April 21, 2017
A weekly roundup of news on drug resistance and other topics in global health.
WHO measures decade of progress against neglected tropical diseases. The World Health Organization (WHO) reports a decade of progress against neglected tropical diseases (NTDs), toward goals set by the WHO NTD Roadmap and London Declaration to control and eliminate 10 NTDs by 2020. NTDs are communicable diseases prevalent in tropical and subtropical climates, including dengue and chikungunya, leprosy, sleeping sickness and Chagas disease. According to WHO Director-General Dr. Margaret Chan, “Over the past 10 years, millions of people have been rescued from disability and poverty, thanks to one of the most effective global partnerships in modern public health.” While substantial progress has been made, the diseases remain in regions lagging in socioeconomic progress. The United Kingdom increased funding to further tackle NTDs this week by £200m, bringing its funding to a total of £360m, to treat and fund R&D for NTDs. [WHO, Financial Times, BBC]
Global health financing report: reflections from two decades and projections for 2040. The Institute for Health Metrics and Evaluation (IHME) reports in The Lancet and in Financing Global Health 2016, as part of its annual series on global health financing. They report on the evolution and patterns of global health financing between 1995 and 2014, which includes development assistance for health, as well as government, prepaid private, and out-of-pocket (OOP) health spending in 184 countries. Over nearly two decades, economic development was positively associated with total health spending and a shift toward government spending, away from a reliance on development assistance and OOP. Looking ahead, from 2015 to 2040, IHME estimates that global health spending will increase from US$9.21 trillion in 2014 to $24.24 trillion in 2040, and that per capita health spending will increase fastest in upper-middle-income countries and remain low in low-income countries. According to author Dr. Joseph Dieleman, “Our study shows that health spending is likely to increase rapidly in high-income countries, while low-income countries, where it is needed the most, are expected to see relatively slow growth.” [Lancet study, Lancet second study, IHME report]
Study clears azithromycin of ventricular arrhythmia suspicion. Research published in the Canadian Medical Association Journal finds no increased ventricular arrhythmia (irregular heartbeat) risk with azithromycin use. The antibiotic, commonly taken for respiratory and urinary tract infections, is in the macrolide class, which has been suspected of causing arrhythmias. The multi-country study included 14 million new outpatient antibiotic users identified in healthcare databases from Italy, the United Kingdom, Germany, the Netherlands, and Denmark. Of the 12, 874 patients who developed ventricular arrhythmia, 30 were azithromycin users. A two-fold risk was found compared to non-antibiotic users, but the excess risk disappeared when azithromycin users were compared to patients who took a different antibiotic, amoxicillin. Author Gianluca Trifiro, MD, from the University of Messina, Italy, said “This finding suggests that the risk of ventricular arrhythmia is more likely to be due to a person’s poor health and caused by their infection, rather than to azithromycin itself.” [CMAJ, CIDRAP]
Faster adaptation among multi-drug, than single-drug resistant bacteria. Genetic mutations, the basis of resistance to antibiotics, often affect the “fitness” of bacteria to survive, replicate, and pass on their antibiotic resistance properties. Successful resistant bacteria characteristically develop “compensatory mutations” that compensate for some of the functional losses. Compensatory mutations have been studied in a number of single-resistant strains, but not before in double-resistants. Researchers at the Instituto Gulbenkian de Ciencia in Portugal compared two strains of E. coli: one resistant to rifampicin only and the other resistant to rifampicin and streptomycin. They found that the double-drug-resistant E. coli strain, with low-fitness levels, acquired compensatory mutations faster than the single-drug resistant strains, and possibly mutations with larger survival benefits. Certain mutations were specific to double-drug-resistance, which may compensate for the interaction between drug resistance mechanisms. The new evidence may lead to novel antimicrobial strategies. [PLoS Biol, CIDRAP]
Meningitis C epidemic continues in African meningitis belt, centered in Nigeria; vaccine in short supply. Since the first reported case in December 2016, 8,000 suspected cases and 750 deaths have been recorded, now in six states in Nigeria that have reached the epidemic threshold, according to the Nigerian Centre for Disease Control, which is tracking the epidemic. Hindering control is the shortage of vaccines for the predominant strain, Neisseria meningitides serotype C—not serotype A, the strain that has caused most epidemics in the recent past. An estimated 800,000 more doses of the vaccine are needed. Part of the problem is that the polysaccharide vaccines used in Nigeria are being phased out globally and being replaced by more effective and long-lasting conjugate vaccines, but the supply of these new vaccines is limited. Dr Olivier Ronveaux, meningitis expert at the WHO said “In the long term, the accelerated development of affordable and effective conjugate vaccines to cover all epidemic types of meningitis is a high priority for WHO and partners.” The International Coordinating Group (ICG) has provided 20 000 vials of antibiotics to treat meningitis C sufferers. [Guardian, NCDC]
India launches National Action Plan on antimicrobial resistance. India launched its national action plan to combat antimicrobial resistance (AMR) in the country. It comes just in time for the deadline of May 2017 imposed by the World Health Organization (WHO) on all Member States in 2015. At least 11 ministries signed the Delhi Declaration on Antimicrobial Resistance at an inter-ministerial meeting on the issue, adopting a comprehensive and collaborative approach to antimicrobial resistance. It follows the “One Health” approach supported by three United Nations agencies: WHO, the Food and Agriculture Organization (FAO), and the Organization for Animal Health (OIE). The Union Health Minister, Shri J P Nadda said “The challenge now is in its efficient implementation through a coordinated approach at all levels of use of antibiotics.” [Government of India]
India blocks international funding to PHFI. The Government of India has barred the Public Health Foundation of India (PHFI) from receiving funding from international organizations, including its biggest donor, the Bill & Melinda Gates Foundation. PHFI is one of India’s largest nonprofit public health organizations, a public-private partnership that was started by the government in 2006 and receives most of its funding from foreign sources. The New York Times reports that more than 11,000 non-governmental groups have lost their licenses to accept foreign financing since 2014 under Prime Minister Narendra Modi. One reason given by the government for the recent action is a charge that PHFI has used money from the Gates Foundation for lobbying media and parliamentarians, which PHFI denies. At least one right-wing group in India has aired grievances against the Gates Foundation for claimed conflicts of interest related to ties to pharmaceutical companies. [NYT]
Image via US Army Africa
