Measles growing in some countries

Gaps in vaccination coverage have led to an increase in reported cases of measles around the world. In 2017, numerous countries experienced severe and protracted outbreaks of the disease.

Because of these immunisation gaps, measles outbreaks occurred in all regions, and there were an estimated 110 000 deaths related to the disease.

Updated disease modelling data provides the most comprehensive estimates of measles trends over the last 17 years. It shows that since 2000, over 21 million lives have been saved through measles immunisations. However, reported cases increased by more than 30 percent worldwide from 2016.

The Americas, the Eastern Mediterranean Region, and Europe experienced the greatest upsurges in cases in 2017, with the Western Pacific the only World Health Organisation (WHO) region where measles incidence fell.

“The resurgence of measles is of serious concern, with extended outbreaks occurring across regions, and particularly in countries that had achieved, or were close to achieving measles elimination,” said Dr Soumya Swaminathan, Deputy Director General for Programs at WHO.

“Without urgent efforts to increase vaccination coverage and identify populations with unacceptable levels of under-immunised or unimmunised children, we risk losing decades of progress in protecting children and communities against this devastating, but entirely preventable disease.”

Measles is a serious and highly contagious disease. It can cause debilitating or fatal complications, including, severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss. Babies and young children with malnutrition and weak immune systems are particularly vulnerable to complications and death.

The disease is preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85 per cent. This is far short of the 95 per cent needed to prevent outbreaks, and leaves many people, in many communities, susceptible to the disease. Second dose coverage stands at 67 per cent.

“The increase in measles cases is deeply concerning, but not surprising,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“Complacency about the disease and the spread of falsehoods about the vaccine in Europe, a collapsing health system in Venezuela and pockets of fragility and low immunisation coverage in Africa are combining to bring about a global resurgence of measles after years of progress. Existing strategies need to change: more effort needs to go into increasing routine immunisation coverage and strengthening health systems. Otherwise we will continue chasing one outbreak after another.”

Responding to the recent outbreaks, health agencies are calling for sustained investment in immunisation systems, alongside efforts to strengthen routine vaccination services. These efforts must focus especially on reaching the poorest, most marginalised communities, including people affected by conflict and displacement.

The agencies also call for actions to build broad-based public support for immunisations, while tackling misinformation and hesitancy around vaccines where these exist.

“Sustained investments are needed to strengthen immunization service delivery and to use every opportunity for delivering vaccines to those who need them,” said Dr Robert Linkins, Branch Chief of Accelerated Disease Control and Vaccine Preventable Disease Surveillance at the U.S. Centers for Disease Control and Prevention (CDC) and Measles and Rubella Initiative Management Team Chairman.

The Measles and Rubella Initiative is a partnership formed in 2001 of the American Red Cross, CDC, the United Nations Foundation, UNICEF, and WHO.

First ever multi-drug Ebola trial for the Congo

The Ministry of Health of the Democratic Republic of the Congo (DRC) has announced that a randomised control trial has begun to evaluate the effectiveness and safety of drugs used in the treatment of Ebola patients.

The trial is the first-ever multi drug trial for an Ebola treatment. It will form part of a multi-outbreak, multi-country study that was agreed to by partners under a World Health Organisation (WHO) initiative.

Until now, more than 160 patients have been treated with investigational therapeutics under an ethical framework developed by WHO, in consultation with experts in the field and the DRC, called the Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI).

The MEURI protocol was not designed to evaluate the drugs. Now that protocols for trials are in place, patients will be offered treatments under that framework in the facilities where the trial has started. In others, compassionate use will continue up to the time when they join the randomisation. Patients will not be treated noticeably differently from before, though the treatment they receive will be decided by random allocation. The data gathered will become standardised and will be useful for drawing conclusions about the safety and efficacy of the drugs.

“Our country is struck with Ebola outbreaks too often, which also means we have unique expertise in combatting it,” said Dr Olly Ilunga, Minister of Health of the DRC.

“These trials will contribute to building that knowledge, while we continue to respond on every front to bring the current outbreak to an end.”

In October, WHO convened a meeting of international organisations, United Nations partners, countries at risk of Ebola, drug manufacturers and others to agree on a framework to continue trials in the next Ebola outbreak, whenever and wherever that is. Over time, this will lead to an accumulation of evidence that will help to draw robust conclusions across outbreaks about the currently available drugs, and any new ones that may come along.

At the heart of the long-term plan and the current trial is always the goal to ensure that patients with Ebola and their communities are treated with respect and fairness. All patients should be provided with the highest level of care and have access to the most promising medications.

