CNS: September 2011

TB diagnostic innovations: Can India take the lead?

No country has more cases of tuberculosis (TB) than India. Research from India played a critical role in the development of the global strategy to stop TB.Yet, Indian industry and academics have not developed any new tools (diagnostics, drugs or vaccines) for TB. Why has India has failed to innovate in TB research and development? To understand this better, we recently organized a conference at St John's Research Institute (SJRI) in Bangalore, India. For the first time, this meeting brought together over 200 representatives from industry, government, donors, academia, civil society and the media to discuss what it takes to innovate in TB diagnostics in India and to move from importation and imitation to innovation.The goal was to stimulate industry interest and investments in TB innovations.

It is a social outcry, one that has borne testimony of its existence when well known Bollywood film-star Shiney Ahuja was accused of raping his domestic help. But his is not an isolated incident say union of domestic workers campaigning for their rights in the Uttar Pradesh (UP) state.They thus organized themselves together to raise their voice against sexual harassment at their workplace and have ensured their voice is heard - loud and clear!

Photo credit: World Heart Federation

World Heart Day, 29 September
Sixty-three per cent deaths are due to non-communicable diseases (NCDs), among which heart diseases or cardiovascular diseases (CVDs) are one of the major killers. The first WHO Global status report on non-communicable diseases (NCDs) (April 2011) confirms that NCDs are the leading killer today, with 3 crores 61 lakh people dying from heart disease, strokes, chronic lung diseases, cancers and diabetes in 2008. Nearly 80% of these deaths (equivalent to 2 crores 9 lakh people) occurred in poorer communities dispelling the myth that such conditions are mainly a problem of affluent societies.

While the world knows several ways of preventing transmission of HIV, a safe and effective vaccine is still lacking on the list. For years researchers around the world have been working on the development of such a vaccine in a challenging, step by step process. But they have reason for optimism. During this year's AIDS Vaccine 2011 conference (Bangkok, September 12-15) more than 400 new studies outlining advances in the search for an AIDS vaccine were presented. Most highlighted, however, was a further analysis of the so-called RV144 trial - the largest AIDS vaccine trial ever conducted (involving more than 16,000 volunteers in Thailand) and the first trial to demonstrate that a vaccine can protect against HIV infection.

Despite pressure from global public health advocates, world leaders missed a critical opportunity to put in place strong safeguards to protect public health from corporate conflicts of interest. The undue influence of profit-driven transnational corporations in the food, beverage, tobacco and pharmaceutical sectors means that current policies promote private interests instead of public health.

The Science of Community Engagement makes the difference: Mitchell Warren

More Needs To Be Done To Improve Maternal Health and Reduce Child Mortality

The Millennium Development Goals 4 and 5 envisage reducing child mortality by 33% and maternal mortality ratio by 75%, between 1990 and 2015. But going by the latest study, “Progress toward Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis,” published in The Lancet, this seems to be a far cry. Recent trends show that very few countries are going to achieve the international targets for improving maternal and child health. In fact, only 9 out of 137 developing countries -- China, Egypt, Iran, Libya, Maldives, Mongolia, Peru, Syria, and Tunisia-- will achieve both the goals by the deadline of 2015, while 5 other countries Bhutan, El Salvador, Morocco, Oman, and Turkey are likely to achieve them by 2020.

France has shown the political courage to first ban the regressive burqa this year, and now the offering of prayers by Muslims in the French streets—given the fact that it is home to Europe's largest Muslim population. I wonder what would be the reaction of Mr Nicholas Sarkozy if he had to deal with not just the religious/social leanings of the Muslims, but of the Hindus, Sikhs and myriad other communities as well, as in India. We Indians not only love to stretch our family and religious festivities/gatherings to the streets, but also take it as our birth right to spit, shit, urinate, and dump garbage in them. The confines of disused barracks, discarded buildings or the lonely interiors of our humble homes are not enough for our mundane activities.

[हिंदी] The Global Asthma Report 2011 shows the tools to manage asthma exist but are not reaching many of the 235 million people affected. Asthma is the most common chronic disease among children and also affects adults. "The tools to treat asthma are already available – there is no reason to delay", says Dr Nils E Billo, Executive Director of The International Union Against Tuberculosis and Lung Disease (The Union). "Moreover, when asthma is not diagnosed, not treated or poorly managed, and when people can not access or afford treatment, they regularly end up having to miss school or work, they are unable to contribute fully to their families, communities and societies, they may require expensive emergency care, and everyone loses. The obstacles to well-managed asthma can be overcome. Asthma is a public health problem that can – and should be addressed now” added Dr Billo.

A week before the United Nations (UN) Summit on Non-Communicable Diseases (NCDs) opens, reviewing outcomes of a new global analysis on breast and cervical cancers is warranted. In developing nations, breast and cervical cancers are rapidly replacing complications from pregnancy and childbirth as the leading causes of death in women below 50 years of age. In the Middle East and North Africa, nearly 40% of all breast cancer deaths are in women of reproductive age, compared to 10% in Europe. In countries such as Bangladesh, the fraction can be higher than 50%. India has a population of 366.58 million women aged 15 years and older who are at risk of developing cervical cancer.

