Wednesday, September 7, 2016

The next great pandemic: What will it look like and where will it come from?

This was originally published on Global Health TV on August 23, 2016.
A few years ago, in a survey by epidemiologist Larry Brilliant, 90 percent of epidemiologists said that a pandemic that will sicken 1 billion, kill up to 165 million and trigger a global recession that could cost up to $3 billion would come in the next two generations. Currently, we’re living through three pandemics  HIV, Zika and cholera. What will the next pandemic look like and where will it come from?
Those are some of the questions science journalist Sonia Shah attempted to answer in an event marking the centennial of the Johns Hopkins University’s Bloomberg School of Public Health and in her book “Pandemic: Tracking Contagions from Cholera to Ebola and Beyond,” published earlier this year. The book should be required reading for anyone interested in the future of global health.
Shah spent six years trying to figure out how microbes turn into pandemic-causing pathogens. She looked at the history of pandemics, particularly cholera because it’s one of our most efficient pandemic-causing pathogens. She went to places where new pathogens are emerging to try to figure out what are the political and social drivers that push these microbes into human populations.

Tuesday, September 6, 2016

UN needs to look beyond patents for improving access to medicines

This was originally published on Devex on August 4, 2016.
The lack of access to medicine has become a regular feature of the health landscape in many developing countries. In the West African country where I’ve been spending time lately, stockouts of essential medicines happen regularly, not only in the public sector (where you might expect it) but also in projects well-funded by donors (where you might not).
The World Health Organization estimates that availability of selected generic medicines was only 38 percent and 46 percent in the public sector in low- and middle-income countries, respectively, and a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief.
Earlier this year, U.N. Secretary-General Ban Ki-moon appointed a High-Level Panel on Access to Medicines to assess this problem and come up with some solutions. Specifically, the purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”
But leaks from the panel’s highly secretive proceedings suggest that the secretary-general told the panel to focus on intellectual property and patents to the exclusion of other issues that hamper access to medicine — weak health systems, questionable government policies, a lack of health workers and a lack of resources.
The high-level panel has said that the leaks do not reflect the views of the panel, and that it is still actively working on the report.

Part of the problem, or the solution?

Far from being barriers to access to medicines, patents and intellectual property have improved access as new technologies developed in high-income countries have been licensed or donated to address those in low- and middle-income countries.
Over the past decade, governments across Europe and North America have devoted big resources to encouraging research on technologies for developing countries. In parallel, pharmaceutical companies have worked through a network of product development partnerships funded by governments and philanthropists to apply skills, expertise and knowledge from the commercial sector to diseases where there is no realistic prospect of shareholder returns. The quid pro quo is that the companies retain their intellectual property for use in markets where governments and insurers can provide that return.  
In 28 interviews on this issue commissioned as part of an ongoing series of reports on access to medicines on Health Issues India, with public health officials, academics or advocates in Brazil, Kenya and Senegal, only one of them (who identified themselves as an AIDS activist), in Brazil, identified patents as a problem. Several of them made the point that patents were not the problem or that patents were actually part of the solution.
A number of these public health experts said that patents are indispensable to promoting lifesaving medical research. If companies couldn’t protect their inventions through intellectual property laws, they’d have little reason to take the enormous risks involved in drug discovery.
Patents not only foster pharmaceutical innovation, but also inhibit counterfeiting and fake drugs, which are widely recognized as serious barriers to access to high-quality drugs.

Potential models 

There are many other barriers to access to medicine. In Kenya, the two most common barriers mentioned were weak health systems and cost of medicines and doctor consultations. Other reasons included late diagnosis and substandard drugs.
In Senegal, three public health officials identified the cost of doctor visits or user fees for diagnostics as the major impediments.
The hearings that the panel ran earlier in the year in London and in Johannesburg, South Africa, suggest that it is ignoring new public-private agreements on access which might address future problems over patent-protected health discoveries.
For example, four pharmaceutical companies in Kenya are selling treatments for noncommunicable diseases at prices far below those charged in Europe and North America as part of major agreements with governments and health providers. These agreements — much lower prices for those who can afford less, combined with a long-term commitment to high-volume treatment — could be models for the future.
One example is AstraZeneca’s Healthy Heart Africa program that, in its first year, conducted one million hypertension screenings in Kenya, opened over 250 health facilities, trained over 2,600 health care workers across 21 counties, diagnosed close to 150,000 patients with high blood pressure and started treatment for 25,000 patients. The program aims to treat 10 million people with hypertension in Africa over the next 10 years.

