Last week the World Health Organization announced that it had approved a second cervical cancer vaccine. Known as Cervarix, this new vaccine is produced by GlaxoSmithKline (GSK), and will supplement the original HPV Vaccine Gardasil, which is produced by Merck, in helping to prevent new HPV infections and subsequent cases of cervical cancer.
The approval of Cervarix allows U.N. agencies and their partners to be able to buy millions of doses of the vaccine for poor countries, where 80% of the 280,000 annual cervical cancer deaths occur each year. Without early screening, women in developing countries often find that HPV, which is often treatable, has already led to cervical cancer. By being able to offer these women a vaccine, they will be able to protect themselves against the HPV virus, and subsequently from the resulting cervical cancer which often present itself, and tens of thousands of lives will be saved.
As of now, cost arrangements are still under negotiation. GAVI, formerly known as the Global Alliance for Vaccines and Immunization prioritized the purchase of cervical cancer vaccines for the world's poorest countries last year, and is currently in talks with both Merck and GlaxoSmithKline (GSK) in the hopes of lowering the vaccines cost for developing countries. In the West, both vaccines typically run about $360 for a three shot dose, but if Cervarix is to make any sort of dent in the 80% of infections occurring in poor countries, costs will have to be drastically reduced.
As of now, Cervarix is not available in either the U.S. or Japan. Gardasil has dominated the U.S. market since its approval in 2006, but the FDA is expected to decide within the next few months whether to approve Cervarix for U.S. markets. If approved, donors will hopefully be able to purchase the vaccine at a reduced cost in order to aid women in poor countries.
To read more about the vaccines Gardasil and Cervarix, click here:
The 62nd session of the World Health Assembly took place in Geneva, from 18 May- 22 May. Although the recent flu pandemic dominated the discussions, monitoring the achievements of the health-related Millennium Development Goals was also on the agenda. Secretary General of the United Nations, Ban Ki-moon, and Sarah Brown, the wife of British prime Minister Gordon Brown, delivered passionate speeches that emphasized the necessity of dealing with global progress toward MDG 5, reducing maternal mortality.
Ban Ki-moon's speech "slammed the world's progress on lowering the maternal mortality rate" stating that of all the Millennium Development Goals, this is the slowest moving. He continued on to say that "maternal health is a key barometer of a functioning health system," and without making significant strides to reduce maternal mortality, hope for other health related progress, such as fighting HIV/AIDS, is limited. In the final moments of his passionate speech Ki-moon stated that, "In the 21st century, no woman should have to give her life to give life," maternal mortality must be quickly prioritized in order to stop the magnitude of avoidable deaths. Even in the face of one of the worlds worst financial crisis, we cannot scale back or stop our efforts in such an important area of health.
Sarah Brown addressed the World Health Assembly with an equally passionate speech. Speaking not as a researcher or a scientist, but rather as a mother, Sarah Brown was quick to point out that "there is no excuse for the fact that pregnancy and childbirth worldwide kill 529,000 women and leave one million children without a mother each year." With an emphasis on the incredibly high statistics of sub-Saharan Africa, Mrs. Brown made it clear that something must be done to save these women's lives, "We have the science, the technology, the medicine, the knowledge, the cultural understanding, the means to educate and inform and if we are moved to act, then let us show we have not only the compassion but the moral commitment and the political will too." Sarah Brown also pointed out the consequences of not acting for the children of these mothers. "When one mother survives a lot survives with her. A mother’s survival is the key to her baby’s welfare and often her baby’s life." With that in mind, it appears that not addressing maternal mortality hurts not only the 529,000 mothers who die each year, but also their children. By promoting effective reproductive health, a child's life will begin positively, and by having a mother to look to for advice and guidance, it is PPD's belief that combating maternal mortality will lead to a better life, and a better role in society for both mother and child.
In conjunction with the World Health Assembly,IRIN, a humanitarian news and analysis project released updates on maternal health in Chad, Zimbabwe and Ghana. In Chad, one of the world's most dangerous places to give birth, UNICEFS efforts to step up obstetric care are examined, in order to better prepare for emergencies. IRIN's report on Zimbabwe shows an increasing trend of maternal deaths, due to understaffed clinics, equipment shortages, and poverty. In regards to Ghana, attention to family planning, skilled attendance, comprehensive abortion care, as well as adolescent health care are necessary in order to combat the increasing rate of maternal mortality present.
The Millennium Development Goals were instituted in 2000, but without much progress since then, recent meetings and events have seen more passionate speeches and dire requests than ever before. Prominent leaders such as Ban Ki-moon and Sarah Brown are instrumental in raising awareness of MDG 5, but without government cooperation and implementation of effective programmes, the target goals will never be met. We have the means, now we must show we have the political commitment and the compassion for women around the world.
Also on the subject of maternal mortality, the NY Times recently published an article focused on maternal mortality. Entitled, "Where Life's Start is a Deadly Risk," the article provides some interesting insights and an even more fascinating image portfolio of childbirth in Tanzania. To check it out, visit: http://www.nytimes.com/2009/05/24/health/24birth.html?_r=1
After years of clinical trials, the World Health Organization agreed to add misoprostol to its Model List of Essential Medicines in April of this year. This is due to the efforts of numerous advocates and stakeholders, including an initiative of Gynuity Health Projects and Family Care International to evaluate misoprostol as an alternative medicine for prevention and treatment of post-partum hemorrhaging.
As a safe and efficient drug for the treatment of incomplete abortion and miscarriage, misoprostol is a necessity to help prevent the 500,000 deaths that occur each year due to childbirth and pregnancy related complications, and ultimately to reach MDG 5, reducing maternal mortality by 75%.
