06 December 2017
Project: Centre on Global Health Security, Universal Health Coverage Policy Forum
“…..This year, at the opening of the One Belt and One Road Initiative forum, Xi Jinping reiterated his pledge to create 100 health projects for women and children in the developing world—a commitment to maternal and child health that fills a void left by the US withdrawal of funding to the United Nations Population Fund. China is also investing in vaccine development and collaboration in biomedical advances with support from organizations such as the Bill & Melinda Gates Foundation. Between 2000 and 2012, China committed a total of $3 billion to 255 projects on health, population, and water and sanitation in Africa. The country also built hospitals and malaria control centers, invested in medical equipment, provided anti-malarial treatment, and trained health care workers. China’s assistance was crucial to both the response to the 2014 Ebola outbreak in West Africa and expanding its soft power further into Africa. China is also increasing its global health partnerships, both academically and across governments, and now boasts multilateral and bilateral partnerships with UN agencies, developed and developing nations, and many international non-governmental organizations. The country is forming public/private partnerships for global health and is engaging in many academic partnerships. It has even established a consortium organization much like the Consortium of Universities for Global Health called the China Consortium of Universities for Global Health, which so far includes 23 member universities…..”
“…..The risks posed by AMR have continued to intensify in the five years since the 2013 report. Numerous welcome initiatives have been launched, but concrete successes in addressing the two drivers identified above remain elusive. We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably. The stakes are incredibly high—if resistance overtakes all our available antibiotics, it would spell the “the end of modern medicine”.…..”
The Pharmaceutical Journal. 2017. “Chief Medical Officer Warns Antibiotic Resistance Could Signal ‘End of Modern Medicine’”. The Pharmaceutical Journal. 17 October 2017. http://www.pharmaceutical-journal.com/news-and-analysis/news/chief-medical-officer-warns-antibiotic-resistance-could-signal-end-of-modern-medicine/20203745.article
Selected AMR Rates
Resistance of Staphylococcus aureus to Oxadcillin (MRSA), % Resistant (invasive isolates)
Resistance of Klebsiella pneumoniae to Cephalosporins (3rd gen), % Resistant (invasive isolates)
Source: Figure courtesy Center for Disease Dynamics, Economics and Policy. Used with permission via Creative Commons license. https://resistancemap.cddep.org/AntibioticResistance.php
Note: Countries in white indicate no data available.
The business of improving global health
Some of the world’s most debilitating diseases are treated by a medication that was originally created for dogs.
It sounds weird, but it’s true. In 1978, a researcher at Merck hypothesized that a new heartworm preventative called ivermectin could help people suffering from onchocerciasis, a neglected tropical disease that causes river blindness primarily in sub-Saharan Africa. Less than a decade later, the drug was approved for use in humans, and Merck announced that it would provide ivermectin for free to anyone who needs it.
Today, it’s used to treat people suffering from a number of parasitic diseases. I recently saw firsthand how the Tanzanian government is administering ivermectin to whole communities to wipe out lymphatic filariasis.
The next ivermectin could be sitting in a lab right now, but we need to be purposeful about finding it. Private sector research can have tremendous benefits for the world’s poorest. If you look at the research agendas of many biotech and pharma companies today, I think there are enormous opportunities to make progress on some of the toughest health challenges.
I spoke about the possibilities that exist at the intersection of global health and the private sector earlier today at J.P. Morgan’s 36th Annual Healthcare Conference in San Francisco. Here is the full text of my prepared remarks:
Remarks as prepared
J.P. Morgan’s 36th Annual Healthcare Conference
San Francisco, CA
January 8, 2018
BILL GATES:
Thank you. It’s great to be here today.
No matter where I go, no matter who I talk to, there’s one point I always try to get across. It’s been my key message for more than a decade. It’s that health is getting better, and it’s getting better faster than ever before.
Since 1990, the world has cut child mortality in half. HIV is no longer a certain death sentence. Many of the so-called neglected diseases that affect a billion people every year aren’t neglected anymore.
I talk about what we’ve accomplished in the past because it makes me optimistic about what we can accomplish in the future. But there’s still a lot of room for improvement. This year, 5 million children under the age of five will die, mostly in poor countries. And hundreds of millions of others will suffer from diseases and malnutrition that sap them, and their countries, of their strength and their potential.
