Campaign for Fighting Diseases Blog

Médecins Sans Facultés

The ever-vocal Medécins Sans Frontiers has just issued a call for pharmaceutical companies to develop new paedriatric drugs for children suffering from AIDS in poor countries.

"In the absence of child-strength pills that combine all needed drugs in one tablet, medical staff and caregivers are often forced to crush combination pills meant for adults," MSF said in a statement issued in Kenya ahead of the World AIDS Day on Thursday.

This all sounds eminently sensible.

But is the same Médecins Sans Frontiers that repeatedly calls for compulsory licenses on currently existing AIDS drugs?

If a company goes to the expense of developing these drugs, only to have their property expropriated, it seems unlikely that they will bother in the first place. And when a company does eventually produce these medicines, you can bet MSF will be yelling the loudest for a compulsory license.

Is it any wonder that the number of HIV/AIDS drugs in the pipeline is declining?

Come on MSF. Let's try to be a bit more rational!

Let's have a change of strategy on AIDS

Richard Holbrooke, the head on the Global Business Coalition on HIV/AIDS, is right on the money in this Washington Post column to mark World AIDS day on the 1st December.  He argues that the current strategy is failing to reverse the spread of the disease:

We are not winning the war on AIDS, and our current strategies are not working. Every year since the first World AIDS Day, the number of people affected has increased. The very best that can be said is that we are losing at a slightly slower rate.

Holbrooke argues that the current strategy - which puts its greatest emphasis on treatment - is  a recipe for long-term, expensive failure, because the numbers of sufferers will continue to rise. And once someone starts ARV treatment, they have to remain on it for the rest of their lives.

Holbrooke is quite right to say that the only way to defeat AIDS is to place more emphasis on prevention. And to do that properly, the world health community needs to give more attention to testing and detection. 

It's good to see that even insiders at the highest levels of the health community are beginning to demand a change of course from the UN on AIDS policy.

Let's see if those in command will begin to take their cue from sensible, evidenced-based suggestions like this, or if they will continue to have their agendas dictated by the activists.

Panflu, Tamiflu and bird 'flu

Here's an interesting story from China about a private company looking to develop a vaccine that might treat the H5N1 virus, which has already caused 140 million birds to die - both through the disease itself and the culling of many others as a preventative measure - and, it is believed, will mutate into a form that spread between humans soon.

Sinovac Biotech started work on a vaccine called Panflu last year after bird flu outbreaks in south-east Asia and have already completed animal trials.  This is good news but the vaccine will still take at least another year to go through human clinical trials and pass through local regulatory approval.  And, of course, we can't even be sure that it will prove an effective means of preventing a human outbreak because we still don't know what a strand that is communicable among humans would actually look like.

Given that the virus has already spread to birds on at least three continents, it seems likely that if one strand of bird flu were to spread among humans, other fatal strands will follow.  This will then almost certainly render what is considered to be our current best line of treatment, oseltamivir (or Tamiflu as it is otherwise known) for which Roche is the patent holder, less effective at protecting us.  Indeed, it seems that the H5N1 virus has already proved resistant to Tamiflu in the case of a 14-year old Vietnamese girl who had contracted bird flu from poultry.

We may still find Tamiflu to be an effective form of treatment, but it is clear that we need other forms of both adaptive and preventive (the vaccine reported above, in this case) treatment, which is why this most recent news from China is very encouraging. The bigger our arsenal of defence against bird flu, the better.

For more insight into bird flu and suggestions for possible reactions, see this article, this post, and this paper.

"3 by 5": a setback in the fight against AIDS

The Economist has a measured piece on the WHO's "3 by 5" programme, and how all references to it seem to have been 'airbrushed' from the latest UNAIDS report. The article correctly notes that the original target of putting 3 million people onto ARV treatment by the end of this year is going to be missed by some way. But:

The reason for worrying about all this is not that the target was missed, but that the feasibility of reaching it was based on a set of over optimistic modelling assumptions about such things as the effectiveness of drug distribution networks and the competence of local health services.

This is a sound analysis. But in the rest of the article, I think the scribes over at The Economist are letting the WHO off a bit too easily.

The "3 by 5" programme is indeed failing, but its prioritisation of treatment over prevention has done real damage. As a result of this misguided strategy, we get the kind of terrible figures presented in the UNAIDS report - for example, that 2005 saw the highest rate of new infections since the disease was first identified.  The WHO's flagship AIDS programme, it seems, has failed to reverse the spread of the disease and may even be responsible for worsening it.

I'll be writing more on this topic next week, to coincide with World AIDS day on the 1st December, so check back on the blog then.

WHO must take side of malaria victims

It seems that the World Health Organization (WHO) has finally accepted the quick, simple, cheap and safe solution to fighting malaria: DDT. But Africans still face a battle with environmentalists and trade blocs who oppose this demonized pesticide.

