Living in a Post-SARS World: What happens when another outbreak occurs?

September 27, 2010

In this day and age of global travel, you can get anywhere in the world during the incubation period of a new pathogen.  In the case of SARS, it took 61 days for a global pandemic.

Timothy Brewer of McGill University in Canada, speaking on the panel: “One Health: Detection and Control of Emerging and Endemic  Zoonotic Pathogens” noted that in the Guandong Province in China, people were walking around with masks, hospitals were shut down, and people were buying white vinegar to disinfect their homes long before most of the world knew what was happening.  He said the outbreak became widely known in November 2002, but it wasn’t until March 2003 that the Chinese government acknowledged it.

In 2005, WHO passed the Revised International Health Regulations, which requires mandatory reporting of outbreaks on international concern. The regulations went into effect June 15, 2007, and although there is no police force backing the regulations, Brewer said it adds more pressure to countries to come forward.

So has outbreak recognition improved over time?

In an analysis of the 398 reported outbreaks by WHO between 1996-2009, Brewer said there has been a slow improvement in outbreak discovery and reporting.

“SARS was the real impetus for outbreak discovery,” he said.

Panelist Jonna Mazet of University of California, Davis, an expert on surveillance, said researchers now have a cell phone network in place in many communities with an application to notify people when people see a sick animal.

But the gaps in zoonotic surveillance are still pretty big.

“Detecting a new respiratory pathogen is tricky unless you get lucky,” Brewer said.  Many of the new pathogens like H1N1 look like other  infections, so unless a pathogen creates unusual symptoms, he said it will be hard to detect especially with a lack of lab capacity.

“Even in 2010, you cannot access the WHO database unless you are with the Ministry of Health,” he said.

Panelist Hector Garcia with the Universidad Peruana Cayetano Heredia Institute of Neurological Sciences in Lima and an expert on cysticercosis (a disease from pigs) and Mazet of University of California, Davis,  said capacity building is a huge need.

Garcia said capacity building needs to happen with organizations and among collaborations. And Mazet said there is a huge need to fix the brain drain and to create a proactive approach. Her experience has been that when hunters in the Congo died of hemorraghic fever and the lab determined the pathogen wasn’t ebola, no one was interested in doing more investigation.

All three of these panelists also discussed the political pressure to keep outbreaks quiet because of the enormous economic consequences. 

For example, Garcia said during a continent-wide cholera outbreak in Peru in 1991 when many people got sick after eating fish, the health minister announced it was unsafe to eat ceviche but Peruvian President Fujimori, fearing a huge impact to the seafood industry, went to the media and said it was OK to eat ceviche.

Prepared by Bobbi Nodell,  Communications Specialist, University of Washington

The Role of Universities in Global Health-Redefining the Paradigm

September 24, 2010

The opening session of the CUGH conference provided a platform for dialog revolving around the various roles academics, researchers, and the universities  that they are linked can play in the emerging field of Global health. The distinguished speakers provided a linear progression of how the field of global health evolved over time and how the role of universities changed to keep up with the evolution of global health.

Some of the topics discussed included, but was not limited to global peace and security, emerging infectious disease, health inequalities, global brain drain, and the necessity for collaborations between universities and other stakeholders in the global health milieu.

An emerging theme that I believe is commonplace in the discourse of the future of global health is the emphasis on collaborations between industry and global health. Susan Hellman, a distinguished professor and chancellor of University of California, San Francisco provided perspective as an individual who worked in both academia and private industry and stressed how important this collaboration can be to the future of global health.

Overall, the opening session set the stage for further discourse on global health services, education, research and collaborative partnerships between academia and industry.  Hopefully the information disseminated over the course of the conference will provide the data that various stakeholders in the global health milieu will need to advance health worldwide.

Prepared by Wendell Jones

Managing Emergencies in a Global Context

September 24, 2010

The session on Enabling Systems addressed the legal, regulatory and administrative infrastructure to support global health.   This session was of importance because recent world events have shown us, there are times when it is not easy to evaluate the impact of world events on various locations where university students, faculty and staff are living, working and/or studying. Many colleges and universities are developing guidelines to assess these situations, whether they occur before individuals associated with their universities leave the United States and after they arrive at their intended destinations.

