UN adopts new framework for world drug problemn

The United Nations 19 April adopted a new framework which puts people at the centre of global policies on drug control.

Speaking at the UN General Assembly special session on the world drug problem (UNGASS), Yury Fedotov, Executive Director of UNODC, told delegates: “Putting people first means reaffirming the cornerstone principles of the global drug control system, and the emphasis on the health and welfare of humankind that is the founding purpose of the international drug conventions.

“Putting people first means balanced approaches that are based on health and human rights, and promote the safety and security of all our societies. Putting people first means looking to the future, and recognizing that drug policies must most of all protect the potential of young people and foster their healthy styles of life and safe development,” he added.

Dr Margaret Chan, the Director-General of the UN World Health Organization, said an estimated 27 million people have drug use disorders, and more than 400,000 of them die each year. “The health and social harm caused by the illicit use of psychoactive drugs is enormous. This harm includes direct damage to the physical and mental health of users, drastically reducing the length and quality of their lives,” she warned.

“In the view of WHO, drug policies that focus almost exclusively on use of the criminal justice system need to be broadened by embracing a public health approach. A public health approach starts with the science and the evidence. It tells us several things,” she added.

Dr Chan said the evidence shows that drug use can be prevented, drug use disorders can be treated, drug dependence that contributes to crime can be diminished, and people with drug dependence can be helped and returned to productive roles in society.

“WHO promotes a comprehensive package of interventions to achieve these objectives. The evidence shows they work,” she stressed, urging Member States to “remember the people” when they begin to implement the new framework.

Developing countries face health financing crisis

Two major studies published in The Lancet in April reveal the health financing crisis facing developing countries as a result of low domestic investment and stagnating international aid, which could leave millions of people without access to even the most basic health services.

Analysing national health spending and global health funding, two studies led by worldwide monitor Update from around the globe Dr Joseph Dieleman from the Institute for Health Metrics and Evaluation (IHME), Seattle, USA, should be a wake-up call to global leaders and governments to deliver greater investment in health.

“Despite tremendous need, our results show that tepid growth in health spending is likely in many of the poorest countries with the largest disease burdens over the next 25 years,” says Dr Dieleman. “Historically, some of these financing gaps have been filled by international aid. But, funding growth has stalled in recent years and future projections suggest that global health funding may not be sufficient to bridge the gap.”

He adds: “These changes in the growth and focus of international aid could have a serious impact on over 15 million people taking antiretroviral therapy in developing countries and on health services in some low-income countries, particularly in sub- Saharan Africa where HIV/AIDS, tuberculosis, and malaria remain among the top threats to health.”

Global health funding increased substantially after 2000, just as the United Nations established the Millennium Development Goals (MDGs). The majority of funding over the past 16 years, almost US$255 billion (around 60% of all international aid) has been focused on MDGrelated health areas. Between 2000 and 2009, growth in aid was greatest for HIV/ AIDS, malaria and tuberculosis. But since 2010, aid for maternal health and newborn and child health has slowed less than funding for other health focus areas, such as HIV/AIDS

“The era of major growth in international aid for health has, at least temporarily, seemed to have ended. This may lead to substantial shifts in how global health is financed. Much will depend on how donors target their scarce resources and how governments fill gaps,” says Dr Dieleman. “Substantial variation between countries and across time, highlights the enormous potential for governments and donors to show their ongoing commitment to ensuring essential health services are affordable to those most in need.”

They report’s authors conclude: “While the challenge is daunting, attaining universal health coverage and its sustainable financing by 2030 is feasible for most countries. Success will depend on governments and partners aligning their objectives into a coordinated strategic effort.”

  • doi: 10.1016/S0140-6736(16)30167-2

Endgame for polio

In a massive undertaking aimed at stamping out polio once and for all – dubbed ‘the switch’ – a United Nations-backed eradication initiative was due late April to begin the largest and fastest globally coordinated rollout of a vaccine into routine immunization programmes in history.

The Global Polio Eradication Initiative (GPEI) announced 14 April that between 17 April and 1 May, 155 countries and territories around the world will stop using the trivalent oral polio vaccine (tOPV), which protects against all three strains of wild poliovirus, and replace it with bivalent OPV (bOPV), which protects against the remaining two wild polio strains, types 1 and 3.

