Archive for the ‘HIV/AIDS’ Category
I recently discovered the UCLA Art|Global Health Center, the mission of which is to “unleash the transformative power of the arts to advance global health“. The arts have the ability to capture issues and tell a story in a way that can make a profound impact on our (social) consciousness and is not something we talk about enough as a tool. One of the more famous examples of this is the AIDS quilt which was conceived of in 1985 by an AIDS activist in memory of Harvey Milk. That quilt has had over 14 million visitors and is the largest community arts project in the world.
The UCLA center has some ongoing projects and last year opened “Make Art | Stop AIDS” that featured traditional art as well as things like condom dresses. Make Art/Stop AIDS “is organized around a series of seven interconnected and at times overlapping concerns expressed in the form of open-ended questions, some of which include direct art historical references to the epidemic: What is AIDS?; Who lives, who dies?; Condoms: what’s the issue?; Is it safe to touch?; When is the last time you cried?; What good does a red ribbon do?; Are you angry enough to do something about AIDS?; and, finally, Art is not enough. Now it’s in your hands.”
Creative art projects have the ability to move the human mind unlike the constant barrage of issues, numbers and headlines that desensitize us over time. If you have seen or heard of any interesting arts based global health projects let us know.
Adriana Bertinin’s condom dresses
Addressing HIV/AIDS-Related Grief and Healing Through Art
History of the AIDS Memorial Quilt
Condom fashion show, China
I was just sent this information (thanks to Becky!) about a new round of funding for microbicides, which comes on the heels of promising results from a trial of the PRO2000 microbicide candidate. We covered this a couple of years ago and at the time I said – the potential of this drug is revolutionary. With microbicides there was great excitement and hope, then there was failure and now there is some maturity. Okay, maybe I am overstating the case, the take home point is that we still don’t have a product and this is not cheap, easy, or quick. Developing a drug is complicated, involves huge risk, can take decades and is highly uncertain. Let’s review the drug development time line again for those of you not familiar – the graph below gives the most simplistic picture:
The early microbicide discussions took place almost 15 years ago (International Working Group on Vaginal Microbicides, source). Over half that amount of time, from 2000-2007, $1.1 Billion has already been invested in microbicide R&D! It takes anywhere from $200M to $1 Billion to bring a single novel drug to market. Let’s hope one of these compounds works and makes it through phase III. But how much will we have spent? $2 Billion, $3 billion? If it works, it will have been worth the money, however, we must ask if we took the most efficient financial route to get to the end point and if there were better financial models – that is a valid question.
The above two headlines on global health funding flows and allocation caught my attention. The original study was published in PLoS Medicine. The article has some great figures (some of which I have reproduced below). A few things immediately stick out – the amount concentrated on HIV/AIDS, TB and malaria is astounding. Second the US is providing 70% of the funding and on the surface one could argue that other countries really could be pitching in more. On that note, the Gates Foundation by itself is out funding the European Commission almost 4 to 1 – if that isn’t embarrassing I don’t know what is. Finally, the US Department of Defense is high on the list (surpassing USAID). Interesting stuff:
“HIV/AIDS, tuberculosis and malaria initiatives accounted for about 80% of the $2.5 billion that was spent on research and drug development for developing countries in 2007… However, pneumonia and diarrheal illness, which are two major causes of mortality in developing countries, received less than 6% of funding.”
“A report released by the United Nations last month suggests that inequality in New York, Washington, Atlanta and New Orleans rivals that of some cities in Africa…The life expectancy of African Americans in the United States is about the same as that of people living in China and some states of India, despite the fact that the United States is far richer than the other two countries.”
Source: UW Geography Blog
“More Black Americans are infected with HIV than the total populations of people living with HIV in seven of the 15 countries served by PEPFAR…Despite extraordinary improvements in HIV treatment, AIDS remains the leading cause of death among Black women between 25-34 years and the second leading cause of death in Black men between 35-44 years…U.S. policy treats AIDS as a foreign policy priority, but virtually ignores the epidemic among Black citizens here at home,””
Source: Louisiana Weekly
The Global Health Council has released the theme for their 2009 conference to be held in Washington, DC: “New Technologies + Proven Strategies = Healthy Communities”. I’ve been helping them with development of their CFP over the summer months – the focus is largely on ICT, but there is consideration given to other technologies also. This is an applied conference with significant international representation. In terms of a broad global health meeting, this is the best I’ve attended.
