Polio in retreat – a feature in Scientific American

An interesting article from Scientific American on global efforts to eradicate polio, and recent indicators of significant progress in regions of India where the virus used to be prevalent.

Polio in Retreat: New Cases Nearly Eliminated Where Virus Once Flourished

New cases in key Indian states are hovering near zero—unprecedented, historic lows—suggesting that a long-time goal of eliminating the virus is within reach in parts of world where it has long been considered intractable

The world’s largest, most intractable source of polio may be on the brink of elimination. In India the states of Bihar and Uttar Pradesh have produced more polio cases this decade—nearly 5,000—than any other location worldwide that has an active immunization campaign. Nigeria saw a handful more cases than the two Indian states because it effectively ceased immunizing in 2003 for a time due to false fears of the vaccine.

Now, even at the peak of polio season, new cases in Bihar, Uttar Pradesh and indeed all of India hover near zero—unprecedented, historic lows. In the past decade the peak months of August and September have seen an average of roughly 140 people, usually children, stricken by poliomyelitis, which attacks motor neurons in the nervous system and can cause paralysis. But for the past four weeks running, Bihar and Uttar Pradesh have hung zeros on the polio scoreboard, according to reports published as recently as October 28 by the Global Polio Eradication Initiative.

Data source: AFP Surveillance Bulletin—India Report for week 41, ending 16 October 2010 (pdf)

Members of the Initiative, a public-private partnership among agencies including the World Health Organization, U.S. Centers for Disease Control, UNICEF and Rotary International, are leery of drawing attention to the trend because it could change. “[W]e are cautious,” says Sona Bari, communications officer for polio at WHO. The CDC’s Steve Wassilak adds, “I would rather celebrate after the fact than before,” although “we can be allowed to think that we are close.”

Polio was supposed to be eradicated worldwide by 2000, per a goal set by the World Health Assembly in 1988. In fact, polio cases have been reduced by 99 percent globally from about 350,000 in 1988; sustained transmission of the virus has been eliminated from all but a handful of countries.

Read the rest of the article online at www.scientificamerican.com.

10 facts about chronic disease

Ten facts (from the World Health Organization) about chronic disease

1. Chronic disease is responsible for 60% of all deaths worldwide
2. 80% of chronic disease deaths occur in low and middle income countries
3. Almost half of chronic disease deaths occur in people under the age of 70
4. Around the world, chronic disease affects women and men almost equally
5. The major risk factors for chronic disease are an unhealthy diet, physical inactivity, and tobacco use
6. Without action, 17 million people will die prematurely this year from a chronic disease
7. One billion adults are overweight – without action, this figure will surpass 1.5 billion by 2015
8. 22 million children under five years old are overweight
9. Tobacco use causes at least five million deaths each year
10. If the major risk factors for chronic disease were eliminated, at least 80% of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented

CDC estimates 1 in 3 adults could have diabetes by 2050

As many as 1 in 3 U.S. adults could have diabetes by 2050 if current trends continue, according to a new analysis from the Centers for Disease Control and Prevention.

One in 10 U.S. adults has diabetes now. The prevalence is expected to rise sharply over the next 40 years due to an aging population more likely to develop type 2 diabetes, increases in minority groups that are at high risk for type 2 diabetes, and people with diabetes living longer, according to CDC projections published in the journal Population Health Metrics.

Diabetes was the seventh leading cause of death in 2007, and is the leading cause of new cases of blindness among adults under age 75, kidney failure, and non-accident/injury leg and foot amputations among adults. People with diagnosed diabetes have medical costs that are more than twice that of those without the disease. The total costs of diabetes are an estimated $174 billion annually, including $116 billion in direct medical costs.

Proper diet and physical activity can reduce the risk of diabetes and help to control the condition in people with diabetes. Effective prevention programs directed at groups at high risk of type 2 diabetes can considerably reduce future increases in diabetes prevalence, but will not eliminate them, the report says.

The projection that one-third of all U.S. adults will have diabetes by 2050 assumes that recent increases in new cases of diabetes will continue and people with diabetes will also live longer, which adds to the total number of people with the disease.

An estimated 285 million people worldwide had diabetes in 2010, according to the International Diabetes Federation. The federation predicts as many as 438 million will have diabetes by 2030.

Burden of NCDs in India – estimated USD 237 billion in lost national income (2006-15)

The Cameron Institute – a not-for-profit, public policy think tank — recently released an analysis of the economic impact of non-communicable diseases in India.

As of 2005, India experienced the “highest loss in potentially productive years of life” worldwide, according to an article published in The Lancet.The projected cumulative loss of national income for India due to non-communicable disease mortality for 2006-2015 will be USD237 billion. By 2030, this productivity loss was expected to double to 17.9 million years lost – almost 1,000% greater than the corresponding loss in the United States, which has a population a third the size of India’s.

