postpartum hemorrhaging
In the advanced world, a postpartum hemorrhage is a very manageable and preventable condition; however, postpartum hemorrhaging is a leading cause of maternal mortality. A staggering 99 percent of all deaths resulting from postpartum hemorrhaging occur in lower income countries. Postpartum hemorrhaging is responsible for 59 percent of maternal deaths in Burkina Faso, 43 percent in Indonesia and 52 percent in the Philippines.

Why Postpartum Hemorrhaging Is Common

In these developing countries, the increased frequency of postpartum hemorrhages is due to a lack of experienced obstetricians and caregivers who can properly treat the condition. There is also a lack of access to proper medications as well as care for those medications.

Oxytocin is currently the most common drug prescribed for preventing postpartum hemorrhages. The World Health Organization recommends that oxytocin be routinely administered and actively managed; however, oxytocin must be stored and transported at two to eight degrees Celsius, two conditions of which developing countries cannot accommodate.

A Possible Solution

A rival drug has been in the works to be as efficient as oxytocin in preventing excessive bleeding post childbirth as well as be more manageable in the living conditions of developing countries. The drug is a heat-stable carbetocin. This type of drug does not need refrigeration and can maintain its efficacy for at least three years when stored at 30 degrees Celsius. These requirements are far more realistic and achievable in developing communities.

The World Health Organization conducted a comparative study between the heat-stable carbetocin and oxytocin for prevention of postpartum hemorrhages. Approximately 30,000 women were sampled and given either drug to study the effects each had on prevention. It was concluded that the heat-stable carbetocin was not inferior to oxytocin.

Saving Mothers’ Lives

With such a high rate of deaths from postpartum hemorrhaging in developing countries due to the strict requirements for oxytocin that cannot be met, the heat-stable carbetocin will drastically improve the mortality rates. The new drug will be readily available and easily managed where it was once not.

Permitting the usage of the heat-stable carbetocin has many benefits that will better developing countries in a multitude of ways. If used widely, the drug could very possibly put an end to this tragically common occurrence.

– Samantha Harward
Photo: Flickr

ATM pharmacies in South Africa Cut Wait Times for Chronically Ill PatientsThe suburb of Alexandra, South Africa, is now home to Africa’s first pharmacy dispensing unit. ATM pharmacies in South Africa are expected to have a profound effect on the wait time for patients and the efficiency of clinics.

Simple Solution to Improve Lives

The machine operates as seamlessly as an ATM that dispenses money and completes the transaction in as little as three minutes as opposed to hours. Also known as an “ATM pharmacy,” the unit comes as a convenience to citizens with chronic illnesses, while freeing up space in local clinics. Most importantly, people dependent on medication have another option in receiving repeat medication that does not compromise safety or effectiveness.

The new development comes from experts from nonprofit Right to Care, Right ePharmacy and the Gauteng Department of Health. Right to Care works to provide prevention, care and treatment for HIV and other sexually transmitted diseases as well as tuberculosis and cervical cancer.

Developers chose Alexandra as the first location because of its large population, burdened facilities, and level of need, Right ePharmacy managing director Fanie Hendriksz said.

The Need for ATM Pharmacies in South Africa

Innovations like ATM pharmacies in South Africa are a step toward higher-quality healthcare, making it easier for patients to be consistent with their medication schedules. One of the main target groups for this project was people with HIV in need of repeat antiretroviral medicine, as South Africa now has the world’s largest AIDS treatment program.

In addition to being overcrowded, some clinics are also understaffed. Nurses may be referred to other clinics to compensate for lack of staff. HIV/AIDS activist Bhekisisa Mazibuko broke into Kgabo clinic pharmacy to make a point about the outlandish wait times for chronic medications in Tshwane, a city not far from Johannesburg. Some patients start waiting in line as early as 3 a.m.

Mazibuko, who lives with HIV, used a brick to break the pharmacy door after it closed for the day at 4 p.m., not attending to patients who had been waiting for hours. He distributed medicine to hypertension, diabetes and HIV patients before being arrested.

A Way Forward

Patients whose conditions are stabilized are encouraged to use the pharmacy dispensing unit (PDU), although a referral from a doctor is necessary. The patient engages in a simple process of scanning their personal ID and entering a pin and speaking with a pharmacist via video correspondence.

Through this video chat, patients can be advised and directed on how to take the medication and its possible side effects. The patient then selects their medication which is robotically dispensed along with a receipt. The PDU has served more than 4,000 people and dispensed 18,000 prescription medications so far.

According to Right to Care chief executive Ian Sanne, the amount of time South Africans spend waiting in line at health facilities is quite extensive and is damaging to economic productivity. ATM pharmacies in South Africa is likely just the beginning of many healthcare innovations in Africa.

