Update to Blue Marble Health Collection

This week sees a major update to the PLOS Collection “Blue Marble Health: the mismatch between national wealth and population health” with the addition of 50 new papers, including two new editorials published today in PLOS Medicine and PLOS Neglected Tropical Diseases.

Blue Marble Health signals a shift in current thinking about global health, highlighting that the stark contrasts associated with health in developing and developed countries may no longer ring true and urging that health outcomes must no longer be defined by simplistic and generalised geographical or economic boundaries.

Blue Marble Health www.ploscollections.org/bluemarblehealth

Blue Marble Health

Writing in PLOS Neglected Tropical Diseases, Editor-in-Chief Dr Peter Hotez cites recent data from the World Health Organization (WHO) to support the hypothesis that neglected tropical diseases (NTDs), long associated with low-income countries, are becoming common afflictions of the world’s poorest people in wealthier countries also. Dr. Hotez notes that the Group of 20 (G20) countries which, together with the nation of Nigeria, represent 86% of the global economy, account for approximately half of the world’s parasitic worm infections, as well as most cases of dengue fever and leprosy.  He concludes that “the global economy could improve significantly through the lifting of the bottom segment of the G20 economies out of poverty,” and that an orientation towards Blue Marble Health at the G20’s 2016 summit could drive “a major breakthrough in global health.”

In the second editorial published today Dr. Larry Peiperl, Chief Editor of PLOS Medicine,  and Dr Hotez examine recent WHO data on years of life lost from non-communicable diseases (NCDs), which include heart disease, diabetes, and most types of cancer.  While such diseases have long been seen as the scourge of wealthy countries, Drs. Peiperl and Hotez argue that their distribution within the G20 countries and Nigeria suggests that the poor living among the wealthy disproportionately share the global burden of NCDs.

This analysis suggests that NCDs may be joining NTDs in following the Blue Marble Health pattern of geographical redistribution with convergence on the world’s poorest people, with adverse implications for human development.  “Strong economies must take responsibility for population-wide preventive action that embraces vulnerable populations now living in extreme poverty.”

The poor living among the wealthy.

Major areas of poverty in the G20 nations and Nigeria, where most of the world’s NTDs occur.

Other additions to the collection provide more evidence to support the Blue Marble Health concept. This includes research into cardiometabolic diseases in rural Uganda, diabetes care in GuyanaLeishmaniasis in Saudi Arabia and the economic burden of Dengue in Mexico, and a Policy Forum calling for national childhood cancer strategies in low- and middle- income countries.

PLOS Medicine and PLOS Neglected Tropical Diseases encourage the community of biomedical and social scientists, humanists, health economists, healthcare professionals, and public health workers to submit papers that highlight health disparities among the poor and otherwise disadvantaged populations, those who are often forgotten in the world’s middle- and high-income countries.

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Hello, We’re Open

Karin Purshouse (@karinpurshouse), a clinical and academic junior doctor in Oxford, invites you to join the conversation with other early career researchers at the next OpenCon Community Call, this Wednesday, July 29.

It is not always easy, as a junior researcher, to stick your head above the parapet and stake your commitment to Open Access. As a junior doctor and early career researcher myself, I find speaking about OA with even my peers can feel controversial. But finding the courage to be an OA advocate as junior researchers through talking and listening is exactly what the OpenCon Community Call is all about.


OpenCon 2014. Image credit: Aloysius Wilfred Raj

The OpenCon Community Call was born after a group of 150 students, librarians and early career researchers met at OpenCon2014 in Washington, D.C. in November last year, bringing together an international community of people interested in Open Access, Open Data and Open Education. From every continent bar Antarctica, we represented fields as diverse as Slavic Languages and Literature to Computational Neuroscience and pretty much everything in between. As conferences go, we all agreed it had been epic – from the peers we had connected with to the caliber of senior figures we were able to both lobby and learn from, it had been a game-changer of a conference for all of us in appreciating our pivotal role in the OA movement. A key concern we shared was how to continue and develop our open community. We wanted to continue to learn from and support each other in striving for open-ness, as well as provide a platform for those new to Open Access to join the conversation. With that, the OpenCon Community Call was conceived.

