16 JULY 2013 | GENEVA/COPENHAGEN - For the first time, EU countries have more people over 65 years of age than under 15 years of age. Echoing the trend seen in Europe, much of the rest of the world, including low-and middle-income countries, is moving in a similar direction. A new WHO report calls for pharmaceutical researchers to adjust their research and development efforts to account for this shifting demographic.

The report, Priority medicines for Europe and the world 2013 update, emphasizes that this shift in EU countries is 'bell weather' for the rest of the world as globally more people will be ageing and face similar health challenges in the future.

The report focuses on pharmaceutical 'gaps', where treatments for a disease or condition may soon become ineffective, are not appropriate for the target patient group, does not exist, or are not sufficiently effective.

"Despite an over three-fold rise in spending on pharmaceutical research and development in Europe since 1990, there is an increasing mismatch between people's real needs and pharmaceutical innovation. We must ensure that industry develops safe, effective, affordable and appropriate medicines to meet future health needs," says Nina Sautenkova, Health Technologies and Pharmaceuticals, WHO/Europe.

From a public health view, the trend of an increasing population over 65 leads to greater prevalence of diseases and conditions associated with ageing, such as heart disease, stroke, cancer, diabetes, osteoarthritis, low-back pain, hearing loss, and Alzheimer disease. In combination with health promotion and disease prevention initiatives, these conditions also require more investment in research and innovation to bridge the pharmaceutical gaps.

Since the original report was published in 2004, progress has been mixed

Patients, and particularly the elderly, often require medication for multiple chronic conditions. However, research and treatment guidelines tend to be more disease-driven than patient-centered. "Multiple small-scale trials of combination therapy have been undertaken but no large scale studies have been initiated. One such example is fixed dose polypills for ischemic heart disease (or myocardial ischaemia)," says Kees De Joncheere, Director of WHO's Essential Medicines and Products department. "Although there are some promising results from small trials, we need the investment in large-scale trials to have the evidence to see if we can get the right formulations and make this work in practice to save more lives."

In addition to conditions related to ageing, the report identifies a number of other important topics for future pharmaceutical research.

One area of concern is the need for more medicines that do not require storage in cool temperatures, such as heat-stable insulin for diabetes and oxytocin for childbirth. This would provide an important benefit to improve health services in countries without consistent access to refrigeration.

As identified in the 2004 report, the increasing resistance of common microbes to the medicines used to treat them, otherwise known as antimicrobial resistance (AMR), threatens to make many current health care interventions impossible. There is an urgent need not only to preserve current medicines, but also to develop new options.

Other highlights of the report include additional critical factors to pharmaceutical innovation, such as optimizing regulatory systems for market authorization; adopting effective pricing and reimbursement policies to create incentives; and leverage of existing electronic health records to obtain valuable data to improve medicine safety and effectiveness. Within Europe there are moves towards adaptive licensing and value-based pricing that will potentially change access to and incentives for new medicines. The need for meaningful patient and citizen involvement in pharmaceutical innovation and access was highlighted.

This report is an update to the 2004 version and is a collaborative product of the experts from WHO, EU Member States, industry, academia and other interested stakeholders including patients.

source:  www.who.int

MANILA, 15 July 2013 - Together with its Member States and partners, the World Health Organization (WHO) continues to make progress against neglected tropical diseases (NTDs) such as leprosy and yaws in the Western Pacific Region.

However, there are pockets in the Region where some of these afflictions continue to take a high toll on the poor. This is according to the latest WHO report—Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases—which charts progress in controlling, eliminating and eradicating these ancient illnesses.

"Tropical diseases are diseases of poverty and neglect," says WHO Regional Director for the Western Pacific Dr Shin Young-soo. "They afflict the most vulnerable people in society in 28 countries and areas in our Region. Although they are usually not fatal, they are distressing and create lasting disability and stigma. We are determined to despatch these diseases to where they belong—in the history books."

International experts, partners and national programme managers will gather in the WHO Regional Office for the Western Pacific for two key meetings on NTDs—the Western Pacific Region Programme Managers Meeting on Neglected Tropical Diseases from 16 to 18 July 2013, and the Western Pacific Regional Programme Review Group on Lymphatic Filariasis and Other Neglected Tropical Diseases on 19 July 2013. Both meetings aim to review the progress of integrated approaches in NTD control or elimination and explore new opportunities, as well as provide specific recommendations for each endemic country to address key challenges regarding NTDs.

