Filed under Health

The world’s first ever malaria vaccine has been developed. This is incredible news: scientists once believed a vaccine for such parascitic diseases would be impossilbe to find, yet here is the first of its kind. The vaccine cuts malaria cases by half, promising a halfing of the global burden of malaria from 200m to 100m if it’s put into use. Furthermore, GlaxoSmithKline, who developed the vaccine, will sell the drug at just a fraction over cost-price, and invest any profits into further tropical disease research.

See here for the Guardian’s full article.

In 2009, 781,000 people died from malaria in sub-saharan Africa. Progress is being made, however:

There has been a fall of nearly 40% in the number of deaths from malaria worldwide in the past decade, the World Health Organization says.

A new report said that one-third of the 108 countries where malaria was endemic were on course to eradicate the disease within 10 years.

Experts said if targets continued to be met, a further three million lives could be saved by 2015.

Malaria has been eradicated from three more countries since 2007.

See the full BBC report here: BBC News - Malaria deaths fall nearly 40% worldwide in last decade

BBC News - ‘First ever’ fall in global TB

The World Health Organisation has announced that the number of people falling ill with TB has fallen for the first time in history.

The number of people who died from tuberculosis peaked at 1.8 million people in 2003; by 2010 this had declined to 1.4 million.

Spectacular progress was made in China, said the WHO, where the death rate fell by almost 80% between 1990 and 2010. In Kenya and Tanzania there has also been a substantial decline in the last decade after a peak linked to the HIV epidemic.

The UN General Secretary Ban Ki Moon has said, “This is major progress. But it is no cause for complacency”

Future challenges include a $1bn funding gap, and the multi-drug-resistant form of the disease.

See here for the full BBC article.

Scientists in Australia have found that mosquitos infected with a particular bacteria (Wolbachia) cannot pass on dengue fever- to their offspring, to humans or to other creatures.

Furthermore, when the scientists released Wolbachia-infected mosquitos into the wild in North-Eastern Australia, the infection quickly spread to the native mosquito population, preventing them from spreading dengue fever too.

This suggests a quick and effective way to prevent the spread of a disease that infects 50 million people, killing 20,000 in over 100 countries every year. Dengue is also a disease for which there no cure. This finding, then, is hugely promising.

A Guardian aricle reports:

The team is seeking approval to release… infected mosquitoes into dengue-endemic sites in Vietnam, Thailand, Indonesia and Brazil to see if it reduces rates of dengue transmission in people.

“It is an alternative strategy for dengue control which could be low-cost and sustainable and suitable for deployment in large urban cities in the developing world,” O’Neill said.

But he added: “With any control [measure] over time, we might expect them to become less effective, like insecticides.

“We don’t know how long that might take to occur. If it provides effective control for 20-30 years, that is still a very good step forward for dengue control.”

See here for the full Guardian article.

Hundreds of thousands of Somalians live in crowded, often unsanitary, camps in Mogadishu; they have moved there to escape famine, drought and insecurity. Now in these camps, they face instances of cholera two to three times greater than last year. Health officials fear cholera could now rapidly spread to the camps’ hundreds of thousands of inhabitants.

IRIN reports:

In Mogadishu’s largest health facility, Banadir Hospital, 4,272 cases of acute watery diarrhoea, a symptom of cholera, have been recorded so far this year, causing 181 deaths. (Random laboratory tests showed that 60 percent of the cases also tested positive for malaria, according to WHO.)

Children under five, weakened by malnutrition, make up three-fourths of the cases…
WHO spokesman Tarek Jasarevic said: “This sudden increase had various reasons. First, the numerous informal settlements of internally displaced persons with makeshift shelters, poor sanitation and limited access to safe water. Second, the limited capacity of existing health partners to access those informal settlements and provide essential health services. And third, the high number of malnourished children due to the ongoing famine increased the susceptibility to waterborne diseases such as acute watery diarrhoea.”

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not prompt.

See here for IRIN’s full article.

Much research into the effects of forced migration look at migration into developed countries. Most migrants, however, live in low or middle income countries, close to the borders with home. Oxford researchers have sought to expand our awareness of people living in such situations, and their research has unearthed often overlooked challenges and especially worrying figures regarding children’s mental health.

Mina Fazal, a co-author of the research (published in The Lancet) explains that children in developing-country refugee camps or settlements “are at high risk of mental-health problems because they are likely to have been exposed to violence, which is the strongest predictor of poor mental-health outcomes”. Furthermore, families in these circumstances generally have very poor access to mental health treatment, and little protection from further risk.

IRIN’s article on the research details,

In Sudan’s Darfur region and in Chad, both boys and girls reported having been raped, usually while collecting firewood. At least 75 percent of children interviewed in internally displaced persons (IDP) camps in Darfur met the diagnostic criteria for post traumatic stress disorder and 38 percent had depression.

Local people, poor themselves, can be hostile and threatening towards newcomers competing for scarce resources. And just being close to home does not always diminish the culture shock. The report says, “Evidence suggests that adaptation to apparently similar settings is not necessarily easy, and refugees themselves draw attention to cultural dissimilarity in settings that western researchers judge to be similar on the basis of religion and language.”

See here for IRIN’s article on the report and here for the research in The Lancet.

