How our government works for Global Health...

It is unbelievable to me how much I have learned from working at Research! America about the US federal government's involvement in global health. You would not believe how the few dollars that is dedicated to this sort of work (a total of less than 1% of our GDP), has actually impacted millions around the globe. While there is always more to be done, I am grateful we have some policies and initiatives in place that focus on the developing world and their needs. For starters look at this slide from the Kaiser Family Foundation summing up the US's involvement in global health....how it breaks down among the various players....(keep following, much more is to come on this topic).

US Department of Defense & Global Health

R!A Briefing Re-Cap on the Importance of DOD and Global Health

July 28^th 2011

Today, I attended a Research! America hosted briefing at the Reserve Officers Association in Washington DC. An expert panel divulged the extraordinary legacy of health research the US Department of Defense has played in the past and continues to lead today. The DOD heads world-renowned research efforts in infectious diseases and health interventions promoting peace and security in its impactful outreach at home and abroad. This briefing was convened by Research! America, the American Society of Tropical Medicine and Hygiene, Center for Strategic and International Studies, and the Sabin Vaccine Institute.

DOD Under-resourced and Under-acknowledged

Karen Goraleski, Executive Director of the American Society of Tropical Medicine and Hygiene, moderated the conversation and introduced the panel of experts “who move in the global health R&D space every day”. Stephen Morrison, an author of the newly released CSIS report on the DOD’s Enduring Contributions to Health[as1] , spoke about the delicacy and depth of the overseas DOD medical labs and the profound impact they have had on communities and regions in which they operate. He highlighted the “readiness” dimension of the labs to react and respond to health threats at a moment’s notice and the complexity of partnerships which make these labs and researchers a public health success. Karen Remley, Commissioner of the Virginia Department of Health, added that from her previous work overseas, “If there was a DOD lab in the country, countries were more willing to work with you.” The DOD’s scientific health research presence at home (at the Walter Reed Institute of Research in Maryland) and at a multitude of laboratories abroad are significant to communities worldwide.

The DOD and Their Track Record of Health Interventions

Colonel Kent Kester, Former Commander of the Walter Reed army Institute of Research, highlighted the research efforts the DOD has continued to expand as part of the DOD’s health force protection mandate because “health threats don’t discriminate and diseases don’t wait”. Dr. Peter Hotez, President of the Sabin Vaccine Institute, shared a lengthy list of DOD’s successful health interventions, including over 6 vaccines (2 of which now include HIV/AIDs and a malaria vaccine). This is just one example of the DOD’s success due to the consistent efforts of health interventions research.

Conclusion

This briefing focused on the DOD’s efforts in global health R&D that have led to major successes. While the proportion of funds directed towards these efforts at the DOD is less than 0.05% of the total DOD budget, the impact already worldwide of these investments has been significant. The DOD’s research efforts are a best buy in global health and are a story worth telling. And we need to continue telling this story and raising awareness of the DOD's success and important role in research for global health issues.

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[as1]Link to CSIS report: http://csis.org/publication/defense-departments-enduring-contributions-global-health

PDPs: A New Relationship to Change the World

We've all heard the term globalization before and understand this term as our world growing smaller and more reliant on one another as a result. This interconnectedness of globalization, has led to an explosion in the global health field and the number of organizations devoted to solving the world's problems has multiplied significantly. From this movement in global health has come the necessity of partnerships. Partnerships in the global health world has come to be essential in pooling resources, knowledge, and improving population coverage offering the best services available. Public-private partnerships (PPPs) and product development partnerships (PDPs) are a few examples of the type of partnerships to be aware of. Without globalization, these different organizations and groups would cease to exist and would cease to have realized the need for one another to increase impact and save lives.

As PDPs are a big part of my research at the moment at Research! America, I wanted to take a moment to delve into the importance of these and shed light on the success stories of PDPs that receive far to little media attention.

What are PDPs?

These are partnerships across public, private and foundation entities working together to speed up the R&D pipeline to bring products faster to market. The keyword here is products, which means this unique partnership has a more concrete goal than PPPs. Often biotechs and pharmaceutical companies are involved and play a critical role in the clinical trials portion. Since PDPs began they have centered around neglected tropical disease products (ie: visceral leishmaniasis, dengue, trachoma, schistosomiasis, and diarrheal diseases). Today, PDPs around vaccine research has grown as vaccines for TB, HIV/AIDs, malaria, dengue, rotavirus, and meningitis are advancing in significant ways.

What are the successes we need to be aware of?

• GAVI (5million future deaths have been prevented, because the increased immunisations GAVI has funded and distributed, Nov 2010)





• PATH-MenAfriVac (20 million have been vaccinated in the meningitis belt in Africa. The meningitis vaccine was made specifically for this region and expectations have been beyond met.) Click here for more.





• One World Health's antibiotic paromomycin intramuscular injection (PMIM) treatment for visceral leishmaniasis ("black fever"/"kala-azar"). Results in Phase 4/India have shown major success and this treatment is inexpensive.

more to be added to this list......

I am constantly amazed how perplexed my colleagues are about product development partnerships. To me they make sense if we look at the progression of time and understand the timeline of global health, they benefit and are cost-effective for all players involved, and have the potential to save more lives than ever before. To me PDPs are not meant to be underestimated and should be carefully observed. These relationships between global entities have the potential to change the world as we know it today, into the future we want it to become.