– Camille Wilson
Photo: Flickr

Hepatitis C Drugs
Three years ago, a 90 percent effective hepatitis C medication, called Sovaldi, was released by Gilead Sciences. A three-month round of treatment costs $84,000. Janssen Pharmaceuticals released its own drug, Simeprevir, at $66,000 per round of treatment, and other pharmaceutical companies like AbbVie and Zepatier charged similar prices as they released their own hepatitis C drugs.

Hepatitis C is a blood-borne disease that can lead to liver cirrhosis and liver cancer, as well as other neurological problems. Worldwide, there are four times as many patients infected with hepatitis C as there are with HIV. About 150 million people live with chronic hepatitis C and 500,000 people die of hepatitis C complications every year.

Before Gilead, Janssen and other companies developed their newer, more effective medications, hepatitis C patients were treated with ribivarin and interferon, an antiviral drug and an immune-system modulator. The drugs caused fatigue, nausea and depression, and after one year of treatment, only 50 percent of patients were cured.

The WHO added hepatitis C drugs to their list of essential medicines, which they update every two years and some pharmaceutical companies offered deals with low-income countries. Gilead, for example, sold Sovaldi for $900 per round of treatment in Egypt in 2014.

The Drugs for Neglected Diseases Initiative made a deal with an Egypt-based pharmaceutical company last spring to sell a highly effective drug combination for $300 per treatment round.

Hepatitis C is especially prevalent in Egypt, affecting over 10 percent of the population, because of a vaccination campaign in the 1960s and 70s where syringes were reused for multiple patients. The disease is so widespread that barbers wear gloves and use disposable razors. Hepatitis C has even been spread between family members through sharing toothbrushes and nail clippers.

However, 80 percent of new infections happen in medical centers; in response to these figures, UNICEF and the WHO are working with the Egyptian government to educate both clinicians and the general population about hepatitis C.

Many patients await treatment, but the Egyptian government anticipates treating 1 million people for hepatitis C in 2016. As the cost of treatment decreases and sterilization and infection control practices are improved, the presence of hepatitis C in Egypt and elsewhere will diminish.

Madeline Reding

Photo: Flickr

Khushi Baby
In rural Rajasthan, North India, an innovative necklace has been introduced into the health system to track a child’s vaccination history. It is helping to increase the number of children protected against diseases that can kill them in the first few years of their lives.

Approximately 1.5 million children die every year from diseases that can be prevented by vaccination and India has one of the worst immunization records in the world. Less than 60 percent of children in India are vaccinated, a number far below the World Health Organization’s target of 90 percent.

The necklace is called Khushi Baby (which means ‘happy baby’) and is a small plastic pendant on a black string. A computer chip in the pendant stores vaccination data as well as the mother’s health records.

The chip interfaces with a mobile app for community health workers. The health workers just need to tap the pendant to the back of a tablet, syncing the devices and storing the information in the chip. The Ministry of Health and other health agencies can then easily access the data.

Particularly for families that live far from cities, getting access to vaccinations can be difficult. Rural areas have fewer clinics and parents are not always aware of when or why their child might need a vaccination. “Many mothers don’t understand the importance of vaccines and choose not to take their children to immunization clinics,” says a statement on the Khushi Baby website.

With the help of the necklace, health workers no longer need to carry cumbersome records for every patient. Furthermore, the necklace allows health workers to see which vaccine the child needs and when. “Khushi Baby wants to ensure that all infants have access to informed and timely health care by owning a copy of their medical history,” said Ruchit Nagar, co-founder of Khushi Baby.

According to the BBC, Khushi Baby costs less than US$1 to make. Currently, there are around 1,500 children in the Khushi Baby system. Health workers plan to expand the program to include the 1 million people within Rajasthan’s health system.

Michelle Simon

Sources: BBC, Antara Foundation, CNN, Daily Mail
Photo: Antara

MenAfriVacOn Feb. 22, 2016, vaccine experts from all over the world convened in Ethiopia with leaders from the 26 African “meningitis belt” countries to celebrate the success achieved by MenAfriVac, a vaccine created for use in Africa.

The vaccine was developed specifically for Africa and targets meningococcal A meningitis, a bacterial infection of the thin lining surrounding the brain and spinal cord. Meningitis is a highly-feared disease due to its capacity to kill its host within hours. Survivors often experience permanent hearing loss, paralysis or even mental retardation.

“We have achieved something truly historic with MenAfriVac®—creating an affordable, effective, tailor-made vaccine for Africa,” said Steve Davis, president and CEO of PATH, a nonprofit global health organization.

