Tobacco companies have largely ignored an Indonesian deadline to put graphic health warnings on all cigarette packs being sold, another setback for anti-smoking efforts in a country that's home to the world's highest rate of male smokers and a wild, wild west of advertising.

Despite having a year and a half to prepare warning photos that are to cover 40 per cent of cigarette packs, most tobacco companies failed to meet Tuesday's deadline, according to the National Commission for Child Protection. It found little sign of change in brands being sold in Jakarta and 11 other cities across the archipelago.

"This clearly indicates that the cigarette industry has defied Indonesian law," said commission chair Arist Merdeka Sirait. "The government has been defeated by the cigarette industry."

Only 409 of the more than 3,300 brands owned by 672 companies nationwide had registered the photos they plan to use on their products as of Monday, according to the Food and Drug Monitoring Agency. They were given a choice of five images last June.

Health Minister Nafsiah Mboi said companies that missed the deadline will be issued warnings, and those that fail to comply could eventually be fined up to US$42,000 and face five years in prison.

Indonesia's biggest cigarette producer, Philip Morris-owned Sampoerna, said it began distributing products with the new warnings on Monday, but needed more time to clear out existing stock. But the labels must be displayed on shelves by Tuesday, Mboi said.

"We believe the government will implement the regulation consistently and fairly, so as to realise a climate of healthy competition among cigarette manufacturers, as well as providing clear information about the impact of smoking on health," Sampoerna spokesman Tommy Hersyaputera said.

Indonesia has a long history of delaying tobacco regulations. The graphic warnings stem from health regulations that passed in 2009, though it wasn't until 18 months ago that a specific decree was issued for implementation. And Indonesia is one of the few countries that has not joined a World Health Organisation tobacco treaty. The order has taken years to reach President Susilo Bambang Yudhoyono's desk, and he still has not signed it. He will leave office in October after elections next month.

Tobacco control is particularly contentious in Indonesia, the world's fifth-largest cigarette producer and a growth market for the industry. Farmers hold rowdy protests when restrictions are proposed, and lobbyists maintain tight connections with politicians in a government rife with graft.

Many forms of tobacco advertising long banned in the West remain ubiquitous here. Towering billboards and LED screens scream messages such as, "Marlboro Ice Blast ... crush it, unleash it." At the main international airport, a bright blue advertisement for Clas mild cigarettes urges, "Act Now! Talk less do more." Tobacco advertisements are still on television, and although new regulations ban sponsorship of events, some companies have continued that practice.

Tobacco-related illnesses kill at least 200,000 each year in the country, which has a population of around 240 million. A national survey in 2012 found that 67 per cent of all males over age 15 smoke – the world's highest rate – while 35 per cent of the total population lights up, surpassed only by Russia.

Most Indonesian men buy strong and pungent kreteks, filled with a mix of tobacco and cloves. But so-called white cigarettes, such as US-based Philip Morris International's Marlboro, have become more popular in recent years. All brands are cheap, selling for about US$1 a pack, making it easy for children to take up the habit.

source: www.scmp.com 

The deadly Ebola virus outbreak in West Africa has hit "unprecedented" proportions, according to relief workers on the ground.

"The epidemic is out of control," Dr. Bart Janssens, director of operations for Doctors Without Borders, said in a statement.

There have been 567 cases and 350 deaths since the epidemic began in March, according to the latest World Health Organization figures.

Ebola virus outbreaks are usually confined to remote areas, making it easier to contain. But this outbreak is different; patients have been identified in 60 locations in Guinea, Sierra Leone and Liberia.

Officials believe the wide footprint of this outbreak is partly because of the close proximity between the jungle where the virus was first identified and cities such as Conakry. The capital in Guinea has a population of 2 million and an international airport.

People are traveling without realizing they're carrying the deadly virus. It can take between two and 21 days for someone to feel sick after they've been exposed.

Ebola is a violent killer. The symptoms, at first, mimic the flu: headache, fever, tiredness. What comes next sounds like something out of a horror movie: significant diarrhea and vomiting, while the virus shuts off the blood's ability to clot.

As a result, patients often suffer internal and external hemorrhaging. Many die in an average of 10 days.

"We have reached our limits," Janssens said.

Doctors Without Borders, also known as Médecins Sans Frontières, is the only aid organization treating people affected by the virus. Since March, they have sent more than 300 staff members and 40 tons of equipment and supplies to the region to help fight the epidemic.

Still, they warn, it's not enough.

"Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites."

The good news is that Ebola isn't as easily spread as one may think. A patient isn't contagious — meaning they can't spread the virus to other people — until they are already showing symptoms.