With slight modifications I lifted the below from the CIMIT Blog (note Video on their blog), certainly a needed innovation for global health:
Via CIMIT: Microfluidic CD4 Cell Counting for Resource-Limited Settings
“The HIV pandemic has created an unprecedented global health emergency. In response, the price of effective, life-saving HIV drug treatment has been reduced by 99%. More than $10 billion is now invested each year to treat people suffering from HIV and AIDS…BUT Treatment is only half the battle. “
“Of the 33 million people living with HIV worldwide, fewer than 10% have access to CD4 counts, the critical blood test used by clinicians to decide when to start treatment. Fewer than 1% have access to viral load assays, which are used for infant diagnosis and for patient monitoring. Both tests are considered essential to effective treatment. The Use Case for appropriate CD4 and viral load tests appropriate for resource-limited settings is clear”:
- Tests need to be performed by a minimally skilled health worker,
- A the true point of care,
- Reliably and inexpensively, and
- Wth reasonable accuracy and precision. The HIV pandemic thus represents an unprecedented opportunity to drive technology development in point-of-care diagnostics.
“Based on this Use Case, William Rodriguez’s lab has developed a series of technologies for an integrated CD4 cell count device, with microfluidics as the key platform…Integrating these microfluidic technologies has led to a prototype handheld device that can accurately capture CD4 cells from a 10 microliter fingerstick sample of whole blood, and accurately measure CD4 counts in under 8 minutes.”
This week’s KaiserNetwork report just hit the two hottest topics for me on HIV right now: male circumcision (Rwanda now has a formal program) and the flattening of vertical HIV funds into primary care, 30 years after the Alma Atta conference had called for a universal primary care package.
“In the two decades since AIDS began sweeping the globe, it has often been labeled as the biggest threat to international health. But with revised numbers downsizing the pandemic — along with an admission that AIDS peaked in the late 1990s — some AIDS experts are now wondering if it might be wise to shift some of the billions of dollars of AIDS money to basic health problems like clean water, family planning or diarrhea.”
“If we look at the data objectively, we are spending too much on AIDS,” said Dr. Malcolm Potts, an AIDS expert at the University of California, Berkeley, who once worked with prostitutes on the front lines of the epidemic in Ghana.
Read the full story at the KFF.
P.S. The CGD blog (Is donor spending on AIDS a “Gross Misallocation of Resources”?) highlights findings from a recent paper on global health funding for HIV, population, infectious disease control, and broad health sector support. Two key points:
- donor support for AIDS has grown from around 5% of total health commitments in 1992-3 to about 30% in 2003-5, a six-fold increase of AIDS’ share, but
- funding for general health sector support is the fastest rising category in absolute terms in the years 2003-5
Tomorrow is World AIDS Day and instead of “barraging you with [another set of] statistics, gruesome photos, or heart-wrenching stories” (quote credit to Mr. Casnocaha), I want to alert you to something we prefer here – solutions, problem solving, technology, and creative thinking. Piya Sorcar, a doctoral student in Stanford’s Learning, Sciences & Technology Design program has used her considerable skills to figure out how to reach the minds of children in devleoping countries when it comes to HIV/AIDS education.
Incorporating a variety of techniques from several disciplines Piya has generated an animation based educational technique and curriculum, the first of its kind in this area. The first results from this groundbreaking technique are in and they have been outstanding. The indefatigable Sorcar has plans to disseminate the educational curriculum free to schools and other organizations. She also has plans to launch the animation on social networking sites such as Orkut (very popular in some developing countries) and Facebook.
This educational technique and curriculum has taken over 2 years to develop and as far as we know no one else is using this animation based method. This work is truly inspirational, overcomes various methodological barriers and just as importantly political barriers (especailly in countries where sex education is banned). The early results indicate tremendous success. I highly encourage you to read the full story below and visit the website where the animation can be viewed: http://www.interactiveteachingaids.org/
We previously covered Piya Sorcar’s work in a post last year and it has been the most read post on this blog with over 1700 visits. You can view that here for further background information.
