World Health Organization


Guest post: Drug prices hurting Russia’s battle against HIV, hepatitis | 

By Natalie Flath, aka Natasha, a health advocate and activist based in St. Petersburg, Russia.

Andre Scvorstov protests outside the Russian headquarters of drug-makers Roche and Merck with sign: “Merck, You are Reducing the Russian Population.”
Andre Scvorstov protests outside the Russian headquarters of drug-makers Roche and Merck with sign: “Merck, You are Reducing the Russian Population.”
Natalie Flath

St. Petersburg, Russia — On a morning walk down Dostoevsky street here in Russia’s second largest city, with my head phones on to block out the sounds on the street, I try to catch up on the news around the world before I start the work day.

“Euromaiden protests in Kiev.” Hey, that’s where my babushka was born.

“University students crowd the streets of Caracas.” That’s where my mom was born.

“Policeman kills an ex-soldier in Tacoma.” That’s where I was born.

Less noticed are these recent news items:

The Guardian WHO calls for access to hepatitis C drugs

NPR WHO calls for high-priced drugs for millions with hepatitis C

FT Price of hepatitis C drug attacked

Many people are, of course, paying attention these days to the unrest and conflicts in Ukraine, and perhaps most are aware of Russia’s ongoing battle with high HIV rates. But few have paid much attention to the needs of the many thousands of residents in this city, not to mention the 150 million people worldwide, infected with hepatitis C – and how the marketplace approach to this global health need is failing.

I’ve been working with St. Petersburg civil society, two grassroots NGOs, for almost 18 months now. I got this gig from first networking with other organizations while still working in Seattle doing biomedical HIV prevention research. After volunteering one summer to work here with HIV-positive children in a tuberculosis sanitorium, I decided to reach out to activists.

That was before people were paying much attention to Russian activists, other than maybe the outspoken punk rockers Pussy Riot, and before the Ukrainians kicked out their president and Russia annexed Crimea.

What I was focused on was the fact that Eastern Europe and Central Asia, a territory mixed with high- and middle-income countries, is experiencing one of the fastest growing HIV and TB epidemics in the world. I was curious to dig deeper into the faces behind the numbers, tap into my Eastern European roots, and discover all the hype about the grassroots movement.

St. Petersburg is a big, urban city and perhaps not your typical rural village that the term “global health” seems to evoke – but what’s happening here deserves as much attention as the iconic poor, rural village in Africa.

My coworker and HIV-positive friend, Andre, showed me his new tattoo – an angel of death sprawling over his liver.

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Global health advocates celebrate polio milestone despite disease resurgence | 

Pakistani policemen stand guard as a health worker gives a child a polio vaccine in Karachi, Pakistan, Sunday, March 9, 2014.
Pakistani policemen stand guard as a health worker administers a polio vaccine in Karachi, Pakistan, March, 2014.

This week, the World Health Organization certified that India and Southeast Asia was ‘polio free.’

Significant progress has been made against this crippling disease, with 80 percent of the planet now free from polio thanks to an aggressive global vaccination campaign largely led for decades by WHO, UNICEF, Rotary International and more recently supported – both financially and from the bully pulpit – by the Bill & Melinda Gates Foundation.

There is indeed cause for celebration, but also alarm.

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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.

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

Visualizing the global rise of cancer | 

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

World Cancer Cases

The World Health Organization this week released its World Cancer Report, generating headlines such as:

NPR  Cancer Cases Rising At An Alarming Rate Worldwide

CNN WHO: Imminent global cancer ‘disaster’ reflects aging, lifestyle factors

Global cancer cases are rising mostly due to population growth and the fact that more people are living into older ages in low- and middle-income countries.

Experts warn that in countries with few resources, expensive chemotherapy is rarely an option, and stress that cancer prevention is the most cost-effective approach to combat the rising toll of this disease in these settings. Tools to prevent cancer range from reducing tobacco use through tighter regulation, to human papillomavirus (HPV) vaccines to prevent cervical cancer, and hepatitis B and C vaccines to prevent liver cancer.

In today’s post, we will use data visualization tools based on the Global Burden of Disease (GBD) Study 2010 to visualize these changes in greater depth, looking at trends in different types of cancer over time and comparing patterns across age groups and countries. Continue reading

The slowly bleeding and diminished champion of global health, WHO | 

Most folks in the global health community say they they fully support the mission of the World Health Organization and then often complain — usually privately, but sometimes publicly — about how horribly bureaucratic, risk-averse and cumbersome it is.

This week in Geneva, as most people I’m sure have not noticed, is the 66th meeting of the World Health Assembly in which WHO member states and organizations discuss how best to prevent the spread of threats like pandemic flu, the challenge of polio eradication, progress made against many childhood diseases and basically try to set the global health agenda for the future.

Margaret Chan
Margaret Chan

“In these troubled times, public health looks more and more like a refuge, a safe harbor of hope that allows, and inspires, all countries to work together for the good of humanity,” WHO Director General Margaret Chan, in her opening statement.

