Category Archives: Tom Paulson

Swine Flu viruses - CDC

When pig flu flew

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Once again, critics are claiming public health experts last year hyped the potential threat of a uniquely piggish version of the influenza virus, the H1N1 virus – or so-called swine flu.

This time, however, some of the critics add that the hype was done to benefit the drug industry.

The World Health Organization and other leading health authorities strongly reject the criticism saying they acted prudently given the risk of a deadly pandemic such as the world experienced in 1918.

The truth is likely somewhere in between.

The recent criticism implies that the WHO was unduly influenced to keep fanning the flames by experts with ties to the drug industry. WHO director Dr. Margaret Chan says they were not.

The WHO did over-react to the threat, but hardly because it would help the drug industry sell vaccines and drugs. Part of the problem here is based on how we react to uncertainty and potentially deadly risks.

If the goal is simply to do whatever it takes to reduce risk, why aren’t we also setting up nuclear-tipped rockets to blast killer asteroids given that scientists say it is a near-certainty that the planet will again be struck by one of these things?

Because, on balance, the cost and trouble of doing so seems unjustified given the level of uncertainty about when and where.

An especially dangerous flu pandemic like 1918 is more likely than a killer asteroid, but when and where it will strike is similarly uncertain.

When the H1N1 virus was first discovered in a flu outbreak in Mexico, authorities sounded the alarm because young people had died and the virus contained a unique combination of pig, bird and human flu genes. The experts said a repeat of 1918 was a distinct possibility.

Pandemic. That was the word that got everyone excited. In the excitement, the pharmaceutical industry was exhorted by WHO and other leading health authorities to step up production of anti-viral drugs and vaccines to respond to the looming threat.

But, technically, flu is always pandemic since it spreads worldwide and kills a large number of people – every year.

As this “swine flu” spread worldwide, it became pretty clear early on that the mortality rate in Mexico was unique and due to some factor (perhaps poor health care) other than the virus. The death rates were not out of the norm for regular flu. But, because of the genetic nature of this virus, WHO and others continued to warn that this flu could still turn exceptionally nasty.

When the threat did not materialize, WHO changed its working definition of “pandemic” to remove its own requirement that to label an outbreak as pandemic must involve excessive mortality.

People were still warned that this was something special. Individuals were urged to get vaccinated and agencies stockpiled drugs.

The recent criticism implies that the WHO was unduly influenced to keep fanning the flames by experts with ties to the drug industry. WHO director Dr. Margaret Chan says they were not.

Who knows? But one big lesson here is that you can’t un-ring a bell.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Putting the Gateses’ mission shift in context

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I could really use a pie chart here, showing all the promised slices of international aid that remain missing or get removed as global priorities shift.

In the previous post, I noted Melinda Gates’ clarion call — and her accompanying $1.5 billion philanthropic pledge — for more to be done for women and children’s health worldwide. The Gates Foundation, Obama Administration and other governments or donor organizations appear to be turning more philanthropic and foreign aid attention to the terrible inequity of maternal and child deaths worldwide.

This a very worthy cause, but of course there are many worthy causes. And not all of them are receiving the funding or attention they deserve. AIDS was once the world’s top global health priority, but now it appears that funding for many existing projects aimed at battling the pandemic will remain flat or decline even as the number of those afflicted continues to increase.

Maybe someone should take a hard look at how many members of the G8 kept their previous global health commitments — and whether these new commitments represent true progress or sort of a shell game.

The Gates Foundation claimed this is not so much a shift in focus as an expansion of an existing priority, but most observers did see it as a shift and a new focus. Some also noted that when you decide to emphasize one thing, it often means you de-emphasize something else.

The Gates Foundation has, for example, decided not to renew funding for a number of projects it helped launch years ago looking for an effective AIDS vaccine. The Global Fund for AIDS, Tuberculosis and Malaria is now struggling to merely respond to existing needs — trying to convince donors not to reduce funds and pointing out it needs something like $15 billion merely to keep on pace for the next few years. Meanwhile, people still die from AIDS and HIV still spreads as most still don’t receive the drugs they need to survive and prevent transmission.

This kind of “cause inequity” and mission shift is often shrugged off as inevitable given we do not exist in a world of unlimited resources.

But what is perhaps less excusable is when donors and governments make promises they don’t keep. In her Monday remarks, Melinda Gates noted that later this month leaders of the most powerful nations on the planet will convene in Canada at the G8 summit in Muskoka, Ontario. The Gateses and members of the Obama administration say they intend to especially push for new commitments to invest in improving maternal and child health.

