NEW YORK – Over half of new cancer drug approvals granted by European authorities between 2014-2016 may have been made based on evidence from biased clinical trials, according to a new study published in The BMJ. The study, led by Dr. Christopher Booth, professor of oncology from Queens University Cancer Research Institute, raises serious questions about the quality and strength of evidence used by the European Medicines Agency (EMA) to approve new cancer drugs.

Half of the 32 new drug approvals relied on evidence from trials that were “at high risk of bias,” according to the study. And an additional 7 of those used results from at least one randomised-control trial (RCT) that was at “low risk” of bias, researchers found in the study, which was partially funded by a civil society group that has protested cancer drug prices and championed access to medicines issues.

A nurse injects medicine into a cancer patient. Photo: WHO/ G. Reboux

Only 7 of the new drugs were approved based on trials that actually measured improvements in survival or quality of life outcomes.

 

Noting that some bias in trials is unavoidable due to the complexity of cancer, the authors were concerned that a number of studies did not give clear reasons for why they may have excluded data from their analyses.

While the authors note that the results may not be generalizable to all new drug approvals, civil society groups were quick to say that the

paper strengthens the case for revamping  the drug approval regulatory process to ensure that new medicines brought to market are indeed effective.

“…Many newly marketed medicines bring negligible or non-existent improvements to survival rates and quality of life for patients, while becoming ever-more unaffordable to already stretched health systems,” Jaume Vidal, senior policy advisor at Health Action International, the group that partially funded the study in a press release.

“Regulators must take on the findings to help ensure new medicines on the market are there for the benefit of the patient and society and not pharmaceutical companies and shareholders.”

 The World Health Organization tends to follow the lead of regulatory agencies such as the EMA or the US Drug and Food Administration in the consideration of new medicines for “pre-qualification” as drugs that developing countries could obtain at negotiated prices. WHO approval, in turn, may be interpreted as a green light to developing countries to begin reviewing and registering new therapies nationally.

 

Image Credits: WHO/G. Reboux.

[WHO/UNICEF]

Despite progress, a pregnant woman or newborn dies somewhere in the world every 11 seconds

More women and their children are surviving today than ever before, according to new child and maternal mortality estimates released today by UNICEF and the World Health Organization (WHO). Since the year 2000, child deaths have reduced by nearly half and maternal deaths by over one-third, mostly due to improved access to affordable, quality health services.

“In countries that provide everyone with safe, affordable, high-quality health services, women and babies survive and thrive,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “This is the power of universal health coverage.”

A mother and her new born baby at Karenga Health Center IV.

Still, the new estimates reveal that 6.2 million children under 15 years died in 2018, and over 290 000 women died due to complications during pregnancy and childbirth in 2017. Of the total child deaths, 5.3 million occurred in the first 5 years, with almost half of these in the first month of life. Women and newborns are most vulnerable during and immediately after childbirth. An estimated 2.8 million pregnant women and newborns die every year, or 1 every 11 seconds, mostly of preventable causes, the new estimates say.

Children face the highest risk of dying in the first month, especially if they are born too soon or too small, have complications during birth, congenital defects, or contract infections. About a third of these deaths occur within the first day and nearly three quarters in the first week alone.

Vast inequalities worldwide

The estimates also show vast inequalities worldwide, with women and children in sub-Saharan Africa facing a substantially higher risk of death than in all other regions. Levels of maternal deaths are nearly 50 times higher for women in sub-Saharan Africa and their babies are 10 times more likely to die in their first month of life, compared to high-income countries.

In 2018, 1 in 13 children in sub-Saharan Africa died before their fifth birthday– this is 15 times higher than the risk a child faces in Europe, where just 1 in 196 children aged less than 5 die.

Women in sub-Saharan Africa face a 1 in 37 lifetime risk of dying during pregnancy or childbirth. By comparison, the lifetime risk for a woman in Europe is 1 in 6500. Sub-Saharan Africa and Southern Asia account for around 80% of global maternal and child deaths. Countries in conflict or humanitarian crisis often have weak health systems that prevent women and children from accessing essential lifesaving care.

Progress linked to universal health coverage

Since 1990, there has been a 56% reduction in deaths of children under 15 years from 14.2 million deaths to 6.2 million in 2018. Countries in Eastern and South-Eastern Asia have made the most progress, with an 80% decline in under-five deaths.

And from 2000 to 2017, the maternal mortality ratio declined by 38%. Southern Asia has made the greatest improvements in maternal survival with a nearly 60% reduction in the maternal mortality ratio since 2000.