The current trial is coordinated by WHO, and led and sponsored by the DRC’s National Institute for Biomedical Research (INRB), in partnership with the DRC Ministry of Health, the National Institute of Allergy and Infectious Diseases (NIAID) which is part of the United States’ National Institutes of Health, The Alliance for International Medical Action (ALIMA) and other organisations.

[Comment] Offline: President Macron—peace needs health

In the Amphitheatre Leroy-Beaulieu-Sorel, located within the Paris Campus of Sciences Po on 27 rue Saint Guillaume, several hundred students gathered last Friday evening to begin their initiation into global health policy making. For the third year running, Sciences Po held a 3-day simulation of the World Health Assembly, the intention being to write a resolution for the agency’s most important governing body. The subject was environmental health. WHO’s Director-General, Dr Tedros, sent a welcoming video message.

WMA backs WHO in call for more doctor involvement in fighting air pollution

The first World Health Organisation conference on air pollution was held in October-November in Geneva, Switzerland.

In its report on air pollution and child health, the WHO said health professionals should help shape public health policy on reducing the exposure of pregnant women, children and adolescents to air pollution.

The report adds that health professionals are trusted sources of information and guidance and play an important role not only in treating ill health caused by air pollution but also in educating families and patients about risks and solutions and communicating with the broader public and decision-makers.

This role must be amplified, and the broader health sector must become more engaged in preparing a comprehensive approach to addressing this crisis, the Who report states.

“Polluted air is poisoning millions of children and ruining their lives,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

“This is inexcusable. Every child should be able to breathe clean air so they can grow and fulfil their full potential.”

The World Medical Association has echoed the call.

Speaking at the WHO conference, Dr Lujain Alqodmani from the WMA welcomed the call and said health professionals must be well informed about air pollution health risks and what measures can be taken to combat the crisis.

One suggestion would be to follow the example of Kuwait University, which has included air pollution as a main environmental health determinant in its medical curriculum.

She said at the WHO conference that the whole health workforce needed to be equipped with the right skills to address air pollution health risks as part of the initial clinical patient evaluation.

Medical education institutions should produce advocacy teaching materials about air pollution and health and be accessible through online tools to health workers and implemented by health care institutions.

“Physicians around the world are aware of air pollution. It impacts the quality of life for hundreds of millions of people worldwide, causing both, a large burden of disease as well as economic losses and increased health care costs,” Dr Alqodmani said.

Lymphatic filariasis eliminated in more nations

Three more countries have wiped out lymphatic filariasis as a public health problem.

Palau, Vietnam, and Wallis and Futuna have eliminated lymphatic filariasis as a public health problem, bringing to 11 the number of countries and areas validated since 2000 in the World Health Organisation (WHO) Western Pacific Region.

WHO Director-General Dr Tedros Adhanom Ghebreyesus and Regional Director Dr Shin Young-soo marked the accomplishment by presenting certificates to representatives from Palau, Vietnam, and Wallis and Futuna during the WHO Regional Committee for the Western Pacific held recently in Manila.

“We sincerely congratulate Palau, Vietnam, and Wallis and Futuna for eliminating lymphatic filariasis as a public health problem,” Dr Shin said.

“Decades of their effort with support from partners – including the governments of France, Japan, the Republic of Korea and the United States of America—as well as donations of medicines have enabled them to achieve this milestone and ensure future generations are safe from this dreadful disease.”

A mosquito-borne disease, lymphatic filariasis is one of 15 neglected tropical diseases that are endemic in the WHO Western Pacific Region. Also known as elephantiasis, the disease is painful and can lead to permanent disfigurement and disability, often causing people to lose their livelihood and suffer from stigma, depression and anxiety.

In 1997, the World Health Assembly resolved to eliminate lymphatic filariasis as a public health problem. In 2000, WHO launched the Global Program to Eliminate Lymphatic Filariasis by 2020. The program focuses on:

stopping the spread of infection through large-scale, annual treatment of all eligible people in affected areas; and
alleviating suffering by managing symptoms and preventing disability among people who are infected with lymphatic filariasis.

Since WHO launched program, a total of 11 countries and areas in the Western Pacific Region have been validated as having eliminated lymphatic filariasis as a public health problem: Cambodia, China, Cook Islands, Niue, the Marshall Islands, Palau, the Republic of Korea, Tonga, Vanuatu, Vietnam, and Wallis and Futuna.

Lymphatic filariasis remains endemic in 13 countries and areas in the Region: American Samoa, Brunei Darussalam, Fiji, French Polynesia, Kiribati, Lao People’s Democratic Republic, Malaysia, Federated States of Micronesia, New Caledonia, Papua New Guinea, Philippines, Samoa and Tuvalu.

