Polio vaccine switchover: An untold success story in global health

Syed Latif, a polio vaccinator and activist, hands out polio information at the Mansehra Polio Resource Center in Mansehra, Khyber Pakhtunkhwa Province of Pakistan. Photo: Mansehra Polion Research Center.

This was originally published on Global Health TV on November 28, 2017.

In April 2016, something extraordinary happened in global health. Thousands of community health workers in more than 120 countries — from African villages to the Himalayas to the Pacific Islands — all mobilized and synchronized their efforts to switch from one oral polio vaccine to another. Any slip-ups could have resulted in creating more “vaccine-derived” poliovirus cases at a moment when we are down to our last few cases of polio.

The fact that many children receiving such oral vaccines were living in areas of high conflict and low development (which means low levels of health infrastructure) made the accomplishment all the more remarkable.

The feat was accomplished in a single day (each country was told to pick one day within a two-week period in April 2016 to make the change).

The story of this amazing synchronized switch constitutes an untold global health success story and can be told with the backdrop of the current number of wild poliovirus type 1 cases down to only 15 — 10 in Afghanistan and 5 in Pakistan. The polio eradication community had hoped that we would be down to zero by 2017. Now they are hoping it will happen in 2018.

Suelen and her family: A Brazil child health success story

Ricardo, Ana Luiza, Suelen and Luis Ricardo in their newly renovated home in Nova Iguaçu, Brazil. Ana Luiza has a successful food truck and is going to law school but still doesn't feel middle class. Photo: David J. Olson

This was originally published on Global Health TV on October 31, 2017.

NOVA IGUAÇU, Rio de Janeiro State, Brazil — In 2012, Suelen hit rock bottom. She was living in extreme poverty with her husband and young son in a dilapidated house with a roof that was leaking water. While she was pregnant with her second child, her husband left her. When that child, Ana Luiza, was born, she was sick with pneumonia and asthma.

Suelen was at her wit’s end. Every day was a struggle. She made a living selling empanadas out of a canvas tent here in this city of 800,000 about 40 minutes from downtown Rio de Janeiro. “I was working all the time every day just to pay for food for the next day,” said Suelen. “I didn’t think about the future, just how I was going to eat tomorrow.”

Today, the situation of the family is the reverse of what it was five years ago. The health and wealth of the family is thriving. They have a highly successful food truck (that is expanding to home delivery). The children are going to good schools. And Suelen is going to law school so she can defend the rights of other black women who are being oppressed.

10 lessons we've learned from AIDS that we can apply to chronic diseases

An assistant at the Etoug-Ebe Baptist Hospital, a subsidiary of the Cameroon Baptist Convention Health Services, takes a blood sample of a patient participating in the Novartis Access program to fight non-communicable disease. Photo: Anne Mireille Nzouanekeu

This was originally published on the Huffington Post on October 30, 2017.

Communicable diseases like HIV/AIDS and malaria have taken a terrible toll on Kenya and other African countries over the last 20 years. In 2010, an estimated 51,000 Kenyans died from AIDS but that number has declined steadily, to 36,000 in 2016. Kenya is now considered an HIV success story. The same is true in many other countries.

Now there is a new epidemic of non-communicable diseases (NCDs) that is rising just as the world is starting to get a handle on communicable diseases, according to the Institute for Health Metrics and Evaluation. The Institute reports that the largest contributors to the loss of healthy life are now high blood pressure, smoking, high blood sugar and excess body weight.

But Dr. Samuel Mwenda, who knows a thing or two about both epidemics, believes there are lessons we have learned in the fight against communicable diseases that can now be applied to NCDs. Mwenda is general secretary and CEO of the Christian Health Association of Kenya (CHAK), a network of Protestant health facilities in Kenya. CHAK now supports 46,000 people living with HIV with antiretroviral therapy, representing about 9 percent of the total number of patients nationally.

In 2015, CHAK turned its attention to NCDs: With the support of Novartis Access, it began offering a portfolio of 15 products to treat cardiovascular disease, diabetes, respiratory illness and breast cancer at a price to governments, NGOs and other institutional customers not to exceed $1.00 per treatment per month. Since then, Novartis Access has also started working in Cameroon, Ethiopia, Pakistan, Rwanda and Uganda.

