Archive for category: Global Health

Information and stories about global health.

, ,

World Bank: Public in Favor of Global Health Initiatives

world bankA new study from the World Bank shows a growing emphasis on global health concerns among the public in developed countries.

The study asked respondents in France, Germany, Japan, the United States and the United Kingdom a series of questions about global issues. A total of 4,000 interviews were conducted, including some that focused on members of the public with university degrees who follow global news closely.

The study reached three important conclusions.

First, many people were concerned about global health and outbreaks of infectious diseases. This is largely due to the outbreak of Ebola, which made headlines around the world in previous months.

In total, 72 percent of those polled followed Ebola news closely over the past year. Among those respondents who are college-educated and who follow global news closely, 85 percent followed Ebola news closely.

Many respondents (31 percent) ranked global health as one of their top three important concerns, just behind terrorism (60 percent) and global warming (40 percent).

Respondents were also concerned that their country was not ready for the next global health outbreak. According to 40 percent of responses, the global community will face an epidemic within the next ten years. Those living in the United States, the United Kingdom and France were most concerned about global infectious disease preparedness.

Finally, and perhaps most importantly, respondents in the survey agreed that it would be of great benefit to increase funding for global health measures in the developing world.

Doing so, most believed, would protect their own countries from the spread of infectious diseases originating abroad. Many felt this would be cost-effective and were supportive of doctors and nurses from their own countries going abroad to help.

The results shed light on changes in public perception of global health following the Ebola outbreak. The anxiety stemming from that event has launched global health into the forefront of international issues, alongside terrorism and global warming.

There is hope that this increased awareness might result in greater levels of funding for preventive measures.

– Kevin McLaughlin

Sources: Devex, Newsweek, World Bank

Sources: Pixabay

,

The Heat Wave in Karachi

Heat_Wave in_Karachi
On June 20, 2015, a heatwave struck the city of Karachi. Karachi is the largest city in Pakistan and is home to about 20 million residents. The heatwave that struck had disastrous consequences for many of the residents of the city, killing about 1,300 people and sending scores to hospitals.

Daytime temperatures in Karachi climbed to about 45 degrees Celsius (113 degrees Fahrenheit), the hottest that it has been in Pakistan since 2000. The effects of the heatwave were also compounded by the fact that it occurred during the Muslim holy month of Ramadan, when people fast until sunset and when eating and drinking during daylight is forbidden by Pakistani law.

What’s more, many residents of Karachi did not have power or access to water during the week of extremely high temperatures. Power cuts in Pakistan are common, but the federal government and the main private power company for Karachi, K-Electric, assured the citizens of Karachi that they would make sure that there was power during the heatwave for when Pakistanis broke their fast at sunset. However, they failed to deliver on their promises, and many died due to the lack of air conditioning, water and fans.

Hospitals filled up quickly, with over 65,000 people visiting them for help and to seek shelter. The hospitals had to rely on donations and volunteers for many of their supplies. Some patients were not able to be treated by doctors, and their families were forced to attempt to take care of them while waiting for assistance.

A human body’s normal core temperature is around 38 degrees Celsius (98 degrees Fahrenheit). When our body temperatures rise to 39-40 degrees Celsius, fatigue begins to impact the body and the brain starts to slow the muscles down in order to cool the body. Above 41 degrees Celsius, our body cells deteriorate, chemical processes are affected and the body’s organs start to fail. This heatwave in Karachi affected the homeless the most, and also had a larger impact on poor families, many of whom did not have access to the air conditioning they desperately needed. Older people also suffered disproportionately.

The largest morgue in Karachi, the Edhi Morgue, normally has the capacity to hold about 200 people. It was soon overflowing due to the number of people killed by the heat and received over 900 bodies in the eight days of the heatwave. Many families who visited hoping that the morgue would help them to bury their dead had to be turned away, and cemeteries in Karachi ran out of room in which to bury the dead, leading to mass graves and burials.

Pakistan has suffered from heatwaves before, but this heatwave has led to an abnormally large number of casualties. Some attribute that to the fact that the heatwave occurred during Ramadan, while others blame pollution and climate change for extreme temperatures. These, combined with power outages and water shortages, most likely led to the massive casualties that occurred during the heatwave.

