Tag Archives: World Health Organization

Malaria Project Failing Due to Lack of Funds

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An article published in the online Malaria Journal argues that the World Health Organization is woefully behind in its 1998 Roll Back Malaria plan that sought to cut malaria deaths in half by 2010 and then in half again by 2015. According to Harvard researchers Vasant Narasimhan and Amir Attaran, the RBM project has attracted barely five percent of the funds it needs to succeed.

Based on surveys of donor countries and external estimates of their spending, Narasimhan and Attaran estimate that RBM receives roughly US$98 million annually. It would need about US$1.5-$2 billion annually to reach its goal of halving malaria deaths.

The odd thing is that this estimate is filled with a bizarre level of uncertainty. Switzerland, for example, told the researchers that not only did they not know how much their country was giving for malaria control, but they did not even know how to go about finding out since malaria control spending was subsumed into larger health spending budgets. Narasimhan and Attaran write that this will pose enormous problems for funding of malaria control efforts,

In short, the Swiss answer, which seems likely to apply to some other donors too, is that the extent of malaria control funding is not just unknown, but actually unknowable. Leaving aside the reasons why this is true (e.g. it is found in integrated health programmes and not easily disaggregated), this poses a huge strategic threat to RBM’s goals: What is the likelihood of increasing malaria control funding, when the donors lack the accounting procedures and ability to know how much they are spending? Without reliable financial surveillance, there is good reason to suspect that aid to malaria control will stagnate, as it has done for decades, without triggering public pressure to demand improvement.

The other interesting thing is that the $98 million spending estimate is significantly smaller than other estimates that put annual malaria control spending at US$130 to $160 million. Part of the reason for the difference is that some organizations, including the World Bank, appear to be exaggerating their malaria control spending (emphasis added),

Although the Bank publicly claims that “at present, World Bank direct financing for malaria control activities is over $200 million in more than 25 countries”, we find on the Bank’s own project list only 10 countries having “active” malaria control projects [22]. In India, where in 1997 the Bank pledged its largest malaria control effort ($164.8 million), the project neared its close in 2003 after disbursing little over a quarter of this amount. In Africa, where 90% of malaria deaths occur, the Bank has only 4 active projects: in the Comoros, Eritrea, Madagascar, and Senegal. Yet not one of these countries suffers particularly intense or sustained malaria transmission – three are hardly malarious at all by African standards – meaning that the Bank’s efforts will contribute little to halving the burden of malaria.

Worst of all, the Bank has practically reneged on the dramatic pledge it made to two dozen African heads of state at Abuja in April 2000 to provide “up to $500 million more…for the fight against malaria in Africa” [23]. Nearly three years after that pledge, Eritrea is the only country to receive a new loan expressly including malaria control (the loan package is $40 million, split among 4 diseases). Assuming that the each disease in the Eritrea loan package receives an equal share, then the Bank’s new lending for malaria control since Abuja amounts to only $10 million; and three years after Abuja, up to $490 million of the $500 million that the Bank promised remains uncommitted and unspent. Furthermore, at this writing (December 2002), the Bank’s own malaria project list shows not one new African malaria control project in the planning pipeline. There seems to be no activity underway at the Bank to keep the promise that was made.

The authors recommend that the World Bank appoint a malaria “czar” to oversee malaria control projects in much the same way it appointed an AIDS “czar” to oversee AIDS control projects.

They also criticize views in Western donor nations that malaria spending is wasted because developing nations do not have the health care infrastructure to meaningfully absorb the aid. Instead, they argue that this is a sort of chicken-or-egg problem — additional spending on malaria would drive the creation of additional health care infrastructure. I suspect donor nations are a bit more skeptical than are Narasimhan and Attaran. As the authors themselves concede, the United States, for example, spent billions on malaria control in the 1960s with very little to show for it.

Source:

Roll Back Malaria? The scarcity of international aid for malaria control. Vasant Narasimhan and Amir Attaran, Malaria Journal, April 15, 2003.

Malaria project in funding crisis. BioMed Central, Press Release, April 25, 2003.

