The 67th World Health Assembly is happening this week in Geneva, and one of the key issues on the agenda is noncommunicable diseases.

NCDs — cardiovascular disease, cancer, diabetes and chronic respiratory disease — result in more than 36 million deaths each year, and 80 percent of these occur in low- and middle-income countries. In Africa, deaths from NCDs are expected to outpace those stemming from infectious, maternal, prenatal and nutritious diseases by 2030.

The World Economic Forum estimates NCDs can cost the global economy more than $30 trillion — or 48 percent of the world's gross domestic product in 2010 — in the next two decades.

But perhaps because the development community is more focused on addressing health issues covered by the Millennium Development Goals — HIV and AIDS, malaria, tuberculosis, and maternal and child health — funding to prevent the spread of NCDs has been minuscule. The latest available sectoral data on development assistance for health indicate NCDs received $377 million, or just 1.2 percent of health funding, in 2011. While this represented a 4.6 percent increase from 2010 allocations, it pales in comparison to what other subsectors are receiving. Development assistance for HIV and AIDS, for instance, is 20 times higher than that for NCDs.

NCDs — which are caused by either genetic or lifestyle factors — are preventable and less costly to combat. According to the World Health Organization, cost-effective interventions in low-income countries would only amount to 4 percent of current global health funding. That figure drops to 2 percent in lower-middle-income countries and 1 percent in upper-middle-income nations.

Collaboration: 'The only way to go'

Community-level outreach is one of the most effective low-cost interventions to prevent and control NCDs. And to implement such programs effectively, partnerships and a multistakeholder approach are vital.

"No one organization has the solution," Dr. Ayham Alomari, senior health officer for community health and noncommunicable diseases at the International Federation of Red Cross and Red Crescent Societies, told Devex.

To change the behavior of members of at-risk communities and encourage them to adopt healthy lifestyles, Alomari said the environment plays a very critical role. By "walking the talk," volunteers can help communities understand the risks associated with unhealthy habits and the benefits of healthy living. The academic community, meanwhile, can provide empirical data on which community-level approaches work, how, why and where.

For many of these health issues, collaboration "is the only way to go," Mario Ottiglio, public affairs and global health policy director at the International Federation of Pharmaceutical Manufacturers & Associations, affirmed. With NCDs, one has to go beyond the health dimensions and look at the messaging and marketing as well.

IFPMA is an international group based in Geneva, Switzerland. Its members include R&D companies and national pharmaceutical associations in developed and developing countries.

"You can't escape the way of partnerships because there are too many interlinked dimensions [in addressing NCDs]," Ottiglio told Devex. "You can conceivably have a partnership between the food sector, the government [and the information technology] industry, and you will have a stake for everybody there."

Last year, IFPMA forged a two-year partnership with the IFRC, which entailed having to design a behavioral change-based toolkit for community-based outreach. The toolkit aims to promote four healthy habits — eat healthy, be physically active, reduce alcohol intake and quit smoking — as a way to prevent and control NCDs.

IFPMA provided in-kind and modest financial contributions to kick-start the program and make sure the basics the volunteers will need are in place. The group is also helping with the messaging and advocacy, according to Ottiglio.

"The plan in the future," Alomari said, is for IFPMA to "be the bridge between IFRC and the private sector." IFPMA will identify potential partnerships and develop the framework for collaboration.

"Our member companies have been traditionally involved in this field," Ottiglio said. "One-quarter of our partnerships focus on NCDs." At present, IFPMA members have been involved in building capacity, raising awareness, devising strategies to facilitate access to medicines, and strengthening and securing the supply chain.

IFPMA and IFRC have trained volunteers in 20 countries in Asia and the Pacific and 13 in Europe, and are planning to conduct training in some 40 countries in the Americas and Africa by the end of the year. Volunteers in the initial 33 countries are now ready to implement the "4 Healthy Habits" initiative, which will be formally launched at a side event on the first day of the World Health Assembly.

Beyond financing and behavior change

Changing the behavior of communities is a key challenge the "4 Healthy Habits" initiative aims to address.

"[The] key for the success of the program is the uptake at the local level, in the sense that those that will be trained will be proactive and can explain the value of the program to the community. Messaging is key," Ottiglio stressed.

But there are key concerns surrounding NCD prevention that are beyond the scope of the initiative. Among these, Alomari noted, is the need to have legislation that can help promote healthy behavior.

"The challenge is for countries to adopt and enforce clear policies that work," Alomari said.