Temperatures have begun to normalize once again, but the residents of Karachi are still suffering from the consequences of the heatwave. In order to help those in Karachi, people have been donating to the Edhi Foundation (https://edhi.org/), which runs an ambulance service and the Edhi Morgue and is working to ensure that those who have died due to the heatwave receive a proper burial.

– Ashrita Rau

Sources: BBC, New York Times, CNN, International Business Times, The Huffington Post, The Guardian, The Edhi Foundation
Photo: Today Online

, , , ,

Potential to Cure Parkinson’s Disease Found in Existing Drug

Potential to Cure Parkinson’s Disease Found in Existing Drug

In a recent report, researchers found that the current drugs Chloroquine and Amodiaquine, two common anti-malaria drugs, could also provide treatment for Parkinson’s disease.

Parkinson’s disease itself is a disease caused by a loss of cells in a part of the brain called the subtantia nigra. This loss of cells causes the reduction of the neurotransmitter called dopamine, or the chemical in the brain that regulates movement and mood.

One of the study’s authors, Dr. Yoon Ho Sup, stated, “Our discovery brings hope for the millions of people suffering from Parkinson’s disease, as the drugs that we have found to have worked in the laboratory tests have already been used to treat malaria in patients for decades.”

Dr. Sup continued, “Our research also shows that existing drugs can be repurposed to treat other diseases and once several potential drugs are found, we can redesign them to be more effective in combating their targeted diseases while reducing the side effects.”

This monumental breakthrough could lead to an inexpensive alternative treatment to many individuals who suffer from Parkinson’s on a daily basis. Creating the new treatment would be beneficial not only from a financial standpoint but also because many of the current treatments involve a varied concoction of many drugs and surgery.

Another of the study’s authors, Professor Kwang-Soo Kim stated, “…[existing] pharmacological and surgical treatments address the patient’s symptoms, such as to improve mobility functions in the early stages of the disease, but the treatments cannot slow down or stop the disease process.”

With the current research and backing of scientific evidence, these drugs are seen to be a potential drug target to treat Parkinson’s itself.

The researchers hope that the drugs can be further modified to continue to better treat Parkinson’s and hopefully slow and stop the process.

– Alysha Biemolt

Sources: Spring, WHO, PNAS
Photo: Medical Press

, ,

US to Increase Funding for Global Health Security Agenda

global_health_security_agenda
The U.S. developed the Global Health Security Agenda to prevent, detect and respond to disease threats. The goal is to stop outbreaks from ever becoming epidemics. Today’s biological threats include the emergence of new microbes, spread through globalization, drug resistance diseases, accidental release and illicit usage of disease. The latest challenges with Ebola prompted the U.S. to increase funding and aid for the Global Health Security Agenda.

One billion dollars have been donated to expand resources to allow countries to deal with biological threats on their own. Investment is desperately needed in the areas of infrastructure, equipment and skilled personnel. The radar includes 17 countries, bringing the total amount of countries to receive aid to at least 60. Countries in Asia and the Middle East to receive the money include Bangladesh, India, Pakistan and Vietnam.

Africa will be the main source of attention, with about half of the money being invested there. The money will contribute to improving or creating systems that prevent and mitigate outbreaks–whether they be intentional or natural–that report outbreaks, and that can respond to outbreaks. To accomplish these goals, the U.S. works directly with partner countries’ governments to create a five year plan.

Another part of the Security Agenda is to build African Centers for Disease Control and Prevention. The African Union stands behind these projects to help promote disease science and research in Africa. There will also be country specific Public Health Initiatives to boost specific countries health agendas and departments.

The one billion dollar investment will aid reaching the health targets set by the World Health Organization and the UN. The Security Agenda works within the global health frameworks to ensure that there is understanding across sectors and countries.

– Katherine Hewitt

Sources: GlobalHealth.gov, The White House 1, The White House 2
Photo: GEN

What is Global Health and Why Should I Care?

global_health
Global health—what does that mean exactly? It isn’t the word “health” that gives us pause. It isn’t the word “global” either. But put the two words together, and people are not sure if it means health in developed countries as well as health in developing countries. Yet we know that “global” means the entire world. Anyway, why does it matter?

Commonly, we tend to think that health issues in developing countries refers to infectious diseases, while health issues in developed countries refers to chronic medical conditions. News of health issues in developing countries focuses on tropical diseases such as Ebola or diseases that have been eradicated in the developed nations such as polio and smallpox. In developed countries, news or feature stories on how to take care of our health focus on diabetes, heart attacks or strokes.

