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11. Counting the Cost of South Africa's Health Burden

Author:
Sahil Angelo and Richard Downie
Publication Date:
07-2015
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
South Africa’s health system is approaching a make or break moment. Can it complete a set of complex organizational reforms and place itself on a sustainable financial footing that will enable it to deliver first-rate health care services to patients? Or will a stalled political process, economic stagnation, and the country’s daunting—and expanding—health burden torpedo the reform effort and cause the system to grind to a halt, with dire consequences for the nation’s health? CSIS explored these questions on a recent research trip to South Africa. This report summarizes the findings
Topic:
Infectious Diseases, Health Care Policy, and Reform
Political Geography:
South Africa

12. U.S. Actions Can Help Keep Global Polio Eradication Strategy on Track

Author:
Nellie Bristol
Publication Date:
07-2015
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The Global Polio Eradication Initiative (GPEI) in April 2013 unveiled an ambitious six-year strategy aimed at finally ending polio worldwide. The four-pronged approach called for stopping transmission in the remaining polio endemic countries while also eliminating rare but paralyzing vaccine-related polio. It outlined plans to ensure proper laboratory and health facility containment of poliovirus as eradication neared. Lastly, the Polio Eradication & Endgame Strategic Plan 2013–2018 urged countries, donors, and international partners to begin planning for the transition of polio program resources to country heath systems and other health initiatives. The drive to eradicate polio is at a pivotal point. The number of cases is down globally compared to last year. Polio programs in both Nigeria and Pakistan are moving in a positive direction while progress in Afghanistan is holding steady. A successful move to bivalent OPV would greatly reduce the number of polio cases caused by vaccine viruses and set the stage for an eventual worldwide switch to IPV. But extraordinary efforts still are required to reach the endgame strategy’s goals.
Topic:
Health, Infectious Diseases, and Health Care Policy

13. Ebola, Liberia, and the “Cult of Bankable Projects”

Author:
Shefa Siegel
Publication Date:
04-2015
Content Type:
Journal Article
Institution:
Carnegie Council
Abstract:
Fragile states are unable to cope with additional shocks like Ebola; without passable roads, electricity, and social solidarity there is no viable way to administer basic medical care or prevent minerals from illegally crossing porous borders, much less suddenly contain a runaway virus. Yet instead of addressing core issues of state failure, development aid continues pushing narrowly focused agendas that have little meaning in places where institutions and infrastructure are broken. Why, in response to the disastrous events we saw unfolding in Liberia, were we not calling for public and private investment in the region to be shifted from one bureaucratic budget line to another?
Topic:
Development, Humanitarian Aid, Infectious Diseases, Health Care Policy, and Ebola

14. Equatorial Guinea Plays a Leading Role in Combating Malaria

Author:
Mark L. Asquino
Publication Date:
09-2015
Content Type:
Journal Article
Journal:
The Ambassador's Review
Abstract:
In August 2014, I attended a ceremony at the Willard Hotel in Washington, DC that celebrated the tenth anniversary of the Bioko Island Malaria Control Project. Those speaking at the event included senior executives from Marathon Oil Corporation, Noble Energy Inc., and Atlantic Methanol Production Company, which are all US petroleum companies that operate in Equatorial Guinea. Teodoro Obiang Nguema Mbasogo, President of Equatorial Guinea, also delivered remarks. All of the speakers were enthusiastic about a dynamic project that has had a trans­formative effect on the health of generations of Equatoguineans by reducing the morbidity and mortality of malaria infection. What follows is an overview of the project’s history as well as the commitment to US innovation and a shared audacity to tackle one of human­kind’s most endemic and fatal diseases.
Topic:
Development, Health, Human Welfare, Infectious Diseases, and Health Care Policy
Political Geography:
United States and Equatorial Guinea

15. Antimicrobial Resistance as an Emerging Threat to National Security

Author:
Maxine Builder
Publication Date:
01-2015
Content Type:
Working Paper
Institution:
Atlantic Council
Abstract:
Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
Topic:
Health, National Security, Infectious Diseases, and Health Care Policy
Political Geography:
United States, China, United Kingdom, America, and Europe

