more_vertThe unfolding outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) dominated discussions at last month’s World Health Assembly (WHA) in Geneva, Switzerland. Several funding pledges were made and WHO estimated that US$26 million will be required to control the outbreak.1 On May 8, 2018, the DRC Government declared an outbreak of Ebola virus disease, initially in a remote area of the Equateur Province (figure).2 As of June 10, 2018, the Government of DRC reported 66 cases of Ebola virus disease and 28 deaths (case fatality rate 42·4%).
Preference: World Health
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[Comment] Offline: Global health and the private sector
I crossed paths with Peter Sands at the World Health Assembly last week. I greeted him warmly, I thought, and asked how he was settling into his new role as Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. He looked uncomfortable. His manner was frosty, possibly even icy. Our conversation, such as it was, faltered. We parted awkwardly. I understand why. After we published a laudatory welcome following his appointment, we criticised the Global Fund’s partnership with drinks manufacturer, Heineken—a partnership endorsed by Peter himself.
[Editorial] Safeguarding medical education in conflict
On May 23, during the World Health Assembly, the International Federation of Medical Students’ Associations (IFMSA) presented Attacks on Medical Education, case reports collected by IFMSA member organisations in seven countries where violent conflict has affected medical education.
National alcohol strategy please
Australia has been without a current National Alcohol Strategy since 2011. In late 2017, the current draft of the National Alcohol Strategy 2018-2026 (NAS) was released for public consultation. The AMA developed a submission expressing frustration at both the time being taken to release the document, and the absence of tangible objectives and indicators. These concerns were echoed in the submissions of a number of other stakeholders.
Much of what is contained in the current draft of the NAS has been proposed in previous iterations of the NAS and related strategies, which appear to have been all but ignored, only to be replicated in the current draft.
The most frustrating example of this discord between the Government’s rhetoric and its actions is the exploration of tax reform. Alcohol taxation has been prime for reform for over a decade.
Former Treasury Secretary Ken Henry delivered a suite of recommendations as part of his strategic plan for Australia’s Future Tax System. Pertinently, he identified volumetric taxation as an effective mechanism for taxing alcohol and outlined a framework in which the revenue of alcohol taxation could be channelled back into initiatives which address the impact of alcohol-related harm. The Henry Tax Review was intended to guide tax reforms for the next decade. We are dangerously close to the end of that decade and one of its most valuable recommendations remains entirely unimplemented.
In 2006, the previous iteration of the NAS conceded that the logic behind volumetric taxation “is difficult to refute”. This is apt; it is difficult to refute. It is equally difficult to defend the failure of consecutive Governments to deliver this reform.
The current draft of the NAS, again, makes a very convincing case for the use of volumetric taxation as a means of curtailing alcohol-related harm, although it remains unlikely that these reforms will ever see the light of the Senate floor.
What drives the reluctance to implement such a simple, affordable, and, most importantly, effective, policy?
A clue can be found halfway through the consultation draft of the latest NAS. In almost the same breath that the World Health Organization’s summation that volumetric taxation is one of the “most efficient strategies to minimise the harmful use of alcohol” is acknowledged, the NAS goes on to stress that the known public health benefits of such measures must be balanced with “conflicting needs of disparate stakeholders”.
In other words, the profit margins of commercial alcohol producers are worthy of the same protection and consideration as the health of Australians.
Perhaps the most telling indication of the effectiveness of volumetric taxation is the reaction garnered by its appearance in the latest draft of the NAS. In response to this proposal, Brett Heffernan, CEO of the Brewers Association of Australia, described the draft NAS as “bereft of scientific rigour”.
Questionable as this may be, Heffernan is given an opportunity to convey these concerns directly to Health Minister Greg Hunt, who has invited stakeholders to participate in a forum to “collaboratively and collectively” work through issues identified with the NAS. Given the makeup of these stakeholders, it is hard to view this forum as anything other than an opportunity for producers to chip away at the already underdone recommendations put forward by the NAS.