According to PATH, more than 90 percent of meningitis epidemics in Africa attacked mostly infants, children and young adults. To zero in on this specific cause of meningitis, PATH partnered with the Meningitis Vaccine Project and the World Health Organization (WHO).

In the five years that MenAfriVac has been in effect, 235 million children and adults have been vaccinated. From 250,000 cases during an epidemic from 1996 to 1997, to only 80 confirmed cases in 2015, the vaccine has effectively protected millions of people.

However, a resurgence is possible within 15 years if an immunization program is not implemented permanently. Several countries applied for funding to begin implementing MenAfriVac into their national childhood immunization programs. Gavi, a global health partnership that focuses on vaccines, has spent $367 million campaigning and stockpiling the vaccine since 2008 to support these countries.

“Meningitis A was a scourge across Africa’s meningitis belt for generations but today we can be proud that a safe, effective meningitis vaccine is protecting hundreds of millions of people from death and disability,” said Dr. Seth Berkley, Gavi CEO. “But we must not be complacent. It is critical that at-risk countries begin introducing this vaccine into their routine schedules and ensuring every child is reached and protected.”

This achievement could not have been possible without the vital partnerships that contributed to the development of the vaccine. U.S. agencies financially supported MenAfriVac, provided technical expertise and participated in clinical studies of the vaccine.

Continued partnerships could lead to solutions for other diseases around the world and have a positive impact on global health.

Emily Ednoff

Sources: Gavi, PATH
Photo: Flickr

nobel_prize_in_medicineFor the past 43 years, a lifesaving treatment for malaria, perfected by pharmacologist Tu YouYou, has received little recognition until winning the Nobel Prize in Physiology or Medicine on Monday, Oct. 5. This long-known remedy has already demonstrated its efficacy through its use in southern Asia; however, the issue still remains as a staggering 90 percent of deaths caused by malaria occur in sub-Saharan Africa.

In 1967, Mao Zedong established a secret project dubbed “Project 523” in order to develop a cure for the widespread disease that disabled thousands of soldiers and civilians. Tu Youyou was selected to work on the cure after the group failed to create a synthetic medicine that proved effective.

Tu Youyou, then a student at the China Academy of Chinese Medical Sciences, began her search in 1969 for any herbal cure to the issue. She collected 2,000 possible remedies before cutting her list to 380 and testing her compounds on mice.

It wasn’t until 1972 that Tu Youyou successfully produced chemically pure artemisinin, which was then assessed by a group of scientists; despite their efforts, the artemisinin weakened as the chemists’ trials continued. After discovering a method in “Emergency Prescriptions to Keep Up One’s Sleeve,” an ancient text on Chinese medicine, Tu Youyou procured another solution which worked 100 percent of the time on primates and rodents.

Tu Youyou tested the medicine herself and human trials began; artemisinin treatments became the fastest-acting antimalarial medicine. Despite this, it wasn’t until 2011 that Tu Youyou’s discovery earned a Lasker prize as its first award.

Tu Youyou’s find has held promise for the eradication of malaria since its discovery, being rewarded with a Nobel Prize in Medicine on Oct. 5, 2015. New drug-resisting malaria vectors, however, have drastically altered the reception of antimalarial therapy across the world. A prominent example is that of sub-Saharan Africa.

The most recent number calculated by the WHO records that in 2013 there were an estimated 198 million cases of malaria worldwide. Malaria is the cause of about 450,000 deaths per year and 90 percent of these occur in sub-Saharan Africa, with 77 percent being children at the age of 5 and younger.

Despite the drug-resisting vectors, mortality rates have fallen 47 percent globally since 2000, with a drop of 54 percent in the WHO’s African region. The WHO also suggests halting production and marketing of artemisinin-based monotherapies until variations of the treatment are developed.

Although no specificity is provided on when other alternatives will be available, the WHO launched an emergency response in April 2013 with the hopes of containing and managing any known outbreaks, continuing today as the WHO emphasizes that “urgent actions now will deliver significant savings in the long run.” It has since received aid from the leaders of the East Asia Summit and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

For now, we must enjoy “[the] gift for the world’s people from traditional Chinese medicine,” Youyou said after winning the Lasker prize in 2011.

Emilio Rivera

Sources: CNN, Columbia, Vox, WHO                                                                                                                                                                                                                                   
Photo: Flickr

pills
After months of negotiation, the public has spoken. Public health outcry surrounding the Trans-Pacific Partnership (TPP) resounds online, in print and on television.

“We have raised our voice as loudly as we can,” said Manica Balasegaram, executive director of Doctors Without Borders’ (DWB) access campaign. “This is a terrible deal for access to affordable medicines.”