Some of this can be addressed by doing a better job of getting lifesaving drugs and vaccines to the people who need them. But there is still a substantial gap between the tools we have and the tools we need to eliminate the most persistent diseases of poverty.
The way to fill that gap is to innovate, and that’s why I’m excited to be here today. Because the tools and discoveries your companies are working on can also lead to breakthrough solutions that save millions of lives in the world’s poorest countries.
It’s true that government-funded basic science research shines a light on promising pathways to health advances.
Philanthropy can help nurture the best ideas through discovery and development, and balance the risk-reward equation for private-sector partners.
But industry has the skills, experience, and capacity necessary to turn discoveries into commercially viable products.
The fact is that global health needs the private sector. And, frankly, the private sector has much to gain from pursuing breakthroughs in global health.
Over the next few decades, developing economies will continue to expand. By 2050, the population of Africa will more than double to almost 2.5 billion. That’s more than twice the forecasted population of the U.S. and Europe combined.
But we don’t have to wait 20 or 30 years. Even in the shorter term, impact and earnings are not mutually exclusive for the private-sector.
As you probably know, global health is our primary focus at the Gates Foundation—although we also work in a few other areas that are big levers for impact . . . like agricultural development . . . and public education here in the U.S. Over the last five years, we have invested nearly $12 billion in global health.
This includes grants and equity investments in companies with promising technologies that have potential application in global health. We also use creative price and volume guarantees that help the private sector mitigate the risk in developing a new product for which demand is unproven.
Our investments have led to new drugs and vector control tools for malaria . . . accelerated the introduction of new vaccines in poor countries . . . and ensured that millions of people in the developing world have access to long-lasting contraceptives and the best-available antiretroviral treatment for HIV.
We are also working with the WHO and regulatory entities in China and Africa to eliminate systemic barriers that slow development of new products and access to new markets. A few years ago, we looked at the data, which showed that in high-income countries it took 6-12 months to get a product registered—compared to 4-7 years in low-income countries. We realized this was as big a challenge as anything else in getting new health solutions to the people who need them.
I’m particularly excited about our work with the Chinese FDA to provide a more efficient and consistent mechanism for testing, review, and approval of medicines and vaccines—using international standards. This would be a game changer in getting quality products into and out of China.
There is another critical intersection emerging between what you do and what we do—and that’s what I’d like to talk about today.
The questions driving your research agendas today in biotech and pharma—and the problems we’re trying to solve in global health—are starting to converge in exciting ways. Many of the solutions you’re working on—harnessing the immune system to tackle cancer, unraveling the mysteries of the brain to treat Alzheimer’s, and learning how bodies absorb nutrition to address the obesity epidemic and other diseases—also have clear applications in global health.
The global health community may not be thinking as much about treatments for cancer, but we need to understand the immune system to tackle deadly diseases like HIV, malaria, and TB.
We aren’t focused on the neurodegenerative diseases commonly associated with aging, but we are concerned about the cognitive development of hundreds of millions of young children in poor countries.
We aren’t dealing with a crisis of obesity in Africa and South Asia, but we are trying to address its inverse, a crisis of stunting, wasting, and undernutrition.
You may be interested in developing products for rich-world markets, but the breakthroughs happening in your labs can also save millions of lives in the world’s poorest countries.
In health and medicine, we learn by analogy. We borrow insights from other fields. And when we ask one kind of question about key systems like the immune system, the brain, or our human microbiota, the answers may also apply to a totally different line of questioning.
A few months ago, a headline caught my eye in The Wall Street Journal. The story was one of many that have highlighted how the HIV virus’s genetic machinery can be used as a tool to modify T-cells so they are capable of attacking specific cancers.
I’m confident that a decade from now, we’ll see a headline that says: “How Cancer Tools are Helping Cure HIV.”
Of course, it’s not quite that simple. Immunotherapy today works only against certain types of cancers and only in certain patients. And, like cancer, infectious diseases such as HIV, TB, and malaria have complex interactions with the immune system of infected individuals.
But there is reason to hope that the insights uncovered in ongoing immunotherapy research for cancer will eventually help us control all infectious diseases. This would be a huge victory for humanity—and potentially a significant market for the life sciences.
Others seem to think so too. Venture capitalists like Bob Nelsen and Bob More have helped raise over $500 million for VIR Biotechnology—including funding from us—to discover and develop treatments for serious infectious diseases.
