Initial round of funding for BRAIN initiative

The US National Institutes of Health announced its first wave of investments totaling $46 million this year to support the goals of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.

More than 100 investigators in 15 states and several countries will work to develop new tools and technologies to understand neural circuit function and capture a dynamic view of the brain in action. These new tools and this deeper understanding will ultimately catalyze new treatments and cures for devastating brain disorders and diseases that are estimated by the World Health Organization to affect more than one billion people worldwide.

Francis S. Collins, M.D., Ph.D, NIH director, said: “The human brain is the most complicated biological structure in the known universe. We’ve only just scratched the surface in understanding how it works – or, unfortunately, doesn’t quite work when disorders and disease occur.

“There’s a big gap between what we want to do in brain research and the technologies available to make exploration possible. These initial awards are part of a 12-year scientific plan focused on developing the tools and technologies needed to make the next leap in understanding the brain. This is just the beginning of an ambitious journey and we’re excited about the possibilities.”

Creating a wearable scanner to image the human brain in motion, using lasers to guide nerve cell firing, recording the entire nervous system in action, stimulating specific circuits with radio waves, and identifying complex circuits with DNA barcodes are among the 58 projects announced.

The majority of the grants focus on developing transformative technologies that will accelerate fundamental neuroscience research and include:

– classifying the myriad cell types in the brain
– producing tools and techniques for analyzing brain cells and circuits
– creating next-generation human brain imaging technology
– developing methods for large-scale recordings of brain activity
– integrating experiments with theories and models to understand the functions of specific brain circuits

“How do the billions of cells in our brain control our thoughts, feelings, and movements? That’s ultimately what the BRAIN Initiative is about,” said Thomas R. Insel, M.D., director of the NIH’s National Institute of Mental Health. “Understanding this will greatly help us meet the rising challenges that brain disorders pose.”

BRAIN initiative

Gavi pledging conference raises record $7.5bn for vaccines

Hundreds of millions of children living in the world’s poorest countries will receive life-saving vaccines as a result of recordbreaking financial commitments – totalling some US$7.5 billion – made at the Gavi Pledging Conference, hosted in Berlin by German Federal Chancellor Angela Merkel on 27 January.

The $7.5bn in pledges will enable countries to immunise an additional 300 million children, leading to 5 to 6 million premature deaths being averted and economic benefits of between US$80 and US$100 billion for developing countries through productivity gains and savings in treatment and transportation costs and caretaker wages, according to a statement issued by GAVI, the Vaccine Alliance funded by numerous governments, philanthropists and the private sector.

The $7.5bn pledged for Gavi’s replenishment will be combined with US$2bn in already assured resources for the 2016-2020 period to enable Gavi to meet the $9.5bn cost of funding vaccine programmes in developing countries over the five year period.

Chancellor Merkel was joined in Berlin by Dr Jakaya Mrisho Kikwete, President of the United Republic of Tanzania, and Ibrahim Boubacar Keïta, President of the Republic of Mali, Erna Solberg, Prime Minister of Norway, Donald Kaberuka, President of the African Development Bank, Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation, ministers from more than 20 implementing and donor countries, civil society groups, CEOs of vaccine manufacturing companies, UN agencies and others who came together to secure commitments to fully fund Gavi-supported immunisation programmes in developing countries between 2016 and 2020.

Speaking at the event, Chancellor Merkel said: “There is a long way still to go but today’s conference is an important milestone in the work of Gavi for the next few years to come. Please let us not fail, let us not lose courage but continue to put all our efforts into this wonderful work and thank all of those who are committed to this goal.”

Bill Gates said: “Today is a great day for children in the world’s poorest countries who will now receive the life-saving vaccines they need. We believe in the next 15 years, poor people’s lives will improve faster than any other period in history and that access to vaccines provided by Gavi are critical to making that happen.”

The Gavi Pledging Conference saw unprecedented engagement from donors, with many deciding to double or even triple their commitments to support Gavi in what will be its highest period of financial need.

Additionally, China, Oman, Qatar and Saudi Arabia made pledges to Gavi for the first time.

Ahead of the conference, vaccine manufacturers committed to maintaining affordable vaccine prices, a move that will not only help Gavi buy more doses with the money secured but also increase the sustainability of vaccine programmes. Countries whose economic status means they are no longer eligible for Gavi support will still have access to many vaccines at the same price Gavi pays for a number of years.

Guinea worm disease nears total eradication

There has been a drastic reduction in the number of Guinea worm cases over the past three decades which points to the success in efforts to eradicate this neglected tropical disease and raises hope for the complete eradication of the disease over the next few years.

According to a recent statement issued by the Carter Center only 126 cases of Guinea worm were reported in 2014. These provisional numbers, reported by ministries of health in the remaining four endemic nations and compiled by the Center, show that cases of the debilitating disease were reduced by 15% in 2014 compared to 148 cases in 2013. When the Center began leading the first international campaign to eradicate this parasitic disease in 1986, there were an estimated 3.5 million Guinea worm cases occurring annually in Africa and Asia.

