Malaria-carrying parasites in parts of Cambodia have developed resistance to a major drug used to treat the disease in Southeast Asia, according to research published on Thursday in The Lancet Infectious Diseases journal.
The drug piperaquine, used in combination with the drug artemisinin, has been the main form of malaria treatment in Cambodia since 2008.The combination is also one of the few treatments still effective against multi drug-resistant malaria which has emerged in Southeast Asia in recent years, and which experts fear may spread to other parts of the world.
The number of people killed by malaria dropped below half a million in the past year, reflecting vast progress against the mosquito-borne disease in some of the previously hardest-hit areas of sub-Saharan Africa.
The World Health Organization’s annual malaria report showed deaths falling to 438,000 in 2015 – down dramatically from 839,000 in 2000 – and found a significant increase in the number of countries moving toward the elimination of malaria.
Malaria prevention measures – such as bednets and indoor and outdoor spraying – have averted millions of deaths and saved millions of dollars in healthcare costs over the past 14 years in many African countries, the report said.
Every few years, stories appear about Vashon Island and its high percentage of unvaccinated kids. It happened again a few weeks ago in the wake of reports of measles outbreaks nationwide. Then the temporary publicity fades and this island of 11,000 goes back to the same old, same old. Which is: a deep divide between the pro and con camps that in most other ways are so much alike. Except that this time it got pretty vitriolic.
From Trust for America’s Health and the Robert Wood Johnson Foundation
Washington scored only four out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks, like Ebola, Enterovirus and antibiotic-resistant Superbugs.
Some key Washington findings include:
|No.||Indicator||Washington||Number of States Receiving Points|
|A “Y” means the state received a point for that indicator|
|1||Public Health Funding: Increased or maintained level of funding for public health services from FY 2012-13 to FY 2013-14.||N||28|
|2||Preparing for Emerging Threats: State scored equal to or higher than the national average on the Incident & Information Management domain of the National Health Security Preparedness Index.||Y||27 + D.C.|
|3||Vaccinations: Met the Healthy People 2020 target of 90 percent of children ages 19-35 months receiving recommended ≥3 doses of HBV vaccine.||N||35 + D.C.|
|4||Vaccinations: Vaccinated at least half of their population (ages 6 months and older) for the seasonal flu for fall 2013 to spring 2014.||N||14|
|5||Climate Change: State currently has completed climate change adaption plans – including the impact on human health.||Y||15|
|6||Healthcare-acquired Infections: State performed better than the national standardized infection ratio (SIR) for central line-associated bloodstream infections.||N||16|
|7||Healthcare-acquired Infections: Between 2011 and 2012, state reduced the number of central line-associated blood stream infections.||N||10|
|8||Preparing for Emerging Threats: From July 1, 2013 to June 30, 2014, public health lab reports conducting an exercise or utilizing a real event to evaluate the time for sentinel clinical laboratories to acknowledge receipt of an urgent message from laboratory.||N||47 + D.C.|
|9||HIV/AIDS: State requires reporting of all CD4 and HIV viral load data to their state HIV surveillance program.||Y||37 + D.C.|
|10||Food Safety: State met the national performance target of testing 90 percent of reported Escherichia coli (E. coli) O157 cases within four days.||Y||38 + D.C.|
Read the full report here.
Local public health officials have confirmed a measles infection in a child who was in one public location in King County during the contagious period.
The child is a King County resident who was unvaccinated and exposed to measles while traveling in Europe. This measles case is unrelated to previous ones in King County in July 2013.
What to do if you were in location of potential measles exposure
Because most people in our area have immunity to the measles through vaccination, the risk to the general public is low. In addition, outdoor exposure locations carry lower risk.
However, all people who were in the following location around the same time as the individual with measles should:
- Find out if they have been vaccinated for measles or have had measles previously, and
- Call a health care provider promptly if they develop an illness with fever or illness with an unexplained rash between August 25 and September 8.
- To avoid possibly spreading measles to other patients, do not go to a clinic or hospital without calling first to tell them you want to be evaluated for measles.
Locations of potential exposure to measles
Before receiving the measles diagnosis, the child was in one King County location where other people might have been exposed. Anyone who was at the following site during the following times was possibly exposed to measles:
Aladdin Gyro-cery, 4139 University Way NE, Seattle (Sunday, August 18, 1 – 3:20 p.m.)
