The good news about polio is that a former global scourge is ever less of a threat, thanks to international determination to wipe out the disease. Over the past half century, the number of cases has declined from hundreds of thousands around the world to a handful in a few countries. When donors this week pledged a fresh $1.2bn, they showed firm commitment to eradication.
The bad news is that so many deadlines have already been missed since efforts began in earnest in 1988, suggesting that specialists picked the wrong disease as their second target after smallpox. Poor management, difficulties in surveillance, problems with vaccines and the evolving patterns of the infection itself have all caused setbacks. Even Guinea worm — in theory an easier disease to eradicate — has proved resurgent.
The aspirational goal of polio eradication is excellent. The risk is donor disillusionment if the latest push fails, and the opportunity cost of large sums of money that could have been better spent in other ways.
Abridged from a discussion with Sue Desmond-Hellmann, CEO of the Bill & Melinda Gates Foundation.
What is the impact of Trump and Brexit?
We’ve been quite clear we disagree about [President Trump’s draft US] “skinny budget”. Foreign aid is about soft power and global health security. The decision on the National Institutes of Health and family planning [cuts] is disappointing. The Foundation’s total annual spending is $4bn. We cannot even dream of making up [the shortfall]. We don’t have the money.
[As for Brexit], the UK are leaders in global health: it isn’t just the money, it’s the attitude. I hope this is a passing phase of nationalism.
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What do you consider the Foundation’s most effective programmes?
At the macro level, polio and family planning. Neglected tropical diseases which are no longer neglected. GAVI [the Vaccines Alliance] is a thing of beauty, getting vaccines out reliably. We have collaborated on malaria work and [HIV antiretrovirals. There are 122m kids who are alive since 1990 who would not have been otherwise. In US education, we are seeing real progress in common core standards.
Are you shifting away from a disease-specific focus?
We have a lot of “vertical” strategies — in HIV, malaria, TB. But the Foundation has started when appropriate to think horizontally: in India and Ethiopia with health systems; in Nigeria, where polio work was applied to Ebola [to stop it and] allow the world to dodge a bullet. It’s easy to criticise vertical thinking but it does increase accountability. I’m not waiting till 2030 [to see if the UN Sustainable Development Goals are achieved].
Consequences of cuts What do the proposed reductions in US overseas spending mean for recipients? While Germany aims to fill some of the gaps, the Trump administration's 'global gag rule' limiting aid for abortion will hit services such as Colombia's Profamilia. A report models the potential impact of the cuts on global health. (NYT, Humanosphere, Devex, Kaiser)
Pollution and health UN agencies called for action to tackle the 1.4m deaths in Europe each year caused by pollution, 15 per cent of the continent’s total mortalities. Environmental risks are responsible for 26 per cent of ischemic heart disease, 25 per cent of strokes and 17 per cent of cancers. (WHO)
Measles milestone Bhutan and the Maldives became the first countries in Southeast Asia to eliminate measles. The WHO has set a deadline for complete elimination from the region of 2020. (Healio)
Defanging snakebite The WHO added snakebite to its priority list of 20 neglected diseases, a move that could spur new efforts to halt a problem that kills more than 100,000 a year and maims many others. (Stat, WHO)
Alternatives to aid African governments should increase health budgets to reach the 15 per cent target of annual expenditure in the African Union's Abuja Declaration. External aid accounts for 24 per cent of spending but this can be unpredictable and is not always aligned with a country’s priorities. (The Conversation)
B is for biotech Verily, the life sciences business of Alphabet, Google’s parent company, is investing in a $300m fund to buy stakes in European biotechs, the latest example of Silicon Valley using its big data analytics to move into medicine. (FT)
Cancer treatment Cell therapies such as Car-T could win regulatory approval — but can the process ever be economically viable enough to satisfy investors? Merck halted enrolment in trials of its immunotherapy drug. (FT)
Deals dry up The total value of large US pharma deals at $13bn is the lowest since 2012, reflecting delays in President Trump’s much-heralded tax reforms and his pledge to crack down on drug prices. (FT)
Testing times for Astra Pascal Soriot, AstraZeneca’s chief executive, warned of a “substantial setback” if trials for Imfinzi, its new immunotherapy drug, fail. The company is facing the expiration of patents on several blockbuster products. (FT)
Infectious disease A new series looks at how our responses are shaped by social attitudes, starting with the yellow fever of New Orleans in the 1850s. (Wellcome)
Tackling emergencies The World Health Organization launched a series of online multimedia courses to improve the responses of front line responders to health emergencies. (WHO)
Politics of health Is there a correlation between individual health and voting patterns? Analysis of the UK, French and US elections seems to suggest so. (FT)
Donating blood World Blood Donor Day, held last Tuesday, aimed to increase the 112m units donated each year. Nearly half of these are made in richer countries, home to just a fifth of the world's population. (WHO)
Care homes criticised The UK competition regulator criticised care homes over fees, contracts, lack of information and scant investment. The sector is worth around £15.9bn a year, with 5,500 operators looking after 433,000 residents. (CMA)
Brexit blues The number of nurses from EU countries registering for work in the UK has dropped 96 per cent since last June’s referendum to leave the EU. There are 650,000 on the list, of which 36,000 were trained in the EU and 67,000 in non-EU countries. (BBC)
White cane 2.0 A camera worn around the neck that transmits signals to a vibrating belt could be the first update to the white cane used by the visually impaired for a hundred years. A Braille touchpad allows user to programme specific tasks, such as finding an empty seat in a lecture theatre. (The Economist)
Best from the journals
Obesity warning Global obesity has doubled since 1980 and is now running at 5 per cent for children and 12 per cent for adults, mirroring trends in type-2 diabetes. The increases are most noticeable in developing middle-income countries such as China, Brazil and Indonesia. (NEJM)
Climate change and health Climate change can be as damaging for mental health as it is on physical health, particularly among the young. Supportive community networks are key to maintaining resilience among affected populations. (Lancet)
Financing health systems With development aid unlikely to grow substantially, domestic schemes that generate and mobilise funds are becoming more important, contributing to programmes for new and underused vaccines, HIV/Aids, malaria, TB and maternal and child health. (The Lancet)
Aircraft noise Long-term exposure to aircraft noise, particularly at night, is linked to incidences of high blood pressure. The study adds to growing concerns about road traffic noise and cardiovascular issues. (BMJ)
Breaking taboos Could a period emoji help overcome embarrassment when discussing menstruation? Unicode, the body that standardises text on computers, will decide in September whether to add the symbol to its library (see below). (The Lancet, Plan International)
Podcast of the week
Crisis in Venezuela The BBC reports on healthcare problems in a country in turmoil as figures show a sharp jump in infant mortality and medicines become difficult to obtain. (BBC Health Check, 9m)
In case you missed it
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Care from the air Are drones and driverless ambulances examples of how healthcare will be delivered in the future? A start-up is already sending medicines by drone in Zambia while tests show the machines cutting an average 16 minutes off the delivery of defribillators to victims of cardiac arrest. (LA Times, The Conversation, JAMA)