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WHO: Ten threats to global health in 2019

WHO

The world is facing multiple health challenges. These range from outbreaks of vaccine-preventable diseases like measles and diphtheria, increasing reports of drug-resistant pathogens, growing rates of obesity and physical inactivity to the  health impacts of environmental pollution and climate change and multiple humanitarian crises.

To address these and other threats, 2019 sees the start of the World Health Organization’s new 5-year strategic plan – the 13th General Programme of Work. This plan focuses on a triple billion target:  ensuring 1 billion more people benefit from access to universal health coverage, 1 billion more people are protected from health emergencies and 1 billion more people enjoy better health and well-being. Reaching this goal will require addressing the threats to health from a variety of angles.

Here are 10 of the many issues that will demand attention from WHO and health partners in 2019.

Air pollution and climate change


Nine out of ten people breathe polluted air
every day. In 2019, air pollution is considered by WHO as the greatest environmental risk to health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease. Around 90% of these deaths are in low- and middle-income countries, with high volumes of emissions from industry, transport and agriculture, as well as dirty cookstoves and fuels in homes.The primary cause of air pollution (burning fossil fuels) is also a major contributor to climate change, which impacts people’s health in different ways. Between 2030 and 2050, climate change is expected to cause 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.In October 2018, WHO held its first ever Global Conference on Air Pollution and Health in Geneva. Countries and organizations made more than 70 commitments to improve air quality. This year, the United Nations Climate Summit in September will aim to strengthen climate action and ambition worldwide. Even if all the commitments made by countries for the Paris Agreement are achieved, the world is still on a course to warm by more than 3°C this century.

Noncommunicable diseases

Noncommunicable diseases, such as diabetes, cancer and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people. This includes 15 million people dying prematurely, aged between 30 and 69.Over 85% of these premature deaths are in low- and middle-income countries. The rise of these diseases has been driven by five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution. These risk factors also exacerbate mental health issues, that may originate from an early age: half of all mental illness begins by the age of 14, but most cases go undetected and untreated – suicide is the second leading cause of death among 15-19 year-olds.

Among many things, this year WHO will work with governments to help them meet the global target of reducing physical inactivity by 15% by 2030 – through such actions as implementing the ACTIVE policy toolkit to help get more people being active every day.

Global influenza pandemic

The world will face another influenza pandemic – the only thing we don’t know is when it will hit and how severe it will be. Global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.

WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are involved in global surveillance and response.

Every year, WHO recommends which strains should be included in the flu vaccine to protect people from seasonal flu. In the event that a new flu strain develops pandemic potential, WHO has set up a unique partnership with all the major players to ensure effective and equitable access to diagnostics, vaccines and antivirals (treatments), especially in developing countries.

Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in places where protracted crises (through a combination of challenges such as drought, famine, conflict, and population displacement) and weak health services leave them without access to basic care.

Fragile settings exist in almost all regions of the world, and these are where half of the key targets in the sustainable development goals, including on child and maternal health, remains unmet.WHO will continue to work in these countries to strengthen health systems so that they are better prepared to detect and respond to outbreaks, as well as able to deliver high quality health services, including immunization.

Antimicrobial resistance

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.

Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these people had multidrug-resistant tuberculosis.

Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.

Ebola and other high-threat pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which spread to cities of more than 1 million people. One of the affected provinces  is also in an active conflict zone.

This shows that the context in which an epidemic of a high-threat pathogen like Ebola erupts is critical –  what happened in rural outbreaks in the past doesn’t always apply to densely populated urban areas or conflict-affected areas.

At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of action on preparedness for health emergencies”.

WHO’s R&D Blueprint identifies diseases and pathogens that have potential to cause a public health emergency but lack effective treatments and vaccines. This watchlist for priority research and development includes Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.

Weak primary health care

 Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life.