Excessive bleeding, (also referred to as post-partum hemorrhage or PPH) is the leading cause of maternal mortality, killing more than 150,000 women every year. Women who suffer from PPH can die very quickly, often within 2 hours, if immediate and appropriate medical care is not available. Many women in developing countries often deliver at home, and are unable to recognize the signs of excessive bleeding in time to seek care. Those who do realize the serious repercussions may still find that there is not available transport or sufficient time to reach the nearest hospital, and even if they were to make it there in time, many facilities are often under supplied and unequipped to handle such emergencies.
The standard drug used in recent years to stop PPH has been oxytocin, but after conducting extensive clinical trials, misoprostol has increasingly demonstrated potential in preventing and treating post-partum hemorrhaging, based on its ability to stimulate uterine contractions and stop bleeding. In addition, misoprostol offers many advantages over the standard treatment; it can be given via a variety of routes (oral, rectal, sublingual, vaginal), it does not require refrigeration, it has a long shelf life, is stable at high temperatures, is inexpensive ($1 per dose) and has relatively few side effects (Lancet source: http://www.thelancet.com/journals/lancet/article/PIIS0140673606695226/fulltext). Due to these characteristics, misoprostol is particularly well suited for developing countries, as it can be used by a wide range of health care providers in low resources settings as well as by midwives and traditional birth attendants in remote villages.
In order to reach MDG 5, reducing maternal mortality by 75% by 2015, we must continue to support organizations and initiatives to gain approval for drugs such as misoprostol. Venture Strategies, a nonprofit organization created to improve the health of low income people in resource-poor settings, and a partner of PPD, has been working to get misoprostol registered in a number of African countries. Due to the efforts of Venture Strategies and partners, in January 2006, Nigeria was the first country in the world to register misoprostol for postpartum hemorrhage. In the past few years misoprostol has also been registered or approved for obstetric/gynecologic indications in several countries, including Ghana, Sudan, Ethiopia, Kenya, South Africa, Tanzania, Uganda, and Zambia.
As the World Health Organization (WHO) has now acknowledged this new drug on its essential medicines list, it is the PPD ARO's hope that significant strides toward reducing maternal mortality will soon be made. Each day more than 350 women die due to severe bleeding, and the creation of a drug that is both effective and actually able to be used in most communities is a huge step in preventing the many unnecessary deaths that occur worldwide.
And read a recent (April 2009) article on global availability (including details on licensing and distribution in each country) from the International Journal of Gynecology and Obstetrics:http://tinyurl.com/misoavail
Since 1950, World Health Day has been celebrated around the globe on April 7th. Each year, the World Health Organization (WHO) chooses a theme, which highlights a key public issue that affects the international community.
This year, the focus is on the resilience and safety of health facilities and the health workers who treat those affected by emergencies. It is the WHO's hope that this annual celebration will promote a greater understanding of the issues at hand, as well as a long term advocacy program that will continue well beyond April 7th, 2009.
Worldwide, the number of disasters and emergencies are constantly increasing. In 2008 alone, 321 natural disasters killed more than 235,816 individuals. With an increasing desire toward urbanization, as well as a continuous population growth, the reliance on hospitals is becoming exponentially greater. In her Statement for World Health Day 2009, Dr. Margaret Chan, the Director-General of the WHO explains that, "when an emergency or disaster occurs, most lives are lost or saved in the immediate aftermath of the event. People count on hospitals and health facilities to respond, swiftly and efficiently, as the lifeline for survival and the backbone of support." However, in some cases the hospitals themselves are prone to simultaneous destruction, and as a result, health care workers are often killed or injured at the time when they are most critically needed. In other instances, health care systems that are already fragile are often unable to continue functioning in the event of such a disaster, further amplifying the tragedy of such an occurrence. Moreover, infectious diseases are one of the most prevalent causes of death and illness during a disaster, and if hospitals are unable to provide necessary care and infection prevention during an emergency, the propensity to amplify such an outbreak will increase, further inhibiting the hospital's capacity to provide other emergency services.
This year, the WHO is emphasizing the importance of investing in health infrastructure that will be able to withstand such disasters, and subsequently provide necessary care to those in need. Resilient construction, safe site decisions, and good planning are all crucial components to maintaining a functioning hospital. By anticipating such emergencies or disasters in advance, hospitals will have a greater ability to prepare themselves in the event that such a tragedy should occur, and will be able to provide the maximum potential for care to those affected.
A concern about funding is completely justified, as the WHO have calculated that the construction of a new hospital that can withstand such destruction costs surprisingly little in relation to the lives that can be saved. In many new health facilities, incorporating earthquake and severe weather protection into preliminary designs will add only 4% to the overall costs. Furthermore, reconstruction of existing facilities has minimal costs, and the incorporation of emergency preparedness and risk management into a hospital's operational plans costs almost nothing. World Health Day 2009 encourages both energy efficient and cost effective designs for the safety of new hospitals, and it is the hope of PPD ARO that such measures will quickly be implemented, helping to save countless lives worldwide.
We can all help to support better health care in emergencies, and involvement from within the community is essential in creating safer hospitals and better outcomes for those affected by such emergencies.
Recommendations for governments include:
Champion the need to make health facilities safe and functional in emergencies for health, social and economic reasons
Integrate “Safe Hospitals” programmes and health-risk reduction into national platforms for disaster-risk reduction
Develop national multisectoral programmes and policies to make health facilities safe in emergencies. Countries that have established a “Safe Hospitals” programme will have taken an important step towards protecting their health facilities and providing health care when most needed
Invest only in health facility projects that ensure safe location, design, construction, provision of care and emergency preparedness
Integrate health facility safety and emergency preparedness into procedures for the licensing and accreditation of health facilities.
