Michael Hagmann

Study confirms effectiveness of antiretroviral drugs for HIV patients

An international team of researchers looking at more than 7700 HIV patients undergoing combination therapy with antiretroviral (ARV) drugs has reported an increase in survival rates and a significantly reduced risk of progression to full-blown AIDS. Predicted survival for people with HIV-1 has continued to increase, since the introduction of HAART [highly active antiretroviral therapy], say the authors--a collaborative team funded largely through a grant from the European Union. The study found that compared with pre- 1997 data--when ARVs were first introduced to curb viral replication--the hazard ratio for death fell sharply to 0.47 (95% confidence interval (CI) = 0.39-0.56) in 1997, dropping further to 0.16 (CI = 0.124).22) in 2001. The authors also said that, compared with pre-1997 data, the hazard ratio of disease progression was 0.46 (CI = 0.38-0.55) in 1997, falling to 0.13 (CI = 0.09-0.21) by 2001. The study shows that ARVs are among the most effective health care interventions. When you compare them, for instance, to anticancer drugs or to anti-hypertensives, ARVs are orders of magnitude better, said Dr Jos Perriens of the World Health Organizations HIV/ AIDS department. The study, published in the Lancet, (2003;362:1267-74), compared disease progression and death rates in the period prior to 1997 to the period between 1999 and 2001, when ARVs were widely available to most, if not all, HIV patients in high-income countries. The studys results, based soley on HIV-positive cohorts in Europe, Australia and Canada, show that ARVs prolong the lives of HIV patients in industrialized countries where hospitals are well equipped with state-of-the-art laboratory facilities. However, numerous small-scale pilot projects run by UNAIDS, a French initiative called the International Therapeutic Solidarity Fund (FSTI) and nongovermnental organizations such as Medecins Sans Frontieres--as well as the Brazilian national AIDS programme--have since demonstrated the feasibility of ARV treatment even in resource-poor settings. In terms of patient compliance and survival rates, ARVs do indeed work extremely well in developing countries-even when compared to best practise in the industrialized world, said Peter Graaff of WHOs Essential Drugs and Medicines Policy (EDM) who also added that their therapeutic effectiveness was the reason for EDMS move to include ARVs on WHOs model list of essential drugs last April. …

The world in 2050: more crowded, urban and aged

The worlds population -- with todays 6.1 billion already more than twice the 1950 figure -- is likely to grow by another 3 billion in the next half-century, according to a recently released UN projection. Most of the population growth will occur in the less developed countries of Africa and Asia, despite the staggering death toll of the AIDS epidemic in these countries. In contrast, populations in all but a few industrialized countries will remain stable or even shrink. Whats more, medical progress will allow people to live longer and thus steadily increase the percentage of retirees in the years to come. These are the conclusions of World Population Prospects: the 2000 Revision, the sixteenth round of global demographic estimates and projections made by the UN Population Division since 1950. Altogether, Mr Joseph Chamie, director of the UN Population Division that compiles the population projections, told the Bulletin the worlds population will be very different in 50 years. It will be substantially larger, especially in the developing countries, significantly older and much more urbanized. The worlds population is currently growing at a rate of 1.2%, or 77 million people, per year with six countries accounting for half of the growth: India (21%), China (12%), Pakistan (5%), Nigeria (4%), Bangladesh (4%,), and Indonesia (3%). Although fertility rates are coming down in every region and in virtually every country of the world, Chamie points out, by 2050 the overall figure is anticipated to swell to 9.3 billion, and nearly nine of every ten people will be living in a developing country -- one out of six in India alone, which will replace China as the most populous nation. Taken together, the population of the worlds less developed nations is expected to grow from 4.9 billion to 8.1 billion. In sub-Saharan Africa, the number of people could even triple. But this is only one side of the coin. For the more developed countries as a whole, population growth is likely soon to come to a standstill at the current 1.2 billion level, according to the UN projection. Notable exceptions, however, are several industrialized countries, such as Australia, Canada and the US, that are projected to be at least a third larger by 2050 than they are today. By mid-century the populations of 39 developed countries are likely to be even smaller than today, e.g. Japan and Germany by 14%, Italy and Hungary by 25%, and countries of the former Soviet Union by 30-40%, leading to a shift in balance. Fifty years ago, when Europe claimed about 20% of the worlds population, Africa amounted to just 8%. In 50 years, however, Africa will have three times as many people as Europe, even though AIDS is anticipated to cut Africas population growth by 15%. …

