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).
“Health efforts are close to wiping out polio, but two significant challenges remain: money and the operational logistics of getting the vaccine to people who need it,” CNN writes in an article examining “how far we’ve come with polio and what’s left to be done.” The news service provides statistics of polio infection globally and a history of polio in the U.S., and compares polio eradication efforts to those of other diseases. “The World Health Organization has an action plan for the next 18 months that could very well lead to eradication, says Oliver Rosenbauer, spokesman for polio efforts at the organization,” the news service writes and highlights a number of challenges moving forward (Landau, 7/30).
“The world’s first vaccine against dengue fever, being developed by French drugmaker Sanofi SA, protected against three of the virus’s four strains in a keenly awaited clinical trial in Thailand,” the company announced on Wednesday, Reuters reports (Hirschler/Regan, 7/25). “The vaccine actually generated antibody responses against all four strains of the virus, but for some reason, one strain was still able to infect children who received the vaccine, the company said, and scientists are now trying to figure out why,” the Los Angeles Times’ “Science Now” blog reports, adding, “Meanwhile, a much larger trial involving 31,000 adults and children is now under way in 10 countries in Asia and Latin America” (Maugh, 7/26). Reuters notes, “Other drug companies are also working on dengue vaccines but Sanofi’s product is several years ahead” (7/25).
“What stands out in my mind from this week’s presentations [at the XIX International AIDS Conference (AIDS 2012)] is that [HIV] interventions previously proved to work in controlled clinical trials are now — over and over again — proving effective outside the research setting, in the real world, in poor and rich communities alike. The pieces are coming together,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, writes in a Washington Post opinion piece. He discusses several of the interventions, including the scale up of antiretroviral therapy (ART), treatment as prevention, voluntary medical male circumcision, and pre-exposure prophylaxis (PrEP). “Ending the HIV pandemic is an enormous and multifaceted challenge, but we know it is possible,” Fauci writes, adding that it will require “commitment” and “investments.” He continues, “We must enhance what works and eliminate what does not, overcome legal and political barriers, and remove the stigma associated with HIV.” Fauci concludes, “The global community has a historic opportunity based on solid scientific evidence to end the AIDS pandemic, opening the door to an AIDS-free generation” (7/26).