Most of 3000 adolescent deaths a day are preventable

Dr Tedros Adhanom Ghebreyesus, the new Director-General of the WHO, spoke at the recent ‘Belt and Road Forum for Health Cooperation: Towards a Health Silk Road’ in Beijing. Following is an excerpt of his speech.

As you know, the world faces increasing and more complex epidemics, pandemics and disasters. Not only are these events more likely to occur, they’re also likely to have a bigger impact on human health, the social fabric, security and the economy.

As a community, as countries that are inextricably linked, we are only as strong as our weakest link.

And this is why a global initiative that elevates health to the centre of economic and social development is immensely encouraging.

[Chinese] President Xi’s proposal for a Health Silk Road, which strengthens and renews ancient links between cultures and people, with health at its core, is indeed visionary.

If we are to secure the health of the billions of people represented here, we must seize the opportunities the Belt and Road Initiative provides.

But how can we accomplish this? Her Excellency [Liu Yandong] has said most of them.

First, we must put in place systems to contain outbreaks or crises where they start, and prevent them from becoming epidemics.

WHO has proposed a strategic partnership with China to target vulnerable countries along the Belt and Road and in Africa.

Among these there are countries in conflict, or coming out of conflict.

We are committed to building response capacity for emergencies, as well as to provide essential health services to countries in crisis.

Second, health is a human right. People should never have to choose between getting the care they need and financial hardship or impoverishment.

The Belt and Road Initiative contains the fundamentals to achieve universal health coverage: infrastructure, access to medicines, human resources, and a platform to share experience and promote best practices.

Third, women, children, and adolescents must be at the centre of global health and development. Women and children are particularly hard hit in emergencies. We need to take concrete steps to protect them, and no thing will help this often vulnerable group more than universal health coverage.

China has much to teach us about these issues.

It is a world leader in disease surveillance and outbreak control, and was one of the first countries to step in during the Ebola outbreak.

China has built a nationwide health insurance scheme that covers more than 95% of its population.

The country also has a great capacity for research and development, and was one of the first countries to meet the Millennium Development Goal for maternal health.

We should build upon these experiences. We will adopt the outcomes document for this event, and begin technical expert discussions to ensure that our words turn into action.


No country meets standards for breastfeeding – UNICEF

No country in the world fully meets recommended standards for breastfeeding, according to a new report by UNICEF and worldwide monitor WHO in collaboration with the Global Breastfeeding Collective, a new initiative to increase global breastfeeding rates.

The Global Breastfeeding Scorecard, which evaluated 194 nations, found that only 40% of children younger than six months are breastfed exclusively (given nothing but breastmilk) and only 23 countries have exclusive breastfeeding rates above 60%.

Evidence shows that breastfeeding has cognitive and health benefits for both infants and their mothers. It is especially critical during the first six months of life, helping prevent diarrhoea and pneumonia, two major causes of death in infants. Mothers who breastfeed have a reduced risk of ovarian and breast cancer, two leading causes of death among women.

“Breastfeeding gives babies the best possible start in life,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “Breastmilk works like a baby’s first vaccine, protecting infants from potentially deadly diseases and giving them all the nourishment they need to survive and thrive.”

The scorecard was released at the start of World Breastfeeding Week alongside a new analysis demonstrating that an annual investment of only US$4.70 per newborn is required to increase the global rate of exclusive breastfeeding among children under six months to 50% by 2025.

Nurturing the Health and Wealth of Nations: The Investment Case for Breastfeeding, suggests that meeting this target could save the lives of 520,000 children under the age of five and potentially generate $300 billion in economic gains over 10 years, as a result of reduced illness and healthcare costs and increased productivity.

“Breastfeeding is one of the most effective – and cost effective – investments nations can make in the health of their youngest members and the future health of their economies and societies,” said Anthony Lake, UNICEF Executive Director. “By failing to invest in breastfeeding, we are failing mothers and their babies – and paying a double price: in lost lives and in lost opportunity.”

The investment case shows that in five of the world’s largest emerging economies – China, India, Indonesia, Mexico and Nigeria – the lack of investment in breastfeeding results in an estimated 236,000 child deaths per year and $119 billion in economic losses.

Globally, investment in breastfeeding is far too low. Each year, governments in lower- and middle-income countries spend approximately $250 million on breastfeeding promotion; and donors provide only an additional $85 million.

