The Center for Strategic & International Studies (CSIS) on Monday released a report called “Eradicating Polio in Afghanistan and Pakistan.” According to the report summary, efforts to eradicate the virus globally “have proved largely successful, in part thanks to the Global Polio Eradication Initiative (GPEI), launched by the international community in 1988,” and “[t]he number of new cases has dropped in the past decade, even in countries where the virus has never been eradicated.” The summary adds, “Today, there are only three countries in the world where the polio virus remains endemic: Afghanistan, Nigeria, and Pakistan” (8/13).
“When you’re dealing with a global public health crisis, having an international presence isn’t just advisable — it is imperative,” Margaret McGlynn, president and CEO of the International AIDS Vaccine Initiative (IAVI), writes in this post in USAID’s “Impact” blog, adding, “That’s why [IAVI], in partnership with USAID, has worked diligently over the past several years to establish itself as a truly global non-profit partner.” She continues, “IAVI has created an enviable network of research centers in sub-Saharan Africa dedicated to assessing novel AIDS vaccine candidates in clinical trials and conducting supporting epidemiological studies on HIV,” and writes that these “partnerships have made meaningful contributions to the research capacity of many developing countries — a capability that is now helping local researchers tackle other diseases” (8/13).
In this post in BMJ’s “Yankee Doodling,” Douglas Kamerow, chief scientist at RTI International and an associate editor for the journal, reflects on the possibility of achieving an AIDS-free generation “if somehow we succeeded in getting all HIV positive people in the world identified and under long term treatment.” He writes that while there has been “astonishing progress against AIDS,” “two concerns immediately arise: the magnitude of the work remaining to find and continuously treat all those infected, and the confusion between that treatment (even if it is somehow universally successful) and actual eradication of the disease.” He concludes, “It is a rosy scenario, but even if it came true it still would not spell the end of the HIV story,” because “[w]e have no vaccine, and the virus keeps mutating” (8/14).
In a series of “News Focus” articles in Science, the magazine examines the global effort to eradicate polio. One article examines the Global Polio Eradication Initiative (GPEI) — a partnership of the WHO, Rotary International, UNICEF, the CDC, and the Bill & Melinda Gates Foundation — and recent reports on the program by an Independent Monitoring Board (IMB), “an oversight body” that provides feedback and guidance. A second and third article look at efforts to vaccinate children against polio in Pakistan, which “is the perfect case study for why it is so hard to eradicate poliovirus from its last few strongholds — and what it might take to pull it off.” The WHO’s Chris Maher “and others attribute the explosion of cases last year to a perfect storm of all the problems that are Pakistan: poverty and illiteracy; a health system in tatters; ethnic and sectarian violence; a government struggling to deal with corruption and dysfunction; huge population movements; and, especially since 9/11, rising extremism and anti-Western views — not to mention the natural attrition that accompanies any program that has dragged on for so long,” according to Science (Roberts, 8/3).
Noting that this week’s issue of the Lancet explores the theme of “[a]ccess to beneficial health technology, including essential medicines and medical devices, for those most in need,” a Lancet editorial states, “Maximizing use of current health technologies (drugs, devices, biological products, medical and surgical procedures, support systems, and organizational systems) is essential to improving global health.” Collaboration between the journal and Imperial College London has resulted in a new Commission on technologies for global health, which examines different ways to broaden the use of new technologies, from bringing down cost to making them more culturally acceptable, the editorial notes.
Using a rodent model to examine the long-term effects of a potential malaria vaccine, a new study published in PLoS Biology by researchers at Penn State University shows that the vaccine could lead to the development of more virulent forms of malaria, the PLoS blog “Biologue” reports (Gross, 7/31). “Vicki Barclay, the study’s lead author, said it shows a need to track the long-term impact of any malaria vaccine, especially since any such vaccine is expected to be ‘leaky’ — meaning it won’t offer complete protection, and the disease will continue to spread, albeit at a slower rate,” CNN’s “The Chart” writes. “Researchers working with the leading candidate vaccine immediately questioned [the study], saying they’ve seen no sign of dangerous changes as a result of their work,” the blog continues (Hellerman, 8/1).
“In April, Partners In Health [PIH] responded to Haiti’s cholera epidemic by providing oral vaccinations to 45,000 people living in the country’s Artibonite region — specifically, to two rice-farming communities hit hard by cholera,” Louise Ivers, senior health and policy adviser at PIH, reports in an article on the organization’s webpage. “In partnership with Haiti’s Ministry of Health, hundreds of community health workers fanned out across the rural, flood-prone area, delivering two doses to each person by the end of May,” she writes, and discusses the impact of the campaign (8/1).
The New York Times reports on efforts by the GAVI Alliance to deliver vaccines for children in war-torn and secretive countries. According to the newspaper, the non-profit group “sold to North Korea a vaccine against five diseases, and has announced plans to roll out other vaccines soon in Yemen, the Republic of Congo and Pakistan.” The newspaper notes that the alliance “does not do the vaccinating, but negotiates low prices from manufacturers and resells the vaccines at prices on a sliding scale, depending on a country’s gross national income per capita.” According to the New York Times, “[F]irst the group studies whether the country can use the vaccine — whether officials can keep it refrigerated even in rural villages, for example, and whether there are enough trained vaccinators” (McNeil, 7/30).
Noting “the total clinic-level cost of providing a year’s worth of antiretroviral drugs … ha[s] dropped” in some countries, Charles Kenny, a fellow at the Center for Global Development and the New America Foundation, discusses “disagreement over the effectiveness of the global AIDS response” in this Bloomberg Businessweek opinion piece. Kenny highlights a debate that took place last week on the sidelines of the XIX International AIDS Conference (AIDS 2012) that “focused on the question: should we use resources for antiretrovirals at a cost (including overhead) of perhaps $350 per patient per life year saved if we could use those resources to provide a course of drugs to cure victims of tuberculosis at a cost of $5 to $50 per life year, or of extending childhood immunizations at the cost of $2 to $20 per life year?” He writes, “Simply, millions of people are dying unnecessarily, for lack of $350 a year or less. It may be those who don’t get AIDS treatment, or those that don’t get other treatments because the available money is being used to buy antiretrovirals.” He continues, “If anything could open treasury accounts in the rich world to provide a larger flow of resources to global health, perhaps it is to get policymakers in those countries to think through these gut wrenching decisions that limited funding (and lack of funding flexibility) forces doctors and ministers and activists alike to make every day” (7/27).
Highlighting the XIX International AIDS Conference (AIDS 2012), which concluded in Washington, D.C., on Friday, this New York Times editorial examines the future of the global AIDS response. “There is no prospect that scientists will any time soon find the ultimate solutions to the AIDS epidemic, namely a vaccine that would prevent infection with the AIDS virus or a ‘cure’ for people already infected with the virus,” the editorial states, adding, “Even so, health care leaders already have many tools that have been shown in rigorous trials to prevent transmission of the virus, making it feasible to talk of controlling the epidemic within the foreseeable future.” The editorial continues, “Instead of waiting for these future possibilities, [NIAID Director Anthony Fauci] and other health leaders are proposing the broad adoption of other available tools to reduce the spread of the virus so as to produce an ‘AIDS-free generation,’ a goal enunciated last year by Secretary of State Hillary Rodham Clinton.” The editorial adds, “The only question is whether the nations of the world are willing to put up enough money and make the effort to do it” (7/27).