Health officials have urged residents to alert MSF or local physicians at the first sign of flu-like symptoms. While there is no cure or vaccine to treat Ebola, MSF has proved it doesn't have to be a death sentence if it's treated early.

Inside isolation treatment areas, doctors focus on keeping the patients hydrated with IV drips and other liquid nutrients. It's working. Ebola typically kills 90% of patients. This outbreak, the death rate has dropped to roughly 60%.

MSF says they'll continue to isolate and treat Ebola patients in West Africa with the resources they have available but urge for a "massive deployment" by regional governments and aid agencies to help stop the epidemic.

World Health Organization officials say they're planning high-level meeting for the Minister of Health in the subregion July 2 and 3 to discuss the deployment of additional resources and experts to the area.

The outbreak will be considered contained after 42 days with no new Ebola cases — that's twice the incubation period.

source: fox2now.com

A strain of the polio virus has been found at an international airport in Brazil, but there are no human cases, the World Health Organization has said.

A WHO statement released on Monday said the virus was found in samples taken from sewage at Viracopos International Airport in Sao Paulo state in March.

It said the local population's high immunity to the disease "appears to have prevented transmission".

Brazil has been polio-free since 1989 and has high vaccination coverage.

The virus was found in "sewage only" and subsequent analysis of similar samples have either been negative or only positive for "non-polio enteroviruses", the organisation said.

The WHO said the sample was a close match with a recent strain isolated in a case in Equatorial Guinea.

The risk of the polio virus spreading from Equatorial Guinea is described as "high" by the UN agency, but it said the risk from Brazil remained "very low".

Polio invades the nervous system and can cause irreversible paralysis within hours. There is no cure for the disease but it can be prevented by immunisation.

Brazil's last national immunisation campaign was conducted a year ago and coverage in Sao Paulo state has been higher than 95%, the WHO said.

source: www.bbc.com

The World Health Assembly is the decision-making body of the World Health Organization (WHO), attended every year by leading government health officials from its 194 member nations. Recently, I was pleased to participate as a member of the U.S. delegation in the 67th meeting of this important group in Geneva.

One of the key topics addressed during this year's assembly was the critical role played by regulatory systems to ensure the safety, quality, and efficacy of medical products. Resolutions addressed the need to monitor and act on the rise in antimicrobial resistance, strengthen regulatory systems, and enhance access to biotherapeutic products.

As part of the resolution on antimicrobial resistance, the WHO will develop a draft global action plan to combat this problem. Member states were urged to strengthen their drug management systems, support research to extend the lifespan of existing drugs, and encourage the development of new diagnostics and treatment options.

The passage of a resolution to strengthen regulatory systems is itself a milestone for global health. It endorses a comprehensive approach to strengthening medical product regulation, and represents a basic change from traditional capacity-building that has focused primarily on sharing technical expertise. The new systems-oriented approach embraces the need for a strong legal framework, and the use of data and information technology, leadership, governance, partnership, and sustainable financing to strengthen regulatory effectiveness and efficiency.

The adoption of this resolution, co-sponsored by Australia, Brazil, Colombia, Mexico, Nigeria, South Africa, Thailand, and the United States, demonstrates a true international partnership across regions, with many nations affirming their commitment to working individually and together to strengthen their regulatory systems. This is the only way governments and their regulatory authorities can continue to build a global product safety net that will benefit patients and consumers around the world.

During the assembly, I had the privilege of co-hosting a special session entitled, "Regulatory Systems Strengthening: Mobilizing People and Resources" with the Mexican Secretary of Health, Dr. Mercedes Juan Lopez. The distinguished panel included Malebona Precious Matsoso, director general for the Department of Health in South Africa; Dr. Mark Dybul, executive director for The Global Fund to Fight AIDS, Tuberculosis and Malaria; Dr. Marie-Paule Kieny, assistant director-general for the World Health Organization; and Dr. Vincent Ahonkhai, the senior regulatory officer of the Bill and Melinda Gates Foundation. The discussions focused on several important themes, including the multiple benefits of strong regulatory systems for the public health, national security, and economic development and investment.

The panelists highlighted the unique challenges and opportunities faced by regulators because of globalization and the extraordinary increase in the global supply of medical products, and the high cost of regulatory system failures to patients and their trust in the health system. More specifically, the discussions focused on the critical role that regulators play in ensuring access to lifesaving medical products by creating an environment of good regulatory practices that support innovation and research, and protect the public from threats resulting from substandard or counterfeit products.

