US funding can save millions of lives through public health programs in 2018

As director of the federal Centers for Disease Control and Prevention (CDC) from 2009 until the beginning of this year, I saw the world make progress against a number of diseases. But in 2018 we will be challenged to make additional progress in protecting public health on multiple fronts – particularly preventing heart attacks, strokes, drug overdoses and epidemics.

Here is an overview of what was achieved this year and what needs to be done in the year ahead.

Opioid overdoses

In 2017 we saw broad recognition that – as we at CDC said back in 2011 – there is a terrible epidemic of opioid overdoses affecting families and communities throughout the United States. The risk is that the continued spread of illicit fentanyl and a lack of concerted action and funding will make it possible for the epidemic to continue.

Preventing epidemics

Many countries improved their ability to track and respond to disease clusters before they become epidemics. However, additional funding for the CDC to partner with other countries to help them develop their ability to stop epidemics will end next year.

If Congress doesn’t provide funding, the U.S. will be forced to abandon these critical efforts, giving our microbial enemies an opening to attack. If in 2018 CDC is forced to retreat from the front lines, the chance that an epidemic like Ebola could happen again will increase.

Programs to prevent epidemics keep Americans safe. They must be continued. Like the war against terrorism, the war against terrible organisms protects our nation from a deadly threat.

Polio eradication

Fewer than 20 cases of polio have been reported around the world so far in 2017.

However, conflicts in Nigeria, Pakistan and Afghanistan – and the need for universal excellence in program operations – may lead to a stalemate in the effort to eradicate polio and protect all children against this dreadful disease forever.

Evaluating preparedness

An additional 40 countries participated in the Joint External Evaluation (JEE) process in 2017, bringing the total to 67. The JEE is a report card for countries to assess how prepared they are to deal with an epidemic. It identifies gaps that need to be addressed.

Unless countries themselves, the World Bank and donor agencies rapidly fill the identified gaps, we will all remain at risk, and countries may lose interest in continuing to assess their status openly and transparently.

This work will be much more difficult if funding cuts force the U.S. to retreat from the field of epidemic prevention.

In 2018, Resolve to Save Lives – the nonprofit organization I now lead – will serve as a catalyst to help countries obtain the technical, operational and financial support they need to address gaps and implement lifesaving programs.

This work is part of our mission to save 100 million lives around the world by implementing proven solutions to prevent heart disease and stroke, the world’s leading causes of death. We are also helping the world prevent the next disease outbreak by catalyzing country action to find, stop and prevent new disease threats.

Blood pressure

Around the world, just one in seven people has their blood pressure under control. The result is literally millions of preventable heart attacks, strokes and deaths, as well as increased medical costs.

Fortunately, the best medicines in the world for the treatment of high blood pressure are generic, safe, effective, once-daily and inexpensive.

This year the American Heart Association and the American College of Cardiology released new guidelines for treating high blood pressure in the U.S.

In our country, life expectancy decreased for the second year in a row – something that hasn’t happened since the 1960s. Opioid use drove this trend, but it was made possible by a stall in the decades-long decrease in cardiovascular deaths.

Better management of blood pressure and cholesterol, and continued decreases in smoking, will be essential to sustaining health progress in the United States. Access to medication and medical care globally will be a major focus of Resolve to Save Lives in 2018.


Global HEARTS is a new initiative from the World Health Organization and the CDC that helps countries scale up prevention and control of cardiovascular disease. This year saw the release of the first draft of the HEARTS technical package details, bringing the world closer than ever to having a playbook to stop the leading cause of death.

Countries now need to implement the HEARTS initiative, increasing the number of people treated for high blood pressure by literally hundreds of millions and reducing sodium intake for billions of people.

Resolve to Save Lives is working with countries around the world to help them achieve their goals of preventing heart attacks and strokes as part of non-communicable disease reduction initiatives.

India Hypertension Management Initiative

In November the government of India and partners took an unprecedented first step toward controlling high blood pressure – a disease that affects more than 200 million adults in India. The India Hypertension Management Initiative gives patients and health-care providers the tools they need for better blood pressure management and control.

However, scaling up effective programs throughout India, particularly for patients cared for by the fragmented private sector, will be difficult.