That sounds great, except for a few disturbing signs — the declining financial support for the WHO to get us all working together and a shift away from a focus on infectious diseases to the latest fashion in global health, non-communicable diseases (like heart disease, diabetes, high blood pressure and so on).

Laurie Garrett, a journalist-now-expert at the Council on Foreign Relations and one of the world’s leading commentators on global health, sees this funding shift at WHO away from infectious disease as troubling:

“Overall, the proposed WHO 2014-15 budget offers startling changes in the mission and direction of the agency, pushing it significantly away from infectious diseases, HIV, TB, malaria, and outbreaks, and towards addressing disabilities, diabetes, heart disease, cancer, and aging…. The tuberculosis cuts are especially mysterious, as the numbers of individuals worldwide getting treatment have increased substantially over the decade, but so has incidence of multi-drug resistant TB. “

More worrisome overall, Garrett writes in the second installment of her coverage of the World Health Assembly, is the decline in funding for WHO that has forced the tough choices and cutbacks.

While there has been a substantial increase in the past decade for global health funding overall, with the growth of private donors like the Gates Foundation as well as the creation of multi-lateral funding mechanisms like the Global Fund to Fight AID, TB and Malaria, many experts are concerned that the shrinking clout and influence of WHO — as goofy as it can be — risks undermining the primary vehicle needed to globally set global health policy.

Here’s a nice overview of what’s going on by Tim France, at Inis Communications, along with this graphic depiction of the WHO budget:

WHO budget
Inis Communications

Malaria is a coiled spring | 

Malaria Mosquito
Flickr, ACJ1

The world has made great strides against malaria, bringing down the estimated global death toll from more than a million — mostly children — to about 650,000 per year today.

That’s been done through a concerted and diversified strategy supported by the international community, through the Global Fund to Fight AIDS, TB and Malaria, Roll Back Malaria, the President’s Malaria Initiative … the list goes on, and on. Countless organizations, public as well as private, have helped distribute hundreds of millions of insecticide-treated bednets, anti-malaria medications, conducted spraying campaigns and worked on a number of fronts to achieve these major gains.

But the situation remains precarious, says one of the world’s leading malaria experts, and malaria today is perhaps  best thought of as a coiled spring held down under pressure.

WHO's malaria chief Dr. Robert Newman describes the massive, mostly hidden, burden of disease
WHO’s malaria chief Dr. Robert Newman describes the massive, mostly hidden, burden of disease

“In one year, if we don’t keep up, we could easily undo this past decade of progress,” said Robert Newman, director of the global malaria program at the World Health Organization. Newman was in Seattle recently and gave a talk at the University of Washington describing the current state of affairs in the battle against malaria. “I’m concerned that we may not be keeping up.” Continue reading

WHO says it has not been bought off by the food and beverage industry | 

Flickr, su-lin

A month ago, some investigative reporters at Reuters did a big expose article contending the World Health Organization had been compromised in its efforts to combat non-communicable diseases — aka NCDs like obesity, diabetes and heart disease — by allowing the food and beverage industry too much influence over its public health initiatives.

Here’s a rebuttal from WHO Director-General Margaret Chan ‘setting the record straight,’ which was issued on Monday. Continue reading

We must end polio – if only so Bill Gates can talk about something else | 

That sounds flip. But it’s not meant to undermine the global campaign to eradicate polio or (continue to) irritate the media folks at the Gates Foundation. It’s meant to underline the frustration I assume Bill Gates and many other advocates of this important global health goal must feel, even if they don’t say so.

News analysis (of sorts)

Today, at the United Nations, Bill Gates, heads of state from the polio-plagued countries Pakistan, Nigeria and Afghanistan, the head of the UN, the fiesty chief of the World Health Organization and other ‘global luminaries’ today repeated the call to push on with the ongoing effort to rid the world of polio.

UN Secretary-General Ban Ki-moon said that the world is at a decisive moment and that he has made polio a “top priority” for his second term.

“Failure to eradicate polio would be unforgivable…. Failure is not an option,” said Dr. Margaret Chan, Director-General of the World Health Organization. India was recently declared polio free, a major achievement for the campaign.

Gates Foundation

Bill Gates and Jeff Raikes in Nigeria for polio vaccination

“The evidence is clear: if we all do our part, we can and will end this disease. But we must act quickly and give ourselves the very best chance to succeed,” said Gates, who had earlier explained on his personal blog why he flew 3,000 miles to speak for three minutes at this somewhat predictable event. “When we defeat polio, it will motivate us to aim for other great health and development milestones.”

Yeah, yeah. Same old stuff. But that last statement by Gates is key.

Chances are, this particular dog-and-pony show among all the other UN dog-and-pony shows — despite the alleged luminaries — may get only passing notice because, well, most people don’t really care about polio. That’s why they bring out luminaries – to get you to pay attention.

(NOTE: The first news report I saw on this gathering of luminosity was an AP story in which the reporter at the polio event asked Gates what he thinks of the new Windows 8 operating system. Gates said, “Very exciting.” No word if the journalist asked about polio….) Continue reading