Belarus, Bangladesh, Cambodia, Kazakhstan, Malawi, Morocco, Mongolia, Rwanda, Timor-Leste and Zambia are some of the countries that have shown substantial progress in reducing child or maternal mortality. Success has been due to political will to improve access to quality health care by investing in the health workforce, introducing free care for pregnant women and children and supporting family planning. Many of these countries focus on primary health care and universal health coverage.

For more about the maternal and child mortality estimates, see the WHO press release.

Image Credits: UNICEF/Zahara Abdul 2019.

Daniel Kass

Health is becoming more prominent in the climate debate in light of the mounting human toll from extreme weather – and that’s only the tip of the ’iceberg’, in terms of what lies in store, says Daniel Kass, senior vice president at Vital Strategies and former Deputy Commissioner of Health for New York City. But health alone is not enough to move the political needle. As the world leaders gather Monday for the UN Climate Summit, to face what UN Secretary General António Guterres, has described as the “Battle of our Lives”, health advocates need to band together with other constituencies in a united front. Kass talked with Health Policy Watch about the issues at stake in the lead-up to Monday’s Summit.

Health Policy Watch:  What do you expect to be the main health-related aspects of climate change that will be discussed at the UN Climate Summit?

Daniel Kass: The evidence about the health impacts is growing, and that will help to focus attention on health at the meeting. It is always easiest to discuss the direct effects of climate change – in particular, weather-related mortality and illness, for example heat stroke and heat-related mortality, coastal flooding and drowning.

But more emphasis needs to be placed on the indirect impacts, and rightfully so, as they are far greater, and more far-reaching. These include impacts that are already with us – heart disease, respiratory disease and deaths from global increases in air pollution; deaths from resurgent vector-borne diseases like malaria as well as from novel vector-borne infections like Zika virus, which tend to spread more widely to human settlements as a result of deforestation, urbanization and related habitat changes.

Still, with the rapid pace of change, there needs to be more discussion about still more indirect impacts. This would include consideration of issues such as:  catastrophic outcomes including malnutrition from disruptions in food supplies; health impacts of water stress/shortages and indirect impacts from increases in water-related conflict and migration; and the potential for social safety net collapse as more resources are diverted to coping with climate-related mitigation.

A woman carries supplies through a flooded street. Thousands of people were displaced by unprecendented flooding in Haiti in 2014. Photo: Logan Abassi UN/MINUSTAH

HP Watch: This is a formidable list.  What are the main challenges to addressing it more effectively?

DK: The current breakdown in global economic and political cooperation is a huge impediment to progress. It is extremely difficult to manage more sustainable production of energy; standards for industrial processes and global commodities like vehicles; and harmonized trade rules and manufacturing standards necessary to address climate-related emissions. Progress depends on finding common ground based upon mutual self-interest. Perhaps the catastrophic threats from climate change will unify the world. But rising nationalism and the political marketing of self-interest does not make me hopeful, in the near term.

HP Watch:  The recent IPCC report also highlighted threats to food security, including the need to reduce meat consumption to ensure a sustainable food supply for a growing population. Do you see this as broadening the health agenda? And what are the concrete implications for the health sector? After all, a recent WHO nutrition report ignored warnings of health risks associated with red meat consumption, including from its own cancer researchers.[1]

DK: Carbon emissions reductions from greater reliance on renewable energy will have enormous health and economic co-benefits. So too will shifts in land use, in particular from reducing the impact of meat production— mammalian in particular.

Diets lower in meat and higher in variety and with greater caloric and nutritional needs met by grains, fruits, and vegetables, bring health benefits at individual and population levels. Remember, as well, that most of the world already lives without ready access to meat – especially beef. While it’s important for health advocates to join the call for more rational and less carbon-intensive food production, it is also important that as population and net global wealth grows, this does not come with a proportional increase in meat consumption. The challenges for nutritionists, agronomists and others are different while they work toward the same aims.

Climate advocates in the West should not get caught in the trap that may be set by proponents of the status quo. Industry wants to frame this as a consumer freedom issue, and sometimes advocates direct their efforts at consumers rather than the corporate and governmental policy actors that bear primary responsibility for reversing trends in CO2 emissions. That’s just what the food, fossil fuel and land oligarchs want to happen.

HP Watch:  Reducing climate emissions from fossil fuel sources, which also cause health harmful air pollution, means scaling back industries such as coal, automobiles, etc., which are lobbying hard to maintain their economic foothold, and even expand in low- and middle-income countries. What forms of political action and policy measures will be necessary to ensure change? 

DK: All of the work that must be done is ultimately political. There is greater public acknowledgement that the status quo cannot be maintained, and there remains no rational economic argument for doing so (once the true health and planetary costs of pollution and climate emissions are accounted for). Broad categories of policies that must be expanded or initiated include:

  • Eliminating subsidies on dirty fuels; shifting incentives to support clean tech innovation and solutions;
  • Prohibiting the dumping of dirty, inefficient vehicles and the export of superannuated technologies like coal-to-electricity to developing countries;
  • Incentivizing healthy and sustainable shifts in consumer and individual behavioural choices, around food, transport, and diet, for example;
  • Reorienting regulations toward steep improvements to achieve specific benefits and outcomes, rather than modest incremental improvements on the status quo.

