more_vertIn 1993 the World Bank published the first edition of Disease Control Priorities in Developing Countries (DCP1), an attempt to systematically assess the cost-effectiveness of interventions for the major sources of disease burden in low-income and middle-income countries.1 World Bank staff in the early 1990s were just beginning to receive requests from countries to finance projects to control AIDS and non-communicable diseases (NCDs). A major motivation for DCP1 was thus to identify reasonable responses in resource-constrained environments to the emergence of AIDS and to the growing burden of NCDs.
Preference: Infectious Diseases and Parasitology
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[Perspectives] Peter Sands: charting a new course for The Global Fund
Peter Sands had a stormy start before taking up his new position as Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria on March 5, 2018. He was plunged into controversy last month after the decision by The Global Fund’s senior management team to partner with Heineken, among other multinationals, and the implications for global health. The organisation, which invests and raises almost US$4 billion each year, is the world’s largest public–private partnership set up to finance programmes to treat and prevent these three diseases and strengthen national health systems in the long term.
New vaccines for improved coverage against flu in Australia
Two new ground-breaking flu vaccines will be given to more than three million Australians.
The Federal Government recently said it will provide the new vaccines to those Australians aged 65 years and over who want them.
In making the announcement, Health Minister Greg Hunt said: “This is a direct response to last year’s horrific flu season, which had a devastating impact around the world, and aimed squarely at saving lives.”
More than 90 per cent of the 1,100 flu related deaths in 2017 were of people aged over 65 years of age. While less than one to two per cent of people who get influenza will end up with a complication from it, it is the elderly who seem hardest hit.
“The medical advice, both from the vaccine producers, the World Health Organisation and the Chief Medical Officer is that the mutation which occurred last year in many countries will be specifically addressed by these new vaccines,” Mr Hunt said.
The new vaccines – Fluad® and Fluzone High Dose® – were registered in Australia to specifically provide increased protection for people aged 65 years and older.
From April 2018, both vaccines will be available through the National Immunisation Program following a recommendation from the Pharmaceutical Benefits Advisory Committee.
“Annual vaccination is the most important measure for preventing influenza and its complications and we encourage all Australians to get vaccinated. We encourage all Australians aged over six months old to get a flu vaccination this year before the peak season starts in June” Mr Hunt said.
The Chief Medical Officer, Professor Brendan Murphy, believes the new ‘enhanced’ vaccines will be more effective.
However, Professor Murphy said: “No flu vaccine is complete protection, the standard vaccine seems to protect well in younger people, but we are confident this will give better protection for the elderly.”
The Department of Health believes the new trivalent (three strain) vaccines work in over 65s by generating a strong immune response and are more effective for this age group in protecting against influenza.
There is now a mandated requirement for residential aged care providers to provide a seasonal influenza vaccination program to all staff as well as the Aged Care Quality Agency continuing a review of the infection control practices of aged care services across the country.
Under the National Immunisation Program, those eligible for a free flu shot include people aged 65 years and over, pregnant women, most Aboriginal and Torres Strait Islander people, and those who suffer from chronic conditions.
The following four strains will be contained within this year’s Southern Hemisphere vaccines:
- A(H1N1): an A/Michigan/45/2015(H1N1) pdm09 like virus;
- A(H3N2): an A/Singapore/INFIMH-16-0019/2016(H3N2) like virus;
- B: a B/Phuket/3073/2013 like virus; and
- B: a B/Brisbane/60/2008 like virus.
Allen Cheng, Professor in Infectious Diseases Epidemiology at Monash University, has warned: “Despite the common perception that the flu is mild illness, it causes a significant number of deaths worldwide. To make an impact on this, we need better vaccines, better access to vaccines worldwide and new strategies, such as increasing the rate of vaccination in childhood.”
AMA President Dr Michael Gannon welcomed the Government’s announcement because it was targeting vaccine coverage for “a particularly vulnerable group”.
MEREDITH HORNE
Taiwan wants back in as a WHA observer
Taiwan has put out a call for international support for it to be allowed to participate in this year’s World Health Assembly, the decision-making body of the World Health Organisation.
Between 2009 and 2016, Taiwan had been invited to attend the WHA as an observer. No invitation was sent last year.
In 2017, pressure from Beijing resulted in the WHA refusing to invite Taiwan to attend the forum, which was the 70th World Health Assembly.
Taiwan’s application to observe most of the WHO’s technical meetings was also declined.
When asked during a media conference at the time why Taiwan was not invited to 70th WHA, the head of WHO Governing Bodies Timothy Armstrong said it was due to an “absence” of a cross-strait understanding.
“Negotiations are still ongoing,” he said. “Anything is possible.”
So Taiwan is seeking an invitation to this year’s WHA.
“Taiwan was not invited to attend the 70th World Health Assembly as an observer in 2017. For many years, however, it has participated in the WHA and WHO technical meetings, mechanisms and activities; steadily contributed to enhancing regional and global disease prevention networks; and dedicated its utmost to assisting other countries in overcoming healthcare challenges in order to jointly realise WHO’s vision that health is a fundamental right,” it says in a statement.
“Therefore, there is widespread support that Taiwan should be invited to attend the WHA.
“Located at a key position in East Asia, Taiwan shares environmental similarities for communicable disease outbreaks with neighbouring countries and is frequently visited by international travellers.
“This makes Taiwan vulnerable to cross-border transmission and cross-transmission of communicable disease pathogens, which could lead to their genetic recombination or mutation, and give rise to new infectious agents.
“However, because Taiwan is unable to attend the WHA and is excluded from full participation in related WHO technical meetings, mechanisms, and activities, it is only after much delay that Taiwan can acquire diseases and medical information, which is mostly incomplete. This creates serious gaps in the global health security system and threatens people’s right to health.”