Trans fat restrictions

This year further demonstrated the public health benefits of reducing artificial trans fat consumption. One study showed there was a significant decline in heart attacks and strokes among New York residents living in areas with trans fat restrictions.

This toxic chemical can be removed from food without altering taste, while drastically improving heart health.

However, only a few countries around the world have policies in place to restrict trans fats. This is something we at Resolve to Save Lives hope to change in 2018.

Resolve to Save Lives was launched this year as an initiative of the global health organization Vital Strategies. We have the tools to address the health issues discussed above and prevent millions of deaths. But unless urgent action is taken, millions of people will continue to die preventable deaths.

We hope that, five years from now, we’ll look back at 2017 as the year these critical public health issues began to improve – similar to improvements we’ve seen in recent decades in progress against HIV/AIDS, polio and smoking.


World Health Organisation (WHO) with Mekong countries call for accelerated action to eliminate malaria before 2030

Representatives from Cambodia, China, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam today called for accelerated action to eliminate malaria in the Greater Mekong Subregion (GMS) by the year 2030. The call comes amid concern over resistance of malaria parasites to antimalarial drugs, including artemisinin—the core compound of the best available antimalarial medicines. To date, resistance has been detected in five of the six GMS countries. The best way to address the threat posed by drug resistance is to eliminate malaria altogether from the countries of the Mekong.

At a high-level meeting convened by the Ministry of Health and Sports of Myanmar in collaboration with the World Health Organization (WHO) and the Asia Pacific Leaders Malaria Alliance (APLMA), representatives from the six GMS countries stressed that eliminating malaria in the Subregion requires urgent and coordinated action, with support from implementing agencies, funders and other partners.

Ministers from the six countries pledged to:

ensure activities to eliminate malaria in the subregion are fully funded, including with more domestic funds;
improve cross-border collaboration and establish an independent oversight body, for which WHO will act as the secretariat;
strengthen systems for the identification and timely reporting of malaria infections, including drug-resistant forms;
provide the best possible prevention, diagnosis and care for all people at risk of malaria, including free services for ethnic minorities and mobile and migrant populations, as part of universal health coverage;
ensure available antimalarial medicines are safe and effective for use;
bring all concerned sectors together to translate policies into time-bound and results-oriented actions; and
engage communities in malaria elimination using innovative communication tools.
Countries requested support from WHO to achieve their malaria elimination goals.

“Malaria is a disease that we can—and must—eliminate from the Greater Mekong Subregion. The drive to achieve this goal by 2030 demonstrates the joint commitment of health leaders from across the subregion to secure the health and well-being of vulnerable populations and ensure no one is left behind,” said Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia.

“The malaria parasite doesn’t need a passport or a visa to cross borders. You must work more closely together as one region, with one strategy to drive elimination. Accelerating malaria elimination in the Greater Mekong will not only improve lives today. It will also free future generations from the plague of malaria, and set an example for the rest of the world,” said Dr Shin Young-soo, WHO Regional Director for the Western Pacific.

WHO helps governments achieve malaria elimination by:

setting and disseminating guidance and policies on malaria control and elimination;
supporting countries as they adapt, adopt and implement WHO global norms and standards for malaria control and elimination;
assisting countries in the implementation of national malaria strategic plans;
helping countries develop robust malaria surveillance systems; and
responding to requests from countries to address threats, operational emergencies and bottleneck issues.
Recent efforts to fight malaria in the GMS have yielded impressive results. According to the latest WHO estimates, malaria cases in the six countries fell by an estimated 74% between 2012 and 2016. Deaths due to malaria fell by 91% over the same period.

This progress was made possible through greater access to effective malaria control tools, particularly artemisinin-based combination therapies for malaria treatment, rapid diagnostic tests, and insecticide-treated nets. Since 2012, targeted provision of these tools to vulnerable populations has increased substantially across the subregion, leading to acceleration in the pace of progress. Resistance to antimalarial drugs, unless addressed with urgency, could undermine these gains.

Malaria is a life-threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. WHO-recommended malaria control tools include: long-lasting insecticidal bed-nets, spraying inside walls of dwellings with insecticides, preventive treatment for infants and during pregnancy, prompt diagnostic testing, and treatment of confirmed cases with effective anti-malarial medicines.