This will require redirecting development funding toward green industries, and imposing conditions with sanctions for failing to meet goals. The greatest spending must happen where the greatest emissions are, and those countries (middle- and high-income countries) will only do so if there is a strong political movement to demand it. There are very positive signs that this is occurring – enabling health and climate advocates to advance calls for policy change. And people are mobilizing around the difficult issues of societal reorganization. The world’s nations spend nearly USD $2 trillion each year on militaries. Investing in planetary survival has a far greater return on investment than war.

HP Watch: Can you speak to the role of cities in reducing climate change and its related health impacts? And do you see the Climate Summit as a key event in planning and preparing for such changes?

DK: There is good reason to think cities will be central to the Summit, and central to potential solutions. The challenges are profound: The world is increasingly urbanized, and this trend is projected to continue. Cities suffer a commensurate global health and economic burden from climate change and air pollution, and a large proportion of urban populations are extremely vulnerable to climate change, loss of habitable area from rising sea levels, drought and flooding, all made worse by the informality of new urban settlements in low-income countries.

Cities can lead the way in mitigation and adaptation, but they typically don’t have the fiscal, political or regulatory authority to do it alone. There is good reason to believe that greater urbanization will ultimately support mitigation. Cities in the industrialized world typically have lower per capita CO2 emissions compared to their suburbs because of their efficiency, density, verticality, and availability of mass transit. Some cities are rethinking the place of automobiles and moving to regulate their own purchase of energy from renewable sources. We need to ensure that we increase knowledge and promote uptake of successful strategies so that more cities follow suit.

HP Watch:  While awareness of the human health impacts of climate change is growing, it still doesn’t seem to be sufficient to drive the kind of dramatic commitments that the SG has in mind.  Will some countries deliver? And if not, what does the world do on the day after the Climate Summit? 

DK: I think of health impacts as a necessary but insufficient way to mobilize additional constituencies around the impacts of climate change. Research and modelling show that the burden of death and disease from more extreme weather, population displacement, more widespread and novel infectious and vector-borne diseases, stress, negative birth outcomes (and the list goes on and on) will overwhelm even wealthy countries’ health systems and exhaust governmental resources in lower income countries. And these impacts are already being felt. Some people, organizations and institutions are motivated by health concerns and they need to be mobilized. Others are mobilized by environmental concerns or economic risk, others by their faith. The threat of irreversible and dramatic climate change can unify these communities. And the desire to avoid dissent is a great motivator for governmental action.

Some countries are already delivering, both in terms of energy transformation and funding to support global work. Others are cynically running in the wrong direction. Local governments, which feel the impacts earliest, are responding globally, but require national and international commitments to make an impact. Following the Climate Summit, the world needs to study the results and ask whether their representatives are serious, whether they are prepared to take rapid action, whether they can be counted on. If the answers are “no,” they should do everything they can to ensure that their term in office is short-lived.

Note: Kass is senior vice president of environmental health at Vital Strategies, a global health organization that works with governments and civil society in 73 countries to help them make rapid progress against cancer, heart disease, obesity, tobacco use, epidemic diseases, drug overdose, road crashes and other leading causes of disease, injury and death. Previously, Kass was Deputy Commissioner for the Division of Environmental Health Service at the New York City Department of Health and Mental Hygiene.

Elaine Ruth Fletcher contributed to this article

 

This story was published as part of Covering Climate Now, a global collaboration of more than 250 news outlets to strengthen coverage of the climate story, co-founded by The Nation and Columbia Journalism Review.

 

[1] International Agency for Research on Cancer (IARC)

Image Credits: Logan Abassi UN/MINUSTAH.

NEW YORK – As heads of state and international organisations gather for the 74th United Nations General Assembly, Monda‎y’s High-Level Meeting on Universal Health Coverage (UHC) is one of the key events of this session. It aspires to elevate access to quality healthcare for the global population by 2030, and one billion more people by 2023.

The stated aim of the event, “Universal Health Coverage: Moving Together to Build a Healthier World,” is to “accelerate progress toward universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

A draft UHC political declaration (note: text starts on p.3) – stripped of controversial language over thorny issues like sexual and reproductive health, and finalized last week – is to be approved at the High Level Meeting. It commits governments to the stated UHC aim of covering one billion more people by 2023, and all people by 2030 (paragraph 24). It also commits governments to halt rising out-of-pocket health expenditures by providing greater financial risk protection (such as insurance) for healthcare procedures.