We are also investors in Immunocore, which is using T-cell technology to help stimulate the body’s immune system. Initially, Immunocore’s “T-cell receptor” technology targeted cancers, but it could also be applied against infectious diseases.
We are backing companies like CureVac and Moderna on mRNA approaches for vaccine and drug development, which have the potential to help us tackle cancer. This approach is also intriguing as a potential immunological intervention for HIV, malaria, flu and the Zika virus.
And mRNA vaccines are likely to be cheaper, easier, and faster to make than traditional vaccines. This would be particularly helpful in containing epidemics—whether they occur through nature or are the result of an intentional biological attack. Today, it typically takes up to 10 years to develop and license a new vaccine. To significantly curb deaths from a fast-moving airborne pathogen, we would have to get that down considerably—to 90 days or less.
Of course, fighting infectious disease is only one of the global health challenges that demand our attention. Another is newborn health. Despite the great progress in reducing child mortality, nearly 5 million children under the age of five will die this year—close to half in the first 28 days of life.
To make inroads against neonatal mortality, we first have to understand and address the underlying vulnerabilities of newborns, especially in poor countries. Right now, we don’t know exactly why many newborns in poor countries die, which makes it very difficult to save them.
But we’re enthusiastic about leveraging the tools of genetics and other research the private sector is working on to help children survive birth, fend off deadly infections, and thrive both physically and cognitively.
I’m also excited about a 20-year study we’re funding in Southeast Asia and Sub Saharan Africa that will give us epidemiological data about what is causing stillbirths and child deaths.
We have a lot to learn from the data, but we already know that one critical factor is the prevalence of preterm birth. It is the single largest cause of newborn deaths, and the children who survive it often face serious and lifelong health problems. Although most premature births occur in Africa and Asia, this remains a problem in rich countries, too.
One of every 10 infants in the U.S. is born preterm, which threatens the health and wellbeing of those children and significantly drives up healthcare costs.
We are just now getting the first effective diagnostic test to identify women at risk for early delivery. A company called Sera Prognostics developed a blood-based diagnostic that recently went on the market in the U.S.
We’re supporting their work on a low-cost version for use in poor countries. By itself, this won’t solve the problem. But it will give healthcare providers a way to identify women at risk and provide care that extends their pregnancy toward full-term.
We also need to better understand the biological mechanisms that underpin preterm birth, starting with the health of the mother during pregnancy. We recently co-funded a genome wide association study that illuminated a correlation between selenium deficiency in pregnant women and preterm birth. More research is needed, but the hope is that dietary supplements could help reduce the incidence of preterm births and newborn deaths.
It is also increasingly clear that the gut microbiome and nutrition—and the interplay between the two—is a big factor in the survival and healthy development of children, no matter where they live.
We know that children in poor countries who are malnourished and vulnerable to enteric infections have underdeveloped microbiomes that weaken their immune system and make them more susceptible to disease and to impaired brain development that lasts a lifetime.
There is also evidence that children in wealthy countries who grow up in super-hygienic environments—with an abundance of processed foods and antibiotics—have poor gut health that makes them more susceptible to obesity, auto-immune diseases, diabetes—and later in life—hypertension.
The solution in both instances is making sure that kids have the right constellation of microbes in their gut—and that they’re eating the right foods to support a healthy microbiome.
We’ve recently begun working with partners who are developing solutions to replace or augment healthy microbes using probiotics, nutritious foods with locally-available ingredients, and even fecal transplants.
We also have to better understand which children are not progressing developmentally, and why that is.
As I mentioned, malnourished children are at risk of being cognitively impaired for the rest of their lives. Recent estimates indicate that 250 million children under the age of five fit this criterion. That’s four of every 10 children in low- and middle-income countries who are more likely to drop out of school and less likely to succeed in the workplace.
In human terms, this is a heartbreaking tragedy. In economic terms, it is a huge drag on the ability of developing countries to lift themselves out of poverty.
One challenge is that we don’t have good tools to assess the brain development of children. The proxy measures we use today are a child’s height—if it’s well below the norm for their age—and whether they live in poverty. There is, of course, value in these indicators. But we can’t adequately gauge the development of an organ that contains 100 billion cells and that scientists have called “the most complex object in the known universe” through measures that are apparent to the naked eye.
We are working with partners to determine if neuroimaging and other technologies can be used in early infancy and young children to accurately predict cognitive development. These are the same tools that companies are using to assess dementia and cognitive decline late in life.
