November 2006
Contact: Stephen M. Apatow, Director of
Research and Development, Humanitarian University
Consortium GraduateStudies
Center
for Medicine,
Veterinary
Medicine and Law. Email: s.m.apatow@pathobiologics.org
Africa - International Public Health Emergency
UN leaders are meeting next week to focus on the current international public
health emergencies impacting continental Africa and the spread of pandemic
avian influenza (International
Conference on HPAI in Bamako, Mali).
During the past 12 months, the Qinghai strain of H5N1 (CDC, Volume 12,
8.8.06) has migrated through Russia, Mongolia, Kazakhstan, Europe, the
Middle East, and Africa (Evolution
of Qinghai H5N1 Bird Flu, Recombinomics, 5.906). This explosion is without
precedent and was driven by H5N1 in long range migratory birds (H5N1 bird flu reaches
Africa, New Scientist, 2.9.06). To date outbreaks have been discovered
in Egypt, Nigeria, Niger, Côte d'Ivoire and Burkina Faso, Uganda and Djibouti
with possible cases being investigated in Somalia and Sudan.
International attention has now shifted attention to human subclinical/atypical
infections (ProMED:
Avian influenza, human (140): atypical infections) of influenza A
subtype H5N1 (human transmissible strains of avian influenza virus that
originated from H5N1 - H3N2,
H1N1 - H2,
H9, H7).
Pharmaceuticals:
The African continent's public health systems are currently viewed as incapable
of handling the scope of current outbreaks, prompting the need for international
intervention. One area that we can facilitate immediate action is with regards
to pharmaceuticals.
The TRIPS Agreement,
as clarified by the Doha
Declaration, makes it clear that WTO members can engage in compulsory
licensing with respect to pharmaceuticals needed to address an international
public health emergency.
Currently we have three significant public health emergencies in continental
Africa, each that would warrant compulsory licenses for all necessary pharmaceuticals.
I. HIV/AIDS
The area in Africa south of the Sahara desert, known as sub-Saharan Africa,
is by far the worst-affected in the world by the AIDS epidemic. The region
has just over 10% of the world's population, but is home to over 60% of all
people living with HIV. An estimated 3.1 million adults and children became
infected with HIV during the year 2005. This brought the total number of
people living with HIV/AIDS in the region to 25.8 million by the end of the
year. HIV prevalence varies considerably across this region - ranging from
less than 1% in Mauritania and Senegal to almost 40% in Botswana and Swaziland.
-- Sub-Saharan Africa:
Avert.
Although HIV/AIDS has reached almost every part of the world, no other
region has been harder hit than sub-Saharan Africa, home to nearly three
quarters of the world’s people living with HIV/AIDS. By the end of 2002,
over 29 million people in sub-Saharan Africa were living with HIV/AIDS.
Of those, 10 million were young people (aged 15-24) and almost 3 million
were children under 15. In 2002 alone, about 2 million adults died of HIV/AIDS
in the region. -- Africa's
Orphaned Generations: UNICEF.
Eight out of every 10 children who have lost parents to HIV/AIDS live in
sub-Saharan Africa. Between 1990 and 2001, the proportion of orphans whose
parents died from HIV/AIDS rose from 3.5 per cent to 32 per cent. There
are more than 34 million orphans in the region today, 11 million of them
orphaned by HIV/AIDS.
Total number of orphans
due to AIDS, 2003:
Nigeria: 1,800,000
South Africa: 1,100,000
Tanzania: 980,000
Zimbabwe: 980,000
Uganda: 940,000
DR Congo: 770,000
Ethiopia: 720,000
Zambia: 630,000
By 2003, 15 million children under 18 had been orphaned by HIV/AIDS worldwide.
About 12 million of these live in sub-Saharan Africa, and it is expected
that this number will have risen to more than 18 million by 2010. Most of
the AIDS orphans who live outside of Africa live in Asia, where the total
number of orphans - orphaned for all reasons - exceeds 87 million. There is
however insufficient information in Asia to provide figures for the number
of AIDS orphans in individual countries.
II. Tuberculosis
The incidence of human tuberculosis increased globally in 2003, but incidence,
prevalence, and death rates were approximately stable or decreased in all
countries except Africa. Of the 15 counties in the world with the highest
rates of tuberculosis, 13 are in Africa. It is estimated that 2.4 million
Africans become infected and 540 000 die annually from the disease. HIV infection
results in humans becoming much more susceptible to all forms of tuberculosis
and it is estimated that 50% or more of new cases are related to prior HIV
infection. -- Status
for Controlling Bovine Tuberculosis in Africa, Prof. Cheryl M E McCrindle,
Department Paraclinical Sciences, Veterinary Faculty, University of Pretoria,
South Africa and Dr Anita Michel, Onderstepoort Veterinary Institute,
Agricultural Research Council, South Africa.
-- TB emergency
declared in Africa: Aids reduces the body's resistance to TB. African
health ministers have announced a regional tuberculosis emergency due to
a sharp rise in the number of cases. BBC, 25 August 2005.
South Africa may forcibly isolate patients being treated for a highly
drug-resistant form of tuberculosis to prevent new infections from spreading
on the AIDS-hit continent, health officials said....."Holding the patient
against their will is not ideal but may have to be considered in the interest
of the public," Ronnie Green-Thompson, a special advisor to the Health Department,
said in a statement. --
S.Africa urged to isolate "killer" TB patients, Reuters, 23 january 2007.
To get a grasp of the Global TB PandemicThreat:
Multi-drug resistant tuberculosis (MDR-TB) are strains of the airborne
disease that are resistant to at least two of the most important first-line
drugs....Cases of drug resistant tuberculosis are higher than previously estimated
and three nations – China, India and Russia – account for more than
half of all cases worldwide, according to new research. -- Drug
resistant TB cases even bigger, IBN Live, 18 December 2006.
III. Pandemic: Avian Influenza
Officials at the Food and Agriculture Organisation (FAO) say Africa's monitoring
systems simply are not adequate to cope effectively with outbreaks. The risk
of human cases is also raising questions about the strength of the continent's
public health systems. -- Africa 'too weak' to
fight H5N1, BBC, 2.9.06.
It is my hope that Africa will serve as reference point for continued discussions
associated with compulsory
licensing with respect to pharmaceuticals, for outbreaks
classified by physicians, epidemiologists and scientific experts as an integral
part of a public
health emergency of international concern. I also hope to fully engage
the International
Bar Association Human Rights Institute in this discussion in the context
of the newly revised International Health Regulations (ProMED,
5.20.2005).
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