Lasly, there is much more to say about Piya’s work which we will save for another post. I have placed some links about World AIDS Day below this entry and as a side note – even rock group Queen is getting into the action with their first new recording in a decade to mark the event.
Doctoral student creates groundbreaking animation to teach HIV/AIDS prevention in developing countries
To combat the stigma associated with discussing HIV/AIDS and sexual practices in India and other developing countries, doctoral student Piya Sorcar has developed a groundbreaking animation-based curriculum to teach HIV/AIDS awareness and prevention in a culturally sensitive manner to young adults around the world.
Sorcar’s project, Interactive Teaching AIDS, is already being used in several countries…The animation emphasizes the biology of HIV/AIDS, presenting a storyline with a dialogue between a curious student and a friendly yet authoritative cartoon “doctor” on the biological facts about HIV,its spread, and its prevention.
“What’s groundbreaking is that she’s shown that we can inform people about AIDS while respecting the culture,” said Communications Prof. Clifford Nass, an advisor to Sorcar’s Ph.D. project. “That’s an enormous accomplishment.”
“The result was Interactive Teaching AIDS, an animation-based tutorial featuring a friendly cartoon doctor and patient who guide participants through the biological aspects of AIDS transmission. The tutorial is available online and on a CD.”
A recent study of the application in India by Sorcar with 423 students in private schools and colleges in North India, showed significant gains in learning and retention levels after interacting with the 20-minute animated tutorial. Prior to testing, only 65% knew that HIV was not spread through coughing; after the tutorial, this percentage increased to 94%. Students stated that they were comfortable learning from the tool, and more than 90% said they learned more about HIV/AIDS through the animated tutorial than any other communication method such as television or school. One month after initial exposure to the tutorial, students were rapidly seeking and educating others about HIV/AIDS prevention through their networks, with nearly 90% sharing information they learned from the tutorial with someone else.
BBC reports that “a study published in the Public Library of Science journal by researchers from the Harvard School of Public Health suggests the policy has saved Brazil around $1bn between 2001 and 2005.” The article itself is available freely online as a part of the open access policy of PLoS.
From the Harvard School of Public Health press release:
The results showed that, although costs for Brazil’s locally produced generic antiretroviral drugs (ARVs) increased from 2001 to 2005, the country still saved approximately $1 billion in that time period through controversial price negotiations with multinational pharmaceutical companies for patented ARVs. Since 2001, Brazil has been able to obtain lower prices for patented ARVs by threatening to produce AIDS drugs locally. Though these negotiations initially prompted major declines in AIDS drug spending, HAART costs in Brazil more than doubled from 2004 to 2005. The steep increase reflects the fact that more people living with HIV/AIDS began treatment and are living longer. The increase also reflects the challenges associated with providing complex, costly second- and third-line treatments as people develop resistance to first-line drugs, live longer and require more complex treatment regimens.
Figure 6 from the article – Impact of Alternative Price and Quantity Scenarios on Total ARV Costs, 2001–2005 – shows how the increase in spending is primarily related to increases in quantities rather than costs (Figure 6.A). This figure also shows how much would have been spent if there were no price changes (6.B) and the theoretical minimum that could have been spent by buying the lowest-priced generics on the market (6.C).
I lifted this from our good friend Jose over at Little Devices that Could. It was part of the INDEX: Design to Improve Life competition (see People’s Choice Award 2007). Business Week has a full profile of this invention that you should see for clear pictures and a description of the safe locking mechanism. Also the comments section bring up some good questions about using a soda can for disposal. Check out the BW story: Life-Saving Design.
According to the WHO, some 16 billion injections are administered globally. In 2005, contaminated needles led to 260,000 HIV infections, 1.3 million early deaths, and 23 million cases of hepatitis. WHO researchers estimate that as many as 50% of injections in developing countries might be unsafe.
Antivirus, the simple design she came up with as a result of her childhood ordeal, just scooped the People’s Choice prize at the prestigious Index: Awards, touted by organizers as the world’s largest design prize…Antivirus is a lightweight plastic cap that fastens to any metal soft drink or beer can, which medics can use to remove and sequester dangerous syringes…The straightforward concept transforms a ubiquitous piece of trash into a potentially life-saving device. See more at Business Week.
