World Health Organization Archives - Humanosphere

World Health Organization

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

“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:

: Inis Communications

FILED UNDER: Basics, World Health Organization

April 25, 2013 | 2:22 PM | By Tom Paulson |

Malaria is a coiled spring |

: 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

“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 →

FILED UNDER: Health, malaria, Robert Newman, World Health Organization

November 20, 2012 | 1:47 PM | By Tom Paulson |

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 →

FILED UNDER: Basics, Politics, food industry, Margaret Chan, non-communicable diseases, World Health Organization

September 27, 2012 | 11:55 AM | By Tom Paulson |

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 →

FILED UNDER: Health, Afghanistan, Bill & Melinda Gates Foundation, Bill Gates, eradication, Nigeria, Pakistan, polio, United Nations, World Health Organization

May 24, 2012 | 11:26 AM | By Tom Paulson |

A(nother) polio emergency, perhaps the final one |

UNICEF

Child receives polio vaccine

The world is close to eradicating polio but this infectious disease has a tendency — like the whack-a-mole game — to pop up just when you think you’ve got it put down.

The polio eradication campaign has been quite successful, getting rid of endemic polio in all but three countries: Nigeria, Afghanistan and Pakistan. But due to major increases in polio lately in these three countries, and some spill-over exportation of the disease into neighboring countries, the World Health Organization today officially declared a polio emergency. Continue reading →

FILED UNDER: Health, eradication, polio, World Health Organization

May 16, 2012 | 11:35 AM | By Tom Paulson |

WHO report highlights chronic diseases & lack of global health strategy |

Flickr, Erebos

Analysis

The World Health Organization has published its annual health report for 2012 and this year decided to “put the spotlight on the growing problem of non-communicable diseases.”

Here are some of the news stories spawned by the WHO report:

Reuters/MSNBC Heart disease, diabetes spreading to poor regions

AP/Washington Post Diseases of affluence are spreading worldwide

Voice of America Non-communicable diseases cause most deaths worldwide

UN Dispatch The Good, Bad and Mixed News in World Health Statistics

This focus on the NCDs, (non-communicable diseases) is certainly legitimate since they are, as a general category, major contributors to the global burden of disease. But another way to look at this, of course, is that the WHO report has turned the spotlight away from other diseases.

Why the focus this year on diabetes, heart disease and other chronic illnesses? Why has the attention been shifted away from the still-expanding HIV-AIDS pandemic, the threat of drug-resistant tuberculosis or malaria?

One easy answer is that the WHO annual statistics report always picks a theme and this year’s flavor is chronic disease.

Before, it was AIDS. Another year, it was TB or malaria. To WHO’s credit, one year the organization focused the attention on the much-neglected problem of mental illness worldwide. Another time, the spotlight was on deaths from accidents (which is a much bigger contributor to global mortality than you might think).

All of these are legitimate health concerns. But the nagging suspicion — or perhaps just inkling — you get from all this is that the shifting spotlight indicates no real strategy for global health.

I’ve long been disturbed by the lack of a clear, comprehensive strategy in global health — as well as the lack of a clear definition of what the hell we even mean by global health. Many tell me to lighten up, that the diversity of opinion and a de-centralized approach to the fight against disease is actually a good thing.

I’m not so sure, and I’m not alone in my uncertainty. See this post from the Center for Global Development’s Amanda Glassman and Kate McQueston Making Priority Setting a Priority for Global Health, which offers links to other related posts.

Update: Here is Amanda’s more recent perspective published in the British Medical Journal.

Kate Kelland of Reuters earlier this week also did a great report on the ‘squishiness’ of the WHO health statistics and the debate over how best to measure the burden of disease globally. It’s worth a read and mentions a group of Seattle number-crunchers, at the UW’s Institute for Health Metrics and Evaluation (e.g. a recent report on malaria) who are trying to bring more reliability and perhaps order to all this.

But, clearly, it’s not just a matter of improving the numbers. The international community has no consensus on what we mean by global health, let alone consensus on which problems deserve the most attention and resources.

