health' for the stark maternal mortality rate."
He noted, "The March 2009 departure of NGOs has affected primary health services, resulting in a decline in the quality of care," adding that shortages of drugs, surgical and anaesthesia equipment were causing additional stress. "Abdur Rab said international donors needed to increase their support for fragile health services in Sudan, with special attention to secondary and tertiary care centres whose funding he said was about to run dry," Reuters/ABC News writes (MacInnis, 11/5).
On Friday, Medecins Sans Frontieres warned that Southern Sudan is facing a "serious outbreak" of kala azar, or visceral leishmaniasis – a neglected tropical disease transmitted by the sand fly, Agence France-Presse/News24 reports. "Outbreaks have been recorded in several locations across the remote states of Jonglei and Upper Nile, with more than 380 patients being treated since October. That is more than [three] times the rate recorded for the whole of the previous year, when only 110 cases were treated, MSF warned," the news service writes. David Kidinda, the MSF medical coordinator in southern Sudan, said, "We suspect that the number of kala azar patients reaching clinics in some areas is just the tip of the iceberg" (11/6).
In light of a Medecins Sans Frontieres (MSF) report calling for sustained HIV/AIDS funding, VOA News writes: "Many AIDS-related groups and activists have been calling on U.S. President Barack Obama to fulfill his funding pledges made during the presidential campaign. But are they asking too much, considering the economic downturn?" Sharonann Lynch, an HIV policy advisor for MSF, said, "PEPFAR has the opportunity to save six million lives and it shouldn't settle for three."
According to VOA News, the Obama administration says it remains committed to PEPFAR and has asked for $6.6 billion to go to the program in FY2010. PEPFAR officials have noted "that the economic crisis does figure prominently in their funding decisions," VOA News writes (De Capua, 11/5).
The Washington Post reports that in an August letter to American ambassadors, Global AIDS Coordinator Eric Goosby wrote, "The landscape around us is changing, with the need to balance a broad portfolio of global challenges at a time of financial crisis ... As a result, we need to plan for the next stage of PEPFAR's development in this context and cannot assume the dramatic funding growth of PEPFAR's early years will be repeated."
In May, Obama announced a $63 billion, six-year global health initiative "pledging to broaden the U.S. approach to global health by focusing on tropical diseases and other preventable illnesses, in addition to [HIV/]AIDS" (Brulliard, 11/6).
"India is falling behind other countries in meeting international commitments to improve obstetric care because it does not adequately monitor deaths and injuries in the critical period following childbirth and fix gaps in its health system and programmes," Human Rights Watch said Wednesday, the Hindu reports.
Though the Indian "government counts the number of births in health clinics and hospitals," it does not track women after they have delivered, "especially in the 24-72 critical hours after childbirth, when the chances of their death are the highest," according to the organization. Also, because health facilities are often under-resourced, women can die or experience significant injuries (Dhar, 11/6).
Aruna Kashyap, a researcher with Human Rights Watch's Women's Rights Division, said, "India should be a leader in protecting and monitoring women's sexual and reproductive health. Yet women continue to die entirely preventable deaths, and health authorities do not track down the reasons or do what is needed to rectify the health system," All Headline News reports.
Puja Marwaha, director of the group Child Rights and You, said India's high maternal mortality rate is the result of "poor investment in rural or health care infrastructure. ... What we need to do is a combination of investment in rural health care from public resources and a drive to root out practices that endanger a mother's health, such as child marriages."
In India, there are almost 78,000 cases of maternal mortality each year, according to UNICEF (Bhowmick, 11/5).
In a statement, Human Rights Watch said, "The Indian government should change its approach to monitoring and examine whether women with pregnancy-related complications are in fact getting the kind of treatment they need and whether they are surviving childbirth in the postpartum period." It pointed out that a new government health information system has the potential to monitor some of these issues, "but it remains to be seen whether this data will be consistently collected and utilized for maternal health care programming at district and state levels" (11/4).
Clinical Infectious Diseases Examines Malaria Treatment
An editorial commentary appearing in Clinical Infectious Diseases examines the insight gained in how best to control malaria, based on recent studies of artemisinin combination therapy (ACTs). "As we move toward the elimination of malaria, it is crucial that policymakers and research groups endorse treatment regimens with high efficacy but do not ignore the additional implications of posttreatment prophylaxis," the authors conclude (Price/Douglas, 12/09).