I was just notified of this event on HIV/AIDS from Sydney Australia. The folks from the Natioanl Press Foundation have put up quite a bit of information including what looks like audio files. Check it out:
“The National Press Foundation in collaboration with the International AIDS Society is holding a training session for 50 international journalists on covering HIV/AIDS in Sydney , Australia . The program coincides with the IAS’s 4th annual conference on HIV Pathogenesis, Treatment and Prevention. We’ll be writing about it on our new blog, The NPF Newsbag (www.nationalpress.typepad.com). We will be posting resources from our speakers’ sessions and will be inviting some of our participating journalists to guest blog.”
More on the business and global health front, in case you missed it: NEW YORK, June 13, 2007 — Eight leading businesses received awards recognizing their outstanding contributions in the fight against AIDS, TB and malaria… GBC honors six companies that conceived and executed effective HIV/AIDS workplace, community, core competency, national action, testing and counseling, and advocacy and leadership programs, as well as two companies with superlative TB and malaria programs. Full story; Video and full coverage on the businessfightsaids.org website.
Coca-Cola China Beverages Ltd., (community)
Standard Chartered PLC (core competency)
Abbott and Abbott Fund (national action)
Eskom Holdings Ltd. (testing and counseling)
HBO (advocacy & leadership)
Eli Lilly (tuberculosis award)
Marathon Oil Corporation (malaria award)
There is not much left to say about the iPhone, it is clearly one of the most hyped electronic gadgets in history and it is an understatement to say that it has lit up the internet (a google search for iPhone yields 103 million hits, compare that to only 70 million hits for a google search on “paris hilton”). It looks like an enterprising non profit decided to see if they can use the iPhone hype to market their cause (getting anti-retroviral treatment to children infected with AIDS in Africa, KCA website). They were first in line at a New York store in order to get an iPhone that they will auction off. The “first iPhone sold” will be presented by Alicia Keys at the Black Ball.
As the highly anticipated iPhone launch approaches, so does the promise of improved communications and connectivity with people around the world. Connectivity is not limited to technology; rather, it’s a fundamental fact that we are “one.” source… Supporters of Keep A Child Alive took advantage of the wildly hyped iPhone launch by standing in line for 4 days and communicating the charity’s grass- roots mission to New Yorkers and media from around the world. At 6 pm on Friday, June 29th, Spike Lee, renowned director, producer, writer and actor, joined Keep A Child Alive volunteers at Apple’s Soho location to purchase the first iPhone.” Full story, Earth Times
I would guess that getting in line on Tuesday will have garnered more knowledge and advertising about their cause than the auction will. I am not sure what the impact has been on the organization, but it is certainly a unique and innovative idea. They have been smart about getting the word out. Of course there is the publicity they received from actually being first in line, but in addition to that, I have seen their cause mentioned on widely popular techie websites such as InfoWorld, Gizmodo and Endgaget and on other sites they have partnerned with (iphonelaunch.tv). The Taproot Foundation also had someone in line for charity (see stories here and here). Some pics below from the folks at Keep a Child Alive (via flickr):
“This morning we started lining up for the iPhone – we are first in line at the Soho Store! We’re doing it with our friends at Keep A Child Alive an amazing organization that provides drugs for kids in Africa.”
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This idea has been mentioned a lot, but I just ran across Computainer on a Uganda listserv. CompuTainer recently announced SIMmed at the 3rd South African AIDS Conference. The technology uses SMS and USSD messaging to track and monitor patient compliance in taking chronic medication such as TB medication, ARV medication, Diabetic medication, Cardio medication and other chronic medication.
With 47% of patients simply forgetting to take medication and a further 33% not taking medication because they feel well we find an issue in medication compliance. With the ongoing struggle against drug resistant strains the introduction of SIMmed has resolved compliance issues.
I don’t have a copy of the report, but according to the listserv posting, in a recently completed trial in TB clinics in South Africa the compliance ratios were raised from between 20% and 60% to a staggering 85% to 93%. Cure rates were raised from a dismal 65% to above 91%.