Voluntary medical male circumcision protects against HIV. "There are over 40 observational studies among heterosexual men, which show that circumcised men have about a 60% reduced risk of HIV compared to uncircumcised men. There were then three randomised controlled trials conducted in Sub Saharan Africa that showed circumcised men were at 60% less risk of HIV than uncircumcised men. All these three trials were stopped by independent Data Safety Monitoring Boards as the effect was so strong and it was thought unethical to not offer circumcision to men in the control arm" said Dr Helen Weiss, Reader in Epidemiology and International Health, The London School of Hygiene and Tropical Medicine (LSHTM). Dr Weiss works mainly on HIV and biomedical behavioural prevention strategies focussing mainly on sub-Saharan Africa and delivered a plenary address at the AIDS Vaccine 2011 conference in Bangkok, Thailand (12-15 September 2011).

Way back in 1997, an article ‘Hepatitis C: Waiting for the Grim Reaper’ by Alex Wodak published in Medical Journal of Australia, warned of a potential Hepatitis C epidemic, ringing the alarm bells for Australia. The author called this viral infection a public health problem comparable in magnitude with HIV, and argued that as injecting drug use is undeniably the major mode of transmission, encouraging drug users to adopt non-injecting routes of administration may be the most effective way of controlling it.

In June of this year, world leaders including the former Secretary-General of the United Nations, Kofi Annan, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) Dr Michel Kazatchkine and 5 former presidents and prime ministers, formed the Global Commission on Drug Policy, and released a report after reviewing the global body of evidence. The report’s very first sentence succinctly describes their findings: “The Global War on Drugs has failed, with devastating consequences for individuals and societies around the world.”

Lessons From Japan Film Festival 2011 is being organized in Lucknow to raise awareness about dangers of nuclear power whether used for civil or military purposes. The Lessons From Japan campaign promotes the use of indigenous energy resources such as coal, gas, hydro (small, micro dams or run of the river categories), solar, wind energy, biogas etc., and ensuring our future energy supplies from Iran and other countries in West and Central Asia. India’s future energy policy should be low carbon and no nuclear.

A new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington shows that insecticide treated bed nets (ITN) have a dramatic effect on child mortality due to malaria, reducing it by 23%. The study, “Net benefits: a multi-country analysis of observational data examining associations between insecticide-treated mosquito nets and health outcomes,” was published in PLoS (Public Library of Science) Medicine recently. The results of this study confirm that children who live in households that own at least one insecticide-treated bed net are less likely to be infected with malaria and less likely to die from the disease. The paper is focused on Africa, but the findings apply to all regions that have a significant malaria risk.

Annie Besant. Maulana Azad. M. K. Gandhi. Binayak Sen. What do they have in common? They were convicted under Section 124(A) of the Indian Penal Code (IPC) or the Sedition Act! This draconian British era legislation "criminalizes the ‘disaffection’ towards the government by words, either spoken or written, or by signs or by visible representations". Unfortunately, this law, introduced in 1860, is still being (ab)used across the country to silence many forms of democratic expression and struggle.

Fuelled by the HIV pandemic and the spread of drug-resistant strains, tuberculosis (TB) has re-emerged as a major threat to global health. TB is a curable disease that continues to affect millions of people globally each year, and is a leading cause of death in HIV positive people. According to the 2009 WHO Report on Global TB Control, there were 9.4 million new TB cases in 2008, out of which 1.4 million (14%) were HIV positive (78% of them were in Africa and 13% in Southeast Asia). Mortality from TB was 1.7 million, and about 0.5 million of these deaths were in People Living with HIV (PLHIV), who are at a much increased risk of contracting TB. In high burden HIV settings (like the sub Saharan region) more than 70% of TB patients are living with HIV. So, universal access to HIV care cannot be achieved without addressing TB.

'Production of quality affordable generic medicines is key in access to life saving /life-extending treatments for people who need it, and narrow national economic interests should not take precedence over a global commitment to save lives of People Living With HIV (PLHIV)...'. This message was brought out clearly at the recently concluded 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP), held in Busan, Korea.

The Busan Police turned violent on peaceful demonstrators at the 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP), which was attended by over 2500 delegates and one of whose main issues is to protect the human rights of populations affected with HIV/ AIDS. Activists including people living with HIV (PLHIV) from all over the world, who attended the 10th ICAAP joined Korean activists in a peaceful anti-Free-Trade Agreements (FTAs) march. Korea is in the process of signing FTA treaties with USA and the European Union (EU), and this is likely to block the production of generic medicines and increase the prices of essential medicines including antiretroviral (ARV) drugs, thus further limiting their access to those for whom they are intended.

HIV/AIDS is a serious health challenge, and the law itself is in crisis in responding to this epidemic in the Asia and the Pacific Region. The legal impediments to universal access, which also enhance stigma and discrimination, were discussed at length at the recently concluded 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP) in Busan, South Korea.