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How Generic Bedaquiline Will Save Thousands of Lives

Generic BedaquilineFollowing recent negotiations between the Johnson & Johnson company and the Stop TB Partnership, generic bedaquiline will become available and affordable to millions of people. Bedaquiline is a crucial medication in treating multidrug-resistant tuberculosis which affects hundreds of thousands of people per year. Johnson & Johnson held a 20-year primary patent on the drug which was set to expire on July 18, 2023. 

Unaffordable Treatment

Hundreds of thousands of people globally contract multi-drug resistant tuberculosis with an estimated 450,000 in 2021 alone. While tuberculosis is relatively treatable, the vast majority of deaths from the disease occur in the global south due to unaffordable treatment pricing. As a result of the Johnson & Johnson patent on bedaquiline, tens of thousands of people were unable to afford life-saving treatment for tuberculosis. 

Despite being largely treatable, thousands of people continued to die from the disease due to this lack of access and affordability. The global south, experiencing higher rates of multi-drug-resistant tuberculosis, was particularly impacted. Despite this, Johnson & Johnson continued to apply for ‘secondary’ patents in countries around the globe. As a result, numerous organizations including Doctors Without Borders (MSF) called upon Johnson & Johnson to withdraw any ‘pending secondary patents’ and not enforce any approved secondary patents ‘for the drug in any country with a high burden of TB.’ If agreed upon, this arrangement could save thousands of lives within a short period.

Successful Negotiations

Following said negotiations between Johnson & Johnson and the Stop TB Partnership, the Global Drug Facility (GDF) was granted the licenses to procure and supply generic versions of bedaquiline to a majority of low or middle-income countries that are most impacted by the disease, including some countries where Johnson & Johnson’s patents remain in effect. However, this agreement is only a ‘partial solution.’ It doesn’t apply across the board and Johnson & Johnson still holds secondary patents in 34 of 49 countries most impacted by tuberculosis. Nevertheless, it could still have a massive impact globally on thousands of people who can afford treatment. 

A Collective Effort

The availability of generic bedaquiline can potentially save thousands of lives. This also highlights the importance of putting pressure on companies and governments to ‘do the right thing.’ Organizations like Doctors Without Borders have been instrumental in persuading Johnson & Johnson to allow cheaper and more accessible tuberculosis treatment to be produced and circulated. It also shows the impact of individuals like popular YouTuber and author John Green who used his influence to spread information about the situation and negotiations, encouraging his followers to contact Johnson & Johnson about their views on a recent YouTube video that was viewed more than 1.3 million times. 

The agreement between Johnson & Johnson and the Stop TB Partnership likely benefited from the involvement of various organizations and individuals who shared their perspectives and advocated for this collaboration. This cooperative effort demonstrates the influence of collective voices in advocating for the interests of many. Consequently, the Johnson & Johnson bedaquiline agreement represents a significant advancement in ensuring accessible and effective care for numerous individuals, showcasing the impact of advocating for the needs of the broader community.

– Jaydin Ruch
Photo: Unsplash

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Schistosomiasis Treatment Bringing Hope for the Future

Schistosomiasis Treatment
Schistosomiasis is a chronic parasitic disease that is particularly threatening to young children. Infection occurs when people come in contact with water infested with parasitic larvae that penetrate the skin. Once inside the body, the larvae develop into adult worms that nest in human blood vessels. The female parasites lay eggs, some of which become trapped in human tissues, causing inflammation and damage to vital organs. Others exit the body in feces and urine. Symptoms of schistosomiasis include diarrhea and abdominal pain. In children, it can result in anemia, stunted growth and reduced cognitive development. Luckily, child-safe schistosomiasis treatment is emerging to help eliminate the disease.

About Schistosomiasis

Alarmingly, the disease can spread through water sources contaminated with infected human excrement, leading to ongoing cycles of infection. Currently, the drug praziquantel is the only available treatment. The World Health Organization (WHO) recommends large-scale administration of praziquantel to both treat the disease and prevent its spread. According to a study published in 2021, periodic administration of praziquantel to school-aged children between 5 years and 14 years old has reduced schistosomiasis prevalence among this group by about 60% over the past two decades.

However, until recently, there has been no safe and effective treatment for preschool-aged children. Furthermore, continued reliance on a single drug could cause parasites to develop drug resistance. Fortunately, a new pediatric medication, arpraziquantel, has been formulated to treat and prevent schistosomiasis in 3-month- to 6-year-old children. Here is why it is promising for mitigating the disease’s spread among this vulnerable group and achieving the World Health Assembly goal of eliminating schistosomiasis as a public health concern by 2030.

