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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: Health Updates
Africa: Health Updates
Date distributed (ymd): 990718
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+
Summary Contents:
This posting contains three recent press releases from the World
Health Organization Regional Office for Africa, one on the HIV/AIDS
emergency, and two on malaria. It also contains a press release
on a new Uganda-U.S. study identifying an inexpensive drug for
preventing mother-to-child HIV transmission.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
New Links on Africa's Health
Africa Policy Strategic Action Issue Area
http://www.africapolicy.org/action/health.htm
Starting point for web links on Africa's health, HIV/AIDS,
malaria, reproductive health, and more.
Fairness & Accuracy in Reporting
on the debate over affordable AIDS drugs for African countries
http://www.fair.org/activism/aids-africa.html
Calls for protest against ABC report grossly biased in favor
of U.S. drug companies' campaign to stop South Africa from producing
affordable generic versions of AIDS drugs.
World Health Organization Regional Office for Africa
For further information:
Contact:
WHO Regional Office for Africa (Temporary Office in Harare),
Division of External Coordination and Programme Promotion
E-mail: dcp@whoafr.org;
Web: http://www.whoafr.org
(site still in development)
Tel: 263-4-703580/ 705043/ 706951 Ext. 3141
Press Release: WHO/AFRO/PR/1999/024
African Countries Urged to Declare
HIV/AIDS a National Emergency
24 June 1999
Harare - African Heads of State and Government have been urged
to declare HIV/AIDS "a national emergency"and to support
the declaration by allocating appropriate resources to combat
the epidemic.
"I hereby call on our Heads of State and Government to
declare HIV/AIDS a national emergency or a national disaster.
And for the sake of the future of our children and of our continent,
I plead that this be done immediately, without further delay,"
Dr. Samba said at a press interview in Harare.
"If our leaders publicly acknowledge that we have this
problem on our hands, people's attention will be even more focussed
on the problem and international assistance will be more forthcoming
to help us tame the epidemic. HIV/AIDS is already wiping out whole
populations in parts of the continent," he said.
Dr. Samba noted that Africa which has only 10% of the world's
resources, carries 90% of the global disease burden and accounts
for close to 70% of people living with AIDS, 83% of AIDS deaths
and 95% of the global AIDS orphans.
"Indeed HIV/AIDS has become a development issue,"
Dr. Samba argued, pointing out that the disease is killing off
the most productive portion of the workforce in Africa, and reducing
life expectancy by up to 20 years, from 65 years about ten years
ago to about 40 years now.
Among the consequences of the spread of HIV/AIDS in Africa
are a weakening productive base, a growing orphan population,
further strains on already under-staffed and under-funded health
services, and the loss of gains made in the health sector in the
continent over the last three decades.
Dr. Samba said factors accounting for this grim situation include
the wide practice of unprotected sex, high incidence of sexually
transmitted diseases and poor access to care and information.
He reiterated his earlier warning that "prevention is
an effective insurance against HIV/AIDS."
According to WHO's 1998 World Health Report, AIDS is now the
number one killer in Africa, and the fourth leading cause of death
worldwide.
The Report, issued in May, says that AIDS caused 1,830,000
deaths in Africa in 1998 alone. This is twice as many deaths as
is caused by malaria which has now been relegated to the number
two position on the continent's roaster of deadly diseases.
Press Release: WHO/AFRO/PR/1999/030
WHO Will Succeed in Malaria Control - Dr. Samba 30 June
1999
The World Health Organization (WHO) Regional Director for Africa,
Dr. Ebrahim M. Samba, has expressed optimism that WHO and its
partners will succeed in their current effort to substantially
reduce the human death toll and economic losses to Africa due
to malaria.
Speaking Wednesday at the opening of a two-day meeting on the
Roll Back Malaria (RBM) partnership in Harare, Dr. Samba listed
four factors which, he said, will guarantee the success of the
RBM project, especially in Africa.