We have some early data showing the promise of these tools in parts of the world with a high incidence of stunting. These images show fewer neural connections in the brains of children who are stunted compared to the brains of normally developing children at 2-3 months of age.
We’re also supporting research to better understand the factors that most affect brain development in children so we can intervene more quickly to minimize the impact of neurocognitive deficits early in life.
On a personal level, I’m particularly interested in deepening our understanding of both the development and the decline of brain function.
I’ve seen first-hand the devastating consequences of stunting on the development of children in developing countries. And men in my own family have suffered from Alzheimer’s.
Although Alzheimer’s research is outside the scope of what we do as a foundation, I’ve personally committed to investing $100 million on new approaches to dementia, including Alzheimer’s—on top of the brain development research we’re supporting through the foundation.
People often ask why Melinda and I decided to focus so much of our philanthropy on global health. It started with a simple question we asked ourselves: how could we do the most good for the greatest number of people?
When we looked at it that way, the answer quickly became clear. The health disparity between rich and poor countries was a big problem. We saw a gap that wasn’t being filled by others. And we believed that our investments in global health could be catalytic. By helping poor countries ease the devastating burden of disease, we could help ease the burden of poverty, too.
One of the major obstacles we faced early on is that in health—as in many other aspects of life—the free market tends to work well for people who can pay . . . and not so well for people who can’t. But over the last decade, our experience has shown that we can stretch the reach of market forces so the private sector’s most exciting innovations also benefit people with the most urgent needs. And with creative thinking, we can do it in ways that are both sustainable and profitable.
Our foundation is in a unique position to share the risk on promising bets that can lead to important new discoveries. And we can help provide more predictability to companies interested in entering new markets that present real challenges—but also tremendous opportunities.
We all share the goal of improving the health and well-being of people globally. Imagine what’s possible if we work together.
Consider a world where the age-old scourge of malaria is finally eradicated . . . where hundreds of millions of people no longer suffer from tuberculosis . . . and where we have a cure for HIV.
In a quarter century, we cut childhood mortality in half. With the passion, expertise, and resources of the people in this room, we can cut child mortality in half again by 2030.
There are many technical challenges to overcome. But when I think about the breathtaking pace of innovation in just the last 10 or 20 years, I believe that even more extraordinary things are possible in our lifetime.
I can think of no more noble purpose than erasing the divide between those who suffer the relentlessness of disease and poverty—and those of us who enjoy good health and prosperity.
Achieving health equity in our lifetime is not only a possibility. It is an imperative, because everyone—no matter where they live—deserves the chance to live a healthy and productive life.
Thank you.
, The High Toll of Traffic Injuries: Unacceptable and Preventable
“….Key findings from the report include:
“…..Almost half of the population – 4.8 million people – are currently severely food insecure. That’s 1.4 million more than the same time a year ago.
It’s projected to get even worse in 2018, with an estimated 5.1 million people expected to go hungry…..”
A Disease Threat Anywhere is a Threat Everywhere.
Today’s world is more connected than ever. In as little as 36 hours1, a pathogen from a remote village can spread to all major cities in six continents. That is why it is critical to detect, report and respond to outbreaks in a timely manner.
A new or existing pathogen is introduced to a community and starts to spread.
Humans or animals start to feel ill or even die with similar symptoms.
CDC performs 24/7 global disease monitoring to identify potential incidents.
An outbreak is suspected. There are several ways to detect and verify a disease through reported cases or from event information.
Local clinics and hospitals see more people with symptoms such as fever, persistent diarrhea, cough and unexplained bleeding.
Laboratory confirms cases of disease found at local clinic.
Disease detective and surveillance teams capture and organize information about events that are a potential risk.
Teams monitor official and unofficial reports of potential disease events from a wide variety of sources including media, rumors, blogs, community members, etc.
CDC works with partners and Ministries of Health to find potential outbreaks through routine reporting of symptoms, lab test results and official and unofficial reports.
Countries conduct lab tests or send specimens for testing.
CDC trains countries how to test, handle and safeguard samples.
Disease detectives investigate to determine the source and size of the outbreak.
CDC trains disease detectives around the world to stop the outbreak at the source.
Lab results confirm if patients test positive or negative for illness.
Health authorities are alerted.
