TIME magaine: Global Health

Time has a series on Global Health:

http://www.time.com/time/specials/packages/0,28757,1995199,00.html

Neglected Tropical Diseases

This is a well-written article that appeared in a recent New York Times
http://www.nytimes.com/2010/05/17/opinion/17Hotez.html

The author (Peter Hotez) is president of the Sabin Vaccine Institute.

PLoS has an entire journal dedicated to the NTDs:
http://www.plosntds.org/home.action

 

Global Health Diplomacy

Recently at the GHEC conference in Mexico I heard some talks by Mexican officials who provided their perspective on the recent H1N1 outbreak.  It is well worth watching on the Kaiser site (see prior blogs).

Here is the intro to an article (PLoS Medicine) that covers a bit of what they mentioned:

One of the most controversial areas of global health diplomacy over the past five years has involved negotiations to increase equitable access to vaccines for highly pathogenic avian influenza A (H5N1) (HPAI-H5N1) and pandemic 2009 influenza A (H1N1) (2009-H1N1). The limited results produced by these negotiations have stimulated calls for a new global framework to improve equitable access to influenza vaccines. The prospects for such a framework are not, however, promising, because the national interests of most developed states vis-à-vis dangerous influenza strains favor retaining the existing imbalanced, reactive, and ad hoc approach to vaccine access. This article examines why negotiating equitable access to influenza vaccines in the context of HPAI-H5N1 and 2009-H1N1 has been, and promises to continue to be, a difficult diplomatic endeavor.

The full article can be found here.

PLoS Neglected Tropical Diseases: Nuclear Weapons and Neglected Diseases: The “Ten-Thousand-to-One Gap”

PLoS Neglected Tropical Diseases: Nuclear Weapons and Neglected Diseases: The “Ten-Thousand-to-One Gap”

This editorial puts into numbers and perspective what the NTD community has been advocating for for many years.

One particularly interesting point: of all the Nuclear Nations only 1 (UK) does not suffer from NTDs. The article points out that there are NTDs in the US, for instance.

The editorial is worth a read, if for no other reason than to become more familiar with NTDs.

Haiti Relief Workers and Dengue

The CDC has issued a Health Alert for relief workers returning from Haiti. Several cases of Dengue Fever have been reported so far. The advisory can be found here.

More information can be found about Dengue at this site:

http://www.cdc.gov/Dengue/#

Clinicians who suspect Dengue should send a blood sample to the CDC (Dengue Branch) and complete this form:

http://www.cdc.gov/Dengue/resources/caseformhaiti.pdf

Fake Meds

"The World Health Organization estimates that, on average, 10 percent of all pharmaceuticals on the global market are counterfeit. In parts of Africa, Asia and Latin America, more than 30 percent of the medicines on sale by retailers are counterfeit. In some regions, the numbers can be as high as 70 percent.

In the United States and most countries in Europe, the incidence of counterfeit medicines is less than 1 percent. However, medicines purchased over the Internet -– where the physical address of the seller is often concealed – are counterfeit in over 50 percent of cases."

Full article:

http://consults.blogs.nytimes.com/2010/04/19/the-dangers-of-buying-medicines-overseas/

PMI Releases 6-Year Malaria Strategy - Kaiser Global Health

PMI Releases 6-Year Malaria Strategy - Kaiser Global Health

A couple of interesting notes from related to the President's Malaria Initiative.

From the article:

Study Finds Single-Dose Malaria Drug As Effective As Standard Treatment

South Korean drugmaker Shin Poong Pharmaceuticals' drug Pyramax "proved as effective as Novartis' leading treatment Coartem in a clinical trial, researchers said on Friday, although an outside expert said the findings had limitations," Reuters reports (Hirschler, 4/22).