The info on the SIMpill is copied here:
A pill bottle which, when opened, delivers an SMS text message to a central server. The SMS contains a unique pill box ID number as well as some information about the battery status of the pill box. Each SMS is time stamped. The central server receives the incoming SMS and, if it is within the time tolerances set for the pill box sending the message is simply stored for statistical purposes.
OK, so this is a bit of a public service announcement, but I just wanted to give a shout out to anyone with a computer that may be often idle. You know you’re the one if you’ve got a slick new machine and it basically serves as a fancy web browser and text editor with occasional number crunching during the dissertation or that last field report … Consider donating that down time to the World Community Grid.
The World Community Grid has been operating in its current form since November 2005 (you can read about the 2005 launch in the KaiserNetwork archives). They run a few extremely large research efforts on fundamental health science that require extremely large amounts of computer time. You can simply visit WCG, download the secure software, and you’re done. It runs in the background when you’re not using your machine and you contribute to research on genetics, cancer, and HIV. Something to consider anyway. And here’s a link for the kids explaining the science in computational grids.
The really interesting update, as reported in the Washington Post today, that Sony’s PS3 is getting involved in networked computing.
With the next software update for the game console, PS3 owners will be given an option to click an icon for Stanford’s “Folding@home” project and download software that the university has designed to help outsource the computing power of the game consoles (which are essentially computers) needed for some of its research.
The software will run “protein folding” simulations, which help researchers understand why proteins sometimes fold incorrectly and mutate into diseases such as Alzheimer’s and Parkinson’s. Each participating PS3 will periodically download and analyze a chunk of the school’s research, and then upload the results. The software, which is due at the end of the month, will run when the PS3 system is not playing games or performing other multimedia tasks.
First congrats to the folks at “Little Devices that Could”, their organization, Aerovax, was nominated for the prestigious Tech Museum Awards. You should definitely check out their site. I am under water right now and would love to post in more depth about several of the following links, but that is not going to happen, so a link drop will have to suffice. Enjoy:
- “What a U.N. Partnership with Big Business Could Accomplish“, HBS, Link
- For a review of the recent UN Silicon Valley meeting check out NextBillion, Link
- And related to the high tech/ICT industry, Amartya Sen on ICT for good, Link
- New book out on foundations: “How Private Wealth is Changing the World” Link
- Tactile Philanthropy has an interesting post on the impact of the Private/For-Profit sector on Non-Profits, quote “Market based solutions are great when they are appropriate, but they aren’t always appropriate.” Link
- Purdue to show low-cost AIDS-testing technology to African officials, Link…”The current cost for CD4 tests per patient in Africa is about $10…We can build a device that will reduce the cost for CD4 tests to 50 or 25 cents.”
- A list of new technologies for the developing world (via LittleDevices), Link
- Technology from the U of Delaware removes viruses from water, significant because viruses are the “smallest of pathogens”, Link
- GlobaLab on the new “revolutionary product to treat malaria” – the launch of ASAQ, a $1 drug Link
- Social enterprise podcasts and downloads, Link
- Italy : ‘Go-India’ Fund for SMEs – $600 Million Fund, Link
- Female Entrepreneurship in Developing Countries, purchase req’d, Link
- CDC and Second Life: There is a debate on the internal CDC message boards on CDC and SL, Link… For those who don’t believe in Second Life, the Amercian Cancer Society raised $40,000 (real money). More detail on CDC in SL, check out the pictures here and check out the Social Marketing blog.
- On the media front, “The Blood of Yingzhou District”, a Chinese AIDS film won the Academy Awards for best documentary, Link
- “Forget Davos, I am booked for TED”, Business Week, Link
Michael Schrage, co-director of the MIT Media, no longer attends TED because he is worried about bumping into Angelina Jolie there, she and TED are apparently not good enough for him, read the article.
- Setting up a “low” cost health information system in Spain, Microsoft Blog, Link
- Low tech solution for preventing airborne disease– open the window! Link
- Building Capacity – S.African Scientists Train In Latest Drug Discovery Techniques At Emory University, Link
- Netherlands provides health insurance for 115,000 Nigerians, via Sociolingo
- Final, random link of the day – Want to see what 60,000 plastic bags looks like? That is the number used in the US every five seconds. Link
The annual Design Indaba Expo in S.Africa was a couple of weeks ago and this condom applicator was a winner.