World Health Organization: Infectious Diseases Kill More than 5 Million Children Annually

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World Health Organization representative Dr. James mwazia recently issued a statement for World Health Day noting that infectious diseases such as diarrhea, malaria and others kill more than 5 million children each year.

The sad irony is that these diseases are easily preventable and treatable but, children in the developing world still die from them because of poor medical infrastructure, official corruption, and the whole host of other ills associate with too many governments in the developing world.

But don’t worry, that won’t stop WHO from spending resources tackling obesity in the developed world. No sir, even WHO has to keep its priorities straight.

Source:

Illness accounts for 5 million deaths. The Independent (Banjul, The Gambia) April 7, 2003.

WHO to Launch Intensive Polio Immunization Effort in India

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Following the largest polio epidemic in recent history, the World Health Organization is launching an intensive immunization effort in India. An estimated 1.3 million volunteers will go to door to door in an effort to vaccinate every child under five.

In 2002 India reported more than 1,500 new cases of the disease — easily the largest outbreak of the disease in decades. WHO had set a goal of eradicating polio by 2002, but now hopes to declare the planet free of polio by 2005.

Unfortunately, the BBC reports that the polio eradication effort faces a $275 million shortfall that could limit its immunization efforts.

Source:

UN targets polio in India. Emma Jane Kirby, The BBC, February 5, 2003.

State of The World’s Vaccines and Immunizations

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A report by the World Health Organization, UNICEF and the World Bank concluded that 3 out of 4 children around the world now have access to essential vaccines. But, of course, that means that fully 25 percent of the world’s children are not routinely vaccinated against childhood diseases.

According to The State of the World’s Vaccines and Immunization, as many as 37 million children under the age of one are not immunized against the six major vaccine-preventable diseases of childhood: tuberculosis, tetanus, whooping cough, diphtheria, polio and measles.

Moreover, the inability of underdeveloped countries to pay for vaccines combined with ongoing property rights disputes over ownership of drugs and vaccines in such countries acts as disincentive for further research into vaccines for diseases that plague the developing world.

According to the report,

Today, vaccine manufacturers have little commercial incentive to develop vaccines against diseases such as HIV/AIDS, TB and malaria, which kill millions of people in developing countries, but relatively few in the developed world. For example, of the approximately US$600 million a year invested in HIV vaccine research, the majority comes from the US National Institutes of Health (a public sector institution). To put that amount in perspective, in 1999, research spending on drugs to treat HIV/AIDS was about US$3 billion in Europe and the United States alone. Other diseases fare just as badly. In the 1996 report Investing in Health Research and Development, WHO highlighted some of the distortions in global health research funding. At the time of the study, acute respiratory infections, diarrheal disease and TB — which together account for almost 8 million deaths a year, mainly among the poor — attracted an estimated US$99-133 million. . . By contrast, more was spent on research into asthma — an estimated US $127-158 million — which accounts for 218,000 deaths a year worldwide.

Of course the report ignores the possibility that the relatively heavy funding in asthma is what is responsible for such a low worldwide death toll, but even so the amount estimated to be spent on research into diseases that kill 8 million people is staggeringly low.

Source:

Vaccine policy leaves millions at risk. The BBC, November 20, 2002.

State of the World’s Vaccines and Immunization Report (PDF). UNICEF, 2002.

Illegal Abortions a Major Killer of Women in Ethiopia

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According to the World Health Organization, complications arising from illegal abortions are now the second leading cuase of death for young women in Ethiopia. Only tuberculosis kills more young women in that poverty-stricken nation.

Abortion is illegal in Ethiopia except in cases where the mother’s life is in danger, but illegal abortions are easy to obtain and widespread. According to WHO, the death rate from illegal abortions in Ethopia is a staggering 1,209 per 100,000 abortions. In the United States, by contrast, the death rate from legal abortions is about 1 per 100,000.

A number of factors help to make the death rate so high, including a lack of access to contraception, a very low literacy rate among women (only about 14 percent of women are literate), and Ethiopia’s poverty which leads to ony about US $1.50 per person being spent on health care resources annually.

Source:

High Death Rate from Illegal Abortions. UN Integrated Regional Information Networks, October 28, 2002.