It was only very recently that the Australian Institute of Health and Welfare released a report which identified alcohol and illicit drug use as causal factors in approximately 1 in 20 deaths in Australia. The alcohol industry will tell you proudly that both alcohol-related harm and alcohol consumption more broadly are on the decline in Australia. True as this may be, that is no reason to ignore evidence-based policies with the potential to achieve further reductions in the burden of this harm.
Next time you hear an alcohol lobbyist promulgating this type of argument, simply replace the word “alcohol” with “tobacco”, and you may find that these arguments immediately lose their substance.
GEORGIA BATH
AMA PUBLIC HEALTH POLICY ADVISER
WHO public health awards for Western Pacific Region
Public health champions from the World Health Organization (WHO) Western Pacific Region were recognised at the 71st World Health Assembly in Geneva, Switzerland.
Dr Nazni Wasi Ahmad from Malaysia received honours for her innovative research using insects to treat people with diabetes, and the Korea Institute of Drug Safety and Risk Management (KIDS) for contributions to drug safety in the country.
“Dr Nazni Wasi Ahmad and the Korea Institute of Drug Safety and Risk Management have made outstanding contributions to public health in our Region,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific.
“The recognition they are receiving today is a strong affirmation of the significance of that work, which positively impacts the lives of many people in Malaysia, the Republic of Korea and beyond.”
Dr Ahmad was awarded the Dr LEE Jong-wook Memorial Prize for Public Health for her research on the therapeutic use of maggots (fly larvae) to clear and expedite the healing of wounds and foot ulcers caused by diabetes. The maggots remove dead tissue and secrete antimicrobial substances that fight infection and promote healing.
The number of people with diabetes is growing around the world, and diabetic foot ulcers are a serious but relatively common complication. If these wounds are not properly treated and become infected, especially with antibiotic-resistant bacteria, it could result in needing to amputate the affected limb.
In Malaysia, about six per cent of patients attending diabetic outpatient facilities develop foot ulcers, and foot complications account for 12 per cent of all diabetes hospital admissions.
Dr Ahmad’s method is effective, affordable, simple and available at any time and in any healthcare setting, including small local clinics, said the WHO.
When accepting the award, Dr Ahmad said: “Today, our therapy is being practised in health clinics in most districts in Malaysia, including in hard-to-reach areas. It is easy to access and affordable for the people, especially socially and geographically disadvantaged groups.
“We brought our research findings from the laboratory to the bedside, and now we’re preventing limb amputation in diabetic patients in health clinics. This is in line with achieving the ultimate goal of primary health care as advocated by WHO—reducing exclusion and social disparities in health and organizing health services around people’s needs and expectations.”
KIDS received the 2018 United Arab Emirates Health Foundation Prize for its outstanding contribution to health development. The Institute works to improve health in the Republic of Korea by working on prevention and recognition of drug safety-related issues, supporting evidence-based decisions on drug safety, disseminating safety information, and increasing public awareness.
The country’s pharmacovigilance system to monitor the effects of medical drugs consists of 27 regional centres. In this decentralised system, KIDS functions as the focal point, gathering and reporting data from these centres.
The data are used to provide the Ministry of Food and Drug Safety with statistics, safety information and reports of all adverse events. The reporting system further feeds into Vigibase, the global database managed by the WHO Programme for International Drug Monitoring.
“Nationwide, KIDS operates 27 regional pharmacovigilance centres, promoting the reporting of adverse drug reaction cases and incorporating the data into the WHO international pharmacovigilance programme. We take various safety measures proactively and are keen to share with WHO and other countries our experience and achievements in drug safety management,” said Dr Soo Youn Chung of KIDS.
Each year, at the World Health Assembly held in Geneva, prizes are given to recognise expertise and accomplishments in public health.
The prizes have been established either in the name of eminent health professionals and international figures or by prominent foundations committed to supporting international and global public health. Nominations are submitted by national health administrations and former prize recipients and reviewed by specialized selection panels of each of the foundations awarding a prize. The WHO Executive Board, in its January session, designates the winners based on recommendations made by the selection panels.
The Dr Lee Jong-wook Memorial Prize for Public Health is given to an individual whose work has gone far beyond the performance of duties normally expected of an official of a government or intergovernmental institution.
