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Move from pruning trees in global health to forest management | 

By guest contributor Dave Algoso

Forest Garden
Wikipedia

Global health efforts in the past decade or so have taken an aggressive and largely successful targeted approach to some of the world’s most harmful diseases such as HIV-AIDS, TB and malaria.

With an unprecedented increase in funding for such efforts in this new millennium, the global health sector has made major gains against particular diseases and other health threats. But funding is limited, and has plateaued of late, focusing attention on getting more ‘value for money.’ Many leaders in this field say they are now seeking to identify the “best buys” in global health.

This was the stated purpose of a recent event hosted by the Center for Global Development (CGD) along with Population Services International (PSI), PATH, Devex, and Merck for Mothers which featured experts from those organizations and others. The event was linked to the release of PSI’s Impact magazine issue on “best buys” in global health, which included findings from a survey of global development professionals.

As Humanosphere pointed out, the conversation at the event itself was unfocused. Participants tried to shoe-horn points about systems strengthening into the “best buys” rhetoric, and no one seemed interested in talking about the survey that was ostensibly the basis for the event. Nevertheless, the event served to emphasize the attention that sector experts are paying to health systems.

Global Health Best Buy survey
PSI Impact

Despite the fuzzy rhetoric, it is time to move past targeting the big, diseased trees on the global health landscape to something more akin to comprehensive forest management. Rather than pruning back each threat that arises, we need to cultivate a stronger ecosystem for health. Continue reading

Back to the fuzzy future in global health | 

Analysis

Globe kid
Flickr, woodleywonderworks

The global health community seems at a loss these days, as indicated by two conferences yesterday I web-participated in devoted to coming up with a future game plan for the field. I’ll get to those, but first some context:

I am long-in-tooth enough to remember when ‘global health’ didn’t exist, not by name anyway, before Bill Gates got into philanthropy and when the only ‘Third World’ disease most of us in the West cared about was AIDS.  And we cared only because that disease figured out how to spread beyond its original confines in Africa. Today, it can seem like everybody and their mother wants a piece of the global health bandwagon.

Or they did anyway, when funding for fighting diseases of poverty in poor communities (my definition of global health, which is debatable) was increasing at the rate of Starbucks franchises.

Global health’s golden age began somewhere around the year 2000 and was due in part to the meteoric rise of the Bill & Melinda Gates Foundation. I think it’s fair to say the Seattle philanthropy revolutionized and resurrected many neglected areas of international health by greatly expanding efforts in children’s immunizations worldwide as well as reinvigorating many moribund fields like malaria and tuberculosis research.

But it wasn’t just because of the Gates Foundation that global health took off. The now almost unimaginable toll taken by AIDS in Africa and other parts of the developing world had become intolerable, at least for many AIDS activists, human rights groups and public health experts. Continue reading

Visualizing a vaccine breaking new ground, and chains, in Africa | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

A child in Burkina Faso receives a vaccination against meningitis.
A child in Burkina Faso receives a vaccination against meningitis.
WHO, PATH

One of the biggest obstacles to expanding immunization to the remotest regions on the planet has been that vaccines must be kept refrigerated at low temperatures.

Keeping vaccines cool during their entire trek – from the manufacturer to a ship or airplane to a refrigerated truck down to the guy riding a bicycle with a cooler – is known as the ‘cold chain.’

A new vaccine created by Seattle-based PATH, with help from the World Health Organization and other partners, now indicates it may be possible to break free from these chains.

The vaccine, known as MenAfriVac, was designed specifically for the ‘meningitis belt’ of central Africa – a region that had seen tens of thousands of annual deaths from this disease, not to mention the survivors left brain damaged, deaf or otherwise disabled.

map-meningitis-belt-engSince the new vaccine campaign began, more than 150 million people have been vaccinated and disease rates have fallen significantly. Africa’s so-called ‘meningitis belt’ may soon disappear.

In addition, a new study of the vaccine’s use in the field is being hailed by some as evidence the cold chain may also soon go the way of horse-and-buggy. Continue reading

Science, vaccines and women’s health suffer deadly setbacks in India | 

IndiaclinicFlickr
Flickr, pugetive

If you think the debate over vaccines in the United States can sometimes be a little wacky, take a look at India.

And if you think irresponsible politicking and journalism can’t kill, think again.

Seattle-based PATH, which in 2009 attempted to test the logistics of expanding the use of HPV (human papilloma virus) vaccine in girls to prevent cervical cancer, has been castigated by critics for ‘unethical human experimentation’ – even though the vaccine is hardly experimental – and is now the target of two lawsuits in India.

One politician, capitalizing on the controversy, even called for PATH to be entirely expelled from India.