Maybe someone should take a hard look at how many members of the G8 kept their previous global health commitments — and whether these new commitments represent true progress or sort of a shell game.

Side note: I couldn’t find any illustration showing all of the broken promises, but for those who like to think the U.S. does more than others when it comes to foreign aid, below is a bar chart that shows otherwise. We give much less, per capita and as a percentage of our GDP, than most developed countries:

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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What we mean when we talk about women & children’s health

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The Gates Foundation on Monday announced that it planned to give $300 million every year over the next five years, a total of $1.5 billion, to programs that are devoted to improving the health of women and children worldwide. This now becomes one of the foundation’s largest initiatives.

“Women and children have finally moved up on the global agenda and I’m here to tell you that’s where they’re going to stay,” said Melinda Gates, speaking on the same day at a star-studded conference in Washington D.C. called Women Deliver. “Policymakers have treated women and children, quite frankly, as if they matter less than men.”

PHOTO CREDIT: The Humanitarian and Development Partnership Team

My friend Kristi Heim at the Seattle Times wrote a good story that tells you all about the grant announcement so I won’t repeat it.

I had noted earlier that the philanthropy was shifting in this direction – which they claim is not a shift but merely an expansion of an existing priority.

Putting aside the question about whether the Gates Foundation can, in fact, guarantee what will be high on the global agenda (is there a global agenda?), it’s perhaps worth considering if women and children’s health issues really have been neglected as a matter of policy and agenda-setting. And if so, how?

Most global health initiatives that battle diseases like AIDS, tuberculosis and malaria benefit both genders and all ages since the bugs don’t discriminate.

And women, even women in poor countries, tend to live longer than men. So what are we talking about when we say women’s health is a neglected area?

I can’t think of any global initiatives devoted to men’s health but we have a number of organizations like CARE, Planned Parenthood and the Global Fund for Women focused on women’s health issues worldwide.

We have even more organizations devoted solely or mostly to children’s health such as Save the Children, World Vision or the United Nation’s Children Fund (aka UNICEF).

The Gates Foundation’s biggest project, GAVI, gets vaccines out to children worldwide.

And women, even women in poor countries, tend to live longer than men. So what are we talking about when we say women’s health is a neglected area?

We’re mostly talking about childbirth.

“When people talk about women’s health, they are often talking about maternal health,” said Emmanuela Gakidou, professor of global health at the UW’s Institute for Health Metrics and Evaluation. Women who survive childbirth may or may not live longer than men generally, Gakidou said, but the number of young mothers and children in poor countries who die from complications associated with childbirth is hugely disproportionate when compared to developed countries.

“. . . the most fundamental need of women in poor countries, she said, is a functioning health system with nurses, midwives and doctors.” — Amy Hagopian, UW professor of global health

For example, she said, Italy sees an average of four mothers die in childbirth for every 100,000 live births while in places like Afghanistan or Malawi it is more like one maternal death out of every 100 births.

“These deaths are entirely preventable,” Gakidou said, adding that the new momentum on this front is because more people recognize “that women should not be dying while they are trying to have a child.”

Amy Hagopian, also a UW professor of global health, said she welcomed the Gates Foundation’s increased interest and investments in maternal health. But the most fundamental need of women in poor countries, she said, is a functioning health system with nurses, midwives and doctors.

“Women are dying because of the lack of these health services,” said Hagopian, adding that the Gates Foundation has so far shown little interest in funding efforts aimed at improving health services. “We already have lots of NGOs working on women and children’s health. Adding more people running around Africa claiming they have come to improve women’s health won’t solve the fundamental problem.”

Hagopian was among a number of people who recently advocated for and won passage of a resolution at the World Health Assembly in Geneva aimed at improving health worker retention in poor countries.

PHOTO CREDIT: The Humanitarian and Development Partnership Team (HDPT) under a Creative Commons Attribution 2.0 Generic License.

The Humanitarian and Development Partnership Team unites all organizations working to alleviate the humanitarian and development crisis in the Central African Republic: United Nations agencies, the Red Cross Movement, NGOs and other organizations. For more information, visit About HDPT CAR or email us at info@hdptcar.net

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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India

India rises, leaving the poor behind

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Unlike in China, a leading physician activist says, India’s rising economic tide is not floating many boats to lift the poor up and out of poverty.