During the Sixty-sixth World Health Assembly in Geneva in May 2013, a resolution on all 17 NTDs was adopted. Among other measures, the resolution urges Member States to:

1. ensure country ownership of prevention, control, elimination and eradication programmes;
2. expand and implement interventions and advocate for predictable, long-term international financing for activities related to control and capacity strengthening;
3. integrate control programmes into primary health-care services and existing programmes;
4. ensure optimal programme management and implementation; and
5. achieve and maintain universal access to interventions and reach targets set out in the WHO global road map to 2020 on neglected tropical diseases.

The resolution also calls on WHO to sustain its leadership in the fight against NTDs; develop and update evidence-based norms, standards, policies, guidelines and strategies; monitor progress, and support Member States in strengthening human resource capacity for prevention and diagnosis, including vector control and veterinary public health. Many Member States highlighted intensifying efforts to tackle dengue.

WHO promotes five public health strategies to control, eliminate and eradicate NTDs: preventive chemotherapy; innovative and intensified disease management; vector control and pesticide management; safe drinking water, basic sanitation and hygiene services and education; and veterinary public health services.

In September 2012, WHO developed the Regional Action Plan for Neglected Tropical Diseases in the Western Pacific (2012–2016), to help countries in the Region to control or eliminate NTDs and link the WHO global road map with national plans of action. The five-year plan focuses on seven key diseases: lymphatic filariasis (LF), schistosomiasis, blinding trachoma, leprosy, yaws, soil-transmitted helminthiases (STH) and foodborne trematodiases (FBT).

Lymphatic filariasis

Three countries in the Region—China, the Republic of Korea and Solomon Islands—have already eliminated LF. Countries and areas still endemic for LF in the Region aim to eliminate the disease before 2020. Brunei Darussalam, Fiji, French Polynesia, Kiribati, the Lao People's Democratic Republic, Malaysia, the Philippines and Tuvalu are currently implementing preventive chemotherapy. American Samoa, Cambodia, Cook Islands, the Marshall Islands, Tonga and Viet Nam have entered the post-mass-drug-administration surveillance phase, which usually happens five years after the completion of five to six rounds of mass drug administration. Palau, Niue, Vanuatu and Wallis and Futuna are now preparing to submit the dossiers for verification of elimination of LF.

Schistosomiasis

Schistosomiasis is endemic in Cambodia, China, the Lao People's Democratic Republic and the Philippines. The Western Pacific Region has successfully controlled Schistosoma japonicum, and elimination as a public health problem will be achieved by 2016. Incidences of schistosomiasis have been significantly reduced in Cambodia, the Lao People's Democratic Republic and the Philippines, but treatment campaigns will need to continue.

Blinding trachoma

Slated for global elimination by 2020, blinding trachoma is suspected or known to be endemic in parts of Australia, Cambodia, China, Fiji, Kiribati, the Lao People's Democratic Republic, Nauru, Papua New Guinea, Solomon Islands, Vanuatu and Viet Nam. Elimination of this disease has been set by the Lao People's Democratic Republic and Viet Nam in 2015, by China in 2016, and by Australia and Solomon Islands in 2020.

Leprosy

During 2010–2011, the number of new cases of leprosy declined from 1324 to 1144 in China, and from 2041 to 1818 in the Philippines. Kiribati, the Marshall Islands and the Federated States of Micronesia have not yet eliminated leprosy. An Action Framework for Leprosy Control and Elimination for the Pacific Island Countries was prepared in 2011, which focuses on integrating leprosy services into general health services, intensifying early case detection through contract tracing and mass screening, and strengthening rehabilitation services.

Yaws

Yaws is mostly endemic in poor populations in remote areas of Papua New Guinea, Solomon Islands and Vanuatu. While mass treatment campaigns in the 1950s using penicillin injections significantly reduced the number of people with yaws, the disease has been resurgent due to incomplete initial intervention coverage. With the availability of an oral drug for mass chemotherapy and new monitoring tools, achieving global eradication is possible by 2020.

Soil-transmitted helminthiases

Preventive chemotherapy for soil-transmitted helminthiases is required in 15 countries and areas in the Region. In 2011, 8.1 million out of an estimated 22.3 million school-aged children at risk were dewormed in 12 countries and areas: American Samoa, Cambodia, Fiji, French Polynesia, Kiribati, the Lao People's Democratic Republic, the Marshall Islands, Papua New Guinea, the Philippines, Tuvalu, Vanuatu and Viet Nam. Cambodia, Fiji, Kiribati and Tuvalu achieved the WHO global target of deworming of 75% of school-aged children.