Financing is an issue as well. Early diagnosis is a vital component of preventing deaths from NCDs. But diagnosis is a problem in communities where health centers are ill-equipped or do not have the necessary equipment at all.

Alomari is hopeful global spending on NCDs will pick up in 2016, after the end of the MDG period. And some developments support this optimistic view.

At last year's meeting, the World Health Assembly approved a 20.5 percent increase in WHO's 2014-2015 budget for noncommunicable diseases — from $264 million to $318 million. This is in stark contrast to the $72 million cut in the allocation for infectious diseases. In 2013, WHO also released a $940.3 million, eight-year action plan to prevent and control NCDs.

Alomari is hoping for more than increased financing for NCDs at this year's World Health Assembly.

"We would want to see that NCD prevention would be included in the agenda of donors and policy makers. We would like to see there is a fund and promotion of community health workforce, including volunteers, as integral components of the health system. See more practical, easy-to-use toolkits and learn from them. We would like to see more programs in the field happening."

Devex is in Geneva to cover the 67th World Health Assembly. Check back in the next few days to see video interviews and more of our coverage from Switzerland. Join the Devex community and gain access to more in-depth analysis, breaking news and business advice — and a host of other services — on international development, humanitarian aid and global health.

source: www.devex.com

Alcohol kills 3.3 million people worldwide each year, more than AIDS, tuberculosis and violence combined, the World Health Organisation said on Monday, warning that booze consumption was on the rise.

Including drink driving, alcohol-induced violence and abuse, and a multitude of diseases and disorders, alcohol causes one in 20 deaths globally every year, the UN health agency said.

"This actually translates into one death every 10 seconds," Shekhar Saxena, who heads the WHO's Mental Health and Substance Abuse department, told reporters in Geneva.

Alcohol caused some 3.3 million deaths in 2012, WHO said, equivalent to 5.9 per cent of global deaths (7.6 per cent for men and 4.0 per cent for women).

In comparison, HIV/AIDS is responsible for 2.8 per cent, tuberculosis causes 1.7 per cent of deaths and violence is responsible for just 0.9 per cent, the study showed.

More people in countries where alcohol consumption has traditionally been low, like China and India, are also increasingly taking up the habit as their wealth increases, it said.

"More needs to be done to protect populations from the negative health consequences of alcohol consumption," Oleg Chestnov of the WHO's Noncommunicable Diseases and Mental Health unit said in a statement launching a massive report on global alcohol consumption and its impact on public health.

Drinking is linked to more than 200 health conditions, including liver cirrhosis and some cancers. Alcohol abuse also makes people more susceptible to infectious diseases like tuberculosis, HIV and pneumonia, the report found.

Most deaths attributed to alcohol, around a third, are caused by associated cardiovascular diseases and diabetes.

Alcohol-related accidents, such as car crashes, were the second-highest killer, accounting for around 17.1 per cent of all alcohol-related deaths.

China, India drinking more

Binge drinking is especially damaging to health, the WHO pointed out, estimating that 16 per cent of the world's drinkers abuse alcohol to excess.

While people in the world's wealthiest nations, in Europe and the Americas especially, are boozier than people in poorer countries, rising wealth in emerging economies is also driving up alcohol consumption.

Drinking in populous China and India is rising particularly fast as people earn more money, the WHO said, warning that the average annual intake in China was likely to swell by 1.5 litres of pure alcohol by 2025.

Still, Eastern Europe and Russia are home to the world's biggest drinkers.

Russian men who drink consumed an average of 32 litres of pure alcohol a year, according to 2010 statistics, followed by other Western countries including Europe, Canada, the United States, Australia and South Africa.

On average, every person above the age of 15 worldwide drinks 6.2 litres of pure alcohol in a year, according to the report.

Counting only those who drink though, that rises to 17 litres of pure alcohol each year.

But far from everyone indulges. Nearly half of all adults worldwide have never touched alcohol, and nearly 62 per cent say they have not touched a drink in the past year, the report showed.

Abstinence especially among women, is most common in low-income countries, while religious belief and social norms mean many Muslim countries are virtually alcohol free.

source: www.smh.com.au

A recent report issued by the World Health Organization reveals that antibiotic resistance is a major threat to public health.

Local health officials say it is important to be aware and take precautions, but people should not live in fear.