16. The Emerging Global Health Crisis

Publication Date:
12-2014
Content Type:
Working Paper
Abstract:
Rates of heart disease, cancer, diabetes, and other noncommunicable diseases (NCDs) in low- and middle-income countries are increasing faster, in younger people, and with worse outcomes than in wealthier countries. In 2013 alone, NCDs killed eight million people before their sixtieth birthdays in developing countries. A new CFR-sponsored Independent Task Force report and accompanying interactive look at the factors behind this epidemic and the ways the United States can best fight it. The co-chairs of the Task Force are Mitchell E. Daniels Jr., Purdue University president, former Indiana governor, and former Office of Management and Budget director, and Thomas E. Donilon, distinguished fellow at CFR and former national security advisor to President Barack Obama. Thomas J. Bollyky, CFR senior fellow for global health, economics, and development, directed the project. The bipartisan Task Force, CFR's first devoted to a global health issue, is composed of a distinguished group of experts that includes former government officials, scholars, and others.
Topic:
Health, Infectious Diseases, and Health Care Policy

17. Insecticide Resistance and Malaria A Threat Decades in the Making

Author:
William G. Brogdon, Anthony Fiore, S.P. Kachur, Laurence Slutsker, and Robert A. Wirtz
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Insecticide (DDT) use to control malaria was first employed successfully in the antimalaria program in Greece in 1947. By 1951, DDT success in controlling malaria was reported in 22 countries. However, that year also saw the first report of DDT resistance, in Anopheles sacharovi in Greece. By 1954, resistance to DDT among mosquitos was known to be a global problem, documented in Europe, the Americas, Africa, and Asia. The World Health Organization–led Global Malaria Eradication Program (GMEP) began in 1955, when resistance was already pronounced worldwide. Scientists did not identify the underlying biochemical mechanism contributing to insecticide resistance until 1958. By then, insecticide resistance was recognized by many to be a major contributor to the ultimate dismantling of GMEP, given the limited capabilities and knowledge of the time. Consequently, the global focus shifted from malaria “eradication” to malaria “control” in the late 1960s.
Topic:
Environment, Health, and Infectious Diseases
Political Geography:
Africa, Greece, and Asia

18. Transformative Tools for Malaria Elimination

Author:
PATH Malaria Center of Excellence
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
Over the past 15 years, malaria has gained increased attention and action from the public health community, with researchers, global and national funders, and, most importantly, national governments and communities in endemic areas. Renewed efforts to fight the disease have resulted in an unprecedented 50 percent reduction in malaria deaths in African children since 2000. This progress has been achieved in large part because effective, efficient, and affordable tools emerged as a result of earlier investments in research and development.
Topic:
Health, Human Welfare, Humanitarian Aid, International Cooperation, and Infectious Diseases
Political Geography:
Africa

19. The Danger of Untreatable Malaria Is Real and Present

Author:
Christopher V. Plowe
Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Center for Strategic and International Studies
Abstract:
The malaria parasite is thought to have killed more people throughout human history than any other single cause. Over the last decade, a large increase in resources for combating malaria — with the lion's share coming from U.S. taxpayers — has resulted in dramatic reductions in malaria cases and deaths in many countries. These successes spurred the Bill Melinda Gates Foundation and the World Health Organization (WHO) to call for global eradication of malaria in 2007.
Topic:
Development, Health, Humanitarian Aid, World Health Organization, and Infectious Diseases
Political Geography:
United States

20. Ebola and the Private Sector: Bolstering the response and West African economies

Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Oxfam Publishing
Abstract:
The current Ebola outbreak in West Africa is unprecedented. The increasing number of cases, the poor health infrastructure, the shortage of skills, knowledge and personnel, and the fear surrounding the disease are proving a huge challenge to affected governments and to the international community as they battle to bring the epidemic under control.
Topic:
Disaster Relief, Health, Human Welfare, and Infectious Diseases
Political Geography:
Africa and West Africa