“The condom applicator has been described by Design Indaba Expo curator Bernard George Smith as one of those rare products that bridges the divide between social, cultural, economic and international barriers by solving a problem common to all. (it is) a small product that could have one of the biggest impacts on our social, cultural and economic future…It has taken years of work to develop this product…The retail price is R28-R30 for a package of three condoms and applicators.” (Link) See Dezeen Magazine for links to the video demonstration.
Thanks to Cat at AIDG for sending this story in, she saw this over at Boing Boing; Gizmodo and Dezeen Mag have also covered this. I am wondering about the usability and cost of this item and if they actually have done user testing on the product. We definitely need new ideas out there and I am curious if people will actually buy and use this. Any opinions on that?
The firm XYZ has also been involved in other design for development projects (link). They have this infant eye tester also: “Infant Eye testing carried out in rural settings requires flexible, durable and innovative design. The Eyeaware achieves this by reducing the component count from ten to two parts, which allow each eye to be tested with one of three lenses whilst the other is being shielded.”
Following on the announcement of the Voxiva $10 million Phones for Health program, I’ve pulled together other programs using text or SMS messaging to improve access to health care and health information in developing countries.
There has been a lot of hope for cell phone technologies for a number of years now. Warren Kaplan’s paper helps bring to light some of the challenges and points to the need for more rigorous evaluation of these programs.
Below are a few services used in developing and developed countries. If you’ve used any of these or others, what’s your experience?
- DocVia.com – a pilot project with the Perinatal HIV Research Unit (PHRU) in Soweto, South Africa to provide drug and appointment reminders.
- SIMpill – On-Cue Compliance Service – drug and appointment reminders among others. Their TB work in Cape Town, South Africa is described.
- Mobile for Good – a program in Kenya delivering health, employment and community content. Users can access health info and ask HIV and breast cancer related questions.
- Frontline SMS – a downloadable SMS platform for NGOs. Looks great for testing the utility of SMSing before scaling up.
- The South African Depression and Anxiety Group has launched a program that enables teens to communicate with counselors
- Kenyan National AIDS Control Council – HIV information program.
- Health-SMS – aims to bring health information services to the UK National Health Service.
A couple of days ago I posted on the “flags as social art” exhibit. I did say in that post that I was unable to verify the numbers or sources of data, even though the official website for the art states “We used real data taken from the websites of Amnesty International and the UNO.“
I apologize for being in a rush with that post because I did go back and take a look at the stats for one flag which seemed a bit far off. Somemone may also want to let WorldChanging know that some of these representations seem inaccurate (see their post from Jan 5, 2007 which I just spotted).
The Angolan flag indicates that half the people in Angola are infected with HIV and half with malaria. Two separate sources indicate this is not true:
When looking specficially at Somalia, the flag may be accurate – UNICEF says that in the country – “Female Genital Mutilation (FGM) has a prevalence of about 95 per cent” (Link). So I am not sure what data was used to make the flags or how the artist arrived at these conclusions. I have not had time to check stats on the other flags and there may be something I mis-interpreted, but perhaps the artist should be more transparent. This concept is a very interesting way of getting across ideas, its a shame that some of the flags may be inaccurate.
UPDATE – There is something a bit funny about the use of stats in these flags, see latest post. What a shame because it is an interesting idea.
An artist friend just sent me this site of flags. Apparently these flags as social art made their debut a couple of years ago, but now they are making the rounds again. The flags use real data to “populate” the colors, however I was unable to verify this. It is never-the-less a very interesting concept, enjoy:
Icaro Doria, Brazilian author/artist: “We started to research relevant, global, and current facts and, thus, came up with the idea to put new meanings to the colours of the flags. We used real data taken from the websites of Amnesty International and the UNO. The idea was to bring across the concept that the magazine offers profound journalism about topics of real importance to the world of today.” More flags here.
At the 3GSM World Congress just this morning in Barcelona, a new public-private partnership was announced between Motorola, MTN (a leading African mobile operator), Voxiva, and PEPFAR.
