UN Chronicle | Halting and Beginning to Reverse the Incidence of Malaria …

Halting and Beginning to Reverse the Incidence of Malaria …
… and Other Major Diseases
By Erika Reinhardt for the Chronicle

Article

The Malaria Challenge
The decoding of the most dangerous malaria parasite, Plasmodium Falciparum, and the most important mosquito that transmits it, Anopheles Gambiae, signals a turning point for global public health. The Tropical Disease Research (TDR) programme and its partners, including its co-sponsor, the World Health Organization (WHO), have pushed for over a decade to bring genetics into the struggle against malaria. For the past two years, TDR has been training more than 100 scientists from Latin America, Africa and Asia, enabling them to analyze the genomes, identify vulnerabilities and build new genetically-based drugs and insecticides.

In an effort to control malaria and save the lives of half of the 800,000 children who die of the disease each year, WHO has urged countries to switch to a new type of treatment whenever there was strong evidence that conventional medicines were no longer working. For decades, the best-known treatment for malaria was chloroquine, an inexpensive medicine that has saved millions of lives. In recent years, however, the malaria parasite has developed resistance to the drug and is no longer an effective treatment in many countries. Resistance to a second-generation drug, known as SP or "Fansidar", is also spreading. As an alternative, WHO recommended Artemisinin-based Combination Therapies (ACTs), which are derived in part from a Chinese herb and kill the malaria parasite very fast, allowing the patient to recover rapidly and with very few side effects. The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria has decided to fund proposals to "Roll Back Malaria" in Zanzibar and Zambia, which include purchasing and phasing-in the use of new ACTS.

International Effort to Eradicate Poliomyelitis
Since the Global Polio Eradication Initiative was launched in 1988, the number of cases has fallen by 99.8 per cent, from an estimated 350,000 cases to 483 in 2001, while the number of polio-infected countries was reduced from 125 to 10. The Global Polio Eradication Technical Consultative Group is overseeing a programme of research and consensus-building on the development of post-eradication polio immunization policy options to be considered by the World Health Assembly as early as 2005. UNICEF and WHO have launched a $50-million appeal for 2003-2005 to immunize 22 million children in the Horn of Africa, which is "one step away" from being certified as polio-free; only two cases have been reported in Somalia and none in Ethiopia and Sudan.

Global Strategy on Traditional Medicine
As traditional medicine becomes more popular worldwide, there is concern among health practitioners and consumers on the issues of safety, policy, regulation, biodiversity and protection of traditional knowledge. WHO released a global strategy that provides a policy framework to assist countries in regulating traditional medicine. About 80 per cent of the people in Africa use traditional medicine. In wealthy countries, growing numbers of patients rely on alternative medicine for preventive or pallative care. Traditional medicine is also used in the treatment of infectious diseases, including malaria. In Africa, North America and Europe, three out of four people living with HIV/AIDS use some form of traditional treatment. The $60-billion global market for traditional therapies is growing steadily. Unregulated commercialization threatens to make these therapies unaffordable to many who rely on them as their primary source of health care. About 25 per cent of modern medicines are descended from plants first used traditionally.

Guide for Essential Medicines
Bad prescribing habits are very common worldwide, according to WHO, leading to ineffective and unsafe treatment, exacerbation of illness and harm to patients, as well as increased costs for insurance systems and Governments. It has released the WHO Model Formulary, a guide that provides comprehensive information on all 325 medicines contained in its Model List of Essential Drugs, which aims to improve patient safety and limit superfluous medical spending. The guide will help national governments and institutions in developing their own national formularies and is particularly relevant for developing countries, where commercial and promotional materials are often the only available source of drug information to health workers, prescribers and patients.
Link Between Trade and Public Health
A joint study by WHO and the World Trade Organization, WTO Agreements and Public Health, examines the link between trade and public health and covers infectious disease control, food safety, tobacco, environment, access to drugs, health services, food security and biotechnology. According to the study, countries have the right to take measures to restrict imports or exports of products when it is necessary to protect the health of humans, animals or plants, and when liberalizing services, they retain the right to regulate in areas such as health. It suggests that policy makers would benefit from closer cooperation, ensuring coherence between their different areas of responsibility.

