The Region of the Americas is the first in the world to have eliminated measles, a viral disease that can cause severe health problems, including pneumonia, blindness, brain swelling and even death. This achievement culminates a 22-year effort involving mass vaccination against measles, mumps and rubella throughout the Americas.

The declaration of measles' elimination was made by the International Expert Committee for Documenting and Verifying Measles, Rubella, and Congenital Rubella Syndrome Elimination in the Americas. The announcement came during the 55th Directing Council of the Pan American Health Organization/World Health Organization (PAHO/WHO), which is currently underway and is being attended by ministers of Health from throughout the Americas.

Measles is the fifth vaccine-preventable disease to be eliminated from the Americas, after the regional eradication of smallpox in 1971, poliomyelitis in 1994, and rubella and congenital rubella syndrome in 2015.

"This is a historic day for our region and indeed the world," said PAHO/WHO Director Carissa F. Etienne. "It is proof of the remarkable success that can be achieved when countries work together in solidarity towards a common goal. It is the result of a commitment made more than two decades ago, in 1994, when the countries of the Americas pledged to end measles circulation by the turn of the 21st century."

Before mass vaccination was initiated in 1980, measles caused nearly 2.6 million annual deaths worldwide. In the Americas, 101,800 deaths were attributable to measles between 1971 and 1979. A cost-effectiveness study on measles elimination in Latin America and the Caribbean has estimated that with vaccination, 3.2 million measles cases will have been prevented in the Region and 16,000 deaths between 2000 and 2020.

\"This historic milestone would never have been possible without the strong political commitment of our Member States in ensuring that all children have access to life-saving vaccines," Etienne continued. "It would not have been possible without the generosity and commitment of health workers and volunteers who have worked so hard to take the benefits of vaccines to all people, including those in vulnerable and hard-to-reach communities. Indeed it would not have been possible without the strong leadership and coordination provided by PAHO, Regional Office for the Americas of WHO."

Measles transmission had been considered interrupted in the Region since 2002, when the last endemic case was reported in the Americas. However, as the disease had continued to circulate in other parts the world, some countries in the Americas experienced imported cases. The International Expert Committee reviewed evidence on measles elimination presented by all the countries of the Region between 2015 and August 2016 and decided that it met the established criteria for elimination. The process included six years of work with countries to document evidence of the elimination.

Measles is one of the most contagious diseases and affects primarily children. It is transmitted by airborne droplets or via direct contact with secretions from the nose, mouth, and throat of infected individuals. Symptoms include high fever, generalized rash all over the body, stuffy nose, and reddened eyes. It can cause serious complications including blindness, encephalitis, severe diarrhea, ear infections and pneumonia, particularly in children with nutritional problems and in immuno-compromised patients.

As a result of global measles elimination efforts, only 244,704 measles cases were reported worldwide in 2015, representing a significant decline from earlier years. However, more than a half of these reported cases were notified in Africa and Asia.

To maintain measles elimination, PAHO/WHO and the International Expert Committee have recommended that all countries of the Americas strengthen active surveillance and maintain their populations' immunity through vaccination.

"I would like to emphasize that our work on this front is not yet done," warned Etienne. "We cannot become complacent with this achievement but must rather protect it carefully. Measles still circulates widely in other parts of the world, and so we must be prepared to respond to imported cases. It is critical that we continue to maintain high vaccination coverage rates, and it is crucial that any suspected measles cases be immediately reported to the authorities for rapid follow-up."

http://en.mercopress.com/

The period has closed for Member States to propose candidates for the post of Director-General of the World Health Organization, with six candidates being proposed from six countries.

The process began on 22 April 2016 and ended 22 September 2016. During that time, WHO's 194 Member States could propose candidates for the post of Director-General, the Organization's chief technical and administrative officer who oversees WHO's international health work.

The current Director-General, Dr Margaret Chan, was appointed in 2006 and will complete her second term on 30 June 2017. The new Director-General will take office on 1 July 2017.

