“Fighting the Flu with One Hand Tied” – op-ed by Prof. Gostin in the Washington Post

The excellent op-ed by Prof Lawrence Gostin*, “Fighting the Flu With One Hand Tied” in the May 1, 2009 edition of the Washington Post highlights the legal and financial limitations of two of the world’s key public health agencies- the World Health Organisation (WHO) and US Centers for Disease Control and Prevention (CDC).

In reference to the revised 2005 International Health Regulations and the experience with SARS, Prof Gostin points out:

…the frightening truth is that the WHO has no real power. It lacks an effective mechanism for monitoring and enforcing national reporting. Its recommendations to countries are expressly “non-binding.” Countries do not even have to share virus samples with it. Indeed, despite painful negotiations over the past two years, the agency has not been able to persuade Indonesia to share samples of avian influenza, threatening vaccine production and public health preparedness.

Professor Gostin also highlights the grim reality of how the world’s poor are also the most vulnerable to, and the least capable of coping with public health emergencies of international concern.

Perhaps more worrying is the lack of capacity in poor countries to detect and respond to emerging threats. This is of particular concern because influenza often emerges in Asia, where crowded cities and close proximity between animals and humans can breed infectious disease. Although Mexico is the likely center of the current outbreak, the genetic material in the swine flu virus is of Eurasian origin. Many poor countries lack adequate surveillance, early warning systems and modern laboratories; they also have negligible public health infrastructures. Although the revised International Health Regulations urge capacity building, Western governments have donated precious little funding, and the WHO has no mechanism or resources for expanding public health capacities within individual countries.

After shedding some light on CDC’s limited legal authority and resources to effectively respond to swine flu -influenza A (H1N1), Prof. Gostin concludes:

The WHO and the CDC are our frontline defense against infectious diseases that can rapidly mutate and travel across continents. It is easy to criticize these agencies and deprive them of resources. It is much harder, but necessary, to build strong public health agencies to do the vital work that we all rely on, especially in the face of an international public health emergency.

*Professor Gostin is a professor of global health law and faculty director at Georgetown University Law Center’s O’Neill Institute for National and Global Health Law, as well as a member of the World Health Organization International Health Regulations Roster of Experts and director of the WHO Collaborating Center on Health Law.

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Health Crisis in Zimbabwe Deepens; Could Be Referred to International Criminal Court

Physicians for Human Rights have suggested that the health crisis in Zimbabwe should be referred to the International Criminal Court for further investigation.  Although the report recognizes that criminal prosecution at the International Criminal Court has not yet “addressed crimes against humanity in the context of willful and state-sponsored actions that lead to massive loss of life resulting from, for example, failures to respond to epidemics, active obstruction of humanitarian aid, or the deliberate destruction of health systems,” such action is not beyond the scope of the Court’s jurisdiction.  Physicians for Human Rights has also called upon the UN to take control of Zimbabwe’s health service.

 

The report was signed by South African Archbishop Desmond Tutu, former UN High Commissioner for Human Rights Mary Robinson and Richard Goldstone, a former chief prosecutor at the International Criminal Tribunal for Rwanda.

 

Under Robert Mugabe‘s rule, Zimbabwe has battled a cholera outbreak that, according to new numbers from the U.N. World Health Organization, has killed 2,024 since August.  The total number of people infected has surged passed 40,000.  The life expectancy fell from 62 years for both men and women in 1990 to 34 years for men and 37 years for women in 2006, the world’s lowest. Zimbabwe experiences around 400 deaths a day from HIV/AIDS.  Maternal mortality in Zimbabwe has risen from 168 deaths per 100,000 in 1990 to 1,100 per 100,000 in 2005.

 

Under international law, Zimbabwe is obligated to provide a minimum level of access to health care to its citizens.  Zimbabwe is a party to the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination against Women, and the African Charter on Human and Peoples’ Rights. The Government has a legally binding obligation to respect, protect, and fulfill these rights for all people within its jurisdiction.

 

The Mugabe-led government has exacerbated the problems facing Zimbabweans blocking international humanitarian organizations from delivering food aid and humanitarian aid to populations in the worst-affected rural areas.

Zimbabwe‘s cholera outbreak has sparked fears that the epidemic has spread to northern neighbor Zambia and southern neighbor South Africa who have seen an increase in cholera-related deaths.