World Health Organization: Malaria treatment stalls as funding flatlines

The global fight against malaria is grinding to a halt, the World Health Organization warned on Wednesday, amid flat-lining funding and political complacency.

Malaria infected an estimated 216 million people last year — about 5 million more than in 2015 — potentially reversing a six-year trend of decreasing infection cases. The majority of the 440,000 lives claimed by the mosquito-borne disease were young children in sub-Saharan Africa.

WHO Director General Tedros Adhanom Ghebreyesus said "progress appears to have stalled" in the fight against the tropical disease.

"Although there are some bright spots in the data, the overall decline in the global malaria burden has unquestionably levelled off," Ghebreyesus said. "And, in some countries and regions, we are beginning to see reversals in the gains achieved."

Fall in funding

Experts fear financial shortfalls and government complacency have thrown progress off track.

"At the current level of funding and coverage of current tools, we have reached the limits of what can be achieved in the fight against the disease," said Abdisalan Noor, lead author of the WHO's annual malaria report.

Investment into malaria prevention — a third of which came from the US last year — has leveled off since 2010. Analysis by the WHO found that funding in countries with a high risk of malaria had dropped to an average of less than two dollars per person per year.

The WHO says a minimum annual investment of $6.5 billion (€5.5 billion) is required to meet its ambitious 2030 targets.

Funding in 2016 stood at just $2.7 billion.

Change in fortunes

The long-term global decline in malaria-related deaths has helped cut child mortality, driving a sharp increase in global life expectancy.

The WHO has repeatedly made announcement on "the massive roll-out of effective disease-cutting tools" and "impressive reductions in cases and deaths."
Mosquito nets soaked in insecticide — mostly delivered through mass distribution campaigns — are the primary method of protection. But in sub-Saharan Africa fewer than half of households have sufficient access to them.

"If we continue with a business-as-usual approach — employing the same level of resources and the same interventions — we will face near-certain increases in malaria cases and deaths," Ghebreyesus said.

Uneven coverage

Some 80 percent of malaria deaths take place in just 15 countries — 14 sub-Saharan African nations and India.

Emergency work is underway in Nigeria, South Sudan, Venezuela and Yemen, where ongoing humanitarian crises pose further public health risks.
Several countries in the Middle East and central Asia have been certified as malaria-free in the last decade, including Morocco, Armenia and Turkmenistan. Last year, Kyrgyzstan and Sri Lanka joined their ranks, having gone three years without recording an indigenous case of malaria.

"We are up against a tough adversary," Ghebreyesus said. "But I am also convinced that this is a winnable battle."


Hot topics in public health go global in Berlin at the World Health Summit

The burning issue at this year’s World Health Summit in Berlin was health security. At this 8th WHS it was clearer than ever that the walls between the traditional disciplines of ‘global health’ and (European) ‘public health’ are rapidly coming down, with health threats anywhere in the world becoming a domestic challenge as well as an international development issue. The topics driving the agenda in Berlin are increasingly preoccupying European Heads of State as well as their G7 and G20 counterparts. It is a welcome signal that the patrons of the WHS, Chancellor Merkel and European Commission President Juncker, are joined by France’s President Macron. Nevertheless, in a blistering keynote speech MSF International President Joanne Liu challenged the mostly-European audience to protect health wherever and whenever threats arise and not only when they reach our shores.

Antimicrobial resistance (AMR) emerged as one of the principal topics under discussion at the 2017 World Health Summit in Berlin, with a number of sessions looking at it from a global, “One Health” perspective and in the broader context of international policy action in support of achieving the Sustainable Development Goals.

Ahead of the WHS, the UK government, with the Wellcome Trust and the governments of Ghana and Thailand, organised another event in Berlin hosted by Professor Dame Sally Davies. EPHA Secretary General Nina Renshaw was invited to present and spoke about the importance of binding measures to tackle pollution in the antibiotic supply chain, as a major accelerator of resistant bacteria in the local environment of pharmaceutical factories which can then spread rapidly.

At the WHS session on AMR, Dr Rüdiger Krech (WHO), underlined the global scope of the AMR problem, recalling that gonorrhoea is becoming increasingly resistant to antibiotics, while also mentioning multi-drug resistant TB, E.Coli and hospital infections including MRSA.