Vulnerability

Globally, an estimated 240 million people suffer from schistosomiasis, most of them living in tropical and subtropical regions. Because the disease spreads through contaminated water, feces and urine, it poses a great risk to communities that lack access to safe water and basic sanitation services. Furthermore, people whose occupations involve contact with water, including fishermen and irrigation workers, are highly vulnerable to the disease, as are women and girls, who risk contracting female genital schistosomiasis while collecting water or carrying out domestic chores. Overall, more than 700 million people live in at-risk areas where transmission is moderate-to-high. Schistosomiasis is especially prevalent in Africa, which is home to an estimated 90% or more of those in need of treatment.

Current Prevention and Treatment

Praziquantel is administered in 500-600 mg oral tablets. It is low-cost and, in large doses, has proven effective in protecting against adult parasites. However, it is less effective against larvae and juvenile parasites, requiring repeated doses to provide protection. In addition to heightening the possibility of drug resistance, this increases expense, the risk of reinfection and the likelihood of continued transmission in low-income countries where medication supplies and people’s access to them are lacking.

In addition to partnering with the pharmaceutical company Merck to supply more than 1.4 billion praziquantel doses to those in need, WHO has therefore emphasized further measures for controlling the spread of the disease. These include improving sanitation and water supplies, controlling the snail populations in which parasites reside, educating endemic communities and administering “large-scale treatment using the pediatric praziquantel formulation.”

A Child-Safe Treatment Brings Hope for the Future

In November 2021, the Pediatric Praziquantel Consortium, an EU-funded international partnership, successfully completed clinical trials on arpraziquantel, a new child-safe, oral treatment for schistosomiasis. According to the Merck-led consortium, clinical trials on infected Kenyan children showed that a single dose of arpraziquantel had a cure rate of about 90%. The medication is a praziquantel derivative, yet, in comparison to the large 500-600 mg tablets, it comes in small 150 mg doses that are safe and effective for preschool-aged children. The tablets are orally-dissolvable to prevent choking and flavored to appeal to children. Additionally, the drug can withstand hot environments, making it suitable for tropical and sub-tropical climates.

The Future Ahead

In 2022, the European Medicines Agency accepted arpraziquantel for review. Pending approval, Merck, working in partnership with stakeholders including WHO and UNICEF, hopes to begin distributing the medication in sub-Saharan Africa in 2024. The ultimate goal is to ensure sustainable, affordable access to medication for all 50 million preschool-aged children in need. Coupled with ongoing efforts to develop other new single-dose treatments, arpraziquantel brings hope that a schistosomiasis-free future is within sight.

– Isla Wright
Photo: Flickr

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Using UV Light Treatment for Neonatal Jaundice in Low-Resource Settings

 

Neonatal JaundiceNeonatal Jaundice is a common problem in newborns and it can have life-threatening complications. Traditional treatment is difficult in low-resource settings, as it requires access to a stable source of electrical power for prolonged periods.

What Is Neonatal Jaundice and How Is It Treated?

A build-up of a substance called bilirubin in the blood causes jaundice. The liver is responsible for removing bilirubin from the body. However, newborn babies’ livers are not yet fully developed. Unfortunately, high levels of bilirubin in the blood can be toxic to the brain, thereby necessitating treatment. Every year, approximately 6 million babies do not receive jaundice treatment.

One of the main forms of neonatal jaundice treatment is phototherapy. In this procedure, babies undergo UV light exposure. They are placed into a crib-like piece of equipment that shines UV light onto the skin for around 48 hours. This results in the conversion of toxic bilirubin into a safer form that is not harmful to the brain and can be easily excreted in the urine.

What Is the Global Context of Neonatal Jaundice?

A study from 2010 by the Child Health Epidemiology Reference Group reported that neonatal jaundice was responsible for a mortality rate of 119 per 100,000 live births in Eastern Europe/Central Asia, Latin America, Sub-Saharan Africa and South Asia. In comparison, the mortality rate in high-income countries is around one per 100,000. The study also found the complication of brain toxicity to be prevalent in 73 per 100,000 live births in the aforementioned regions. In high-come countries, the prevalence rate is 10 per 100,000.

Standard commercial phototherapy machines cost around $3,000 and require a constant supply of electricity. As things stand, heavy power usage is a major concern for hospitals in low-income and middle-income countries. Not only is the demand for power costly, but there is also no guarantee of access due to unreliable power supply in these settings. For this reason, the use of traditional phototherapy machines is challenging in low-resource settings.

The Bili-Hut

Dr. Donna Brezinski developed an innovative solution known as the Bili-Hut. It is a portable, battery-operated device that only costs $400 per unit. The design utilizes LED lights that can run on a 12-volt car battery for up to a month. Additionally, it has a lower upfront cost and can run independently, with no need for connecting to a hospital’s power supply source.