Similar activities for women of childbearing age need to be scaled up in Cambodia, Fiji, Papua New Guinea and Viet Nam and need to begin in the other endemic countries.

Foodborne trematodiases

Six countries in the Region are endemic for foodborne trematodiases: Cambodia, China, the Lao People's Democratic Republic, the Philippines, the Republic of Korea and Viet Nam. In Cambodia, mapping continues to identify areas where foodborne trematodes are transmitted. At least 600 000 people in Cambodia are infected with opisthorchiasis. Pilot control interventions based on WHO's recommendations are planned.

Medicines such as praziquantel and triclabendazole are available through donations to the endemic countries. In the Lao People's Democratic Republic, preventive chemotherapy with praziquantel started in 2007; in 2011, approximately 325 000 adults and children out of an estimated 2.6 million people at risk were treated. In Viet Nam, preventive chemotherapy with praziquantel started in 2006. In 2011, more than 128 000 people were treated for clonorchiasis as part of a campaign targeted to people in high-risk communities. In the Republic of Korea, approximately 4000 people were treated for clonorchiasis in clinical settings in 2011.

"The achievements so far are both measurable and encouraging," says Dr Shin. "We have momentum on our side. But we must not relax our efforts when success is so close. History would not forgive us."

source:  www.solomontimes.com

The relationship between Timor-Leste and Indonesia has improved steadily since the independence referendum in 1999. Indonesia is now one of Timor-Leste's key trade partners and has strongly supported its application for membership of ASEAN. The two countries are also working toward settling border disputes that have been unresolved for many years.

This mood of cooperation is also working in the health sector.

Since Timor-Leste regained its independence, public health officials in Dili and Indonesian West Timor have faced substantial challenges in regard to the control of tropical infections which have an enormous impact on the health of already marginalised populations. Diseases such as lymphatic filariasis (elephantiasis), intestinal worm infections (especially hookworm) and yaws are highly prevalent across the island of Timor and cause chronic disfigurement, disability and death.

Elimination of these diseases can be achieved by mass drug administration (MDA) to affected populations (target 75-80%) annually for a period of 5-7 years. Such a program requires high levels of coordination and cooperation by health officials and the engagement of affected communities.

Efforts to free the developing world from these and other tropical infections received a boost in 1998, when the World Health Assembly resolved to eliminate them globally by 2020. The chances of doing so were greatly enhanced when a consortium of pharmaceutical companies pledged to donate the drugs required to treat these infections free of charge to all countries participating in the World Health Organization (WHO) Global Elimination Program.

Many countries have now commenced this program with support from the WHO, pharmaceutical companies, the Gates Foundation and other donors. However, it has not begun in Timor-Leste and has been interrupted in Indonesian Timor due to low capacity in the health workforce and a lack of donor support. The situation has been complicated by the recurrence of conflict in Timor-Leste and the logistical challenges involved in bringing together teams to work across national borders.

In December 2011 the Timor-Leste Minister of Health signed Memoranda of Understanding (MOU) on cross-border cooperation for public health with the Indonesian Minister of Health in Jakarta and with the Governor of Nusa Tengara Timur (NTT) Province in Kupang, West Timor, both vital steps in implementing the program. Under the latter MOU it was agreed that the Government of Timor-Leste and the Indonesian Provincial Government of NTT would cooperate to monitor and implement shared public health challenges. This cross-border cooperation is particularly important for the East Timorese enclave of Oecusse, which is completely surrounded by Indonesian territory.

The program is scheduled to commence in 2014. A senior public health expert from the Ministry of Health in Jakarta has recently assisted the Timor-Leste Ministry of Health to develop a detailed program implementation plan that includes cross-border cooperation on disease surveillance and information sharing on the progress of program implementation. Furthermore, a public health official from NTT will be invited to join the Task Force and vice versa.

Cross-border cooperation will be critically important during the post-MDA enhanced surveillance program to verify disease elimination and to ensure that Timor Island can be certified free of these diseases by the WHO in the shortest possible time. Such collaboration represents a practical example of cross-border cooperation that is of mutual public health benefit for Indonesia and Timor-Leste.

source:  www.lowyinterpreter.org

10 July 2013 – One in three people is now covered by at least one life-saving measure to limit tobacco use, according to a United Nations report which highlights the progress over the past five years of reducing potential smokers through advertising bans and awareness campaigns.

