Never Be Silent

In its entirety:

HANOI, Vietnam – Diarrhea doesn’t make headlines. Nor does pneumonia. AIDS and malaria tend to get most of the attention.

Yet even though cheap tools could prevent and cure both diseases, they kill an estimated 3.5 million kids under 5 each a year globally — more than HIV and malaria combined.

“They have been neglected, because donor or partnership mechanisms shifted their emphasis to HIV and AIDS and other issues,” said Dr. Tesfaye Shiferaw, a UNICEF official in Africa. “These age-old traditional killers remain with us. The ones dying are the children of the poor.”

Global spending on maternal, newborn and child health was about $3.5 billion in 2006, according to a report by the Bill & Melinda Gates Foundation. That same year, nearly $9 billion was devoted to HIV and AIDS, according to UNAIDS.

Pneumonia is the biggest killer of children under 5, claiming more then 2 million lives annually or about 20 percent of all child deaths. AIDS, in contrast, accounts for about 2 percent.

If identified early, pneumonia can be treated with inexpensive antibiotics. Yet UNICEF and the World Health Organization estimate less than 20 percent of those sickened receive the drugs.

A vaccine has been available since 2000 but has not yet reached many children in developing countries. The GAVI Alliance, a global partnership, hopes to introduce it to 42 countries by 2015.

Diarrheal diseases, such as cholera and rotavirus, kill 1.5 million kids each year, most under 2 years old. The children die from dehydration, weakened immune systems and malnutrition. Often they get sick from drinking dirty water.

The worst cholera outbreak to hit Africa in 15 years killed more than 4,000 people in Zimbabwe last year. The country recently reported new cases of the waterborne disease, and more are expected as the rainy season peaks and sewers overflow.

Rotavirus, a highly contagious disease spread through contaminated hands and surfaces, is the top cause of severe diarrhea, accounting for more than a half million child deaths a year.

A vaccine routinely given to children in the U.S. and Europe is expected to reach 44 poorer countries by 2015 through the GAVI Alliance.

“Every child in the United States gets it, even though they have access to clean water and hygiene,” said John Wecker, of the Program for Appropriate Technology in Health, a Seattle-based nonprofit that is part of the vaccine alliance. “The only effective way to prevent these deaths is through vaccination.”

Diarrheal diseases received more attention in the 1980s and 1990s, he said, but interest has waned or been diverted elsewhere, allowing them to creep back.

“How did the leading killers end up at the bottom of the global health agenda? I don’t know,” Wecker said at a recent GAVI meeting in Hanoi. “We’ve got the tools. We’re not looking for the next technological breakthrough. It’s here now and it’s not being used.”

Death can often be prevented by giving children fluid replacement, a simple recipe of salt and sugar mixed with clean water to help ward off dehydration. Yet 60 percent of children with diarrhea never receive the concoction, according to a WHO and UNICEF report released last month.

“It is so preventable,” said Dr. Richard Cash, a Harvard University expert who helped develop the oral rehydration therapy 40 years ago. “Preventing the deaths is at the very least what we should be striving for.”

I get to share good news! From CNN, an editorial about the initiatives undertaken on the island of Zanzibar to eradicate malaria. Excerpt:

ZANZIBAR, Tanzania — I recently accompanied Margaret Chan, Director General of the WHO, and Ray Chambers, U.N. Special Envoy for Malaria, on a trip to Africa to see firsthand the region’s fight against malaria.

The single most memorable image of the trip was from a pediatric hospital ward on the Tanzanian island of Zanzibar: a dozen beds and not a single patient in them. Imagine that.

I have searing memories of visiting wards much like this elsewhere in the world where there were as many as three children to a bed and more sleeping on the floor, deathly ill with malaria.

Where have all the patients gone? After all, malaria is a big killer in much of the developing world. It is probably the most prevalent disease that mankind has ever suffered.

Each year, there are over 250 million cases and almost one million deaths — most of them young children, and the vast majority in Africa.

But in many countries, malaria is also a success story. Since 2000, the number of reported malaria cases, deaths, or both has declined by at least half in 25 countries. Zanzibar — a relatively small but striking example — has virtually eliminated the disease over the past five years. These successes show what a combination of political will, technical resources, and financial commitment can do when applied to a strategy that works.

Op-Ed from former Senate Majority Leader Bill Frist in the Boston Globe. Excerpt:

We need to expand our thinking to encompass holistic solutions that go into improving the health of the world’s poor. We need to think profoundly about our practices and the significance of sound policies to sound health. Global health must deliver more than a pill to the poor to relieve their immediate pain; it must deliver a system-wide program of rehabilitation to increase the productivity and prosperity of their communities.

Doing this requires a multi-dimensional approach. It means moving beyond the focus on high-profile diseases to also invest in overlooked, but treatable, diseases. In addition to HIV/AIDS and malaria, blindness is rampant in developing countries, where a child goes blind every minute. This means up to 700,000 children face a difficult reality, with a tragic 70 percent of them dying within the first year of going blind. Yet, such blindness, caught early, is preventable…

Broadening the discussion on global health - from combating neglected diseases, to investing in health skills, systems, and infrastructure, to advocating pro-health policies - is not easy. Just ask Congress as it works on the monumental task of healthcare legislation to address a range of concerns that impact healthcare for Americans. The challenges, though different, are just as pressing for developing countries, as a number of factors affect the delivery of healthcare for their citizens’ productivity and ability to compete in the global economy. Thinking about - and ultimately acting upon - a systemic approach to global health, grounded in good policies, provides the best medicine for delivering tangible and sustainable results that will improve the quality of life for the world’s poor.

From the ONE Campaign:

The Government of Uganda announced that they will import 17.4 million bed nets in an attempt to combat malaria, the number one cause of death in the country. With plans to start distribution in September, the Ugandan Ministry of Primary Health Care hopes to eventually provide every Ugandan with a free, insecticide-treated bed net.

With the new imports, in addition to the six million nets that have already been distributed in the past three years, the State Minister for Primary Health Care James Kakooza estimates that there will be enough nets for every two people to share one. Priority will first go to pregnant women and children but the Ministry aims to eventually reach all citizens.

According to allAfrica.com, the Ugandan government spends 10% of their annual health budget on managing malaria. In addition to net coverage, the Government has already approved DDT spraying to further combat the spread of the disease. The health ministry aims to emulate the progress of other malaria-stricken countries some of which have made remarkable strides in reducing malaria illness and deaths in recent years through expansion of prevention and treatment initiatives. “We can also do it here in Uganda,” explained Kakooza, “It is just a matter of time.”

Malaria remains the leading cause of death and illness in Uganda. According to the Ugandan health ministry, it kills 320 people a day and accounts for approximately 40% of outpatient visits to health care facilities and 20% of admissions to the hospital.

Malaria plagues not only the country’s health but also its productivity. Health minister Stephen Mallinga noted that Uganda, along with many other African countries, is lagging behind as a result of malaria, which can be a significant cause of poverty. In addition to improving the health of the country, eradicating malaria would increase work capacity and alleviate poverty, further propelling the country toward development.