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Posts Tagged ‘public health

Vaccine Diplomacy: The Key to Eradication

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By Juan Ignacio Moliva, PhD

Directors of Global Smallpox Eradication Program. From left to right: J. Donald Miller, William H. Foege, and J. Michael Lane.
Source: Wikipedia

In a rapidly connecting world, scientific diplomacy has grown into an important tool in foreign policy’s mission to maintain worldwide stability. Broadly described as the collaboration between nations to address common problems across all branches of science, scientific diplomacy is relied upon to help address multinational scientific challenges. The goal of science diplomacy is to build technical, research-based partnerships, both formal and informal, to further advance humanity’s understanding of the world. Collaborations between nations are required to achieve global solutions – whether those countries be rich or poor, big or small, stable, or unstable. While recent accomplishments of this branch of diplomacy include the Paris Climate Agreement and the Iran Nuclear Deal, arguably the greatest scientific diplomacy success is the eradication of smallpox. This was accomplished through a branch of scientific diplomacy, vaccine diplomacy, a derivative whose goal is to promote vaccination to achieve global health goals and common foreign policy objectives that deal with the eradication of disease.

Before its eradication, smallpox was one of the world’s worst diseases; a virus that killed 30% of those infected. The eradication of smallpox exemplifies a worldwide collaboration to solve a deadly problem. The first multinational attempt to eradicate smallpox occurred in 1950 by the Pan American Health Organization. Though the initial campaign was largely successful, it failed to eliminate the virus. A global effort was then initiated by Viktor Zhdanov, a scientist from the USSR, who suggested a worldwide program of eradication in 1958. The success of this project depended on the collaboration between the United States and the Soviet Union, two countries in the midst of a cold war. With the backing of the international community, the WHO launched the Intensified Smallpox Eradication Programme in 1967, and the last case of smallpox, a Somali hospital cook named Ali Maow Maalin, was recorded in 1977. Global cooperation not only enabled the eradication of smallpox but was necessary for its success. 

In an attempt to replicate the success with smallpox, multinational organizations have partnered to eradicate other deadly or debilitating diseases via vaccination, including polio, malaria, and measles amongst many others. Although considerable progress has been made (polio and measles have been reduced by >99%), several factors have prevented complete eradication. Polio remains endemic to three countries, Pakistan, Nigeria, and Afghanistan, and its eradication has been inhibited primarily due to armed conflict. Eradication of measles, on the other hand, which has re-emerged due to the anti-vaccination movement in developed countries, remains tied to weak health systems and poor sanitation in rural parts of the world. Malaria, though more prevalent than polio and measles, has also been targeted by the WHO for eradication. However, weak health systems, drug and insecticide resistance, climate change, and lack of funding remain major obstacles. 

The major branches of vaccine diplomacy are the allocation of resources and the establishment of international partnerships that will be beneficial for the eradication of disease and allow for rapid responses to outbreaks. To achieve these goals, vaccine diplomacy promotes the use and availability of vaccines in regions of the world where resources may be limited and works to enable access and affordability of vaccines to low-income populations that are at risk. Vaccine diplomacy also aims to strengthen international collaboration. Failure to share biological samples of pathogens has the risk to hinder the global response to emerging diseases. Indeed, this occurred in 2007 when the government of Indonesia decided to stop sharing H5N1 influenza samples, which endangered the WHO’s Pandemic Influenza Preparedness Agreement. Finally, another critical component of vaccine diplomacy is to emphasize honesty and cooperation during outbreaks. The worldwide outbreak of a novel coronavirus (COVID-19) that began in China raised concerns that the Chinese government was not being honest about the number of cases. The fact is infectious diseases do not respect national boundaries. In the past ten years, the world has experienced multinational outbreaks of influenza, measles, Ebola, Middle Eastern Respiratory Syndrome (MERS), Zika, cholera, Chikungunya, and others. With the ever-increasing human population, it is becoming easier for newly emerging pathogens to spread. Honesty and cooperation will be critical to ensure a rapid response and prevent mass loss of life. 

How can vaccine diplomacy help use finally eradicate some of these lingering infectious diseases? Effective vaccine diplomacy must meet the following conditions: First, and most important, is increasing access to free, effective, and easily administrable vaccines to regions of the world where the disease is endemic. The most effective solution to eliminating diseases is to provide the vaccine at no cost. This will require international support and coordination between multinational agencies and low-income countries. Second, efforts should center on enhancing surveillance and effective communication of the disease to ensure a rapid and appropriate turnaround from detection to neutralization. This will involve mobilizing community leaders and assisting individuals that may have been displaced due to natural disasters or civil unrest. Third, to eliminate the spread of disease, access to clean water and improvements to sanitation must be prioritized in developing nations. Fourth, vaccine diplomacy must include effective health promotion and communication to the public. The rise of skepticism in vaccines has brought back dangerous pathogens from the brink of extinction in the developed world. Eradication will depend on effective educational campaigns that stress the importance and safety of vaccines. 

Why should we eradicate these diseases? The vision of eradication has a significant worldwide impact and showcases international collaboration. Eradication can also be seen as a cost-effective solution to diseases. When a disease is eradicated resources are no longer needed to prevent or treat that disease. Additionally, those individuals that would have been affected by the disease can then contribute to the economy. It’s estimated that the global benefit-cost ratio for smallpox eradication was 450:1, meaning that every $1 invested in smallpox eradication brought $450 in economic gain. Eradication of disease also fits under social justice and equality. Echoed by Melinda Gates, “… we have not had malaria transmission in the United States since the mid-1930s. Our kids don’t die of malaria. We have the tools to eliminate it [worldwide]. How is it justifiable that we don’t?” The benefits outweigh the costs and trained vaccine scientists with diplomatic experience must lead the way to finally rid the world of preventable diseases. 