According to the report on the Global Tobacco Epidemic 2013, the number of people covered by bans on tobacco advertising, promotion and sponsorship increased by almost 400 million since 2003, bringing the total number of people covered to 2.3 billion.

In addition, the report shows that 3 billion people, most of which live in low and middle-income countries, are now covered by national anti-tobacco campaigns, most of them.

However, the report, which was produced by the World Health Organization (WHO), notes that to achieve the globally agreed target of a 30 per cent reduction of tobacco use by 2025, more countries have to implement comprehensive tobacco control programmes.

"If we do not close ranks and ban tobacco advertising, promotion and sponsorship, adolescents and young adults will continue to be lured into tobacco consumption by an ever-more aggressive tobacco industry," said WHO Director-General Margaret Chan. "Every country has the responsibility to protect its population from tobacco-related illness, disability and death."

Tobacco is the leading global cause of preventable death and kills 6 million people every year. It can cause cancer, cardiovascular disease, diabetes and chronic respiratory diseases. By 2030, WHO estimates that it will kill more than 8 million people every year.

Bans on tobacco advertising, promotion and sponsorship are one of the most powerful measures to control tobacco use. As of today, 24 countries with 694 million people have introduced complete bans and 100 more countries are close to a complete ban. However, 67 countries currently do not ban any tobacco advertising, promotion and sponsorship activities.

"We know that only complete bans on tobacco advertising, promotion and sponsorship are effective," said Douglas Bettcher, the Director of WHO's Prevention of Noncommunicable Diseases department. "Countries that introduced complete bans together with other tobacco control measures have been able to cut tobacco use significantly within only a few years."

The report also notes that more than half a billion people in nine countries now have access to appropriate services to help them quit smoking, 20 countries have put strong warning label requirements in place, and 32 countries passed complete smoking bans covering all work places, public places and public transportation. This last measure, WHO says, has proved to have the highest level of achievement, keeping hundreds of millions of people smoke-free.

In 2008, WHO identified six evidence-based tobacco control measures that are the most effective in reducing tobacco use. These measures consist of: monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco use, warning people about the dangers of tobacco, enforcing bans on tobacco advertising, promotion and sponsorship, and raising taxes on tobacco.

source:  www.un.org

The World Health Organization's emergency committee of experts is reviewing the outbreak of MERS coronavirus to assess its pandemic potential and the need for measures like travel restrictions.

The UN health agency's panel of international experts looking into Middle East coronavirus held its first meeting by teleconference on Tuesday. The group is advising WHO on whether the outbreak is a public health emergency of international concern.

Since April 2012, 80 laboratory confirmed cases of human infections with MERS coronavirus have been reported to WHO, including 45 deaths. Of the cases, 65 occurred in Saudi Arabia.

"While it is clear that human-to-human transmission does occur, it is not clear whether transmission is sustained in the community," WHO said on its website.

Sustained human-to-human transmission is one of the defining features of a pandemic.

Under the International Health Regions, the declaration of a pandemic means a virus is spreading from person to person in a sustained manner in at least two regions. The declaration acts as a signal to governments to spend more on containing the virus.

Affected countries include Jordan, Qatar, Saudi Arabia, the United Arab Emirates, France, Germany, the United Kingdom, Italy and Tunisia. All the European and North African cases have had a direct or indirect connection to the Middle East, according to WHO.

Representatives from all nine countries made presentations by video link, said WHO spokesman Gregory Hartl.

"Our expectation is that there will not be a decision today," Hartl told Reuters.

Limited transmission among close contacts who had not been to the Middle East has occurred in France, Italy, Tunisia and UK, WHO said. Close contacts include family members, co-workers, fellow patients and healthcare workers.

More information could also help governments advising people travelling to Saudi Arabia for hajj pilgrimage in October as well as the year-round umrah pilgrimages. Umrah is likely to be more crowed during the Ramadan fast, the U.S. Centers for Disease Control and Prevention said on its website.

There are currently no travel restrictions related to MERS from the Public Health Agency of Canada, which recommends general travel advice. In June, WHO experts advised countries at risk from MERS to plan for mass gatherings. The UN health agency issues similar recommendations before major international sporting events.

Mild and asymptomatic cases that could go undetected are another concern, WHO said in its latest statement. If mild cases are going undetected then the death rate is lower than it currently seems.

Dr. Theresa Tam, head of the Public Health Agency of Canada's health security infrastructure branch, is one of the 15 members of WHO's emergency committee. Tam has worked in the fields of respiratory diseases like flu and pandemic preparedness.