Download and read the entire report.

India’s PM wants country to be world leader in IP

According to an article in the Economic Times, India’s Prime Minister Manmohan Singh recently made a forceful plea for fostering an environment that promoted scientific advancement in the country to help it become a “world leader” in creating intellectual property.

“Innovation and knowledge will be the key-factors in our progress in the 21st century,” said the Prime Minister.  ”We must, therefore, foster an environment that promotes and nurtures scientific achievement and makes us a world leader in creating intellectual property.”

Singh also said that scientific and technological prowess was key to the country’s development, noting that ”scientific development is an integral part of the journey towards inclusive, balanced and sustainable growth.”

Canada launches one of world’s largest health studies to gain insight into disease prevention and management

The largest population-based health study ever conducted in North America was launched this past month in an effort to help better understand the causes, prevention and treatment of diseases such as cancer, heart disease, asthma, and diabetes.

The Ontario Health Study (OHS) will be the biggest community-based health study ever done in Ontario and is also part of the Canadian Partnership for Tomorrow Project, made up of five regional health studies across the country.

Medical researchers at universities, research institutes and hospitals across Ontario are conducting this study. The governments of Ontario and Canada are funding the Study.

The Study began with an initial phase in which more than 8,000 adults living in three communities in Ontario took part. The main phase of the Study has begun, and is now open to all residents of Ontario who are at least 18 years old.

Altogether, aggregate data from hundreds of thousands of Canadians over time will help build one of the world’s largest profiles of risk factors for diseases.

Source:  World Health Advocacy.

WHO report on NTDs highlights ongoing commitment of pharmaceutical industry

An interesting article on neglected tropical diseases — and a recent report from the WHO — sourced from World Health Advocacy.

First WHO report on NTDs highlights ongoing commitment of innovative drug companies

The World Health Organization today released their first report on neglected tropical diseases – diseases that affect mainly poor people and cost billions of dollars in lost productivity annually.

“Good medicines are available for many of these diseases, and research continues to document their safety and efficacy when administered individually or in combination,” said Dr Margaret Chan, WHO Director-General. “Generous drug donations by pharmaceutical companies have helped relieve some of the financial barriers and allowed programmes to scale up coverage.”

Leading research-based pharmaceutical companies have already provided high-quality medicines free of charge for hundreds of millions of poor people suffering from such diseases, mainly in remote areas of Latin America, Asia and Africa, according to the WHO.  In coordination with the launch of this report, additional long-term industry commitments to combating neglected tropical diseases were announced today, including:

• Novartis renewed its commitment to donate an unlimited supply of multidrug therapy and loose clofazimine for leprosy and its complications.
• GlaxoSmithKline announced a new five-year commitment to expand their donation of albendazole through WHO, in addition to their current donation for lymphatic filariasis to treat school-age children for soil transmitted helminthiases in Africa. The commitment includes 400 million doses per year for this purpose.
• Sanofi-aventis has agreed to renew its support for the WHO programme to eliminate sleeping sickness, and its support for Buruli ulcer, Chagas disease and leishmaniasis for the next five years.

This continued support will ensure that necessary resources will be available also to move forward in combating leishmaniasis, Buruli ulcer and Chagas disease. In addition:

• Bayer has started discussions with WHO on how to evolve their current commitment to fight sleeping sickness and Chagas disease.
• EISAI has committed to work towards the global elimination of lymphatic filariasis by providing diethylcarbamazine (DEC) and
• Johnson&Johnson has recently also announced expanding its donation of mebendazole to supply up to 200 million treatments per year for treatment of intestinal worms in children

Despite these commitments from innovative drug makers, Dr. Chan added, “Production of medicines used to treat NTDs must be made more attractive to companies that manufacture generic pharmaceuticals.” It is important to note that many of these products are off- patent, but generic companies have not invested in their production.

“Neglected tropical diseases blight the lives of a billion people worldwide and threaten the health of millions more,” said Dr. Chan in the report.

The WHO report provides an overview of 17 neglected tropical diseases and provides details on their prevalence, distribution, economic and social impact as well as prevention and control strategies. Examples of these diseases include:

• Lymphatic filariasis – a mosquito-borne disease that causes intestinal worms and disfigures limbs and genital parts, costing an estimated $1.3 billion a year in lost productivity in Africa and South East Asia.
• Dengue fever – about 1 million confirmed cases of dengue are reported annually to WHO. The aggregated annual economic cost of dengue was estimated to be at least US$ 587 million. Preliminary adjustment for underreporting could raise this total to US$ 1 800 million
• Trachoma – in 57 countries where trachoma is endemic millions of people have irreversible visual impairment and blindness caused by the disease, and more than 40 million people are in need of treatment. The economic cost of trachoma in terms of lost productivity is estimated at US$ 2.9 billion annually.
• Chagas disease continues to persist in the Region of the Americas, but the estimated number of infected people has fallen from approximately 20 million in 1981 to around 10 million in 2009. A recent study in Colombia estimated an average expected annual cost per patient with chronic Chagas disease of US$ 1028. On average, the estimated lifetime cost of treating a patient with chronic Chagas disease in Colombia is US$ 11 619.