Panelists also reported on progress that is being made as nations increasingly collaborate to share information, reduce inefficiencies, and work toward regulatory convergence. For example, participants learned about the World Health Organization's decades-long efforts to support countries in strengthening their systems, and about WHO's prequalification program to ensure that select priority essential medicines, diagnostics, and vaccines are of high quality, safety, and efficacy for international procurement agencies and developing countries with limited regulatory capacity.

These kinds of collaborative strategies are essential in this global age. Only by strengthening our international partnerships, and by building regulatory systems that work together and support each other, can we ensure the quality, safety and efficacy of the medical products that the citizens of our nations depend upon.

source: www.qualitydigest.com

An Ebola outbreak continues to spread in three West African countries, and the death toll in the outbreak has risen to 337, the World Health Organization says.

Health officials have struggled to contain the outbreak, which is believed to have begun in Guinea, where the majority of the cases and deaths have been.

It has also touched Sierra Leone and Liberia, where it recently flared again after about two months with no new cases.

"This is a complex outbreak involving multiple locations in three countries with a lot of cross-border movement among the communities," Fadela Chaib, a spokeswoman for the UN health agency, wrote in an email.

"This makes this one of the most challenging Ebola outbreaks ever."

In an update published on its website on Wednesday, the agency said that more than 500 suspected or confirmed cases of the virus had been recorded.

That appears to be a large increase since the last update, published about a week earlier, when the agency reported about 240 had died of the disease. But there is sometimes a significant lag in tallying cases, and the organisation said the numbers were constantly in flux as test results came in.

"The jump in cases is due to reclassification, retrospective investigation, and consolidation of cases," Chaib wrote.

This is the first time Ebola has struck three countries at once and the first major outbreak in West Africa. Fear of the disease, for which there is no cure, has hampered efforts to isolate the sick.

Chaib said more work was required to get sick people into treatment facilities and to track down people that the sick had come into contact with, so they could be monitored for symptoms.

source: www.aljazeera.com

A group of 129 physicians, epidemiologists and others from 31 countries sent an open letter to the World Health Organization on Monday urging the United Nations agency to hold firm in what seems to be its intention to impose strict regulations on electronic cigarettes.

The letter was a response to one sent last month by 53 other experts who urged the WHO to go easy on e-cigarettes, which the advocates called "part of the solution" in the fight against smoking.

The latest letter, in contrast, said manufacturers should be required to present data that show the products are safe and help smokers quit, and disclose ingredients in the "vaping" liquid the devices burn.

Regulating e-cigarettes like tobacco products, the signatories wrote, is necessary to "prevent initiation of use among youth and other non-tobacco users, protect bystanders in public areas from involuntary exposure, regulate marketing, and prohibit unsubstantiated claims."

E-cigarettes use battery-powered cartridges to produce a nicotine hit via inhalable vapour without the tar and other carcinogens in inhaled tobacco smoke. Advocates said classifying e-cigarettes as tobacco products, and requiring comparable regulation, would threaten their potential to reduce the death and disease caused by smoking.

Their letter said e-cigarettes "could be among the most significant health innovations of the 21st century," adding that "the urge to control and suppress them as tobacco products should be resisted."

It remains unclear whether most e-cigarette consumers will be smokers using the devices to quit or non-smokers to whom they are a "gateway" product to nicotine addiction and smoking. One study published last month in the journal Circulation reported that most e-cigarette consumers are "dual users," both smoking and vaping.

The letter from opponents warned that although e-cigarette vapour has fewer toxic components than regular smoke, more than half a dozen studies have shown it can include ultrafine particles damaging to lungs, plus "carcinogens and reproductive toxins, including benzene, lead, nickel, and others."

The letter was organized by tobacco scientist Dr. Stanton Glantz of the University of California, San Francisco, and others.

The WHO is assessing its position on e-cigarettes, and has indicated it is leaning toward restrictions like those on all nicotine-containing products, including banning advertising and flavours.

source: www.theglobeandmail.com

Citing a need to respond to important infectious disease threats in South East Asia, public health officials from Thailand, Viet Nam and Indonesia agreed today to actively collaborate on a new study on sepsis, an major cause of death due to infectious diseases in the region.

The extent of sepsis in South East Asia is currently unknown but health care experts suspect that it accounts for a substantial number of deaths there. Preliminary results from a currently unpublished Thai study show that one in 6 patients who presented with sepsis died, a figure much higher than expected.

"We need to know the extent of sepsis, its causes and outcomes, so we can treat it more effectively and thereby save thousands oflives in South East Asia," said Dr Nguyen Tran Hien, Director of the National Institute of Hygiene and Epidemiology, Ministry of Health, Viet Nam, and Chair of the Governing Board of SEAICRN, speaking today at SEAICRNs annual meeting.

