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.

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.

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.

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.

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:

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.

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.

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.

“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

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.

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.

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.

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.

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.