Dramatic global health improvements save lives but new threats emerge

This was originally published on the Global Health TV on September 26, 2017.

Over the last decade, we’ve made great progress against diseases and health conditions that can kill people, especially children under 5, but because of political and budget challenges, we risk backsliding on those gains. And we’re facing a tsunami from health issues that do not always kills us – namely, obesity, conflict and mental illness – but cause poor health.

Those are my take-aways from two major reports that came out this month, one tracking how we are doing against the Sustainability Development Goals, particularly in global health, and the other a scientific study focused solely on global health.

“Goalkeepers: The Stories Behind the Data 2017,” a report from the Bill & Melinda Gates Foundation, was aimed at last week’s United Nations General Assembly. To draw attention to the report, the Gateses held a high-profile event featuring former President Barack Obama. The report touts the many global health advances that have been made but also cautions about the risks of complacency.

Initiatives to expand access to medicine on the rise, but need better evaluation

In Nairobi, Kenya, parents receive prescription medicines for their children as part of a free medical camp operated by Slums Information Development & Resources Centers. Photo: George Onyango, Courtesy of Photoshare

This was originally published on Global Health TV on August 31, 2018.

In the 1990s and 2000s, AIDS activists and other global health advocates started pressuring pharmaceutical companies to share their largesse with low- and middle-income countries (LMICs) by supplying critical medicines for free or at subsidized prices, especially for HIV/AIDS. The pressure was successful, and led to a series of access-to-medicine (AtM) initiatives.

The international community increasingly recognizes that the pharmaceutical industry must play a leading role in improving access to medicines. And apparently pharma companies themselves also acknowledge this responsibility, according to a study published in Health Affairs by a team of researchers at Boston University Department of Global Health. That study found that the number of these initiatives grew from 17 in 2000 to 102 in 2015. The researchers called this “clear evidence” that pharmaceutical companies had responded to calls to increase their commitment to improving access to medicines.

Most access-to-medicine initiatives are poorly evaluated but moves are afoot to change that

This was originally published on The Lancet Global Health Blog on August 11, 2017.

Two decades ago the World Health Organization and health activists were pressuring global pharmaceutical companies to launch more “access-to-medicine” (AtM) initiatives in low- and middle-income countries. The good news: That has started to happen. The bad news: Startlingly few of these initiatives have any idea what kind of impact they are making.

Those are some of the conclusions of a new study, published in Health Affairs in April. A team of researchers associated with the Boston University Department of Global Health discovered that the number of AtM initiatives from 21 companies had grown from 17 in 2000 to 102 in 2015 but they found published evaluations for only seven of them.

From those seven evaluations, the researchers found 47 articles that met their inclusion criteria for evidence, and all of them were published in peer-reviewed journals. They determined that 62 percent of these were low quality, 32 percent were very low quality and 6 percent were moderate quality. None of them were rated high quality.

The bottom line of the study: “Overall, our findings suggest that current efforts to evaluate the impact of industry-led access-to-medicines initiatives are inadequate.”

Teaching brain surgery in Africa: Compelling book reveals neglected area of health

Dilan Ellegala (left), the central character in "A Surgeon in the Village," supervising brain surgery in Tanzania. Photo: Tony Bartelme

This was originally published on Global Health TV on August 3, 2017.

“In early 2010 Bill Hawkins, then executive editor of the Post and Courier in Charleston, South Carolina, told me, ‘I met this crazy brain surgeon who opened a guy’s head with a wire saw in Africa. Check him out. Maybe we’ll send you to Tanzania.’ Not many reporters get such an invitation, but thanks to Bill, I was soon on my way.’”

So writes Tony Bartelme in “A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa,” an informative and highly engaging book about a neglected area of global health – the dearth of surgeons in low- and middle-income countries. The book, published in March, is based on hundreds of hours of interviews that the author conducted in the U.S. and during five trips to Tanzania between 2010 and 2015.

When I started reading this book, I approached it as an obligation – something I had to do to inform myself, and possibly my readers, about an area of global health I knew nothing about.

But to my great surprise, I not only found it informative, I enjoyed it. The book is written in short chapters and in more of a novelistic style than most pieces of non-fiction. What I thought would be a chore turned into a pleasure. Perhaps that is because Bartelme is an experienced journalist who knows how to tell a good yarn.