Written by sciencepolicyforall

April 24, 2020 at 2:13 pm

Science Policy Around the Web April 16th, 2020

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By Dorothy Butler, PhD

Source: Pixabay

Pandemic brings mass vaccinations to a halt

GAVI, the Vaccine Alliance, has a mission to improve access to vaccines for children in vulnerable populations like those in developing countries. The World Health Organization (WHO) and other agencies have partnered with GAVI in their mission to eliminate diseases, such as polio and measles, through mass vaccination campaigns. 

However, due to the growing threat of the novel coronavirus, the consistency of many of these vaccination programs is under threat. GAVI estimates that at least 13.5 million people in the least developed countries will not be protected from diseases like measles, polio, and HPV due to a disruption of vaccinations in these countries. Vaccine shortages are already being reported as a result of border closures and disruptions to travel. Not only are shortages of vaccines posing a threat, but the spread of coronavirus from visits to administer vaccinations also is a concern. It is not easy to choose between giving live-saving vaccinations and stopping those same vaccinations to help potentially curb the spread of coronavirus. But that is what organizations like GAVI have been faced with. Ultimately, they have chosen to postpone mass vaccination campaigns for these diseases. 

Other organizations such as the Global Polio Eradication Initiative (GPEI) have also chosen to halt their vaccination campaigns. GPEI has successfully eliminated polio from many countries, including Iraq, Somalia, Yemen, and Syria. However, there is concern that with this pause in the vaccination campaign, polio could see a resurgence in countries who are now termed polio-free. While those involved in the GPEI are hopeful that social distancing practices used to combat the spread of COVID-19 might also help slow the spread of polio, they are continuing to work on plans to continue polio virus surveillance and to amass a stockpile of polio vaccines for when the program can continue again. 

Additionally, organizations like GAVI have redirected some of their funds. Hopefully, the redirection of funds and manpower to support the health systems in developing countries will allow them to better respond to the virus. While the work continues to help stop the spread of coronavirus, they will also prepare for the hard work of restarting the mass vaccination campaigns once they can. 

(Leslie Roberts, Science)

Written by sciencepolicyforall

April 16, 2020 at 9:27 am

It’s time to talk about menstrual health, period.

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By Federica La Russa, PhD

Image by Carrie Z from Pixabay

Menstruation is a natural occurrence for 1.8 billion girls and women of reproductive age. Yet millions of menstruators across the world are denied the right to experience menses in a safe and dignified way. Women worldwide still face menstruation related health, social, and economic challenges which require immediate attention.

One of the most common health-related issues to menstruation is pain associated with periods, called dysmenorrhea. This is often associated with underlying debilitating pathological conditions such as endometriosis, which affects 200 million women worldwide. Research, diagnosis, and management of dysmenorrhea are dramatically overlooked at tremendous detriment to the quality of life of affected women. Lack of education, stigma, and taboos define major social and cultural-related issues around menstruation. A study performed by UNICEF showed that 1 out of 3 girls in South Asia had no prior knowledge of menstruation before menarche, whereas in Western cultures, hiding menstrual status was prevalent in social or work-related settings. As a consequence, women experienced high levels of fear, shame, and feelings of social and personal restriction across multiple cultures. In the UK, nearly 80% of adolescent girls experienced concerning menstrual symptoms without reporting them to a health professional.

Social and cultural-related issues are accompanied, and often worsened, by economic-related issues. The most pressing burden is period poverty, or limited access to sanitary products, due to a lack of availability and/or affordability or proper hygienic measures and infrastructures.  A study showed that 65% of women and girls in Kenya were unable to afford sanitary pads, and only 32% of rural schools in the country had access to running water near the toilets, hand washing facilities, and soap. Period poverty is also a problem for high-income countries. A recent study conducted in the United States revealed that 64% of the surveyed women were unable to afford sanitary supplies at some point during the previous year, and 46% of the women interviewed had to decide between menstruation hygiene or food. Further, anecdotal information suggests that on average, women spend more than $4000 over a lifetime on sanitary products, not including out-of-pocket costs of health-related issues. 

Moreover, endometriosis is estimated to cost $69.4 billion per year in excess health expenditures in the United States alone. Hence, the economic burden of health-related menstrual issues does not only affect patients and their families, but also the health care system. The economic burden of menstruation and period poverty can result in detrimental health and behavioral practices. The absence of facilities in many countries, coupled with the shame and fear of exposing the menstruation state, exacerbate anxiety and stress during menstruation and result in many adolescents being forced to miss or even drop out of school. It was estimated that in Africa, 1 in 10 girls missed school due to menstruation, and a similar statistic was reported in a recent study conducted by Plan International UK, where 1 in 10 girls aged 14–21 years were forced to stay home from school due to period poverty. Growing evidence suggests that missing school results in a lack of education, which has a long-lasting impact on girls’ economic potentials and empowerment. Indeed, it has been shown that low levels of education can exacerbate girls facing an increased risk of sexual exploitation as well as early marriage and pregnancy. The economic burden of menstruation also causes productivity loss at school or work. In the United States, 13% of the 32748 women interviewed in a cross-national survey reported absenteeism at work, and 80% reported decreased productivity, highlighting the impact of this phenomenon not only on women, but on society as a whole. 

