The Wall Street Journal examines how “Greece has seen decades of advances in public health rolled back, as a flood of illegal immigrants, a dysfunctional government and budget cuts ravage a once proud health-care system.” Noting “[o]ver the past two years, more than 50 endemic cases of [malaria] and more than 100 imported cases have been identified in Greece,” the newspaper writes, “The return of malaria, a scourge in developing countries, to Greece is a disturbing indicator of the nation’s decline since it crashed in 2009 under the weight of a debt binge.” The Wall Street Journal examines the history of malaria’s return to the country and how the government is responding. “In addition to malaria, public health officials say they are worried about rises in everything from infectious respiratory-tract diseases and skin conditions to tuberculosis and HIV,” the newspaper notes (Granitsas, 11/14).
The Affordable Medicines Facility-malaria began as a pilot program in 2010 to “provide a ‘co-payment’ to the manufacturers of [artemisinin-based combination therapies (ACTs)], thereby allowing commercial wholesalers and private or government health services to purchase the drugs at a fraction of the already low negotiated price,” Kenneth Arrow, a Nobel laureate in economic sciences in 1972 and an emeritus professor of economics at Stanford University, writes in a New York Times opinion piece. The program subsidized ACTs — a newer, more effective malaria treatment — to “sell [them] as cheaply as [less-effective] chloroquine in Africa’s private pharmacies and shops, where half of all patients first seek treatment for malaria-like fevers,” he states. “Strikingly, it has worked,” Arrow writes, noting a recent independent review of the program published in the Lancet.
In a post in the Center for Global Development’s (CGD) “Global Health Policy” blog, Owen Barder, a senior fellow and director for Europe at the CGD, reports on the results of a large Phase III clinical trial conducted in Africa on the malaria vaccine candidate RTS,S, published online in the New England Journal of Medicine on Friday. “The study of the phase III trials finds that in babies (aged 6-12 weeks) the vaccine only reduces malaria by less than a third. This is disappointing because this is less than half the effectiveness that had been suggested by the phase II clinical trials,” he writes. “The RTS,S vaccine demonstrates that it may, in principle, be possible to develop a vaccine against malaria, even if this particular candidate vaccine is not eventually successful,” Barder states and highlights an Advance Market Commitment approach proposed by the CGD, under which “donors would not choose research programs to fund” but would instead “contract to pay for a successful vaccine, if and when it is developed” (11/10).
Recent successes in increasing the treatment and decreasing the incidence of HIV/AIDS, tuberculosis (TB), and malaria, along with other global health advances, “is thanks to the hard work and cooperation of people from many different walks of life: politicians of all stripes, business leaders, grassroots activists, clergy, health workers, government agencies and many more,” Deborah Derrick, president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, writes in the Huffington Post “Impact” blog. She says the Global Fund to Fight AIDS, Tuberculosis and Malaria has been “[c]entral” to these developments, and the “U.S. government has been a crucial leader in supporting international health and the Global Fund.” She adds, “Sustained commitment will ensure more lifesaving success.” Derrick also recognizes the work of doctors and businesses.
The BMJ examines the history of fraud allegations against the Global Fund to Fight AIDS, Tuberculosis and Malaria and the organization’s ongoing reform efforts. “Most observers agree that after a honeymoon first decade, the Global Fund had grown so big, and the economic climate and attitudes to diseases such as AIDS have changed so dramatically, that more rigor and efficiency was needed, fraud or no fraud,” BMJ writes. The Fund is expected to appoint a new director “and a new funding model, to be announced on November 15, [which] are supposed to get things back on track” (Arie, 11/12).