Excerpts from Earth Times, Feb 13, 2007:
“Leading players in the mobile phone industry and the U.S. Government have joined forces to fight HIV/AIDS and other health challenges in 10 African countries. Phones for Health is a cutting-edge US$10 million public-private partnership, which brings together mobile phone operators, handset manufacturers and technology companies – working in close collaboration with Ministries of Health, global health organizations, and other partners – to use the widespread and increasing mobile phone coverage in the developing world to strengthen health systems.”
“Health workers will also be able to use the system to order medicine, send alerts, download treatment guidelines, training materials and access other appropriate information,” said Paul Meyer, Chairman of Voxiva, the company that has designed the software. “Managers at the regional and national level can access information in real-time via a web based database.”
Read the rest of this entry »
Today we are lucky to have another guest blogger, Tim France, who brings a wealth of qualifications to the table. Tim is Technical Adviser at Health & Development Networks, and an active member of the HDN Key Correspondent Team. Tim obtained his PhD at the University of Wales College of Medicine (Cardiff, UK). In 1990, he switched careers to focus on promoting the public understanding of science and health. He has since held positions with the World Health Organization Global Programme on AIDS, the UN Joint Programme on AIDS, and various non-governmental organizations, mostly writing and editing HIV/AIDS-related technical guidelines and policy materials, as well as developing information dissemination strategies. He has also been Scientific Editor of two popular scientific journals: the British Journal of Hematology and the European Journal of Cancer. Tim’s blog is called Just a Minute.
Tim has written a piece on the recent controversy regarding Dr. Chan’s comments on compulsory licensing. This post is cross-listed on Tim’s blog and the HDN website listed above. Enjoy:
More Trust Needed on Shared Health Goals, by Tim France
Despite unprecedented investment in international health programmes, seven specific diseases still claim one in every four deaths worldwide. There has never been a more acute need or opportunity for the World Health Organization (WHO) to do its job. To do so, the agency must achieve an extraordinary partnership among diverse stakeholders. Hasty criticisms of WHO in the past week reveal some of the challenges working together presents.
With expectations rising about her leadership of WHO, Dr Margaret Chan’s recent unconsidered comments about compulsory licensing of essential drugs raise real concerns. But over-interpretation of her brief remarks by the media spawned a new analysis of WHO’s ‘position’ on compulsory licensing. AIDS organisations’ willing transformation of that analysis into an accepted truth appears increasingly like an unstrategic goal with each passing episode.
Chan was in Thailand to take part in a conference on neglected diseases. Her keynote speech praised drug companies for their donations of drugs against diseases such as trypanosomiasis, lymphatic filariasis and schistosomiasis. These are medicines that are otherwise impossible to obtain for most of the people who need them. Media reports later referred to Chan as having “praised the pharmaceutical industry lavishly in her address,” without referring to the specific context of the drug donation programmes.
The titles of these two articles – Thailand to break AIDS, heart drugs patents from ETNA (Thailand) and Thailand backs patent drug copies from the BBC – suggest different actions on behalf of the Thai government, but they both report on the same: Thailand has approved production of patented HIV and cardiovascular pharmaceuticals. The drugs in question are Kaletra, an antiretroviral protease inhibitor produced by Abbott Laboratories, and Plavix, an anti-clotting agent from Sanofi-Aventis and Bristol-Myers Squibb.
From the ETNA article:
BANGKOK, Jan 30 (TNA) – The Thai Public Health Ministry confirmed Monday that it has issued compulsory licenses for the production of two drugs, one for the treatment of HIV/AIDS and another for a cardiovascular drug, paving the way for immediate production and imports of lower-cost generic versions.
[Thai Public Health Minister Dr Mongkol na Songkhla] said the decision to break the patents was not taken lightly but the move was necessary to ensure that the affected Thai patients have access to cheaper generic versions of the life-saving drugs.
He added that generic production of Plavix, for instance, would reduce the cost from about 70 baht (US$2.06) a pill to less than six baht (18 cents).
This is the second time Thailand’s military-backed government has broken an international drug patent in the interest of the health needs of the country’s poor.
In November it introduced Thailand’s first compulsory licencing for Merck’s Efavirenz anti-retroviral AIDS treatment.
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
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.
- 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.