EPHA’s points appear to be echoed by attendees at both events. Notably, Thomas Cueni (Director General, International Federation of Pharmaceutical Manufacturers & Associations) recognised the problem of environmental spill-over in e.g. India in the supply chain of cheaply produced generic drugs, with public procurement (e.g. certified suppliers) and consumer choice as powerful tools that could be exploited. He also stated that if voluntary initiatives don’t work, regulatory approaches could be considered, with some companies willing to share data with WHO.

Jeremy Knox of the Wellcome Trust emphasised that the evidence base regarding behaviour change is not as developed as it should be. He pointed out that Wellcome is developing a new policy and advocacy stream on AMR working in collaboration with civil society, while at the same time making a major investment in the CARB-X Global Partnership.

Discussion turned to the question of developing and managing antimicrobials effectively as a “global public good” and the flawed business model for antibiotics, with companies not following rhetoric with action, according to Dr Krech, keen on investing in more profitable medicines and on avoiding any regulation. In turn, Cueni explained some key industry obstacles, noting high risk of failure in the development process. He argued for a globally funded model but was sceptical that this would happen anytime soon. Mr Knox stated that it was high time that governments and companies began to experiment with available innovation models, the best of which combine push and pull incentives.

Another problem highlighted by participants was that antibiotics are cheaper than diagnostics, which means it is easier to omit testing before prescribing them.

Representing the German Federal Ministry of Health, Karin Knufmann-Happe also mentioned the environmental dimension of AMR – specifically, antibiotic waste and residues in water – as a key element of Germany’s inter-sectoral national strategy (2015), designed to be closely aligned with the WHO Global Action Plan. She revealed that Germany’s efforts to influence the G7 and G20 agendas is motivated by the recognition that some issues cannot be tackled at the national level alone, and that tackling AMR also involves health systems strengthening. A new global AMR R&D hub is planned to be established in Germany to pursue a long-term vision.

Vaccination also featured strongly at the WHS, including as a measure to reduce antibiotic use, especially reflecting growing concerns over vaccine hesitancy and recent vaccine-preventable disease outbreaks, including measles in Europe. 


Obesity a bigger threat to world health than malnutrition: Global Nutrition Report 2017

Overweight and obesity are on the rise in almost every country, with 2 billion of the world’s 7 billion people being overweight or obese, says The Global Nutrition Report 2017.

In India, 16% of adult men and 22% of adult women are overweight.

The study, conducted across 140 countries, says there is a less than 1% chance of meeting the global target of halting the rise in obesity and diabetes by 2025.

Undernutrition in children is decreasing globally, but progress is not fast enough to meet internationally-agreed nutrition goals, including the Sustainable Development Goals (SDG) target to end all forms of malnutrition by 2030.

According to the report, 155 million under-fives are stunted; and 52 million children worldwide are defined as wasted, meaning they do not weigh enough for their height.

The report brings to light the crucial need to tackle the double burden of undernutrition and obesity, in order to address India’s national nutrition strategy.

Thirty-eight percent children in India under the age of 5 are affected by stunting, and 21% of under 5s are defined as ‘wasted’ or ‘severely wasted’, meaning they do not weigh enough for their height.

Rising rates of anaemia in women of reproductive age is also a big concern, with the report showing more than half of India’s women and almost one in three women affected worldwide and no country on track to meet global targets.

A staggering 88% of countries studied face a serious burden of two or three forms of malnutrition.

“The world can’t afford not to act on nutrition or we risk putting the brakes on human development as a whole,” said Corinna Hawkes, co-chair, Global Nutrition Report’s Independent Expert Group, and director, of the Centre for Food Policy at City, University of London.

“We will not achieve any of the Global Goals for SDGs by the 2030 deadline unless there is a critical step change in our response to malnutrition in all its forms. Equally, we need action throughout the goals to tackle the many causes of malnutrition.”

