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From Moscow and New Delhi to Johannesburg, there has been growing political commitment to tackling tuberculosis in recent months, ahead of World TB Day on Saturday. This September, the UN General Assembly is set to escalate the debate with heads of state around the world.
The momentum is essential: TB is the world’s most lethal infectious disease, with an estimated 28,500 new cases and 4,600 deaths every day. In countries suffering economic difficulties, the epidemic is re-emerging. A case in point is Venezuela, as a result of poverty, poor nutrition and overcrowding.
Even in far richer regions, much more needs to be done. Fresh data from the European Centre for Disease Prevention and Control showed a modest overall decline in cases across Europe being offset by a rise in extreme multi-drug resistant TB.
Last July, G20 leaders in Hamburg stepped up pledges to tackle anti-microbial resistance, both a significant cause and consequence of TB treatment difficulties. In November in Moscow, President Vladimir Putin hosted the first Global Ministerial Conference on Ending TB. This month, Narendra Modi pledged to end the disease in India by 2025.
The backdrop is a desperate need for further scientific research into new drugs and diagnostics, and leadership to improve prevention, detection and treatment. The question is how far the leaders will follow up their bold words with actions, not least for more domestic funding.
What is distinctive about the SAMRC?
We are probably the biggest local funder of medical research in Africa. There are very few governments which spend their own money for research. Our job is to change the lives of South Africans with health-related research that focuses on the [UN’s] Sustainable Development Goals. We try to do work that would be hard in a university setting. We focus on the 10 most common causes of mortality, from basic discovery to translational research, health policy and regulation.
What have been the most important projects you have funded?
We alerted the government to the interlocking epidemics of communicable and non-communicable disease, maternal and child mortality and injuries. We have made huge investments in TB on clinical research to reduce treatment duration, address drug resistance, develop point-of-care diagnostics and understand immunological clusters. We are leaders in gender-based violence, and looking at HIV risk. We are developing interventions for maternal and child health, including Doppler [ultrasound] to explore blood flow in the placenta and avoid still birth. We are trying to find ways of diagnosing diabetes early and are working on TB and HIV vaccines.
What is the project you are most excited about?
My legacy project is the African Genomics Centre, built in collaboration with the Beijing Genomics Institute, which should open in Cape Town in May. We will be responsible for the first whole-genome sequencing platform on African soil. Normally we send out samples to other countries. By bringing whole-genome sequencing into South Africa, we have the capability to develop bioinformatics and big data capacity. It will open up a whole field of science.
US drug prices The tragic case of a Texas teacher who died after balking at the high price of her flu medicine threw the spotlight again on US drug prices. FT analysis of confidential and public data found she should have paid much less for her medication.
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Water worries Around 844m people have problems accessing water. Competition with agriculture and industry, political conflict and displacement all fuel the problem. Some 842,000 people die each year from diarrhoea because of unsafe drinking water, sanitation, and hand hygiene. (Water Aid, WHO)
Ebola funding gap Less than a third of the $4.5bn pledged by donors to support countries hit by Ebola has materialised. The US, the World Bank and African Development Bank were among donors that promised money for Guinea, Liberia and Sierra Leone. A study assesses the mental health impact of the outbreak in Sierra Leone. (WSJ, BMJ)
Abortion disparities Although abortion rates have dropped overall over the past 25 years, poorer countries have seen little change. The Trump administration is facing heavy criticism over its inclination to cut back support for maternal health at home and abroad. (Gutmacher Institute, Project Syndicate)
New CDC chief Robert Redfield, an Aids researcher, is the new head of the Centers for Disease Control and Prevention, the leading US public health agency, replacing Brenda Fitzgerald who left after revelations involving tobacco shares. Critics point to his inexperience in public health and his history of controversial positions on HIV/Aids. (Science)
Good news on Guinea worm South Sudan, the world's newest nation, has stopped transmission of Guinea worm in an important victory for global health. It is on course to be just the second human disease — after smallpox — to be eradicated. (Carter Center)
Opioid supply and demand Tasmanian poppy farmers grow almost half the world’s supply of raw material for opioid painkillers but have been hit hard as countries try to cut back on prescriptions. As the US firmed up plans to execute drug dealers, a report showed opioids were the top prescribed drug in 11 states. (FT, Vox, Kaiser Health News)
Challenge from China Pharma companies are stepping up their push into the US generics market. The FDA approved 38 Chinese versions of drugs last year, up from 22 the previous year, although the total is still a long way behind India, the world's largest exporter of generics. (FT)
Tech titans' march on health The extent of tech companies' ambitions for health is reflected in the more than 300 patents filed over the past few years by Alphabet/Google, Microsoft and Apple. A report examines the changing landscape for life sciences companies as healthcare and technology merge to become “health technology.” (Forbes, Ernst & Young)
Brexit blast MPs said regulatory alignment with the European Medicines Agency must continue after Brexit to avoid disruption to the supply chain, from research and development through to drugs being available in pharmacies. (BMJ, Houses of Parliament)
Future of the NHS An LSE/Lancet Commission on the NHS will examine funding, staffing, health inequalities and access to care. Alzheimer's breakthroughs could cost the service £9bn a year. The pay cap for NHS workers — in place since 2010 — was lifted. (The Lancet, FT)
Gaming a pandemic In what it said was the biggest experiment of its kind, the BBC constructed a virtual flu pandemic across the UK using a smartphone app and GPS data to assess how it would spread and how many people it would kill. Watch on BBC iPlayer.
Best from the Journals
Funding shortfalls Development finance for neglected diseases treatments — apart from one-off crises such as Ebola — has been dropping since 2009. New approaches are needed to mobilise funding from countries, donors and the private sector. (BMJ)
India's forgotten elderly One in five Indians will be 60 or older by 2050 but structures such as pensions and health insurance are rare. “If you are old, you should die, is the mindset of many people in India,” explains one doctor. (BMJ)
Obesity: illness of the poor A 60-year study of UK children's weight shows how obesity has replaced low weight as an indicator of poverty. The new head of the Royal College of Paediatrics and Child Health said a US trade deal and an influx of sweet and fatty American foods could scupper the UK's anti-obesity drive. (The Lancet Public Health, Guardian)
Preventing child deaths Deaths among children in Europe aged 5-14 have dropped considerably since 1990, but there are marked differences in levels and causes between countries. More needs to be done to combat causes that are highly preventable, such as road injuries, drowning and lower respiratory infections. (The Lancet)
Ocular opportunity A patch developed from stem cells has been used to treat age-related macular degeneration at London's Moorfields Hospital. The condition accounts for almost half of all visual impairment in the developed world. (Nature)
Genetics and ethics The science of gene editing is fast outstripping debate around its implications. A single co-ordinating body — such as the UK's Nuffield Council on Bioethics — is needed to keep the public informed of the broader ethical issues and avoid conflict. (Nature)
Keepin' it real An interactive music programme is helping US children recognise the symptoms of stroke using the FAST acronym — face drooping, arm weakness, speech difficulty, time to call 911 — and take immediate action. Promptly calling emergency services improves recovery prospects by 24 per cent. (Stroke)
Podcast of the week
Dealing with back pain Low back pain can affect anyone and is the leading cause of disability in richer countries and increasing rapidly in poorer ones. This podcast discusses approaches to treatments around the world and the associated personal and cultural beliefs about back pain. (The Lancet)
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