The formula is simple – we talk about all things Open in a ‘safe’, low pressure environment, keep up to date with OA developments and support each other with new projects and initiatives to promote OA in our environments. Hosted monthly, each call is one hour of structured news sharing and discussions via a teleconference call, and the agenda and minutes are continuously updated and available. Everyone is free to contribute to the call or the agenda/minutes, and we have a coordinating team who provide the structure for the call. Around 20-25 participants representing both familiar faces as well as new ones have been attending each call. We’ve had everything – discussions about developing OA policies at universities and other academic institutions, guest speakers such as Kevin Smith from Duke University who spoke to us about Elsevier’s recent press release on a new sharing policy, or individual quandaries, such as how Ebola research can be made OA or how to get local initiatives off the ground.
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Category: General | 1 Comment

Simple but elusive – why are we still talking about HIV drug delivery?

Ahead of the International AIDS Society (IAS) Conference held in 2015 in Vancouver, Canada (July 19-22), Helen Bygrave of MSF discusses her frustrations with the lack of implementation of simple, programmatic strategies for improving HIV care.

My main memory of the last IAS conference I attended, held in Vienna in 2010, was a resounding standing ovation for a presentation (including this video) by one of my colleagues working in Mozambique. In a situation where antiretroviral therapy (ART) had not been extensively decentralised, and where drug supply limitations meant people had to attend a clinic every month to pick up their drugs, a simple idea had transformed the way that patients received their HIV care. In short, people living near each other had got together and agreed to take it in turns to pick up each other’s drugs. This resulted in less time spent at the clinic and lower transport costs for patients and an immediate reduction in workload for clinic staff.

Simple, no? So why are people living with HIV/AIDS still queuing up all day every month (or couple of months if they are lucky) outside a clinician’s door to pick up their ART? Many of them feel well, their CD4 counts are fine, and some now even know that their viral load is undetectable. There must be a more efficient way to deliver medications to these patients.


Community ART group in Zimbabwe; image credit: Helen Bygrave

How we deliver ART as a chronic medication has become a hot topic of debate. Examples range from facility-based fast-track through to adherence clubs, community ART groups (CAGS), and, finally, some examples of community-based pharmacies are appearing. These strategies have been variously named alternative-refill strategies, community models of care, and differentiated models of ART delivery. Whatever the title, the strategy must be patient-centred, ie responsive to patients’ needs, and context-adapted – since what might work in a busy clinic in Johannesburg may not work in rural Zimbabwe. My dream is to be able to offer patients a range of options to choose from when collecting their repeat drug refills. Some of the community strategies may even provide opportunities beyond easing drug supply, such as strengthening community engagement with the aim of mobilising local communities, reducing stigma, and enhancing their link with health-care systems.

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Category: Conference news, General, HIV | 3 Comments

Dismantling gains in global health?

As the Third International Conference on Financing for Development begins in Ethiopia, Áine Markham of Médecins Sans Frontières warns that basing funding decisions on country-level finance indicators could be a step backwards for global health, especially in middle-income countries. 

This month signals a critical moment for the future of global health financing as high-level political representatives meet in Addis Ababa for the Third International Conference on Financing for Development to discuss how the new Sustainable Development Goals (SDGs) will be funded. Current trends in stagnating spending on aid and a finance-driven rhetoric risk abandoning the achievements of recent decades.