The United Arab Emirates Health Foundation Prize is awarded to a person, institution or nongovernmental organization that has made an outstanding contribution to health development.
Other prizes presented at the World Health Assembly this year were: the Ihsan Doğramacı Family Health Foundation Prize to Professor Vinod Kumar Paul (India); the Sasakawa Health Prize to the Fundación Pro Unidad de Cuidado Paliativo (Pro Palliative Care Unit Foundation) (Costa Rica); and His Highness Sheikh Sabah Al-Ahmad Al-Jaber Al-Sabah Prize for Research in Health Care for the Elderly and in Health Promotion to Association El Badr, Association d’aides aux malades atteints de cancer (El Badr Association, Cancer Patient Association) (Algeria).
CHRIS JOHNSON
[Comment] New leadership for the WHO Regional Office for the Eastern Mediterranean: exceptional election in an exceptional time
On May 19, 2018, during the 71st World Health Assembly, the 21 health ministers, or their representatives, from the Eastern Mediterranean region are due to elect a new Regional Director for the WHO Regional Office for the Eastern Mediterranean (EMRO) in a special session of its regional committee. The exceptional election follows the unexpected death of Mahmoud Fikri who was WHO EMRO Regional Director for only 8 months during 2017. WHO has accelerated the normally lengthy election process to fill the vacuum in WHO EMRO leadership.
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Safeguarding planetary health, banning nuclear weapons, and the first Nobel Peace Prize born in Australia
Nobel Prize Winner Associate Professor Tilman Ruff is keynote speaker at the AMA Leadership Development Dinner on Friday, 25 May 2018 at the National Portrait Gallery in Canberra. He is Co-President of International Physicians for the Prevention of Nuclear War (IPPNW, Nobel Peace Prize 1985); and founding international and Australian Chair of the International Campaign to Abolish Nuclear Weapons (ICAN), awarded the Nobel Peace Prize for 2017 “for its work to draw attention to the catastrophic humanitarian consequences of any use of nuclear weapons and for its ground-breaking efforts to achieve a treaty-based prohibition of such weapons”.
“The World Health Organisation concluded that nuclear weapons pose the greatest immediate threat to human health and welfare. They are the only weapons to loom as an existential threat over all of us, every day that they exist, ready to fire. Yet rather than disarming as they are obligated, all nuclear-armed states are massively investing in not just retaining, but in modernising their arsenals. And tens of additional states, including Australia, claim to rely on nuclear weapons and assist in preparations for their possible use,” said Associate Professor Tilman Ruff.
“The dangers of nuclear war are as high as they have ever been, and growing. Current evidence of the catastrophic worldwide climate effects and famine that would follow a nuclear war using even a tiny fraction of the global nuclear arsenal, and successful approaches to control of other indiscriminate and inhumane weapons, underpin the historic UN Treaty on the Prohibition of Nuclear Weapons. Adopted by 122 nations on 7 July 2017, the Treaty is a planetary health good of the highest order. It provides the only currently defined path to the eradication of nuclear weapons, a stated aspiration of and legal obligation for all governments. As called for by the Council of the World Medical Association this week, all states should join and implement the Treaty without delay.”
Written by Tilman Ruff, MB, BS (Hons), FRACP, AM
Keynote speaker at the AMA Leadership Development Dinner 2018
2018 AMA Leadership Development Dinner
Tilman Ruff is Associate Professor in the Nossal Institute for Global Health at the University of Melbourne; international medical advisor for Australian Red Cross; Co-President of International Physicians for the Prevention of Nuclear War (IPPNW, Nobel Peace Prize 1985); and founding international and Australian Chair of the International Campaign to Abolish Nuclear Weapons (ICAN), awarded the Nobel Peace Prize for 2017 “for its work to draw attention to the catastrophic humanitarian consequences of any use of nuclear weapons and for its ground-breaking efforts to achieve a treaty-based prohibition of such weapons”. He headed the IPPNW delegation to and participated throughout the treaty negotiations in New York.