In addition, the child was at several public locations in Oregon while contagious, including a tennis tournament. A number of the participants who were at the tournament are from King County; health officials are following up directly with them. ‘
More information on Oregon exposures is available here.
If you were in these areas at the times above and are not immune to measles, the most likely time you would become sick is between August 25 and September 8.
Public health officials have notified the locations where the public may have been exposed.
Measles vaccinations for European travel
Measles outbreaks are occurring frequently in Europe. All travelers to Europe should be fully vaccinated with two doses of measles vaccine before travel.
Measles is a highly contagious and potentially severe disease that causes fever, rash, cough, and red, watery eyes. It is mainly spread through the air after a person with measles coughs or sneezes.
Measles symptoms begin seven to 21 days after exposure. Measles is contagious from approximately four days before the rash appears through four days after the rash appears. People can spread measles before they have the characteristic measles rash.
People at highest risk from exposure to measles include those who are unvaccinated, pregnant women, infants under six months of age and those with weakened immune systems.
For more information about measles, a fact sheet is available in multiple languages at: www.kingcounty.gov/healthservices/health/communicable/diseases/measles.aspx
For help finding low cost health services, call the Family Health Hotline at 1-800-322-2588.
Seattle has become a major center for global health research, activism and philanthropy.
But how much do you know about U.S. global health activities?
For example, how much of the U.S. federal budget is spent on global health?
Which region of the world receives the largest amount of U.S. government funding for global health?
What is the leading cause of death in low-income countries?
The Kaiser Family Foundation has created a quick 10-question, online quiz on global health to test your knowledge.
The answers might surprise you..
Other Kaiser quizzes examining HIV/AIDS, Medicare, Health Reform and the Uninsured are also available.
Seattle’s global health organization PATH announced today that Steve Davis has been appointed president and CEO.
In his new position Davis will oversee PATH’s annual budget of $305 million, a staff of nearly 1,200, and a portfolio of projects based in PATH offices in 22 countries.
PATH projects include the development of an affordable meningitis vaccine, improved screening and treatment for HIV/AIDS and tuberculosis, and low-cost filters for safe drinking water.
Davis comes to PATH from McKinsey & Company, where he was global director of social innovation.
In that position, Davis led a global team that consults for nongovernmental organizations (NGOs), governments, and the private sector, with a focus on global health and development, research and development, and Asia and Africa.
Previously, Davis was a long-term CEO of Corbis, a global digital media leader, and served as interim CEO of the Infectious Disease Research Institute, a nonprofit biotech working on vaccines, diagnostics, and drug discovery for infectious diseases of poverty.
His previous experiences also include serving as interim director of PATH’s India program, practicing law with K&L Gates, and working on refugee and human rights issues.
Mr. Davis earned his bachelor’s degree from Princeton University, his master’s degree from the University of Washington, and his juris doctor from Columbia University.
Davis will join PATH on June 11 and be based at PATH’s Seattle headquarters.
He succeeds former president and CEO Dr. Christopher J. Elias, who led PATH through significant growth for ten years.
Dr. Elias left PATH in January to become president of the Global Development Program at the Bill & Melinda Gates Foundation.
A malaria vaccine developed by the pharmaceutical company GSK and Seattle’s PATH has been shown to halve the risk of severe malaria in African children.
Malaria strikes an estimated 225 million people worldwide each year, killing more than 780,000 — most of whom are African children.
Currently, there is no approved vaccine for the prevention of the disease, which is caused by the parasite Plasmodium falciparum.
The new results, which have been published online in the New England Journal of Medicine, were announced today in Seattle at a Malaria Forum hosted by the Bill & Melinda Gates Foundation, which provided major funding for the trial.
The study, which was conducted in seven countries in sub-Saharan Africa, found that three doses of the vaccine, called RTS,S, reduced the risk of a child developing high fever and chills by 56 percent and of severe malaria by 47 percent.
In the study ,the researchers looked at malaria rates among the first 6,000 children, aged 5 to 17 months, in the 12 months after they had received the third dose of the three-dose vaccine regimen.