When diseases such as Ebola emerge in a developed country such as the U. S., we are jolted by the knowledge—knowledge we already have—that infectious diseases know no geographic boundaries. Ebola is not the only tropical disease to reach the U. S.

The chikungunya virus has reached a cumulative total of 2,500 cases since 2013 in the U. S. Erik Iverson, President of Business and Operations at the Infectious Disease Research Institute in Seattle, expects a “dramatic and well-reported increase in the number of chikungunya cases suffered in the U.S. over the next couple years—particularly from Florida up through the Eastern Seaboard.”

Chikungunya is a viral disease transmitted from human to human by the bites of infected female mosquitoes. Fever and debilitating joint pain are the outstanding symptoms. It has no cure but is usually not permanent or fatal. It can occasionally cause other health problems, however, such as eye, neurological, heart and gastrointestinal complications. It is a disease associated with Africa, Asia, and the Indian subcontinent. In recent decades it has spread to Europe and the Americas.

Leprosy, another tropical disease, also exists in the U. S. One hundred cases are reported every year, mostly in the south. No one knows exactly where it is coming from. Researchers and health officials have named armadillos as the source in the U. S., but some U. S. victims have had no access to armadillos.

Tuberculosis, is another disease that knows no boundaries as World TB Day reminds us with the past theme “tuberculosis anywhere is tuberculosis everywhere.” London is now considered to be the TB center of Europe, and cities in the U. S.—Los Angeles, Seattle, and Indianapolis—have each had a significant number of cases.

Swine flu and avian flu are not diseases of the past either. The swine flu is still part of the seasonal flu vaccine in the U. S. While avian flu poses a very low threat to infecting humans, it does cause a huge risk to our food supply which in turn creates economic havoc for our farmers. May 2015, saw the worst outbreak of avian flu in our nation.

Iowa, our largest producer of eggs, and Minnesota, our largest producer of turkeys, were hit the hardest. Iowa declared a state of emergency as egg prices as well as fear of buying anything related to poultry rose. Minnesota turkey farmers spent $7 million trying to prevent the spread of the disease. Approximately 41 million chickens and turkeys were destroyed in Iowa and Minnesota combined due to the avian flu. Minnesota has just been cleared by the Minnesota Board of Animal Health to restock their farms.

Recently, I hesitated to buy my favorite eggs due to the exaggerated price. I buy them because they are pasteurized, and I have a fear of salmonella having bought a dozen that was infected not long ago. Luckily, I had hard boiled the one egg I ate from the package before I knew it was recalled. They are usually significantly more expensive than even the eggs that are cage free. But when I saw the price had gone up even more, I wondered about our economy—and with good reason it turns out. But salmonella wasn’t the culprit, avian flu was.

If the avian flu affects our Thanksgiving this year, as a nation, we may take more notice. This may cause more awareness that illnesses anywhere can be illnesses everywhere. But awareness isn’t enough. According to Iverson, we are regrettably not concentrating our time, attention and research on these potential domestic health care problems. “[T]oo often, we assume that diseases like TB, chikungunya or leprosy are ‘global’ dangers, only affecting poor people in developing countries, rather than threats to the U.S.”

Ebola, avian flu and swine flu are profound examples of diseases that all too quickly affect the world. The Global Health Technologies Coalition’s 2015 Policy Report reminds us that if we are not prepared with the essential tools and systems to fight infectious diseases worldwide, they “can have devastating regional and international impact.”

The meaning of global health matters because as the GHTC analysis reiterates, “No matter how geographically distant a threat may seem, a threat to some is a threat to all.”

– Janet Quinn

Sources: KARE-TV, SiouxLandMatters.com, World Health Organization 1, World Health Organization 2, Xconomy
Photo: Stroke Smart

,

Arktek: Keeping Vaccines Cool

vaccinesEven in this day and age of technology, there are roughly 1.5 million children who die every year from vaccine-preventable diseases. One of the main reasons is the lack of reliable electricity in developing countries. What if there was a way to keep life-saving vaccines at a cool temperature in places of extremely warm temperatures with no reliable power for months?