In 1991, there were 23,735 villages with endemic transmission of Guinea worm disease in 21 countries in Africa and Asia. As of the end of 2014, there were only 30 endemic villages in four countries – all in Africa. South Sudan reported 70 cases, Chad (13), Mali (40), and Ethiopia (3).

Considered a neglected tropical disease, Guinea worm disease (dracunculiasis) is contracted when people consume water contaminated with Guinea worm larvae. After a year, a meter-long worm slowly emerges from the body through a painful blister in the skin. In the absence of a vaccine or medical treatment, the ancient disease is being wiped out mainly through community-based interventions to educate and change behavior, such as teaching people to filter all drinking water and preventing contamination by keeping anyone with an emerging worm from entering water sources.

Speaking at a New York press conference to open Countdown to Zero: Defeating Disease, a new exhibition on disease eradication created by the American Museum of Natural History in collaboration with The Carter Center, former US President Jimmy Carter, whose Carter Center leads the international campaign to eradicate this waterborne disease, said: The number of cases of Guinea worm disease continued decreasing in 2014, bringing Guinea worm eradication closer to the finish line.

“We believe eradication of Guinea worm disease is very possible in the next few years, but success will require the strong commitment and focus of the four remaining endemic countries and the many international partners in this public health initiative.”

WHO calls for investment to tackle neglected tropical diseases

The World Health Organization (WHO) issued a report in February which urges affected countries to scale up their investment in tackling 17 neglected tropical diseases in order to improve the health and well-being of more than 1.5 billion people. This investment would represent as little as 0.1% of current domestic expenditure on health in affected low and middle income countries for the period 2015-2030.

Neglected tropical diseases cause blindness, disfigurement, permanent disability and death, particularly among the poor. WHO’s new report, Investing to Overcome the Impact of Neglected Tropical Diseases, outlines an investment case and essential package of interventions for these diseases.

In the face of climate change countries need to strengthen their ability to anticipate and meet new challenges in terms of vector ecology and management. Diseases spread by insects are on the move because of rapid and unplanned urbanization, population movement and environmental change. Dengue is one of them: it is now present in more than 150 countries.

“Some of the neglected tropical diseases are no longer strictly tropical,” says Dr Dirk Engels, Director of the WHO Control of Neglected Tropical Diseases Department. “The potential for spread provides yet another strong argument for making the needed investments – while ramping up research and development efforts – to bring all these diseases under control and eliminate as many of them as rapidly as possible.”

Dr Margaret Chan, WHO DirectorGeneral, says: “Increased investments by national governments can alleviate human misery, distribute economic gains more evenly and free masses of people long trapped in poverty.”

The report highlights progress made in recent years, largely attributed to a scaleup of control interventions in reaching the poorest. For example, in 2012 alone, more than 800 million people were treated for at least one neglected tropical disease.

In 2014 there were just 126 cases reported of Dracunculiasis (guinea-worm disease), compared to almost 1800 in 2010 and 3.5 million in the mid-1980s. Eradication of this disease is achievable with continued effort and investment. The report sets specific investment targets for many of the 17 diseases. It stresses that countries must make firm and sustainable budgetary commitments if they are to meet WHO targets and accelerate progress.

Investing to Overcome the Impact of Neglected Tropical Diseases

New resistance to antimalarial drug artemisinin poses global threat

Resistance to the antimalarial drug artemisinin is established in Myanmar posing a serious threat to the global control and eradication of malaria.

Artemisinin resistance has reached within 25 km of the Indian border and threatens to follow the same historical trajectory from Southeast Asia to the Indian subcontinent seen in the past with other antimalarial medicines, says the Wellcome Trust.

Atemisinin is the frontline treatment against malaria infection. If drug resistance spreads from Asia to the African sub-continent, or emerges in Africa independently as we’ve seen several times before, millions of lives will be at risk.

Professor Mike Turner, Head of Infection and Immunobiology at the Wellcome Trust, said: “Drug-resistant malaria parasites in the 1960s originated in Southeast Asia and from there spread through Myanmar to India, and then to the rest of the world where it killed millions of people. The new research shows that history is repeating itself with parasites resistant to artemisinin drugs, the mainstay of modern malaria treatment, now widespread in Myanmar. We are facing the imminent threat of resistance spreading into India, with thousands of lives at risk.”

The collection of samples from across Myanmar and its border regions was led by Dr Kyaw Myo Tun of the Defence Services Medical Research Centre, Napyitaw, Myanmar, and coordinated by the Mahidol-Oxford Tropical Medicine Research Unit (MORU) in Bangkok, Thailand – a collaboration between Mahidol University in Thailand and Oxford University and the Wellcome Trust in the UK.

The researchers examined whether parasite samples collected at 55 malaria treatment centres across Myanmar carried mutations in specific regions of the parasite’s kelch gene (K13), a known genetic marker of artemisinin drug resistance. The team confirmed resistant parasites in Homalin, Sagaing Region, located only 25 km from the Indian border.