Sunset on Addis Ababa; image credit: Jean Rebiffé, Flickr

Arguably, some of the greatest gains in global health during the past 15 years can be attributed to initiatives such as the Global Fund to fight AIDS, Tuberculosis and Malaria. The Global Fund, with its well-focused goals and multi-stakeholder governance mechanisms, created results-orientated funding that prioritised effectiveness, improved health outcomes and positively influenced national and international policies. Importantly, its inclusion of civil society as a national ‘watch-dog’ safeguarded the pertinence of health interventions in recipient countries. The Global Fund and other initiatives such as Gavi, the vaccine alliance, broke with tradition and funded critical interventions including recurrent costs such as health staff, drugs and renewable medical commodities. These initiatives, which have stemmed from the Millennium Development Goals (MDGs), galvanised global attention and funding on fighting killer diseases and ill health.

These important advances are now being eroded. The continued use of gross national income to allocate official development assistance (ODA), which includes development assistance for health, has potentially catastrophic effects for over 70% of the world’s poor who live in the 105 countries classified as middle-income. The risk with the current moves by donors to change modalities and channels of assistance to countries in this bracket could see the health needs of people living in these countries deprioritised with national health expenditure unable to replace external support. Over 50% of the humanitarian medical programmes of Médecins Sans Frontières (MSF) are in ‘middle-income’ countries such as, Sudan, Kenya and South Africa and we are alarmed by the disparity between global rhetoric and the reality faced by the populations we serve.

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Category: General, MSF | Tagged | 2 Comments

Lessons and Challenges for Developing and Delivering HIV Programs for Sex Workers

Today sees the addition of an important paper to the PLOS Collection Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers; published in PLOS Medicine, David Wilson of World Bank looks at lessons learnt and challenges for developing and delivering HIV programs for sex workers.

The burden of HIV is heavily disproportionate in sex workers, where the high rates of partner change in their work and their vulnerability increase the likelihood of sexual transmitted infections. The Collection, writes Wilson, “challenges AIDS researchers and practitioners to initiate a new generation of comprehensive sex worker HIV prevention programs for a changing sex work context”.

Other articles featured in the collection highlight the cost effectiveness of community mobilisation efforts in improving the uptake of services and influencing transmission of HIV and other STIs. Evidence shows the impact of HIV programmes with sex workers – such as those in Thailand and India – when they are implemented at a sufficient scale. Countries in Africa such as Benin, Burkino Faso and Nigeria have also executed effective and feasible interventions, but analysis of these show that funding in these programmes remains inadequate and, as a result, the large scale responses that are required do not exist.

Image Credit: Rebecca Selah, Flickr.com; PublicDomainPictures, Pixabay.com; alkautsar eddiejakoeb, Flickr.com; hdptcar, Flickr.com

Image Credit: Rebecca Selah, Flickr.com; PublicDomainPictures, Pixabay.com; alkautsar eddiejakoeb, Flickr.com; hdptcar, Flickr.com

With the increased burden of HIV infection, the rapid scale-up of combination prevention programmes and HIV care and treatment, in order to improve conditions for sex workers and the general population to contain the HIV epidemic on a global scale, is key.

Please visit the collection at: www.ploscollections.org/achievingHIVimpact

Category: Collections, General | 2 Comments

Advocating for Equitable Access to Global Health Internship Opportunities

Kaleem Hawa, Oluwaseyi Owaseye, Tara Kedia, and Ashton Barnett-Vanes comment on unequal access to global health career training opportunities and announce a fundraising campaign to help support internships at WHO Headquarters for young health professionals from low and middle income countries.

Image Credit: tup wanders, Flickr

Image Credit: tup wanders, Flickr

Global health is a field in which thousands of interns work every year. Some may undertake an internship as part of their academic programme, others as a work placement. Irrespective of an intern’s professional background, these placements afford candidates the opportunity to boost their skill sets, prepare or launch their global health careers, and develop academic or experiential global health knowledge that may be invested back into their local health systems.

Curiously, whilst equitable access to health care is a core value of global health and universal health care, equitable access to internships in this field has received far less scrutiny. A report by the UN’s Joint Inspection Unit in 2009 using 2007 data found that United Nations internships (including those offered by the World Health Organization) were inaccessible to many, with almost 60% of candidates from a high-income country. Surveys conducted in 2011 and 2013 at World Health Organization Headquarters (WHO-HQ) in Geneva, Switzerland support this finding, with only a quarter of WHO-HQ interns coming from low- or middle- income countries (LMICs). In many cases, this inaccessibility stems in part from the financial barriers and costs of living associated with an unpaid position in an expensive, global city like Geneva.

