WHO: Tuberculsosis Efforts Falling Behind

The World Health Organization issued a report this month noting that the world is falling behind in efforts to contain tuberculosis. According to the WHO,

A strategy that can cure up to 90% of all tuberculosis cases, and thus is the best chance for controlling the global epidemic, is reaching only 27% of the world’s TB patients. . . . According to the new WHO report, at the current rate, TB targets set for 2005 will not be reached until 2013.

Tuberculosis currently kills about 2 million people a year, and is the number one preventable cause of death in the developing world.

The main thing holding back better treatment of tuberculosis is money. WHO estimates that countries around the world need to spend about $300 million more per year to control tuberculosis.


Funding ‘hits tuberculosis fight’. The BBC, March 24, 2002.

Only a fraction of TB patients get the best care. World Health Organization, Press Release, March 22, 2002.

Is the World Health Organization Part of the Problem?

Brian Doherty has an excellent, scathing attack on the World Health Organization for the January 2002 issue of Reason which argues that the organization is a bureaucratic nightmare more interested in self-preservation than actually doing something about improving health in the developing world.

Doherty writes that when the WHO was founded after World War II it had a substantive impact on health, especially in the developing world. WHO played a major role in tackling a number of infectious diseases, culminating with its role in the eradication of small pox in 1977.

But after the victory over small pox, WHO started turning away from focusing on infectious disease in the developing world to most First World concerns. First under Director General Hiroshi Nakajima and then Gro Harlem Brundtland, WHO began to turn away from infectious disease. Doherty writes,

In a world still fighting infectious disease, Brundtland’s WHO has issued statements, studies, and reports on such topics as blood clots in people who sit still on airplanes too long, helping people remain active while aging, the hazards of using cell phones while driving, the importance of debt relief for poor countries, how tobacco is “a major obstacle to children’s rights,” and rates of alcohol abuse among European teens.

Doherty is especially troubled by the recent WHO analysis of world health problems which relied on a measurement called the disability adjusted life year. The idea behind the DALY is that someone suffering from a severe illness or disability is living a lower quality of life than someone who is not. But WHO’s attempt to quantify produced bizarre results whereby, for example, WHO claims that 16 percent of the years lost to disability in sub-Saharan Africa come from mental illness. Any organization that thinks mental illness is one of the major health problems facing that region, however, is crazy.

Doherty’s article finishes with a stark reminder of just how ineffective WHO is and how misguided its focus on things like years lost to disability are,

Nothing condemn’s WHO’s current agenda more than some of its own pronouncements. In a 1999 press release, WHO declared that six illnesses accounted for 90 percent of all infectious disease deaths among people under 44 years: malaria tuberculosis, measles, diarrheal diseases, acute respiratory infections (including pneumonia), and AIDS. The same press release declared that “the tools to prevent deaths from each of these six diseases now cost under $20 per person at risk, and in most cases under $0.35. Yet these diseases still caused over 11 million deaths in 1998.”

. . . we have WHO declaring that 11 million deaths — 90 percent of all infectious disease deaths for people under 44 years — could have been easily prevented with an expenditure of, at its lowest, $3.9 million, and at its highest, $220 million. That is, anywhere from 0.4 percent to 20 percent of WHO’s budget for one year.

What does WHO spend its money on instead? Doherty cites an analysis of WHO’s 1994-95 budget that found WHO spent as much on its meetings and its executive board as it did on immunizations, tuberculosis and diarrheal diseases combined. Seventy percent of its budget went to administrative overhead and its Geneva headquarters.


WHO Cares? The World Health Organization cares more about its own life than the lives of the poor. Brian Doherty, Reason, January 2002.

Goats as Malaria Vaccine Factories

So called “farmaceuticals” — genetically engineered animals that express drugs in their milk — has long been predicted as a likely eventual outcome of biotechnology efforts and that possibility took a big step forward with the recent announcement of initial success using mice to produce a malaria vaccine for monkeys. This advances is especially noteworthy since the technique used should scale well to larger animals such as goats, which could have an enormous impact on controlling disease in the developing world.

In this instance, researchers developed mice that secreted an experimental malaria vaccine in their milk. Two separate strains of transgenic mice were created, each of which carried a form of a gene to produce a surface protein of a strain of malaria. The mice were designed so that the gene to produce the proteins could be turned on only by the cells that line the animals’ mammary glands, ensuring that the proteins would be secreted in the milk of the animals.

The vaccine was then purified and injected into monkeys who were then exposed to the malaria parasite. In the extremely small experiment, only one of the five monkeys who received the vaccine contracted malaria, compared to six out of seven monkeys in a control group who did not receive the vaccine.

Doing this with mice is amazing, but here’s where things get very interesting. When researchers designed the mice to express the protein, they used DNA from goats, meaning it should be possible to create goats which also express the protein. In fact Science Daily reports that preliminary, unpublished research suggests the procedure works well in larger animals.