India’s rich and middle-class sectors are riding higher, getting richer, says Dr. Jonathan Fine, founder of the Nobel Peace Prize-winning group Physicians for Human Rights, while India’s hundreds of millions of poor people remain firmly anchored to the bottom.

“Things are actually getting worse in many of India’s rural villages,” Fine said on a recent visit to Seattle. The Boston physician spoke Tuesday at the UW to the student-run Global Health Group. Fine was in Seattle to meet with — and recruit volunteers for — a local branch of an organization devoted to assisting India’s poor, Association for India’s Development.

Dr. Jonathan Fine, speaking to UW students

Malnutrition rates tell the story of inequity in India, Fine said. Hundreds of millions of Indians continue to live on semi-starvation diets, he said, despite there being enough food in India to feed everyone and despite India’s overall economic progress.

According to UNICEF, China has reduced its rate of child malnutrition to 7 percent while in India today more than 40 percent of young children are malnourished – a rate worse than in many sub-Saharan African countries.

“Initiatives aimed at improving health and welfare won’t have much effect if malnutrition is not dealt with first,” Fine contended. Hungry people are more prone to illness, he said, and malnourished children don’t learn or develop properly. “The Indian government continues to largely neglect this massive problem.”

Tapoja Chaudhuri, who teaches at the UW’s South Asia Center, and her soon-to-be-doctor husband Sunil Aggarwal (he gets his MD in a week), agreed with Fine’s comments and are, for the same reasons, planning to become more active in efforts to assist India’s poor. Both said the gap between rich and poor in India is growing.

Chaudhuri, who grew up in Calcutta, said there are terrible conflicts raging across many parts of India today due to these entrenched inequities. Though the government portrays the fight as against communist terrorists, Chaudhuri said the conflicts are fueled not so much by ideology but by the disenfranchisement of many poor communities. Government economic policies, she said, tend to focus on large-scale development projects rather than on anything that directly benefits the rural poor.

“It is not at all paradoxical to me that India’s rapid economic growth is accompanied by high rates of malnutrition,” Chaudhuri said. The way India is achieving its overall growth, she said, is by often bulldozing over – figuratively and literally — already impoverished communities.

Chaudhuri plans to work on social justice issues in India next fall while Aggarwal, who plans to someday go there as a doctor, completes his residency at Virginia Mason Medical Center.

MAP CREDIT: Ssolbergj under a Creative Commons License.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Africa

UW Study: AIDS treatment IS prevention

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For the last few years, AIDS experts have been arguing about the claim made forcefully by some Swiss scientists that giving anti-viral drugs to people with HIV also prevents transmission of the virus to others.

While there had been some anecdotal and hypothetical evidence supporting this contention, there wasn’t much hard proof.

A Seattle team of scientists has now provided some pretty solid evidence, reported in the current issue of The Lancet.

Dr. Connie Celum

“We found a 92 percent reduction in transmission among those who went on (drug therapy),” said Dr. Connie Celum, a leading AIDS prevention researcher at the University of Washington and senior author of the study.

Working in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia) with nearly 3,400 couples in which one partner is HIV-infected, Celum’s team followed 349 couples for two years after the infected partner qualified to begin taking anti-HIV drugs (ARVs, anti-retrovirals).

Standard procedure for starting ARVs is based on when the blood level of an immune cell targeted by HIV, known as the CD4 cell, drops below a certain threshold. In most African countries, that threshold is a CD4 count of 200 or lower (normal being from 500 to 1,000).

It’s worth noting, however, that there’s a fierce debate going on right now about whether it makes sense to use a higher threshold (of say 350, as is often done in the U.S.) or to just put people on ARVs as soon as they are infected.

San Francisco’s Department of Health recently recommended that all HIV-infected people should get ARVs no matter what their CD4 count.

Of the couples in Celum’s study, only one of the HIV-infected partners on medication transmitted the virus to her partner as compared to 103 infections transmitted by HIV-positive partners not on ARVs.

Given that the AIDS pandemic is still on the increase and millions of those infected worldwide are still not receiving these life-saving drugs, the UW team’s findings give strong support to the urgent need for expanding access to drugs as an effective means to stop the spread of AIDS. Some experts say the spread of AIDS in Africa could be contained in as little as five years if everyone infected received treatment now.

AIDS activists used to chant “Treatment is Prevention” to make the case that people must be guaranteed access to treatment in order to encourage them to be tested and engage in prevention.