These are vastly improved knowledge of the disease itself,
the availability of "infinitely better tools" for malaria
control, genuine involvement of Africans in control efforts, and
commitment by Africa's political leadership to the Roll Back Malaria
project.
Unlike previous anti-malaria efforts, RBM is an all-embracing
initiative which seeks to mobilize and coordinate a global coalition
including leaders from malaria-endemic countries, the WHO itself,
UN agencies, NGOs, scientific communities and public and private
sector organizations.
The RBM partnership, which is unique in international health,
is led by WHO with its medical expertise, and draws from the special
expertise of participating agencies and organizations, thus pooling
resources to eliminate costly overlaps.
Dr. Samba stressed that the success of the RBM movement, and
the partnership which drives it, will depend on the commitment,
interest and strategic actions of national governments.
This in turn is dependent on the full support of WHO, and of
concerned development partners, working in synergy to support
national strategies that will yield the greatest possible benefits
for people whose lives are affected by malaria.
Dr. Samba was also optimistic that by the end of the RBM project,
health systems in African countries will have been sufficiently
strengthened to tackle other health challenges.
In his remarks, the Manager of the Roll Back Malaria project,
Dr. David Nabarro, called on the meeting to identify clear directions
for the future. "We stand ready to serve and we look up to
you to guide us on the way forward," he said.
Among other things, the two-day meeting is reviewing the implementation
of RBM in Africa and how the partnership is working to support
the project. It is also expected to agree ways through which national
authorities can effectively coordinate actions and partners at
the country level to roll back malaria.
WHO experts say almost all the 550 million people south of
the Sahara are at risk from malaria which kills more than one
million Africans yearly. Economic losses attributable to the disease
were estimated at $2 billion in 1998, and projected to reach $3
billion by 2000.
Press Release: WHO/AFRO/PR/1999/032
Roll Back Malaria to Cost $2 Billion over 10 Years
6 July 1999
It will cost $2 billion to implement the World Health Organization's
Roll Back Malaria (RBM) project over the next 10 years, according
to a report on the second meeting of the RBM partnership which
ended in Harare at the weekend.
The report, released on Tuesday, says that "there is an
absolute shortage of funds for health in Africa," and calls
on funding institutions to be more flexible in accommodating "cross-cutting
initiatives" in the global fight against malaria.
It stresses the need for both short-term and longer-term mobilization
strategies, and for governments and donors to jointly develop
flexible and transparent funding mechanisms and reporting systems.
The report adds that for the RBM partnership to produce sustainable
results, adequate funding levels must be maintained, increased
accountability and transparency should be the norm, while capacity-building
should be continuous.
It also calls for the integration of malaria control activities
with ongoing health sector development programmes and suggests
that RBM could well serve as a lens to view and promote progress
in health sector development in Africa.
On the progress made in rolling back malaria in Africa, the
report says activities so far undertaken include: the development
of a draft strategy and work plan; the development of advocacy
materials and a framework for monitoring progress; the development
of modalities for initiating RBM at the country level, and the
development of communication linkages between global and regional
partners.
According to the report, activities slated for implementation
over the next two years include: the development of a framework
for country-level implementation of RBM; identification of country
needs and provision of appropriate resources for the intensification
of priority health actions, and the institution of functional
partnerships at the national and local levels in malaria-endemic
countries.
Others are the establishment of effective mechanmisms for the
involvement of community-level organizations in the RBM movement,
and the incorporation of private sector bodies including the media,
NGOs, professional associations and research groups in national
and global partnerships.
The RBM partnership is a broad network of national governments,
international and bilateral organizations, NGOs, the private sector
and others contributing resources and skills to reduce the malaria
burden across the globe. It was launched in New York in October
1998 by WHO, UNICEF, UNDP and the World Bank, and formally established
in Geneva two months later.