The sepsis study, which began late 2013 in Thailand and in early 2014 in Viet Nam, and which will start in Indonesia in late 2014, is supported by the Ministries of Health in Indonesia, Thailand and Vietnam, and by SEAICRN's global partners, which include the US National Institute of Allergy and Infectious Diseases, the Wellcome Trust and the World Health Organization (WHO).

"I urge that the Ministry of Health in all South East Asia countries actively participate in this important sepsis study," said Dr Muhamad Karyana, Chairman of INA-RESPOND, Center for Applied Health Technology and Clinical Epidemiology, Ministry of Health, Indonesia. "It is crucial that policy makers and leading research institutes collaborate and conduct high-quality research to provide evidence-based information to improve health care in our region."

Conducted by the South East Asia Infectious Disease Clinical Research Network (SEAICRN), the sepsis study seeks to identify the causes and outcomes of sepsis, improve its treatment, and help public health authorities and medical researchers across South East Asia better respond to other potentially deadly public health threats in South East Asia as new infectious diseases emerge.

"New and emerging infectious diseases are another threat to human health in Thailand and South East Asia, and researchers andpolicy makers need to be prepared to act promptly when they emerge," said Dr Supamit Chunsuttiwat, Senior Medical Officer, Department of Disease Control, Ministry of Public Health, Thailand.

"We learned during the 2005 H5N1 avian influenza outbreak that waiting for an outbreak to start makes it difficult to perform the best and most informative research," said Dr Direk Limmathurotsakul, Assistant Professor at the Faculty of Tropical Medicine, Mahidol University and Director of SEAICRN. "Initiating and collaborating on large multi-national clinical studies like this one to define the causes, management and outcome of sepsis will allow us to detect new emerging infectious diseases in South East Asia and plan a coordinated, more effective response."

Founded in 2005 in response to growing concerns about the H5N1 avian influenza pandemic, SEAICRN is a collaborative partnership of national public health agencies and medical researchers ideally positioned to swiftly initiate research in response to infectious disease threats. SEAICRN also aims to increase scientific knowledge and directly contribute to improvedclinical management of infectious diseases, such as sepsis, leptospirosis, dengue infection, and hand, foot, and mouth disease (HFMD) caused by Enterovirus 71 (EV71).

Participating SEAICRN institutes in Thailand include Siriraj Hospital, the Faculty of Tropical Medicine and Mahidol-Oxford Tropical Medicine Research Unit (MORU) at Mahidol University, Queen Sirikit National Institute of Child Health (Bangkok), Chiangrai Prachanukroh Hospital (Chiangrai), and Sappasithiprasong Hospital (Ubon Rathchathani).

In South East Asia, SEAICRN participating institutes include Indonesia's Cipto Mangunkusumo Hospital (Jakarta), Dr Sardjito Hospital (Vogyakarta) and Dr Wahidin Soedirohusodo Hospital (Makassar); and Viet Nam's Children Hospital 1 (Ho Chi Minh City), Children Hospital 2 (Ho Chi Minh City), Hospital for Tropical Diseases (Ho Chi Minh City), National Hospital for Pediatrics (Hanoi), National Hospital for Tropical Diseases (Hanoi), and Hue Central Hospital (Hue).

SEAIRCN's global partners who provide financial, scientific, operational and administrative support include the University of Oxford and the Wellcome Trust from the United Kingdom; the USA's National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIH/NIAID); the World Health Organization (WHO), Mahidol-Oxford Tropical Medicine Research Unit (MORU), Oxford Universities Clinical Research Unit (OUCRU) from Viet Nam, INA Respond, FHI 360 and Social & Scientific Systems, Inc.

source: english.vietnamnet.vn

The 2014 World Cancer Report, issued by the World Health Organisation (WHO), indicates that the number of new cancer cases has reached an all-time high.

On the 19 May 2014, Dr Margaret Chan, the Director-General of the WHO, gave a stirring speech to the 67th Health Assembly on the heavy health burden associated with cancer. Dr Chan was particularly interested in public health measures designed to combat the global tobacco epidemic.

Investor State Dispute Settlement Clauses

Dr Chan expressed her opposition to the use of investor-state dispute settlement clauses by Big Tobacco 'to handcuff governments', particularly in respect of lost profits following the introduction of cigarette packaging designed to reduce smoking. In a similar vein, former Australian Prime Minister Julia Gillard has warned that investor-state provisions give companies 'a new place to take disputes — a tribunal that stands separate from and above domestic legal systems'.