"It doesn't need to be a major scare," said James Clark, microbiology department manager at Alverno Central Laboratory in Hammond. "You can prevent the spread of anything you may be colonized with – of normal flora – by diligently washing your hands."

Antibiotics are medicines that fight bacterial infections by killing bacteria or preventing them from reproducing, according to the Centers for Disease Control and Prevention. They do not fight infections caused by viruses, including colds and the flu.

Taking antibiotics when a person is sick from a virus may do more harm than good, because each dosage increases the chance of the bacteria building a resistance.

People can spread an infection antibiotics cannot cure, according to the agency.

Bacteria and organisms can mutate and change genetic makeup to produce compounds to inactivate the antibiotics.

"Over time, they become more and more resistant to the variety of antibiotics," Clark said.

Resistance is a long-emerging trend.

"It's accelerating its spread and its incidence," he said. "In the early '80s and '70s, there was very little resistance to antibiotics."

Pharmaceutical companies are running out of ways to create new, stronger antibiotics. Bacteria are quick to figure out when an antibiotic has been modified, Clark said.

"The killer bugs have a much higher incidence in undeveloped countries where antibiotics are not controlled," Clark said. "In Mexico, you can walk into a drug store and tell them you have an infection and buy just about any antibiotic."

Several factors contribute to the growing problem.

The rising use of antibiotics by physicians who are possibly over-treating patients, hospital-acquired infections and agribusiness adding antibiotics worldwide to animal feed are main contributors, said Dr. Alex Stemer, president of Franciscan Medical Specialists.

The World Health Organization report suggests tracking and monitoring the problem, preventing infections in the first place through better hygiene, vaccination and infection control in health care facilities and developing new diagnostics, antibiotics and tools so health care workers can stay ahead of resistance.

In many parts of the world, there has not been antibiotic stewardship, which would restrict people from over-using antibiotics, Stemer said.

Stemer described Chicago and Lake County as "hot zones" for resistance.

"Bugs are geographically localized," he said.

Lake County has seen an emergence of CREs. CRE stands for carbapenem-resistant enterobacteriaceae, a family of germs difficult to treat because of their high levels of antibiotic resistance, according to the CDC.

"CREs are almost untreatable bugs with high mortality rates," Stemer said. "We have to be very aware of this and attuned to this."

Almost all area hospital have adopted a strict antibiotic policy for better stewardship, Stemer said.

"Throughout almost all of Lake County, these efforts have been in place for over a decade," he said.

Resistance to one of the most commonly used antibiotics to treat urinary tract infections caused by E. coli is widespread.

Fluoroquinolones were first introduced in the 1980s and had virtually zero resistance, according to the World Health Organization. Now, there are countries across the globe where the treatment is ineffective in more than half of the patients, the group's report states.

"Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," said Dr. Keiji Fukuda, assistant director-general for health security for the World Health Organization.

source: www.nwitimes.com

Three residents of Pekanbaru, Riau were placed in quarantine because they showed symptoms of Middle East Respiratory Syndrome (MERS) after two men died, likely from the infection, in Denpasar, Bali and Medan, North Sumatra.

"It's true, there are residents who are suspected to have MERS," Riau Health Agency head Zainal Arifin said, as quoted by the state-run Antara News Agency on Wednesday. "They've just returned from the minor hajj and have MERS indicators."

The virus is similar to the one that caused Severe Acute Respiratory Syndrome (SARS), which emerged in China between 2002 and 2003, killing some 800 people. It was first detected in Saudi Arabia in 2012.

Saudi Arabia is a nightmare for epidemiologists because hajj pilgrims travel there, spend time in dense crowds, and disperse back to the far corners of the world with the potential to carry infections home. Hundreds of thousands of Indonesians make the journey each year.

The Indonesian government has urged the pious to postpone their pilgrimages until the extent of the outbreak is better understood.

Pulmonologist Azizman Saad, who treated two of the quarantined patients at Awal Bros hospital in Riau, said that they had high fevers and difficulty breathing.

"In the latest examination, the condition of the patients had improved and the fevers had dropped," he said.

He said throat swabs and blood samples were undergoing tests at a Healthy Ministry laboratory.

"Today we've just sent the samples to Jakarta, so there's no confirmation that the three are positive for MERS," he said.

Two deaths

A man who died in Medan, North Sumatera on Sunday after returning from Saudi Arabia was likely the country's first victim of the virus, a health official said on Tuesday.

The man's family refused to allow doctors to take a saliva sample to test for the virus.