FILED UNDER: Health, annual report, Institute for Health Metrics and Evaluation, non-communicable diseases, World Health Organization

May 15, 2012 | 12:18 PM | By Tom Paulson |

Doctors Without Borders criticizes Gates-backed global vaccine strategy |

Bill Gates at World Health Assembly

The global health strategy to expand childhood immunizations, largely backed by the Bill & Melinda Gates Foundation, is too focused on new vaccines and neglects the fundamental need to improve basic public health and immunization programs in poor countries.

So says Medicins Sans Frontieres (MSF), aka Doctors Without Borders, in a new report issued today by the organization entitled The Right Shot: Extending the Reach of Affordable and Adapted Vaccines.

The medical relief and aid advocacy organization is critical of a new, 10-year, multi-billion dollar “Global Vaccines Action Plan” expected to be adopted by global health leaders at the World Health Assembly meeting next week. The plan is largely funded by the Gates Foundation.

MSF says it favors expanding access to new vaccines — just not at the expense of basic immunizations.

“Twenty percent of the world’s children aren’t even getting the basic vaccines,” said Kate Elder, MSF vaccine policy adviser. The Gates Foundation is driving much of the global health policy decisions around vaccinations, Elder noted, and “Bill Gates’ priority is new vaccines.” The philanthropy’s influence is distorting the agenda to favor new vaccines over basic improvements, she said.

Daniel Berman, MSF’s deputy director for access, cited a recent initiative to distribute a new $7-per-dose pneumococcal vaccine in DR Congo in the middle of a measles outbreak. Why, Berman asked, are donors and health agencies pushing this new, expensive vaccine in Congo if Congolese children still aren’t getting a 30-cent measles vaccine?

The approach appears aimed more at supporting drug industry desires to promote new products than at finding the most efficient and sustainable means for fighting the diseases of poverty, he said.

UNICEF

The Right Shot may be a new report from MSF, but it is hardly a new criticism of the Gates Foundation’s approach to vaccines. Others have criticized the philanthropy before for a tendency to place industry interests above the concerns of poverty advocates.

The Seattle philanthropy, though contacted in advance of the report’s release, declined to comment or respond today to the MSF criticism – or to the group’s call for a new global strategy with more emphasis on beefing up basic, routine immunizations. The organization sponsored by the foundation to promote the new global strategy, the Decade of Vaccines collaboration, also did not respond.

Jeffrey Rowland, spokesman for the Global Alliance for Vaccines and Immunization, GAVI, did respond to the criticism. Continue reading →

FILED UNDER: Health, Bill & Melinda Gates Foundation, Doctors Without Borders, GAVI, Medicins Sans Frontieres, vaccines, World Health Organization

May 8, 2012 | 11:29 AM | By Tom Paulson |

Why we need a new and improved World Health Organization |

The World Health Organization is in a sorry state these days, by most accounts. It seems to have lost its rudder and is reportedly plagued by a lumbering, highly politicized and fractured membership who can hardly get together on anything.

Yet many say the WHO remains critical to our future well-being — if only because the world needs some kind of publicly accountable organization to guide strategy and provide intelligence in our ongoing fight against disease.

Writing in Nature, Laurie Garrett at the Council on Foreign Relations and Tikki Pang, a former policy director at WHO, argue the case for reforming and improving the 64-year-old agency:

The World Health Organization (WHO) is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms.

It’s a good overview of what’s wrong with the WHO and what these two think needs to change. I asked Laurie to further explain why we need the WHO. Now that global health is almost an industry until itself, do we really need this creaky old UN agency?

In an email, she replied:

We desperately need a functioning WHO. Here’s a list of issues that plague us right now, and a viable, breathing WHO should solve. No other global entity can (or will):

- Drug resistance, specifically NDM-1 plasmid control. If we don’t act globally and aggressively 100% of antibiotics will be useless with the decade.

- Global drug safety and integrity

- Pandemic influenza, especially the risk of man-made H5N1 (bird flu).

- Health systems metrics – global measurement standards that donors will back.

- Drug-resistant malaria, specifically artmesinin resistance. We are in a race for time, and need far more aggressive global policies FAST or malaria becomes incurable.