New WHO Chief Pledges to Make Polio Eradication a Priority

Newly installed World Health Organization director-general Jong-wook Lee pledged to step up efforts to eradicate polio by 2005, but the WHO might not have the funds to follow up on Lee’s pledge.

In a July press release, Lee said,

Polio eradication is a top priority. I want to see this disease gone once and for all. We have eliminated it from almost every country in the world. Now is the time to boost our action and resolve, and wipe it out everywhere. I am immediately upgrading WHOÂ’s capacity to support India, Nigeria, Pakistan and Egypt in their efforts to immunize every child against polio.”

Lee appointed SARS expert David Heymann to head up WHO’s polio eradication efforts who noted the dangers of not eradicating polio as soon as possible,

Just as with SARS, polio knows no boundaries. In January, a child was paralyzed by polio in Lebanon for the first time in ten years. That virus travelled from India. Unless we stop transmission in the remaining polio-endemic countries, polio will spread to other countries and paralyze children, potentially reversing the gains already made.

But the WHO is also begging for money, claiming that it needs an additional $210 million for polio eradication efforts or it might have to scale back its efforts to fight the disease.

In 2002, there were less than 2,000 reported cases of polio worldwide and the disease is only present in seven countries. Lee argues it would be well worth the money to eradicate the disease worldwide once and for all.

Source:

WHO faces $210M shortfall in polio fight. Jonathan Fowler, Associated Press, July 29, 2003.

WHO steps up polio fight. The BBC, July 29, 2003.

New WHO Director-General steps up global polio eradication effort, as polio threatens other countries. Press Release, World Health Organization, July 29, 2003.

World Health Organization seeks eradication of polio by 2005. Lawrence K. Altman, New York Times, July 29, 2003.

World Health Organization Urges More Funding for Fight Against Tuberculosis

The World Health Organization recently released a report on the state of tuberculosis in the world and called on donor nations to provide funds to distribute and monitor the administration of anti-tuberculosis drugs in the developing world.

The WHO’s basic conclusion is that the tuberculosis situation is declining fueled by the twin killers of AIDS and poverty. WHO estimates that one in three of the world’s 42 million HIV positive individuals also has tuberculosis.

Back in the early 1990s WHO declared tuberculosis to be a global emergency, and the situation with the disease today is much worse.

The cost of drugs that combat tuberculosis is only $10 for a complete regimen of drugs that will cure about 95 percent of cases. But in order for this to work, the entire series of drugs must be taken on a timetable. Poor health care systems in the developing world mean that even among individuals who receive drugs, few actually complete the entire regimen. This not only renders the drugs useless, but also dramatically increases the risks of more drug-resistant strains of tuberculosis.

According to WHO estimates, fewer than 1 in 3 African patients receives the entire series of drugs, and in Russia that percentage is even lower.

Aside from the devastating toll the disease takes among those afflicted with it, there is a bigger danger that a drug resistant form of the disease could emerge that would spread the disease along the lines of India. India is the epicenter of the tuberculosis epidemic with two million new cases annually.

WHO estimates that it needs another $4 billion or so to fulfill its plan to stop the spread of tuberculosis by 2005.

Sources:

WHO calls for widespread free access to anti-TB drugs for people living with HIV. Press Release, World Health Organization, July 15, 2003.

TB drugs ‘should be free’. The BBC, July 15, 2003.

TB advocacy report 2003. World Health Organization, 2003.

Malaria Project Failing Due to Lack of Funds

An article published in the online Malaria Journal argues that the World Health Organization is woefully behind in its 1998 Roll Back Malaria plan that sought to cut malaria deaths in half by 2010 and then in half again by 2015. According to Harvard researchers Vasant Narasimhan and Amir Attaran, the RBM project has attracted barely five percent of the funds it needs to succeed.

Based on surveys of donor countries and external estimates of their spending, Narasimhan and Attaran estimate that RBM receives roughly US$98 million annually. It would need about US$1.5-$2 billion annually to reach its goal of halving malaria deaths.

The odd thing is that this estimate is filled with a bizarre level of uncertainty. Switzerland, for example, told the researchers that not only did they not know how much their country was giving for malaria control, but they did not even know how to go about finding out since malaria control spending was subsumed into larger health spending budgets. Narasimhan and Attaran write that this will pose enormous problems for funding of malaria control efforts,

In short, the Swiss answer, which seems likely to apply to some other donors too, is that the extent of malaria control funding is not just unknown, but actually unknowable. Leaving aside the reasons why this is true (e.g. it is found in integrated health programmes and not easily disaggregated), this poses a huge strategic threat to RBM’s goals: What is the likelihood of increasing malaria control funding, when the donors lack the accounting procedures and ability to know how much they are spending? Without reliable financial surveillance, there is good reason to suspect that aid to malaria control will stagnate, as it has done for decades, without triggering public pressure to demand improvement.

The other interesting thing is that the $98 million spending estimate is significantly smaller than other estimates that put annual malaria control spending at US$130 to $160 million. Part of the reason for the difference is that some organizations, including the World Bank, appear to be exaggerating their malaria control spending (emphasis added),

Although the Bank publicly claims that “at present, World Bank direct financing for malaria control activities is over $200 million in more than 25 countries”, we find on the Bank’s own project list only 10 countries having “active” malaria control projects [22]. In India, where in 1997 the Bank pledged its largest malaria control effort ($164.8 million), the project neared its close in 2003 after disbursing little over a quarter of this amount. In Africa, where 90% of malaria deaths occur, the Bank has only 4 active projects: in the Comoros, Eritrea, Madagascar, and Senegal. Yet not one of these countries suffers particularly intense or sustained malaria transmission – three are hardly malarious at all by African standards – meaning that the Bank’s efforts will contribute little to halving the burden of malaria.