The Bili-Hut forms part of a kit, which also includes a “Bili-ruler” and a “Bilistick”. The former measures the degree of jaundice while the latter measures jaundice concentration in a newborn’s blood.

Crib’A’Glow

Virtue Oboro identified the need for more effective phototherapy treatment in Nigeria when her son experienced a delay in receiving treatment due to a lack of phototherapy units. She developed the Crib’A’Glow, a phototherapy unit that runs on renewable energy using a solar panel, a battery and a charge controller. The solar panel powers LED lights in the crib to provide a fully functioning phototherapy unit. It can function in low-resource settings and only costs around $300-$550.

Using solar power is an innovative solution. Apart from minimizing the running cost of the unit, it also ensures the unreliable power supply in Nigeria has no impact on the service process.

Virtue’s solution has helped to treat more than 1250 babies across Nigeria since 2016. Additionally, the Champions of Science Africa Innovation Challenge 2.0 provided additional funding for the project in 2019, with the hopes of reaching 1 million babies.

With the help of innovators like Virtue and Dr. Brezinski, there is hope for overcoming the challenges of delivering phototherapy in low-resource settings.

– Jess Steward
Photo: Flickr

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Traditional Medicine Advances Healthcare in Vietnam

Healthcare in VietnamIn the fourth century BCE, China became the primary ruler of a northern section of Vietnam. Before this period, northern Vietnam and southern China shared multiple ethnic groups, many of which held traditional healing beliefs. As a result, traditional forms of medicine in Vietnam are very similar to those in China. Shared herbal medicine practices and theoretical frameworks continued to spread when China began its 1,000-year occupation of Vietnam, in 111 BCE. During this time, Vietnam’s medicinal use of plants and China’s theoretical framework around traditional healing merged to create an alternative form of medicine that persists today in healthcare in Vietnam.

Traditional Medicine in the East

Alternative, or traditional, medicine is often overlooked in Western contexts and seen as less effective or taboo. This is because of medical hegemony, or “the dominance of the biomedical model [and] the active suppression of alternatives,” as defined by the International Journal of Complementary & Alternative Medicine. Medical hegemony indicates an underlying power dynamic between the East and the West. While many people in the West believe that Western medicine is best, many others around the world believe that traditional medicine is legitimate. People in Vietnam, China and other countries have used traditional medicine for over 4,000 years. It actually inspired the growth of Western practices, though its treatment methods are now entirely distinct from biomedicine.

Since its origin, traditional medicine has been prescribed by healers and traditional medicine doctors primarily for its preventative properties. Healers commonly use herbal medicines in an oral or topical form to treat developing symptoms of a certain ailment. Traditional healing can also commonly include physical exercise, massage or acupuncture to promote the flow of blood and energy. In addition to the physical effects of treatment, traditional medicine is theorized to have hormonal and energy-balancing properties, like the Chinese concept of yin and yang.

Vietnam’s Healthcare System

While the use of traditional medicine is still common throughout cultures that partake in traditional healing, it is often not used on its own. In contemporary Vietnamese medical culture, individuals seeking care consult both traditional and biomedical practitioners for treatment. The two systems can be complementary: biomedicine aims to physically eradicate an illness, while traditional medicine treats the symptoms and psychosocial harm of the ailment. For example, if a person develops cancer in Vietnam, they might consult a biomedical physician for chemotherapy and a traditional medicine doctor for a remedy that counters the symptomatic effects of chemotherapy.

Gaining a dual perspective from biomedicine and traditional physicians in Vietnam is so common that this practice is reflected in the country’s health insurance system, which makes both kinds of medicine accessible. The payment method for healthcare in Vietnam varies based on the sector in which a person obtains treatment, whether public or private. Treatment in the public sector is covered in full, with an occasional co-pay expense, as public health insurance is compulsory in Vietnam. Private health insurance is paid out of pocket. Both public and private insurance can cover traditional medicine hospital expenses, though the costs for traditional medicine are generally paid privately.

However, when a person is unable to pay for either public or private insurance, they are still able to access traditional forms of medicine. In Hanoi, a major city in Vietnam, there is a full street of vendors that sell traditional medicinal herbs. These vendors can even help to fill prescriptions from hospitals at a reduced price, making traditional medicine more accessible to the public.

Improving Public and Personal Health

The accessibility of traditional medicine with and without health insurance fills gaps in healthcare in Vietnam, making the population healthier overall. In addition, the Vietnamese prioritize preventative medicine because the population is familiar with traditional health values. With ready access to health resources, along with a generalized understanding of the values of self-care, healthcare in Vietnam excels.

– Lilia Wilson
Photo: Flickr