Universal Health Coverage Day launched to accelerate equitable access to healthcare

A new global coalition of more than 500 leading health and development organizations worldwide is urging governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty. The coalition was launched 12 December, on the first-ever Universal Health Coverage Day, to stress the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics such as Ebola.

Universal Health Coverage Day marks the two-year anniversary of a United Nations resolution, unanimously passed on 12 December 2012, which endorsed universal health coverage as a pillar of sustainable development and global security. Despite progress in combatting global killers such as HIV/AIDS and vaccine-preventable diseases such as measles, tetanus and diphtheria, the global gap between those who can access needed health services without fear of financial hardship and those who cannot is widening. Each year, 100 million people fall into poverty because they or a family member becomes seriously ill and they have to pay for care out of their own pockets. Around one billion people worldwide can’t even access the health care they need, paving the way for disease outbreaks to become catastrophic epidemics.

“The need for equitable access to quality health care has never been greater, and there is unprecedented demand for universal health coverage around the world,” said Michael Myers, Managing Director of The Rockefeller Foundation, which is spearheading Universal Health Coverage Day. “Universal health coverage is an idea whose time has come – because health for all saves lives, strengthens nations and is achievable and affordable for every country.”

For much of the 20th century, universal health coverage was limited to a few highincome countries, but in the past two decades, a number of lower- and middle-income countries have successfully embraced reforms to make quality health care universally available. Countries as diverse as Brazil, Ghana, Mexico, Rwanda, Turkey and Thailand have made tremendous progress toward universal health coverage in recent years. Today, the two most populous countries, India and China, are pursuing universal health coverage, and more than 80 countries have asked the World Health Organization for implementation assistance.

“Putting people’s health needs ahead of their ability to pay stems poverty and stimulates growth,” said Dr Tim Evans, Senior Director for the Health, Nutrition and Population Global Practice at the World Bank Group. “Universal health coverage is an essential ingredient to end extreme poverty and boost shared prosperity within a generation.”

The 500+ organizations participating in the first-ever Universal Health Coverage Day coalition represent a diverse crosssection of global health and development issues, including infectious diseases, maternal and child health, non-communicable diseases and palliative care. Across these issues, knowledge and technologies exist to save and improve lives in significant numbers, but the impact of these tools is severely hampered by lack of equitable access to quality health services.

Universal Health Coverage Day

Broad Institute, Harvard, MIT license CRISPR-Cas9 gene-editing technology to Editas Medicine for therapeutic applications

The Broad Institute, Harvard University, the Massachusetts Institute of Technology and Editas Medicine have entered into a worldwide license agreement to grant Editas access to intellectual property related to genome editing technology that has wideranging therapeutic potential and could lay the groundwork for treating diseases where a gene’s expression needs to be altered.

The agreement relates to technology that engineers the CRISPR-Cas9 system – a naturally-occurring part of the bacterial immune system. Researchers at Harvard Medical School, the Wyss Institute for Biologically Inspired Engineering at Harvard University, Broad Institute, MIT, the McGovern Institute for Brain Research at MIT, and Harvard University Faculty of Arts and Sciences (FAS), have optimized the CRISPR-Cas9 system to allow for insertion, replacement, and regulation of targeted genes in higher organisms, with the potential to one day be used in humans.

CRISPRs (clustered regularly interspaced short palindromic repeats) are DNA loci containing short repetitions of base sequences. Each repetition is followed by short segments of “spacer DNA” from previous exposures to a virus.

By altering gene expression with this gene-editing technology the human therapeutic applications are vast and could include turning down CCR5 gene to prevent in HIV entering its target cells, for example, or repairing gene mutations such as in sickle cell diseases or haemophilia.

In addition to their therapeutic implications, CRISPR–Cas9 systems enable scientists to modify genes and better understand the biology of living cells and organisms.

“The CRISPR-Cas9 technology represents yet another great example of how new insights into nature’s design principles can be rapidly leveraged to develop new engineering innovations, in this case genome reengineering methods that can be used to create an entirely new class of targeted therapeutics,” said Wyss Institute Founding Director Donald Ingber, M.D., Ph.D. “This breakthrough also demonstrates our collective commitment to accelerate the transition from fundamental discovery to clinical application.”