Worst of all, the Bank has practically reneged on the dramatic pledge it made to two dozen African heads of state at Abuja in April 2000 to provide “up to $500 million more…for the fight against malaria in Africa” [23]. Nearly three years after that pledge, Eritrea is the only country to receive a new loan expressly including malaria control (the loan package is $40 million, split among 4 diseases). Assuming that the each disease in the Eritrea loan package receives an equal share, then the Bank’s new lending for malaria control since Abuja amounts to only $10 million; and three years after Abuja, up to $490 million of the $500 million that the Bank promised remains uncommitted and unspent. Furthermore, at this writing (December 2002), the Bank’s own malaria project list shows not one new African malaria control project in the planning pipeline. There seems to be no activity underway at the Bank to keep the promise that was made.

The authors recommend that the World Bank appoint a malaria “czar” to oversee malaria control projects in much the same way it appointed an AIDS “czar” to oversee AIDS control projects.

They also criticize views in Western donor nations that malaria spending is wasted because developing nations do not have the health care infrastructure to meaningfully absorb the aid. Instead, they argue that this is a sort of chicken-or-egg problem — additional spending on malaria would drive the creation of additional health care infrastructure. I suspect donor nations are a bit more skeptical than are Narasimhan and Attaran. As the authors themselves concede, the United States, for example, spent billions on malaria control in the 1960s with very little to show for it.

Source:

Roll Back Malaria? The scarcity of international aid for malaria control. Vasant Narasimhan and Amir Attaran, Malaria Journal, April 15, 2003.

Malaria project in funding crisis. BioMed Central, Press Release, April 25, 2003.

World Health Organization: Infectious Diseases Kill More than 5 Million Children Annually

World Health Organization representative Dr. James mwazia recently issued a statement for World Health Day noting that infectious diseases such as diarrhea, malaria and others kill more than 5 million children each year.

The sad irony is that these diseases are easily preventable and treatable but, children in the developing world still die from them because of poor medical infrastructure, official corruption, and the whole host of other ills associate with too many governments in the developing world.

But don’t worry, that won’t stop WHO from spending resources tackling obesity in the developed world. No sir, even WHO has to keep its priorities straight.

Source:

Illness accounts for 5 million deaths. The Independent (Banjul, The Gambia) April 7, 2003.

WHO to Launch Intensive Polio Immunization Effort in India

Following the largest polio epidemic in recent history, the World Health Organization is launching an intensive immunization effort in India. An estimated 1.3 million volunteers will go to door to door in an effort to vaccinate every child under five.

In 2002 India reported more than 1,500 new cases of the disease — easily the largest outbreak of the disease in decades. WHO had set a goal of eradicating polio by 2002, but now hopes to declare the planet free of polio by 2005.

Unfortunately, the BBC reports that the polio eradication effort faces a $275 million shortfall that could limit its immunization efforts.

Source:

UN targets polio in India. Emma Jane Kirby, The BBC, February 5, 2003.

State of The World’s Vaccines and Immunizations

A report by the World Health Organization, UNICEF and the World Bank concluded that 3 out of 4 children around the world now have access to essential vaccines. But, of course, that means that fully 25 percent of the world’s children are not routinely vaccinated against childhood diseases.

According to The State of the World’s Vaccines and Immunization, as many as 37 million children under the age of one are not immunized against the six major vaccine-preventable diseases of childhood: tuberculosis, tetanus, whooping cough, diphtheria, polio and measles.

Moreover, the inability of underdeveloped countries to pay for vaccines combined with ongoing property rights disputes over ownership of drugs and vaccines in such countries acts as disincentive for further research into vaccines for diseases that plague the developing world.

According to the report,

Today, vaccine manufacturers have little commercial incentive to develop vaccines against diseases such as HIV/AIDS, TB and malaria, which kill millions of people in developing countries, but relatively few in the developed world. For example, of the approximately US$600 million a year invested in HIV vaccine research, the majority comes from the US National Institutes of Health (a public sector institution). To put that amount in perspective, in 1999, research spending on drugs to treat HIV/AIDS was about US$3 billion in Europe and the United States alone. Other diseases fare just as badly. In the 1996 report Investing in Health Research and Development, WHO highlighted some of the distortions in global health research funding. At the time of the study, acute respiratory infections, diarrheal disease and TB — which together account for almost 8 million deaths a year, mainly among the poor — attracted an estimated US$99-133 million. . . By contrast, more was spent on research into asthma — an estimated US $127-158 million — which accounts for 218,000 deaths a year worldwide.

Of course the report ignores the possibility that the relatively heavy funding in asthma is what is responsible for such a low worldwide death toll, but even so the amount estimated to be spent on research into diseases that kill 8 million people is staggeringly low.

Source:

Vaccine policy leaves millions at risk. The BBC, November 20, 2002.

State of the World’s Vaccines and Immunization Report (PDF). UNICEF, 2002.