A second possible victim died in Bali on Wednesday morning, also after returning from Saudi Arabia.

The 50-year-old Nusa Dua resident, identified as A.S., passed away twelve hours after he was admitted to Sangha Hospital in Denpasar.

"The patient was treated for 12 hours and he did not survive," Sanglah Hospital medical support team head Ken Wirasandhi told the Jakarta Globe.

The man sought treatment at Surya Husada hospital on Tuesday after he experienced breathing difficulties and coughing. His family said he had just returned from a pilgrimage to Saudi Arabia.

Ken said the patient suffered from chronic lung disease but that MERS might still have been the cause of death.

"We treated him as a suspected [MERS patient] because of his travel history," he said, adding that the patient had been placed in quarantine.

The hospital had been through two previous MERS scares — a local resident and a Saudi Arabian tourist — but both tested negative, Ken said.

A.S.'s test results have not come in yet.

source: www.thejakartaglobe.com

For the first time ever, the World Health Organization on Monday declared the spread of polio an international public health emergency that could grow in the next few months and unravel the nearly three-decade effort to eradicate the crippling disease.

The agency described current polio outbreaks across at least 10 countries in Asia, Africa and the Middle East as an "extraordinary event" that required a coordinated international response. It identified Pakistan, Syria and Cameroon as having allowed the virus to spread beyond their borders, and recommended that those three governments require citizens to obtain a certificate proving they have been vaccinated for polio before traveling abroad.

"Until it is eradicated, polio will continue to spread internationally, find and paralyze susceptible kids," Dr. Bruce Aylward, who leads WHO's polio efforts, said during a press briefing.

Critics, however, questioned whether Monday's announcement would make much of a difference, given the limits faced by governments confronting not only polio but armed insurrection and widespread poverty.

"What happens when you continue whipping a horse to go ever faster, no matter how rapidly he is already running?" said Dr. Donald A. Henderson, who led the WHO's initiative to get rid of smallpox, the only human disease ever to have been eradicated.

The WHO has never before issued an international alert on polio, a disease that usually strikes children under 5 and is most often spread through infected water. There is no specific cure, but several vaccines exist.

Experts are particularly concerned that polio is re-emerging in countries previously free of the disease, such as Syria, Somalia and Iraq, where civil war or unrest now complicates efforts to contain the virus. It is happening during the traditionally low season for the spread of polio, leaving experts worried that cases could spike as the weather becomes warmer and wetter in the coming months across the northern hemisphere.

The vast majority of new cases are in Pakistan, a country which an independent monitoring board set up by the WHO has called "a powder keg that could ignite widespread polio transmission."

Dozens of polio workers have been killed over the last two years in Pakistan, where militants accuse them of spying for the U.S. government. Those suspicions stem at least partly from the disclosure that the CIA used a Pakistani doctor to uncover Osama bin Laden's hideout by trying to get blood samples from his family under the guise of a hepatitis vaccination program. U.S. commandos killed the al-Qaida leader in May 2011 in the Pakistani garrison town of Abbottabad.

At the end of last month, there were 68 confirmed polio cases worldwide, compared with just 24 at the same time last year. In 2013, polio reappeared in Syria, sparking fears the civil war there could ignite a wider outbreak as refugees flee to other countries across the region. The virus has also been identified in the sewage system in Israel, the West Bank and Gaza, although no cases have been spotted.

In February, the WHO found that polio had also returned to Iraq, where it spread from neighboring Syria. It is also circulating in Afghanistan (where it spread from Pakistan) and Equatorial Guinea (from neighboring Cameroon) as well as Nigeria, Ethiopia, Somalia and Kenya.

Officials also worry countries torn by conflict, such as Ukraine, Sudan and the Central African Republic, are rife for polio reinfection.

Some critics say it may even be time to accept that polio may not be eradicated, since the deadline to wipe out the disease has already been missed several times. The ongoing effort costs about $1 billion a year.

"For the past two years, problems have steadily, and now rapidly mounted," Henderson said in an email. "It is becoming apparent that there are too many problems (for the polio eradication effort) to overcome, however many resources are assigned."

Henderson and others have suggested the extraordinary efforts needed for polio eradication might be better spent on other health programs, including routine vaccination programs for childhood diseases. But he conceded that transitioning to a control program would be difficult. "If not eradication, how does one accomplish a 'soft landing' which could sustain the global program on immunization?" Henderson said.