“Myanmar is considered the frontline in the battle against artemisinin resistance as it forms a gateway for resistance to spread to the rest of the world,” said Dr Charles Woodrow from the Mahidol-Oxford Tropical Medicine Research Unit and senior author of the study at Oxford University.

“With artemisinins we are in the unusual position of having molecular markers for resistance before resistance has spread globally.

The more we understand about the current situation in the border regions, the better prepared we are to adapt and implement strategies to overcome the spread of further drug resistance.”

Professor Philippe Guerin, Director of the Worldwide Antimalarial Resistance Network (WWARN) and coauthor of the study, said: “This study highlights that the pace at which artemisinin resistance is spreading or emerging is alarming.”

Gathering near ‘real-time’ information on malaria drug resistance is crucial to help predict the geographic routes of drug resistance and inform national and regional patient treatment strategies. Mapping the spread together with a more systematic review and revision of medicine dosing strategies, especially for vulnerable groups such as children and pregnant women, will help to preserve and ultimately prolong the lifespan of these life-saving medicines.

It is only through researchers, policy makers, doctors and funding partners working collaboratively that the global health community can minimise the threat of resistance and safeguard the vital public health gains we have made in malaria control and elimination.

WHO calls for worldwide adoption of ‘smart’ syringes

Use of the same syringe or needle to give injections to more than one person is driving the spread of a number of deadly infectious diseases worldwide. Millions of people could be protected from infections acquired through unsafe injections if all healthcare programmes switched to syringes that cannot be used more than once. For these reasons, the WHO is launching a new policy on injection safety to help all countries tackle the pervasive issue of unsafe injections.

A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with hepatitis B virus, up to 315,000 with hepatitis C virus and as many as 33,800 with HIV through an unsafe injection. New WHO injection safety guidelines and policy released in February provide detailed recommendations highlighting the value of safety features for syringes, including devices that protect health workers against accidental needle injury and consequent exposure to infection.

The WHO also stresses the need to reduce the number of unnecessary injections as a critical way of reducing risk. There are 16 billion injections administered every year. Around 5% of these injections are for immunizing children and adults, and 5% are for other procedures like blood transfusions and injectable contraceptives. The remaining 90% of injections are given into muscle (intramuscular route) or skin (subcutaneous or intradermal route) to administer medicines. In many cases these injections are unnecessary or could be replaced by oral medication.

“We know the reasons why this is happening,” says Dr Edward Kelley, Director of the WHO Service Delivery and Safety Department. One reason is that people in many countries expect to receive injections, believing they represent the most effective treatment. Another is that for many health workers in developing countries, giving injections in private practice supplements salaries that may be inadequate to support their families.”

Transmission of infection through an unsafe injection occurs all over the world. For example, a 2007 hepatitis C outbreak in the state of Nevada, US, was traced to the practices of a single physician who injected an anaesthetic to a patient who had hepatitis C. The doctor then used the same syringe to withdraw additional doses of the anaesthetic from the same vial – which had become contaminated with hepatitis C virus – and gave injections to a number of other patients. In Cambodia, a group of more than 200 children and adults living near the country’s second largest city, Battambang, tested positive for HIV in December 2014. The outbreak has been since been attributed to unsafe injection practices.

The new “smart” syringes WHO recommends for injections into the muscle or skin have features that prevent re-use. Some models include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back, while in others the needle retracts into the syringe barrel at the end of the injection.

The WHO is urging countries to transition, by 2020, to the exclusive use of the new “smart” syringes, except in a few circumstances in which a syringe that blocks after a single use would interfere with the procedure. One example is when a person is on an intravenous pump that uses a syringe.

Pamela Paulk appointed head of Johns Hopkins Medicine International

Pamela Paulk, M.S.W., M.B.A., has been named president of Johns Hopkins Medicine International, the division of Johns Hopkins Medicine that develops international health care collaborations and provides medical concierge services for patients who travel from other regions to receive care at Johns Hopkins. Paulk was due to assume the role on March 1.

Throughout her 40-year career, including her most recent role as senior vice president of human resources for Johns Hopkins Medicine and the Johns Hopkins Health System, Paulk has distinguished herself through her exceptional ability to lead in complex environments, integrate large-scale operations and develop constructive business relationships across diverse groups.

Over the past 17 years, the organization has entered into more than 50 collaborations in nearly every region in the world, including a recent joint venture in Saudi Arabia designed to strengthen the health care delivery system for Saudi Aramco’s 350,000 employees, beneficiaries and retirees. These collaborations are designed to leverage Johns Hopkins’ extensive expertise in medicine, nursing, public health, medical education, research and health care administration while tailoring this knowledge to local needs and culture in a way that advances health care in the region.

“For the last 17 years, Johns Hopkins Medicine International has been a pioneer in improving health care around the world by tapping into Johns Hopkins’ leading-edge patient care and vast knowledge base,” says Christopher W. Kersey, M.D., M.B.A., chairman of the board of Johns Hopkins Medicine International. “Pamela possesses a truly unique combination of skills – a stellar operational track record and outstanding leadership skills – that will be necessary to take Johns Hopkins Medicine International to the next level.”

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