WHO attacks tobacco sponsorship of sports

In late November, WHO joined forces with the international governing bodies of motor racing, football, and the Olympic Games, as well as with well-known athletes, in a drive to sweep Big Tobacco out of sporting arenas worldwide. The launch of the Tobacco Free Sports campaign, as this drive is called, coincided with the gathering in Geneva of government representatives of WHOs 191 member states for the third round of negotiations on the Framework Convention on Tobacco Control (FCTC), an international treaty that seeks, among other things, strong controls over global advertising and sponsoring activities by the tobacco industry. Tobacco is a communicated disease. It is communicated through advertising and sponsorship. The most pernicious and pervasive form of that marketing is found in sports stadiums and arenas worldwide, said WHO Director-General Dr Gro Harlem Brundtland at the launch. The main goal of the campaign, Dr Derek Yach, WHO executive director for noncommunicable diseases and mental health, told the Bulletin, is to keep tobacco products out of sporting events and to encourage more people, especially young ones, to engage in sports. We want to get rid of a bad thing and promote a good one because we see that the two just dont mix. Its an unhealthy association. Mr Johann Koss, Norwegian four-time Gold Medallist in speedskating and chairman of Olympic Aid, an athlete-led humanitarian nongovernmental organization, couldnt agree more. Tobacco and sport do not belong together. As athletes and role models, we will try to eliminate all forms of tobacco in all levels of sport, he commented to the Bulletin. Whats more, adds Yach, linking the sports excitement to smoking makes sporting events the number one route for tobacco manufacturers to target the worlds youth. Experts estimate that tobacco companies pump at a minimum tens of millions of dollars each year into sponsoring major sports events. In the United States alone, according to the US Federal Trade Commission, the major domestic cigarette companies reported spending more than US

Deadlock on access to cheap drugs at global trade negotiations.

110 million on sporting events in 1999. And their strategy, seems to pay off. When British American Tobacco (BAT) took over sponsorship of the India-New Zealand cricket series held in India in 1996, a survey conducted a few months later in the Indian state of Goa (and published in the 17 August 1996 British Medical Journal) showed that the likelihood of children experimenting with tobacco almost doubled. About a year ago, WHO started approaching leading sports organizations to try and hammer out a plan to ban tobacco sponsoring for all major sporting events. For the 22 November launch WHO had teamed up with the CDC, the International Olympic Committee (IOC), the Federation Internationale de Football Association (FIFA), and the Federation Internationale de lAutomobile (FIA). …

Alcohol takes its toll on Europe's youth.