Urgent Help is Needed to Stem Zimbabwe’s Cholera Epidemic

According to the BBC, Zimbabwe’s government has asked the international community for urgent help in tackling its cholera outbreak.  The ongoing cholera outbreak has claimed over 480 lives and led to more than 11,700 recorded cases since August.

Cholera is an infectious disease caused by ingesting contaminated food or water.  In its most severe forms, cholera is one of the most rapidly fatal illnesses known with death following within 18 hours to several days, unless oral rehydration therapy is provided.

UNICEF has announced a 120-day plan to help Zimbabwe deal with this emerging humanitarian crisis as Zimbabwe deals with the cholera outbreak, the closure of hospitals and the collapse of the education sector. 

As a result of these crises, Zimbabwe’s economy is now largely shattered and severe food shortages are commonplace. 

“The UN agency will immunize up to 1.5 million children, procure essential medicines for 70 per cent of the national population, provide clean water and sanitation to many communities, distribute ready-to-use nutritional foods at therapeutic feeding centres and unveil a national awareness campaign on cholera prevention.”  

UNICEF also plans to provide aid to Zimbabwe’s estimated 250,000 orphans–the country is believed to have the highest orphan percentage in the world, at one in every four children.

For Some, Tuberculosis Diagnosis is a Prison Sentence Without End

xdr-tbAccording to the BBC, in some parts of the world being diagnosed with Extreme Drug Resistant Tuberculosis(XDR-TB) is equivalent to being handed an indefinite prison sentence.

Tuberculosis is a public health crisis and has been declared a national emergency in South Africa.   Estimates suggest that nine million people contract standard TB every year.  Ninety percent of those who contract TB living in the developing world. 

The standard course of TB treatment is six months of antibiotics.  For most people, this treatment works so long as they continue to take the drugs for the entire six months.  Health care workers attempt to ensure that people stick with their treatment by requiring that patients go to a clinic every day and be watched taking their pills. Some patients feel better after a couple of months, however, and stop coming.

This failure to finish treatment enables the bacteria to build resistance to the drugs.  It is this “non-compliance” that has led the bacteria to mutate into two drug-resistant strains of MDR-TB and the much more dangerous strain XDR-TB. They are now found in 45 countries.

According to the WHO, and based on data from an XDR-TB outbreak in South Africa, XDR-TB has an alarmingly high mortality rate.  Of the 544 patients studied, 221 had MDR-TB. Of the 221 MDR-TB cases, 53 were defined as XDR-TB. Of the 53 patients, 44 had been tested for HIV and all were HIV-positive.  52 of 53 patients died, on average, within 25 days.

Protecting the public’s health has become the focus in the battle against these new drug-resistant strains of TB.  It is why people with the new strains are being kept virtual prisoners, even if the cost is their personal freedom.  Patients are generally required to stay in the hospital until they have tested negative for TB.   As of now, only one XDR patient in the South African hospital has left permanently cured.

Google Tracks and Predicts the Flu

In addition to predicting outbreaks of malaria and meningitis through Google.org, it turns out the google search engine itself is quite the predictor of flu outbreaks.  According to the New York Times, people type phrases such as “flu symptoms” into a search engine long before visiting a doctor, enabling google to identify flu outbreaks before cases are even reported even to the CDC

For example, Google’s search data showed a spike in queries about flu symptoms two weeks before the CDC reported that flu cases had spiked in mid-Atlantic states in early February.  Unlike google, the CDC relies on data collected and compiled from health care providers, labs and other sources.

Public health experts hope that Google’s accelerated recognition of an outbreak can help accelerate the response of doctors and other health care providers, reducing the spread of the disease and, hopefully, saving lives.

The service covers only the United States, but Google is hoping to eventually use the same technique to help track influenza and other diseases worldwide.

Check out google’s new flu tracking service here.

Google.org Invests in Identifying Public Health Outbreaks

google.orgAs reported in America.gov, and announced on October 21, Google.org is making an initial grant of $14.8 million for its “Prevent and Predict” program.   The money is going to six partnerships in Africa and Southeast Asia and is aimed at helping nations and international organizations for both animal and human health to identify possible public health outbreaks before they become emergencies. 

According to Google.org Executive Director Dr. Larry Brilliant: “The teams we’re funding today are on the frontiers of digital and genetic early-detection technology.”

Google.orgis focusing on environmental changes as key determinants in public health emergencies, particularly those pertaining to malaria and meningitis whose transmission can depend on climatic conditions such as rainfall, humidity and temperature.

Read more about where Google.org’s money is being spent, after the jump. Continue reading