In the light of this, it is not surprising that tackling period poverty, and the consequences  interjecting health- and social-issues, has historically attracted attention with public and private stakeholders seeking to address menstrual hygiene challenges in schools and workplaces with a variety of programsAFRIPads, for instance, is a social enterprise founded by a Canadian couple in 2010 aimed to locally produce and globally distribute Menstrual Kits to provide protection and comfort to girls and women during menstruation. A powerful, although rather new, approach to the problem is the rapid increase in activism against period poverty. In the United States, the menstrual movement Period aims to end period poverty and stigma by advocating for free sanitary products in schools, shelters, and prisons, and eliminating the so-called “tampon tax”. Period was founded in 2014 by two 16-year- old students. To date, it has reached a network of 400 chapters distributed in all 50 states and addressed over 850,000 periods through product distribution. More recently, campaigning against period poverty has resulted in legislative changes. After proposing the Period Products (Free Provision) Bill in 2017, the Scottish parliament member Monica Lennon finally saw it pass through the first of the legislative stages on February 25th, 2020. As a result, at least 1000 women and girls from low-income homes will benefit from free sanitary products. 

Ignoring menstrual health and hygiene is an unacceptable violation of a woman’s right to dignity, non-discrimination, equality, and freedom from violence and abuse.  Addressing menstrual health as a global challenge is therefore of vital importance not only for women, but also for health systems and societies as a whole. Menstrual health and hygiene are indeed interlinked with many of the United Nation Sustainable Development Goals, which provide a shared strategy to ensure inclusive and equitable quality education, achieve gender equality, empower women and girls, and aid available and sustainable management of water and sanitation for all. Without overcoming the challenges linked to menstrual health, none of these can be successfully completed. Therefore, menstrual health and hygiene should become part of a more structured and organized economic agenda that fully supports the health of girls and women worldwide.

Written by sciencepolicyforall

March 27, 2020 at 3:42 pm

Science Policy Around the Web March 19th, 2020

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By Kellsye Fabian, MSc, PhD

Image from Pixabay

Trial of Coronavirus Vaccine Made by Moderna Begins in Seattle 

The National Institute of Allergy and Infectious Diseases (NIAID) announced that the first-in-human clinical trial of an experimental vaccine for COVID-19 began on March 16, 2020. The vaccine is composed of genetic material called mRNA that induces the creation of a stabilized form of the spike protein of the SARS-CoV-2 (also known as coronavirus and 2019-nCoV), which causes COVID-19. Once present in the body, this protein stimulates an immune response to SARS-CoV-2, hopefully resulting in the development of immunity to COVID-19. It was developed by Moderna Inc in collaboration with investigators from the Vaccine Research Center (VRC) at NIAID. The clinical trial is being conducted at Kaiser Permanente Washington Health Research Institute in Seattle, which was chosen before the US had any known coronavirus cases and not because of the outbreak that erupted there. 

The main goal of this Phase I trial is to determine if the vaccine is safe. Three different doses of the vaccine will be tested on healthy adults, with 15 individuals in each group. So far, 4 participants were vaccinated on March 16 and 4 more were planned to be injected on March 17. There will be a pause to monitor the individuals before more people receive the vaccine. How well the participants tolerate the vaccine and whether the vaccine stimulates the immune system to make antibodies that can stop the SARS-CoV-2 from replicating will be assessed. After safety is established, later studies will be conducted to investigate its efficacy.

The Chinese authorities shared the genetic sequence of SARS-CoV-2 on January 11, 2020 and only two days afterwards, the VRC and Moderna finalized the sequence for the vaccine. The first clinical batch of the vaccine was completed on February 7. In February 24, after analytical analyses were performed, the batch was shipped to NIAID for use in clinical trial. On March 4, The Food and Drug Administration gave the go-ahead for the trial to begin. The rapid development of this vaccine was possible due to previous knowledge on related coronaviruses, SARS and MERS, that had caused other outbreaks. However, despite the accelerated progress and even if the vaccine is proven to be safe and effective, it will not be available to at least a year.

(Denise Grady, New York Times

Alcoholics Anonymous vs. Other Approaches: The Evidence Is Now In

A new report from the Cochrane Collaboration that reviewed 27 studies showed that Alcoholics Anonymous (AA) and similar Twelve-Step Facilitation (TSF) programs (AA/TSF) had increased rates and lengths of abstinence when compared with other common methods, such as motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT). The data show that other treatments might result in about 15-25% of people who remain sober, compared to 22-37% of AA participants. AA/TSF also reduced drinking intensity, measured by drinks per day, at the same rate as methods provided by therapists or doctors who don’t rely on AA’s peer connection.

Rigorous studies of programs like AA are always confounded by the question: Do participants do better than nonparticipants because they are more motivated (i.e. self-select) or is it something inherent in the program? Even randomized trials can suffer from bias from self-selection if people assigned to AA don’t attend and if people assigned to the control group do. Despite the challenges, outstanding randomized trials studying AA have been conducted in recent years. 

One study found that subjects randomly assigned to therapist-directed AA/TSF resulted in more AA meetings attended, more active AA participation, and more abstinent days. Other studies also show that increased AA participation is associated with improved alcohol abstinence. Overall, the findings suggest that people already in treatment could get superior outcomes if they also participate in AA. 

In addition to increased abstinence, AA also has the benefit of lower cost. AA meetings are ubiquitous, frequent, and free. Furthermore, several studies found that participation in AA/TSF resulted in decreased psychiatric visits, outpatient visits and inpatient care, which leads to decreased health care cost. According the lead author of the Cochrane review, Dr. John F. Kelly of Harvard School of Medicine and Massachusetts General Hospital, “It’s the closest thing in public health we have to a free lunch.”