Primary health care can meet the majority of a person’s health needs of the course of their life. Health systems with strong primary health care are needed to achieve universal health coverage.Yet many countries do not have adequate primary health care facilities. This neglect may be a lack of resources in low- or middle-income countries, but possibly also a focus in the past few decades on single disease programmes. In October 2018, WHO co-hosted a major global conference in Astana, Kazakhstan at which all countries committed to renew the commitment to primary health care made in the Alma-Ata declaration in 1978.

In 2019, WHO will work with partners to revitalize and strengthen primary health care in countries, and follow up on specific commitments made by in the Astana Declaration.

Vaccine hesitancy

Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.

In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.

Dengue

Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades.

A high number of cases occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease.An estimated 40% of the world is at risk of dengue fever, and there are around 390 million infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.

HIV

The progress made against HIV has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment), and providing access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection).

However, the epidemic continues to rage with nearly a million people every year dying of HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died. Today, around 37 million worldwide live with HIV. Reaching people like sex workers, people in prison, men who have sex with men, or transgender people is hugely challenging. Often these groups are excluded from health services. A group increasingly affected by HIV are young girls and women (aged 15–24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite being only 10% of the population.This year, WHO will work with countries to support the introduction of self-testing so that more people living with HIV know their status and can receive treatment (or preventive measures in the case of a negative test result). One activity will be to act on new guidance announced In December 2018, by WHO and the International Labour Organization to support companies and organizations to offer HIV self-tests in the workplace.


Small molecule therapeutics (SMTs) polymer nanoparticles (NP) and have been proposed as potential prereferral treatments for snakebite

Bulfone TC, Samuel SP, Bickler PE, Lewin MR.

Developing Small Molecule Therapeutics for the Initial and Adjunctive Treatment of Snakebite.

J Trop Med. 2018;2018:4320175. Published 2018 Jul 30. doi:10.1155/2018/4320175

  • Snakebite envenomation is a neglected tropical disease that causes more than 100,000 deaths every year
  • SMTs represent a potentially useful adjunctive therapy to antivenoms, the current mainstay of care for symptomatic snakebite.

Engineered nanoparticles bind elapid snake venom toxins and inhibit venom-induced dermonecrosis

  • Jeffrey O’Brien,
  • Shih-Hui Lee,
  • José María Gutiérrez,
  • Kenneth J. Shea
PLOS

“…..The work describes hope for treatment of snakebite, a broad-spectrum antivenom comprised polymer nanoparticles (NPs) engineered to sequester the major protein toxins in elapid snakes. The stable, low-cost NPs can be administered subcutaneously immediately after the bite at the site of envenoming to halt or reduce the extent of local tissue damage and mitigate the systemic distribution of toxins post-envenoming…..”

 

 


Vanuatu: Vaccines Delivered by Drone

NYT

“…..with support from Unicef, the Australian government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, began its drone program on Monday. It will initially serve three islands but may be expanded to

many more..…”

 

Locator Map for Vanuatu…”

 


Taxing red and processed meat according to its health impacts: New research

Springmann M, Mason-D’Croz D, Robinson S, Wiebe K, Godfray HCJ, Rayner M, et al. (2018) Health-motivated taxes on red and processed meat: A modelling study on optimal tax levels and associated health impacts. PLoS ONE 13(11): e0204139. https://doi.org/10.1371/journal.pone.0204139

PLOS 1

“……Including the social health cost of red and processed meat consumption in the price of red and processed meat could lead to significant health and environmental benefits, in particular in high and middle-income countries. The optimal tax levels estimated in this study are context-specific and can complement the simple rules of thumb currently used for setting health-motivated tax levels...….”

 


The United Nations: 13 million people in Yemen are facing starvation.

BBC


People in sub-Saharan African can expect to live for 11 years longer than the generation that went before them.

The Guardian

  • Factors including recovery from HIV epidemics, reductions in child mortality, improved nutrition and access to drinking water have driven life expectancy from 49.7 years in 1990 to 60.7 years in 2017.
  • The number of years children typically spend in school has also increased across the region, growing 14% over the past decade.

