Global Health Ideas

Finding global health solutions through innovation and technology

Archive for January 2007

Tidbits: Cheap Vaccines From Tobacco, Bush on Malaria & PEPFAR, Gates Foundation Ethics, Davos

  • Breakthrough in Vaccine Manufacturing via Tobacco & Other Plants-
    “A breakthrough in research will help make certain vaccines much cheaper and ideal for people in poor countries…Henry Daniell (his website had video as well) has found a way to genetically engineer plants to make large amounts of certain vaccines…Scientists first inject plants, like tobacco, lettuce or carrots, with vaccine genes. These are then planted in a greenhouse before being crushed and put into capsules to be taken by patients…ust one acre of tobacco plants, for example, could produce enough anthrax vaccine to inoculate everyone in the United States…Professor Daniell says he decided to work on cheap vaccines after witnessing the impact of disease in his native India.” LINK. As a side note, for more innnovate work on vaccines, check out the work by the CGDEV (Center for Global Development.
  • Bush on Malaria and AIDS Relief (PEPFAR) –
    From last nights State of the Union 2007 – “I ask you to provide $1.2 billion over five years so we can combat malaria in 15 African countries…We must continue to fight HIV/AIDS, especially on the continent of Africa”. LINK.
  • Davos (World Economic Forum) Conversation –
    There are many people blogging about Davos, NextBillion has some more references. One more for you to check out is DavosConversation.org (LINK).
  • Gates Foundation and Ethics of Philanthropy –
    The decision by the Gates Foundation continues to be debated. Check out this carnival of opinions sounding off from the blogosphere in one spot. LINK to TactilePhilanthropy.
  • Infrastructure in India –
    Vinod Khosla’s Marshall Plan for rural India, “One out of 10 people on this planet is a rural Indian…” LINK to Salon article.
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Written by Aman

January 24, 2007 at 7:53 am

Posted in Global Health

Call for Private Sector Involvement in Malaria Efforts

Public-private partnerships have been all the rage, here are two recent articles on that front. The first is an opinion piece calling for more private sector involvement and the second is a demonstration of using private businesses to distribute insecticide resistant mosquito nets.

Increased innovation needed in the fight against epidemics , Jan 11, 2007

In a Jan. 1 editorial, the P-I rightly pointed to the need for partnerships to address global health challenges and meet goals to reduce disease and death. However, the editorial overlooked the integral role of the private sector in developing new solutions to fight epidemics… “The only way to win the war against malaria is to find new and even more effective ways to prevent infection and treat those who are sick. That includes the development of new drugs and diagnostics, as well as a malaria vaccine that has the potential to offer widespread protection against the disease… While the research that will fuel new tools is often found in academia and in the government sector, we need the involvement of industry — namely pharmaceutical and biotechnology companies — to turn research into life-saving products.”

Public-Private Cooperation Helps Fight Malaria, Jan 18, 2007

Dr. David McGuire is the director of USAID’s NetMark Project, which promotes the use of bed nets and helps African businesses distribute them.  He says NetMark is partnered with nearly 40 companies in eight countries (Ghana, Nigeria, Mali, Senegal, Zambia, Uganda, Ethiopia and Zimbabwe), which in turn sell more than 15 brands of ITNs…Health experts say there are many advantages to such private-public partnerships; donors are able to stretch their dollars by taking advantage of the private sector’s efficient distribution network, stimulate the local business community in high unemployment areas, and create competition among venders to keep prices low…The involvement of the private sector has also led to the creation of Africa-based factories, including several in Tanzania, that can manufacture the nets, rather than relying on imports.

Written by Aman

January 23, 2007 at 8:16 am

Celebrities, HIV Babies & Chronic Diseases in Low Income Regions

You might be wondering what celebrities and babies have to do with chronic diseases in devleoping countries. An article in the New England Journal of Medicine (NEJM) last week implied that sympathy for HIV+ poor babies has an impact on funding for chronic diseases in developing countries (see excerpt 1 below) and that this should be pointed out. This linkage is weak at best, more likely not linked at all, and in either case posits a false dichotomony of supporting a single response to either chronic or infectious diseases.

We may be starting to turn the corner with respect to attention paid to chronic diseases in the “Global South” and let me state up front that I think this is overdue. Health Affairs last week published an excellent piece [“Reducing the Burden of Cardiovascular Disease (CVD) in the Developing World”] and the current issue of the New England Journal of Medicine (NEJM) has two articles on chronic diseases [“Expanding Priorities – Confronting Chronic Disease in Countries with Low Income” and “Obesity and Diabetes in the Developing World”]. I would like to bring your attention to the first NEJM piece [“Expanding Priorities”] by Dr. Anderson, professor at Johns Hopkins.