Member States proposed the following candidates for the post of Director-General of WHO:

• The Government of Ethiopia has submitted the nomination of Dr Tedros Adhanom Ghebreyesus;
• The Government of Italy has submitted the nomination of Dr Flavia Bustreo;
• The Government of France has submitted the nomination of Professor Philippe Douste-Blazy;
• The Government of the United Kingdom of Great Britain and Northern Ireland has submitted the nomination of Dr David Nabarro;
• The Government of Pakistan has submitted the nomination of Dr Sania Nishtar;
• The Government of Hungary has submitted the nomination of Dr Miklós Szócska.

On 1-2 November, a forum will be held for candidates to present their visions to WHO Member States, and the public, and answer questions from Member States on their candidacy. The forum will be webcast in all languages on the WHO website.

In January 2017, WHO's 34-member Executive Board will draw up a shortlist of no more than 5 candidates. Executive Board members will then interview the candidates and nominate up to 3 to be put before the World Health Assembly in May 2017, when Member States will appoint a new Director-General by ballot.

Previously, WHO's Executive Board submitted just 1 nominee to the World Health Assembly, which then made the final appointment. The World Health Assembly is WHO's decision-making body and is attended by delegations from all WHO Member States. The Assembly's main functions are to determine WHO's policies, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget.

http://www.who.int/

NEW DELHI: In a rare scathing attack, the World Health Organisation's India representative has slammed India's government-owned disease surveillance system, saying it does not capture the true picture of the outbreaks.

The hint is that the low numbers being reported by the government of chikungunya and dengue cases could be because of this faulty system.

Henk Bekedam, the Delhi-based WHO representative to India, has called for continued investment in "enhancing surveillance and laboratory capacities".

WHO says India's system to detect diseases relies only on a select few government hospitals. The system entirely bypasses the patients who visit the private sector.

Since a substantial section of the population use healthcare facilities in the private sector, it is important to capture that data for a better understanding the national burden, he said.

The WHO has called for reporting of not just laboratory verified cases of dengue, but also probable cases, saying engagement with the private sector would be critical.

http://www.ndtv.com/

Jakarta. The most common type of cancer detected in patients across hospitals in Indonesia is breast cancer, Breast Cancer Foundation of Indonesia, or YKPI, chairwoman, Linda Gumelar, said in Jakarta, on Wednesday (07/09).

"In 2010, the number of breast cancer patients was detected in 28.7 percent of total cancer patients," Linda, a former minister for women's empowerment and child protection, said.

The Ministry of Health data in 2013 also revealed that 1.4 in every 1,000 women had breast cancer – a total of around 347,000 people.

According to data from the International Agency for Research on Cancer (IARC), cancer has accounted for 8.2 million deaths worldwide, and it is estimated that this number will increase to 13 million cancer-related deaths by 2030.

"In Indonesia, new cases of breast cancer have caused the highest mortality rate, where 21.5 deaths in every 100,000 persons are caused by breast cancer. What is alarming is that 70 percent of new breast cancer patients only visit a health center at an advanced stage," Linda said.

Linda promoted the National health insurance program, or JKN, managed by the National health insurance scheme, or BPJS, saying that it is an important tool for cancer patients, especially when cancer treatment is physically and financially taxing.

In many countries around the world, October is widely regarded as breast cancer awareness month, a global movement that attempts to raise awareness of the disease and promote education and detection.

According to the World Health Organization, almost 50 percent of breast cancer cases and 58 percent of deaths take place in developing countries, due to lack of early detection programs.

http://jakartaglobe.beritasatu.com/

Global public health experts have called for "fundamental and extensive reform" of the World Health Organisation (WHO) including major outsourcing of key activities, warning that the organisation is already at risk of repeating the mistakes it made in handling the Ebola crisis.

Writing in the British Medical Journal (BMJ), Professor Joel Negin of the University of Sydney and Dr Ranu Dhillon of Harvard Medical School say that only radical reform of the organisation will ensure it can get sufficient funding in the coming years and tackle public health crises.

Negin describes the current WHO response to an outbreak of drug-resistant tuberculosis in Papua New Guinea as having a "similar pattern" to the Ebola catastrophe.