All together, a total of 15,460 children are enrolled in the study in two age groups–a younger group, 6 to 12 weeks-old and a slightly older group 5 to 17 months-old.
The trial is ongoing, and results of the vaccine’s efficacy in infants 6 to 12 weeks-old are expected by the end of 2012, but a interim analysis of all of the infants and children enrolled in the trial 6 weeks to 17 months finds that at an average of about one year the vaccine reduced the risk of of severe malaria by a third, 34.8 percent.
In a commentary that accompanied the article, Dr. Nicholas White, professor of Tropical Medicine at Mahidol University in Thailand, writes that if all goes well, the RTS,S vaccine should become available in just over 3 years. “It’s been a long time coming, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans.”
But, he adds, questions remain: how long, for example, will the vaccine remain protective, how much will the vaccine cost, and, will the recent drop in malaria deaths due to other interventions, such as the increased use of insecticide-treated bed nets, cause a loss of support for expensive anti-malaria initiatives.
“How,” he asks, “will the necessary funding be sustained in the face of a global economic downturn, along with a reduction in political pressure associated with declining mortality form malaria?”
Despite the world economic crisis, funding for global health from both public and private donors continues to rise, albeit more slowly, according to a report by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.
The report, Financing Global Health 2010, found that funding for global health worldwide has risen markedly over the past two decades, from $5.66 billion in 1990 to $26.87 billion in 2010 — a 375 percent increase.
The fastest growth was seen between 2004 and 2008, when funding rose 13 percent a year on average, the report found, but that rate has since slowed to 6 percent a year between 2008 and 2010.
The U.S. government and private U.S. donors had made substantial contributions, making up one-half of all global health funding in 2008, the report found.
However, in general, the recent increases in funding were driven by government donations as the recession led to a fall in private donations to non-governmental organizations (NGOs), the report found. Funding from U.S. NGOs, for instance, fell 24 percent from 2009 to 2010.
In many cases, funds did not necessarily go where the need was greatest, the report said. For example, countries such as Bangladesh, the Democratic Republic of the Congo and Brazil, rank high on the “burden of disease list” but received much less aid than would be expected if aid was based purely on disease burden, the report said.
At the same time, countries such as Tanzania, Ethiopia, Uganda, Kenya, and Mozambique received more funds in proportion to their disease burden, in part because all received health aid from the U.S.-funded President’s Emergency Plan for AIDS Relief (PEPFAR) from 2004 to 2008 to help combat HIV/AIDS in these countries, the report said.
When viewed in the context of specific health focus areas, the contrast between need and funding can be even more apparent. For example, 16 of the 20 countries with the highest maternal mortality ratios in 2008 do not appear among the 20 countries that received the most DAH (development assistance for health) between 2003 and 2008.
In fact, 11 of the 30 countries with the highest disease burdens do not appear in among the 30 countries that receive the most assistance, the report found.
Other findings from the report:
- Spending on HIV/AIDS programs has continued to rise at a strong rate to $6.16 billion in 2008, making HIV/AIDS the most funded of all health focus areas.
- Funding for maternal, newborn, and child health, in contrast, received $3.17 billion, about half as much funding as HIV/AIDS as of 2008.
- Malaria and tuberculosis are often included with AIDS as top priorities in combatting infectious diseases, but both receive far less funding: $1.19 billion for malaria in 2008 and $0.83 billion for tuberculosis.
- Aid for malaria and tuberculosis also appears to go to countries that do not have large groups at risk for these diseases. For example, of the 30 countries that receive the most malaria health funding adjusted for disease burden, only three – Eritrea, Sao Tome and Principe, and Swaziland – are located in sub-Saharan Africa, where malaria is most acute.
- Despite much discussion about the need for to build health systems in developing world countries, only $1 billion went to health sector support in 2008, low compared to other health focus areas.
- Funding for noncommunicable diseases, such as cancer, diabetes and cardiovascular disease, which are growing problems in the developing world as these areas grow more prosperous, was $121.25 million in 2008, just 0.5% of all development assistance for health.
The imbalances identified by the report will need to be addressed, said Dr. Christopher Murray, director of the institute and lead author of the report.
