A century after the Spanish flu pandemic killed 50m people — more than those who died on the battlefields of the first world war — policymakers are still struggling to find better ways to tackle the virus.
The World Health Organization this week launched a new influenza strategy up till 2030, stoking a debate that has been simmering since the last pandemic a decade ago.
For all the concerns about Ebola and new emerging infections such as Mers and Sars, old-fashioned flu — in new and constantly mutating forms — continues to impose a heavy burden. There are an estimated 1bn cases a year, 3m — 5m of which are severe, and some 300,000-600,000 deaths.
As the WHO report points out, globalisation, urbanisation and mobility risk accelerating the spread of the next pandemic, as do factors including factory farming and international trade in fowl which harbour avian viruses that can mutate and put humans at risk.
The need to identify the most widespread flu strains each year and produce vaccines by archaic methods in response remains cumbersome. Improved drugs and diagnostics are needed — not least to avoid the misuse of antibiotics, driving fresh drug resistance.
For now, centuries-old prevention techniques including handwashing and avoiding crowds while infected remain essential complements to new treatment technologies.
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Why are you so concerned about pneumonia?
It’s the biggest neglected disease, the biggest killer of children, causing nearly 1m deaths each year. Existing interventions could save so many more lives. But it’s not hit the donors’ radar because it affects the poorest. That’s an appalling failure of UN agencies and charities like ours. We need to get it on the agenda or we will never reach the 2030 goal of zero preventable deaths.
What needs to be done?
Every high-burden country should have an action plan to identify those most at risk. We need to radically scale up diagnostics and the provision of antibiotics, and to strengthen referral to ensure patients have access to low-cost oxygen. Pneumococcal vaccine would have a big impact but it is the most expensive product bought by Gavi (the global vaccines alliance), which only funds it for low income countries. It also needs to be more widely used in middle-income countries like India.
What do you think of the current criticism of international aid?
The UK is one of the richest nations in the world. The idea that it can’t afford to play a leadership role diminishes us as a country. We should be telling the truth about what aid can do: not exaggerated claims but real evidence for the public, and providing a platform for the children who benefit so they can tell their own stories. Dfid (the UK aid agency) is more accountable and produces more evidence than almost any other [UK] ministry.
Venezuelan health emergency The terrible state of public health in Venezuela, ravaged by political and economic crises, has seen for half a decade now big jumps in infant and maternal deaths and outbreaks of vaccine-preventable diseases. Blackouts have also hit supplies of drinking water. (The Lancet, Reuters)
America first President Trump's US budget proposals included more money to fight HIV at home — albeit much less than needed — but also cuts in overseas programmes such as The Global Fund to Fight Aids, Tuberculosis and Malaria and Pepfar, the HIV/Aids initiative. (NYT, Devex, Washington Post, Vox)
FDA chief Ned Sharpless, director of the US National Cancer Initiative, was named acting head of the Food and Drug Administration. Tobacco stocks fell as investors bet the FDA would continue former head Scott Gottlieb's strong stance against the industry. The regulator announced new restrictions on the sale of flavoured ecigarettes. (FT, NYT)
Food for thought The world's dietary habits are heading in the wrong direction, according to an FT report on the future of food: while 1bn people go hungry, twice that number eat too much of the wrong stuff. The WHO published new tools to monitor the digital marketing of unhealthy products to children. Food standards are also becoming a key Brexit issue. (FT, Stat, WHO, The Lancet)
Chemical hazards The $5tn global chemical industry was responsible for 1.6m preventable deaths and 45m disability-adjusted life years in 2016. The sector is set to double in size by 2030, posing new challenges to contain leakages and stop them entering the food chain. (UN Global Chemicals Outlook)
The selling of sleep World Sleep Day aimed to “raise awareness of sleep as a human privilege often compromised by the habits of modern life,” but the idea that we should all aspire to a single unbroken block of sleep is a recent invention, says one author, who suggests we become aware of “new sleep hygiene and the agendas that it carries”. (WSD, Guardian)
Life on the frontline “When people leave their home in the morning, they don't know if they'll be back in the evening.” The BBC spent a week with an ambulance crew in Kabul, the Afghan capital and one of the most dangerous cities in the world. (BBC)
Genetics and ethics Developers of Crispr, the genetic editing tool, were among those calling for a moratorium on editing human genes following the Chinese “designer babies” furore. A new documentary charts the history of Crispr, “the most important scientific discovery of the 21st century”. (Nature, FT, Wonder Collaborative)
Widening the gene pool The $2.7bn Human Genome Project has been referred to as “an operating manual for Homo sapiens,” but its overwhelmingly white European base means people from different backgrounds will not benefit from the genetic revolution. (Stat)
Vaccination education Unvaccinated children are now banned from Italian schools after a damaging row about compulsory vaccinations which led to measles cases shooting up. The New York Times opinion section has found a fun way of getting the message across. (BBC, NYT)
Best from the journals
C-section alert Maternal deaths following caesarean births in Africa may be 50 times higher than in richer countries, highlighting the need for improved procedures. Deaths of babies born via C-section were double the global average. (The Lancet Public Health)
Fake drugs 'pandemic' The cost to the world economy of falsified or substandard medicines is up $200bn and is associated with thousands of deaths — especially in poorer countries — and increasing antimicrobial resistance. Fake anti-malaria drugs alone kill 155,000 children each year. (American Journal of Tropical Medicine and Hygiene)
Choking to death Deaths from air pollution in Europe could be as high as 790,000 a year — double previous estimates. Total deaths worldwide could be 8.8m rather than the previous estimate of 4.5m, or more than the total number due to smoking. English authorities want to discourage drivers of highly polluting vehicles entering populated areas. A US study found black and Hispanic Americans suffered unduly from air pollution caused by white American consumption.
A separate report from the UN said environmental damage could kill millions by 2050 if action was not taken. (European Heart Journal, FT, Environmental Pollution, PNAS, Reuters)
Vulnerable adolescents The global population of people aged 10-24 is now the biggest in history at more than 1.8bn. These adolescents face growing inequalities when it comes to health risks. (The Lancet)
Not so sweet Many of the big children’s drink brands were once owned by tobacco companies. Here’s how they developed techniques to market these sugary drinks to children. (BMJ)
Democratic dividend Democratic rule appears to be a more important indicator of human health than a country's wealth. Life expectancy in countries that moved to democracy between 1970 and 2015 increased by 3 per cent compared with those that remained autocracies. (The Lancet)
To boldly go . . . (NEJM) Space medicine has hitherto been the concern of governments and their career astronauts, but as the age of private space travel draws near, this will widen to cater for a much more diverse group.
Podcast of the week
Can a better understanding of our genetic make-up help us eat better? Darren Dodd and Clive Cookson, FT Science Editor, discuss developments with neuroscientist Miguel Toribio- Mateas. (FT, 12 mins)
The FT Digital Surgery Summit in San Francisco on March 21 will examine how next-generation surgical technologies are transforming performance in the operating room. For more information and to apply for a complimentary place, visit the event website here.
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Future shock The use of genetic data to personalise our diets and medicines is growing apace, but how do people respond when their medical future is laid bare? What if your report mentions a heightened risk of a condition for which there is no cure? (Independent)
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