Where India stands

  • 38%: Stunted under-5 children
  • 21%: Wasted’ or ‘severely wasted’ under-5 children who weigh less for their height
  • 16%: Overweight adult men
  • 22%: Overweight adult women
  • 51%: Anaemia in women of reproductive age

Source: The Global Nutrition Report 2017


World Health Organisation warns of airborne Madagascar plague spreading to Africa

The organisation has said more than 1,300 people have become infected with the disease, which is primarily affecting Madasgascar off the coast.

It has spent millions of dollars in efforts to fight the disease and has sent specialists to the affected areas in cities like Antananarivo.

Figures from the WHO state at least 93 people have died, and there was a high risk it could spread to countries on the eastern coast of the continent of Africa, like Tanzania, South Africa and Mozambique.

Some of the cases of plague are reported to be pneumonic, which means it can be transmitted by coughing or sneezing, and is airborne.

It is almost always fatal if left untreated, but if caught early enough, can be eliminated with antibiotics.

The disease is caused by the same type of bacteria which wiped out nearly 50 million people in Europe during the years of the Black Death.


Robert Mugabe Was Just Appointed a World Health Organization 'Goodwill Ambassador'

Zimbabwean President Robert Mugabe has been called a lot of things by supporters and critics over his 94 years on this planet: revolutionary; freedom fighter; dictator; alleged perpetrator of human rights violations. He’s about to add another controversial moniker to the list—”Goodwill Ambassador” to the World Health Organization (WHO).

New WHO director-general Tedros Adhanom Ghebreyesus announced that Mugabe would be a goodwill ambassador to the public health agency at a conference in Uruguay. Mugabe, according to Ghebreyesus, who is from Ethiopia, could then leverage the high profile (if largely symbolic) role “to influence his peers in his region,” ostensibly referring to African countries. Mugabe would be an ambassador on broad health issues like noncommunicable diseases such as heart disease and cancer.

The decision was immediately met with outrage by major public health and medical groups like Cancer Research UK, the World Heart Federation, Action Against Smoking, and about two dozen others who slammed Mugabe’s “long track record of human rights violations.” Zimbabwe has faced long-standing international sanctions over such allegations—including of violent crackdowns on political dissidents, claims of electioneering, and starkly anti-LGBT policies. Economic crises have also rocked the nation, making health recovery efforts that much more difficult.

So why would the WHO make such a controversial appointment? Part of the answer may lie in Zimbabwe’s significant life expectancy reversal in recent years. When Mugabe first came to power in 1980, average life expectancy was just over 59 years, according to the World Bank. It fell precipitously through 1990s and mid-2000s in the wake of the HIV epidemic, ongoing economic turmoil, collapsing health and food resources. “The government of Robert Mugabe presided over the dramatic reversal of its population’s access to food, clean water, basic sanitation, and health care,” wrote the charity group Physicians for Human Rights in 2008, two years after life expectancy in Zimbabwe had fallen catastrophically to just over 42 years.

But Zimbabwe has also taken steps to buck the trend over the past decade and life expectancy is now back to about the level it was at when Mugabe took office. The country has dedicated far more resources toward HIV testing and treatment than many other African nations and enlisted young frontline community health care workers to combat HIV/AIDS and provide primary medical services to local communities. That’s likely what led Tedros to refer to Zimbabwe as “a country that places universal health coverage and health promotion at the center of its policies to provide health care to all” during his speech.

The rationale may not be good enough for many who point to Mugabe’s use of state violence and homophobic policies and rhetoric which may, for instance, lead fewer at-risk men to get tested for HIV/AIDS. But it appears the WHO doesn’t want the perfect to be the enemy of the good in public health initiatives, controversial though the Mugabe decision may be.



7 000 newborns die every day, despite steady decrease in under-five mortality, new report says

At current trends, 30 million newborns will die within first 28 days of life between 2017 and 2030

News release

19 OCTOBER 2017 | NEW YORK/GENEVA/WASHINGTON DC - Every day in 2016, 15 000 children died before their fifth birthday, 46% of them – or 7 000 babies – died in the first 28 days of life, according to a new UN report.

Levels and Trends in Child Mortality 2017, reveals that although the number of children dying before the age of five is at a new low– 5.6 million in 2016, compared with nearly 9.9 million in 2000 – the proportion of under-five deaths in the newborn period has increased from 41% to 46% during the same period.