Lancet Examines Role Of Public, Private Sectors For Delivery Of Health Services For Developing Countries
A Lancet comment examines the debate over the role of the public and private sectors in financing and delivering health services in developing countries. "No one set of policy choices will be appropriate in every country," the authors write. "Above all, donors and national governments should focus on practical ways to address the realities of health markets, recognising the importance of public stewardship of mixed health systems as key to health and financial protection goals. To do this, they will need to engage in systematic collection of information, expansion of institutional capacity, and development of long-term policy roadmaps facilitated by national processes for policy dialogue that engage public and private actors" (Lagomarsino, 11/7).
Blogs Cover MIM Malaria Conference
Several blogs wrote about the 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference, which concludes Friday in Nairobi, Kenya. Highlights appear below:
- Johns Hopkins University's Bill Brieger wrote about some of the conference activity on "Malaria Matters." In one post, Brieger describes a symposium at the conference that highlighted the ACT Consortium, which "is in the process of addressing four key issues in ACT delivery through research projects in 9 countries" (11/6).
- The Global Health Council's "Blog 4 Global Health" addresses malaria's impact on six of the Millennium Development Goals. According to the blog, "one of the take home messages here at the MIM conference has been the benefit of malaria control on childhood survival, MDG 4" (Benjamin, 11/4).
- Malaria No More's "Buzzwords" blog features a series of posts covering the conference. One of the posts describes a visit to Mwea Mission Hospital. "A large problem in applying our existing tools for fighting malaria is patient compliance" (Uno, 11/5).
- The conference has its own blog that includes video interviews with a number of malaria experts who attended the conference. Robert Newman, director of the WHO's malaria program, and Rose Leke, of the University of Yaounde, are among those included.
Tropical Medicine & International Health Examines Threat Of 'Global Financial Crisis' To TB
"The global financial crisis poses a threat to global health, and may exacerbate diseases of poverty, e.g. HIV, malaria and tuberculosis," writes the author of a Tropical Medicine & International Health commentary. "Securing health gains in global tuberculosis control depends on protecting expenditure by governments of countries badly affected by tuberculosis and by donors, taking measures to increase efficiencies, prioritizing health expenditures and strengthening government regulation. Lessons learned will be valuable for stakeholders involved in the health sector response to tuberculosis and other diseases of poverty," the author writes (Maher, 11/3).
Blog: U.S. Policy Makers Should Look At Europe's Global Health Strategy
"While it can be difficult sometimes to see beyond 'the beltway,' perhaps the U.S. efforts at a 'global' strategy should take into consideration similar efforts from around the globe," according to the Center for Global Development's David Wendt on the "Global Health Policy" blog. Wendt notes current efforts by the EU to help determine their global health policy.
"In the U.S., international development programs are diffused across a number of agencies and there is no overarching strategy. When policy coherence happens across agencies, it is usually only around a single vertical program such as PEPFAR. … I’d encourage U.S. policymakers working on the Global Health Initiative and stakeholders in developing countries to take a look at the [European Commission] issue paper on their role in global health ..." (11/2).
Blog: Plan Could Expand Access To Children In Need
Developing countries "have limited ability to pay" for vaccines to protect their children, which provides "little incentive" for vaccine "to make the enormous investments required to develop and manufacture new vaccines for the developing world," Joe Cerrell, director of Global Health Policy and Advocacy at the Bill & Melinda Gates Foundation, writes on Reuters' blog, "The Great Debate."
"As we continue expanding access to basic vaccines that have existed for decades, we also need to ensure that new vaccines quickly reach children in need," he writes before outlining plans for the Advance Market Commitment (AMC), "a groundbreaking partnership," which promises to pay vaccine makers if they "produce affordable pneumococcal vaccines designed specifically for poor countries … Thanks to donor funding and the manufacturers’ pricing commitments, developing countries will be able to purchase the vaccines at guaranteed prices of no more than $3.50 per dose. The first of the new vaccines could become available as soon as 2010," he writes (10/31).
The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2009 Henry J. Kaiser Family Foundation. All rights reserved.