Now, it appears that treatment is not simply a necessary partner to prevention. Science has shown that saving the life of an infected person is also a powerful method for preventing another infection.

MAP CREDIT: Martin23230 under a Creative Commons Attribution-Share Alike license.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Child survival improving worldwide–except in America

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Contrary to many earlier gloomy estimates, researchers in Seattle have found substantial reductions in child mortality worldwide.

They also found the U.S. does far worse than most of the rest of the developed world, including much less wealthy countries like Croatia or Estonia.

“Previous estimates had shown child deaths falling slowly and neonatal deaths nearly at a standstill,” said Julie Knoll Rajaratnam, a global health researcher at the University of Washington’s Institute for Health Metrics and Evaluation. Rajaratnam was lead author of the study published in the current issue of The Lancet.

Annualized rate of decline in under−5 mortality rate (%)

Earlier estimates had shown mortality among children younger than 5 years declining only slowly worldwide over the last few decades, with neonatal mortality largely remaining consistently high in poor countries. The Seattle team decided to take a more in-depth look at a lot more data, analyzing more than 16,000 different reporting systems in 187 countries (census reports, birth histories, hospital records, etc.) and applying some fairly sophisticated mathematics.

Researchers report under-5 mortality in children dropped from 11.9 million deaths in 1990 to 7.7 million deaths in 2010 – a 35 percent reduction in two decades.

They discovered more improvement than had previously been reported, with under-5 mortality in children dropping from 11.9 million deaths in 1990 to 7.7 million deaths in 2010 – a 35 percent reduction in two decades. Many poor sub-Saharan countries showed improvement, such as Ethiopia cutting its child mortality rate exactly in half from 202 deaths per 1,000 live births in 1990 to 101 deaths per 1,000 births in 2010. And contrary to expectations, neonatal death rates are falling even faster.

The primary purpose of the report was to examine how many countries are on target to achieve this portion of a massive international assistance project known as the Millennium Development Goals. Though most Americans remain oblivious to this ambitious project, it has likely helped to focus the international community’s previously highly disorganized and often counterproductive attempts at assistance. Most poor countries are still far from achieving these goals aimed at reducing poverty, improving health, education and general well-being.

Many initiatives, especially over the past decade, have made MDG Goal 4 — improving child survival — a renewed top priority in global health. The Gates Foundation’s largest funded project GAVI, which is aimed at getting basic immunizations to children, is already estimated to have prevented 3-4 million deaths in the last decade.

Though U.S. child mortality rates were not a primary focus of the article, it’s perhaps worth noting this new estimate hasn’t improved our ability to keep kids alive. We still rank way down on the list among developed countries, 42nd place to be precise, below Croatia, Estonia and Hungary.

Thumbnail Photo: USAID

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencer from 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Thailand AIDS Vaccine Trial: Back Story Troubles

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HIV: the AIDS virus

My report on the largest AIDS vaccine trial ever done – and, more importantly, the only such study to show effectiveness against HIV – was published Monday as part of a broader report on where we are at in the search for an effective AIDS vaccine.

The study was done in Thailand, where I went a few months ago at the request of the AIDS Vaccine Advocacy Coalition. Mitchell Warren, director of AVAC, said he wanted an independent journalist to do an assessment of this historic project. His views were featured Monday on Huffington Post explaining the broader significance of the study.

Maybe Mitchell knew ahead of time that this was a controversial story, but I didn’t. I went to Thailand believing the Thai Prime-Boost vaccine trial was just a scientific success story. It certainly was a success, in terms of its stunning results.

But when I got to Thailand, I learned from Thai AIDS activists about some serious problems that could have derailed the whole thing — and may, if not recognized and resolved, impede future progress in AIDS vaccine research.

Basically, the Thai government didn’t really understand that for clinical research to succeed the community has to be convinced of its value and of the need to participate in these studies.

Three young woman volunteers in Thai AIDS vaccine study

This study enrolled 16,000 people, mostly young people, who had to come in to clinics repeatedly to get multiple vaccinations, get blood drawn and subject themselves to a lot of scrutiny. I met some of them; an impressive bunch of young people who recognize the urgent need for an effective AIDS vaccine. But many threatened to drop out during the trial due to lack of adequate community engagement.

Thailand is a democracy, but officials there still have a tendency to tell people what to do. That doesn’t work in proper clinical research and the Thai government discovered this. You can read all about it in AVAC’s report.