Young man exchanging syringes on the street in Maldives

 


A recent World Bank report concluded, rising temperatures in SE Asia could diminish the living standards of 800 million people.

NYT

2017 Was the Second Hottest Year on Record

“……a recent analysis of climate trends in several of South Asia’s biggest cities found that if current warming trends continued, by the end of the century, wet bulb temperatures — a measure of heat and humidity that can indicate the point when the body can no longer cool itself — would be so high that people directly exposed for six hours or more would not survive……..”


Attacks on Medical Education across the Globe

Attacks on Medical Education : Document

“…..The aim of this report is to explore an impact of violence on medical education, with its specific components, such as education facilities, teaching hospitals, libraries, professors, medical students and all other directly related components…..”

“….Venezuealan Case Studies:

Threats / intimidation of medical personnel of the Central Hospital of San Cristóbal during protests: During the month of April and May several threats were reported against the personnel of the Central Hospital of San Cristóbal, Táchira state, because the National Guards forbade treating the wounded during social protests, intimidating some doctors who attended these wounded youth, despite the multiple protests that took place in the hospital, this intimidation did not stop.

Tear gas pumps near the Del Valle maternal and child hospital on 04/20/2017: The use of tear gas bombs by the Bolivarian National Police and the Bolivarian National Guard in Longaray and the Intercomunal Avenue of El Valle affected the patients of El Valle Children’s Maternity Hospital. Gases seeped into hospital facilities affecting workers, mothers and newborns17.

Detention of the professor of medical school of the Universidad Central de Venezuela, MD Óscar Noya, on 04/20/2017: Oscar Noya is a doctor and professor at the Central University of Venezuela (UCV). He works continuously for the population that lives in the upper Orinoco. Through the Twitter social network it was possible to know that in the afternoon of Thursday, April 20, Dr. Oscar Noya was arrested, when participated in the protest. Moya was helping people affected by tear gas in Santa Monica, Caracas…..”


Global motorcyclists: A unique methodology to identify traffic hotspots around the world and then try to find answers to extinguish them

DUKE

“…..Crowdsourcing. They would survey motorcyclists about road traffic “hotspots”—areas of high-density crash locations—in the region. They hypothesized that the people who spend their days traversing across town would have valuable insights that could help inform future road safety interventions. It turns out they were right.  Staton, Vissoci, Østbye and Luciano Andrade, a post-doctoral researcher working with Staton, initially tested this method in Kigali, Rwanda, and Galle, Sri Lanka, in collaboration with Stephen Rulisa in Rwanda and Vijitha Da Silva in Sri Lanka. They asked moto drivers in Rwanda and tuk-tuk (three-wheel) drivers in Sri Lanka to identify dangerous locations in the region and label the severity of danger of each location. Then, the researchers compared police data to the information the drivers provided.

The study not only showed that data from these “high road utilizers” aligned well with police data, but also identified potential additional hotspots. The research team also found that this crowdsourcing approach is less costly than collecting police data and is easily reproducible, adaptable and interpretable. They were able to replicate the study in Moshi, Tanzania, a year later in collaboration with KCMC researcher Mark Mvungi and got similar results…..

The next step….is to formulate targeted, cost-effective interventions to minimize the risk in these traffic hotspots. These interventions might include measures such as adding speed bumps; improving road pavement conditions, visibility and signage; and promoting helmet use……”


Is it possible? 2 doses a year of an antibiotic can sharply cut death rates among infants in poor countries.

NY Times

“…..In the study — known as the Mordor trial and published in the New England Journal of Medicine — 190,238 children under age 5 in 1,500 villages in Malawi, Niger and Tanzania were given one dose of azithromycin or a placebo every six months for two years.

Overall, there were 14 percent fewer deaths among children getting the antibiotic; the reduction was strongest in Niger, where infant mortality is highest.

The protection appeared to be greatest for infants aged 1 month to 5 months; the antibiotic prevented one in four deaths in this group…..”


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