Slate covers Copenhagen Consensus ID priorities: Big 3 + new vaccinations and deworming

Denmark’s bang-for-your-buck global health proponent commented in Slate last month  on the Copenhagen Consensus 2012 report,which emphasizes the continuing import of malaria, TB (and a hoped-for HIV vaccine) but also other essential health interventions that are less famous: new(ish) vaccines, including Haemophilus influenza B (a cause of meningitis in infants), Streptococcus pneumonia, Hepatitis B, and rotavirus and shigella (viral and bacterial) diarrheas. These are all huge causes of disease children.

improved immunization saves more lives per year than would be saved by global peace.

spending $300 million a year [on malaria[ would prevent 300,000 child deaths…Spending $300 million [on deworming campaigns] would mean about 300 million children could be dewormed, with benefits in economic terms 10 times higher than the costs.

It’s good to see newer vaccines and neglected tropical diseases up there with the Big 3 diseases (even if  Peter Hotez’ recent PLoS editorial calling Chagas disease the AIDS of the Americas is a little senastionalist.)

You can see the rest of Lomborg’s Copenhagen Consensus 2012 series on Slate here, including newer articles.

PEPFAR works! | Eran Bendavid et al in JAMA

PEPFAR’s success with HIV … may be the clearest demonstration of aid’s effectiveness in recent years.

- Bendavid, Holmes, Bhattacharya and Miller, in last week’s JAMA global health issue, reporting on a striking figure of over 700,000 deaths averted in African focus countries as a result of PEPFAR (the President’s Emergency Plan for AIDS Relief, launched by George W. Bush). The authors use Demographic and Health Survey data from across sub-Saharan Africa to compares trends in mortality due to all causes in countries that received PEPFAR funding against countries that did not. They note that their data do not tell us whether all differences in death rates were related to HIV/AIDS, or if there were spillover effects of the program.

The graph below shows death rates over time in PEPFAR countries with a solid line and closed circles and non-PEPFAR countries with a dashed line and open circles. You can see that deaths have fallen sharply in the countries with PEPFAR:

This issue also includes an editorial by Ezekiel Emanuel, commenting on the results. As he points out, this tremendous success highlights what global health programs can achieve; what it doesn’t tell us is whether broader health assistance programs (such as Obama’s proposed Global Health Initiative) could have used the money just as well or better. Emanuel asks “Is PEPFAR worth it?” and points out that during 2003-2008:

PEPFAR received $20.4 billion, malaria $1.7 billion, maternal and child health $2.2 billion, and family planning $2.4 billion. Neglected tropical diseases, such as schistosomiasis and soil-transmitted helminths, which affect approximately 1 billion people worldwide—and the very poorest of the world’s population—received a paltry $45 million cumulatively in US global assistance over the 6 years.To this day, PEPFAR continues to receive 75% of all US global health funding.


PEPFAR works but it’s expensive compared to some other health interventions. In an ideal financial environment, all health problems would receive attention, and everything that works could be done. However, this is not the reality. I agree with Emanuel that governments should take evidence of success like this and use it to improve health for HIV/AIDS as well as other areas, including more “mundane” problems, such as NTDs and diarrheal disease.


JAMA. 2012;307(19):2060-2067. doi:10.1001/jama.2012.2001

Source: jama.jamanetwork.com

We will be left behind until we can demonstrate we are problem solvers and that our investments lead to transformative change for communities worldwide, rather than a community that continues to sell poverty and peddle for more money on emotions rather than measurable results.
…
An effective eradication campaign would combine flowing water, latrines and proper handwashing plus medication to truly eradicate NTDs.

The London Declaration and Eliminating NTDs - The Huffington Post

Ned Breslin, CEO of Water For People, commenting on the absence of water, sanitation and hygiene (WASH) programs from recent London Declaration to eradicate NTDs. For similar thoughts, see an earlier post regarding a recent study demonstrating that WASH programs can be important to fight helminthic infections.

Source: The Huffington Post

New data on neglected tropical diseases; new funding commitments

Photo credit: Rémi Kaupp, wikimedia commons.

Photo from speaking of medicine blog: Rémi Kaupp, wikimedia commons.

Last week, a meta-analysis review on the effect of improved sanitation on soil-transmitted helminths (roundworm, hookworm, and whipworm—a group of parasitic neglected tropical diseases) was published in PLoS Medicine. The title link is to a Public Library of Science (PLoS) “Speaking of Medicine” blog post that summarizes the results, which are based on putting data from of existing studies together and looking for an overall effect. The upshot from Ziegelbauer et al is that improved sanitation can reduce the transmission/incidence of these parasites and that expanding improved sanitation should accompany current drug treatment-based control efforts. Of course, we already had plenty of evidence to support expanding water and sanitation program based on diarrheal disease alone, but reducing helminthic infections could be a huge boon. Hookworm, roundworm, and other NTDs tend to be age-old (“medieval”) afflictions that may not be directly fatal, but cause malnutrition and be severely disabling. Getting rid of them might not show up as clearly in mortality statistics, but good do a world of direct and indirect good for millions of people’s lives.

Almost on cue, a new NTD initiative among governments, Big Pharma, and the Gates Foundation was announced on Monday. It looks like it is entirely focused on drug development, but maybe studies will add to the chorus of voices that have been steadily calling for improved water and sanitation.