FT Health: Nation states must do more to fund fight against disease

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The flurry of activity around the World Malaria Report and World Aids Day this week is a good illustration of how much work in global health is organised and financed at an international rather than local level.

Despite significant advances in tackling both diseases in recent years — as well as others such as tuberculosis — financing remains heavily reliant on donors. Support from endemic countries, even those with growing economies, has often not followed.

And in a more inward-looking world, reliance on foreign support is becoming a risky proposition. As poorer countries become better off, taxpayers in richer countries may become yet more reluctant to help.

International advocacy has not been focused enough on mobilising political commitment in the countries most affected. Donor support may also have created complacency.

Peter Sands, the new head of the Global Fund to Fight Aids, Tuberculosis and Malaria, has stressed the need to make the case for returns on investment in health more clearly. Health ministers need to take the message to their finance ministry counterparts. The payback may not be immediately evident, but the costs of its neglect will be heavy for future generations.

Three questions

Pedro Alonso, director of the World Health Organization malaria programme, in the week of its new malaria report.

What are the key findings of the report?

The malaria community is at a crossroads. We’ve inherited unprecedented progress since 2000. Never has the world seen such progress in such a short period of time. We’ve ticked all the right boxes, and developed an ambitious but achievable strategy till 2030 that would bring us to where eradication could be considered.

But the truth we are reporting this year is that for the first time in the last 10 years, we are not showing great progress. Funding has stalled, and with the same tools, it was totally predictable that we would stop making progress. The moment we lift our foot from the accelerator, we don’t just stop — we go backwards.

Are there important overlaps between HIV and malaria?

Both are major infections which interact with and impact the immune system. HIV patients are much more susceptible to malaria. There are some potential interactions of the drugs. There is a significant research agenda. They are both also “poverty-related diseases” for which we need improved surveillance, diagnosis and treatment. You need a certain degree of “verticalism” but inevitably all these disease programmes must be included in a functioning health system, with universal health coverage.

Why did you become interested in malaria?

Last weekend I was in the Gambia, where we were celebrating the 70th anniversary of the Medical Resource Council system there. It’s my alma mater. I started work there in 1984. I arrived as a very young recently graduated physician and I knew very little of what malaria was. My first patient had malaria — and the second. The third had pneumonia, and the fourth again malaria. I ended up discovering this extraordinary disease, the most dominant problem for pregnant women and children, and I saw the massive knowledge gaps we had.

Chartwatch

The hunt for Alzheimer’s treatments There are just four drugs to treat the symptoms of a disease that affects 44m people across the world, but nothing to halt or slow its progress. The FT is supporting Alzheimer’s UK for its Seasonal Appeal: you can find all our coverage on our hub page, including an interview with David Cameron, former prime minister, on the UK’s role in fighting the disease. (FT)

News round-up

Marking World Aids Day The number of people newly diagnosed with HIV in Europe is growing “at an alarming pace”, the WHO said. Another study highlighted the 10-24-year-olds disproportionately affected. Campaigners slammed proposed US cuts for HIV programmes while others said more countries needed to share the burden of fighting Aids.

On the positive side, new HIV vaccines are giving hope, and women in Malawi have an ingenious new ally in the fight against infection from unfaithful partners. Listen to FT Health’s debate on HIV developments . (Reuters, DSW, Devex, The Hill, BBC video, FT Health, ECDC)

Yemen misery deepens Millions of Yemenis are without running water as fuel runs out. The country is already suffering the world’s largest cholera outbreak and is on the verge of famine, made worse by a Saudi Arabia-led coalition blockading its northern ports. Cases of diphtheria are spreading. (BBC, WHO)

Venezuelan woes mount Already suffering from a shortage of medicines, Venezuela has now been hit by malaria. Illegal mining — where rainforests are cut down and miners work in pools of stagnant water — is being blamed. Sexually transmitted diseases and unplanned pregnancies are also rising because of a shortage of contraceptives. (Reuters, Washington Post)

First dibs USAID launched what it called the world’s first development impact bond, aimed at cutting maternal and newborn deaths in India. “Dibs” are results-based contracts, where investors provide financing for social programmes upfront. Donor organisations then repay investors their principal plus a return, depending on targets met. This video explains the theory. (Devex)

Polio project packs up The global initiative to fight polio is winding down after a largely successful campaign — just 11 cases were reported in the first 9 months of 2017 — but this could lead to the collapse of immunisation schemes in developing countries. Actor Andrew Garfield discusses his role in polio pioneer film Breathe. (Devex, LA Times)