“More than 300,000 mothers still die every year, and more than 7 million children die before the age of 5. Chronic diseases need more attention, and countries need better health care infrastructure,” Dr. Murray said. “All of these pressing health issues require funding, and it is becoming increasingly difficult to balance competing needs.”
To learn more:
- Read the report: Financing Global Health 2010
- Visit the Institute of Health Metrics and Evaluation’s website
Three years ago, the Bill & Melinda Gates Foundation called for the eradication of malaria, a goal that some experts believe is impossible.
In today’s Seattle Times science reporter Sandi Doughton writes about new developments in the Foundation’s controversial initiative.
“Chief among the new priorities is a vaccine that would prevent mosquitoes from spreading the disease. People who are inoculated could still get malaria, but mosquitoes that bite them would not be able to infect anyone else.”
But, she notes,”some experts fear its emphasis on eradication will divert too much money and energy away from efforts to treat the disease and toward a far-off goal,” Doughton writes.
“The increased focus on the future means the Gates Foundation is ending its support for some efforts to lessen the disease’s current toll. Those include research to improve treatment of the severe infections that strike children and pregnant women, and that are responsible for most of the estimated 850,000 annual deaths from malaria.”
Dr. David Brandling-Bennett, leader of the foundation’s malaria programs, admitted that eradication may be decades away but said that it’s important to start working on the necessary drugs and vaccines, which can take a decade or more to develop, now.
To learn more:
- Read Doughton’s article Gates Foundation shakes up science with goal to end malaria
You can view a two-hour webcast of the event online here.
(LocalHealthGuide covered the event and will provide an summary of the discussion over the weekend.)
The forum focused on a recent report by the Center for Strategic and International Studies’ (CSIS) Commission on a Smart Global Health Policy.
The Washington, D.C.-based, CSIS is a bipartisan, nonprofit organization founded in 1962 to find ways for America “to sustain its prominence and prosperity as a force for good in the world.”
In the report, the commission’s 25-member expert panel argues that a “smart, strategic, long-term global health policy will advance America’s core interests” and “enhance America’s influence, credibility, and reservoir of global goodwill” while at the same time “save and lift the lives of millions worldwide.”
The panel recommends the U.S. adopt a five-point agenda for global health:
Maintain the commitment to the fight against HIV/AIDS, malaria, and tuberculosis
Funding for initiatives targeting these diseases is under threat due to the recession and concerns that money might be better spent on other efforts, such as child and maternal health and health systems strengthening.
U.S. leadership can ensure that “immediate budgetary woes do not derail our efforts,” the commission says and argues that by leveraging these “disease-focused investments” it will be possible to create “lasting health systems” and provide “long-term solutions.”
Prioritize women and children in U.S. global health efforts
The U.S. should double its annual investment in child and maternal health to $2 billion to expand models of care that have been proven effective, the commission says.
These investments should focus on a few core countries in Africa and South Asia, the commission says.
“Affordable tools exist to reduce infant deaths in the first month of life; expanded immunizations can improve child survival; and expanded access to contraceptives can bolster women’s health,” the commission says.
Strengthen prevention and capabilities to manage health emergencies
“Disease prevention offers the best long-run return on investment,” the commission concludes. Emerging health threats, such as infections disease outbreaks, require “long-range collaborative investments”, including making it possible for poor countries to have access to affordable vaccines and medications needed to combat pandemics.
Ensure the United States has the capacity to match our global health ambitions
In order to meet its potential, the U.S. needs a predictable, long-term global health plan, the commission argues. “An essential step is to forge a global health strategy, organized around a forward-looking commitment of about 15 years, careful planning, and long-term funding tied to performance targets,” the commission says.
Among its recommendations, the commission recommends that a deputy adviser at the National Security Council be charged with formulating a global health policy and promoting coordination and collaboration between government agencies involved in implementing global health programs.
In addition, the commission recommends the creation of an Interagency Council on Global Health to report to this deputy adviser as well as a senior global health coordinator to be located in the Office of the Secretary of State to coordinate day-to-day operations.
Make smart investments in multilateral institutions
While the U.S. will continue to put a strong focus on its own direct investments in global health, The commission urges the U.S. to “bolster its collaborations” with the World Health Organizations, the World Bank, the Global Fund to Fight AIDS, Tuberculosis, and Malaria and other international agencies.