Young health professionals from high disease-burden regions have fewer international training opportunities than their peers from lower-burden regions (Figure 1). In the South-East Asia (SEARO) and Africa (AFRO) regions, 81% of countries are defined as low- or lower-middle income. The unpaid status of these internship programs likely restrain such candidates from applying without self-funding or financial support. Perniciously, these countries have the highest health burdens (Figure 1).

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Category: Global Health, WHO | 4 Comments

Nepal after the recent earthquakes: reconstruction and vaccine-preventable enteric diseases

In the wake of the recent devastating earthquakes, PLOS Medicine Consulting Editor Lorenz von Seidlein visited Nepal to assess outbreak risks. Lorenz travelled with Anuj Bhattachan, International Vaccine Institute, Seoul, Korea and guidance from Deepak C. Bajracharya and Shyam Raj Upreti  from the Group for Technical Assistance, Kathmandu, Nepal. The assessment was requested by the epidemiology and disease control division of the Ministry of Health of Nepal and facilitated by Stop Cholera. Here he reports on the damage he witnessed and considers the choice of administering vaccines pre-emptively versus reactively in response to an outbreak.

IMG_2400b Gorkha collapsing with hill

Image credit: Lorenz von Seidlein

The two earthquakes in April and May 2015 seem to have selectively erased much of northern Nepal’s architecture and history. Many buildings in urban Kathmandu were constructed during the last 20 years. These buildings, in many cases multi-storey or high-rise, did not collapse during the recent earthquakes. The older buildings in urban Kathmandu are brick and mortar constructions without a frame. These vintage structures give Kathmandu its characteristic charm but they fell like dominoes during the first earthquake on 25th April. In rural districts the buildings are mostly stone and clay; they are perfectly adapted for the high altitude climate of the Himalayas but offer very little resistance against an earthquake. Most of the stone houses completely crumbled or have large enough cracks to suggest imminent collapse. According to government figures, 488,579 houses were destroyed and 260,026 damaged. The probability of a quick reconstruction is small because of the widespread damage. Furthermore, majority of men of working age are employed abroad, leaving a denuded local labour force.1

Current estimates suggest that 8,151 people died and some 17,866 people were injured in the two quakes. Currently most health care is required for acute trauma but trauma will be replaced by other presentations during the coming months. Water resources of the 660,000 to 1.3 million people were affected and between 850,000 to 1.7 million need sanitation support. Concurrently 945 health facilities, mostly village health posts, are partially or totally damaged. Health services have been severely compromised. Routine childhood vaccinations had to be suspended in some districts. The makeshift temporary living conditions, disruptions to water supply and sanitation, and strained health services foreshadow an aftershock of a different variety: enteric diseases may seize this opportunity to spread through an already devastated country.
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Category: Cholera, Vaccines | 4 Comments

Malaria and Epstein-Barr Virus: A Lethal Combination

A recent study in PLOS Pathogens investigates how Epstein-Barr virus and malaria co-infection may create a lethal combination if the timing is right.

Spleen section for mock infected, MHV68 infected, P. yoelii XNL infected and MHV68 and P. yoelii XNL co-infected animals at day 8 post infection with P. yoelii XNL (or day 15 post-infection with MHV68)

Spleen section for mock infected, MHV68 infected, P. yoelii XNL infected and MHV68 and P. yoelii XNL co-infected animals.  Image credit: Matar et al. (2015)

Epstein-Barr virus and malaria are two infections that can each be controlled on their own, but a new study in PLOS Pathogens shows that co-infection can perhaps become more lethal than each infection alone, providing one possible explanation for why young children are so much more vulnerable to severe malaria.