Teens Pay The Deadly Price Of Religious Taboo. Tewedaj Kebede, Panos, July 2001.

Many Ethiopian Teens Dying from Illegal Abortions. Women’s E-News, November 4, 2002.

WHO Considers Changing Its Ringworm Treatment Policy

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Due to the surprising results of research carried out on children in Zanzibar, the World Health Organization is considering lowering the age at which it treats children for ringworm parasites.

Infection of young children by ringworm parasites is fairly common in Africa, but WHO’s policy has been that it only treats children older than 24 months for the condition. This is because it was widely believed that ringworm infection among infants was milder than in older children and, hence, the benefit to be gained was minor.

But preliminary results from the Zanzibar study suggest that treating infants for ringworm parasites can make a significant impact on both malnutrition and anemia.

Researchers previously thought that the problem of anemia among children was due to a lack of iron in the diet, but the Zanzibar study suggests that in infants, the ringworm parasite plays a much larger role in causing anemia than previously thought.

WHO’s coordinator on parasitic diseases, Dr. Lorenzo Savioli, told the BBC that WHO is already preparing to change its recommendations on ringworm treatment which could result in millions of infants across Africa receiving medication to treat the parasite.

WHO has already investigated drugs that are used to treat ringworm to ensure they are not toxic to infants.

Source:

Child worm crackdown considered. The BBc, May 5, 2002.

Dictators, Development and Malaria

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North and South Korea offer a nice look at the real sources of underdevelopment in Third World countries. That distinction was recently highlighted with word from the World Health Organization that North Korea has been experiencing a malaria epidemic over the past few years.

During the 1970s, malaria was eradicated from both countries. In 1997, however, malaria made a comeback in North Korea. The main reason is that although North Korea has a well–funded army, it does not have a well-funded water and sanitation system.

As a result, WHO estimates that last year there were as many as 300,000 cases of malaria in North Korea. WHO recently released an appeal for aid, noting that although much aid has been given to North Korea to avert famine, it also needs money to combat malaria and other problems.

South Korea, on the other hand, is prosperous to the point that it donated almost $700,000 of equipment to help its neighbor to the north fight malaria.

Both North and South Korea emerged from World War II as dictatorial societies. The North’s political system became ever more rigid and totalitarian, whereas the South’s political system gradually was forced to accept liberal democracy, both from internal and external forces.

The main problem still facing the developing world is too many regimes that have more in common with North Korea than with South Korea. A lack of democracy and political rights is a deadly combination.

Source:

WHO battles malaria in North Korea. Caroline Gluck, The BBC, April 1, 2002.

WHO: Tuberculsosis Efforts Falling Behind

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The World Health Organization issued a report this month noting that the world is falling behind in efforts to contain tuberculosis. According to the WHO,

A strategy that can cure up to 90% of all tuberculosis cases, and thus is the best chance for controlling the global epidemic, is reaching only 27% of the world’s TB patients. . . . According to the new WHO report, at the current rate, TB targets set for 2005 will not be reached until 2013.

Tuberculosis currently kills about 2 million people a year, and is the number one preventable cause of death in the developing world.

The main thing holding back better treatment of tuberculosis is money. WHO estimates that countries around the world need to spend about $300 million more per year to control tuberculosis.

Source:

Funding ‘hits tuberculosis fight’. The BBC, March 24, 2002.

Only a fraction of TB patients get the best care. World Health Organization, Press Release, March 22, 2002.

Is the World Health Organization Part of the Problem?

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Brian Doherty has an excellent, scathing attack on the World Health Organization for the January 2002 issue of Reason which argues that the organization is a bureaucratic nightmare more interested in self-preservation than actually doing something about improving health in the developing world.

Doherty writes that when the WHO was founded after World War II it had a substantive impact on health, especially in the developing world. WHO played a major role in tackling a number of infectious diseases, culminating with its role in the eradication of small pox in 1977.