Researchers tested the new treatment, which is a combination of pyronaridine and artesunate, "at seven sites in Africa and three in Southeast Asia alongside the standard drugs, artemether and lumefantrine," Agence France-Presse writes. "A total of 1,272 malaria patients were enrolled, with 849 randomly assigned to pyronaridine-artesunate, which was taken once a day over three days, and 423 to artemether-lumefantrine, taken twice daily, also for three days."

The study results, published Friday in the journal Lancet, found that both drugs "were equally effective in clearing out malarial parasites in the blood at a 28-day mark, and had an equal number of reported side effects," AFP reports. The researchers recommend that pyronaridine-artesunate be incorporated into malaria treatment programs since it "costs less than one dollar to treat an adult and less than 50 cents for a child," the news service writes (4/22).

An accompanying Lancet comment by Francois Henri Nosten of the Mahidol-Oxford University Tropical Medicine Research Programme "said a limitation of the study was that it consisted of many older African children and adults who had probably acquired some malaria immunity," according to Reuters. "He also raised concerns about patients on Pyramax having raised liver enzymes, a possible signal of liver toxicity" (4/22). Writing in the Lancet, Nosten said, "My criticism is that it might satisfy developed-world regulatory requirements but it provides limited information of value to the clinician in the field" (4/24).

GHEC Mexico

I'd like to recommend a few specific talks from the GHEC (Global Health Education Consortium) Conference, being held now in Cuernavaca, Mexico. You can find the entire list on the Kaiser Global Health site.

I've particularly enjoyed
The talk on Ethics and Equity



Walter Patrick on Alliances in Global Health


Paulo Buss on Social Determinants of Health, from Fundacion Oswaldo Cruz (Brazil)


The discussion on "Global Health Diplomacy" was well-moderated by James Sepulveda of the Gates Foundation, and in part revealed H1N1 from Mexico's perspective, which was quite revealing.

Today's plenary session was by Paulo Buss and was also quite good. That should be posted on the site soon.

Plumpy-Nut and patent

This has been brewing for a couple of years:


Legal fight over Plumpy'nut, the hunger wonder-product

By Hugh Schofield
BBC News, Paris

Should a revolutionary humanitarian food product be protected by commercial patent, when lifting restrictions might save millions of starving children?

Update on Haiti Project

The Child Health Campaign in Pestel is going great! This is the project supported by Variety International, the Children's Charity.

The health workers have already reached over 2800 kids in the first 3 weeks! Sister Fidelis has been out-and-about, taking lots of photos of the workers in action, so I'm anxious to see those. I will send some along when I get them.

The workers are finding a lot of malnutrition, and we'll be able to report exact numbers from their data. Also, the deworming (anti-parasite) medication is a big hit! The parents are thrilled to see the dead worms after the medication is given! One kid had about 60 worms!
And another kid had over 100 worms (they counted them!).

This is going to lead to BIG improvements in their growth and health. We'll measure the kids again later this year to see what kind of growth improvements occurred as a result of this. We received the donations from a very generous organization called Vitamin Angels. They have been fantastic to work with. For places like Pestel these kinds of programs accomplish a great deal for very little money, as you know. You can imagine that the villages are likely to be even more receptive to the campaign when we run it again at the end of this year because of how these seen the tangible results of the medication working. That'll allow us to build on this success and make strides in educational initiatives, for example.

We're also exploring a potential arrangement with a group that works in Haiti called Medika Mamba. They are graciously providing us with a $500 donation of "RUTF" = ready-to-use-therapeutic foods. RUTFs are the mainstay of therapy for severe malnutrition. They have a program to rehab severely malnourished children back to health. The challenge after that will be keeping them out of malnutrition, so if you have thoughts or want to help with that planning, let me know.

I'll plan to pick up the donation in Port-au-Prince on my next trip, and then Sister Fidelis will be piloting the project with one of her nurses. If we find that the program is successful, and if we can come up with a sustainable way to keep it going, we very well may embark on one of the most pressing and important campaigns for Pestel--malnutrition.