At the end of 2002, the United States rejected a compromise proposal aimed at giving developing countries without local manufacturing capacities access to affordable life-saving drugs. At a December meeting at the World Trade Organization (WTO) in Geneva, negotiators of several of the 144 WTO members expressed their regret about the failure to reach an agreement by the intended deadline, which was the end of last year. Eduardo Perez Motta, Chairman of the WTO Trade-related Aspects of Intellectual Property Rights (TRIPS) Council and author of the compromise proposal, even apologized to sufferers from diseases in the developing world for the failure to come up with a viable solution. Meanwhile, in an attempt to reinvigorate the stalled negotiations, European Union (EU) Trade Commissioner Pascal Lamy put forward another compromise solution. The bone of contention is the export of generic versions of drugs protected by patent to developing countries that lack manufacturing capacity to produce the generics themselves. At their fourth conference in Doha, Qatar, in November 2001, WTO ministers adopted a Declaration on TRIPS and public health. The agreement, usually referred to as the Doha Declaration, allowed poor countries to produce urgently needed drugs even if the drugs in question are under patent protection, a procedure known as compulsory licensing. Even back then, however, WTO negotiators admitted there was a shortcoming in the Doha Declaration: the contentious paragraph 6 the Declaration bluntly states that members with insufficient or no manufacturing capacity could face difficulties in making effective use of compulsory licensing ... We instruct the Council for TRIPS to find an expeditious solution to this problem and to report to the General Council before the end of 2002. This is because, according to TRIPS guidelines, drugs made under compulsory licence are intended predominantly for the domestic market, that is, not for export. But the recent TRIPS Council meeting failed to deliver one, even though a compromise proposal, drafted and circulated by Perez Motta, was on the table. At the end of lengthy argument, the United States was the only country that refused to endorse the proposal. The US delegation considered the compromise--which did not restrict the range of diseases covered--to be too broad in scope, and insisted that instead the agreement should be limited to drugs for HIV/AIDS, malaria, tuberculosis and similarly infectious epidemics. According to a statement by the United States trade representative Robert Zoellick, issued on 20 December, such a focus on infectious diseases would reflect the original intentions of the Doha Declaration. That is not the way Ellen THoen of Medecins sans Frontieres (MSF) sees it. Already in Doha the United States tried to limit the scope of diseases, she pointed out. None of those proposals of theirs made it through those negotiations. As a matter of fact, paragraph 4 of the Doha Declaration is very clear about this point: no limits [in terms of disease range]. In a way these attempts open up the whole Doha Declaration again. For THoen the latest developments represent a tragic U-turn in the health-trade debate. THoen is not alone in her critique. Celine Charveriat of Oxfam says: The fact that the European Union and the United States argued that developing countries should not have access to affordable generic drugs for asthma and diabetes, which kill and debilitate millions in these countries, proves that profits still come before peoples lives and that the WTO has powers totally beyond its competence. …

TB drug prices slashed for poor countries

Whether it is drinks or drugs -- getting high seems to be increasingly popular among European teenagers. In most European countries, todays 16-year-olds consume more alcohol, cannabis and other drugs than ever. And theyre paying a price. Alcohol is to blame for one in four deaths of young European men aged 15 to 29. These bleak findings were presented in late February at the European Ministerial Conference on Young People and Alcohol in Stockholm, where WHO and the Swedish government had convened European health ministers, other high-ranking decision-makers and young citizens from 51 European countries to discuss the impact of alcohol and drugs on the health of Europes coming generations -- and to sketch out a region-wide action plan to keep them safe and dry. Concerted measures are necessary, says Dr Cees Goos, the coordinator of WHOs Alcohol, Drugs and Tobacco Unit in Copenhagen, because the alcohol industry is out to aggressively infiltrate their future market. Theyre sponsoring fun events, they put their banners on web pages, theyre trying everything to get at young people. And they seem to be getting results, if the findings of the 1999 European School Survey Project on Alcohol and other Drugs (ESPAD), which were presented in Stockholm, are anything to go by. Conducted by the Swedish Council for Information on Alcohol and Other Drugs (CAN), the ESPAD project collects data by questionnaire survey on alcohol, tobacco and drug use among 15-16-year-old high school students in 30 European countries. Altogether, nearly 100 000 students participated in the 1999 survey. According to the report, binge drinking, that is, having five or more drinks in a row, has increased by 21% to 55% in almost half of the countries; heading the list is Slovenia, where the number of binge drinkers has more than tripled. As in 1995, when the first ESPAD was conducted, alcohol use among youngsters is still most prevalent in Denmark, Ireland and the United Kingdom, where between 36% and 51% of the teenagers had imbibed alcohol 20 times or more within the last 12 months. Not surprisingly the frequency of drunkenness has also increased. Among the countries with the highest alcohol intoxication rates, the proportion of 16-year-olds who were drunk three times or more within the last 30 days rose from 21% to 30% in Denmark and from 15% to 24% in Ireland, while rates in Finland and the United Kingdom remained largely unchanged at about 18% and 24%. Whats more, illicit drug use also rose by 20-400% in the 30 countries as a whole. …