During this session participants discussed the steps their universities are taking to assure the safety of students, faculty and staff traveling abroad such as hiring travel and safety managers or creating workshops that provide information on a comprehensive approach to managing emergencies in a global context.  Some key elements of managing emergencies in a global context include travel and security information, cross-cultural training, creating travel registries, expanding the scope of current training programs, emergency evacuation insurance plans and developing international travel committees.

These are important steps to take because these precautions can help universities and various programs within universities to assess global situations, whether they occur before personnel leave for international travel or while they are at their destinations of choice.  Likewise, all participants involved in this session makes it clear that safety and security are their top priority for all university personnel when traveling and while abroad.

Prepared by Catherine Claiborne

Stephen Morrison: US Global Health Initiative

September 23, 2010

Stephen Morrison, CSIS

Missed Stephen Morrison’s excellent presentation on the Global Health Initiative and USG global health policy?  Read his remarks here.  Morrison is director of CSIS Commission on Smart Global Health Policy.

The Wellcome Trust Approach to Capacity Building

September 22, 2010

Val Snewin opened the session describing The Wellcome Trust, a global charity based in the UK dedicated to achieving extraordinary improvements in human and animal health, and how they fund different programs around the world to help build up health services workers, especially researchers. The Wellcome Trust funded seven consortia involving 70 institutes, of which the session highlighted funded work that impacts India, Kenya and Africa. Speakers from each country explained about how their programs are structured and their learnings – the speakers all agreed that the consortia need to focus on the long-term success like career paths in order to establish the right supporting programs, especially mentorship, that ultimately build up capacity and maintain it.

Andrew Haines from the London School of Hygiene and Tropical Medicine said the priorities of the consortia in Africa are developing mentorship, MSc training, supporting PhD students, professional development and career planning, and establishing research support centers in the region. They face many challenges though in making the consortia successful – money, Internet bandwidth, expectations and the government’s visa restrictions are all hurdles. Haines said there is no real financial reward for the staff’s time in research from universities so they actually have a net loss. With limited bandwidth in Africa, it makes distance learning a serious problem. They’ve implemented several approaches to try to address the challenges including sharing resources like research methods add staff development in region, they are doing more courses taught by LSHTM staff based in the country, and they are licensing distance learning courses.

For India, Srinath Reddy of the Public Health Foundation of India, spoke about the foundation’s focus on improving health outcomes through education;  research, policy and advocacy; training; and public health practice. PHFI is in partnership with the Wellcome Trust for capacity building – they began doing annual meetings in 2007, in which seven institutions participated – these groups had never previously collaborated. In 2008, that number has grown to 12. Its proposal to the Wellcome Trust is nurturing young faculty, fostering research, and active sharing of resources.

 Sam Kinyanjui of the Kenya Medical Research Institute walked through how they’ve managed to implement a program that has shown a strong track record of its students in the program going on to get PhDs or to Masters tracks – many of those in the Masters tracks have even submitted and were chosen for fellowships from the Wellcome Trust. The KEMRI does demographic and epidemiological surveillance for 240,000 people, clinical surveillance and investigation, and utilizes high quality labs and data centers. Kinyanjui showed a startling image of the KEMRI first research facility, a dilapidated small shed where they squeezed 20 members in, located in the middle of overgrown grass. Now, 20 years later, the research capacity is s large, high quality building with multiple spaces for training and which houses 750 staff.

 Prepared by Erika Bitzer

The Know-Do Gap: We know what needs to happen, but now we need to scale up and do something

September 22, 2010

The Know-Do gap was a recurring theme in this afternoon’s session, Health Systems and Implementation Science, focused on universities and researchers going beyond identifying the issues in global heath to implementing solutions which can scale and be sustained. Getting from knowing what to do, to actually doing it is a tough challenge facing health systems worldwide.

Dr. David Peters, the director of the Health Systems Program at John Hopkins University, approached the challenge by outlining a system that programs can follow along with the principles that need to be followed for it to be successful. His guidance on the principles were to focus on the purpose of the system, build on interventions that have already proved to be successful, scrap the blueprint, engage the key stakeholders, incorporate incentives, and use data for systematic learning. He also noted there can be unintended consequences.

