Tag Archives: Africa

Ebola – the search for a vaccine

LONDON, 27 January 2015 – When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn’t care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

“That isn’t the reason why we don’t have vaccines for Ebola. The reason we don’t have a vaccine is because it wasn’t a priority for anyone, and there are understandable reasons for that…. The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

Now, clearly, it has become a priority. So if it isn’t just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health…

“Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot.

Rohit Malpani is director of policy and analysis for MSF’s Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it’s better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been “a bit of a moving target”.

“Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups – health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn’t being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, ‘Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa’. And the impact might be to put off people at risk from coming to get help, because they think, ‘Oh God, I’m going to be vaccinated’. When we do these trials for antibody response, it’s important that we do them on white people as well as black people, partly because it is important scientifically, but also because it’s important for public perception.”

More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don’t know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn’t be enough.”

Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can’t be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

[Courtesy of IRIN]

Advertisements

Chad: Meningitis Vaccine Cuts Cases By 94 Per Cent

Thurs 12 September 2013 @ 16.30

A meningitis vaccine that has recently been rolled out in several African countries has reduced the incidence of the disease by 94 per cent in Chad after just a single dose per person, in what scientists say is a startling success for the new vaccine, called MenAfriVac.

And the presence of the bacteria responsible for the disease in people’s throats – carriage prevalence – dropped by 98 per cent, according to the study published in The Lancet today.

The research, based on an analysis of data from 1.8 million vaccinations in Chad, revealed that there were no cases of serogroup A meningococcal meningitis, the most dangerous strain of the disease, following vaccination.

“This is one of the most dramatic outcomes from a public health intervention that I have seen,” said lead author Brian Greenwood.

“There are now real prospects that the devastating effects of this infection in Africa can be prevented,” said Greenwood, a professor of clinical tropical medicine at the London School of Hygiene & Tropical Medicine, United Kingdom, which carried out the study together with the Centre de Support en Santé Internationale in Chad and other partners.

Deadly epidemics of meningitis A occur regularly in Sub-Saharan Africa’s meningitis belt, a band of 21 countries stretching from Senegal in the west to Ethiopia in the east, where around 450 million people are at risk.

Continue reading

Kenya: 30,000 Children Targeted in Polio Campaign

THE government aims to immunize at least 30,100 children in Bondo district during the five-day polio vaccination which begins today.

The vaccination programme coordinator Ann Okoth said the door to door exercise will target children from the age of 5 years and below.

She appealed to parents and guardians to ensure all eligible children get the vital immunization. She was speaking yesterday during a preparation forum ahead of the exercise.

Okoth lamented that some parents had a tendency of denying their children access to such important services, and therefore warned that such cases will not be tolerated whatsoever.

She said the vaccination team was prepared to traverse the district including the islands of Mageta, Sifu, Ndeda and Oyamo to ensure that no child is left out during the exercise.

Okoth cautioned the parents to be wary of criminal elements who may take advantage of the exercise to rob residents by impersonating vaccination officials. “Our team will be provided with certified accreditation from the Ministry,” she added.

Continue reading

Namibia Winning HIV Fight

July 2013:

Namibia is rank as one of only seven countries – out of the total of 22 sub-Saharan countries – that made “a marked increase in progress in stopping new infections in children,” as part of the UN Global Plan to eliminate new HIV infections among children by 2015.

Namibia has reduced new HIV infections among children by 58 percent since 2009, according to the UNAIDS progress report released yesterday. Together with Botswana, Ethiopia, Ghana, Malawi, South Africa, Zambia, Namibia is one of the countries that “have rapidly decreased new HIV infections among children by 50 percent.”

The Global Plan is an initiative by the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United States President’s Emergency Plan for AIDS Relief (Pepfar), unveiled in June 2011 during the UN General Assembly High Level Meeting on AIDS. The report has two main targets to be achieved by 2015, which is to have a 90 percent reduction in the number of children newly infected with HIV, and a 50 percent reduction in the number of AIDS related maternal deaths. The Global Plan focuses on 22 countries that account for 90 percent of all new HIV infections among children. Among those countries are India, Nigeria, the Democratic Republic of Congo, Cameroon, Tanzania, Zimbabwe, Kenya, Chad, Angola, Uganda, and Burundi.

The report shows that the number of new HIV infections among children in Namibia in 2012 was 700. One out of ten pregnant women living with HIV did not receive antiretroviral medicines to prevent mother to child transmission of HIV, the report highlights.

Meanwhile, four out of ten women or their infants did not receive antiretroviral medicines during breastfeeding to prevent mother to child transmission of HIV, the report indicates. The report also reveals that 13 000 children were eligible for antiretroviral therapy in 2012 and that nine out of ten children are receiving HIV treatment.