Fighting fake meds The first report from the WHO’s Global Surveillance and Monitoring System revealed that one in 10 medical products in poorer countries was substandard or fake. Globalisation, as well as online marketplaces, is complicating regulation as manufacturing, packaging and distribution spread across several countries. A separate report examined their impact on health. (WHO, FT)

Tobacco blowback The tobacco industry in Southeast Asia is fighting back against controls, stopping tax increases in Malaysia and Indonesia, and helping Vietnam waive duties on tobacco imports from Cambodia. Indonesia, Vietnam and the Philippines have some of the world’s highest concentrations of tobacco users. Evidence suggests taxation is the most effective way to control the substance. (Guardian, The Conversation)

Viagra without prescription The UK is the first country to allow over-the-counter sales of Pfizer’s Viagra in an attempt to shut down a burgeoning black market in the erectile dysfunction drug. (Guardian)

Smartphones and depression A surge in depression, suicide and contemplation of suicide among US teenage girls seems to mirror the rise of smartphones, according to an analysis covering 1999-2015 by the Centers for Disease Control and Prevention. A study from South Korea says smartphone addiction is creating an imbalance in the brains of young people. Facebook is introducing its system for spotting suicidal intent to other countries after successful tests in the US. (Chicago Tribune, Science Daily, Reuters)

Mums and mental health The BBC staged “the UK’s biggest conversation” about mothers and mental health. Its survey said a third had experienced problems around parenthood and more than two-thirds had sought professional help for conditions such as acute stress, anxiety and post-partum depression. (BBC)

Sewage sniffing robots Sewage monitoring is the most direct way of finding out which drugs, such as opioids, are being used in a community. Wastewater epidemiology is gaining ground because it is anonymous, eliminates self-reporting errors in surveys, is non-invasive — and can be monitored in real time. (Smart Cities Dive)

Obesity isn’t grrrrrrrrreat Kellogs is rebranding Frosties cereal as an adult dish, in what critics say is an attempt to get round guidelines on sugary foods for children, while Coca-Cola’s Christmas truck is getting a frosty response from England’s public health chief. More than half the food and drink ads shown during UK family programmes — as opposed to child-specific broadcasts — are for products high in fat, sugar and salt. (Telegraph, Guardian, Times)

Best from the journals

Human trafficking The consequences of trafficking and exploitation of workers is a real threat to global public health. Problems associated with disposable labour, complicated supply chains, unscrupulous employers and weakening protections need to be addressed to help the 40m suffering a form of “modern slavery”. (PLoS)

Health in India The first comprehensive analysis of health reveals vast inequalities between states in India, home to 18 per cent of the world’s population. (The Lancet)

Roots of antibiotic resistance Penicillin fed to livestock in the 1950s may have encouraged antibiotic-resistant bacteria to evolve and spread before it was even used in humans. The overuse of antibiotics in animals is still prevalent, the WHO warned in November. (The Lancet Infectious Diseases, WHO)

Effect of smoking curbs Public smoking bans have had little or no effect on employment in US bars and restaurants. (BMJ)

Scarlet fever After decades of decline, cases of scarlet fever in England have shot up since 2014. Vietnam, China, South Korea and Hong Kong have also experienced an upsurge. The cause is yet to be unidentified. (Lancet Infectious Diseases)

New specialisms 1: The virtualist As digital technology advances and patients become more comfortable with “virtual” services, the time is ripe for a new medical speciality: the medical virtualist. As well as technical prowess, practitioners need to be taught a good “webside manner”. (JAMA)

New specialisms 2: The climate doctor Climate-related health problems are increasing but few clinicians are able to communicate these threats. We need researchers and public health practitioners trained in climate issues to explain their effects on disease and develop clinical interventions. (BMJ)

Podcast of the week

US opioid crisis Bertha Madras from President Donald Trump’s commission on tackling opioids and drug addiction explains the group's key recommendations. (CSIS Take as Directed, 47m)

In case you missed it

Previous edition: HIV — reasons to be cheerful

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Final thought

Fighting nomophobia Could this be one way to combat the fear of having no mobile phone? The substitute phone is a black plastic device that allows users to swipe, pinch and scroll to satisfy the urge to pull out their smartphone. The Christmas present of the future? (CNN, Financial Post)