Later in the session, Dr. James Blanchard, director if the Center for Global Public Health at the University of Manitoba spoke, and reiterated the concern of unintended consequences which is an oversight on the lack of complexity these “systems” have.

A student from the audience who had just returned from Zambia wondered if government programs or NGO run programs were more effective at implementing systems. Dr. Peters answered saying it depends. “ Both can be successful, but in many ways both can fail,” said Dr. Peters. He explained that sometimes NGOs can deal with things governments may not want to deal with, but there are other things those NGOs are weaker at. More than any which type of organization doing the work, he said it’s important to “Do it, measure it, show it, revise it.”

Dr. Rashad Massoud, the director of USAID Health Care Improvement Project, talked about applying improvement science to strengthen health systems. He reminded the group of the adage that if we continue to do what we are doing, we’ll keep getting the results we are getting; if we want something different, we must do something different. “Change must happen, but you don’t necessarily need to change everything,” explained Dr. Massoud.

He told us about work done in Niger to reduce post-partum hemorrhage – they know that when a woman receives three specific elements, one of which is a drug, they are able to essentially stop the hemorrhages from occurring. The new procedure was implemented but the drug needs to be refrigerated. Well, how accessible are refrigerators in Niger? Not very. They tend to be locked after hours, when many women go into labor. So while the solution was identified, they weren’t able to implement it consistently. So the teams started brainstorming and came up with the ideas of keeping the medicine in coolers or keeping the syringes on hand and bringing them to the delivery center. This solution effectively curbed the hemorrhages.

Prepared by Erika Bitzer

Engineering, Innovative Technologies and Global Health

September 22, 2010

The four panelists for the “Engineering, Innovative Technologies, and Global Health” session looked at ways that bioengineering is driving advances in global health.

 Joseph Hughes of Georgia Tech said that more 1.5 million children die each year because of preventable water- and sanitation-related diseases, but solving this problem isn’t easy. Water sanitation requires many things, including infrastructure, capital, and regulation. While there is no “silver bullet” technology yet for the developing world, there are promising developments, Hughes said.  Water can now be decontaminated by using UV rays from the sun to kill germs; Hughes is also looking at ways to sanitize water in bottles using visible light, which is a more abundant light source.

Catherine Klapperich of Boston University demonstrated a prototype of a small, portable tool that could be used to test a patient for HIV on the spot, or at “point-of-care.”  The tool, which is about the size of a student microscope, doesn’t require a power supply. The sample pops out of the tool so it can be processed and then shipped and stored. 

University of Washington professor Paul Yager showed slides of a point-of-care diagnostic tool prototype developed as part of the Gates Foundation-funded Grand Challenges in Global Health initiative. The tool, called DxBox, can detect six different pathogens and is about the size of a Netbook. “We want to be able to backpack it into a small village somewhere,” said Yager. DxBox is being developed by Seattle-area company Micronics. Yager also talked about what his lab envisions as the next step in point-of-care diagnostics – using a cell phone to run the diagnostic code or sending the data elsewhere for analysis.

The fourth speaker, panel moderator Sakti Srivastava of Stanford , described how students in the Biodesign program at Stanford prioritize clinical needs and then seek to address them through prototypes . Students in the program recently helped develop the Stanford-Jaipur Knee, a prosthetic limb now in trial in India.  Billed as the $20 knee, it was recognized by Time magazine as one of the best inventions of 2009.

The panel made numerous joking references throughout the session to the “valley of death.” This was described as the long, difficult passage between an idea or even the prototype and the product  actually being made and put to use. Does that mean that the need should always be identified first, someone in the audience asked? One of the panelists said there was no perfect answer. It’s important to have a need in mind, but you don’t want to suppress the innovation that comes out of brainstorming either.

Prepared by Mary Janisch

Chronic Diseases, Innovations in Health Systems and Data for Decision Making

September 22, 2010

The participants in this session all reinforced the need for using innovative approaches to address global health issues. In describing the problem of rising cancer incidence in developing countries, Sofia Merajver quoted the gospel of Matthew, “The harvest is plentiful, but the workers are few.” She pointed out that the vast burden of cancer deaths is borne by low and middle-income countries, which have the fewest resources to deal with cancer and other chronic diseases. Recognizing that strategies for addressing cancer deaths in high income countries are not appropriate for low income countries, her team developed local cancer registries, which allowed them to better understand the types of breast cancer affecting women in North Africa and the Middle East. This in turn led to dramatic reductions in stage 4 breast cancer.  