Alcohol use disorder and alcoholism are often overlooked public health priority despite the fact that in the US, alcohol causes approximately 88,000 deaths per year, accounts for the majority of all addiction treatment cases, and results in $250 billion in economic lost. The newly released review gives hope that a cost-effective and efficacious method to address this problem has been available for approximately 85 years – Alcoholic Anonymous. 

(Austin Frakt and Aaron E. Carroll, New York Times

Written by sciencepolicyforall

March 19, 2020 at 2:15 pm

School-Based Health Education Works – But Fails to Meet Education Guidelines

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By Kristyn Kamke, PhD

Image by Gerd Altmann from Pixabay

A considerable burden of disease in the United States is attributed to 17 risk factors, including tobacco use, poor diet, alcohol and drug use, limited physical activity, and risky sexual activity. These risk factors represent modifiable health behaviors, highlighting an opportunity to prevent leading causes of disability and death, including cancer, heart disease, and diabetes. Studies show that primary prevention, which refers to intervention prior to the onset of a health problem, not only provides the optimal chance of reducing disease incidence but is also more cost-effective than secondary or tertiary prevention (i.e., intervention at early stages of a health problem or management of an existing health problem to slow or stop progression, respectively). Health risk behaviors typically begin in adolescence, establishing childhood and early adolescence as prime developmental stages to implement primary prevention strategies. Given children and adolescents spend an average 7 hours per day in school on 181 days of the year, school-based health education serves as one of the most common, effective, and opportune methods of primary prevention. Unfortunately, many state- and school-level health education policies and/or implementations fail to meet established guidelines, limiting the overall health impact of school-based health education.

Health education is a theory- and research-based academic subject, which imparts health knowledge onto students, encourages them to develop skills in behavior maintenance and change, and models healthy behavioral norms. The National Health Education Standards advise students in grades 3-12 receive 80 hours of health education per year, amounting to about 27 minutes per day each school year. In 45 states and DC, health education is required every year from elementary school through high school, and health education is either recommended or required for some grade levels in the remaining 5 states. This requirement is based on research showing that establishing and maintaining health behaviors requires time and sustained education and practice to be effective. However, a Centers for Disease Control and Prevention (CDC) report on school health reveals that a median 49% of schools in each state required more than one health education course for grades 6-12 in 2018, suggesting students are receiving inadequate time for learning and practicing health behaviors. 

In addition to insufficient time spent on school-based health education, health education policies and implementation are not adequately comprehensive. According to researchers at Child Trends, only 30 states and DC have comprehensive health education laws (i.e., those that address at least 75% of recommended health education topics). Physical activity topics are most comprehensively covered (69.3%), whereas pregnancy, HIV, and STD prevention are covered at the lowest rate (17.6% for grades 6-8; 42.8% for grades 9-12). Some of the most neglected coverage areas for each health topic are those focused on skill development. Thirty-two states and DC require that health education includes health skills training, such as analyzing the influences of health behavior; accessing valid health information, products, services; goal-setting; decision-making; interpersonal communication; self-management; and advocacy. While educators report teaching these skills in health education, it is unclear to what degree students are able to practice them, a necessary component for establishing healthy behaviors. For example, teachers in only 60% of schools per state reported that students had the opportunity to practice sexual health skills (e.g., communicating with a partner about sex), the only topic area in which skill practice was assessed. 

Perhaps most alarming is the lack of requirements for an evidence basis for school-based health education. While a median 86% of schools provide information on goals, objectives, and expected outcomes of health education for teachers, only about 76% provide written health education curriculum, 65% provide guidance on the sequence of health education, and 67% provide plans to assess student performance. This lack of guidance is exacerbated by the fact that only 3 states require and 8 states recommend health education teachers have a certification in health education, and 15 states advise health educators pursue professional development training, although both certifications in health education and professional development training are associated with better student outcomes. Thus, it is unclear what education students are getting and if that education results in increased implementation of healthy behaviors. 

Implementation of health education without a supporting evidence-based foundation risks more than just failure to improve health outcomes — it can also make health worse. A notable example of this is the substance abuse prevention program D.A.R.E., widely implemented across the United States with little research backing. Subsequent evaluations of D.A.R.E. suggested that D.A.R.E., at best, had no effect on drug use behavior and, at worst, actually increased drug use, disproving the proverb that something is better than nothing. Unfortunately, the ability to implement evidence-based health education is limited by the dearth of evidence-based, comprehensive health education programs. Most extensively evaluated and efficacious health education programs target a specific health topic (e.g., tobacco use), with only 3 commercially available programs that cover multiple topics. Even if schools were financially able to acquire multiple health education curricula targeting individual health topics, difficult for schools who lack funds for health education, evidence would still be needed to support the sequence in which health education topics should be covered and whether multiple curricula can be effectively combined. Furthermore, comprehensive health education interventions are more efficient than those covering individual topics, given many health-related skills can be translated across health domains. This highlights an area in which researchers must intervene, to both aid in development and evaluation of comprehensive health education interventions. 

Schools are optimally positioned to engage in primary prevention of key health risk behaviors in the US through provision of health education to students. While states have embraced the necessity of health education, often recommending or requiring it, implementation of health education in schools has failed to meet many established guidelines, of which just a few are presented here. Discrepancies between state policy and school-based health education policy and implementation may be attributable to several factors, such as perceived lack of time for health education in already busy schools attempting to meet federal academic standards, lack of oversight from states to evaluate implementation of health education, unclear guidelines for educators responsible for delivering health education, or lack of funds to acquire evidence-based health education programs. Regardless of reason, traditional academic subjects, such as science or math, are prioritized above health education, which threatens the health of children and adolescents. However, academic achievement-focused goals should not preclude efforts to establish rigorous health education guidelines. In fact, academic achievement is bolstered by student health. The time has come to support health education as a vital element of education, providing students with the opportunity to live longer, more productive and healthier lives.

