WHO Release Report on Maternal Mortality Around the World

In October the World Health Organization released its estimates of the continued prevalence of maternal mortality. WHO estimates that worldwide 529,000 women die during childbirth.

Not surprisingly, 95 percent of those childbirth deaths occur in Africa and Asia, while only about 2,500 maternal deaths (less than one percent of the world total) occurred in developed countries.

In the United States, for example, the risk of dying during childbirth was 1 in 2,500. In Sweden it reached an astounding low of 1 in 29,800. But in places like Afghanistan and Sierra Leone, the risk was 1 in 6, while in Angola, Malawai and Niger the risk was 1 in 7.

In the developed world, the lifetime risk of a woman dying during childbirth as 1 in 2,800, while in developing countries it was 1 in 61. For Africa as a whole, the life time risk was 1 in 20.

Not surprisingly, the World Health Organization fond that lack of access to quality medical care was the major cause of most maternal deaths.


Africa childbirth deaths ‘unacceptable’. The BBC, October 20, 2003.

Fears of Polio Vaccine Grip Nigeria

The World Health Organization’s goal of eradicating polio worldwide by 2005 ran into a major obstacle in October 2003 when three Nigerian states suspended polio vaccination over fears that the vaccine could cause AIDS, cancer and infertility.

The largely-Muslim northern states of Kaduna, Kano and Zamfra ordered a stop to a WHO-sponsored vaccination program. Reuters quoted Dr. Datti Ahmed, president of Nigeria’s Supreme Council for Sharia Law, as saying,

A lot of documents have come into our possession indicating there are grave doubts and concerns about the safety of the oral polio vaccine being used in Nigeria. We therefore called on the authorities to suspend the immunization program and investigate these fears.

WHO representatives dismissed such objections saying the polio vaccine was safe.

Unfortunately, Nigeria is one of only 7 countries where the disease is still prevalent and many children there are not vaccinated. Authorities worry that the disease could expand from Nigeria into surrounding countries. According to WHO representative Dr. David Heymann,

In some parts of Nigeria, only 13 percent of children have been vaccinated, largely because of the fears about it that have been disseminated. Nigeria is now exporting the disease. It has already cost Nigeria’s five neighbors $13 million to launch their own campaigns against it and that could go up to $20 million if it is confirmed that Chad has cases.

The government set up a group to test the polio virus, but that group dealt another setback to the polio eradication in January when it issued results claiming it found high levels of estrogen in the polio vaccine which would render those who received the vaccine infertile.

Both the WHO and the Nigerian state dismissed these claims, but WHO’s efforts to vaccinate children in Nigeria appears to have been severely set back which bodes ill both for the children there who are unnecessarily exposed to the risk of contracting polio as well as neighboring states and the rest of the world that would like to see polio eradicated.


Health experts losing battle to promote polio vaccine in Nigeria. AFP, Friday January 9, 2004.

Nigeria orders polio vaccine tests. Associated Press, October 29, 2003.

Nigeria debates polio campaign. Anna Borzello, The BBC, December 22, 2003.

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.


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.


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.


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.


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