The idea behind campaigns like the one headed by DWB is to remove the intellectual property laws (many pertaining to pharmaceuticals that treat life-threatening conditions) from the Trans-Pacific Trade Partnership (TPP).

As it stands, according to a November 13 Wikileak, the TPP would seek to extend the patent on brand-name pharmaceuticals an additional five years (delaying the onset of cheaper generic drugs that compete with brand-names), as well as 12 years of “data exclusivity” for biologic drugs, of which include many cancer and multiple sclerosis therapies.

While these intellectual property rights are sure-fire ways to keep pharmaceutical prices high—even unreachable for many in developing countries—defenders of the TPP laud them as ways to improve health, not hamper it.

The first line of the secret TPP document that was leaked by Julian Assange in 2013 decries that the thought process behind these intellectual property laws is to “enhance the role of intellectual property in promoting economic and social development in relation to the new digital economy, technological innovation, and transfer the dissemination of technology and trade.”

As increases in antibiotic resistance demands more innovation in pharmaceuticals, they remove incentives for Big Pharma to pursue antibiotic options (data shows that the more times you use these antibiotics, the less effective they are, so profits are capped).

Beneath this intellectual property clause that is a roadblock to doctors and patients everywhere, lies a real problem–how can we incentivize further development of life-saving antibiotic therapies?

The best way our society knows how to incentivize something is to monetize it. The idea of writing hours of code at a computer was abhorrent, for many, until Bill Gates and Steve Jobs turned personal computers into million-dollar industries.

The intellectual property laws surrounding pharmaceuticals (especially, antibiotics) exist to serve this purpose—to create an industry that is robust, profitable and differentiated.

It is even present in the existing TRIPS free trade agreement which guarantees some intellectual property laws in free trade agreements, even providing special waivers to certain developing countries that exempt them having to abide by pharmaceutical patents until at least January 2016.

“The LDC waivers [exemption from TRIPS-sponsored patent law for drugs] are among the important flexibilities available in the TRIPs agreement,” wrote a UNAID 2012 report.

“Retaining the flexibility to adapt intellectual property law and policy to meet national development objected has facilitated the development of robust generic industries such as India and Brazil. Generic competition, primarily from Indian pharmaceutical manufacturers, has been one of the key factors in the dramatic decrease in prices of…medicines for HIV treatment.”

If the TPP must go through, which according to some reports will happen before the dawn of the 2016 election year, the TRIP waiver program has already given us the skeleton of a tool to combat it.

If intellectual property rights for biologic therapies and drugs in the US are to be tightened, the extension of the waivers for generic development elsewhere may be necessary.

Diversify the market–let the developing nations step in with their own budding pharmaceutical industries and mollify the situation that the TPP has the power to create.

Emma Betuel

Sources: UNITAID, UNAIDS, About News, Doctors Without Borders (MSF), WikiLeaks, Health Affairs, Center for American Progress
Photo: Pixabay

UNLV’s New Research on HIV

Researchers from the University of Nevada Las Vegas have begun working on new research on HIV, human immunodeficiency virus, by finding ways to stop the virus from infecting human cells.

UNLV has already earned several financial grants for the research, including one from the National Institutes of Health.

The researchers are looking at genetic codes called minimotifs that direct cellular function. Their goal is to understand how the codes can help cells fight off HIV by blocking the virus from interacting with the cells.

“We chose HIV as our model system because we know viruses depend solely on cells to live,” said Kiran Mathew, a researcher at UNLV, in an interview with the Las Vegas Review Journal. “It’s a great model system we can use to test out the effects of (the codes) in the cell.”

According to the U.S. Centers for Disease Control and Prevention, about 1.2 million Americans were infected with HIV as of 2012, with roughly 50,000 new cases each year.

By the end of 2014, close to 37 million people were living with HIV/AIDS worldwide and about 15 million people living with HIV were receiving antiretroviral therapy. The World Health Organization cites sub-Saharan Africa as the most affected region by HIV/AIDS globally with 26 million people infected in 2014. The region also accounts for almost 70 percent of the global total of new HIV infections.

There is currently no cure for HIV. The Food and Drug Administration has approved more than 25 antiretroviral drugs to help fight infections and improve quality of life for patients. With successful treatment, HIV infection can become a chronic, manageable disease. But therapy must be life long and there are limitations to diagnosis, treatment and care in geographical areas that are most heavily affected.

The promising new research coming out of UNLV might help develop new HIV drugs, code for other diseases and make personalized drugs specific for a patient’s genetic makeup. But first the findings must be published and patented before pharmaceutical companies could begin the process of bringing it to market where patients can benefit.

Megan Ivy

Sources: Review Journal, CDC, WHO
Photo: Flickr