The WHO's Roll Back Malaria (RMB) started in 1998: millions of dollars later, a WHO report admits "malaria has got somewhat worse during this period." The real tragedy is that malaria would have got somewhat better if the WHO had adopted a sensible strategy from the start. Spraying the inside walls of residential buildings with DDT and other insecticides should be central to this. It prevents most mosquitoes from entering dwellings and it repels or kills those insects that do make it inside.

Over the last few decades, however, the WHO and various NGOs have deliberately discouraged the use of DDT, egged on by western environmentalists who claim it is dangerous. However, Namibia, Botswana, Mozambique and SA have experienced tremendous success by using DDT. DDT is what eradicated malaria in the southern US and Mediterranean Europe in the mid-20th century. There has never been any evidence of harm to humans or animals: one of its proponents, J Gordon Edwards, used to eat spoonfuls of it at lectures and he died this year whilst hiking, at 85.

This week the WHO said it would make DDT part of its malaria campaign. But Africa faces still faces numerous hidden barriers, such as NGOs and western governments refusing to fund supplies of DDT or threatening to ban exports from areas where it is used. The European Union threatened Uganda this year with bans on agricultural exports if it started using DDT against malaria, even though such very limited use was allowed by a little-publicized WHO rule and by the 2004 Stockholm Convention on Persistent Organic Pollutants.

These types of barriers will continue to be used against African produce in Europe and the US by governments and environmentalists unless the WHO publicly and noisily takes the side of malaria victims. Africans must demand that RBM's plans include DDT, plus a campaign to counter the opposition of western governments, NGOs, and environmentalist pressure groups. Millions of African lives depend on it.

The real bloodsuckers

Over at the Globalisation Institute, there is some confusion over how EU trade policy is preventing Uganda from taking steps to tackle malaria with DDT.

One of the misconceptions that has been growing is that the EU is forcing developing countries to go without DDT for fighting malaria. It is being claimed that the EU threatened Uganda with sanctions for using DDT against malaria.

Sounds outrageous. But it is just an urban myth. The EU did no such thing.

Unfortunately, that is not the case.  Back in the Spring, EU representatives suggested to Ugandan ministers that if Uganda chooses to use DDT for malaria control, exporters will have to procure expensive equipment to ensure that their products do not contain any amount of residual DDT; otherwise they will face sanctions against their agricultural products.

This negotiating technique is also known as blackmail, because it would render Ugandan agricultural exports uncompetitive.

And seeing as Uganda only plans to use the chemical for Indoor Residual Spraying, it is also completely absurd.

You can read the full story about EU's shameful treatment of Uganda here.

LIES, AIDS FIGURES AND STATISTICS

Statistics do not lie: people do, helped by casual ignorance. A good example is the United Nations’ mysterious figures for Uganda’s success against AIDS.

The UN and Uganda claim that the prevalence of HIV/AIDS infection in Uganda has fallen from 15% to 5% (or from 30% to 7%, according to Foreign Minister Sam Kutesa on 15 September 2005), which sounds great until you remember that there is no cure for HIV/AIDS: you can reduce the number of new infections but the only way the number of existing victims can fall is if they die.

To increase the confusion, the aid industry mixes up the terms “rate” and “level”: rate means the amount of increase in a given time whereas level means how many people have it at a given time.

If the rate of infection in Uganda were 5% and this really meant that five new people out of a hundred get the virus every year, the number of people infected would double every 15 years (that is the magic of compound interest at work). If, however, the level were 5%, meaning that five people out of a hundred are HIV-positive, this might sound more reassuring but we still do not know what the rate of (new) infection is now. More worryingly, we do not know what happened to all those other people who made up 15% of the population ten years ago.

For the percentage level of HIV/AIDS victims to fall, they either have to die or the population has to increase a lot or a bit of both.

Doing the calculations confirms that death is the secret of Uganda’s success:

• the population of Uganda rose from 17.4 million in 1990 to 23.5 million in 2000, an increase of 35%, according to World Bank figures;

• if the number of people with HIV (the level) made up 15% of the population in 1990 (2.61 million people) and had remained the same in 2000, that same number would then make up only 11% of the population;

• the current official HIV+ level is about half that: this implies that either half the HIV+ victims have died and that there were no new infections, or, realistically, that much more than half the victims have died and there were also new infections.

The good news, however, is that there are separate indications that the new infection rate may be falling: national estimates are unreliable but a count of infected pregnant women in hospitals in Kampala in 2004 did show a drop of two-thirds over the previous ten years, indicating that the rate of new infection had fallen. On the other hand, a random test of 700 children tested in war-torn Gulu province in September 2005 showed 300 were HIV+, district hospital spokesman Dr. Geoffery Openythoo told reporters.

Similar statistical obscurantism applies throughout Africa, concealing and distorting the real impact of this plague.

Who's WHO is it anyway?

Next week I'm off to Stockholm in order to participate in a consultation meeting with the WHO. This brings back memories of the few days I spent in Geneva last may for the World Health Assembly.  It turned out to be little more than a two-week boondoggle, at which there was very little meat for the truly sick and vulnerable people of the world.