In a similar way, Pamela Andreatta and colleagues were able to use cell phone technology to show that use of bimanual uterine compression can reduce deaths from post-partum hemorrhage. Her team trained illiterate traditional birth attendants in rural Ghana to collect data and report it via SMS messaging. A spinoff of this research was the growing sense of empowerment of the traditional birth attendants.

Woutrina Miller provided another example of ways in which technology can be borrowed from one arena and used to meet global health challenges. She described an innovative and cost-effective way of detecting water-borne pathogens which uses the principles of hemodialysis technology to concentrate pathogens from large water sources. 

Two of the panelists reported on efforts to address chronic diseases in Brazil. Beatriz Carlini spoke about a study on the impact of telephone counseling for those wishing to quit smoking in Brazil, and James Macinko presented some work showing that Brazil’s roll-out of a strong, universal primary health system was associated with a dramatic reduction in hospitalization rates.

Finally, Erika Arteaga, from the People’s Health Movement, gave some provocative comments on how policy decisions based on the principle of economic growth can actually lead to worsening health, and gave the example of the 3-fold increase in cancer incidence among indigenous people impacted by the Texaco Oil Spill in the Amazon. She alluded to the need for stronger advocacy for the rights of vulnerable populations, and promoted a political ecology framework for looking at global health issues.

Prepared by David Roesel

Global Health Policy and Diplomacy

September 22, 2010

The world currently faces a plethora of challenges that transcend national borders: economic upheaval, the spread of emerging pathogens like H1N1 influenza, the increasing global migration of people and goods, climate change, and the ever-widening gap between wealthy and vulnerable populations. Each of these impacts human health, and the speakers in this session each started with the premise that it is time to draw on the art of diplomacy to build coalitions to address these issues.

Sara Curran introduced the session by asking the question “Why do we need health diplomacy?” She was followed by Kelly Lee, from the London School of Hygiene and Tropical Medicine, who offered a historical perspective on the art of diplomacy and the emergency of what she calls “New Diplomacy.” She argues that there is a shift in the actors, agendas, and technologies in modern diplomacy, and a rise in the influence of human rights and social justice. “Maybe in the future,” she reflects, “ “Might makes Right’ will be replaced with ‘Right makes Might.’ ” She hopes that through the framework of global health diplomacy, people working in separate disciplines can start to work together in harmony.

Peter Lamptey, from Family Health International, added to the discussion with his arguments for why global health is in America’s interest. In addition to providing economic opportunities and promoting U.S. leadership and values broad, he stated that a global health framework is important to protect people from issues such as food safety, counterfeit pharmaceuticals, and biological terrorism that transcend national boundaries. He points out the successes that have already occurred as a result of U.S. funding of global health, but admits that there are many challenges ahead, including shrinking economic resources, the need for improved coordination and agenda-setting, and the need to better match funding to better reflect the global burden of disease. 

A representative spoke on behalf of Margaret Hamburg on the role that the FDA plays in the global sphere. In its vast mandate to oversee all imported food, drugs, cosmetics, and medical devices to the U.S., she feels that the FDA is able to help promote stronger international collaborations, scientific partnerships, and regulatory networks.

Lawrence Gostin pointed out the problems of the current donor-led approach to global health.  He feels that it undermines states’ responsibilities for the health of their own people, replacing national policy with a dizzying array of separate, uncoordinated, donor-led programs. “You may think that your own program has been a success,” he says, “but when you talk to health ministers in low income countries, you find out that they are in despair, because they are unable to know what is going on in their own country.” He proposes turning the traditional approach to global health on its head, and to begin by asking “What does each state owe to its own citizens?” He discussed the Joint Learning Initiative on National and Global Responsibilities, which calls for a bottom-up approach to global health led by the global South.

Prepared by David Roesel

Watch the closing plenary LIVE at 5 pm PST

September 21, 2010

Here’s the link:

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