A nurse consults her patient with family planning needs. Sexual and reproductive health has been a controversial issue in the UHC debate. Photo: Dominic Chavez/World Bank

While the lofty vision of this far-reaching effort is further detailed in the 11-page declaration text, observers will look to leaders’ statements for signals of how concrete actions may follow.

Some two dozen heads of state are said to be planning to attend Monday’s UHC session at the General Assembly (GA), which began Wednesday and runs to 30 September.

The draft agenda for the one-day UHC meeting shows a mix of plenary segments with government statements, and two panels. There may be more than two dozen heads of state in attendance, according to sources.

In the draft version of the agenda, panel speakers included: the prime ministers of Bangladesh and Spain; the heads of the UN, WHO, World Bank, UNHCR, GAVI, Oxfam, and Medtronic; and well-known political figures such as former WHO Director General Gro Harlem Brundtland (the “Eminent High-Level Champion of UHC and member of the Elders”); Jeffrey Sachs founder of Columbia University’s Earth Institute; former New Zealand Prime Minister Helen Clark, now the Board Chair of the Partnership for Maternal, Newborn & Child Health; and Keizo Takemi, member of the Japanese House of Councillors and WHO UHC Goodwill Ambassador.

A series of side events are taking place around the High-Level Meeting, many of which are open to all. A list of side events UHC2030 is hosting or co-organizing during the General Assembly is here. A list of further events during the General Assembly is in the UNGA guide 2019.

The UN has, in recent years, stepped up its high-level political attention to health issues, with a landmark declaration on AIDS, and in last year’s GA session, high-level meetings on non-communicable diseases, and tuberculosis. Observers argue, however, that such meetings lead to optimistic language but not enough concrete progress. From a development perspective, achieving UHC will require governments to take the broad declaration and fit it to their specific national needs, while increasing outlays for stronger health systems.

“Next week’s High Level Meeting on Universal Health Coverage is a window of opportunity that we need to seize,” Francesca Colombo, head of OECD’s Health Division, told Health Policy Watch. While acknowledging that the declaration sets ambitious aims, she said that drawing attention to the UHC issue at the UN’s highest level was already a “tremendous achievement.”

However, she acknowledged that the declaration and the High Level Meeting were just the beginning of the journey. “It’s unfinished business.” she said. “Much more needs to be done to draw attention to health as a critical economic development issue.”

Political Declaration

The final political declaration contains 83 paragraphs that capture the remarkably broad scope of global and public health issues such as health systems, financing, emergencies, health workers, gender, children, aging, migrants and refugees, discrimination and violence, communicable and non-communicable diseases, digital health and data, access to health technologies, and partnerships.

The declaration contains calls to use all levels of policymaking, governments, regions and the multilateral system and existing agreements, and details dozens of specific topics, such as eye and oral care, mental health, protection in armed conflict and humanitarian issues, sanitation, safety, healthy diets, and neglected diseases. It has numerous references to improving women’s health and involving them more completely in health care, and it stresses that primary health care is essential for UHC.

A core focus of UHC efforts is on financing and budgets, but no specific commitments are made, despite the many mentions throughout. The declaration does, however, cite the WHO’s recommended target of public spending of 1 percent of GDP or more on health. It also cites WHO estimates that an additional US$ 3.9 trillion in global spending by 2030 could prevent 97 million premature deaths and add between 3.1 and 8.4 years of life expectancy in LMICs.

The declaration repeatedly cites the need for affordable health care and medicines, vaccines and diagnostics, and urges bolstered domestic budgets and global coordination through financial groups like the Global Fund for AIDS, Tuberculosis and Malaria. It also mentions a growing strategy of pooling resources allocated to health, and it gives a clear message about the importance of private sector funding and contributions.

The declaration also highlights statistics showing the magnitude of need for stronger health systems to fulfill the aims of UHC – such as the shortfall of 18 million health workers especially in low- and middle-income countries.

And it declares “that action to achieve universal health coverage by 2030 is inadequate and that the level of progress and investment to date is insufficient to meet target 3.8 of the [SDGs], and that the world has yet to fulfill its promise of implementing, at all levels, measures to address the health needs of all.”

SDG 3.8 states: “achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.”

The text’s preamble of 23 paragraphs describe problems and shortfalls in the global, regional and national efforts in health, stating that in many cases efforts are not on track to fulfill the SDGs by 2030 and must be stepped up. Paragraphs 24 to 81 are action items to be undertaken across every front, from national governments to the UN system.

The UHC declaration calls for another high-level meeting to be held at the UN in New York in 2023 to review implementation of this year’s declaration. Next year’s General Assembly will receive a progress report on implementation of the declaration, and a report on recommendations on implementation. Next year’s General Assembly will decide the modalities for the 2023 meeting.