To put modern medicine in a bit of perspective, antibiotics will do very little good in a child with severe malnutrition. Antibiotics help the body fight infection. The key here is that the medications help the body. The body must still ultimately kill the remaining infection.

Post-Earthquake Video by Dr. Fredrick

These videos and photos were taken in early March 2010, and they tell a bit of the story of how the earthquake has affected the rural area of Pestel, Haiti. The PSU-COM Global Health Center has partnered with Variety International, The Children's Charity to begin to address the great and pressing health needs in Pestel.

Thanks to donations by many individuals, businesses, and the hard work of 40 medical students a new health campaign is underway in Pestel to provide Vitamin A and Albendazole (an antiparasitic medication) to all children. We anticipate reaching about 15,000 to 20,000 children with these important medications!

Video from Global Health Scholars Program

This video was produced by Sean Boley, a 2nd year Global Health Scholar at Penn State College of Medicine. Sean published a similarly-themed article in the International Journal of Healthcare and Humanities.

GHSP 2010 San Pablo, Ecuador SWOT Analysis from Sean Boley on Vimeo.

Haiti report 1/30/10

http://www.reliefweb.int/rw/rwb.nsf/db900sid/MUMA-8277PZ/$File/full_report.pdf

Food and shelter remain the priorities for assistance to hundreds of thousands of people in need.

• Health priorities include mobile clinics for first aid, psychosocial support and post-operative care.

Cases of tetanus have been reported. Suspected cases of measles were confirmed as chicken

pox.

• The WASH Cluster is reaching almost 500,000 people a day with water.

• The port has been declared unsafe for incoming ships following an in-depth assessment. Port-au-

Prince airport is operating at peak capacity with an average of 120 incoming flights per day,

although ‘no-shows’ are becoming an issue.

• The Government reports that some 340,000 people have now left Port-au-Prince with the largest

number of arrivals in Artibonite department.

• Crowd control requirements at food distribution sites remain a concern. Inflated prices for food and

other essentials are contributing to rising tensions among the population.

An isolated case of typhoid has been reported.

ACF and Concern are targeting an estimated 40,000 children for treatment of severe acute malnutrition.

Approximately 1,000 children requiring artificial feeding have been identified.

This looks to be a very useful website for raw data:

http://haiti.oneresponse.info

Haiti January 26, 2010

A few updates:

Haiti: Earthquake Situation Report #13

200,000 family sized tents are requested to support the one million people displaced by the earthquake. Only a fraction of the required tents are in country or in the pipeline, according to IOM.

• Tens of millions of ready-to-eat meals are required to meet the needs of 2 million people for 15 days.

• The distribution of assistance continues in Port-au-Prince and other affected areas such as Jacmel, Carrefour, Leogane and Petit Goave. Tents, food, health (post-operative care and epidemiological surveillance), sanitation and hygiene are the priorities for assistance.

From Twitter:

Following Montreal conference, Sec. #Clinton announced agreement was reached on initial steps in long-range plan for #Haiti

From CNN.com

150,000: Latest estimate of the death toll, from the Haitian Health Ministry. The European Union and the Pan American Health Organization, which are coordinating the health-sector response, have estimated the quake killed 200,000 people.
194,000: Number of injured
134: Estimated number of people rescued by international search teams since the quake

90: Percentage of schools in Port-au-Prince that have been destroyed

Urban slums

This is a powerful website that looks at the issues people living in slums (across the world) face:

http://www.theplaceswelive.com/

It's quite well-done.

Haiti news

The Government has declared the search and rescue phase over. There were 132 live rescues by international search and rescue teams.

CNN reports that another man was rescued, 10 days after the earthquake.

The number of people leaving Port-au-Prince is increasing daily. More than 130,000 people have taken advantage of the Government's offer of free transportation to cities in the north and south west. FAO estimates that the number of people leaving cities for rural areas could reach one million, putting pressure on already vulnerable communities.

WHO reports that despite difficult conditions, there are no reported outbreaks of communicable diseases including cholera, measles and rubella.