“The involvement of the pharmaceutical industry in NTDs, and subsequent donations made to support their control, have increased access to high-quality medicines free of charge for hundreds of millions of poor people,” according to the report. “The increasing willingness and commitment of local and global communities of partners to work with endemic countries have brought resources, innovation, expertise and advocacy to efforts to overcome NTDs. Intersectoral collaboration, involving education, nutrition and agriculture, has reinforced NTD control.”

WHO unveils new global plan to stop TB

The World Health Organization laid out a new plan on Wednesday to combat tuberculosis and the nearly 2 million deaths it causes each year through a combination of better testing, diagnosis and drugs.  (Source:  Reuters)

“The Global Plan to Stop TB 2011-2015″ will cost about $47 billion, with money going to fund more testing labs and research projects to develop and deliver medicine to treat the disease, it said in its plan.

“The stakes are high: without rapid scale-up of TB prevention and treatment, some 10 million people will die of a curable disease by 2015,” said Marcos Espinal, the partnership’s executive secretary.

All countries are affected but most of the cases occur in Asia and Africa. India and China account for 35 percent of all cases. TB ranks as the eighth-leading cause of death in low- and middle-income countries, it said.

The WHO is looking for about half the money for the programme to come from high-income countries and said if fully implemented, it could save about 5 million lives.

It is aiming for a 90 percent treatment success rate by 2015, up from 86 percent in 2008/09 and to have all TB patients tested for HIV.  About one-fourth are tested now and TB is a leading killer of those infected with HIV.

The plan also calls for more testing and better treatment strategies for multi-drug resistant strains of TB. The WHO first launched its plan to end TB in 2001 and adjusted its strategy in 2006.

Access to medicines in India: feedback from a gov’t consultation on compulsory licensing

India’s Department of Industrial Policy & Promotion (managed by the Ministry of Commerce and Industry) recently released a Discussion Paper on Compulsory Licensing and invited feedback from civil society groups, industry, academia and other stakeholders to guide their formulation of a compulsory licensing policy.

The Discussion Paper expressed concern regarding the availability of new products and technologies in India, including medicines and other pharmaceutical products, and seeks to explore whether compulsory licensing could be a viable solution.

Many of the submitted comments, including those of foreign business lobbies, warned that a proposal to allow government-owned or private companies to manufacture products and technologies patented by other companies, to ensure they are not in scarce supply, could discourage overseas investment in India.

Of particular interest was a submission by the Organization of Pharmaceutical Producers of India, which noted that:

Even a prima facie analysis of the situation in India would make it apparent that patents are not the primary cause for poor access to medicines in India.  Sales of patented products account for much less than 1% of the Indian Pharmaceutical market.

Thus, compulsory licensing of patented medicines can have no meaningful impact on improving access to medicines for the vast majority of the Indian population who lack the financial capability to pay for even generic, off-patent, medicines that comprise even more than 99% or so of the Indian Pharmaceutical market.

Over the past several years, the experience in most middle and low-income countries has been that private-public partnerships and affordable publicly supported health insurance do much more to improve access to medicines.

We do not believe that compulsory licensing of patented inventions is a sustainable or viable course of action to address India’s healthcare challenges.   Proposals to promote the use of compulsory licenses could inhibit technological development in the pharmaceutical sector in India and thereby undermine efforts to make medicines and other products widely available to patients.

Other key points raised in the OPPI’s commentary included:

• The use of compulsory licensing is rarely the best policy option and cannot be a suitable tool to deal with the long-term healthcare issues confronting India.
• It has been demonstrated that patents are not a principal barrier to access to essential medicines, particularly here in India.  The World Health Organization (WHO) determined that during 2000-2007 period, India had significantly greater lack of access to essential medicines than many African countries, even though it had excluded pharmaceuticals from patent protection for almost 30 years.

The US-India Business Council (USIBC), which represents nearly 350 global companies, also expressed concern that adopting the proposed policy would inhibit the growth of intellectual property-intensive industries. It will create uncertainty and have a chilling effect on innovation and investment.  Similar views have been expressed by BusinessEurope, a European trade body, and Japan Pharmaceutical Manufacturers Association (JPMA), a drug industry lobby representing at least 68 top pharmaceutical companies in Japan.  (Source:  Livemint.com)

The impact of mass media on health behaviour

This week’s Lancet podcast discusses the effect of mass media campaigns on health behaviour and the challenges of measuring their success.

Listen: The Lancet, Oct. 9 – the effect of mass media campaigns on health behaviour.