The Global Breastfeeding Collective is calling on countries to:

• Increase funding to raise breastfeeding rates from birth through two years.

• Fully implement the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest.

• Enact paid family leave and workplace breastfeeding policies, building on the International Labour Organization’s maternity protection guidelines as a minimum requirement, including provisions for the informal sector.

• Implement the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.

• Improve access to skilled breastfeeding counselling as part of comprehensive breastfeeding policies and programmes in health facilities.

• Strengthen links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.

• Strengthen monitoring systems that track the progress of policies, programmes, and funding towards achieving both national and global breastfeeding targets.

Breastfeeding is critical for the achievement of many of the Sustainable Development Goals. It improves nutrition (SDG2), prevents child mortality and decreases the risk of non-communicable diseases (SDG3), and supports cognitive development and education (SDG4). Breastfeeding is also an enabler to ending poverty, promoting economic growth and reducing inequalities.

The Global Breastfeeding Scorecard http://uni.cf/breastfeeding


Scientists replay movie encoded on DNA

For the first time, a primitive movie has been encoded in – and then played back from – DNA in living cells. Scientists funded by the US National Institutes of Health say it is a major step toward a “molecular recorder” that may someday make it possible to get read-outs, for example, of the changing internal states of neurons as they develop.

“We want to turn cells into historians,” explained neuroscientist Seth Shipman, Ph.D., a post-doctoral fellow at Harvard Medical School, Boston. “We envision a biological memory system that’s much smaller and more versatile than today’s technologies, which will track many events non-intrusively over time.”

Shipman, Harvard’s Drs. George Church, Jeffrey Macklis and Jeff Nivala report on their proof-of-concept for a futuristic “molecular ticker tape” online July 12, in the journal Nature. The work was funded by NIH’s National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, and the National Human Genome Research Institute.

The ability to record such sequential events like a movie at the molecular level is key to the idea of reinventing the very concept of recording using molecular engineering, say the researchers. In this scheme, cells themselves could be induced to record molecular events – such as changes in gene expression over time -- in their own genomes. Then the information could be retrieved simply by sequencing the genomes of the cells it is stored in.

“If we had those transcriptional steps, we could potentially use them like a recipe to engineer similar cells,” added Shipman.

These could be used to model disease – or even in therapies.”

For starters, the researchers had to show that DNA can be used to encode not just genetic information, but any arbitrary sequential information into a genome. For this they turned to the cutting-edge, gene editing technology CRISPR. They first demonstrated that they could encode and retrieve an image of the human hand in DNA inserted into bacteria. They then similarly encoded and reconstructed frames from a classic 1870s race horse in motion sequence of photos – an early forerunner of moving pictures.

The researchers had previously shown that they could use CRISPR to store sequences of DNA in bacteria. CRISPR is a group of proteins and DNA that act as an immune system in some bacteria, vaccinating them with genetic memories of viral infections. When a virus infects a bacterium, CRISPR cuts out part of the foreign DNA and stores it in the bacteria’s own genome. The bacterium then uses the stored DNA to recognize the virus and defend against future attacks.

“The sequential nature of CRISPR makes it an appealing system for recording events over time,” explained Shipman.

The researchers then similarly translated five frames from the race horse in motion photo sequence into DNA. Over the course of five days, they sequentially treated bacteria with a frame of translated DNA. Afterwards, they were able to reconstruct the movie with 90% accuracy by sequencing the bacterial DNA.

Although this technology could be used in a variety of ways, the researchers ultimately hope to use it to study the brain.

“We want to use neurons to record a molecular history of the brain through development,” said Shipman. “Such a molecular recorder will allow us to eventually collect data from every cell in the brain at once, without the need to gain access, to observe the cells directly, or disrupt the system to extract genetic material or proteins.”

  • doi: 10.1038/nature23017

Global hepatitis burden improving

New WHO data from 28 countries – representing approximately 70% of the global hepatitis burden – indicate that efforts to eliminate hepatitis are gainingmomentum. Published to coincide with World Hepatitis Day on 28 July, the data reveal that nearly all 28 countries have established high-level national hepatitis elimination committees (with plans and targets in place) and more than half have allocated dedicated funding for hepatitis responses.