Vaccines; A Best Buy in Global Health

Everyone deserves a shot at life. Studies show that vaccines reduce childhood morbidity and mortality while simultaneously being cost-effective. Many vaccines for children only cost a few cents including measles (23 cents), polio (13 cents) and meningitis (50 cents). Vaccines save lives and are a great return on investment. For every one year increase in average life expectancy, countries achieve an average 4% increase in GDP per capita (Bloom et al, 2004). It is well worth the research efforts to improve life quality and reduce childhood mortality. While we know that health research is a long-term process, our investments in life-saving vaccines and other global health research have yielded effective partnerships and major success stories.

Today, many innovative partnerships are working together to pool expertise and address the research and accessibility challenges associated with vaccine and many global health efforts. One of today’s greatest success stories is a private-public partnership (PPP), the Global Alliance for Vaccines and Immunizations Initiative (GAVI). Using innovative financing mechanisms to bolster support for vaccines in the developing world, GAVI distributed routine immunizations like measles, tetanus, polio, hepatitis B, and pertussis in over 70 countries. To date, GAVI’s efforts have prevented the deaths of 5 million children (WHO-UNICEF coverage estimates for 1980-2009, as of July 2010).

We need to continue to support organizations like GAVI that embody research and innovation at its finest. As the GAVI pledging conference is around the corner (June 13th, London), we
need to remember that vaccines are the tool we need to save lives and the best buy in global health we have available to us to bring hope and a future to the world’s children and communities. The time to provide others with a shot at life is now.

World Aids Day is December 1st!

Double-click on the poster below to view this week's activities commemorating World Aids Day at Tulane::

The First Global Symposium for Health Systems Research

(Tuesday November 23rd)

This Symposium was mandated by the WHO and was an important gathering of 1,200 leading experts from multidisciplinary sectors to discuss health systems research. Where are we now? What are the methods of research we can improve to adequately address health systems? How can we make health systems more efficient and effective? What does the current literature say about these issues? What are the future directions research needs to take?

Universal health care coverage was a major topic discussed pertaining to health systems research. How can we achieve this financially? There seems to be a major gap in research on international financing of health systems. Current literature focuses on national health care financing. We need research efforts to stress international health care financing. It is not possible for some countries to support universal health care coverage, however this does not mean universal health care coverage is not out of reach. It is possible to provide health care financing for a universal health care plan (US $40 per person, per year). Some countries will just need help getting off the ground to begin such a massive global endeavour. The ultimate goal is for nations to be self-sustaining, however, in the beginning this will not be possible. The first reading assigned for this meeting looks at how this is possible, supporting a national interest. A moral/altruistic attitude toward approaching a universal health care plan is not necessary in arguing that this is a good idea for all nations. Read the article below as it really gives a good contextual argument for universal health care.

**Ooma, G., Hammonds, R. & Damme, W. (2010). The International Political Economy of Global Universal Health Coverage.

http://http://www.hsr-symposium.org/images/stories/3international_policy_economy.pdf

On the Global Symposium for Health Systems Research Website, you will find ALL the plenary webcasts and background papers for this symposium. Instead of offering you our meeting's discussion points I highly recommend that you watch the webcasts sessions below and GO TO THE WEBSITE HOME and click around to find the topics of interest to you:

http://http://www.hsr-symposium.org/index.php/symposium-background

Webcast from Plenary from Friday Nov 19th: HSR stewardship, financing and capacity: Opportunities and obstacles to improved research.

http://http://www.hsr-symposium.org/index.php/hsr-webcast

And also read this background paper:

**Mylene, L., Powell-Jackson, T., & Blaau., D. (2010). Managing Incentives for Health Providers and Patients in the Move Towards Universal Coverage.

http://http://www.hsr-symposium.org/images/stories/1managing_incentives.pdf

I learned so much from this website and I hope you will take the time to review some of the information this website has to offer. HSR (health systems research) is a critical topic to understand for our generation and for professionals in medicine and public health that will become leaders in the future.

The Epidemiologic Transition (Part 1)

This session was facilitated by Menal Jham and delved into the various Epidemiologic Transitions we have witnessed over the ages. Omran (2005) breaks these general transitions we have witnessed into the following:

1.The Age of Pestilence and Famine
2.The Age of Receding Pandemics
3.The Age of Degenerative and Man-Made Diseases
4.The Age of Delayed Degenerative Diseases
5. The Age of Obesity and Inactivity (present day)

"The epidemiologic transition in demography and medical geography can be defined as a phase of development witnessed by a sudden and stark increase in population growth rates brought about by medical innovation in disease or sickness therapy and treatment, followed by a re-leveling of population growth from subsequent declines in procreation rates". This theory was posited by Abdel R Omran in 1971.

Our group discussed that these transitions can not necessarily be applied to every country and nation in the world. Some "pockets" in the world are still in the Age of Pestilence and Famine.
Why is this? Does most of the population follow Omran's transistion Ages?

We also discussed if these transition ages be used as a prediction model for those "pockets" in the world which may be in another Age? We think no, as evidenced by the technology transition in Africa with cell phones. We did not witness a transition in many African countries to landlines before the dawn of cell phones. Landlines never were widely distributed before cell phones. Therefore, because we see this technology adjustment which seems to have skipped a transition step, we might see an Age adjustment follow suit. Omran's ages are not linear or predictive of future health and disease experiences. They also seem to be more readily applicable to the developed countries overall.

These transitions offer to us a way to identify patterns and trends in health and disease, in which certain parts of the world have witnessed. They are helpful in recognizing demographic patterns, economic and social determinants and the consequences of these combined.

I am also interested in what would the mirrored "social/psychological" Ages to those Omran has laid out for health? For example, if the US is now in the Age of Obesity and Inactivity, would the Social Age be titled as The Age of Complacency and Indulgence?

This population theory is unique in revealing to us the history of health and disease through a broad lens. Interesting read...anyone have thoughts on how this could be useful to us today?