The UHC political declaration text is accompanied by a letter from the President of the General Assembly, María Fernanda Espinosa Garcés and the two co-facilitators of the political declaration negotiations, Georgia’s Ambassador Kaha Imnadze and Thailand’s Ambassador Vitavas Srivihok.

Sexual and Reproductive Health Settled

In the final agreed text, negotiators resolved an issue over references to sexual and reproductive health rights, which had prevented consensus on an earlier draft negotiated over the summer.

Negotiators removed the controversial reference to sexual and reproductive health at the end of paragraph 29, according to the letter from the co-facilitators’, Imnadze and Srivihok. The paragraph previously stated:

  1. “Take measures to reduce maternal, neonatal, infant and child mortality and morbidity and increase access to quality health-care services for newborns, infants, children as well as all women before, during and after pregnancy and childbirth, including in the area of sexual and reproductive health;”

The final text of paragraph 29 now ends after the word “childbirth”.

However, the text retained intact the reference to sexual and reproductive health in paragraph 68, which also hearkens from the SDGs. That states:

  1. “Ensure, by 2030, universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, which is fundamental to the achievement of universal health coverage, while reaffirming the commitments to ensure universal access to sexual and reproductive health and reproductive rights in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences;”

Meanwhile, reference to sexual and reproductive health was also removed from a third paragraph, 69, on gender rights, which had previously stated:

  1. “Mainstream a gender perspective on a systems-wide basis when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving gender equality and the empowerment of women in health policies and health systems delivery and the realization of their human rights, consistent with national legislations and in conformity with universally recognized international human rights, acknowledging that the human rights of women include their right to have control over and decide freely and responsibly on all matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence;”

It now reads:

  1. “Mainstream a gender perspective on a systems-wide basis when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving gender equality and the empowerment of women in health policies and health systems delivery;”

The co-facilitators also noted that negotiators moved paragraph 12 up to paragraph 6, with no change to the text, effectively raising its profile somewhat. That paragraph emphasises the importance of “national ownership and the primary role and responsibility of governments at all levels to determine their own path towards achieving universal health coverage….”

Measuring Impact

The overarching set of guideposts for the UHC declaration work is the 2030 Sustainable Development Goals (SDGs), which include many objectives related to health throughout the 17 SDGs, along with the dedicated “Good health and well-being” goal of SDG 3. The declaration is filled with undefined goals, but it also contains numerous references to measuring progress. It will remain to be seen whether the momentum, pressure and language of the commitments will be strong enough to bring about the much-hoped for UHC achievements.

 

Image Credits: Dominic Chavez/World Bank.

Hans Kluge, director of Health Systems and Public Health in WHO’s European Regional Office, has been nominated to become WHO/Europe’s next Regional Director (RD).

Kluge, proposed by Belgium, was selected Tuesday by WHO’s 53 European member states out of a field of six candidates in a secret ballot during the WHO Regional Committee for Europe meeting (RC 69) underway this week in Copenhagen. His “nomination” must still be approved by the WHO Executive Board at its next meeting in February 2020 – although that is regarded as a technicality.

Kluge will replace Zsuzsanna Jakab, who left the post to become Deputy Director General at WHO’s Geneva Headquarters earlier this year. Jakab developed the RD position as a hub of power, leaving the legacy of Health 2020, a European policy framework for strengthening public health, promoting people-centered systems, and reducing health inequalities.

Hans Kluge (Center) Photo: @hans_kluge

Kluge has been a public health doctor for 24 years, including stints with Médecins Sans Frontières in Liberia and Somalia and in WHO’s Regional Office for South-East Asia, where he specialized in programmes on TB, AIDS and malaria, said a WHO press release. His work in Europe, which included advancing TB programmes in prison systems of the former Soviet Union, reflects the region’s diverse social landscape.

More recently, Kluge promoted community-based primary health care in Greece during the country’s financial crisis and European commitments made at the Global Conference on Primary Health Care in Astana, Kazakhstan, in 2018.

In a Twitter video promoting his candidacy, Kluge said that WHO’s European Region should move from “diagnosing” challenges to more assertive action.

“WHO doesn’t need to continue diagnosing the challenges forever,” Kluge said. “WHO needs to become agile in supporting countries that allows them to act, based on evidence and good practice….

“I see the WHO Regional Office as acting as a hub for evidence and know-how development. It will be a platform for solutions and tools that can be adapted to the local context based on the many innovations being undertaken in member states. To help countries reach the health-related sustainable development goals, underpinned by Universal Health Coverage.”