Written by sciencepolicyforall

March 6, 2020 at 3:54 pm

Maternal Mortality on the Rise in the United States

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By Kathleen Huntzicker, ScB

Image by Sasin Tipchai from Pixabay

Despite leading the world in healthcare spending, the United States has the highest maternal mortality rate of any developed country. According to the Centers for Disease Control and Prevention (CDC), about two women die every day in the United States due to complications with a pregnancy or a delivery. The United States also holds the unfortunate distinction of being one of the only countries in the world with a rising maternal mortality rate – while most other countries have improved maternal health over time, the death rate of pregnant or recently-delivered women in the United States has doubled since 1987. Growing activism has helped to raise awareness of these sobering statistics; however, the United States has yet to meaningfully curtail its rising number of deaths.

The CDC defines a pregnancy-related death as “the death of a woman while pregnant or within one year of the end of a pregnancy – from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” Although the United States has done little to decrease the occurrence of these deaths over the past four decades, it has managed to successfully track pregnancy-related deaths for over 100 years. Since 1915, the National Vital Statistics System has published mortality rates for each state using data collected from death certificates. While these numbers help to illustrate gross trends over time, they can only provide limited insight into the factors that might drive changes in mortality rate. Additionally, societal perceptions of what constitutes an “accidental” death have changed markedly since 1915. Just decades ago, a suicide following a pregnancy might have been considered an accident, whereas doctors today recognize that the mental health of a woman is not independent of her pregnancy status. To provide more detailed and standardized data sets, state and local governments began forming Maternal Mortality Review Committees (MMRCs) with the goal of developing novel strategies to combat peri- and post-partum maternal death. In 1968, there were only six states without an active MMRC, but by 1990, many states had dismantled their committees over liability concerns. Upon the recommendation of the CDC, the United States then pioneered the Pregnancy Mortality Surveillance System in 1986 to collect death certificates and other related health information from all fifty states. This system was instituted in the hopes that a comprehensive study of all maternal deaths might fill in gaps in the current understanding of maternal mortality, allowing both lawmakers and medical professionals to better focus on the most vulnerable populations of women and to determine what types of community interventions might be most successful.

These monitoring systems have revealed that every woman does not experience the same odds of suffering a pregnancy-related death. In fact, the mortality rate for non-Hispanic black and non-Hispanic American Indian or Alaskan Native women is more than double that of non-Hispanic white women, with the disparity only increasing in older age groups. Additionally, nationwide data indicate that women who receive no prenatal care are up to four times as likely to suffer a pregnancy-related death than women who do attend prenatal doctor visits prior to delivery. Women without any prenatal care represent fewer than 5% of non-Hispanic white women in the United States, but as many as 10% of non-Hispanic black women and 13% of non-Hispanic American Indian or Alaskan Native women. A study out of Mount Sinai School of Medicine found that maternal deaths were not consistent across hospitals, either, and that hospitals mainly serving minority women were more likely to experience a pregnancy-related death, even after controlling for the race of the patient. This finding suggests that the racial disparities could depend not only on access to health care, but also inconsistencies in how pregnant women are treated from hospital to hospital.

One glaring example of such a medical inconsistency is the rate of cesarean sections across medical centers. While many pregnant women assume that their doctor’s decision to perform a c-section is dependent only on the health of the mother and child, collected statistics appear to suggest otherwise. Rates of c-section by hospital vary drastically: a team from the University of Minnesota found that nationwide, rates for individual hospitals ranged as low as 7% and as high as 70%. Even when treating women with low-risk pregnancies, some hospitals were more than fifteen times as likely to perform a c-section than others. These statistics are especially worrying given that c-sections have been linked to severe complications in delivery, including hemorrhage, emergency hysterectomy, infection, and cardiac arrest. In fact, a Canadian study found that women undergoing a planned c-section are up to three times more likely to experience severe complications than women who delivered vaginally. In the United States, almost one-third of babies are delivered via c-section, a rate six times higher than it was 50 years ago, and about 1.5 times higher than the global average. With c-section rates continuing to increase, it might be reasonably expected that the rates of maternal morbidity and mortality could rise as well.

Though the statistics may seem grim, some policy measures appear to hold promise for improving future outcomes. The California Maternal Quality Care Collaborative (CMQCC) succeeded in cutting its state’s maternal mortality rate in half, largely due to the addition of emergency delivery toolkits in over 200 hospitalsacross the state. The collaborative team targeted the two most preventable causes of maternal death – hemorrhages and hypertension – by designing best-practice protocols for peripartum emergencies and training hospital teams to carry them out. The CMQCC recommends that every maternity ward feature a cart with all the necessary equipment to treat an emergency hemorrhage, including sponges, clamps, and a Rusch balloon to staunch heavy uterine bleeding. Similar toolkits have now been implemented across 18 states, with much success. However, even in California, which now boasts the lowest maternal mortality rate in the country at four deaths per 100,000 women, racial and economic disparities remain, indicating that simply adding a hemorrhage cart to all hospitals cannot be the only answer to the rising maternal mortality rates in the United States.

