Malaria-spreading mosquito © PA
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Despite a few bright spots, this week’s World Malaria Report paints a gloomy picture of stagnating progress and increasing concentration of the burden of one of the world’s most lethal diseases. 

Paraguay has been certified as free of the parasite, while Algeria, Argentina, Uzbekistan and China are not far off. Rwanda, Ethiopia and Pakistan show reduced infection levels. 

Yet the countries with the highest burden — including Nigeria, DRC, Mozambique and Uganda — went backwards. Put more starkly: the annual death toll remains 435,000, and the disease still kills a child every two minutes. 

Reversing the trend will require radical new approaches, greater funding and a fresh focus by donors and high burden countries alike.

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Three questions

Bernard Pécoul, executive director at the Drugs for Neglected Diseases Initiative, which has just gained EU regulatory approval for its drug fexinidazole to treat sleeping sickness.

How significant is this approval?

It’s a major milestone. We spent 13 years developing this product. This will open the door for its use very soon in DRC and then Uganda. Until now you needed a lumbar puncture, treatment injections or slow infusions in hospital for stage two of the disease. The new treatment is oral — taken once a day with food — with no need to move patients who often live in remote places. 

What will be the challenges in uptake?

Sanofi, our industrial partner, has committed to provide drugs for distribution to the affected countries for many years. The next phase will be to train people. The big change will be to adapt a strategy for simpler screening and confirmation of the disease.

How is DNDI working as a public-private partnership?

The willingness has always been there to work with industry, but now we have agreements with 20 large companies and quite a lot of generics companies. Signing an agreement is not so complex, though when you go into details on price, procurement and development, it’s more complicated. We started with a paediatric formulation of an existing anti-malarial. Now we have a new chemical entity and seven or eight in the pipeline. We’re making quite a lot of progress. 


Chartwatch

Mental health matters More than one in six people in the EU have a mental health problem, according to the OECD. Costs on health systems, social security benefits and reduced productivity mean the total burden across the bloc's 28 countries is more than €600bn — or four per cent of GDP. Lower income groups are adversely affected. A separate report showed one in eight children and young people in England had a mental disorder in 2017.


News round-up

Access to drugs An annual index ranks the big pharma companies on how they are improving access to their products in poorer countries. Just five companies account for 63 per cent of R&D on the most urgently-needed new drugs. Industry focus is on five diseases: malaria, HIV/Aids, tuberculosis, Chagas disease and leishmaniasis. (Access to Medicine Foundation) 

Air pollution A new index measures the effect of air quality on life expectancy. Particulate matter on average cuts two years off human life, relative to the levels deemed “safe” by the World Health Organization, and much more in China and India. Critics pointed out the harm to children from the US plan to abandon clean power proposals. (AQLI, Huffington Post)

China crisis Cheap cigarettes are fuelling a potential public health crisis in China. The state tobacco monopoly is undermining government efforts to persuade people to quit, and smoking rates are rising in the country’s richest cities. (FT Confidential) 

Mosquito squadrons There have been new sightings of the Asian tiger mosquito in Belgium. There are no health fears so far but the insect has a painful bite and can transmit diseases such as dengue and chikungunya. (Institute of Tropical Medicine Antwerp)

Sleep more, earn more The idea that sleep has intrinsically less worth than wakefulness and is something that can — and should — be traded has produced a chronic sleep deficit in Japan. One Tokyo company is paying its workers a bonus if they can prove they get more than six hours a night. (FT)

Disease control The remote African islands of Bijagos are helping researchers study cures for some of the world's deadliest diseases. Their isolation means there is little risk of contamination between test sites. (BBC) 

Toilet trouble World Toilet Day highlighted the plight of the 4.5bn people who do not have access to a safe toilet. India is making progress in building toilets but faces a new challenge: where to put the waste. (World Toilet Day, Devex)

Deadly traffic There are 1.25m deaths from road traffic each year — the number one cause for those aged 15-29. The risks are highest in Africa at 26.6 per 100,000 people. The UN's goal is to reduce deaths and injuries from these incidents by 50% by 2020. (Twitter, The South African)

Lengthening lives As scientists begin to uncover the specific processes that cause deterioration in old age, there is hope for much longer lives. Listen to our podcast with the author of “the 100-year life”. (NYT, FT)

Standing desks overhyped A study highlights links between sedentary lives and illness. Standing desks are not the answer: “They’re not cures for anything and standing is not exercise.” (Jama, NYT)

Vaccine costs The main thing holding up the development of vaccines is funding. “If budgets were built on lives saved per dollar, spending on vaccine research would rival that on defence research.” (NYT)

Probing the pill A BBC documentary examines the science around the contraceptive pill and discusses research that says it increases risks of depression and breast cancer. (BBC iPlayer, 59m)


Best from the journals

Diabetes and insulin The number of people who need insulin for type-2 diabetes is set to rise more than 20 per cent by 2030. Without serious improvements in supply, only around half of these 79m people will have access to the drug. Another study shows a link with night shifts and unhealthy lifestyles. There are ten times more young people with type-2 in the UK than previously thought. (The Lancet Diabetes and Endocrinology, BMJ, BBC)

Tackling TB A 27-year analysis of tuberculosis across 195 countries says few will meet the UN target to end the epidemic by 2030. Although preventable and treatable, it kills more than a million people each year. (The Lancet)

Poverty and public health Inequalities in life expectancy in England are widening and the most deprived communities are now seeing no gain at all. The Lancet stresses the role of poverty reduction in public health. Health inequalities are a prime cause of the “productivity gap” between the north and south of the country. Child obesity is also a function of inequalities. (The Lancet, FT, The Conversation)

Nuts news There are finally hopes of finding a medicine for people with peanut allergy. A lucrative market awaits: sales of peanut allergy treatments could reach $4.5bn by 2027, with 3m potential patients in the US alone. (NEJM, FT)

Noise annoys Hospital noise is getting worse, regularly exceeding international recommendations. Levels over 100 dB — the equivalent of loud music in headphones — have been recorded in intensive care units. (BMJ) 


Podcast of the week

Is Big Pharma ignoring the poor? How do you fight fatal disease outbreaks when the big pharmaceutical companies walk away? (The Guardian, 17m)


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Final thought

Holiday reading If you're stocking up for the holiday season or shopping for presents, here's a list of 120 must-read global health books. (Nature)

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