Nutritionists unimpressed by sugar lobby's outcry

In July 2001 the WHO Medecins Sans Frontieres the Harvard Medical School and other partners managed to persuade drug manufacturers to reduce prices for five second-line tuberculosis (TB) drugs by 48-97% for delivery to poor countries. These drugs such as capreomyocin cycloserine para-amino salicylic acid ofloxacin and ciprofloxacin are needed to treat multidrug-resistant (MDR) TB strains that have developed resistance to first-line antibiotics. Under the agreement the overall price tag for treating an MDR-TB patient will amount to less than US

World Trade Organization still threatens supply of affordable AIDS drugs

3000 which normally costs US

UN to help developing countries assess safety of GM crops

15000. The price reductions were made possible through bulk purchasing arrangements and the creation of a mechanism to ensure proper use of the drugs the so-called Green Light Committee. It is noted that maintaining the integrity of the second-line drugs is crucial and was the prime reason for creating the Committee. The project will run for 2 years and provide treatment for about 2000 patients worldwide with the Green Light member organizations monitoring the progress of the project.

WHO helps countries prepare for bioterror attacks

Threats by the US sugar industry to lobby Congress to cut off the American contribution to WHO have failed to make the organization withdraw a contentious expert report on nutrition and health. The report, entitled Diet, nutrition and the prevention of chronic disease, was formally launched in Rome on 23 April. It concluded that a diet low in saturated fat, sugar and salt and high in fruit and vegetables was required to tackle the epidemic rise in chronic diseases worldwide. In a series of letters to WHOs Director-General Dr Gro Harlem Brundtland, the sugar lobby attacked the reports recommendation that sugar should represent at most 10% of the daily energy intake. They claimed that the reports conclusions were scientifically flawed and reflect the expert panels complete disregard of the preponderance of scientific evidence. At WHO, however, these reproaches made little impression. We took into account all the comments we received from various stakeholders [upon publication of a draft version on the Internet]. But we felt no need to reconsider the recommendations, said Dr Pekka Puska, Director of Noncommunicable Diseases and Health Promotion at WHO. Denouncing a WHO report as unscientific, he adds, is a standard procedure if big commercial interests are at stake. Thats what the tobacco people used to say. Though the situation is reminiscent of WHOs fight with big tobacco companies, which has been going on for years, Puska is quick to point out that food is not tobacco. Tobacco is an unnecessary product that kills its consumers, whereas food is necessary for life. So its a question of changing dietary patterns from unhealthy to healthy. Besides, there is already a lot of collaboration going on between WHO and vast parts of the food industry. The nutrition and health report, which had been commissioned jointly by WHO and the UN Food and Agriculture Organization (FAO), is the result of a two-year expert consultation. Thirty independent experts from 20 countries analysed the best currently available scientific evidence on the relationship of diet, nutrition and physical activity to chronic diseases, says Dr Ricardo Uauy from the London School of Hygiene and Tropical Medicine who chaired the expert group. The strength of the report is that it is a real consensus document. At the end, 30 scientists were happy with every single word in it. The 100-page report provides the scientific basis on which WHO can build its global strategy on diet, physical activity and health in accordance with a World Health Assembly resolution adopted in May 2002. The strategy aims at reducing the growing burden of chronic conditions such as cardiovascular disease, cancer, diabetes and obesity, which have reached epidemic proportions--not only in industrialized countries but in developing ones as well. Chronic diseases were the cause of some 60% of the 56 million deaths reported globally in 2001. We have known for a long time that foods high in saturated fats, sugars and salt are unhealthy; that we are, globally, increasing our intake of energy-dense nutritionally poor food as our lives become increasingly sedentary, said Dr Brundtland at the launch of the report. …