- There are enough fuel supplies in country for the next two-three weeks until the port is likely rehabilitated to receive new supplies.

From http://www.reliefweb.int/rw/rwb.nsf/db900SID/MYAI-7ZY7VE?OpenDocument&RSS20=18-P

"Starting on the day after the Jan. 12 earthquake in Haiti, major American charities have received donations at the average rate of $1.64 million per hour.

The Chronicle of Philanthropy yesterday released a report indicating donations of $355 million for the period Jan. 13 through Jan. 21. Do the math and it works out to an average of $1.64 million per hour.

Keep in mind these donations are independent of the US government support and this report excludes international donations. Among Christian groups on the COP list, Catholic Relief Services and World Vision were top recipients, with $19 million and $15 million in gifts, pledges, and cash respectively."

http://blog.christianitytoday.com/ctliveblog/archives/2010/01/us_donations_to.html

Updates on Haiti

According to a report this morning by OCHA:

Banks are now opening in Haiti. This is a very important step so that people can withdraw money, and families and friends can transfer funds down to Haiti.

Patients are starting to flood into the Dominican Republic, overwhelming the health capacity in that country.

The security situation in PAP is generally stable, with pockets of violence.

The port is operational but not fully up to capacity. They are currently able to accept about 250 containers per day, with a goal of 350 per day.

UNICEF is on the ground registering displaced children.

Aid is getting through to more and more locations. Water is available at many water points

throughout Port-au-Prince but quality remains an issue.

• WFP has provided around 3 million meals to more than 200,000 people. The goal is to distribute 10 million meals over the next week, reaching 100,000 people a day.

• Tens of thousands of people still do not have access to shelter. The Government is identifying sites for temporary settlements.

• Untreated injuries, infectious diseases and sanitary conditions remain a priority concern to prevent death.

• Some 150 planes are landing daily at the Port-au-Prince airport and another 1,000 planes are

waiting to get in. The road from the Dominican Republic remains the best option for the majority of incoming cargo.

Haiti news

From USAID on Twitter: PaP airport has received flights from: Belgium-Bolivia-Brazil-Canada-Cuba-France-Mexico-Portugal-Spain-Sweden-Turkey-US-Ukraine, & the UN

From the White House:

The USNS Comfort arrived in Haiti today. The Comfort brings a hospital with a capacity for over 1,000 beds on board and has already started to receive patients by helicopter.

The airfield is open for 24/7 operations – 153 flights were expected for today. The U.S. was using 38 of those slots.

• The major focus of military efforts is establishing water distribution sites, and delivering fuel, food, and medicine.
• As of January 20, approximately 11,500 military personnel (2,000 ashore and 9,500 afloat) are a part of the relief effort.
• To date, more than 6,174 Americans have been evacuated.

http://www.whitehouse.gov/blog/2010/01/21/continuing-updates-haiti-earthquake-disaster-response

USAID update on Health in Haiti

On January 15 at 1800 hours local time, four of the five 35-member U.S. Department of Health and Human Services (HHS) Disaster Medical Assistance Teams (DMATs) arrived in Port-au-Prince to commence rapid response medical care operations, as had a 35-member International Medical Surgical Response Team and a 35-member Incident Response Team. The aircraft transporting the remaining DMAT and a Disaster Mortuary Operational Response Team was diverted to Turks and Caicos due to air traffic congestion. The group is scheduled to depart for Haiti later on January 15.

 According to PAHO, at least eight hospitals and/or health centers are unable to function due to earthquake-related damage. Functioning health facilities are overwhelmed, forcing individuals to seek treatment in makeshift areas.
At least 13 countries in North and South America have confirmed the deployment of medical teams, and 24 international search and rescue teams are operating in Haiti, with four additional teams en route.


Health and Human Services (HHS) and USAID are recommending donations to Red Cross and CIDI.org (Center for International Disaster).