It remains clear that the federal government, as well as state and local governments, must do more to address the alarming rate of maternal death in the United States. Importantly, black women, American Indian or Alaskan Native women, and women in high poverty areas are at least twice as likely to die as a result of pregnancy or childbirth. Therefore, it is imperative that any policy solution adequately address the vastly different standards of care that are received by American women dependent on their race, chosen hospital, or state of residence. With governmental access to increasingly larger data sets and growing public and political awareness of the issue, we can hope that the maternal mortality rate in the United States will decline in the coming years. Even so, the state of maternal health in the country is a sobering reminder of the stark health disparities that exist between races, neighborhoods, hospitals, and income levels – and, particularly in the case of maternal mortality rate, the unique health risks and dangers experienced by American women.

Written by sciencepolicyforall

February 22, 2020 at 8:50 am

The Challenge of Global Health Diplomacy

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By: Somayeh Hooshmand, PhD

Image by Jukka Niittymaa from Pixabay

Improving population health is the central concern for all human societies. In the past, it was enough for a nation to take action on their own to improve the health of their citizens. In today’s globalized world, there aren’t any borders or walls for a wide range of health issues. Migration and mobility of people within and between countries around the world, the high volume of trade, the flow of information and the flow of capital across geographic boundaries can spread diseases (such as polio, anthrax, HIV/AIDS, SARS, pandemic flu) and threats of bioterrorism quickly, thereby affecting many countries simultaneously. Consequently, many health issues cross national borders and cannot be resolved by any one country acting alone and other nations cannot pull away from action. It requires a wide array of activities between nations as well as collaboration between many sectors (both governmental and nongovernmental) and better communication among nations to strengthen economic growth, national security, human dignity and human rights, human security, social development as well as environment. 

Global health is focused on achieving improvements in the health and well-being of all people worldwide, and involves many disciplines both within and beyond the health sciences. In today’s world, heath is tied up with foreign policy and policy makers often need familiarity with the different policies and ongoing international political diplomacy and negotiations to address crises. To this end, the Oslo Ministerial Declaration was drafted in 2007, by seven foreign ministers including Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand, to promote and discuss the importance of integrating health issues into foreign policy. In the declaration, it is clearly stated that “We believe that health is one of the most important, yet still broadly neglected, long-term foreign policy issues of our time…We believe that health as a foreign policy issue needs a stronger strategic focus on the international agenda. We have therefore agreed to make ‘impact on health’ a point of departure and a defining lens that each of our countries will use to examine key elements of foreign policy and development strategies, and to engage in a dialogue on how to deal with policy options from this perspective.”

In the 21st Century, health has become increasingly relevant to foreign policysecurity policy, development strategies. As each nation has its own constitutional, political and financial differences according to their own standards and circumstances, it has become clear that new skills are needed to conduct global health diplomacy and negotiations in the face of other interests. 

The direct or indirect effect of economic, socio-cultural, and political factors on health requires more diplomats to enter the health arena to interact with the non-governmental organizations and non-state actors, scientists, and activist groups. On the other hand, public health experts need to be trained and have the practice and experience of diplomacy. Both public health experts and diplomats need to interact more productively to create effective outcomes throughout global health negotiations to solve global problems. Global health diplomacy (GHD) aims to promote international cooperation in solving health problems. It can be defined in a number of ways, though overall it is defined as “multi–level, multi–actor negotiation processes that shape and manage the global policy environment for health”.  Global health diplomacy is of considerable importance not only in the discipline of foreign policy but also within other disciplines such as international law, politics, economics and management. However, the challenges in diplomatic negotiations and foreign policy which support global health goals are vast and diverse and are greatly in need of effective leadership and collective action.

One of the challenges in global health diplomacy is the lack of a shared goal and differing political priorities between nations in deciding which health issues should be included explicitly in national foreign policy. Countries attempt to link health issues to foreign policy and national security threats in order to receive significant political support and funding. International resources are generally limited and new funding and development assistance for health is difficult to obtain. Policy makers need to be educated in identifying a particular health issue as a national or international priority and determining its importance relative to other public health issues in order to avoid drawing resources away from health issues of global importance.

However, some health issues – particularly infectious diseases like poliomyelitis – are widely considered as global concerns and inserted into foreign policy issues for countries, but they are not a national security threat. Although addressing these issues is not rooted in a concern for their economic or security impact, they require sustained support and resources to achieve a global good.

Another challenge facing health diplomacy is while the health sector wants to focus its attention more on improving the conditions that allow people to be healthier, foreign policy places importance on national security and economic growth as its top priorities. The health sector must balance the fact that while health is their central goal, it is often not the central goal of foreign policy and can have a negative impact on foreign policy. Therefore, they can sustain engagement and trust among each other by finding mutual benefit in the context of global health goals. 

Although, several governments have placed health issues more prominently in foreign policy decision-making over the past decade, some non-democratic nations have placed little significance in incorporating health issues into their foreign-policy agendas. 

Global health diplomacy plays an important role in advancing human security and ensuring human rights and dignity by linking health and international relations. Human security is concerned with human freedoms and human fulfillment. However, some human security issues have remained a major source of human security violations in undemocratic regimes, like mass atrocities, human trafficking, torture and genocide, war, bioterrorism, environmental degradation, and public health crises. One of today’s global health diplomacy challenges on human security arises from the fundamental values differences in the political character of democratic and nondemocratic countries in negotiations. Some of the key values of democratic governments – like transparency and freedom, pursuit of happiness, justice, and equality – would naturally lead to an increase in human security. These core values differ extremely from the values of authoritarian governments which are based on compliance, coercion and propaganda. Therefore, these two regime types have very little in common and health diplomacy cannot lead to lasting agreement and peace in addressing human security problems. In global health, promoting democracy could improve population health and can contributed to a significant power shift within global health diplomacy.