Jan 18, 2007 NEJM Excerpt 1 (from Expanding Priorities -Confronting Chronic Diseases) – “Sympathy is also a powerful driver of public opinion and funding. When a celebrity holds a baby with AIDS, the heartrending photographs generate attention, compassion, and donations. A photograph of a 40-year-old man with hypertension would be far less compelling, even if we knew he was a father, husband, and primary breadwinner.” [emphasis added].

While my current research focuses largely on chronic diseases and I do understand the frustration of the authors (infectious diseases such as HIV/AIDS get all the attention) there is something critical missing from their overall point. Anderson discusses reasons why more attention is paid to infectious diseases and in my opinion makes a mistake in trying to make comparisons to chronic diseases. In the article he seems to imply that because many more people die from chronic diseases and because the associated treatment is more cost-effective and lower cost compared to HIV/AIDS, we should shift funding and attention to things like hypertension in developing countries. To Anderson’s credit, this message may have not been his intention, after all the article is entitled “Expanding Priorities”, not “Changing Priorities”. I also have to give him credit for his willingness to enter such a potentially contentious debate (if framed as such) . However, the tone, approach, comparisons made, and failure to mention critical aspects about the implications of infectious diseases leaves the article lacking.

It is one thing to call for increased attention to the burden of chronic diseases in the global health arena; however it is entirely another thing to insinuate that there are misaligned priorities (which would be a fine if backed up by a well thought out argument). The critical piece Anderson fails to mention is the tremendous impact on the basic social, cultural, and economic fabric that HIV/AIDS is having in some regions of the world. If people are dying before they get chronic diseases, what would be more prudent – a focus on chronic diseases or a focus on acute infectious diseases (even if chronic disease treatment is lower cost)?

The article on CVD in Health Affairs lays out a much more cogent argument with a different tone that appeals to the cause the authors are trying to make, it is definitely worth reading. I am surprised this article was even published in NEJM. Perhaps I am being too harsh and mis-read the article, if someone has another perspective, I would love to hear it.

Excerpt 2 – NEJM (Expanding Priorities -Confronting Chronic Diseases) “…cardiovascular disease alone accounts for nearly 30% of all deaths worldwide and 10% of all years of healthy life lost to disease…Three infectious diseases — tuberculosis, human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS), and malaria — have attracted the greatest attention from international donors, but together they are responsible for only 10% of the deaths in the world (12% in low-income countries) and 11% of the disability-adjusted life-years (13% in low-income countries). Despite the fact that a substantial burden of disease in the world’s poorer countries is caused by noncommunicable chronic diseases, most international aid agencies have focused primarily on preventing and treating infectious diseases.”

Number of Deaths in Low and Lower Middle Income Regions – NEJM Jan 18th, 2007

ldc_deaths.jpg

Written by Aman

January 22, 2007 at 1:09 pm

Johns Hopkins Health Sciences Informatics Fellowships

Not many educational institutions are dealing with the critical need for people trained in designing, administering, and maintaining information and information technologies in health care settings. The Division of Health Science Informatics (DHSI) at the Johns Hopkins University School of Medicine has created a training fellowship aimed at filling this gap. The program aims to,

  • To achieve a baseline level of competency in health sciences informatics
  • To assimilate the fundamentals of health sciences informatics research
  • To develop proficiency in one or more defined areas of health sciences informatics
  • To increase knowledge of fields related to health sciences informatics, such as computer science, biostatistics, and evaluation methodology
  • To observe and participate in collaborative research and development activities in health sciences informatics
  • To complete a health sciences informatics research experience that includes proposal development, project execution, data evaluation, and reporting of results
  • Applications are due soon. Feb 15, 2007. Check out their website, DHSI Training Fellowship

    Written by Mahad Ibrahim

    January 22, 2007 at 1:34 am

    Posted in Education, ICT

    Winner of BMJ “‘Medical’ Milestones”

    Although sanitation is far from synonymous with medical practice, the British Medical Journal announced that sanitation received the highest number of votes (out of 11,000) for most significant advancement in health since 1840 [Jan 5th THDblog post lists top 15 innovations]. See video announcement at the BMJ website. Be sure to fast forward through 3 minutes 20 seconds of silent conference room set-up.

    Via the Genetics and Health blog here is the breakdown of the voting behind sanitation. You can read the full story in the Guardian.

    • Antibiotics – 14.5%
    • Anaesthesia – 13.9%
    • Vaccines – 11.8%
    • Discovery of DNA structure 8.8%

    Written by Ben

    January 21, 2007 at 4:04 pm

    Neglected Diseases Update

    Sleeping sickness is estimated to cause 48,000 to 100,000 deaths a year in Sub-Saharan Africa. Effective disease control has been hampered by lack of safe oral drug treatments. Friday, Essential.org’s IPhealth listserv emailed a revised news article from SciDev.Net about a breakthrough cure. The email, prefaced by the Drugs for Neglected Diseases initiative (DNDi), stated that, although DNDi did not agree with the original SciDev.net article, the new drug combination (eflornithine and nifurtimox) appears to be efficacious against the Trypanosoma brucei parasite [Jan 10, “Calls for fast access to sleeping sickness drug“].