On World Hepatitis Day, WHO called on countries to continue to translate their commitments into increased services to eliminate hepatitis. The WHO has also added a new generic treatment to its list of WHO-prequalified hepatitis C medicines to increase access to therapy, and is promoting prevention through injection safety: a key factor in reducing hepatitis B and C transmission.

“It is encouraging to see countries turning commitment into action to tackle hepatitis.” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Identifying interventions that have a high impact is a key step towards eliminating this devastating disease. Many countries have succeeded in scaling-up the hepatitis B vaccination. Now we need to push harder to increase access to diagnosis and treatment.”

World Hepatitis Day 2017 was commemorated under the theme “Eliminate Hepatitis” to mobilize intensified action towards the health targets in the 2030 Sustainable Development Goals. In 2016, the World Health Assembly endorsed WHO’s first global health sectors strategy on viral hepatitis to help countries scale up their responses.

The new WHO data show that more than 86% of countries reviewed have set national hepatitis elimination targets and more than 70% have begun to develop national hepatitis plans to enable access to effective prevention, diagnosis, treatment and care services. Furthermore, nearly half of the countries surveyed are aiming for elimination through providing universal access to hepatitis treatment. But WHO is concerned that progress needs to speed up.

“The national response towards hepatitis elimination is gaining momentum. However, at best one in ten people who are living with hepatitis know they are infected and can access treatment. This is unacceptable,” said Dr Gottfried Hirnschall, WHO’s Director of the HIV Department and Global Hepatitis Programme.

“For hepatitis elimination to become a reality, countries need to accelerate their efforts and increase investments in lifesaving care. There is simply no reason why many millions of people still have not been tested for hepatitis and cannot access the treatment for which they are in dire need.”

Viral hepatitis affected 325 million people worldwide in 2015, with 257 million people living with hepatitis B and 71 million people living with hepatitis C – the two main killers of the five types of hepatitis. Viral hepatitis caused 1.34 million deaths in 2015 – a figure close to the number of TB deaths and exceeding deaths linked to HIV.

Hepatitis C can be completely cured with direct acting antivirals (DAAs) within 3 months. However, as of 2015, only 7% of the 71 million people with chronic hepatitis C had access to treatment.

WHO is working to ensure that DAAs are affordable and accessible to those who need them. Prices have dropped dramatically in some countries (primarily in some high-burden, low-and lower middle income countries), facilitated by the introduction of generic versions of these medicines. The list of DAAs available to countries for treating hepatitis C is growing.

WHO has just prequalified the first generic version of one of these drugs: sofosbuvir. The average price of the required three-month treatment course of this generic is between US$260 and $280, a small fraction of the original cost of the medicine when it first went on the market in 2013. WHO prequalification guarantees a product’s quality, safety and efficacy and means it can now be procured by the United Nations and financing agencies such as UNITAID, which now includes medicines for people living with HIV who also have hepatitis C in the portfolio of conditions it covers.

With high morbidity and mortality globally, there is great interest also in the development of new therapies for chronic hepatitis B virus infection. The most effective current hepatitis B treatment, tenofovir, (which is not curative and which in most cases needs to be taken for life), is available for as low as $48 per year in many low and middle income countries. There is also an urgent need to scale up access to hepatitis B testing.

Use of contaminated injection equipment in healthcare settings accounts for a large number of new HCV and HBV infections worldwide, making injection safety an important strategy. Others include preventing transmission through invasive procedures, such as surgery and dental care; increasing hepatitis B vaccination rates and scaling up harm reduction programmes for people who inject drugs.

WHO has launched a range of new educational and communication tools to support a campaign entitled “Get the Point- Make smart injection choices” to improve injection safety in order to prevent hepatitis and other bloodborne infections in health-care settings.

Injection Best Practice Guidelines http://tinyurl.com/ya4et56b

World Hepatitis Summit

World Hepatitis Summit 2017, 1–3 November in Săo Paulo, Brazil, promises to be the largest global event to advance the viral hepatitis agenda, bringing together key players to accelerate the global response. Organised jointly by WHO, the World Hepatitis Alliance (WHA) and the Government of Brazil, the theme of the Summit is “Implementing the Global health sector strategy on viral hepatitis: towards the elimination of hepatitis as a public health threat”.

 

 

 

 

Date of upload: 22nd Sep 2017

                                  
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