WHO’s Regional Committees are semi-autonomous governing bodies of member state representatives, which meet once a year to set policy in each of WHO’s six regions. The European meeting of health ministers and other high level representatives, 16-19 September, is taking place under the banner of health equity, health literacy and accelerating primary health care.

 

 

 

Trauma surgeon and veteran field worker, Christos Christou, has taken over the Médecins Sans Frontières (MSF) reins as International President, following his election by the organization’s International General Assembly last June.

Christou, former president of the MSF Greece Board of Directors, will be faced with the leadership challenges of an organization that has grown from a grassroots volunteer movement into a sprawling multi-billion dollar operation with a presence in 74 countries worldwide.

Hailing from a small town in central Greece, Christou joined MSF in 2002 working as a field doctor with migrants and refugees in Europe, followed by field stints in Zambia, and later in conflict zones including South Sudan, Iraq and Cameroon, MSF said in an announcement of the leadership change.

New MSF International President Christos Christou on a 2013 field operation. Photo: Isabel Corthier/MSF

Christou replaces the Canadian physician Joanne Liu, who served as international president for six years, an unprecedented two terms of three years each.

The period has been marked by a non-stop series of humanitarian and health challenges that ranged from old and new conflicts in Afghanistan, Syria, Iraq and Yemen to a unprecedented wave of refugees and migrants fleeing Africa, the Middle East and Central America; and two Ebola outbreaks, including the one still ongoing in the Democratic Republic of Congo.

“As our President, Joanne made sure the reality of people caught in crises was brought directly to the attention of the authorities and public around the world,” said Christopher Lockyear, Secretary General of MSF International, in the MSF statement.

“Joanne worked relentlessly through the West Africa Ebola outbreaks of 2014-2016, and the [US] bombing of our trauma centre in Kunduz, Afghanistan in 2015…Joanne was also particularly vocal on the brutality of inhumane migration policies that MSF teams witness around the world, from Mexico, to Libya and Europe.”

In a recent interview, Liu said that the DRC Ebola crisis was a kind of milestone in the history of relief work.

As the DRC national government asserted its control over both strategy and operational Ebola response, MSF and other humanitarian groups were compelled to recognize that they were not in the drivers seat, or in the words of Liu “…at the end of the day we are a guest wherever we are.”

However, that should be seen as a positive trend, she told the New Humanitarian. It signals a shift away from a “neocolonialist” mindset where health and relief workers came to the rescue of powerless countries.

“MSF is most of the time a great responder, a fairly good doer, a very bad partner,” Liu said, in the interview. “We deeply need to improve. Our survival and our success in the next decade is [going to be dependent on] how meaningfully we partner with local agencies or local [health ministries].”

Joanne Liu examines a baby in an MSF feeding centre in Nigeria in 2017. Photo: Malik Samuel/MSF

The outgoing president also acknowledged the huge internal management challenges of the present-day MSF, which treats some 11 million people a year and wields a budget of $US 1.6 billion.

The decentralized structure of the organization, employing 68,000 people at field level, as well as in 48 offices and five operational centres, has created huge internal strains and new leadership challenges, Liu admitted.

“At times, the Game of Thrones seems to be a baby playground compared to what MSF can be,” she quipped.

 

Kenya initiated a national pilot of the world’s first malaria vaccine today, joining Ghana and Malawi to introduce the landmark vaccine as a tool against a disease that remains a leading killer of children under the age of 5 years, particularly in Sub-Saharan Africa.

The vaccine, known as RTS,S, will be rolled out nationally in phases to children from 6 months of age in eight counties across the country, beginning in Homa Bay, in western Kenya, said a WHO press release. It is the first vaccine with the potential to significantly reduce malaria infection in children, including life-threatening severe malaria, which claims the life of one child every two minutes.

Malaria vaccine launched in Kenya. Photo: WHO Africa Region

“Africa has witnessed a recent surge in the number of malaria cases and deaths. This threatens the gains in the fight against malaria made in the past two decades,” said Dr Matshidiso Moeti, WHO Regional Director for Africa, speaking at the Kenya launch event. “The ongoing pilots will provide the key information and data to inform a WHO policy on the broader use of the vaccine in sub-Saharan Africa. If introduced widely, the vaccine has the potential to save tens of thousands of lives.”

WHO said that the aim is to vaccinate about 120,000 children per year in Kenya. The WHO-coordinated pilot is a collaboration with the ministries of health in Ghana, Kenya and Malawi, as well as international and local NGOs. PATH and GSK, the vaccine developer and manufacturer, are donating up to 10 million vaccine doses for the pilot. Financing for the pilot programme has been mobilized through a collaboration between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and UNITAID.