[Comment] Offline: UHC—one promise and two misunderstandings
On April 7, 2018, World Health Day, WHO launches a new campaign—Universal Health Coverage: Everyone, Everywhere. This is a noble cause. As the agency notes: half the world’s population is unable to access essential health services; 100 million people are pushed into extreme poverty each year because of out-of-pocket expenditures on health; and catastrophic spending on illness and disease is a truly global problem. Therefore, “our next historic achievement is right in front of us: health for all humankind…Together, we can make universal health coverage happen in our lifetime.” The campaign will run throughout 2018.
Poll finds understanding gap between alcohol and disease
Many Australians are unaware of the links between alcohol consumption and a range of cancers and other diseases, according to a recently released survey.
But a vast majority of them believe they have a right to such information and that Governments have a responsibility to educate them.
A new poll, released by the Foundation for Alcohol Research and Education (FARE), reveals that Australians have a lack of understanding of the official drinking guidelines that could help keep them healthier.
The same poll also reveals that they want to know about the long-term harm associated with regular alcohol consumption, and they are increasingly of the opinion the alcohol industry is deliberately downplaying independent university research linking alcohol to a range of harm, including cancer and cardiovascular disease.
The Annual Alcohol Poll 2018: Attitudes and Behaviours, conducted by YouGov Galaxy, found that fewer than half of Australians are aware of the link between alcohol misuse and stroke (38 per cent), mouth and throat cancer (26 per cent) and breast cancer (16 per cent).
While 70 per cent of Australian adults are aware of the Australian Guidelines to Reduce Health Risks from Drinking Alcohol, only one in four of them (28 per cent) are aware of the content.
FARE’s Chief Executive Michael Thorn said the lack of knowledge of both the link between alcohol consumption and the risks of cancer and other chronic diseases, together with a clear understanding of how to avoid those risks, was extremely alarming.
“It really is a dangerous cocktail. Community awareness of alcohol’s link with a range of chronic health conditions remains low,” Mr Thorn said.
“In the case of alcohol’s link to breast cancer, the awareness is only 16 per cent. Nor are Australians armed with the knowledge that would reduce their risk of long-term harm. Only one in four Australians have some awareness of the actual content of the official drinking guidelines.”
Now in its ninth year, FARE’s national alcohol poll provides valuable trend data and insights into community perspectives on alcohol
This year, Australians were asked for the first time whether they thought they had a right to know about the long-term harm associated with regular alcohol use.
When advised that the World Health Organisation recognises that alcohol is linked to approximately 200 disease and injury conditions such as breast cancer, liver disease, mouth cancer and stroke, the vast majority of Australians (84 per cent) agreed that they had a right to that information, with 80 per cent of Australians reporting that Governments have a responsibility to educate Australians on this matter.
“If there is a silver lining here, it is that Australians clearly recognise their rights as consumers to be fully informed of the harm associated with the products they consume,” Mr Thorn said.
“The lesson here for Government is that it must do a better job of ensuring Australians fully understand the long-term harm from alcohol, and are given the information that would help them reduce that harm.”
The 2018 Poll findings make clear that the job cannot be left to the alcohol industry – 61 per cent of Australians believe that the alcohol industry would downplay independent university research findings linking alcohol consumption to a range of harm such as cancer and family violence.
Polling revealed that community perceptions of the alcohol industry have not improved since 2015, finding that the majority of Australians continue to believe that the alcohol industry targets people under the age of 18 years (55 per cent), and that it has too much influence with Governments (57 per cent).
The full is available at www.fare.org.au.
CHRIS JOHNSON
Immunisation data pinpoints communities at risk
The latest release of Australia’s childhood immunisation and HPV immunisation rates show a wide variation of uptake across communities.
While new data from the Australian Institute of Health and Welfare (AIHW) confirms childhood immunisation is increasing, Australians continue to fall short of the 95 per cent national goal.
Nationally, 93.5 per cent of all children aged five were fully immunised in 2016–17. Aboriginal and Torres Strait Islander children aged five had a higher national immunisation rate, of 95.7 per cent.
“The greatest improvement was seen in the Central Queensland, Wide Bay and Sunshine Coast Primary Health Networks (PHN) area, which rose from 91.6 per cent in 2015–16 to 93.3 per cent in 2016–17,” said AIHW spokeswoman Tracy Dixon.