Philip Morris, an American tobacco and cigarette company, has challenged Uruguay's graphic health warnings for tobacco products under an investment agreement between Uruguay and Switzerland,as well as Australia's plain packaging of tobacco products under an investment agreement between Australia and Hong Kong.

There have been parallel problems in the field of access to medicines. Eli Lilly, an American pharmaceutical company, has challenged Canada's patent laws under an investment clause of the North-American Free Trade Agreement.More generally, the United Nations Conference on Trade and Development (Unctad) has reported a sharp rise in investor-state dispute settlement disputes.

Such disputes are not an isolated occurrence. Multinational tobacco companies have lobbied for the inclusion of investor-state dispute settlement in submissions to the United States Trade Representative for regional trade deals such as the Trans-Pacific Partnership (TPP) and the Trans-Atlantic Trade and Investment Partnership (TTIP). Big Tobacco also intends to use investment clauses as a means of delaying and frustrating the roll-out of the World Health Organization's Framework Convention on Tobacco Control across the world.

Plain Packaging of Tobacco Products

Dr Chan's speech also alluded to the battle over Australia's plain packaging of tobacco products in the World Trade Organization (WTO). Five countries — Ukraine, the Dominican Republic, Honduras, Cuba, and Indonesia — have challenged Australia's regime of plain packaging of tobacco products in the WTO. The complainants argue that the plain packaging of tobacco products violates the Trips Agreement 1994, which deals with trade-related aspects of intellectual property, as well as the GATT. The countries also allege that Australia has breached articles of the Agreement on Technical Barriers on Trade 1994. These arguments echo the position of the large multinational tobacco companies.

In response, Australia has maintained that the plain packaging of tobacco products is designed to address the global tobacco epidemic identified by the WHO, and to implement the WHO's Framework Convention on Tobacco Control. Australia has also emphasised that plain packaging of tobacco products is consistent with its international trade obligations under the Trips Agreement 1994, the Agreement on Technical Barriers on Trade 1994, and the GATT.

The five complaints have progressed slowly. There is some concern that the complainants have been stalling and delaying the dispute. In May 2014, WTO Director General Roberto Azevêdo appointed three panellists to examine the dispute against an Australian public health measure requiring tobacco products to be sold in plain packaging in the country. A decision is expected in six months.

A number of leading experts recently highlighted the strength of Australia's case in a submission and a presentation to the New Zealand Parliament. The submission observed that tobacco companies and their allies were prone to misrepresenting international trade law, by greatly overstating 'the constraints that international trade and investment agreements impose on governments' autonomy to regulate in the public interest in general and for public health in particular.' Australia's position is strongly supported by countries, such as Ireland and New Zealand, who are also implementing plain packaging of tobacco products.

Are Regional Trade Agreements Bad for Public Health

Dr Chan also expressed reservations about the public health impact of regional trade agreements, such as the TPP and the TTIP. Chan raised concerns about the impact of deals on public health issues, such as access to affordable medicines, as well as tobacco control measures like graphic health warnings, and the plain packaging of tobacco products.She observed that regional trade agreements can have a chilling effect: 'For bilateral and regional free trade agreements, as well as under World Trade Organization agreements, pressure can also come from fear that trade sanctions may be imposed by trading partners.'

Likewise, former New York Mayor Michael Bloomberg has also expressed his concerns that the TPP will promote the free trade in tobacco. Mr Bloomberg has stated that 'the Obama administration appears to be on the verge of bowing to pressure from a powerful special-interest group, the tobacco industry, in a move that would be a colossal public health mistake and potentially contribute to the deaths of tens of millions of people around the world.'

To conclude, Dr Chan emphasised that 'health is a smart investment', and that public health must be prioritised over economic interests. She argued that trade agreements which allow corporations to challenge government policies introduced to protect public health concerns are fundamentally out of step with this reality. Dr Chan looked forward to the development of strategies for a 'tobacco end game' that could end tobacco use altogether.

This article was written by Matthew Rimmer, an Australian Research Council Future Fellow, working on Intellectual Property and Climate Change. He is an Associate Professor at the ANU College of Law, and an associated director of the Australian Centre for Intellectual Property in Agriculture. This article was originally published on East Asia Forum and reproduced here with their kind permission.

Read more: Smoke and Mirrors in Trade Disputes will Harm Public Health And Weaken Tobacco Control http://www.establishmentpost.com/smoke-mirrors-trade-disputes-will-harm-public-health/#ixzz34Tz0kqsP

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