This is the challenge Bill Gates presented to Nathan Myhrvold. The result was a thermos model device that looks like a keg and can be easily transported on a motorcycle. Arktek, the Passive Vaccine Storage Device, uses regular ice water and no power, keeping vaccines at a temperature just above freezing for months.

Arktek has just one small battery for the display screen at the top, which has a built-in cell phone to send text messages to alert others if, for example, you are running low on ice. The device was tested in up to 110 degrees Fahrenheit, where it can last 6 to 8 weeks. In a cooler area, it can last for months.

Well, how this is possible, you may ask?

Arktek uses super insulation, similar to what is used for cryogenic fluids, at very low temperatures and to protect spacecraft from extreme temperatures.

The device has already saved millions of lives. It was used in West Africa to transport the experimental Ebola vaccine during the recent outbreak. According to Bill Gates, the current vaccine-preventable disease to focus on is polio, which the Bill & Melinda Gates Foundation hopes to eradicate by 2018. Once polio is conquered, the next vaccine-preventable disease would be malaria.

The device is also practical in countries with reliable power, such as the United States, for the transportation of organs. Currently, organs are transported in hand-held coolers that do not last long very long. Myhrvold states the example that if the organs are not transported within a certain amount of time they will go bad in the current device used. That is when Arktek comes in handy, as a superior alternative method for transporting organs.

Arktek has received awards and recognition for its innovative technology. These include the 2014 Good Design Award in the Humanitarian Category from the Chicago Athenaeum Museum of Architecture & Design and the 2014 ViE Award for the best technological development.

Arktek is the result of Intellectual Ventures’ Global Good Program and Intellectual Ventures Lab. The innovative company is owned by Nathan Myhrvold, former Chief Information Officer at Microsoft. Intellectual Ventures has partnered with AUCMA, China’s largest refrigeration manufacturer, to help distribute these devices to remote areas. This is a partnership that will save millions of lives from vaccine-preventable diseases and potentially result in a healthier future for the world’s poor.

– Paula Acevedo

Sources: CNN Videos, Intellectual Ventures
Photo: Fast Company

, ,

Mind Over (or at Least on Par with) Matter for HIV Patients

HIV_Patients
HIV-positive individuals face enormous challenges, in terms of both size and quantity, and the psychosocial aspect of their plight is often underestimated.

Living with the stigma of being someone who is “infected” can interfere with opportunities, relationships and one’s overall position in society. Many individuals living with the diagnosis face issues ranging from anxiety to suicidal thoughts, from personality disorders to substance abuse.

Feeling the reality of mortality, along with the sudden ostracism from the community that a person once belonged to due to the stigmatized nature of HIV, is enough to bring up these issues for anyone.

While the war against the physical symptoms and spread of the diseases is in full force, the psychological issues faced by sufferers are just as important to address.

While these “side effects” are not always taken into consideration as a priority, the World Health Organization itself “recommends that attention to the psychosocial needs of people with AIDS should be an integral part of HIV care,” according to a National Institutes of Health (NIH) study. Globally, there are many cases where it is being done with great effectiveness.

Microcredit programs provide small loans to people who, due to their life-threatening diseases and discrimination (despite legislation seeking to prevent it), are hard-pressed to receive them from other places. In the case of the Positive Partnership Program in Thailand, loans are provided for partnerships between one HIV-positive and one HIV-negative person.

Infected individuals who received loans through this program reported feeling a greater sense of self-efficacy, increased acceptance in the community and an overall improved outlook on life. HIV-negative individuals who participated in the program reported an increased understanding of HIV and decreased levels of anxiety, fear and discomfort toward HIV-positive individuals.

Programs like this one are exemplary in the move toward integrating HIV-positive individuals into the rest of society. This is on top of the opportunity they offer them to reach and prove their full mental and economic potential, as, in the study’s period of 2004-2006, 91% of the loans given were repaid on time.

Projects similar to this one include a study of a cognitive-behavioral-group program for HIV-positive men in Hong Kong, and another done in rural Uganda using interpersonal psychotherapy. Both of these studies showed that psychosocially-based programs were effective in reducing symptoms of depression and increasing overall mental health.

In truth, the efforts of groups that work to reduce stigma and increase quality of life are incalculably important. As lecturer in ethics and HIV prevention Bridget Haire says, “showing the nation how people living with HIV are a vibrant, vital and productive part of our community cannot be overestimated.”