In 2009 the HIV transmission rate from mother to child including breastfeeding was 19 percent and it has decreased every year since then, to reach 9 percent in 2012. Although there is a marginal increase in the number of women who acquired HIV from 2009 to 2012, the number of women acquiring HIV infection is largely constant, the report indicates. In 2009, 4 700 women reportedly acquired HIV and increased to 5 100 in 2012, while 94 percent of all pregnant women are receiving HIV treatment, according to the report.

The report hints that that improved access to family planning could further reduce the number of new HIV infections among children and improve maternal health. About 59 percent of pregnancy related deaths were attributed to HIV. In addition, there is a 21 percent unmet need for family planning, the report adds.

Countries reported to have achieved a moderate decline are Burundi, Cameroon, Kenya, Mozambique, Swaziland, Tanzania and Zimbabwe. Those with reported slow declines are Angola, Chad, Ivory Coast, the Democratic Republic of Congo, Lesotho and Nigeria.

UNAIDS Executive Director, Michel Sidibé said the progress in the majority of countries is a strong indication that with focused efforts every child can be born free from HIV. “But in some countries with high numbers of new infections progress has stalled. There is a need to find out why and remove bottlenecks, which are preventing scale-up,” Sidibé said.

The Deputy Permanent Secretary in the Ministry of Health and Social Services, Dr Norbert Forster on Monday said over 92 percent of public health facilities in Namibia are providing prevention from mother to child transmission (of HIV) services. Forster made the remarks at the launch of Namibia’s first national public health laboratory policy.

“Namibia is actually at the threshold of eliminating mother to child transmission. I commend all the women, especially those in far remote rural areas, often with no transportation to take them to health facilities, for all their efforts to access prevention from mother to child services,” Forster said.

[Courtesy of AllAfrica News]

Africa: 7 Million on HIV/Aids Antiretroviral Treatment

23 May 2013:

The number of people in Africa receiving antiretroviral treatment increased from less than 1 million to 7.1 million over seven years, according to a United Nations report which documents the progress in the AIDS response in the world’s second largest continent.

“Africa has been relentless in its quest to turn the AIDS epidemic around,” said the Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS), Michel Sidibé.

Antiretroviral treatment increased from less than 1 million in 2005 to 7.1 million in 2012, with nearly 1 million added in the last year alone. AIDS-related deaths were also reduced by 32 per cent from 2005 to 2011.

The UNAIDS Update on Africa, which was released to coincide with the beginning of the African Union’s (AU) 21st summit in Addis Ababa, which began Sunday and runs through 27 May, attributes this success to strong leadership and shared responsibility in Africa and among the global community. It also urges sustained commitment to ensure Africa achieves zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“As we celebrate 50 years of African unity, let us also celebrate the achievements Africa has made in responding to HIV–and recommit to pushing forward so that future generations can grow up free from AIDS,” Mr. Sidibé said.

The report states that 16 countries–Botswana, Ghana, Gambia, Gabon, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe–now ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child.

Despite positive trends, Africa continues to be more affected by HIV than any other region of the world, and accounts for 69 per cent of people living with HIV globally. In 2011 there were still 1.8 million new HIV infections across the continent, and 1.2 million people died of AIDS-related illnesses.

In the report, entitled Update, Mr. Sidibé emphasizes that sustained attention to the AIDS response post-2015 will enhance progress on other global health priorities. He also identifies five lessons in the AIDS response that will improve the world’s approach to global health. These are: focusing on people, not diseases; leveraging the strength of culture and communities; building strong, accountable global heath institutions; mobilizing both domestic and international financial commitments; and elevating health as a force for social transformation.

“These strategies have been fundamental to Africa’s success at halting and reversing the AIDS epidemic and will support the next 50 years of better health, across borders and across diseases,” he said.

The report also stresses AU leadership is essential to reverse the epidemic. At this year’s Summit, AIDS Watch Africa, a platform for advocacy and accountability for the responses to AIDS, tuberculosis and malaria founded by African leaders in 2001, will review progress on health governance, financing, and access to quality medicines, among other areas, and measure whether national, regional, continental and global stakeholders have met their commitments.

The AU, UNAIDS and the New Partnership for Africa’s Development (NEPAD) will also launch the first accountability report on the AU-G8 partnership, focusing on progress towards ending AIDS, Tuberculosis and Malaria in Africa.

[Courtesy AllAfrica News]

NIGER: Cholera Outbreak

NIAMEY, 22 May 2013:

Cholera has struck 248 people in Ayorou in the Tillabéry Region of northwestern Niger, killing six, two of them Malian refugees.

Among the sick are 31 Malian refugees who are living in Tabareybarey and Mangaize camps near the Mali border, according to the Tillabéry health services and the UN Refugee Agency (UNHCR).

In the camps and in surrounding villages, UNHCR has upped the supply of clean water to refugees, is distributing oral rehydration solution, soap, and disinfectant tabs to clean water, but more drugs are urgently needed, it said in a 21 May communiqué. NGO Médecins sans Frontières is treating those who have contracted cholera in camps.