But after the victory over small pox, WHO started turning away from focusing on infectious disease in the developing world to most First World concerns. First under Director General Hiroshi Nakajima and then Gro Harlem Brundtland, WHO began to turn away from infectious disease. Doherty writes,

In a world still fighting infectious disease, Brundtland’s WHO has issued statements, studies, and reports on such topics as blood clots in people who sit still on airplanes too long, helping people remain active while aging, the hazards of using cell phones while driving, the importance of debt relief for poor countries, how tobacco is “a major obstacle to children’s rights,” and rates of alcohol abuse among European teens.

Doherty is especially troubled by the recent WHO analysis of world health problems which relied on a measurement called the disability adjusted life year. The idea behind the DALY is that someone suffering from a severe illness or disability is living a lower quality of life than someone who is not. But WHO’s attempt to quantify produced bizarre results whereby, for example, WHO claims that 16 percent of the years lost to disability in sub-Saharan Africa come from mental illness. Any organization that thinks mental illness is one of the major health problems facing that region, however, is crazy.

Doherty’s article finishes with a stark reminder of just how ineffective WHO is and how misguided its focus on things like years lost to disability are,

Nothing condemn’s WHO’s current agenda more than some of its own pronouncements. In a 1999 press release, WHO declared that six illnesses accounted for 90 percent of all infectious disease deaths among people under 44 years: malaria tuberculosis, measles, diarrheal diseases, acute respiratory infections (including pneumonia), and AIDS. The same press release declared that “the tools to prevent deaths from each of these six diseases now cost under $20 per person at risk, and in most cases under $0.35. Yet these diseases still caused over 11 million deaths in 1998.”

. . . we have WHO declaring that 11 million deaths — 90 percent of all infectious disease deaths for people under 44 years — could have been easily prevented with an expenditure of, at its lowest, $3.9 million, and at its highest, $220 million. That is, anywhere from 0.4 percent to 20 percent of WHO’s budget for one year.

What does WHO spend its money on instead? Doherty cites an analysis of WHO’s 1994-95 budget that found WHO spent as much on its meetings and its executive board as it did on immunizations, tuberculosis and diarrheal diseases combined. Seventy percent of its budget went to administrative overhead and its Geneva headquarters.

Source:

WHO Cares? The World Health Organization cares more about its own life than the lives of the poor. Brian Doherty, Reason, January 2002.

Goats as Malaria Vaccine Factories

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So called “farmaceuticals” — genetically engineered animals that express drugs in their milk — has long been predicted as a likely eventual outcome of biotechnology efforts and that possibility took a big step forward with the recent announcement of initial success using mice to produce a malaria vaccine for monkeys. This advances is especially noteworthy since the technique used should scale well to larger animals such as goats, which could have an enormous impact on controlling disease in the developing world.

In this instance, researchers developed mice that secreted an experimental malaria vaccine in their milk. Two separate strains of transgenic mice were created, each of which carried a form of a gene to produce a surface protein of a strain of malaria. The mice were designed so that the gene to produce the proteins could be turned on only by the cells that line the animals’ mammary glands, ensuring that the proteins would be secreted in the milk of the animals.

The vaccine was then purified and injected into monkeys who were then exposed to the malaria parasite. In the extremely small experiment, only one of the five monkeys who received the vaccine contracted malaria, compared to six out of seven monkeys in a control group who did not receive the vaccine.

Doing this with mice is amazing, but here’s where things get very interesting. When researchers designed the mice to express the protein, they used DNA from goats, meaning it should be possible to create goats which also express the protein. In fact Science Daily reports that preliminary, unpublished research suggests the procedure works well in larger animals.

If this result holds, this could revolutionize vaccine research into diseases that largely afflict the developing world. Vaccine research in the developed world is problematic enough. Regulatory and liability issues, combined with expensive manufacturing processes have stunted vaccine research into diseases that still afflict people living in the developed world. When it comes to research on a vaccine for a disease like malaria, those concerns are even larger given the economic situation of much of the developing world (and hence the likelihood that much of the developing world would be unable to afford such a vaccine even if it were available).

Being able to have such medications produced by a herd of goats, however, would drastically lower the costs of such vaccines. Considering the World Health Organization estimates that as many as 1 million people die annually from malaria-related complications, this technology could have an enormous public health impact.

Sources:

Scientists Milk Animals for Malaria Vaccine. Science Daily, December 18, 2001.