The study, led by Samuel H. Speck and Tracey J. Lamb of the Emory University School of Medicine finds that Epstein-Barr virus (EBV) may contribute to the development of severe malaria and malaria-related deaths in sub-Saharan African children. Almost all African children will be infected with both Epstein-Barr virus and malaria by the age of 6-12 months. Because both of these infections occur around the same time in these children, many are at a high risk for co-infection before the age of 1.
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Category: co-infection, Epstein-Barr virus, General, malaria | 2 Comments

MSF Scientific Day 2015: a conference without borders

Sarah Venis, Research Coordinator at Médecins Sans Frontières, highlights the topics at the 2015 MSF Scientific Day, May 7th and 8th in London and New Delhi.

At the time of writing, the West Africa Ebola epidemic at last appears to be under control, and as the response is scaled down there is more capacity within Médecins Sans Frontières (MSF) to begin to appraise the evidence collected, technological approaches trialed, and lessons learned. Much of the analysis is yet to come – the work that will be presented at the 2015 MSF Scientific Day on May 7th and 8th is an early snapshot across some of the most important areas of uncertainty in the response.

MSF staff member in personal protective equipment, Liberia. Image credit: Yann Libessart/MSF

MSF staff member in personal protective equipment, Liberia.
Image credit: Yann Libessart/MSF

The MSF Scientific Day, now in its 12th year, aims to connect audiences – across countries, organisations, specialties, and disciplines – to promote debate on the state of the evidence underpinning medical humanitarian operations. Anyone with access to the internet or a smart phone can watch online and ask questions via the MSF Scientific Day website or Twitter using #MSFsci. The posters are also available at a permanent MSF Scientific Day archive hosted by f1000 and this year we are running a poster competition – please view and vote for your favourite.

This year, the conference is taking place over two days (May 7th, 8th) and is hosted in New Delhi as well as London. In addition to the auditorium delegates, we hope that our virtual audience (in 2014 over 2200 people in over 100 countries) will once again join us. The intention behind both the new event in India and the online version of the conference is to engage MSF field staff, partner organisations, and other relevant medical and policy audiences to help guide field operations, influence policy, and increase the benefit for the populations in which the research was conducted.
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World Malaria Day 2015: A Conversation between Allan Schapira and Lorenz von Seidlein

On World Malaria Day 2015, Allan Schapira and Lorenz von Seidlein discussed the accomplishments and challenges of the fight against malaria.

Image Credit: James Gathany, Wikimedia Commons

Image Credit: James Gathany, Wikimedia Commons

Lorenz: Is there much to celebrate on World Malaria Day 2015?

Allan: Well, in 2000 we estimated there were roughly 801,000 malaria related deaths in Africa. In 2014 we estimate that this number had dropped to 528,000 malaria deaths.

Lorenz: 528,000 malaria deaths are really nothing to celebrate. That is a lot of misery.

Allan:  Indeed, but the malaria mortality rate in Africa has decreased by more than 50% ¹ over less than 15 years – that’s an epic achievement, but certainly not enough. I find it striking that the number of ACT courses procured in the world in 2013 was as high as 392 million courses, while the estimated proportion of all children with malaria who received ACTs was estimated at only 9 to 26%.

Lorenz: 74 to 91% of children with malaria are not treated. Again there is not much to celebrate.

Allan: The first problem to deal with is the unsatisfactory and slowing decline in malaria mortality in Africa.  While there is room for improvement of ITN coverage, the priority should be to scale up access to early effective treatment including improved care-seeking.  There is always scope for cost-effectiveness studies and comparisons of private and public approaches, the surest and most rapid way to reduce malaria mortality is a massive scale-up of community case management of childhood illness (CCM), which will also help reduce pneumonia and gastroenteritis mortality. It will also strengthen health systems, which is now better understood as a priority, as the international community is trying to deal with Ebola.  CCM is still conducted as a pilot activity.  Why has it not been mainstreamed?

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Category: Global Health, Malaria | 1 Comment