This effort will provide better protection for children against polio, particularly those most vulnerable to infection, the Initiative said in a press release from its partners, which include the World Health Organization (WHO), the UN Children’s Fund (UNICEF), Rotary International, the United States Centers for Disease Control and Prevention (CDC).

This transition, referred to as the global vaccine ‘switch,’ is possible because type 2 wild polio has been eradicated. The switch has been recommended by the Strategic Advisory Group of Experts on Immunization and endorsed by the World Health Assembly as a critical component of the polio endgame strategy.

“We’re closer than ever to ending polio worldwide, which is why we are able to move forward with the largest and fastest globally synchronized vaccine switch ever,” said Michel Zaffran, Director of Polio Eradication at WHO. “It is a massive undertaking, but it is testimony to how much progress is being made toward achieving a lasting polio-free world and to the commitment of all countries to make this dream a reality,” he explained.

According to the initiative, currently, only two countries remain that have not stopped endemic transmission of wild polio: Pakistan and Afghanistan. In 2015, 74 cases of wild poliovirus and 32 cases of circulating vaccine-derived poliovirus were recorded.

The oral polio vaccine (OPV) has been used to stop polio in most of the world. On very rare occasions in under-immunized populations, the live weakened virus contained in OPV can mutate and cause circulating vaccine-derived polioviruses (cVDPV). More than 90% of cVDPV cases in the last 10 years have been caused by the type 2 vaccine strain.

Withdrawing tOPV and replacing it in routine immunization programs with bOPV will eliminate the risks associated with the type 2 vaccine strain and, just as importantly, boost protection against the two remaining wild strains of the virus, noted the Initiative.

The switch must be globally synchronized because if some countries continue to use tOPV it could increase the risk of the spread of type 2 poliovirus to those no longer using tOPV. The switch is the first major step toward the eventual removal of all OPV after wild polio transmission has been stopped.

“This is an extremely important milestone in achieving a polio free world,” said Reza Hossaini, Chief of Polio at UNICEF. “Hundreds of thousands of vaccinators and health workers have been trained for the switch to happen quickly and effectively, so that children everywhere can be protected from this devastating disease.”

Health needs from humanitarian emergencies at an all-time high

WHO and partners need US$2.2 billion to provide lifesaving health services to more than 79 million people in more than 30 countries facing protracted emergencies this year, according to WHO’s Humanitarian Response Plans 2016.

WHO and health partners are working together to provide urgent health services including essential medicines, vaccines and treatment for diseases such as cholera and measles, often in insecure and extremely difficult settings. Collectively we need $ 2.2 billion to provide lifesaving health services, of which WHO is appealing for $480 million.

“The risks to health caused by humanitarian emergencies are at an all-time high,” says Dr Bruce Aylward, Executive Director a.i., Outbreaks and Health Emergencies, WHO. “And the situation is getting worse. The increasing impact of protracted conflict, forced displacement, climate change, unplanned urbanization and demographic changes all mean that humanitarian emergencies are becoming more frequent and severe.”

In Syria, one of the biggest humanitarian emergencies, WHO and partners are seeking funds to provide 11.5 million people with health services including trauma and mental health care, and to provide vaccines, medicines and surgical supplies to almost 5 million Syrian refugees living in neighbouring countries.

WHO also needs urgent funds to support 6.8 million people threatened by the worst drought in decades in Ethiopia, with one of the priorities to provide emergency health services to save the lives of more than 400,000 severely malnourished children.

In addition to more than 30 protracted emergencies, WHO is also responding to sudden onset emergencies, such as Cyclone Winston that impacted Fiji in February 2016, and to infectious disease outbreaks including Zika virus, the remaining risks of Ebola in West Africa and Angola’s worst outbreak of yellow fever in 30 years.

In one of the most profound transformations in its history, WHO is rolling out a new Health Emergencies Programme that will increase operational capacity in countries and enable a faster, effective and predictable response to all kinds of health emergencies including outbreaks and humanitarian crises.

WHO Humanitarian Response Plan 2016
www.who.int/hac/donorinfo/2016/who_ humanitarian_response_plan_2016.pdf

WHO, OIE launch new global framework to eliminate rabies

A new framework to eliminate human rabies and save tens of thousands of lives each year has been launched in December by WHO, the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and the Global Alliance for the Control of Rabies (GARC).

The framework calls for three key actions – making human vaccines and antibodies affordable, ensuring people who get bitten receive prompt treatment, and mass dog vaccinations to tackle the disease at its source.