Eric Lander, president and director of the Broad Institute, said: “The Broad, MIT, and Harvard share the goal of developing innovative technologies such as CRISPR–Cas9 and promoting their translation to benefit patients. We’re committed to making these technologies broadly available for research and also ensuring that therapeutic development – bringing this technology to the clinic – has the best chance of success.”


The agreement includes a mechanism to ensure that no promising target genes will be neglected; genes that are not being pursued by Editas will be made available for licensing to other parties so that new medicines based on this technology can be developed for any disease that could be treated by this approach. Broad Institute, MIT, and Harvard University partners have made CRISPR-Cas9 technology broadly available to the research community, and have freely granted licenses to academic scientists, and non–exclusively to industry partners, for development of research tools and reagents and will continue to do so.

Also included in the agreement are additional technologies relating to engineering and optimization of transcription activator–like effector (TALE) proteins that can also be programmed to target and modify specific genes, as well as a novel protein-based drug delivery system, which could potentially achieve up to one thousand–fold more effective drug delivery than conventional methods.

“We have already seen how the CRISPR molecular system has proven to be so powerful in basic research,” said Jeffrey S. Flier, Dean of Harvard Medical School. “The potential for this approach to translate into new ways to treat human conditions that have proved vexing is compelling and warrants new and innovative collaborations among academia and industry.”

Obesity-attributable absenteeism costs US more than
$8 billion per year

A study conducted by researchers at Columbia University’s Mailman School of Public Health shows that obesity costs the United States $8.65 billion per year as a result of absenteeism in the workplace – more than 9% of all absenteeism costs. The consequences of obesity among the working population go beyond healthcare and create a financial challenge not only for the US but for individual states as well. Findings are published online in the Journal of Occupational and Environmental Medicine.

“In areas where local wage level is higher or have high burden of obesity, the value of lost productivity really adds up,” said Y. Claire Wang, MD, ScD, co-director of the Obesity Prevention Initiative at Columbia University’s Mailman School of Public Health, and senior author.

To calculate the loss in worker productivity, researchers used nationally representative data about height, weight, and missed workdays for health reasons among 14,975 people from the National Health and Nutrition Examination Survey for the years 1998 to 2008. They also analyzed body mass index (BMI) data for 2012 by state for more than 100,000 people using the Behavioral Risk Factor Surveillance System.

“Obesity and healthy-living behaviours are often seen as just individual choices,” noted Wang, Mailman School associate professor of Health Policy and Management. “But our paper really highlights the fact that the burden is beyond just individual choices.”

Previous studies of this kind tend to focus on healthcare cost resulted from treating obesity-related illness which is only one dimension of its burden to the society. For instance, in 2011, Wang and her colleagues published a study in The Lancet estimating a $66 billion higher medical expenditure by 2030 if the US trend in obesity continues. However, in thinking about obesity, especially severe obesity, as a threat to a competitive, healthy workforce, the authors present this problem as a priority from an economic standpoint. “Healthy community and healthy workers mean business.” Wang said.

Organic Vaccines in commercial evaluation agreement with US NIH over MERS

On July 7 and September 3, 2014, Organic Vaccines LLC, a 98% held subsidiary of Organic Vaccines Plc, entered into a commercial evaluation license agreement with the US National Institutes of Health and a three-year collaborative agreement with the US National Cancer Institute, with a principal goal of developing human monoclonal antibody-based techniques targeting the Middle East Respiratory Syndrome Coronovirus (MERS-CoV).

Patrick Rambaud, President and CEO of Organic Vaccines Plc commented: “These agreements shall enable OV to complement its strategy against MERS CoV. During our meeting of September 18th at the control and command center of the Ministry of Health in Jeddah (Saudi Arabia), we have explained the science and exposed our strategy. Our objective is to be at the earliest in a position to offer a stopgap treatment on a compassionate basis.

“We have already started complementary studies to meet WHO requirements and submit our dossier.”

Organic Vaccines Plc is a biopharmaceutical company focusing on the development of preventive and therapeutic vaccines produced using the patient’s own white blood cells. Areas of vaccine development cover children vaccines, flu vaccines and HPV adult vaccines (preventive and therapeutic) as well as the implementation of white blood cell banks. Vaccines should avoid side effects and will be developed using the AAPC technology (artificial antigen presenting cells). Organic Vaccines’ scientific team is a world renowned team of scientists, including Professor Bruce Beutler, recipient of the 2011 Nobel Prize for medicine.

In a statement, the company said: Most people confirmed to have MERS-CoV infection developed severe acute respiratory illness. About 43% of infected people in Saudi Arabia have died.