A side note: Was this journalism? I think so. Many of my traditional journalist friends tell me that because I was paid by AVAC, this was not journalism. Yet some of these are the same people who think running someone’s blog about their love of cats on the Seattle PI’s web site is something now called “citizen journalism.” I don’t know the answer to the question. I’ll let readers judge for themselves.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Gates adds family planning as top scientific priority

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Earth against the black void of spaceWhen Bill Gates started dabbling at philanthropy back in the 1990s, he initially expressed great interest in population issues. It didn’t really work out. Long story. Let’s just say this was (and is) an especially sensitive issue. People with all sorts of agendas see bogey men coming out of the shadows if anyone ever so much as mentions population control.

But the Gateses are determined people. Perhaps a subtle, indirect approach to family planning will work this time.

Few noticed that a flurry of grant awards given out this week from the Gates Foundation signaled a shift in this direction, a renewed interest in supporting this original philanthropic goal. The Gates program that awarded the grants, previously devoted to fighting disease, for the first time funded research to fight unplanned pregnancy.

Andrew Serazin, Gates Foundation Explorations

Andrew Serazin, Gates Foundation Explorations

“It is a little bit different,” acknowledged Andrew Serazin, a young scientist (and Rhodes Scholar) who helped launch the overall program, known as Grand Challenges Explorations.

On Tuesday, the Seattle philanthropy announced it had awarded its fourth round of 78 grants — $100,000 apiece in “seed money” for all sorts of far-fetched ideas.

The idea behind the Explorations program, Serazin explained, is to support scientific projects that show promise but seem, well, a bit wacky and unconventional – a cell phone app to diagnose malaria; a vaccine that gets into the skin through sweat; parasite-killing lasers; the use of ultrasound as a reversible male contraceptive … to name a few.

Adding “new contraception technologies” as a goal for Explorations fits into the foundation’s broader strategic plans for global health, Serazin said, but he acknowledged it is a bit of a departure from the program’s previous focus on fighting disease. “Issues in family health, like contraception, are becoming more of a focus for the Gates Foundation.”

The Explorations program itself was a shift from the original, larger-scale strategy of the Grand Challenges in Global Health program.

Yes, we’re talking about two Gates programs called Grand Challenges. Stay with me here.

The original one, with lots of money and big grants for grand projects, was launched by Gates at Davos in 2003 to try to direct more scientists to work on developing world problems.

But it came under criticism for allegedly favoring Western scientists with big labs at big institutions.

So the Explorations program was created to make it easier for smaller labs – and developing country scientists – to get funding for new ideas.

So far, Serazin said, about 10 percent of the Explorations grants go to developing country scientists. He said they hope to do better on that score but it will always be the quality of the application – the idea – that counts more than who or where the application comes from.

Nearly 400 Gates Grand Challenge Grants Worldwide

A map of the world showing where the Gates Grand Challenges projects are located.

Click to go to an interactive map of the Grand Challenges projects.

As of Wednesday, the Grand Challenge’s web site (go here for interactive map of grants) didn’t list the new priority – contraception technologies – under the Goals pull-down menu. It is in there, but the link for more info didn’t work. I assume the BMGF web masters, notified of this, will have fixed the glitch by the time most folks read this post.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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Drug safety watchdogs needed worldwide

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Something like 90 percent of all the sick people in the world at any given moment – aka the “global burden of disease” — live in poor countries.

Most drugs and vaccines are made for and used by the rich world. In the last decade, the international community has responded to this inequity with a number of grand initiatives aimed at improving access to many medications in the developing world.

But drugs and vaccines don’t always work the way they are supposed to work. Some are just bad products. Good drugs often vary in performance in different people, or different parts of the world. Many get misused, due to lack of proper diagnoses or lack of basic information. And sometimes the donations are not motivated by the most charitable of impulses.

Drug watchdogs Andy Stergachis and Alex Dodoo

“Some donated drugs are the ones nobody else wants and that drug companies are trying to get rid of,” said Alexander Dodoo, a pharmacologist from the University of Ghana Medical School who is pushing for better monitoring of drug safety and efficacy in the developing world.

Dodoo and a local colleague in this endeavor, UW epidemiologist Andy Stergachis, spoke last week in Seattle to promote the practice of “pharmacovigilance.” Stergachis and his UW colleagues are world leaders in this field (which, frankly, could use a better name) and are already working on this problem in a number of countries in Africa and Asia.