[Comment] Putting nursing and midwifery at the heart of the Alma-Ata vision

The Alma-Ata vision of a health system rooted in primary health care, which is person-centred and multisectoral, is as relevant now as it ever was. Nursing and midwifery can play a more central part in making this vision a reality. The health workforce has always been central to the 1978 Declaration of Alma-Ata that recognised the important role of health workers in achieving this vision.1 More recently, the World Health Assembly adopted resolutions on the Global Strategy on Human Resources for Health in 20162 and the Working for Health 5-year action plan in 20173 that committed countries to develop a primary health care workforce responsive to population needs as part of universal health coverage.

[Comment] Primary health care and universal health coverage: competing discourses?

In October, 2018, WHO celebrates 40 years since the International Conference on Primary Health Care (PHC) and offers a renewed vision of PHC—building on, but not replacing, the Declaration of Alma-Ata.1 In those four decades, PHC has faced challenges. Undermined early by the divisive selective-comprehensive debate, PHC was marginalised by structural adjustment and sectoral reforms in the 1990s.2 PHC was, however, acknowledged in the World Health Report 2000 Health Systems: Improving Performance as a precursor of the new universalism: “high quality delivery of essential health care, defined mostly by the criterion of cost-effectiveness, for everyone, rather than all possible care for the whole population or only the simplest and most basic care for the poor”.

[Comment] 10 years after the Commission on Social Determinants of Health: social injustice is still killing on a grand scale

In 2008, WHO launched the final report of the Commission on Social Determinants of Health (CSDH) that concluded “social injustice is killing people on a grand scale”.1 A decade later, how should we judge the CSDH’s impact? A Google search for the CSDH yields 156 000 results and the accompanying Lancet paper has had 932 citations.2 The CSDH led to two World Health Assembly resolutions and more than 100 countries adopted the Rio Political Declaration on Social Determinants of Health in 2011.3 The CSDH’s report has become a foundational text for how crucial social determinants are to health and health equity.

Health leaders challenge global policy makers on cancer

Global health leaders have put out an urgent call to countries to improve action on cancer services.

At the World Cancer Leaders’ Summit (WCLS) in Kuala Lumpur, Malaysia, on October 1, health leaders from United Nations agencies, the non-profit and private sectors, and academia came together to issue the call.

They asked countries to increase access to, and investment in, cancer services to improve vital early detection, treatment, care, and public health data.

Insisting that the need for global action on cancer was more urgent than ever, the group presented new data from the International Agency for Research on Cancer (IARC) estimating that there will be 18.1 million new cancer cases diagnosed and 9.6 million cancer deaths in 2018.

This means that countries are way off-course to meet the ambitious global target of reducing premature deaths from non-communicable diseases (NCDs), like cancer, 25 per cent by 2025 as agreed by the World Health Organisation in 2013, they said.

Union for International Cancer Control President, Professor Sanchia Aranda, said: “Cancer is not just a health concern, but also a serious threat to development. The growing burden has clear implications for patients, their families, and health systems, but also for the economic growth of a country as a whole.”

UICC President-elect, HRH Princess Dina Mired said: “We know Treatment for All is possible in every country. What we need is strategic national plans and national champions for cancer control to implement these measures.”

CHRIS JOHNSON

Too many people in the world not active enough to stay healthy

A quarter of the world’s population is not active enough to stay healthy, according to new research by the World Health Organisation.

In wealthier nations, the figure is even higher.

Australia ranks 97^th in the world (out of 168) for the number of people getting enough physical activity.

The study found that 30.4 per cent of Australian adults do not engage in the recommended amount of activity to stay healthy.

The minimum amount recommended by the WHO is 150 minutes of moderate physical activity a week, or 75 minutes of vigorous physical activity per week.

The research, first published in the Lancet Global Health journal, found that about 1.4 billion adults across the globe were not physically active enough to keep in good health, with one in three women and one in four men not exercising sufficiently or even moving about enough.

In affluent countries, about half as many people are physically active as those in poorer countries.

In the developing world, many people are involved in physical labour every day, while greater wealth often equates to a more sedentary lifestyle.

These astonishing results indicate that more people are at risk of serious health problems like heart disease, type 2 diabetes, cancer and dementia.

Kuwait has the highest rate of inactivity, however, at 67 percent, followed by American Samoa and Saudi Arabia both, at 53 per cent, and Iraq at 52 per cent.

In the UK, 40 per cent of women and 32 per cent of men do not move enough. In the US, it is 48 per cent of women and 32 per cent of men.

The study involved 1.9 million people in 168 countries, with participants self-tracking their activity in 2016. Once analysed and aggregated, the results meant about a quarter of the earth’s population are at risk of poor health due to insufficient physical activity.