“Rabies is 100% preventable through vaccination and timely immunization after exposure, but access to post-bite treatment is expensive and is not affordable in many Asian and African countries. If we follow this more comprehensive approach, we can consign rabies to the history books,” said Dr Margaret Chan, WHO Director- General.

Tens of thousands of people die from rabies each year and, worldwide, 4 out of every 10 people bitten by suspected rabid dogs are children aged under 15 years. One person dies every 10 minutes, with the greatest burden in Asia and Africa.

The cost of vaccines to protect humans from rabies is, however, beyond the reach of many of those who may need it. And treatment for people who are bitten can cost US$40-50, representing an average of 40 days of wages in some of the affected countries. Recognizing that human vaccination is currently not always affordable, the new framework emphasizes prevention through vaccinating dogs – whose bites cause 99% of all human rabies cases. A dog vaccine costs less than US$1.

“Vaccinating 70% of dogs regularly in zones where rabies is present can reduce human cases to zero. Eliminating canine rabies through dog vaccination is the most cost-effective and only long-term solution,” states OIE Director-General Dr Bernard Vallat. “Human deaths can be prevented when mass dog vaccination is combined with responsible pet ownership and stray dog population management, both complying with OIE intergovernmental standards, as well as with bite treatment, as recommended by WHO.”

Whilst vaccinating dogs will be key in the new approach, the elimination of rabies – and saving the lives of those who are bitten – will not be possible without more widely-available human vaccines.

Currently, about 80% of people exposed to rabies live in poor, rural areas of Africa and Asia with no access to prompt treatment should they be bitten. Bringing treatment closer to victims and providing wider access to affordable vaccines and potent rabies immunoglobulins, which neutralize the rabies virus before it can get a hold in the body, are vital to achieving zero rabies deaths.

Bringing down the cost of human rabies vaccines and treatments will require strong international collaboration to make quality-assured vaccines and rabies immunoglobulin available to health centres in regions where rabies is endemic.

As of 2015, WHO and the OIE Vaccine Bank have delivered more than 15 million doses of canine rabies vaccines in many countries.

New study shows more people are obese than underweight worldwide

In the past 40 years, there has been a startling increase in the number of obese people worldwide – rising from 105 million in 1975 to 641 million in 2014, according to the most comprehensive analysis of trends in body mass index (BMI) to date, published in The Lancet.

The age-corrected proportion of obese men has more than tripled (3.2% to 10.8%), and the proportion of obese women has more than doubled (6.4% to 14.9%) since 1975. At the same time, the proportion of underweight people fell more modestly – by around a third in both men (13.8% to 8.8%) and women (14.6% to 9.7%).

Over the past four decades, the average age-corrected BMI increased from 21.7kg/ m² to 24.2 kg/m² in men and from 22.1kg/ m² to 24.4 kg/m² in women, equivalent to the world’s population becoming on average 1.5kg heavier each decade. If the rate of obesity continues at this pace, by 2025 roughly a fifth of men (18%) and women (21%) worldwide will be obese, and more than 6% of men and 9% of women will be severely obese (35 kg/m² or greater).

However, excessively low body weight remains a serious public health issue in the world’s poorest regions, and the authors warn that global trends in rising obesity should not overshadow the continuing underweight problem in these poor nations. For example, in south Asia almost a quarter of the population are still underweight, and in central and east Africa levels of underweight still remain higher than 12% in women and 15% in men.

“Over the past 40 years, we have changed from a world in which underweight prevalence was more than double that of obesity, to one in which more people are obese than underweight,” explains senior author Professor Majid Ezzati from the School of Public Health at Imperial College London, London, UK. “If present trends continue, not only will the world not meet the obesity target of halting the rise in the prevalence of obesity at its 2010 level by 2025, but more women will be severely obese than underweight by 2025.”

He adds: “To avoid an epidemic of severe obesity, new policies that can slow down and stop the worldwide increase in body weight must be implemented quickly and rigorously evaluated, including smart food policies and improved health-care training.”

The findings come from a comprehensive new analysis of the global, regional, and national trends in adult (aged 18 and older) BMI between 1975 and 2014. For the first time, this includes the proportion of individuals classified as underweight (less than 18.5 kg/m²), and severely obese (35 kg/m² or higher) and morbidly obese (40 kg/m² or higher).

  • doi: 10.1016/S0140-6736(16)30054-X



Date of upload: 15th Mar 2016

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