Organic-Vaccines is completing necessary documentation to file an authorization for compassionate use of its Monoclonal Antibodies from the WHO. The objective is to be able to combat the recurrent mortality and be prepared for a potential outbreak in springtime. Camels give birth in spring and are suspected to be the virus reservoir. A similar stopgap action in Queensland, Australia, with similar antibodies was applied successfully on humans against Nipah and Hendra viruses without any side effects. Queensland Ministry of Health has demonstrated an efficient strategy for emergency prior to develop a vaccine to be available later. Organic-Vaccines is counting on full cooperation from Jeddah’s Control and Command Center and from the Saudi MOH to meet deadlines and fasten its process for being able to protect first responders and avoid disorganization of the health system in case of emergence of a MERS CoV outbreak.

Global malaria mortality rate falls by nearly 50%

The number people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World Malaria Report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region - where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.

Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific by 2030.

In 2013, two countries reported zero indigenous cases for the first time (Azer baijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay. Uzbekistan and Turkmenistan). Another four countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under five years of age and infants.

In addition, resistance to artemisinin has been detected in five countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

World Malaria Report 2014

WHO updates guidelines for cervical cancer control

Cervical cancer is responsible for some 270,000 deaths annually worldwide with nearly nine out of 10 occurring in developing countries, but it is the most easily preventable form of cancer for women, the World Health Organization (WHO) said early December.

WHO revealed these findings in the newest version of the Comprehensive Cervical Cancer Control: A guide to essential practice, launched at the World Cancer Leaders’ Summit in Melbourne, Australia.

“WHO’s updated cervical cancer guidance can be the difference between life and death for girls and women worldwide,” Dr Nathalie Broutet, a leading WHO expert on cervical cancer prevention and control, said.

“There are no magic bullets, but the combination of more effective and affordable tools to prevent and treat cervical cancer will help release the strain on stretched health budgets, especially in low-income countries, and contribute drastically to the elimination of cervical cancer,” he added.

The main elements to prevent and control cervical cancer are to: vaccinate 9 to 13-year-old girls with two doses of the Human papillomavirus (HPV) vaccine; use HPV tests to screen women for cervical cancer prevention; and communicate more widely, according to WHO.

“The disease is one of the world’s deadliest – but most easily preventable – forms of cancer for women, responsible for more than 270,000 deaths annually, 85% of which occur in developing countries,” the UN health agency said. “An estimated 1 million-plus women worldwide are currently living with cervical cancer.”

Girls in more than 55 countries are protected by routine administration of the vaccine and encouragingly, a growing number of low- and middle-income countries are introducing the vaccine in the routine schedule, WHO said.

As for the testing to screen for the virus, once a woman has been screened negative, she should not be rescreened for at least 5 years, but should be rescreened within 10. “This represents a major cost saving for health systems, in comparison with other types of tests,” WHO said.

The new guidance, known as the “Pink Book,” provides a comprehensive cervical cancer control and prevention approach for governments and healthcare providers and underlines recent developments in technology and strategy for improving women’s access to health services to prevent and control cervical cancer.

Comprehensive cervical cancer control

WHO publishes new HIV antiretrovirals guidelines

On World AIDS Day 2014, the World Health Organization issued new recommendations to help countries close important gaps in HIV prevention and treatment services.

Despite tremendous progress in recent years, with a record 13 million people accessing antiretroviral treatment in 2013, many people still lack access to comprehensive HIV treatment and prevention services. In 2013, 2 million people were newly infected with HIV. In low and middle income countries, around 1 in 3 adults living with HIV had access to treatment. Only 1 in 4 children could get the medicines they needed, and many people with HIV still lacked the means to prevent and treat other infections.

The guidelines include advice on providing antiretroviral drugs for people who have been exposed to HIV – such as health workers, sex-workers, and survivors of rape – what is often described as “postexposure prophylaxis”, or PEP. They also include recommendations on preventing and managing common “opportunistic infections” and diseases such as severe bacterial and malaria infections.

The guidelines are published as a supplement to WHO’s 2013 consolidated guidelines on the use of antiretrovirals. The guidelines promote earlier, simpler and less toxic interventions to keep people healthier for longer, and to help prevent transmission.

On post-exposure prophylaxis for HIV and the use of Co-Trimoxazole prophylaxis for HIV-related infections


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