People who have been infected with MERS coronavirus have experienced influenza-like illness such as coughing, mucous, shortness of breath, malaise, chest pain and fever. Many have also had gastrointestinal symptoms such as diarrhea.

source:  www.cbc.ca

TORONTO - A top official of the Public Health Agency of Canada has been named to a special panel to advise the World Health Organization on the new MERS coronavirus.

Dr. Theresa Tam has had years of experience with the public health agency, both in respiratory diseases and pandemic preparedness and more recently as branch head for the health security infrastructure branch.

Tam is one of 15 experts from around the world who have been named to the WHO's so-called emergency committee, which will hold its first teleconference on Tuesday.

The group is being asked to assess the evolving situation and offer the WHO guidance on how to handle the outbreak, which to date has claimed at least 44 lives.

Its first order of business will be to decide whether the outbreak qualifies as a public health emergency of international concern under the provisions of a global health treaty called the International Health Regulations.

Other members of the committee include Dr. Martin Cetron, head of global migration and quarantine at the U.S. Centers for Disease Control, Prof. Maria Zambon, director for reference microbiology services with Public Health England, and Dr. Ziad Memish, deputy minister of health for Saudi Arabia, the country which to date has recorded the most MERS cases.

Members of the committee are experts in infection control, epidemiology and public health, and come from a range of countries.

The WHO announced on Friday that it was convening an emergency committee on MERS, which has infected at least 80 people since April 2012.

Dr. Keiji Fukuda, the WHO official who announced the formation of the committee, explained that while the agency doesn't currently feel MERS is a full-fledged crisis, it made sense to get outside advice on the situation at this point.

"This is a situation which makes us uneasy, but we can't say that it's a full-blown global pandemic. But we would like to have it assessed by other people too and have that input," Fukuda, assistant director-general for health security and the environment, said in an interview.

The release announcing the committee's membership contained conflict of interest declarations for two members of the committee, Zambon and Prof. Babacar Ndoye, a consultant and trainer in hospital hygiene, infection control and patient safety, from Dakar, Senegal.

The statement said Ndoye is in the process of setting up a training program in Senegal on hygiene and infection control, though the program has no relationship with industry.

Zambon, who has been with Public Health England (formerly known as the Health Protection Agency) since 1994, has as part of her government responsibilities liaised with industry on topics including vaccines and antiviral drugs. While the agency has received industry funds through collaborative research and development agreements, Zambon has not personally received funding, the statement said.

source:  www.timescolonist.com

The Representative of the Pan American Health Organization (PAHO) in Peru, Fernando Leanes praised Sunday the ongoing government's efforts to promote the health system reform which will contribute to the progressive health universal coverage of the population.

He described as a political demonstration of outstanding value the government's aim to achieve the universal health coverage based on primary care and the core principles of inclusion and development.

The PAHO official said that the guidelines set by the National Health Council (CNS) need to be transformed into regulations and investments which consolidate inclusive and supportive model to which the government aspires.

In this regard, Leanes noted that a group of PAHO experts have been providing technical assistance to the Ministry of Health (Minsa) and, in addition, they will accompany Peru's reform process.

Likewise, PAHO representative hailed the incorporation of students and self-employers workers to the country's Integral Health Insurance (SIS).

"This is an important reform, because it leads to the universal health coverage which is mandated by the World Health Organization's (WHO) member states," he said..

source:  www.andina.com.pe

The World Health Organization is forming an emergency committee of international experts to prepare for a possible worsening of the Middle East coronavirus (MERS), which has killed 40 people, WHO flu expert Keiji Fukuda said on Friday.

Fukuda said there was currently no emergency or pandemic but the experts would advise on how to tackle the disease if the number of cases suddenly grows. Most of the cases of MERS so far have been in Saudi Arabia, which hosts millions of Muslim visitors every year for the annual haj pilgrimage.

"We want to make sure we can move as quickly as possible if we need to," Fukuda told a news conference.

"If in the future we do see some kind of explosion or if there is some big outbreak or we think the situation has really changed, we will already have a group of emergency committee experts who are already up to speed so we don't have to go through a steep learning curve."

The emergency committee is the second to be set up under WHO rules that came into force in 2007, years after the 2002 SARS outbreak. The previous emergency committee was set up to respond to the 2009 H1N1 pandemic.

Fukuda said MERS (Middle East Respiratory Syndrome) remained a patchwork of infections that had not yet swept through countries or communities as influenza can. The committee was partly being formed to consider big gaps in knowledge about the disease, he added.

source:  english.ahram.org.eg