Health-Worker Crisis in Africa
The emerging crisis of health manpower in Africa threatens to defeat the efforts of Governments, private health-care providers, non-governmental organizations and donors for health improvement. At a joint consultative meeting, organized by WHO and the World Bank, participants stressed that doctors, nurses and other health workers were the most important health input. Unsuitable training programmes, inadequate cooperation among the many parties concerned, and losses of staff to opportunities outside Africa made the region's health-care facilities barely able to function. The recruitment by European countries of large numbers of graduating nursing students, particularly in South Africa, has created an additional sense of urgency to the crisis. Participants recognized that new funding initiatives, such as debt relief through the heavily indebted poor countries (HIPC) programme and the global HIV/tuberculosis/malaria fund, combined with heightened awareness among Africa's development partners, provided new opportunities to address the health manpower issues in their various dimensions.

Pollution Kills Millions of Children
Every day, 5,500 children die from diseases caused by consuming water and food polluted with bacteria, according to "Children in the New Millennium: Environmental Impact on Health", a report released by UNICEF, UNEP and WHO. The report warns of low public awareness of children's special vulnerability to environmental health risks. Diarrhoea and acute respiratory infections, largely influenced by environmental degradation, are two of the leading causes of child mortality. The report also identifies other environmental problems directly affecting children, such as high levels of toxic chemicals and depletion of natural resources. Lead in the environment—much of it from leaded gasoline—causes permanent neurological and developmental disorders. Millions of children work in agriculture, putting them at high risk of pesticide poisoning. They are also disproportionately vulnerable to global environmental problems, such as the impact of climate change, depletion of the ozone layer and loss of biological diversity. The report calls for increased national investment in early child care. One notable success in many countries is the transition to unleaded fuel.

India and China Rapidly Expand TB Control
India and China have demonstrated how the strategy, known as DOTS, promoted by WHO for control and treatment of tuberculosis (TB), can be rapidly and effectively expanded. According to WHO, both countries have achieved high rates of case identification and cure, even where the technology and public health infrastructure are inadequate. While the two case studies highlight the effectiveness of DOTS, they also underline the difficulties of implementing it. In both countries, nearly half the population is not yet covered by the strategy, and case identification rates for TB remain below the global target of 70 per cent.

Nurse preparing a hypodermic syringe for a TB patient. WHO Photo/P.Virot

The study on China analyzed the effects of DOTS after ten years in operation. By 2000, 8 million suspected TB cases had been evaluated, 1.3 million smear-positive cases treated under DOTS, and 90 per cent of the treated cases cured. In the areas where DOTS is being implemented, 30,000 deaths annually have been averted and the percentage of previously treated TB cases has decreased. In India, DOTS coverage expanded to nearly half of the national population over a three-year period that began in October 1998, during which the number of patients under the treatment increased from 80 to over 1,300 per day, reaching more than a million TB patients by early 2002. The rapid expansion of DOTS coverage has saved nearly 200,000 lives and over $400 million in indirect costs. WHO and its partners are leading the global effort against tuberculosis by expanding the Strategy, which is used in 148 countries. The Global Plan to Stop TB has set two main targets for 2005: identify 70 per cent of estimated new infectious TB cases and cure 85 per cent of cases identified. The DOTS expansion projects in India and China were funded with loans from the World Bank.

New Rules on Recycling Old Batteries
The technical group of the Basel Convention on the Transboundary Movement of Hazardous Wastes and Their Disposal has finalized guidelines promoting the environmentally-sound recycling of spent lead-acid batteries, an important step in the efforts to reduce the global risk of lead poisoning. UNEP reports that lead has caused innumerable poisonings, particularly in children and workers, and that the safe recycling of lead-acid batteries requires strict environmental and occupational standards that can only be ensured by specialized firms. In many developing countries, spent batteries are broken manually using an axe, which is extremely dangerous to the workers.

Venous Thrombosis in Air Travel
WHO has launched a comprehensive research programme to investigate air travellers' thrombosis. Epidemiological, pathophysiological and clinical studies will determine the frequency and causes of venous thrombosis and identify risks and ways to prevent it. Research will be conducted under the auspices of WHO and the International Civil Aviation Organization. The International Air Transport Association is fully committed to the programme and will give its full support. Preliminary results from some studies will be available within a year, although the full programme will take up to four years to complete.

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