Meanwhile, the international biomedical research community, including the U.S. National Institutes of Health, and the pharmaceutical industry have suspended more than a hundred clinical trials throughout India because of the government’s new rules that require those running the trials to compensate any study volunteers who later suffer injury or death – whether the injury or death is directly caused by the study or not.

Vivien Tsu
Vivien Tsu

“This has become very harmful,” said Vivien Tsu, a women’s health expert at PATH who led the HPV study in India. “The HPV controversy and the arguments over clinical trials in India have ended up fueling each other in a way that undermines public health, not to mention India’s role in biomedical research.”

Humanosphere has followed the dispute over the PATH HPV study for a few years now. Many perhaps expected the controversy would subside over time as the evidence accumulated to show it was both beneficial and well-intended. Just the opposite has happened. Continue reading

Gates-backed test malaria vaccine is celebrated, half glass full | 

African child with cerebral malaria
African child with cerebral malaria
Mike Urban

An experimental malaria vaccine, made by GSK with backing and support on the research side from the Bill & Melinda Gates Foundation and Seattle-based PATH, has (again) been shown to protect half the children in the study were immunized against malaria.

The results, announced today in Durban, South Africa, are pretty much the same as earlier findings that continue to emerge from a long, ongoing study of GlaxoSmithKline’s RTS,S vaccine.

The scientific gist of the latest findings, as was reported back in 2008, is that the vaccine appears to protect about half the kids from getting sick, its ability to protect drops significantly following vaccination, it requires repeat doses and GSK estimates it will cost a few dollars at least.

Is that a glass half full or half empty? Continue reading

The next big thing (pause) in sex: female condoms | 

Once upon a time, not that long ago actually, most American women didn’t use tampons.

After they had been invented and introduced as a product, it still took some seventy years for them to gain widespread adoption. People are loathe to change their habits when it comes to intimate parts of the body, even when there are obvious health benefits.

That’s what Patricia Coffey, who works at Seattle-based PATH on global health technologies, says when she argues that the female condom, which she helped develop, could be the next big thing in reproductive health.

Billions of male condoms are sold every year, but they put the onus on men to use them, or on women to get their male partners to use them. Sometimes those interactions are fraught with power imbalances or even threats of violence. With the female condom, one of which she brought to the studio to demonstrate, women can be more empowered in reproductive and sexual decision making.

But how much does a female condom cost to produce? Does it detract from sexual pleasure? Does anyone really use this thing, overseas or in the US? One-word spoilers: Too much, no, and yes, according to PATH. Listen to the podcast for the whole story, though, plus a review of the week’s headlines (Tanzanian agriculture, the American Masai warrior, and progressive mental health models in Guinea).

And don’t worry, I edited out the cringe-worthy sex jokes.

Subscribe and rate the Humanosphere podcast on iTunes. Past podcasts are here.

It’s female condom day! Also, it’s ozone day! | 

A female condom fashion show at PATH, 2012
A female condom fashion show at PATH, 2012

Seattle-based PATH is both a developer and big proponent of the female condom, so no surprise it is among the handful of organizations promoting the fact that today is Female Condom Day. It’s also International Day for the Preservation of the Ozone Layer.

Chances are, both milestones will be celebrated equally enthusiastically. Or not.

The female condom was developed years ago to allow women more control over their reproductive health, safety and choice. It’s good in concept but, as has been reported here and there, the reception so far has been fairly poor. Some complain it’s too expensive as compared to the male condom; other say it’s too cumbersome.

There’s no question women need to gain more control over their reproductive health. It’s not yet clear if the female condom is going to be a key method for achieving that.

Bill Gates’ humanitarian plan for world (vaccination) domination | 

Bill Gates vaccine
UN

Bill Gates loves vaccines.

He says so all the time. The media, as well as the social media hipsterverse, regularly report on this love affair, usually cheering along with Gates in favor of the cause of polio eradication — a cause which was advanced recently at a meeting he and other glitterati convened in Abu Dhabi, the world’s richest city.

Gates says the very foundation of his foundation comes from his realization in the 1990s that kids were dying for lack of access to a vaccine we in the rich world take for granted. As a result, boosting vaccination worldwide became the prime mover, the raison d’être, for what would soon be the world’s biggest philanthropy.

Yet few appreciate today just how revolutionary, and unlikely, was the start of this love affair.

Promoting this powerful, fundamental tool for children’s health may look now like an obvious humanitarian thing for a philanthropist to do. But it wasn’t either obvious or that celebrated when the Bill & Melinda Gates Foundation started down this path (pun intended) in the 1990s.

The Gates Foundation’s push for a revolution in immunization was greeted, from the outset, by a weird combination of controversy and apathy. Continue reading