"They are being slow in their response, not taking it as seriously as some others suggest they should. Some on the ground are saying this is like Ebola with wings, and we have a potentially cavalier attitude from the WHO," he says.

The WHO faced severe public criticism for its handling of the Ebola crisis in West Africa in particular over the failure to declare a public health emergency quickly enough. About 11,000 people died in the outbreak, which started in 2013. Dhillon and Negin say that there have been similar failings in public health responses in Sri Lanka in 2009, Haiti in 2010 and South Sudan in 2013.

At the heart of the vision for reform outlined in the article is a radical change to the way the WHO operates, with vital activities outsourced to other key players in the global health field, such as the Bill and Melinda Gates Foundation, the Global Fund for Aids, TB and Malaria, and frontline humanitarian response groups including Médecins Sans Frontières (MSF).

The report says: "WHO should aim to outsource a number of its functions to other global agencies that are already leading the way. This would allow the WHO to focus on a small number of core activities where it has comparative advantage and to coordinate or orchestrate the broader array of global health actors to take on other activities."

Negin points to recent calls, following the Ebola epidemic, for the WHO to establish a humanitarian rapid response team. "Why does this role fall to WHO when organisations such as MSF and the International Rescue Committee already have committed experts willing to travel to crisis zones and systems in place to quickly mobilise a response? These organisations have the credibility, track record and networks to fulfil this role and could further be reinforced instead of trying to create parallel mechanisms within WHO."

Responding to the BMJ article, a spokesman for the WHO said that the organisation is already undergoing two waves of reform following public discussion on its functions.

"The first [of these] was triggered by the financial situation after the global financial crisis. On top of this, the Ebola outbreak has shown that WHO needed to reform its work on emergency response to become, in addition to its normative and technical mandates, much more operational in the field.

"WHO is the world's best-placed convenor and has been mandated by its 194 member states to build an effective emergencies response and management function. This is currently under way."

Much of the WHO's work in the humanitarian sector is severely underfunded but Negin believes that without substantial reform and a willingness to use the expertise already existing across the sector, funders will not be prepared to give the large sums that the WHO needs, putting its operations at risk.

"A lot of donors are more impressed by the actions of other global health actors so they cut their funding for the WHO ... I just want [the organisation] to be more focused on a few things it does well, [such as] orchestrating the global health community expertise. WHO is being bypassed and only with reform can it play the role it should play."

https://www.theguardian.com/

The World Health Organization says the outbreak of Zika remains an international health emergency and that while the virus continues to hit new countries, experts still aren't sure how big the risk is that pregnant women who catch the virus will give birth to brain-damaged babies.

The U.N. health agency convened its expert committee this week to assess the latest status of the epidemic.

Dr. David Heymann, the committee's chair, said Friday that considerable gaps remain in understanding Zika and the complications it causes — including babies with serious neurological problems — and WHO concluded that the outbreak remains a global emergency.

"This extraordinary event is rapidly becoming, unfortunately, an ordinary event," Heymann said, explaining that health officials around the world should prepare for the imminent arrival of the disease spread mostly by mosquitoes, but also through sex.

In the absence of any effective treatments or vaccines for the disease— and given past failures to wipe out the mosquitoes that mostly spread Zika — Heymann said it will largely be up to individuals to avoid infection.

"People have to assume responsibility for this on their own," he said, adding that people at risk of the disease should wear long sleeves and insect repellent.

WHO said it was also unknown just how big the risk is for pregnant women. Although Zika has been proven to cause a range of neurological problems in babies, various studies have put the risk anywhere from 1 to 30 percent.

"We don't have a definitive answer," said Dr. Peter Salama, WHO's director of emergencies. "The risk is relatively low, but significant."

Despite Zika's spread to more than 70 countries and territories, Brazil has the vast majority of cases of microcephaly, or infants born with abnormally small heads. Heymann said that studies are ongoing in the country and that the explanation could involve numerous factors.

"It could be all the way from genetic (factors) to nutritional to environmental contaminants," he said.

Salama said officials are still trying to figure out whether the two known strains of the disease both cause microcephaly. So far, it is primarily the Asian strain of Zika, which is circulating in the Americas, that has been definitively linked to the severe birth defects.