“The lives of 50 million children under-five have been saved since 2000, a testament to the serious commitment by governments and development partners to tackle preventable child deaths,” said UNICEF Chief of Health, Stefan Swartling Peterson. “But unless we do more to stop babies from dying the day they are born, or days after their birth, this progress will remain incomplete. We have the knowledge and technologies that are required – we just need to take them where they are most needed.”

At current trends, 60 million children will die before their fifth birthday between 2017 and 2030, half of them newborns, according to the report released by UNICEF, the World Health Organization, the World Bank and the Population Division of UNDESA which make up the Inter-agency Group for Child Mortality Estimation (IGME).

Most newborn deaths occurred in two regions: Southern Asia (39%) and sub-Saharan Africa (38%). Five countries accounted for half of all new-born deaths: India (24%), Pakistan (10%), Nigeria (9%), the Democratic Republic of the Congo (4%) and Ethiopia (3%).

“To achieve universal health coverage and ensure more newborns survive and thrive, we must serve marginalized families," says Dr Flavia Bustreo, Assistant Director-General for Family, Women’s and Children’s Health at WHO. "To prevent illness, families require financial power, their voices to be heard and access to quality care. Improving quality of services and timely care during and after childbirth must be prioritized.”

The report notes that many lives can be saved if global inequities are reduced. If all countries achieved the average mortality of high-income countries, 87% of under-five deaths could have been averted and almost 5 million lives could have been saved in 2016.

“It is unconscionable that in 2017, pregnancy and child birth are still life-threatening conditions for women, and that 7 000 newborns die daily,” said Tim Evans, Senior Director of Health Nutrition and Population at the World Bank Group. “The best measure of success for Universal Health Coverage is that every mother should not only be able to access health care easily, but that it should be quality, affordable care that will ensure a healthy and productive life for her children and family. We are committed to scaling up our financing to support country demand in this area, including through innovative mechanisms like the Global Financing Facility (GFF). ”

Pneumonia and diarrhea top the list of infectious diseases which claim the lives of millions of children under-five globally, accounting for 16% and 8% of deaths, respectively. Preterm birth complications and complications during labour or child birth were the causes of 30% of newborn deaths in 2016. In addition to the 5.6 million under-5 deaths, 2.6 million babies are stillborn each year, the majority of which could be prevented.

Ending preventable child deaths can be achieved by improving access to skilled health-professionals during pregnancy and at the time of birth; lifesaving interventions, such as immunization, breastfeeding and inexpensive medicines; and increasing access to water and sanitation, that are currently beyond the reach of the world’s poorest communities.

For the first time, mortality data for older children age 5 to 14 was included in the report, capturing other causes of death such as accidents and injuries. Approximately 1 million children aged 5 to 14 died in 2016.

“This new report highlights the remarkable progress since 2000 in reducing mortality among children under age 5,” said UN Under-Secretary-General for Economic and Social Affairs Mr. LIU Zhenmin. “Despite this progress, large disparities in child survival still exist across regions and countries, especially in sub-Saharan Africa. Yet many deaths at these ages are easily preventable through simple, cost-effective interventions administered before, during and immediately after birth. Reducing inequities and reaching the most vulnerable newborns, children and mothers are essential for achieving the SDG target on ending preventable childhood deaths and for ensuring that no one will be left behind.”

The report also notes that:

  • In sub-Saharan Africa, estimates show that 1 child in 36 dies in the first month, while in the world’s high income countries, the ratio is 1 in 333.
  • Unless the rate of progress improves, more than 60 countries will miss the UN Sustainable Development Goal (SDG) to end preventable deaths of newborns by 2030 and half would not meet the target of 12 neonatal deaths per 1,000 live births by 2050. These countries account for about 80% of neonatal deaths in 2016.

Notes to editors

Broadcast quality images and b-roll available here. Download the report here.


The United Nations Inter-agency Group for Child Mortality Estimation or UN IGME was formed in 2004 to share data on child mortality, harmonise estimates within the UN system, improve methods for child mortality estimation report on progress towards child survival goals and enhance country capacity to produce timely and properly assessed estimates of child mortality.

UN-IGME is led by UNICEF and includes WHO, the World Bank Group and the United Nations Population Division of the Department of Economic and Social Affairs. For more information visit: