There were some new approaches to tackling old diseases at the World Health Assembly this week, which was dominated by efforts to escalate progress towards universal health coverage and worries about the growing impact of climate change.
Efforts to deal with the ancient scourge of snakebite received a boost with the publication of a new strategy and indications of fresh funding after a long period of neglect and declining production of antivenoms.
A new vaccine for Ebola has helped limit the spread of the latest outbreak beyond the war-torn eastern part of the Democratic Republic of Congo, although there are concerns about funding, instability and attacks on health workers seeking to tackle the infection.
Affordability also came under scrutiny, with calls for greater transparency in drug pricing.
The most striking plea for free, high-quality care at the point of need came from Richard Horton, the editor-in-chief of The Lancet, who, in his defence of the UK’s National Health Service as a model for universal health coverage, revealed he had just been treated for metastatic cancer: “There is no beauty in disease. But there is inspiration to be found in health.”
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Matshidiso Moeti, regional director for Africa for the World Health Organization
What are your top priorities?
My work involves supporting 47 sub-Saharan countries to improve health. The concerns of African leaders are progressing towards universal health coverage, action to improve services for people, and the financing of health. We’ve seen some progress in the domestic allocation of funds but it’s not yet near where it needs to be. Our region is lagging behind on healthcare workers. We need capacity to tackle disease outbreaks and at the same time the evolving problem with chronic non-communicable disease.
Why has the WHO not declared a public health emergency for Ebola in DRC?
The director-general convened our emergency committee, which took into account the efforts to work with neighbouring countries and improve their preparedness. The decision needs to be constantly reviewed. But we need to be fair about how we communicate the risk. The committee would like to avoid isolation in a way that might impede the response. We need access and openness to ensure supplies into the country can continue as needed. It is an area of insecurity and protracted political instability so I imagine anything seen to be stigmatising might exacerbate the hostility and put those involved further at risk.
Have you tackled criticisms of management in WHO-Afro?
Some of this perception is history: assumptions about the way people are recruited. I think the idea that a politician was plucked out and appointed as a WHO representative has already been gone for quite a while. There have been mechanisms put in place which have shifted things quite significantly. Since I’ve been in post, we have further improved the process of appointments, including for senior technical positions. We advertise all positions, even that of my office director, so the best person is selected. We have reinforced our human resources team, and on selection teams use people who are very familiar with the work.
Access to medicine The pharma industry is making progress in improving the availability of drugs in developing countries, according to an independent assessment. Priority diseases are receiving more R&D spending and there are more drugs in the pipeline. Initiatives to help patients obtain treatment in poorer countries are also increasing. (FT/Access to Medicine Foundation)
Malaria milestones Argentina and Algeria — where the parasite was discovered in 1880 — were declared “malaria-free”, defined as experiencing at least three consecutive years with no indigenous cases. A new vaccine could have significant consequences. (WHO, BBC)
Ebola crisis deepens The Ebola outbreak in the Democratic Republic of Congo worsening amid attacks on treatment centres and mistrust of international experts. The WHO declared the virus “public enemy number one” and appointed a new Ebola chief, although it is yet to declare a global health emergency. (NYT, Reuters, Devex)
Abortion arguments The US abortion debate intensified after President Trump appeared to throw his weight behind the antiabortionists. The UN weighed in, while the FT warned that new laws would bring social strife. Google said it would block misleading ads for anti-abortion groups. The debate is raising questions about early pregnancy and miscarriage. (Reuters, FT, Guardian, NYT)
No smoke without ire Brazil is suing British American Tobacco and Philip Morris International, the two biggest cigarette companies, to recover health treatment costs of tobacco-related diseases. Social media companies came under fire for allowing “influencers” to promote smokeless products such as PMI's IQOS device. (Reuters, Bloomberg)
Drug industry funding Patient organisations — especially in the UK — are increasingly involved in drug and policy research but funding by industry risks turning them into seemingly independent third parties that can promote new medicines irrespective of problematic clinical profiles or costs. The top five funders are Pfizer, Takeda, Novartis, AbbVie, and Lilly. (BMJ)
'Decolonising' global health Some activists argue the legacy of colonialism is still apparent across global health, prioritising unfettered access to the markets of poorer countries, even as big business — in processed foods for example — contributes towards ill health in those countries. (Devex)
The superbug shuffle Public health messaging need not be boring. Here's a Ghanaian dance troupe encouraging people not to buy antibiotics without prescription and inadvertently add to antimicrobial resistance. (Wellcome Trust)
Anti-vaxxers attacked Anti-vaccination campaigns are not the only reason some children fail to get their shots: poverty and inadequate access to healthcare also play their part. The US health secretary blasted the anti-vaxxers; health experts were told vaccine hesitancy should be fought like a “contagious disease;” and some in the UK called for child vaccinations to become compulsory. (NPR, HHS, BMJ)
Mental health watch Actor David Harewood tells the story of his breakdown to help others understand what it is like to experience psychosis, an illness whose geographical spread is puzzling scientists. Former journalist and UK government communications chief Alastair Campbell discusses his depression and some radical new treatments. (BBC iPlayer, The Conversation)
UK science boost British medical research got a £1bn windfall after LifeArc, a charity that helps move discoveries from the lab to patients, sold its royalty interest in the blockbuster cancer drug Keytruda. Another fillip came from Manchester, the city fast becoming a world leader in gene medicine, when a German diagnostic company said it was setting up a biomarker discovery business with the city’s university. (FT, Quiagen)
Food for thought The UK's Food Standards Agency, which estimates that about 10 people die a year from reactions to the 14 main EU-defined allergens, has come out in favour of new labelling rules for a product’s ingredients. Investment is soaring in plant-based foods. (FT)
Dementia awareness The WHO issued new guidelines to minimise the risk of dementia. A local authority in Japan is providing sufferers with a QR code (similar to a bar code) on a badge so they can be tracked if they go missing. Dementia Awareness Week initiatives included volunteering in restaurants and a book helping children understand the disease’s effect on elderly relatives. (BBC, Healthline, Alzheimer's UK, BRE)
Best from the journals
Suffering is soaring The number of terminally-ill people needing palliative care is set to double by 2060 to 48m a year, putting a serious burden on health services, especially in poorer countries. Cancer and dementia are two of the greatest drivers. Estimates say just 14 per cent of those who need palliative care receive it and most of these are in richer countries. (Lancet Global Health)
Health financing Governments need to prioritise health spending in their budgets, particularly in those countries that will soon become ineligible for help from the big international funders. The yearly cost of implementing universal health coverage has been estimated at $100 per head, or $50 for a basic package of high priority interventions. (BMJ)
Migrant health The world’s estimated 150m migrant workers are at high risk of work-related injury and illness, according to a study that illustrates for the first time the precarious and often dangerous nature of their working lives. Migrant workers are more likely to be employed in low-wage and unsafe jobs and to experience a range of physical and psychological problems, made worse by their limited access to health services. (The Lancet)
Mapping HIV The most detailed maps so far of HIV in sub-Saharan Africa — even down to village level — allow much more efficient targeting of healthcare resources. The region is home to 71 per cent of people living with HIV. (Nature)
Timeline of human health A new study for the first time identifies the 50 most common health problems for each decade of life and the average age at which they are diagnosed. This podcast explains its significance. (The Lancet Digital Health, Lancet audio 14 mins)
Low birth weight Global targets to reduce low birth weight among children — defined as below 2500g — look likely to be missed. The measure is an important indicator for short-and long-term health. (The Lancet Global Health)
Big Data and health As the role of “Big Data” in healthcare intensifies, there are lessons to be learned from the intelligence world in how software is written and data are managed. Is artificial intelligence in health being overhyped when the most urgent problem is not a lack of data but changing behaviour in patients and clinicians? See also an interesting Twitter chat at #NHSAutomation. (NEJM, Jama, BMJ)
Diet and obesity One factor common among various strands of dietary advice it to avoid “ultra-processed” foods. This study shows their links with obesity. (Cell Validator)
Podcast of the week
Choked Journalist Beth Gardiner travelled the world documenting the menace of air pollution and the effectiveness of policies to combat the menace that kills some seven million people a year. (Global Dispatches, 28 mins)
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Nature nurtures Some ammunition for those parents struggling to prise kids from their bedrooms: A new study suggests exposure to nature as a child is associated with greater mental wellbeing in later life. (Environmental Research and Public Health)
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