In recent months, officials in Guinea-Bissau reported several microcephaly cases shortly before Zika was officially detected. Salama said that while Zika samples from the country appear to be from the African strain, it hasn't been determined whether the African strain of the virus might also be responsible for the neurological problems.

http://latino.foxnews.com/

The condition of the country's healthcare system couldn't be more ironic. While it is dubbed as one of the potentially biggest markets in the world, Indonesia seems incapable of giving patients more than the most basic of care.

Barely having recovered from a nationwide fake vaccine scandal that affected more than a million children, a recent study by the University of Indonesia (UI) has uncovered potential fraud in the National Health Insurance (JKN) scheme's hospital claims costing as much as Rp 7 trillion (US$526.7 million).
These incidents further call into question the government's capacity to manage the healthcare scheme, which already covers 170 million individuals, one of the largest in the world. Hospitals and health facilities, which are still far from adequate in quantity, are still weak at delivery points and with little scrutiny from the government.

Although the meager care is a logical consequence of the scant system, it is hardly tolerable. The government should prioritize the expansion of healthcare provision as more people register for national insurance. The persistent lack of health infrastructure facilities, as a result of the domestic failure to keep up with growing demand for care, should no longer be accepted as an excuse.

The ideal is to have the government build the health infrastructure by establishing health centers in remote areas that are less attractive for the private sector. But as the government is grappling with financing its more than $400 billion worth of infrastructure projects, it may consider opening up the domestic healthcare sector to foreign investors and providers to accelerate expansion.

Indonesia has been seen as a promising market exactly because of the largely underdeveloped health system. It is among the 15 fastest growing markets globally, according to Oxford Business Group, which estimated that the country's healthcare sector will be worth $50 billion by 2020.

In the earlier years of the JKN, rolled out by the Health and Social Security Agency (BPJS Kesehatan), it has already driven sales of medical devices, such as MRI machines, PET-CT scanners, most of which are imported. The market is still lucrative despite complicated import mechanisms.

The presence of foreign operators may increase the availability of services and spur competition in the sector. The problem of opening the domestic healthcare market to foreign investors, however, is more than just cutting red tape and rolling out the red carpet to investors.

The government should also improve monitoring of healthcare providers, especially hospitals and other medical centers in which malpractice frequently occurs and in which the fake vaccines were found.

Without a strong regulatory framework and effective monitoring system, the opening of the domestic healthcare market will only lead to further abuse of patients.

The UI study found that among the irregular claims from hospitals were an abnormally high number of babies delivered via C-section under the JKN, about 54 percent of 1.5 million babies delivered from January 2014 to July 2015. The unusually high prevalence of this procedure, which normally should be less than 10 percent of total child births, increased substantially the sums that had to be paid out by BPJS Kesehatan.

Even if more foreign providers are present, a lack of monitoring of the quality of drugs and treatments will prevent improvement in the quality of service, while costs will rise as a result of imported drugs and treatments. And how much will people have to pay for the government's basic insurance if costs spiral out of control?

The government should encourage investors and providers that can accept the modest market that characterizes the country. These investors should have an interest in producing generic drugs and have the capability to expand services for lower- and middle-income patients under the JKN.

More also should be done to improve the JKN's tariff system. With evidence of mismanagement, the BPJS Kesehatan should not rely on a reimbursement system to hospitals to support the health scheme. The agency should instead limit drugs and types of treatments that can be provided by hospitals and health centers under the insurance scheme. It can also start to directly procure drugs from pharmaceutical companies, rather than only accepting bills from hospitals.

Bargaining directly with pharmaceutical companies and other providers is a common practice in more advanced national insurance schemes in other countries.

In France, doctors and other health professionals in private practice are paid directly by patients. Health centers are still reimbursed by fees and charges set nationwide, while state hospitals receive annual operating budgets. In the UK, the National Health Service (NHS) directly carries out its own drug procurement.

These two pioneers in national health insurance schemes are not without criticism. Both are currently experiencing deficits amid an economic slowdown and ageing populations in the region.