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Science Policy Around the Web January 9th, 2020

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By Silvia Preite, PhD

Image by kalhh from Pixabay 

New administration strategy revitalizes century-old Tuberculosis vaccine (BCG)

 Tuberculosis (TB) is a disease caused by the airborne bacteria Mycobacterium tuberculosis. TB is one of the deadliest human infections, especially in poor and developing countries, leading to 1.7 million deaths and 10 million new cases each year. The only available licensed vaccine against TB is the Bacillus Calmette-Guérin (BCG), a live attenuated strain of the related pathogen Mycobacterium bovis. Significant efforts have resulted in the administration of this century-old vaccine to more than one billion people worldwide. BCG is administered intradermally (i.d.) and is mainly effective against disseminated TB in children. However, its efficacy in preventing the transmissible pulmonary form in adults is limited, especially in countries where the infection is endemic. Therefore, developing a more effective vaccine is a high-priority effort to curb the spread of this infectious disease. 

 In a recent paper published in Nature, Darrah et al. compared the traditional i.d. administration route to several alternatives including, aerosol inhalation and intravenous (i.v.) injection in non-human primates. Six months after vaccination, Darrah et al. infected the animals with M. tuberculosis and followed the disease progression. The results were quite striking: the authors found only modest protection through i.d. and aerosol administration, in contrast, i.v. administration led to almost complete protection from the disease. Immunological mechanisms behind this extraordinary results remain to be entirely determined. However, a greater influx of adaptive immune cells called T lymphocytes in the lung upon i.v. administration could contribute to this major vaccine efficacy. 

 This study opens new possibilities for future BCG vaccination strategies and more effective TB prevention. Notably, i.v. administration is not a preferred administration strategy in developing countries because it requires expert medical personal and continuous refrigeration. Nevertheless, this publication sheds new light on a tried-and-tested vaccine, opening up new exciting possibilities to improve TB vaccination efforts. Moreover, this work could further drive investigations into the immunological mechanisms behind these events.

(Source: P. A. Darrah et al. Nature 577, 95–102; 2020)

Written by sciencepolicyforall

January 9, 2020 at 3:18 pm

Science Policy Around the Web December 17th, 2019

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By Mary Weston, PhD

Source: Wikimedia

E-cigarettes linked to lung problems, first long-term study on vaping finds

The first study evaluating long-term health effects of electronic cigarettes (e-cigarettes) has found that vaping increases the risk of developing a chronic lung disease. 

Researchers tracked the smoking habits and health of over 32000 U.S. adults who, at the beginning of the study, showed no signs of lung disease. After monitoring for only three years (2013-2016), they found that those who used e-cigarettes were more likely to develop a chronic lung disease compared to non-users. These respiratory diseases include asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). 

Adults who smoke combustible cigarettes had a higher chance of developing lung diseases compared to e-cigarettes, but many adults tend to use both forms of tobacco, an activity which compounds disease threat. “The risks of e-cigarettes and cigarettes are independent of each other, and so if you’re a dual user — meaning you’re smoking and using e-cigarettes at the same time — you have the risks of smoking multiplied by the risks of e-cigarette use,” said one of the study’s authors Stanton Glantz

Specifically, the odds of an e-cigarette user acquiring a respiratory disease increased by a factor of 1.3, combustible smokers saw an increase in 1.6, and dual users were 3.3 times more likely to develop a disease.  

In this study, the surveyed participants self-reported their habits and health conditions, which may lead to recall bias and could have influenced the researchers’ results/conclusions. However, this paper contributes to increasing evidence that vaping can cause physical harm, including lung tissue chemical burns and clogs from the carrier oil vitamin E acetate. Further, this research did not include a separate form of vaping-related illnesses, EVALI (e-cigarette or vaping associated lung injury), an outbreak that is still not completely understood, but has affected more than 2400 people and caused 52 deaths as reported by the CDC

(Ericka Edwards, NBC News)

Written by sciencepolicyforall

December 17, 2019 at 9:49 am

The Emerging Policy and Public Health Crisis at the U.S.-Mexico Border

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By Emma Kurnat-Thomas, PhD, MS, RN

A photo released by the DHS Office of Inspector General on May 30, 2019 shows migrants waiting for immigration processing at a crowded Customs and Border Protection detention center in El Paso, TX

One of the agencies comprising the U.S. Department of Homeland Security, Customs and Border Protection (CBP), is the largest federal law enforcement organization in the U.S. and is tasked with securing the county’s border. CBP employs 45,600 federal agents/officers and enforces U.S. trade, customs and immigration regulations. There are 328 ports of entry (airports, seaports, and land checkpoints) and an additional 14 pre-clearance locations around the world. Hired officers and agents must meet stringent application and performance requirements, and depending on their role and assignment, must execute arduous tasks and obligations that are both physically demanding and dangerous as they protect the U.S. from terrorism. 

Foreign conflicts, trade arrangements, immigration policy, and U.S. Presidential priorities and executive orders drives what CBP encounters at our borders. Unfolding over the past 12-24 months, an immigration crisis is emerging at the U.S.-Mexico border that carries significant health policy and scientific policy ramifications. Beginning in January 2017, U.S. Administration officials aimed to set a strong deterrent against illegal immigration and human trafficking. This included a “zero tolerance” policy targeting illegal border crossings that separated thousands of children from their parents and reclassified them as “Unaccompanied Alien Children”, (UAC’s). UAC are individuals <18 years old who lacks lawful immigration status and are without a U.S. parent or legal guardian. UACs who are received at ports of entry at the Southwest border are examined and processed in accordance with the terms of applicable laws (Trafficking Victims Protection Reauthorization Act of 2008, P.L. 110-457; the Homeland Security Act of 2002, P.L 107-296; and the Flores Settlement Agreement of 1997). CBP apprehends and detains UACs, arranges for transfer to temporary custodial care provided by the Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR), until the U.S. government (Immigration and Customs and Enforcement) can arrange for repatriation or removal. As part of this process, DHS and ORR implemented a biometric and biographic information-sharing agreement

Health Policy Implications: Sanitation, Health and Communicable Diseases 

Aggressive immigration enforcement at the Southwest border has resulted in additional space, services, funding, agency personnel, equipment and infrastructure requirements to support the increasing numbers of children and families detained at CBP facilities and UACs transferred to DHHS ORR (Vought Office of Management and Budget Letter to Vice President Pence, 2019). A number of news outlets regularly cite deteriorating health and humanitarian conditions at strategic CBP stations, such as El Paso, TX. Several DHS Inspector General investigations in May and June 2019 found evidence of detainees and child migrants exposed to severe overcrowding, prolonged detention beyond that permitted by law, improper food, laundry, hygiene, water, and that conditions could be classified as ‘squalid’. Further, they cited an immediate risk to the health and safety of DHS agents and officers that were tasked with executing these policies. Extended migrant and child migrant detention in overcrowded and squalid conditions has resulted in unintended public health consequences including the spread of communicable diseases, such as influenza. Immigrants and migrant detainees are physically and psychologically vulnerable to infectious diseases, particularly if they are travelling from areas with inadequate nutrition, insecurity, and dangerous living conditions. Influenza in particular has taken a severe toll, resulting in the deaths of several children (diagnosed on autopsy report), and sickening hundreds of detainees and CBP officers and agents. To address these ongoing issues, the Centers for Disease Control (CDC) recently visited the El Paso, TX facility and made recommendations to assist CBP and DHS. Specifically: “to prioritize screening and isolation of ill migrants, early antiviral treatment, and flu vaccinations for all staff”, and provision of flu vaccines “at the earliest feasible point of entry for all persons at least six months of age”, but particularly for pregnant women and children. However, there are components of these recommendations CBP leadership has elected not to follow due to resource and logistics limitations.    

Science Policy: Genetic Testing and Confidentiality  

On October 2, 2019, the DHS announced a plan to obtain DNA profiles for all immigrant detainees and place them in the Federal Bureau of Investigations database used for criminal forensics, the Combined Index Data System (CODIS). Bioethicists and legal scholars have criticized the plan because it wrongfully targets one of the most vulnerable populations. Migrants fleeing political violence, criminal oppression, and civil wars are at risk of not having sufficient material or educational means to fully understand privacy and discrimination implications of this policy. CODIS uses Short Tandem Repeats (STRs)—short repeating DNA segments of the noncoding portions of the genome. Approximately 20 STR makers are used to establish an individual’s DNA profile in CODIS. A 2017 study in PNAS using two data sets for 872 people (one with 642,563 genome-wide Single Nucleotide Polymorphisms and one with 13 STRs used in forensic applications) found 90-98%  accuracy can be obtained when connecting forensic STR records to SNP records (in either direction), suggesting privacy risks. These potential risks would extend to individuals, and their families who may or may not be legal citizens of the U.S., if genetic profile data from CODIS were to be combined with health research or ancestry databases. And as CODIS increases use of STR marker loci number—accuracy and ease of making these linkages also increases. There is concern among scientists of scope creep. Collecting migrant samples and information for a defined purpose now, may in the future expand to further use of detainee samples and genetic information in unanticipated ways without their informed consent

If It’s Foreign Policy and Executive Decision-Making–What Can Scientists Do?  

Often news and medical research articles present understandingly shocking pictures and dramatic aspects of this debate without suggesting what can be done about it. As scientists, we can all use our voices within our various specialties to promote the dignity and welfare of those needing the most help in whatever occupational role, standing, that we carry the authority to use (i.e. infectious disease, genetic testing and confidentiality, nutrition and sanitation, ethical legal social implications, social science and integrity of childhood development, the protection of children and families, or the health and welfare of the police officers/CBP agents exposed to harsh conditions and witnessing these traumatic events). There seems to be a need for clarity and data around the impacts these policies beyond ‘how many apprehended immigrant detentions in FY 2016 vs FY 2019’. For example, how can we use the science we do have to make solid policy decisions to support our nation’s health in trying circumstances—and by providing compassionate health care to detained unassisted child minors, ensuring privacy and confidentiality of migrants and their families. What types of science do we need to understand more about what is going on—particularly in terms of communicable disease outbreaks, transmissions, and genetic privacy and confidentiality.  

We can use our voices within our respective professional circles of influence and we can express our concern in written letters to our elected government officials. We can volunteer or donate funds as permitted within our Hatch-Act restriction requirements. While we can’t solve the immigration crisis, we can do our part as scientists to support the health of the least—which impacts the prosperity of our whole. 

This Christmas season, I wanted to use my nursing scientist voice for children, families, and others impacted by these events. This blog post represents my “policy” part in not remaining silent despite the onslaught of worrisome Southwest-border health and science policy news headlines. It’s our duty to help spread hope for those impacted by such tragic circumstances when there seems to be a lack of it—especially at Christmas—so I encourage others to do the same!  

Written by sciencepolicyforall

December 3, 2019 at 4:19 pm