High on the agenda were spurious initiatives against obesity and a global plan to ‘promote healthy lifestyles’. There was much talk of road safety and blood pressure. But there was not one session on Africa.

What is going on at the WHO?  Bearing in mind its limited resources, it should be focusing on genuine global threats such as avian flu, as well as communicable diseases that disproportionately affect the poor such as water-borne diseases and malaria.

Instead, the WHO has elected itself an international health nanny, lecturing mainly healthy people in rich countries about all kind of politically-correct health issues. It's surprising they don't yet have a global strategy on the dangers of running with scissors.

The problem is that the WHO is funded almost entirely by a handful of wealthy western countries.  So, in order to ensure this cash doesn't dry up, the WHO bureaucrats end up pandering to the priorities of Western politicians, instead of those of people in poor countries.

That means money is wasted on crazy schemes that try to regulate everything from baby formula to food additives, while at the same time millions of children in Africa struggle to eat at all.

The WHO has a chance over the next few years to get back to its core mission and stop trying to regulate the world.  Donor nations should really insist on this.

Read more: The World Health Organization: a time for re-constitution

The UN’s misguided pursuit of equality

It might seem obvious to readers of the CFD blog that market-driven economic growth is the best way to tackle global poverty and improve human health. At the UN, however, there is a firmly held belief that inequality between people and states is the real barrier to progress, and that a host of government-led interventions are needed to close the gap between rich and poor and meet the floundering Millennium Development Goals.

At the heart of this fixation with inequality is the belief that economic growth will only come to the poorest regions of the world if their people are better educated and healthier. What is needed, therefore, is a massive scale up of state education and health services, to be funded by buckets more aid.

Besides being completely unsustainable, this sort of approach is likely to have little impact on outcomes. Such government-run services are often woefully inefficient and corrupt, and their massive expansion would also be likely to crowd out the private sector. We know the private sector is capable of providing more efficient services for the poor - particularly in education, and even in healthcare.

The only way to meet the Millennium Development Goals is to encourage private-sector led economic development. This will improve health and with it labour productivity by allowing people to afford better living conditions, sanitation and health technologies. One study shows that if economic growth in lower-income countries had been just 1.5 per cent higher in the 1980s, at least 500,000 infant deaths could have been prevented.

It is discouraging that the aid industry does not share this perspective. Its obsession with inequality is likely to lead to towards ever more redistributive policy recommendations, which will undermine economic freedom and with it growth.

Isn't it time they tried something that actually works?

This argument is further elaborated in The Real Determinants of Health, published by International Policy Network.

Malaria risk 'depends on house'

According to researchers from the Wellcome Trust, differences in households can account for around a third of the variations in attack rates by malarial mosquitoes.  Dr Ian Hastings of the London School of Hygiene and Tropical Medicine told the BBC:

"We don't yet know exactly what makes the difference between a good or a bad house. But a lot probably depends on whether there is a mosquito-breeding site in the back yard, the quality of the building and whether insecticides or other repellents are used.

"Identifying and improving factors that put some homes at much lower risk than others would go a long way towards relieving the burden of disease in children living under such conditions."

Quite. We've known for a long time that the most effective way of tackling malaria is to spray the insides of houses with DDT.

This helps prevent mosquitoes from entering dwellings and it repels or kills those insects that do make it inside. Because it minimises the chances of humans being bitten, it effectively prevents the transmission of the malarial parasite, making it an excellent tool for preventing the spread of the disease.

India, for example, started a nationwide programme of indoor DDT spraying in the 1950s, which it has continued to this day. Despite the fact that its population has mushroomed to over a billion in this period, deaths from malaria have decreased to a few thousand each year.

What a shame, then, that the WHO's Roll Back Malaria programme has not embraced fully DDT use. Instead, it has fixated on insecticide-treated bednets, which are both difficult to distribute and unreliable.

Let's hope that this bit of new research brings a bit of the focus away from bednets towards making dwellings less mosquitoe-friendly. DDT has got to be a central part of any such strategy.

WHO's chronic disease report challenges the activists

The WHO has just released its annual report on the global burden of chronic disease, in which it states that ailments such as cardiovascular disease, cancer and diabetes now account for 45 per cent of the global disease burden. Around 70 per cent of this burden now occurs in lower-income countries.

The WHO is right to point out that poor countries now suffer from an increasingly similar spread of diseases as rich countries. This is in some ways a positive finding, as the rise of chronic diseases is partly the result of more and more people living beyond middle age, thanks to greater global economic growth and prosperity.

What the WHO's findings do show is that activists' attempts to skew funding of R&D away from these so-called 'western' diseases towards tropical and neglected diseases are way off the mark.
People in lower-income countries are in just as much need of drugs for chronic conditions as those in the rich world. It is therefore right that global R&D patterns currently reflect the needs of the enormous number of people around the world that suffer from chronic disease.