The biggest disappointment is finding that the JKN is failing before it even gets around to extending healthcare to all of the country's population. It is like firing up the gas in the burner but the hot air balloon still never being able to get off the ground.

http://www.thejakartapost.com/

Singapore has confirmed 41 cases of locally transmitted Zika virus, mostly among foreign construction workers, and said it expected more cases to be identified.

All but seven of those infected had fully recovered, the Health Ministry and the National Environment Agency said in a statement on Sunday. The seven remain in hospital.

On Saturday, authorities confirmed a 47-year-old Malaysian woman living in southeastern Singapore as the city-state's first case of a local transmission of the virus.

Zika, carried by some mosquitoes, was detected in Brazil last year and has since spread across the Americas. The virus poses a risk to pregnant women because it can cause severe birth defects. It has been linked in Brazil to more than 1,600 cases of microcephaly, where babies are born with small heads.

Singaporean authorities said they tested 124 people, primarily foreign construction workers employed on a site in the same part of Singapore. That site has been ordered to halt work, and workers' dormitories are being inspected. Seventy-eight people tested negative and five cases were pending. Thirty-four patients had fully recovered.

Four Singaporean men had developed symptoms of the virus in the past week and were hospitalized on Saturday. It was not clear where the foreign workers were from or when their cases were detected. Singapore hosts a large contingent of workers from the Asian subcontinent.

None of those infected had traveled recently to Zika-affected areas. "This confirms that local transmission of Zika virus infection has taken place," the statement said.

The ministry "cannot rule out further community transmission since some of those tested positive also live or work in other parts of Singapore," the statement said. "We expect to identify more positive cases."

The World Health Organization said in a statement on Sunday that it did not know "which lineage of Zika is circulating" or "what the level of population immunity is to this lineage of Zika in Asia."

"It is important for countries to remain vigilant through surveillance for cases, to continue vector control, to inform people about Zika and how they can protect themselves, and to have the health system ready to supply the services needed to prevent and manage Zika and its consequences," the group told Reuters.

Singapore, a major regional financial center and busy transit hub, which maintains a constant vigil against the mosquito-borne dengue virus, reported its first case of the Zika virus in May, brought in by a middle-aged man who had been to Brazil.

CLEANUP

Singapore deployed about 200 NEA officers to clean drains and spray insecticide in the mainly residential area early on Sunday to counter mosquito breeding grounds, and volunteers and contractors handed out leaflets and insect repellent.

All medical services in Singapore had been alerted "to be extra vigilant" and immediately report any Zika-associated symptoms to the health ministry.

Singapore said there were "ongoing local transmission" cases in Indonesia, Thailand and Vietnam. Other countries in the region to have detected the Zika virus since 2013 include Bangladesh, Cambodia, Laos, Malaysia, Maldives and the Philippines, according to the WHO.

Malaysia said on Sunday it stepped up surveillance at main transit points with Singapore - handing out leaflets on Zika prevention and having paramedics ready to handle visitors with potential symptoms of the virus.

In Thailand, where close to 100 cases of Zika have been recorded across 10 provinces this year, the Department of Disease Control was screening athletes returning from the Olympic Games in Brazil, but was not otherwise changing its prevention measures.

"Every country in this region has Zika transmission cases," said Prasert Thongcharoen, an adviser to the DDC. "Thailand has, however, managed to contain the problem through early detection."

A Foreign Ministry spokesman said Indonesia was "following developments". Oskar Pribadi, a Health Ministry official, said there had been no recent Zika cases in the country.

Vietnam has to date reported three cases of locally transmitted Zika infection.

The current strain of Zika sweeping through Latin America and the Caribbean originated in Asia, where people may have built up greater immunity.

(Reporting by Marius Zaharia; Additional reporting by Aradhana Aravindan in Singapore, A. Ananthalakshmi in Kuala Lumpur, Amy Lefevre in Bangkok, Agustinus Beo Da Costa in Jakarta, My Pham in Hanoi, Julie Steenhuysen in Chicago and Trevor Hunnicutt in New York; Editing by Ian Geoghegan and Peter Cooney)

http://www.reuters.com/