Big news came last week when the Obama administration finally named a new administrator for USAID – Raj Shah. Shah formerly worked at US Department for Agriculture as well as the Gates Foundation, helping them develop new initiatives such as GAVI.
He’s got an impressive resume, with a strong history developing innovative global health programs and working with many partners. An appointment long over-due, Shah will face an uphill climb, with an agency that has seen its mission be questioned and its morale decline. The Obama administration has been working behind the scenes for months now on re-orienting their foreign aid and global health strategy, and hopefully Shah’s nomination will now get the ball rolling. We’re curious as to what the plan really is.
The buzz on the nomination of Shah has largely been positive, and there are hopes that this will be an inspired choice. However, he’s not as well known as some names that had been discussed for the job, and there are serious questions that a 36 year old doctor can possess the gravitas to really elevate foreign aid as a key priority in DC. Innovative ideas matter in DC, but so do the backgrounds of the people proposing them. We certainly wish Shah the best on this job, because the position has the potential to shape the lives of literally billions of people across our planet.
GlaxoSmithKline and Pfizer just spun off each of their AIDS drug divisions to form a new join company, ViiV Healthcare.
Dominque Lement, the newly appointed head of ViiV HealthCare, thinks this could be a new path to innovation:
Our intent is to look at what we can do with the portfolio we get from Pfizer and Glaxo to build new combinations which will completely transform the way we treat HIV.
Mark Harrington of the Treatment Action Campaign has his doubts:
We’d love to be proved wrong, but we’re worried that fewer companies in the field could mean innovation is slowed down.
It might just be my raising in the capitalism of the US, but I tend to think that Mark is right on this one. This is a realm where we want feisty competition driving drug makers to out-produce and out-innovate their rivals.
I don’t know about everyone else, but I’ve been eating up the most recent TED talks. Rory Sutherland’s chat has been particularly intriguing to me:
Mr. Sutherland makes an ingenious point about how human beings make valuations. Perceived value is more important than the real value of a product. This video begs the question: how do we add a certain perceived value on top of the real value we already see in making global health more equitable?
As reported in a recent article in Foreign Policy magazine, the prohibitive cost of ACT (Artemisinin combination therapy) often leads to many people relying on outdated – and ineffective – malarial medications:
Over a million people die unnecessarily from malaria in Africa, according to a survey by ACTWatch … of seven countries in Africa … found that most people in these countries are obtaining ineffective anti-malarials in the private market, due to the low availability and high prices of the far more successful… ACT. ACT costs 20 times more than the older medications to which malaria has developed resistance. At about $11 it’s 65 times more than the average daily wage in many of these countries.
Here’s a video from the Gates Foundation giving an overview of some modern day polio eradication efforts, and, specifically, how the mapping of the virus fits into the overall strategy of the campaign:
Of course, one of the criticisms of the polio eradication campaign has been that it is usually specifically targeted on only immunizing against polio, but does not address any of the other factors that may be more salient to the health of communities. For a child in such a community, who is living in chronic poverty, and has limited access to food, clean water, and education, immunization against polio is necessary, but it is certainly not sufficient.
On Friday, President Obama announced the end of the discriminatory HIV Travel Ban that has survived, somehow, for over twenty years in American foreign policy. Obama, after lifting the ban, said this:
Twenty-two years ago, in a decision rooted in fear rather than fact, the United States instituted a travel ban on entry into the country for people living with HIV/AIDS. Now, we talk about reducing the stigma of this disease — yet we’ve treated a visitor living with it as a threat. We lead the world when it comes to helping stem the AIDS pandemic — yet we are one of only a dozen countries that still bar people from HIV from entering our own country. If we want to be the global leader in combating HIV/AIDS, we need to act like it.
This is a move that should have been done long ago to break the stream of misunderstanding the very human AIDS problem. It’s a first step, not a capstone. While lifting a legislative discrimination, the country (and the world) needs to look towards slowly erasing the perpetuated social stigma imposed upon HIV infected populations. We need to make it relatable, and this is a great step in the general direction of greater awareness.
The Inaugural 2009 “mHealth” Summit started today in Washington D.C., to bring together researchers, policy-makers, health professionals to discuss the role of mobile technologies in public health. As the conference website states:
Mobile technologies have the potential to transform global health care on many fronts, from research and diagnostics to training and preventative interventions. Targeting experts from such diverse fields as medical research, software design, clinical health care, hardware manufacture and network transmission, the summit hopes to spur development and deployment of innovative, practical, affordable and effective solutions to health challenges in underserved and resource-poor populations.
While the use of mobile wireless technologies is certainly not new in public health, it is interesting to see a formal meeting being held to discuss its efficacy and place in the development of robust health systems around the world.
The Associated Press reported a couple days ago about new findings from the U.N. World Food Program. According to recent research, 200 million people worldwide are joining the ranks of the hungry.
These findings come in the midst of falling global commodity prices. So why are more people going hungry if it’s getting cheaper to buy food? Josette Sheeran, executive director of the agency, warns of growing environmental degradation and it’s powerful impact on the world’s hungry.
All we know is that the world is facing increasingly frequent and ferocious natural disasters and the most vulnerable people and nations are getting hit hard and we better prepare now.
What does this mean for our approach to global health? I think it shows that we must take our environmental impact on the world just as seriously as our fiscal impact…
The politics over whether HIV/AIDS should receive as much funding as it does is heating up in the global health community. Jeremy Shiffman, a professor at Syracuse University, has also pointed out that HIV/AIDS funding may have displaced money for other critical diseases and issues, such as diarrhea, malnutrition, and child health. Many philanthropies and NGOs, such as Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Clinton HIV/AIDS Initiative (CHAI) and other bodies are contemplating shifting their funding and focus away from AIDS.
While surely this is a complicated policy issue that requires real debate – and I plan to write more about it – the global health community can’t get caught in a cycle of viewing all problems as having “scarce resources”, and then creating competition among a few issue/disease areas for these scarce resources. It’s a self-fulfilling cycle, with horrific consequences for the world’s poor. Policy-makers declare the need to allocate based on scarce resources —- > We don’t end up really making the impact that’s required with these scarce resources —> We don’t end up having enough resources to solve the problems, as they grow bigger and more “expensive” to address. Surely if bankers on Wall Street can get huge bonuses and bailouts – and seemingly don’t have much of a ’scarce resource’ issue – then the world’s destitute sick can get the same sort of advocacy and support? Idealistic, I know, but we’re talking about a TINY amount for global health in the grand scheme of things.
What we need is a nuanced debate about how we can on the one hand use HIV/AIDS resources to build up entire health systems, how we can maintain political will for all health-related aid required to continue to strengthen health systems (which might still involve a major disease-specific focus), and continue to expand the pie available for ALL global health challenges.
The Gates Foundation announced 76 grants of $100,000 to tackle public health problems through developing innovative solutions. As The Associated Press reports:
The five-year health research grants are designed to encourage scientists to pursue bold ideas that could lead to breakthroughs, focusing on ways to prevent and treat infectious diseases, such as HIV, malaria, tuberculosis, pneumonia and diarrheal diseases.
From projects focusing on “diagnosis of pneumonia using sound recordings” (where microphones on small devices, such as an iPod, could record abberant coughs and breathing patterns which could then be processed to diagnose pneumonia) to “highly sensitive TB detection paper cups” (which would consist of a polymer that would change color if TB-positive sputum was put into the cup) there are a number of varied ideas that will be researched on. You can check out the grants here.