Perhaps even more poignant are the words spoken by one of the participants in the Thai Positive Partnership Program: “Life is much improved. My social life is back. I may have HIV, but I am still a human being. I have my self-esteem, and my honor.”

– Em Dieckman

Sources: UNAIDS, NCBI, The Conversation
Photo: Flickr

, ,

President’s Malaria Initiative: Progress and Future

presidents_malaria_initiative
In 2005, George Bush launched the President’s Malaria Initiative (PMI) to work towards eradicating malaria across 15 high-risk African countries.

By acting quickly and efficiently, PMI has helped to reduce malaria mortality by 50 percent since 2005. Over 6 million people are alive today – without the influence of PMI, they would have died from malaria.

Since its creation, PMI has expanded and has helped hundreds of millions of people by core preventative strategies: providing people in high-risk zones with durable and insecticide-treated mosquito nets, antimalarial treatment options, fast-acting diagnostics, indoor anti-mosquito spray and prevention options for pregnant women.

Malaria is a disease carried by mosquitoes, which bite and infect people, leaving them ill with fevers, chills and symptoms associated with the flu. If the disease is not treated, people are at risk of death. In 2013, 198 million cases of malaria were reported, and of those, half a million people died. Many of these deaths were children under the age of 5.

The World Health Organization estimates that 106 countries and 3.4 billion people are at risk of malaria infection.

Mali is an example of where PMI has contributed to improving the quality of life of citizens through malaria treatment. The entire population of Mali is at risk of contracting malaria with 90 percent of citizens living in the central and southern regions where the disease is endemic.

People in transit, perhaps fleeing their homes due to displacement, are even more at risk because of their weaker immune systems. Malaria is the primary cause of death in Mali, especially for children under the age of five.

Despite malaria’s omnipresence in Mali, the devastation caused by malaria has diminished since PMI’s inception in 2005. The mortality rate of children under the age of 5 has decreased by 50 percent in 2013.

PMI’s success is not limited to Mali – the Initiative has made incredible progress across Africa. It has distributed over 31 million mosquito nets, sprayed over 5 million households with insecticides (impacting 18 million people), given over 13 million antimalarial medications for pregnant women and trained over 27,000 health workers.

According to the Bill and Melinda Gates Foundation on their website, Impatient Optimists, “Malaria is clever, resilient and capable of evading our most dependable interventions. If we aim for a malaria-free world, the global response must constantly evolve and adapt to challenges that don’t even exist yet.” The strategies that have worked in the past may not work in the future. Eradicating malaria fully will be a constantly transforming process.

In partnership with the President’s Malaria Initiative and other organizations, the Gates Foundation is committed to eradicating malaria in the future. On Impatient Optimists, the Foundation highlighted its goals broadly: “We need to expand access to prevention, diagnosis and treatment, which PMI has proven capable of doing on a massive scale. We also need to build stronger health systems and introduce new tools and strategies, an increasingly important part of PMI’s work in recent years.”

The reduction of malaria in the world so far illustrates the potential for completely eradicating malaria in the future — a goal that will save millions of lives.

– Aaron Andree

Sources: CDC, Impatient Optimists, PMI
Photo: Impatient Optimists

,

Safe Surgery: A New Focus for Global Health

Safe Surgery
In 2010, 16.9 million people in developing countries died from surgically treatable conditions. If 2015 is anything like 2010, the death toll this year will be higher than that of malaria, HIV/AIDS and tuberculosis combined.

According to a study done by The Lancet in 2012, about two-thirds of the world’s population do not have access to even basic surgery. Where the average amount of surgeons per 100,000 people in the United States is 35, the average in developing nations typically lies anywhere from 1.7 in Bangladesh, to 0.1 in Sierra Leone (before the Ebola outbreak). Even those countries that have access to the surgeons are often lacking in anesthetic and sanitation, which opens up an entirely new world of problems including infection and psychological trauma.

President of the World Bank Jim Young Kim and Dr. Paul Farmer, founder of Partners in Health, are calling surgery “the neglected stepchild in global health.”

Surgery’s subservient status is turning commonplace conditions into killers. Complications like obstructed labor, hernias, and cataracts—the cures to which are readily available in any surgeon’s toolkit—will take over 28 times more lives than cancer this year.