David Cameron today announced that the UK will increase its funding of two ‘highly cost-effective’ health interventions: the provision of pneumococcal and rotavirus vaccinations. 814 million pounds will be donated, which the Prime Minister states will treat 80 million children and save 1.4 million lives in the developing world.

Health researchers have estimated that the best use of the pneumococcal vaccine provides one DALY (disability adjusted life year- the equivalent of giving someone a year of life at full health) for every $100 spent. Thus, if all of the investment were spent on pneumococcal vaccines, it would save around 13,200,000 years of healthy life! This puts the intervention in the category of highly cost-effective measures.

However, one can still do more than 30 times better… And that is very important. It’s like getting a “96% off” sale, or 3000% extra free, in the cost of curing life-wrecking diseases in the third world. For example, if Cameron had instead decided to boost the treatment of soil-transmitted helminthic infections, he could have saved 30 DALYs (rather than 1) for every $100 spent. Or, by directing aid to the Schistosomiasis Control Initiative, roughly one DALY would by provided with every 2 pounds and 9 pence ($3.41) spent.

Likewise, here you can see how the DALYs/$100 provided by Rotavirus immunisations (the other vaccinations pursued by DfID’s aid boost) are dwarfed by certain measles and other vaccinations.

Cameron/ DfID’s conception of cost-effectiveness may be confused by their tendency to think about cost-effectiveness as “getting vaccines from GSK at the lowest possible price”. Vaccines, however, are only important for the health outcomes (and other good side effects) they produce. Thus, rather than principally focusing on getting the best price for vaccines, we should focus on getting the best price for health outcomes. For this, DALYs are the best available measure.

In keeping the UK’s pledge to raise aid to 0.7% of GDP by 2015, and in consciously boosting aid to more effective causes, this is certainly a welcome move in the right direction. We just hope that with their increased focus on cost-effectiveness, DfID and David Cameron will spot the even greater opportunities to help some of the world’s most vulnerable people offered the most cost-effective interventions.

Sources:

http://www.independent.co.uk/news/uk/politics/pm-announces-extra-814m-for-vaccines-2296883.html

http://www.sciencedirect.com/science/article/pii/S0140673607601950

http://www.sciencedirect.com/science/article/pii/S0140673607601950

Margaret Chan, director general of the WHO, has stressed the importance of basic sanitation in her address to the World Health Assembly. Here is an article about sanitation on the Guardian’s “Poverty Matters” blog.

It might seem that sanitation programs would be highly cost effective:

• Approximately 10% of the world’s diseases could be prevented by good sanitation (Chan).
• Hand-washing with soap at critical times can reduce the incidence of diarrhoea by up to 47%. (UN Water). An important finding, given that diarrhoea kills one child every twenty seconds.
• The integrated approach of providing water, sanitation and hygiene reduces the number of deaths caused by diarrhoeal diseases by an average of 65% (WHO)*
• For every $1 invested in water and sanitation, $8 is returned in increased productivity (UNDP)
• Lack of safe water and sanitation costs sub-Saharan Africa around 5% of its Gross Domestic Produce (GDP) each year (UNDP)
• 443 million school days are lost each year due to water-related diseases (UNPP)
• 11% more girls attend school when sanitation is available. (UK DFID)
• 15 pounds can be enough to provide someone access to safe water, improved hygiene and sanitation (WaterAid)

However, Giving What We Can has found that huge and important differences in the cost effectiveness of

a) Construction Programs (the construction of infastructure to improve water supplies)

b) Promotion Programs (the promotion of good sanitation and hygiene practices)

Construction programs are less than a tenth as efficient as some health interventions, and is thus not a top-recommended intervention.

Promoting sanitation practices, and even more so promoting hygiene practices like handwashing, is, however, highly cost-effective. It may be as cost-effective as the treatment of neglected tropical diseases.

We are thus undergoing further research into the cost-effectiveness of hygiene promotion. However, as of yet, we do not know of any charities that focus solely on hygiene promotion, so are not able to make recommendations.

See our short explanation of the cost-effectiveness of water and sanitation interventions here.

A vaccine for Dengue Fever is in the process of being developed, and might be ready for use by 2015. However

 While dengue vaccine development has been widespread among research institutions and pharmaceutical companies, Sanofi Pasteur, the largest vaccine developer in the world, is years ahead of the rest. If all goes well in the ongoing clinical trials, experts say immunizing the public may begin as soon as 2015. But the estimated 300 to 400 million people who will want the vaccine is too much for just one manufacturer.

With 2.5 billion at risk of dengue fever, health officials expect many of the urban poor (dengue is an urban, mosquito-born disease) to miss out on this important vaccine.

See here for an IRIN article, which explains more about the vaccine and dengue fever itself.

Intervention by the Cambodian government has helped bring Schostosomiasis rates down from 30-70% to just 5% in its most affected provinces.

Irin reports,

Since 2002, the Cambodian government has overseen a vast deworming programme. In 2004, the country was the first to reach the WHO’s goal of covering three-quarters of school-aged children, or three million people.

This is a major triumph: the Carter Centre reports “In terms of its social and economic impacts, snail fever is second only to malaria as the most devastating parasitic disease in tropical countries” (Irin).

See here for the full Irin article, which explains and illustrates many of the causes, consequences and ways to tackle Schistosomiasis.