Effective drug regimen for preventing transmission of HIV
Family Health International
July 15, 1999
For more information: NIAID (National Institute of Allergy
and Infectious Disease), a component of the National Institutes
of Health (NIH). NIAID conducts and supports research to prevent,
diagnose and treat illnesses such as HIV disease and other sexually
transmitted diseases, tuberculosis, malaria, asthma and allergies.
Press releases, fact sheets and other materials are available
on the NIAID Web site (http://www.niaid.nih.gov).
Telephone contact: Office of Communications And Public Liaison
(301) 402-1663
Durham, NC - Researchers Identify a Simple, Affordable Drug
Regimen That is Highly Effective in Preventing HIV Infection in
Infants of Mothers with the Disease.
A joint Uganda-U.S. study has found a highly effective and
safe drug regimen for preventing transmission of HIV from an infected
mother to her newborn that is more affordable and practical than
any other examined to date. Interim results from the study, sponsored
by the National Institute of Allergy and Infectious Diseases (NIAID),
demonstrate that a single oral dose of the antiretroviral drug
nevirapine (NVP) given to an HIV-infected woman in labor and another
to her baby within three days of birth reduces the transmission
rate by half compared to a similar short course of AZT. If implemented
widely in developing countries, this intervention potentially
could prevent some 300,000 to 400,000 newborns per year from beginning
life infected with HIV.
"This extraordinary finding is the most recent in our
efforts to bring an end to AIDS, not only in the United States
but in countries around the world," says Health and Human
Services Secretary Donna E. Shalala. "American scientists
along with our international partners are committed to developing
treatments that not only work, but that are also feasible in other
health care settings. These results achieve both those goals."
"This study represents the most promising advance to date
toward the goal of finding strategies that can be used worldwide
to prevent the spread of HIV from infected mothers to their infants,"
says NIAID Director Anthony S. Fauci, M.D. NIAID is a component
of the National Institutes of Health.
In an announcement from Kampala this morning, Ugandan officials
hailed the finding. "This research provides real hope that
we may be able to protect many of Africa's next generation from
the ravages of AIDS," says Crispus Kiyonga, M.B.Ch.B., Uganda's
Minister of Health. "We commend the collaborative effort
of our country's scientists, led by Professor Francis Mmiro from
Makerere University Faculty of Medicine, and their U.S. colleagues,
led by Dr. Brooks Jackson from The Johns Hopkins University School
of Medicine." Finding affordable interventions for developing
countries is key to curtailing the global AIDS epidemic. In parts
of the hardest-hit area, sub-Saharan Africa, up to 30 percent
of pregnant women are infected with HIV, and 25 to 35 percent
of their infants will be born infected. The UNAIDS estimates that
approximately 1,800 HIV-infected babies are born every day in
developing countries.
Unfortunately, the standard AZT regimen used to prevent perinatal
HIV transmission in the United States is too expensive and impractical
for widespread use in developing countries where many women may
not receive prenatal care.
Based on average U.S. wholesale costs, the cost of the drug
used in the nevirapine regimen in the current study is approximately
200 times cheaper than the long-course AZT used in the United
States, and almost 70 times cheaper than a short course of AZT
given to the mother during the last month of pregnancy - a regimen
tested in Thailand by the Centers for Disease Control and Prevention
and reported effective in 1998.
The Uganda study investigators, part of the NIAID-supported
HIV Prevention Trials Network (HIVNET), opened the trial two years
ago at Mulago Hospital, affiliated with Makerere University, in
Kampala, Uganda. They completed enrollment last April. All women
entered into the study were in their ninth month of pregnancy.
None had taken antiretroviral drugs while pregnant.
The study, known as HIVNET 012, compared the safety and efficacy
of two different short-course regimens of antiviral drugs administered
late in pregnancy. The women were assigned at random to receive
either a 200-mg dose of oral nevirapine at the onset of labor,
followed by a 2-mg/kg oral dose given to their babies within three
days of birth; or a 600-mg dose of AZT at the onset of labor,
and 300-mg doses every three hours thereafter during labor. The
infants born to mothers in the AZT group received 4 mg/kg given
twice daily for the first week of life. Both drugs appeared to
be safe and well-tolerated.