WHO said that the vaccine has a proven track record from Phase 3 clinical trials, which were conducted between 2009 and 2014 through a network of African research sites, including three sites in Kenya (Kombewa, Siaya and Kilifi) and enrolling more than 4,000 Kenyan children. Children receiving four doses of RTS,S experienced significant reductions in malaria and malaria-related complications in comparison to those who did not receive RTS,S. Health benefits of the vaccine were added to those already seen through the use of insecticide-treated bed nets; prompt diagnosis; and effective antimalarial treatment. The vaccine, where available, will be given in four doses: three doses between 6 months and 9 months of age, and the fourth dose at 24 months (age 2).

After thirty years under development, WHO said that the vaccine is soon to be added to the core package of WHO-recommended measures for malaria prevention. Other key measures include use of insecticide-treated bed nets, indoor spraying with insecticides and access to malaria testing and treatment.

Kenya is one of three countries selected from among 10 African country applicants for the RTS,S pilot. Key criteria for selection included well-functioning malaria and immunization programmes and areas with moderate to high malaria transmission.

For more about the initiative, see the WHO Press release

 

Image Credits: WHO Africa Region.

At a first-ever Global Vaccination Summit, health leaders worldwide ramped up efforts to tackle “vaccine hesitancy”, which has prompted the recent resurgence of vaccine-preventable diseases such as measles.

“After many years of progress, we are at a critical turning point. Measles is resurging, and 1 in 10 children continues to miss out on essential childhood vaccines. We can and must get back on track,” said Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, speaking Thursday at the meeting in Brussels, co-hosted by WHO and the European Commission.

While vaccine hesitancy isn’t the only cause of gaps in vaccination coverage, it has visibly contributed to the global increase in measles, with cases rising by 30% between 2016-2017.  Over the past three years, seven countries around their world, including four in the European Region, lost their status as measles-free countries, largely driven by gaps in coverage exacerbated by a spread of vaccine misinformation.

A girl receives a measles vaccine in Paraguay. Photo: PAHO

Countries including Albania, Czechia, Greece and the UK, which had previously eliminated the disease, lost that status. And the United States, where vaccine resistance has become a major public health debate, is in danger of losing its measles-free status due to an outbreak that occurred earlier this year. Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – was cited by WHO as one of the top 10 threats to global health in 2019.

Tackling Vaccine Misinformation

Vaccine hesitancy is driven by complacency, lack of convenience and confidence in vaccines, according to a WHO report. The spread of vaccine misinformation has greatly contributed to decreasing public confidence in the safety and efficacy of vaccines.

Some 48% of the EU public believes that vaccines can often produce serious side effects; 38% believe that they cause the disease that they are intended to protect against; and almost a third are convinced that vaccines actually weaken the immune system, according to a Eurobarometer poll.

“Misinformation about vaccines is as contagious and dangerous as the diseases it helps to spread,” noted Dr. Tedros in a statement, also referring to the role social media has played in spreading vaccine misinformation. Recent moves by Facebook and Pinterest to redirect “vaccines” searches to the US Centers for Disease Control and WHO vaccine sites have been applauded by the global health community as combating the propaganda of anti-vaccine groups, often known as “anti-vaxxers”.

Rising numbers of measles cases in the United States. Photo: CDC

However, people who choose not to vaccinate based on false information should not be attacked, speakers at the Summit underlined. Better education and engagement of health professionals in communicating with patients, particularly parents, about their concerns is key to improving acceptance of vaccination.

 “People who believe vaccine misinformation are not bad people… let’s not demonise them and build a wall, but rather extend a hand and build the bridges,” said Ethan Lindenberger, a formerly unvaccinated teen who has become a vaccine advocate, in a special address to Summit delegates.

Trust in Vaccination Tied to Trust in Healthcare

Vaccine resistance is not only a high-income country phenomenon, speakers at the Summit also underlined. People in developing nations also share concerns about vaccination, and  community mistrust in health systems contributes to vaccine hesitancy around the world.

Vaccine hesitancy may also be driven by an overall lack of access to essential health services. Members of under-served communities may become suspicious when a vaccine initiative is introduced, perceiving it as something imposed by outsiders with an agenda. Language around the introduction of new vaccines, must be thus be carefully designed in order to gain the trust of communities, particularly in places with historically low access to healthcare.

Introducing new vaccines as “experimental” for example, has at times generated pushback from under-served communities who don’t wish to be “guinea pigs” for the rest of the world, noted Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies.

Other participants noted that the response to the outbreak of Ebola in the Democratic Republic of Congo had suffered, particularly at the outset, as a result of the failure to gain community trust in the vaccine being used, despite its strong record of efficacy.

Vaccine Costs and Logistics Remain Barriers in Developing Countries

Along with combatting vaccine misperceptions, more effort still must be invested in overall support for the introduction and scale-up of vaccines in developing countries.