Aylward said the WHO and its partners, including the U.S. Centers for Disease Control and Prevention, aren't yet considering pushing back their latest deadline to eradicate polio by 2018.

CDC Director Dr. Tom Frieden said the reemergence and spread of polio out of Pakistan, Cameroon and Syria pose "a serious threat to our ability to eradicate polio."

"Conflicts in many areas where polio is circulating are hampering efforts to vaccinate but success remains within reach," Frieden said.

Still, the independent board monitoring the progress being made on polio has called for overhauling the program.

"Few involved in (polio eradication) can give a clear account of how decisions are made," concluded a recent report by the group. "If a billion-dollar global business missed its major goal several times, it would be inconceivable that it would not revisit and revise its organizational and decision-making structure."

source: www.huffingtonpost.com

The Indonesian government is warning pilgrims about a viral respiratory disease that spread rapidly in Saudi Arabia in recent weeks.

With an outbreak of the deadly Middle East Respiratory Syndrome coronavirus (MERS-CoV) reported in Saudi Arabia, Indonesian health officials are moving to prevent the infectious disease from spreading to the archipelago.

Hajj pilgrims from Indonesia in particular, could be exposed to the virus in crowds at Mecca and at other sites in the kingdom and then bring it home, officials warn.

On Friday (May 2nd), the Indonesian government announced it would work with Saudi Arabia and other nations to contain the health threat, state-run Antara reported.

The Health Ministry also notified Indonesians travelling to Saudi Arabia-- particularly those going on minor Hajj pilgrimages-- to take precautions against the disease, Antara quoted Health Minister Nafsiah Mboi as saying. Its symptoms are similar to bird flu or avian influenza.

As many as 138 cases of MERS-CoV were identified in Saudi Arabia between April 11th and 26th, according to the World Health Organisation (WHO). As of April 26th, WHO counted 261 lab-confirmed cases worldwide since September 2012, including 95 fatal ones.

Getting the word out

No MERS-CoV cases have been reported in Indonesia, but a 61-year-old Indonesian man living in Saudi Arabia died of the disease in a Jeddah hospital on April 27th, Tjandra Yoga Aditama, disease control and environment health director for the Health Ministry, told reporters April 29th.

The Indonesian government will follow up by tracking down people who interacted with this man, Tjandra said.

"We will continue this process for the next two weeks with the Indonesian Consulate in Saudi Arabia, as well as with the World Health Organisation. We will also have a meeting with future Muslim pilgrims from Indonesia to ensure their safe travel," he told Khabar Southeast Asia.

Because as many as 250,000 pilgrims from Indonesia go on Hajj every year, the government is now busy informing those travellers about the risks of exposure to MERS-CoV, Religious Affairs Minister Suryadharma Ali said.

"With this huge number of people, every citizen must be aware of this virus. Every citizen is responsible to look after [his] health and resilience while performing Hajj," he told reporters.

Despite the health scare, Jakarta resident Farida Manti plans to join the throngs of Muslims from across the globe converging on Mecca for the Hajj in early October.

"I only can take preventative measures to avoid this virus. However, I will not cancel the pilgrim trip. I have been planning this for years," Farida, who plans to attend with seven relatives, told Khabar.

source: khabarsoutheastasia.com

Antibiotic-resistant "super bugs" have become a major threat to public health around the world, the United Nations says in a report released this week.

The U.N. World Health Organization report focuses on bacteria that have evolved to the point where current antibiotics no longer can combat them to treat the infections they're responsible for.

The report is not a warning for a future time, U.N. officials say, because the threat is here today and puts persons of any age living in any country in the world at risk.

The time to act is now, they say.

"Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," said Keiji Fukuda, WHO Assistant Director-General for Health Security.

The United Nations' concern over the issue is shared by a number of world health entities.

The U.S. Centers for Disease Control and Prevention has predicted "potentially catastrophic consequences" that could prevail if bacteria continue to evade treatment, noting super bug infections are involved in the deaths of around 23,000 in the United States annually.

Elevated resistance rates have been found globally in common bacteria involved in infections of the bloodstream, wounds, and the urinary tract.

Drug-resistant strains of bacteria that cause pneumonia and tuberculosis have also been seen worldwide, the U.N. report noted.

Pneumonia bacteria that are increasingly resistant to penicillin are now showing up in more than 50 percent of pneumonia cases in some areas of the world, it said.

In some parts of the Americas, the reported noted, as many as nine out of 10 infections involving Staphylococcus aureus are proving resistant to the antibiotic methicillin, a situation garnering its own acronym, MRSA.