Call for change

One of the biggest barriers to access to medicines is lack of resources, particularly developing countries’ own funding of the health of its citizens (which is where most of the funding should be coming from).
In 2001, African leaders met in Abuja, Nigeria, and pledged to allocate 15 percent of their national budgets to health. The 2015 DATA Report weighed in on the extent to which African nations are meeting their own health needs. Between 2011 and 2013, just eight of the 47 countries for which there was data available spent 15 percent or more on health: Uganda, Rwanda, Malawi, Swaziland, Nigeria, Ethiopia, Liberia and Togo (based on data from the WHO). Twenty countries did not reach even the 10 percent level.
Until that changes, and the U.N. looks beyond patents for real solutions, access to medicines will continue to be a problem.

Friday, September 2, 2016

Controversy brewing over the greatest barriers to access to medicine

A worker selects medicine from the MEDS (Mission for Essential Drugs and Supplies) warehouse in Nairobi. MEDS is jointly owned by the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya. Photo: Bedad Mwengi

This was originally published on Global Health TV on July 16, 2016.

In comments last week at the International AIDS Conference in Durban, South Africa, UN Secretary General Ban Ki-moon said four things deserved credit for getting the AIDS pandemic under control — people living with HIV, biomedical companies, generic medicines and international finance.

But despite his gratitude to biomedical companies and generic medicines, the secretary-general is overseeing a process that threatens to undermine those companies' ability to improve access to medicine in developing countries.

The World Health Organization says an estimated 2 billion people (27% of the world’s population of 7.5 billion) lack access to essential medicine, most of them in Africa and Asia, but a full three-quarters of the world’s population (around 5.5 billion) have no access to proper pain relief treatment.

To address this staggering problem, the Secretary-General set up a High-Level Panel on Access to Medicines earlier this year. The purpose of the panel was “to review and assess proposals and recommended solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.”

Sounds like a great and noble idea, right? But some expert commentators say the panel is on track to do more harm than good because of its terms of reference.

Thursday, September 1, 2016

Kenya starts to shift focus to chronic diseases while not relenting in HIV fight

A patient at a rural health camp in Mwae County, Kenya has his blood pressure checked as part of a full physical exam. If he needs hypertension treatment, he will get it as part of the cost of the camp. Photo: Bedad Mwangi

This was originally published on Global Health TV on June 28, 2016.

For some time, huge disparities between global health spending and the global disease burden have raised concerns that this funding was not being allocated based on the evidence. That is, money was not always going where the disease burden was greatest.

The Institute for Health Metrics and Evaluation (IHME) has pointed out that the disparities are most extreme in HIV/AIDS on the high end and non-communicable diseases (NCDs) on the low end.

As the toll from communicable diseases like AIDS and malaria decline and people live long enough to get NCDs, we need to invest more in fighting NCDs (also called “chronic diseases”) and reduce these glaring disparities between global health spending and disease burden. Countries like Botswana, Eritrea, Kenya Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia — all countries that increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS — now have to pivot to NCDs without taking their eyes off of HIV.

Kenya is an excellent case in point.

Monday, August 29, 2016

A Christian warrior for health takes on chronic disease after battling AIDS

Dr. Samuel Mwenda after receiving the award as the 2016 Christian International Health Champion.

This was originally published on the Huffington Post on June 21, 2016.

In Kenya, non-communicable diseases (NCDs) such as cardiovascular and respiratory disease, diabetes and cancer used to be quite rare, because communicable diseases like AIDS and malaria were more likely to kill you first. That is why life expectancy peaked in 1987, and then went down in the 1990s, as AIDS made its presence felt.