“It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands but it is not being put to full use,” said European Commission President Jean-Claude Juncker, in a statement.

Global vaccination coverage rose impressively in earlier decades before plateauing over the last few years at about 86% of newborns and infants under the age of 12 months.  According to Gavi, The Vaccine Alliance, over 20 million children remain unvaccinated every year because of barriers to access.

Costs of vaccines remain another key barrier, said Jakaya Mrisho Kikwete, the ambassador to Gavi and former president of Tanzania. He called on the international community to continue supporting governments in lower income countries, which cannot afford expensive vaccines on their own.

Gavi, a public-private partnership that helps low and lower-middle income countries introduce new vaccines, recently launched its third replenishment campaign, asking donors for US$7.4 billion to help finance a bold effort to vaccinate 300 million more people by 2025.

Problems in “reaching the last mile” – or reaching the most remote communities – have also plagued vaccine delivery systems. Over half of the 20 million unvaccinated children in the world live in crisis or humanitarian settings where health services delivery systems are weak or have failed.

And for the hardest to reach places, vaccination cannot just be the only health service delivered to these populations, notes the CEO of RA International, Soraya Narfeldt. It must be integrated into a comprehensive package of health interventions – so that people regain confidence in health systems.

Ultimately, she notes, “that trust comes from access to health services, caring health workers, and a health system that meets the needs of the people” regardless of the health intervention.

On that note, the Summit concluded with a call to integrate vaccination delivery more fully into the platform for Universal Health Coverage (UHC) platform, due to be the focus of a UN High-Level Meeting on 23 September, in less than two weeks time.

 

 

Image Credits: Pan American Health Organization (PAHO), CDC.

Digital health holds the potential to transform health systems so that they become more proactive and responsive to patients, advocates said at Wednesday’s launch of a two-day international conference that brought together members of the global healthcare and artificial intelligence (AI) communities in Switzerland’s pharmaceutical industry hub, Basel.

But using AI doesn’t inherently empower women or other vulnerable groups, some speakers and participants also pointed out. Policies have to be shaped to ensure that such technologies advance equity and access to health care.

The two-day Intelligent Health 2019 conference, organized by Novartis Foundation, brings together experts from some 67 countries, as well as representatives of the World Health Organisation, and other international agencies, along with tech giants such as Google and Microsoft.

“Digital tech can transform our health and care systems from being reactive to becoming proactive and even predictive. That’s the challenge the Novartis Foundation is now fully focused on,” said Dr. Ann Aerts, Head of the Novartis Foundation, speaking about the conference aims in a blog.

“Some of the biggest medical and health problems in the world today can be solved by harnessing the power of AI, big data and digital solutions. We have the potential to unite multi disciplinary groups ….from governments, corporates, healthcare providers and global clinician communities to radically transform the quality of lives globally” said Sarah Porter, CEO & Founder of Inspired Minds, a conference co-organizer.

However, like all innovations and technologies, AI is neutral, and humans have to ensure that it is used for everyone’s benefit, others emphasized.

“In order for AI tools to actually impact health outcomes positively, the algorithms need to be diverse and inclusive,” Stephanie Kukku, of UCL Hospital, London, was quoted as saying in a presentation.

Using AI doesn’t necessarily lead to the empowerment of patients, one participant pointed out in a tweet:  “We need to acknowledge the real barriers patients are facing to accessing quality care.”

 

 

Image Credits: A Health Blog.

Reducing pesticide self-poisonings is one of the most effective ways to reduce suicide deaths –the second leading cause of death among young people aged 15-29 years, after road injury, according to a new WHO report.

Release of the WHO report, Preventing suicide, a resource for pesticide registrars and regulators, coincided with World Suicide Prevention Day on Tuesday.

Photo: WHO

The report reflects the growing body of evidence that regulations to prohibit the use of highly hazardous pesticides can lead to reductions in national suicide rates. In Sri Lanka, a series of bans led to a 70% fall in suicides and an estimated 93 000 lives saved between 1995 and 2015. In the Republic of Korea – where the herbicide paraquat accounted for the majority of pesticide suicide deaths in the 2000s – a ban on paraquat in 2011-2012 was followed by a halving of suicide deaths from pesticide poisoning between 2011 and 2013.

Globally, there is one suicide death every 40 seconds. While 79% of the world’s suicides occurred in low- and middle-income countries, high-income countries have the highest rate, at 11.5 per 100 000, according to a WHO press release.

Globally, there are an estimated 10.5 deaths by suicide per 100 000 people a year. Rates varied widely, however, between countries, from 5 suicide deaths per 100 000, to more than 30 per 100 000. Nearly three times as many men as women die by suicide in high-income countries, in contrast to low- and middle-income countries, where the rate is more equal.

Image Credits: WHO.