“People are dying, and living with disabilities that could be avoided if they had good surgical treatment,” said Andy Leather director of the King’s Centre for Global Health in the United Kingdom during an interview with the BBC.

While surgery may still be the “neglected stepchild” in a global health family that includes AIDS and Ebola, the problems facing surgical conditions in the developing world are much more straightforward than finding a vaccine for Ebola or a cure for AIDS. Researchers Halie Debas, Richard Gosselin, Colin McCord, and Amardeep Thind have outlined four “surgically significant interventions” which could reduce the preventable death toll overnight. They recommend focusing efforts on providing “competent initial surgical care to injury victims,” dealing with obstetrical complications (like obstructed labor), competent management of abdominal life-threatening conditions (like Peritonitis), and providing services for simple surgical conditions like cataracts and clubfoot.

In addition to these four areas of interest, the World Health Organization has compiled a “safe surgery checklist” to help reduce mortality caused by unsafe surgery. Complied in three parts, the checklist provides sets of instructions for the pre-anesthetic procedure, pre-incision procedure and proper sanitation. This checklist was developed by doctors from the WHO in collaboration with surgeons and anesthesiologists from Botswana, Kenya, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

In general, the local experts agreed that the checklist addressed the poor organizational culture, lack of effective communication and negative personal attitudes that have acted as barriers to safe surgery in Africa, specifically. The checklist has been administered to 198 facilities in Africa and is looking to expand its dissemination in the coming months.

Health officials have warned that as disease prevention becomes more advanced, a new focus of global health initiatives must be dealing with these easily preventable deaths. There is no reason that clubfoot, which can be easily cured by surgery, should kill more than AIDS, an illness where a cure may be years in the making.

– Emma Betuel

Sources: WHO 1, BBC, The Lancet, WHO 2, The Irish Times, National Center for Biotechnology Information
Photo: Flickr

,

Global Mental Health Spending

Mental_Health
Inequities in public health spending and focus are often seen among income level, race, and different diseases. However, there are also huge discrepancies in the funding and attention of different aspects of health. Particularly, mental health is lacking. Globally, 1 in 10 people suffer from a mental illness, and yet only a mere one percent of the global health workforce works in mental health. This puts the average mental health worker allegedly responsible for 10,000 people(based on world statistics). We know that the distribution of mental health professionals is not equal around the world. For example, in the U.S., though our mental health workforce is lacking and treating mental illness continues to be a huge public health challenge for us, we still have better access and generally more advanced treatment than millions of people suffering around the world.

One of the reasons for such low accessibility is the overall lack of funding in this area. It is estimated that only $2 per capita per year is spent on mental health in low and middle-income countries. Even higher income countries are not spending nearly enough with an average rate of 42 beds per 100,000 population. With a lack of funding, few countries have any programs in place to spread awareness of care or even to accept new patients. Less than half of countries surveyed by the World Health Organization have at least two functioning mental health promotion and prevention initiatives. Of countries that do have programs in place, most are focused on combating stigmas and largely on suicide prevention. There is a huge gap in care for women with mental illness pertaining to maternity or violence.

Along with a lack of funding comes a lack of professionals entering the field. Since 2011, the number of nurses entering into mental health professions has increased, but only by a slight 35 percent. This number also does not showcase the distribution of the new professionals entering the field- most in higher income countries. Furthermore, the countries where the largest inequities are seen are often the places where people are most susceptible to mental illness. In middle and low-income countries, there are often higher incidences of violence or more disastrous effects of natural disasters, which prove to be traumatic for the people who experience and deal with the consequences of such events. Thus, mental illness can easily manifest and often go untreated.

The World Health Organization has put into effect the Comprehensive Mental Health Action Plan 2013-2020, which aims at improving leadership, providing comprehensive care services, implementing promotion and prevention strategies, and strengthening information systems, evidence, and research as each pertains to mental illness. Hopefully, as the plan gains traction, we will start to see real progress in bridging the gaps in mental health care around the world. While higher-income countries in general have the resources, it is a matter of stepping back and refocusing to make quality and sustainable investments for long term success so that developing nations follow suit. Also, once more developed nations start to improve their care, they will be able to implement similar cost-effective programs in developing countries.

– Emma Dowd

Sources: CBC , Economic Times, US News, WHO
Photo: Boston’s Children Hospital