    According to Girardo Priotto of Doctors Without Borders, “The situation is so desperate in the field that we are not happy with two more years of waiting for the final results of the current trial, so we are looking for ways of extending access to this treatment through additional studies.”…

    Thousands of people each year are diagnosed with advanced-stage sleeping sickness, which is fatal if not treated. Current treatment, with the drug melarsoprol, itself causes the death of around six per cent of patients. In addition, some patients are also resistant.

    No data were released in this report and it remains unclear how efficacious the new treatment regime may be. ClinicTrials.gov details the study design and collaborators.

    More broadly in the neglected diseases field, there is resurgent interest in drug development: from discovery to trials to regulatory approval. OneWorldHealth is a well publicized example [see Oct 8th post “Non Profit Rx Venture“] and several others including Essential.org, DNDi, and the Tropical Disease Initiative [check out the 50 min video on Shannon’s Blog], each of which specialize in some link on the drug development chain. The World Health Organization and many high profile partners are also putting more muscle into the neglected diseases fight. Check out the October Preventive Chemotherapy in Human Helminthiasis news release, quoted here:

    “Preventive chemotherapy does not necessarily stop infection taking place but it can help to reduce transmission,” the Director of the UN World Health Organization, Department for the Control of Neglected Tropical Diseases, Lorenzo Savioli, said. “The benefit of preventive chemotherapy is that it immediately improves health and prevents irreversible disease in adults.”The approach contained in a newly published manual, Preventive Chemotherapy in Human Helminthiasis, focuses on using a set of low-cost or free drugs to simultaneously treat the four most common diseases caused by worms and afflicting over 1 billion people: river blindness (onchocerciasis), elephantiasis (lymphatic filariasis), chistosomiasis, and soil-transmitted helminthiasis. The cost: as low as 40 cents per person per year.

    “In the same way as we protect people against a number of vaccine-preventable diseases throughout their lives, the regular and coordinated use of a few drugs can protect people against worm-induced disease, improving children’s performance at school and the economic productivity of adults,” Mr. Savioli said.

    The new approach provides a critical first step in combining treatment for diseases which, although different, require common resources and delivery strategies for control or elimination. The second key component brings together for the first time dozens of agencies, non-governmental organizations (NGOs), pharmaceutical companies and others into a coordinated assault on neglected diseases.

    The diseases’ impact can be measured in the impaired growth and development of children, complications during pregnancies, underweight babies, significant and sometimes disabling disfigurements, blindness, social stigma, and reduced economic productivity and household incomes.

    These effects can be dramatically reduced by using highly effective drugs of proven quality and excellent safety record – the majority donated free by companies or costing less than $0.40 per person per year, including the cost of the drugs and their delivery.

    Another recent development in neglected diseases drug discovery by British researchers [Guardian story, hat tip to Innovation blog] has huge potential cost-savings but, at least according to the Innovation blog, the technique “effectively amounts to a sophisticated form of reverse engineering that skirts patent laws and this is not the same as conducting original drug development.” Definitely a story to watch…

    Desk Clearing: Social Capitalist Awards, Gates Foundation, Mobile Phones as a Human Right and more…

    It’s time to do some housekeeping, there are several interesting stories this week that you will find below. Also do not forget to vote for the 59smartestorgs online.

    Other

    • Fast Company has another issue devoted to the Social Capitalist Awards with several articles. Link
    • More on the Gates Foundation story, it looks like they have decided to stick to their guns. WorldChanging haswritten extensively on this, check it out (Transforming Philanthropy) and Philanthropy 2173 is asking you to vote on this issue. For the LA Times article see the link below:
    • Gates Foundation to keep its investment approach. Link
    • Are mobile phones a human right? Link
    • RH Reality Check has a posting about the US lack of support for UNFPA, an issue taken up by an impressive grass roots campaign, known as 34 Million Friends. You can view a video here.

    Pharmaceutical & Device Developments/Breakthroughs

    • A Real-World AIDS Vaccine? Link
    • Researchers Discover Drug That Blocks Malaria Parasites. Link
    • Nigeria to enact law to back malaria, HIV drugs. Link
    • Roche Diagnostics Submits West Nile Virus Blood Screening Test to FDA. Link
    • This is a very cool story about the discovery of forgotten “cures”.
      Ancient Book of Herbs Used in the War on Bacteria. NY Times link, via MedGadget.
    • For another take on the “Ethical Pharmaceuticals” Model, check out this lengthy piece.

    Written by Aman

    January 19, 2007 at 7:10 am