If this result holds, this could revolutionize vaccine research into diseases that largely afflict the developing world. Vaccine research in the developed world is problematic enough. Regulatory and liability issues, combined with expensive manufacturing processes have stunted vaccine research into diseases that still afflict people living in the developed world. When it comes to research on a vaccine for a disease like malaria, those concerns are even larger given the economic situation of much of the developing world (and hence the likelihood that much of the developing world would be unable to afford such a vaccine even if it were available).

Being able to have such medications produced by a herd of goats, however, would drastically lower the costs of such vaccines. Considering the World Health Organization estimates that as many as 1 million people die annually from malaria-related complications, this technology could have an enormous public health impact.


Scientists Milk Animals for Malaria Vaccine. Science Daily, December 18, 2001.

WHO Wants High Cigarette Taxes?

    The World Health Organization and World Bank want governments around the world — especially in developing countries — to act as nanny’s and raise taxes on cigarettes by at least 10 percent to discourage people from smoking. A study commissioned by the two organizations, “Tobacco Control in Developing Countries,” claims about 42 million smokers would kick the habit if taxes were raised by 10 percent.

    The WHO/World Bank is especially imperious when it comes to smokers in the developing world, with the authors of the report nothing that since people in the developing world generally have less money, the tax would hit them especially hard and provide a big incentive to stop smoking. As the spokesman for British American Tobacco told the BBC, however, a more likely result would be widespread smuggling of cigarettes. Smuggling and underground economies are already a staple in developing countries (and more power to them), and adding another highly taxed good to the mix would only encourage more smuggling.

    Ultimately, though, as the study puts it the whole point here is control. The WHO thinks people shouldn’t smoke and it is more than willing to use the power of the state to enforce their views about personal behavior.

    An amusing twist to the story was added by Prabhat Jha, co-author of the study, trying to defend against claims by the tobacco industry that raising cigarette taxes would cost jobs. Jha told the BBC, “As people don’t spend money on cigarettes, they will spend money on other goods. They will buy popcorn, they go the movies. These generate alternative jobs and also alternative revenues.”

    The only problem with that picture, aside from using the threat of state-sanction forced to arrive at it, is that the WHO has also been going on over the past couple years about obesity, and it is just a matter of time before it starts to recommend higher taxes on fattening foods like popcorn and sedentary activities like watching movies. After all if we had higher taxes on those, people would spend more time eating granola and jogging on the beach.

    The PR flack for the tobacco companies, Dave Betteridge, got it right when he told the BBC, “It should be for adults only, but provided that you are aware of the health risks — and it is hard to think that there are people who are not aware of these — if you want to smoke then you should be free to smoke.”

Global plea to raise smoking taxes. The BBC, August 9, 2000

Central Planning Is Healthy

    How do you tell if your country has a good health-care system? Does it give individuals few choices over treatment? Does it rely heavily on central planning and rationing of health care? If so, it’s top notch. Anything else falls short of the ideal.

    That, at least, is the distinct impression given by a recent World Health Organization report which ranked the nations of the world by the quality of their health-care system. France’s heavily socialized system came it at number one, while the United States was way down the list at number 37.

    Why? Largely because in the United States, health care spending is done by individuals and corporations rather than the state. To the WHO, if an individual spends $100 out of his or her pocket on health care, that’s a travesty, but if the government taxes a citizen $100 and then spends that money to pay for a doctor visit, that’s the hallmark of a great health care system.

    To WHO it also depends who the health care dollar is spent on. The WHO report includes a measure of “disability-adjusted life expectancy” which is the average number of years a person lives without a serious illness. Essentially that means that to WHO every $1 spent on providing care for people with long-term chronic illnesses is an inefficient expenditure. This is a value judgment there that spending money on the disabled wastes resources that might go to say reducing infant mortality (this is a common value judgment

    The fatal flaw in the United States system is the one area where it excels, according to the WHO report — the United States ranks number one in the world using WHO’s criteria for responsiveness to patients. There aren’t any long waiting lists to receive medical treatment as there are in many countries. The state doesn’t dictate which medications can be prescribed or forbid people over a certain age from having certain treatments. Unfortunately that very element of choice interferes with the ability of the state to plan the “correct” outcomes.

    And central planning is really what constitutes a good health care system for the WHO. An article on the rankings in the Washington Post captured the flavor and intent of the report when it noted the poor ranking given to China’s health care system:

    A generation ago, China emphasized disease prevention and universal primary care. (It was one of the first Third World countries to eradicate smallpox and was famous for its “barefoot doctors.”) With the arrival of a market economy in the 1980s, medical care became financed largely by out-of-pocket payment by consumers. Today it ranks 188th out of 191 nations in the WHO assessment’s “fairness of financing” measure.

    The erosion of organized planning for health may be one reason Chinas’s life expectancy has barely budged in the past 20 years, despite the huge growth in its national wealth, a traditional driver of health improvement, [WHO’s Julio]Frenk said.

    The WHO report and rankings reflect the values of bureacrats who long for the sort of power and control over people’s lives that a country like China exerted at the height of its centralized planning.