“Despite the majority of Australian children being immunised, it’s important that we don’t become complacent. We need to maintain high immunisation rates to protect the vulnerable groups in our community.”
Vaccines have played a big part in helping halve the number of child deaths since 1990. The World Health Organisation (WHO) estimate vaccines save 2-3 million lives each year.
Importantly, the new AIHW data helps to identify where Australian communities of low immunisation are. Categorised across Australia’s 31 PHN, the data shows variation in immunisation rates that range, from 98 per cent in the Nepean Blue Mountains, NSW to 89.8 per cent in Western Victoria, for example.
Health Minister Greg Hunt said the Government would strategically use the new data to target geographical areas with low immunisation rates and identify the 10 per cent of Australians there who have some doubts or uncertainties about it.
“They’re the areas we’re focusing on and, in particular, now we’re able to micro-target through Facebook, through Google, through GP practices,” he said
The Government currently targets areas of low immunisation through the Get the Facts campaign, which seeks to provide parents, through a range of platforms, with evidence based information on the benefits of immunisation.
“The messaging here is very, very clear, that immunisation is both safe and it saves lives,” Mr Hunt said.
The effectiveness of the Government’s No Jab No Pay policy is to increase vaccination rates has been supported by another report that shows an increase in an uptake in Australia of a vaccine containing measles.
The National Centre for Immunisation Research and Surveillance (NCIRS) report found the proportion of children fully immunised at one and five years of age had reached the highest levels ever recorded in mid-2016 (at 93.9 per cent and 93.5 per cent respectively), just after the introduction of the No Jab No Pay policy.
Dr Frank Beard, public health physician, and head of coverage and surveillance at NCIRS explained: “While Australia has been certified free of local measles, we need to maintain high immunisation rates as we are constantly at threat from measles coming into the country from overseas and spreading locally.”
He added that: “Measles catch-up vaccination in adolescents is particularly important, as recent outbreaks have disproportionately affected this age group due to inadequate vaccination.”
Last year Europe faced a four-fold increase in measles, with 20,000 cases and 35 lives lost.
“Every new person affected by measles in Europe reminds us that unvaccinated children and adults, regardless of where they live, remain at risk of catching the disease and spreading it to others who may not be able to get vaccinated… a tragedy we simply cannot accept,” warned Dr Zsuzsanna Jakab, WHO Regional Director for Europe.
The other part of the AIHW data released related to HPV vaccination rates and showed an increase for both girls and boys in the uptake of the HPV vaccine among Australian teenagers.
Professor Karen Canfell from Cancer Council Australia welcomed the increase: “As well as helping protect girls against cervical cancer in the future, increasing rates of vaccination across both teenage males and females will help reduce our population’s overall risk of a range of cancers linked to the HPV virus.”
Unfortunately, boys are falling behind in the fight to eradicate HPV. Nationally, 80.1 per cent of girls aged 15 were fully immunised against HPV, compared to only 74.1 per cent of boys aged 15.
Mirroring the childhood immunisation rates, the AHWI data also revealed: where you lived effected the likelihood of being vaccinated. HPV immunisation rates ranged from 85.6 per cent of girls fully immunised in Central and Eastern Sydney (NSW) to 69.2 per cent in Tasmania.
“It is concerning that one in five teens still aren’t directly protected through vaccination and there are some communities where uptake remains lower. We need more research to understand these trends,” Professor Canfell said.
She also believes both vaccination and cervical screening are necessary to combat HPV.
“To further work towards a future without cervical cancer, we encourage parents to ensure their teenagers get vaccinated, and we recommend all eligible women participate in cervical screening,” she said.
Australia was the first country to introduce a free HPV vaccine program, starting with girls in 2007, and including boys from 2013. Later this year the new HPV vaccine is being rolled out which protects against additional strains of HPV making it even more effective.
Details about the AIHW report can be found here: https://myhealthycommunities.gov.au/our-reports/immunisation-rates-for-children/march-2018
And here: https://myhealthycommunities.gov.au/our-reports/HPV-rates/march-2018
MEREDITH HORNE