Taiwan has also been keen of late to highlight its international successes in both medical breakthroughs and global assistance.
In recent years it has transformed from aid recipient to assistance provider. It has established many disease prevention systems. Taiwan insists it needs the WHO to protect the health of its own people, but that it can also contribute greatly to global health protection.
“With an interest in making professional health contributions and protecting the right to health, Taiwan seeks participation in the 71st WHA this year in a professional and pragmatic way, in order to become a part of global efforts to realise WHO’s vision for a seamless global disease prevention network,” its statement says.
Interestingly, the WHO’s own constitution states:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
CHRIS JOHNSON
[Editorial] The Global Fund under Peter Sands
Within the space of a few short weeks, the reputation of Peter Sands, incoming Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has gone from respected to reckless according to some critics. In an Offline column last November, The Lancet’s Editor offered an unreserved welcome to Sands, praising his “credibility” and “refreshing new vision”. Sands had assiduously built a compelling argument for governments to take the economic costs of infectious diseases more seriously.
[Perspectives] Human arrogance and epidemics
There was a time not so long ago, in the early 1990s, when warnings about emerging epidemics and infectious diseases were derided, the Cassandras were mocked, and the power of human ingenuity and countermeasures were hailed. Globalisation of HIV/AIDS, of course, curbed such hubris, but medical and public health leaders, including the top tiers of WHO, viewed HIV as an exception to the rule. And as Michael Merson and Stephen Inrig detail in their agonising account The AIDS Pandemic: Searching for a Global Response, that notion of AIDS exceptionalism spawned an international non-response that allowed the virus to sweep across the world, becoming the third largest pandemic in human history.
Government focus on rheumatic heart disease
Rheumatic heart disease is receiving serious political attention, as the Federal Government makes inroads into addressing and improving the health of Aboriginal Australians.
Indigenous Health Minister Ken Wyatt has convened a roundtable in Darwin to look at charting a comprehensive roadmap to end rheumatic heart disease (RHD).
The roundtable brought together RHD and infectious diseases specialists, health professionals, Indigenous health advocates, philanthropists, service providers and government agencies.
“RHD and acute rheumatic fever take about 100 Aboriginal and Torres Strait Islander lives each year and many of these are young people,” Mr Wyatt said.
“The tragedy is compounded by the fact that RHD is almost entirely preventable, with many organisations, including governments, grappling strongly with pieces of the RHD elimination puzzle.
“Now, through this roadmap we are determined to tackle the whole challenge and eliminate this disease as a significant Indigenous public health problem.”
RHD is a long-term outcome of a condition called acute rheumatic fever (ARF), which typically occurs in childhood. As a result of ARF the affected person develops inflammation of the heart valves with resulting damage and malfunction. ARF typically precedes the RHD by decades.
RHD can be usually resolved if it is detected early, but people are being treated for the condition when it is too late. RHD is most accurately diagnosed using ultrasound.
Indigenous children and young adults in the Northern Territory are estimated to suffer from RHD at more than 100 times the rate of their non-Indigenous counterparts. The Kimberley is also an RHD hotspot, with two-thirds of all Western Australian Indigenous people suffering from RHD living in the region.
The Government has allocated $23.6 million under the Rheumatic Fever Strategy over the next four years. It is also working to address the underlying social and cultural determinants that contribute to RHD, including providing $5.4 billion to States and Territories to help them to provide remote housing, under a national agreement. While the Agreement is due to end on 30 June 2018, the Commonwealth has begun discussions with State and Territory Governments on future funding arrangements.
“While RHD affects children and young adults around the world, in Australia it is a sad reflection of the health gap between Indigenous and non-Indigenous children,” Mr Wyatt said.
“We know this is a disease of poverty, of overcrowding, of difficulty with access to health services.
“The roadmap will acknowledge there is no single silver bullet to eliminate RHD. We are now looking to tackle all the determinants – including environmental health, housing and education – as we work together to help strengthen these communities against this devastating disease.”
AMA President Dr Michael Gannon has repeatedly described the lack of effective action on RHD to date as a national failure; calling for an urgent coordinated approach.
At the launch of the AMA’s 2017 AMA Report Card on Indigenous Health, Dr Gannon said: “Governments must fund health care on the basis of need. There is no doubt whatsoever that funding and resourcing of Indigenous health does not meet the overall burden of illness.”
A copy of the AMA’s 2016 Indigenous Report Card, which focused specifically on RHD, can be found at: article/2016-ama-report-card-indigenous-health-call-action-prevent-new-cases-rheumatic-heart-disease
MEREDITH HORNE
[Correspondence] Germany’s expanding role in global health – Authors’ reply
Germany’s role in global health is expanding, as we outlined in our contribution to the recent Series on Germany and health.1 Manfred Wildner and colleagues rightly argue that this expansion requires a strong domestic public health sector, yet Germany’s public health infrastructure is fragmented2 and in need of domestic investment.1 The kind of investment required remains an issue of debate. Wildner and colleagues call for a reconciliation of public health services focusing on infectious disease control, and revived academic public health focusing inter alia on health promotion.
[Correspondence] Inequalities in non-communicable diseases in Israel
In their analyses of the inequality of prevalence of non-communicable disease, Khitam Muhsen and colleagues (June 24, 2017, p 2531)1 discuss the discrepancy in life expectancy between Arabs and Jews in Israel, which has been increasing over the past 25 years. Although the paper reviews differences in cause-specific mortality and in several risk factors for non-communicable diseases, Muhsen and colleagues did not explore the contribution of the major differences in socioeconomic status between these two groups.
[Correspondence] Inequalities in non-communicable diseases in Israel – Authors’ reply
We thank John Yudkin for his comments on our Series paper1 discussing the inequalities in non-communicable diseases between the major population groups in Israel.