UNHCR is worried that cholera could spread quickly due to the high concentration of refugees in the region.

Most of the cases were inhabitants of the town of Ayorou, which hosts a Sunday livestock market frequented by people from all across the region. The Ministry of Health is trying to temporarily shut down the market, which is just next to the River Niger, the suspected source of the contamination. The Health Ministry has also banned anyone from using, or drinking, water from the river, though this is very difficult to monitor.

The World Health Organization is supporting local health authorities to contain the disease’s spread.

Last year 5,785 people contracted cholera in Niger, and 110 of them died, according to UNHCR.

[Courtesy of IRIN]

DRC: Malaria “Leading Killer of Children”

DRC 21 May 2013

Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are hampering the fight against malaria, a leading killer of children, say experts.

Malaria accounts for about a third of outpatient consultations in DRC clinics, Leonard Kouadio, a UN Children’s Fund (UNICEF) health specialist, told IRIN. He added, “It is the leading cause of death among children under five years and is responsible for a significant proportion of deaths among older children and adults.”

Kouadio continued: “Recent retrospective mortality surveys have revealed that in all regions of the country, the fever is associated with 40 percent of [deaths of] children under five.”

Malaria is also a leading cause of school absenteeism in DRC, and it may have other adverse effects. “In cases of severe malaria, children who survive face serious health problems such as epilepsy, impaired vision or speech,” he said.

According to UN World Health Organization (WHO) estimates, out of about 660,000 malaria deaths globally in 2010, at least 40 percent occurred in DRC and Nigeria.

In DRC, malaria accounts for about half of all hospital consultations and admissions in children younger than five, according to the government’s National Programme for the Fight against Malaria (NMCP).

On average, Congolese children under five years old suffer six to 10 episodes of malaria per year, according to UNICEF’s Kouadio.

Other leading causes of death among under-five Congolese children include acute respiratory infections, diarrhoeal diseases and malnutrition, according to UNICEF’s 2013-2017 DRC Country Programme Document.

“It is apparent that major deficiencies in the health system have contributed to the severity of recurrent outbreaks [of malaria],” Jan Peter Stellema, Médecins Sans Frontières (MSF) operational manager, told IRIN via email.

“Mosquito nets are not being sent to vulnerable areas, and there are shortages of rapid diagnostic test [kits and] drugs and the equipment for carrying out blood transfusions vital for children suffering from anaemia caused by malaria.”

Other problems include costly care and management challenges.

For example, the treatment of an uncomplicated bout of malaria ranges from about US$22 to $35, and treatment for severe cases can cost $75 to $100, according to NMCP. Such costs are prohibitive for a large number of people, many of whom live on about one dollar a day.

“In DRC, the absence of other healthcare providers and overstretched health systems leave people vulnerable to contracting malaria.

Too many health centres lack the supplies necessary for coping with a new outbreak, and as a result children are dying because they did not receive care for malaria,” MSF’s Stellema said.

According to the DRC Country Programme Document, “Governance, management and coordination problems plague the [health] system at the national, provincial and local levels, thereby undermining political commitment, planning, budgetary expenditure, coordination and alignment of partnerships, the accountability and transparency of service providers, and the participation of the population in management of the services.”

It adds, “Combined with extreme poverty, these factors create financial barriers hampering families’ access to nutrition and services, and weaken the social standards that are essential for keeping families together and maintaining a protective environment for children.

“The absence of government investment and the fragmentation of public assistance have eroded the capacity of civil society and of functional public facilities to maintain quality services,” adds the DRC Country Programme Document.

“The re-mergence and expansion of certain epidemics (polio, measles and cholera) are proof of that.

In addition, little has been done to modernize infrastructure. Essential supply systems, such as the cold chain, have not been put in place,” it states.

There is an urgent need to address the struggling health system to fight malaria, experts say.

“The fight against this scourge must remain a top priority of the country, despite the lack of financial resources,” said UNICEF’s Kouadio.

“The government and its partners should increase the funding for the fight against malaria in the DRC, in particular, acquisition and universal distribution of mosquito nets to households, provision of essential drugs and rapid diagnostic test [kits], and dissemination of environmental sanitation measures.”

Malaria occurs almost year-round in DRC due its tropical climate and its river and lake system.

The country has some 30 large rivers totalling at least 20,000km of shoreline, and 15 lakes totalling about 180,000km, which offer environments conducive to the proliferation of diseases and disease vectors, including the Anopheles mosquito, which spreads malaria.

According to MSF’s Stellema, the DRC government and national and international health actors need to take rapid and sustainable measures to prevent and treat malaria in order to avoid unnecessary child deaths.

In 2012, MSF treated half a million Congolese for malaria, many of them children under five.

“MSF’s emergency response is saving lives in the short term. But in the longer term, the organization cannot address the [malaria] crisis alone,” said Stellema.

[Courtesy of IRIN]