“By pooling resources and efforts with others, the United States is better able to build health systems, extend the reach of vaccine and infectious disease programs beyond U.S. partner countries, devise alliances to meet trans-sovereign challenges, and mobilize resources and leadership among our partners.”
“If we pursue these steps,we can accomplish great things in the next 15 years,” the commission concludes, including:
- Cut the rate of new HIV infection by two-thirds
- End the threat of drug-resistant tuberculosis
- Eliminate malaria deaths
- Significantly expand access to contraceptives.
- Reduce by three-quarters of the 500,000 mothers who die each year in pregnancy
- Save over 2.6 million newborns from dying in the first month of life.
- And significantly reduce the more than 2 million deaths of children under five years of age caused by vaccine-preventable diseases.
The panel for the Seattle conference included:
- Governor Christine Gregoire
- Anne-Marie Slaughter, Director of Policy Planning, U.S. Department of State
- Dana Hyde, Senior Adviser to Deputy Secretary of State Jacob Lew
- Dr. Tadataka (Tachi) Yamada, President, Global Health Program, Gates Foundation
- Dr. Rajeev Venkayya, Director, Global Health Delivery, Gates Foundation
- Dr. Chris Elias, President and CEO, PATH
- Admiral William J. Fallon, US Navy (Retired)
- Dr. Helene Gayle, President and CEO, CARE
- Dr. John Hamre, President and CEO, Center for Strategic and International Studies
Nearly three years ago, Bill and Melinda Gates called upon the world to eradicate malaria (Seattle PI).
That upset a lot of people, many of them specialists in malaria, largely because it was regarded as violating Voltaire’s warning against seeking perfection at the expense of the good.
Eradication had long been a taboo word in the malaria field because previous attempts at eradication had failed only to watch the disease come roaring back.
And with those additional failures came even greater loss of confidence in later attempts to control or contain malaria in many poor countries.
As a result, malaria efforts and research fell into a state of neglect. As the Gates Foundation’s Dr. Gina Rabinovich said of the international community: “They didn’t get rid of malaria but they did a pretty good job of getting rid of (malaria research).” And so the malaria parasite has been doing pretty well, even increasing in scope.
Worldwide, the current estimate is that there are anywhere from 250 to 400 million cases of infection and maybe a million deaths (mostly in children) every year.
There are more precise numbers, but the precision is misleading. Malaria’s heavy toll is among the very poor, mostly in Africa, their diseases generally undiagnosed and their deaths undocumented — just like other invisible tragedies of the poor.
On Monday, at PATH’s bright, shiny new South Lake Union headquarters, a small and dedicated group of people gathered to celebrate efforts aimed at restoring confidence in the notion that malaria can be beaten.
It was a day too late to officially mark World Malaria Day, on April 25, but who cares?
Monday, it turns out, was actually World Intellectual Property Day, Confederate Memorial Day and Worldwide Pinhole Photography Day.
I’d say the global problem of malaria trumps any of these, on any day.
At the PATH event, several local organizations working to prevent malaria by distribution of insecticide-impregnated bed nets described their successes and ongoing challenges.
Thanks to the work of organizations like PATH, Rotary International, World Vision and many others — especially the Global Fund, which is the major source of funding — working in partnership with governments in Africa, hundreds of millions of nets have been distributed (along with anti-malarial drugs) in the last half decade or so preventing perhaps as many as a million deaths.
But the international community is still nowhere near achieving its goal of “universal coverage” with nets (UNICEF report) and only very few of those needing drugs get them still.
Stefan Kappe, of Seattle Biomed (aka Seattle Biomedical Research Institute), described his team’s work on a malaria vaccine – soon to start testing in human volunteers.
Others talked about the problem of drug resistance, and of the need for a greater and sustained commitment from donors to fully fund efforts to fight malaria.
“The hard work is still ahead of us,” said Dr. Kent Campbell of PATH. The successes so far achieved remain fragile and tentative, Campbell said, but there is now much more evidence that malaria can be beaten even with simple tools like bed nets.
Eradication? The opinion of most experts is that this will be impossible without a vaccine. But the U.S. rid itself of malaria without a vaccine. Other countries have as well.
As Voltaire also said: “Opinions have caused more ills than the plague.”
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.