“Look in the global strategies for HIV, [tuberculosis (TB)], malaria, maternal and child health, polio eradication, [neglected tropical diseases (NTDs)], and [non-communicable disease (NCDs)] — among many others — and you’ll see Nigeria at or near the top of the ‘Must Win’ countries,” Todd Summers, a senior adviser at the Center for Strategic & International Studies’ (CSIS) Global Health Policy Center, writes in the CSIS “Smart Global Health” blog. “Home to 170 million people, many of them desperately poor, Nigeria carries a huge and disproportionate share of burden for many of the world’s most deadly diseases,” he writes, noting the country, “one of the most important countries for all three diseases, is losing more in revenues than all of the Global Fund’s annual contributions combined.” He continues, “So, somehow, the Nigerian government needs to do a better job of capturing the revenues it’s due, and channeling a greater percentage of that revenue to the urgent health needs of its citizens, but that doesn’t seem to be happening.” However, Summers concludes “there’s some good news to report” on overall governance in the country, and he provides some examples (11/8).
RTS,S Malaria Vaccine Shows Low Protective Effect Among African Infants In Large Phase III Clinical Trial
Published online in the New England Journal of Medicine on Friday, a study on a large Phase III clinical trial conducted in Africa on the malaria vaccine candidate RTS,S/AS01 “reported disappointing results” among “infants who received their first shot between six and 12 weeks of age,” Nature reports. “The low protective effect of the vaccine was around half that reported last year in older children in the same study, and that of an earlier, smaller trial of babies of the same age group,” the journal notes (Butler, 11/9). The “GlaxoSmithKline experimental malaria vaccine touted as a new weapon in the fight to eradicate the disease proved only 30 percent effective when given to babies as part Africa’s largest ever clinical trial,” Reuters writes, adding, “The surprisingly poor result for the world’s first potential vaccine against malaria leaves uncertain whether it can have a useful role in fighting the mosquito-borne disease that kills hundreds of thousands of children a year” (Kelland/Hirschler, 11/9).
“Nigeria’s worst flooding in at least half a century has killed 363 people since the start of July and displaced 2.1 million people,” according to the country’s National Emergency Management Agency, Reuters reports. Between July 1 and October 31, 7.7 million people were affected by the flooding and 18,282 people were injured, the agency said, the news service notes (11/5). In makeshift camps without “water, sanitation or medical care, authorities fear outbreaks of disease could make things worse,” VOA News reports. In addition, “emergency officials say with tens of thousands of hectares of farmland destroyed, they fear food shortages in the coming months,” according to the news agency. In October, “[t]he Nigerian government … allocated $112 million to help families that have been displaced in 24 of Nigeria’s 36 states since the flooding began in July,” VOA writes (Murdock, 10/30).
“Growing resistance to a key anti-malarial drug derived from a shrub used in traditional Chinese medicine is threatening to roll back gains made in combating the disease,” according to experts attending a U.N.-sponsored malaria conference that concluded on Friday in Sydney, Australia, the U.N. News Centre reports. Malaria “therapies based on artemisinin — an extract from the sweet wormwood bush used for centuries in Chinese medicine as a fever cure — were” formulated in combination with other antimalarials to form artemisinin-based combination therapies (ACTs) that the WHO thought would be effective for years, but resistance to the ACTs has begun to appear in some areas, the news service notes. “Specifically, [the Roll Back Malaria Partnership] noted, artemisinin resistance has been detected in Cambodia, Myanmar, Thailand and Vietnam,” the news service writes (11/2). Agence France-Presse examines efforts to fight drug-resistant malaria on the Thai-Myanmar border (Rook, 11/4).
IRIN examines the controversy surrounding the Affordable Medicines Facility-malaria (AMFm), writing, “The argument over the way it operates has reignited ahead of a board meeting of the [Global Fund to Fight AIDS, Tuberculosis and Malaria] on 14-15 November, which is due to assess the success of the project and its reliance on private sector providers.” The news service reports on an evaluation of AMFm published recently in the Lancet and another paper by Oxfam criticizing the facility. The Global Fund Board, which administers AMFm, “is meeting in nine days to decide whether AMF has worked as was intended, and whether it should be continued, scaled up, or abandoned altogether,” IRIN writes (11/5).