Authorities report disease outbreak to appropriate national and international organizations in accordance with the International Health Regulations.
CDC’s global rapid responders are deployed when a country requests additional support to:
Implement infection prevention and control measures and distribute medical countermeasures
Conduct public health communication and education
Enhance local surveillance systems to track outbreaks
Improve local lab testing for faster diagnosis
CDC is at the frontline of disease detection and response, working 24/7 to protect the health, safety, and security of American people. CDC’s work
ensures that outbreaks are contained before they can spread and reach the U.S.
This is a snapshot of an outbreak investigation and does not reflect all the steps that may occur. Information presented in this example depicts a prompt outbreak identification. Several factors affect the investigation and can prolong the timing and results. Delays in response activities can lead to outbreaks spreading quickly and spillover to other communities.
Sweetened beverage tax will help beat NCDs in the Philippines
19 December 2017
The World Health Organization (WHO) commends the Philippines as it passes a landmark law today with new tax provisions for sugar-sweetened beverages (SSB). The Tax Reform for Acceleration and Inclusion (TRAIN) Act provides a Php6 per litre tax (approximately 14% increase in price) for caloric and non-caloric sweetened beverages. The initiative makes Philippines among the first countries in Asia to introduce SSB tax in their national agenda.
Evidence has shown that SSB tax can reduce consumption of sugars and help prevent overweight, obesity, and noncommunicable diseases (NCDs) such as diabetes and cardiovascular disease. In the Philippines, overweight and obesity rates have been steadily increasing and diabetes and cardiovascular disease now cause 4 out of every 10 deaths among Filipinos. With 87% of Filipinos suffering from tooth decay, the reduction of sugars intake will also reduce this risk. The revenue to be generated from the SSB taxation also has the potential to be utilized for health-promoting purposes.
Taxation of SSBs is a great step forward in protecting the health of Filipinos. Experience in other countries has shown positive results. Mexico, for instance, implemented 10% excise tax on SSBs in 2014 and demonstrated an average reduction of 7.6% in purchases of taxed beverages in its first two years of implementation. The reduction in consumption is predicted to have positive impacts on health outcomes and reductions in health care expenses in Mexico.
We congratulate the legislators and health advocates who together have worked hard during the past years to push the inclusion of SSB tax into law. This tax will save many lives over the next years.
“Summary
• In some parts of the world it is common practice for patients to be detained in hospital for non-payment of healthcare bills.
• Such detentions occur in public as well as private medical facilities, and there appears to be wide societal acceptance in certain countries of the assumed right of health providers to imprison vulnerable people in this way.
• The true scale of these hospital detention practices, or ‘medical detentions’, is unknown, but the limited academic research to date suggests that hundreds of thousands of people are likely to be affected every year, in several sub-Saharan African countries and parts of Asia. Women requiring life-saving emergency caesarean sections, and their babies, are particularly vulnerable to detention in medical facilities.
• Victims of medical detention tend to be the poorest members of society who have been admitted to hospital for emergency treatment, and detention can push them and their families further into poverty. They may also be subject to verbal and/or physical abuse while being detained in health facilities.
• The practice of detaining people in hospital for non-payment of medical bills deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care.
• At the root of this problem are the persistence of health financing systems that require people to make high out-of-pocket payments when they need healthcare, and inadequate governance systems that allow facilities to detain patients.
• Universal health coverage (UHC) cannot be achieved while people are experiencing financial hardship through their inability to pay for healthcare, so by definition any country that allows medical detention is failing to achieve UHC.
• Health financing systems should be reformed by moving towards publicly financed UHC, based on compulsory progressive pre-payment mechanisms. This would enable hospitals to become financially sustainable without the need to charge significant user fees……”
“…..Uganda has implemented an innovative solution. Here, liquid morphine is produced by a private charity overseen by the government. And with doctors in short supply, the law lets even nurses prescribe morphine after specialized training.
About 11 percent of Ugandans needing morphine get it. Inadequate as that is, it makes Uganda a standout not just in Africa, but in the world…….”
“…..The United States…..produces or imports 31 times as much narcotic pain-relievers it needs whether in legal or illegal form: morphine, hydrocodone, heroin, methadone, fentanyl and so on.
Haiti, by contrast, gets slightly less than 1 percent of what it needs. And Nigeria, on a per-capita basis, gets only a quarter of what Haiti gets: 0.2 percent of its need……”