Study design, data collection and analysis was provided by
a team of researchers led by Dr. Thomas Fleming, a biostatistican
at the Fred Hutchinson Cancer Research Center and the University
of Washington School of Public Health and Community medicine in
Seattle.
For the interim analysis, the study team looked at data from
618 mothers (308 receiving AZT and 310 receiving nevirapine) and
their infants.
Nevirapine was markedly more effective. At 14 to 16 weeks of
age, 13.1 percent of infants who received nevirapine were infected
with HIV, compared with 25.1 percent of those in the AZT group.
"In this study, the short-course nevirapine regimen resulted
in a 47 percent reduction in mother-to-infant HIV transmission
compared with a short course of AZT. The implications of this
study for developing countries, where 95 percent of the AIDS epidemic
is occurring, are profound," says Brooks Jackson, M.D., the
lead U.S. investigator on the trial.
Long-term follow-up of both the mothers and their babies remains
a high priority to assess any late drug toxicities as well as
long-term survival. The mothers and their children will continue
to be actively followed until the babies are 18 months old. This
period is critical to establish the efficacy of the intervention
because even if a baby is born HIV-free, he or she may acquire
the virus during breastfeeding. The data analyzed so far cover
only the first three months of the newborn's life. Ugandan and
U.S. investigators will soon launch a follow-up study to evaluate
the efficacy of nevirapine administered to the mother during labor
and to the newborns for a longer period of time.
Breastfeeding is practiced widely in developing countries.
Most studies indicate that the rate of HIV transmission via breastfeeding
is highest in the first few months of life. No intervention has
yet been shown to prevent HIV transmission through breast milk
other than not breastfeeding.
The single-dose nevirapine regimen to mother and infant substantially
lowers the cost barrier that has kept many countries from adopting
drug strategies that prevent perinatal HIV transmission. Still,
access to other health care services required to implement this
regimen, such as counseling and voluntary HIV testing, are beyond
available resources of many developing countries. But if further
research upholds nevirapine's good safety record, the investigators
say that potentially all pregnant women who live in areas of high
HIV prevalence could receive the drug during labor, even in the
absence of an established HIV diagnosis.
In the United States and other industrialized countries, many
HIV-infected pregnant women already take combination drug regimens
that include AZT. A study now being conducted in the United States
and Europe is evaluating if adding nevirapine to standard treatment
regimens will have any extra benefit in preventing perinatal HIV
transmission in these countries. For pregnant women who do not
know their HIV status until they begin labor, the nevirapine regimen
provides a last-minute prevention option.
Nevirapine, developed by Boehringer Ingelheim Pharmaceuticals,
is a non-nucleoside reverse transcriptase inhibitor, and is in
a different class of antiviral drugs than AZT but works against
the same HIV target enzyme that is critical for the virus to infect
new cells. It can be easily stored at room temperature. Besides
being inexpensive and potent, nevirapine is rapidly absorbed and
transferred across the placenta to the infant, and it breaks down
slowly. For these reasons, it was thought that even a single dose
to the mother and infant might provide enough protection to the
baby during the time of exposure to HIV at birth. In March 1996,
nevirapine was licensed in the United States for treatment of
HIV infection in adults. AZT, made by Glaxo Wellcome, was first
approved in the United States to treat AIDS in 1987. In August
1994, AZT received an additional indication for use in preventing
perinatal HIV transmission.
This material is being reposted for wider distribution
by the Africa Policy Information Center (APIC). APIC's primary
objective is to widen the policy debate in the United States around
African issues and the U.S. role in Africa, by concentrating on
providing accessible policy-relevant information and analysis
usable by a wide range of groups and individuals.
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