As more bacteria show signs of antibiotic resistance, it raises the specter of diseases spreading more quickly and a corresponding higher death rate, Fukuda said.

"Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine," he said.

Changes are needed in the way in which antibiotics are produced, prescribed and used or more and more of them will become ineffective with disastrous implications for the future, he said.

source: www.techtimes.com

Geneva: A landmark challenge to Australia's plain-packaging law for cigarettes and cigars at the WTO could have vast implications for how governments square the rules of trade with radical public health measures.

The case against Canberra has been spearheaded by cigar-producing nations Cuba, the Dominican Republic and Honduras, which say brandless packaging is an assault on their trading rights.

World Trade Organization chief Roberto Azevedo is expected within days to name a three-member panel of independent experts on the laws of commerce, who will then have six months to issue a ruling on whether Australia is out of line.

"Resolution of this dispute is critical because it will go a long way toward indicating whether the WTO will allow countries to take reasonable actions that are intended to protect the public's health in an equitable and non-discriminatory fashion", Michael Siegel, a professor at the Boston University School of Public Health, told AFP.

The WTO panel was authorised in late April by a closed-door meeting of its dispute settlement body.

The Geneva-based WTO ensures that its 159 member economies respect the rules of global commerce and its panels have the power to authorise counter-measures by the wronged countries, such as raising import tariffs on the guilty party's goods.

An initial ruling would not be the end of the story, however, as the WTO dispute settlement process can grind on for years, amid appeals, counter-appeals and assessments of compliance with rulings.

Australia's law was fought tooth and nail by the tobacco industry before and since its entry into force in December 2012.

But it is lauded by the World Health Organization and campaigners around the globe, who appreciate Canberra's longstanding vanguard role in the fight against tobacco use -- the leading global cause of preventable death, claiming six million lives a year worldwide.

- Key anti-smoking measure -

The legislation requires all tobacco products to be sold in drab green boxes, use the same typeface and contain graphic images of diseased smokers.

Canberra and its supporters argue that by hitting the industry's branding power and by pushing stark messages, the law will help curb the number of smokers, notably young people who might otherwise take up the habit and thereby replenish the industry's customer base.

"Tobacco plain packaging is a legitimate measure designed to achieve a fundamental objective: the protection of public health," a spokesperson for Australia's Department of Foreign Affairs and Trade told AFP.

"Australia will vigorously defend the challenges to tobacco plain packaging in the WTO. Australia is confident the tobacco plain packaging measure is consistent with WTO obligations," the spokesperson said.

"Introducing tobacco plain packaging was the next logical step to restrict promotional material on tobacco products, closing one of the few remaining avenues for tobacco advertising in Australia."

Australia maintains that because plain packaging treats all players equally, it does not constitute discrimination under the so-called TRIPS agreement covering trade and intellectual property rights.

The argument that the law breaches trademark rules also failed to convince the Australian High Court in a case brought by tobacco firms.

Canberra also accuses its rivals of dragging out the process of filing WTO complaints, thus discouraging other countries from adopting similar legislation until their compatability with trade rules is clear.

Plans to bring in plain packaging rules across the 28-nation European Union have been sluggish, but Britain, Ireland and New Zealand have now said they plan to forge ahead.

- 'Detrimental to fair competition' -

Honduras, Cuba and the Dominican Republic say the legislation harms their traditional cigar brands, thereby hurting farmers and hundreds of thousands of cigar-sector employees in the three countries.

"We will do everything we can in order to protect the jobs, export revenues and intellectual property rights that are invaluable to our developing economy," said the Dominican Republic's WTO ambassador, Luis Manuel Piantini.

"Plain packaging is not only an ineffective health policy, but also one that is detrimental to fair competition in the marketplace," he added.

Fellow plaintiffs Indonesia and Ukraine, meanwhile, are both leading raw tobacco and cigarette exporters.

Analysts say the case tests the balance between TRIPS rules and measures that government argue are in the public interest, meaning a ruling could open a Pandora's box of other cases.

TRIPS public interest exemptions have in the past been interpreted as being related to security or morals, rather than health or the environment, said Fredrik Erixon, director of the European Centre for International Political Economy.

"This is going to set a precedent," he told AFP.

"What we're talking about here is the extent to which a government actually can deny a company the right to communicate its own trademark, to distinguish its own goods from other goods."

source: www.ndtv.com