But since about 2002, as more Kenyans have gotten AIDS treatment, life expectancy has started going up again and, if current trends continue, Kenya will return to its historic peak of 60 years in 2017, according to a World Bank blog.

That’s great news. But it also means many Kenyans are surviving AIDS only to live long enough to be killed by NCDs. Annually, 28 million people die from NCDs in low- and middle-income countries like Kenya, representing nearly 75% of deaths from NCDs globally. Health programs, therefore, must turn their attention to this new pandemic without losing focus on the existing one (AIDS). This scenario is playing out not only in Kenya but also in Botswana, Eritrea, Malawi, Mozambique, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zambia. All of these countries increased their treatment coverage by more than 25% between 2010 and 2015, according to UNAIDS.

Dr. Samuel Mwenda is a seasoned veteran of campaigns against both pandemics. For 13 years, as the general secretary and CEO of the Christian Health Association of Kenya, a network of Protestant church facilities in Kenya, he has led CHAK’s comprehensive approach to HIV/AIDS prevention, care and treatment. Kenya is now considered an AIDS success story, with CHAK making a significant contribution to that success. UNAIDS says that Kenya is one of the countries “showing the most remarkable progress in expanding access to antiretroviral medicines and reducing the number of new infections.”

"Millions Saved" shows that global health programs can achieve success

This was originally published at Global Health TV on May 24, 2016.

If you are reading this article, you probably already believe in global health, and its ability to improve the quality of life and save lives. Every month we tell some of these stories here at Global Health TV.

But some people do not believe that global health programs work or, perhaps, are just indifferent to that fact. The Kaiser Family Foundation recently released a survey of the U.S. general public that showed that the visibility of U.S. global health effort are declining – only 36% have heard a lot or some about U.S. efforts in the past year, down from 57% in 2010.

That’s why books like “Millions Saved: New Cases of Proven Success in Global Health,” written by Amanda Glassman, Miriam Temin and a team at the Center for Global Development, are so important. They provide us with specific examples of global health success that they culled from more than 300 examples of rigorous impact evaluations, and explain why there were successful.

“Around the world, people are benefitting from a global health revolution,” wrote Glassman and Rachel Silverman, both of the CGD, in a blog of the British Medical Journal (BMJ). “More infants are surviving their first months of life; more children are growing and thriving; and more adults are living longer and healthier lives. This amazing worldwide transformation begs several questions: What, specifically, are we doing right? What are the policies and programs driving the global health revolution from the ground up? Or put more simply, what works in global health, and how do we know?”

Thursday, May 12, 2016

In West Africa, progress on family planning but millions not treated for HIV

Women gather for the launch of the national family planning campaign in a low-income neighborhood of Bamako, Mali in April.
This was originally published on Global Health TV on April 26, 2016.

BAMAKO, Mali — Last year, there were several reports of how West Africa, after decades of seriously lagging behind the rest of the world (and Africa) in family planning, was finally starting to embrace it. IntraHealth International covered this topic extensively on its Vital blog, and I wrote about my own views of family planning in Mali here at Global Health TV.

Senegal, in particular, emerged as a family planning leader in West Africa and provided hope for the rest of the region. The three main reasons for Senegal’s success were strong political will, better coordination and collaboration and innovative approaches, according to Babacar Gueye, IntraHealth country director in Senegal.

New programs here in Mali, like Keneya Jemu Kan (USAID Communications et Promotion de la Santé, in the Bambara language), are making a major push to increase health indicators beyond the anemic progress of the past three decades. For example, the percentage of married women using any modern method of family planning in Mali has only increased from 1.3% in 1987 to 9.9% in 2013, and Keneya Jemu Kan is working to bend that rate upwards. (Full disclosure: I work as a consultant for Keneya Jemu Kan).

But a disturbing new report from Médecins Sans Frontières (MSF), or Doctors Without Borders, claims that similar progress is not being made in HIV/AIDS. On the contrary, MSF claims that millions of people in West and Central Africa are being left out of the global HIV response despite globally agreed goals to curb HIV by 2020, and is calling on the international community to develop and implement an urgent plan to scale up antiretroviral treatment for countries where critical medicines reach fewer than one-third of the population in need.