In the U.S., we have an extensive (and expensive) system of clinical testing and regulation that is supposed to assure safety and efficacy — but still often fails.

The anti-arthritis drug Vioxx, for example, was recalled in 2004 after wider use revealed it raised the risk of heart attack and stroke. A batch of the blood-thinner Heparin was recalled in 2008 only after the FDA began investigating reports of deaths and injuries. It turned out that a tainted and counterfeit ingredient had been supplied to its manufacturer, Baxter, by a Chinese pharmaceutical firm. Last fall, nearly a million swine flu shots were recalled when it was discovered they had lost potency.

Such problems have led to the call for a much more robust and aggressive system of “post-market approval” monitoring of drugs – aka pharmacovigilance — in the U.S.

The need is even greater today in the developing world because many poor countries have nothing like the FDA or any kind of system for monitoring the performance of medicines.

Combine this lack of monitoring with the flood of new medications now being donated and the risks increase markedly.

Dodoo told a story about a potent anti-malaria drug, called LapDap, developed by a European drug company and promoted by health officials in Ghana. Once put into wide use, it ended up causing serious side effects. Dodoo said later analysis showed an estimated 20 percent of Africans had a genetic variation that made the drug toxic given their different metabolism. The episode prompted public outrage, he said, and generated mistrust of the government’s anti-malaria campaign.

“We have to recognize that the information about safety gained during drug development (i.e., clinical testing) is always going to be incomplete,” said Stergachis. Today’s major health campaigns are courting disaster, he said, if they expand developing world access to medications without better safety monitoring in those countries.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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globalhealthspending

Two reports on global health funding—increasing, but to what effect?

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Earth against the black void of spaceTwo reports in the last several weeks, both of them in The Lancet, are worth looking at together. One was from Dr. Chris Murray and his data-crunchers at the Seattle-based Institute for Health Metrics and Evaluation, which reported a big increase in global health spending, and another more recent one is from a Georgetown University professor, who says we aren’t spending enough – in the right way — to make a difference.

Murray and his team reported that international assistance spending on health has quadrupled over the last 20 years. That was largely considered good news, except for the fact that some poor countries have decreased their own public spending on health in proportion to how much foreign assistance they receive (Seattle Times).

That’s the bad news part of this trend and it may really be bad, if not kind of sneaky, but the reality is probably a bit more complicated. This is because health, especially in many of these poor countries, is often not solely — perhaps not even primarily – determined by what is spent on health care.

Development assistance for health has increased dramatically (2007 US$/Billions)

This is the point made in the current Lancet by Lawrence Gostin, a Georgetown professor specializing in global health law. Gostin’s argument, (which he made earlier here) notes that the international community still spends a relatively paltry amount on health.

Yes, health spending as foreign assistance is now more than $20 billion annually, which sounds impressive. But Gostin compares this to the $300 billion spent just on agricultural subsidies (aka food aid, in which the U.S. is the main player and many say hurts smallholder farmers while increasing poor country aid dependence) and the $1.5 trillion spent on foreign military ventures.

Put in that context, he notes that foreign assistance on health accounts for about 1 percent. He contends we need a new Global Plan for Justice, in which all developed countries will contribute 0.25% of their Gross National Income to fund a broad spectrum of programs incorporating health improvements together with water, sanitation and many of the other problems that are the “underlying” causes of poor health in poor countries.

This amount, Gostin said, is easily attainable and in line with previous aid pledges made (though not always fulfilled) by rich nations.

Well, okay, here we have another global fund idea (see my earlier post). Gostin may have made his proposal even more confusing by throwing in climate change mitigation as an additional focus.

Chances are it won’t fly. But it’s worth thinking about. Many public health experts say it’s clear that improving health in poor countries is the most cost-effective way to affect a lot of other socioeconomic improvements. If people are healthy, they can work more and provide for their family. If kids are healthy, they learn better. The list goes on. Others focus on the “social determinants of health” and contend the key to improving health is first making more fundamental improvements in basic infrastructure like schools, roads, water and, of course, government.

Murray’s report and Gostin’s pitch should remind us that any effort to improve health in poor countries will not be simple to accomplish or even measure.

Earth in the black void of space. Photo: NASA

Tom Paulson covered science, medicine and global health as reporter for the Seattle Post Intelligencerfrom 1987 to 2009, before the print version of the paper closed and PI became the online news site. Now he continues to report as a freelance and blogs about the local global health scene at his website: A Page from Tom Paulson.

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