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If climate change is spreading disease around the world in unexpected ways, so too is conflict. The UN estimates that, as at the end of last year, the number of people forcibly displaced at any given time had almost doubled over the past two decades to 66m. This has boosted infections and undermined disease control, adding to the human tragedy.
Aleppo ulcer — a parasitic illness carried by sand flies — is resurgent among Syrian refugees, while polio has been identified in the former Islamic State stronghold of Raqqa. Health has been undermined by conflict in South Sudan and Yemen.
Yet there are precedents to inspire hope. Former US President Jimmy Carter was able to negotiate a ceasefire in 1995 between warring factions in Sudan to tackle Guinea worm. In conflict zones today, however, health workers are ever more targeted rather than respected.
Edited extracts of written answers from Margaret Chan, who finishes her term as director-general of the World Health Organization at the end of this month. She describes her legacy in more detail here. Some critics say she lacked sufficient authority over member states.
What do you consider your greatest achievements as DG?
One of the most rewarding — and challenging — parts of the job is managing a multilateral organisation. Cultural traditions and religious convictions frequently colour health debates, especially on abortion. But during my tenure all resolutions, even in very difficult and contentious areas, were always approved by consensus, often involving significant compromises by individual countries. It says something about the collective responsibility for health.
What were your greatest disappointments?
I had great hopes that polio would be eradicated during my tenure. Thanks to the Global Polio Eradication Initiative, it has been eliminated from some of the most remote and challenging areas in the world, including in India. We are very close, but challenges remain. Weak health systems, remote locations, insecurity and conflict all stand in the way of our final destination.
What are the biggest challenges for your successor?
Financing will probably be one of the biggest. Member states keep asking WHO to do more with the same budget, while resisting proposals to “sunset” [phase out] some areas of work. Achieving universal health coverage is critical to fairness and health for all. WHO must continue to strengthen systems for vital statistics. Scientific evidence must continue to be the bedrock of policy. While ministries of health are WHO’s principle partners, the multiple determinants of health demand engagement with a broader group of actors.
Peak pharma? Analysts cut drug sales forecasts for 2017-2022 by $390bn in the expectation of lower prices but investors seem relaxed about President Trump's promise to stop drug companies "getting away with murder" as intense industry lobbying continues. (FT, Stat)
Polio in Syria The polio outbreak in Syria is expanding as the country prepares to vaccinate 328,000 children under five, followed by another 114,000 aged between two and 24 months. The Syrian cases were caused by viruses from the oral vaccine still used in some developing countries. The US stopped using the oral vaccine in 2000. (Stat)
Developing diagnostics The WHO is complementing its essential medicines list with an essential diagnostics list. The EDL is intended to provide evidence-based guidance to countries to create their own national lists of essential diagnostic tests and tools. It will initially focus on diseases such as TB, malaria, HIV and hepatitis but will be expanded to encompass other conditions, including non-communicable diseases. (WHO)
Vaccine verdict Researchers were dismayed by an EU court ruling that said vaccines could be blamed for illnesses without the need for scientific evidence. “Potentially, this ruling affects all drugs and threatens the development of new drugs,” said one. (CNN)
Trumpcare Republican healthcare proposals in the Senate would hit the Medicaid programme for the poor and give tax cuts for the wealthy, while allowing states to opt out of requiring insurers to provide maternity care, emergency services and mental health treatment. (NYT, FT)
HIV setback Six of Donald Trump’s HIV advisers have resigned, saying the US president did not care about the epidemic. The final straw was his Medicaid proposals which would hit those living with the disease. In the UK, however, there has been a “remarkable” drop in new cases. (Newsweek, BBC)
China crackdown More than 100 Chinese medical papers have been retracted by an international journal because of fake peer reviews. The country has experienced a surge in academic scandals, such as plagiarism, while the drug regulator has questioned companies’ clinical data. (FT)
Dementia developments The Dementia Discovery Fund, launched in 2015 by the UK government and pharma companies, could reach £230m by the end of its initial five-year period. It aims to move beyond the “amyloid hypothesis” — the idea that Alzheimer’s is caused by the build-up in the brain of plaques of beta amyloid protein. This has dominated work without producing any new drugs. (FT)
Big science “The Human Project” is asking 10,000 New Yorkers to volunteer personal data — from blood samples to mobile phone data — for a mass experiment lasting 20 years. The researchers hope to find links between human behaviour and conditions ranging from asthma to Alzheimer's. (Stat)
Pandemics and the poor Poor countries always bear the brunt of pandemics and should be the focus of prevention efforts. These should include investment in surveillance and monitoring of preparedness, equitable access to medicines and money for economic recovery using safety nets such as the World Bank's emergency financing facility. (Brookings)
Fighting Elephantiasis How an army of health workers is helping to rid India of lymphatic filariasis. The WHO has set a target date of 2020 for eliminating the disease, present in 73 countries. (FT).
Evidence-based medicine Academics are urging improvements to the way we produce, use and communicate evidence about medicines. The call comes at a time when faith in medical science is diminishing and distrust of industry-funded clinical trials is growing. (Academy of Medical Sciences)
Vanishing vapers There has been a substantial drop in American youth using tobacco — mainly because of a fall in ecigarette use. Tobacco is the leading cause of preventable disease and death in the US, a habit that nearly always begins during youth and young adulthood. (CDC)
Frequent flyers beware A new warning on “aerotoxic syndrome” says a link has been found between passengers and cabin crew breathing unfiltered or “bleeding” air — possibly contaminated by engine oil — and a range of illnesses. (WHO)
Cosmetic surgery Health experts said the lack of regulation in the UK industry was a “cause for concern”, criticising among other problems the lack of certification among surgeons. It also condemned advertising promoting unrealistic body images and online plastic surgery games aimed at children. (Independent, Nuffield Council on Bioethics)
Holiday reading The 35 best health and science books to read this summer. (Stat)
Best from the journals
Zika update Our knowledge of the Zika virus is based only on a short period of 10 years, with most efforts deployed over the past year. This makes it impossible to accurately predict when the next pathogen will emerge. (The Lancet)
Migration and health The Lancet calls for a better understanding of the health of migrants. Legal definitions need to be clarified, research expanded and domestic services adapted. (The Lancet)
Climate warning About 30 per cent of the world’s population is exposed to deadly temperatures at least 20 days a year. If greenhouse gas emissions continue to rise, this could reach 74 per cent by 2100. The elderly and anyone with conditions that put a strain on their organs are most affected by the resulting heat stress. (Nature)
TB doubts The WHO’s target to eliminate tuberculosis is threatened by the spread of drug-resistant forms. (The Lancet)
Dirty old town An interactive graphic mapping air pollution around London hospitals and clinics shows that more than half are surrounded by pollution above legal limits. (BMJ)
Podcast of the week
Tobacco and lung cancer Uruguay — with a cancer specialist for a president — has introduced some of the most radical tobacco controls in the world and attracted the wrath of Philip Morris in the process. (BBC, 27m)
In case you missed it
FT Health last issue: Polio and donor disillusionment
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Smash the cistern! Some 2.4bn people lack access to basic toilet facilities and 840,000 die each year from poor water, sanitation and hygiene. But with initiatives such as the Gates Foundation’s Reinvent the Toilet Challenge, alternatives are emerging. Is a waterless, off-grid solution that is being trialled in Madagascar the answer? (Mosaic)