DoD and Global Health

I just stumbled across an interesting article on U.S. Department of Defense efforts in global health and infectious disease. I thought it was particularly interesting since I'm currently working within one of the overseas laboratories it mentions.

Shedding light on the Department of Defense’s little-known contributions to global health
By Meredith Mazzotta

The U.S. Department of Defense might not incite thoughts of contributions to global health, but a briefing Thursday on Capitol Hill – hosted by The American Society of Tropical Medicine and Hygiene (ASTMH), Center for Strategic & International Studies (CSIS), Research! America and the Sabin Vaccine Institute (SVI) – shed new light on that thinking.

“The Walter Reed Army Institute of Research (WRAIR) is one of the largest developers of vaccines in the non-private sector,” said Peter Hotez, MD, PhD, president of the SVI and ASTMH, and a presenter at the briefing on DoD’s Essential Contributions to Global Health. “Most of the interventions that we have that we can use to fight neglected diseases in low- to middle-income countries are because of WRAIR.”

There are many reasons for that, according to fellow panelist Col. Kent E. Kester, MD – a former commander at WRAIR and a malaria vaccine researcher, scientist and soldier. “Our primary mission is force health protection – developing medical solutions to protect our deployed service members. If you have health threats that don’t discriminate between someone living in a small village in Kenya or an Army Corps of Engineers building bridges in country X, it has much broader implications and force health protection means much more,” Kester said.

What is more, “sick nations are dangerous nations – that’s a truism,” he said.

Hotez agreed, noting the “very intimate” relationship between tropical infections and conflict. “We can actually show that if you go to the countries with the highest rates of neglected tropical diseases, they were most likely involved in conflicts at some point over the past 20 years. Is it because these are places where there has been a lot of conflict and a breakdown of the public health infrastructure? That’s certainly true, but we think tropical infectious diseases have been shown to be highly destabilizing,” Hotez said.

The annual budget of the DoD is approximately $630 billion, .05 percent of which is going to produce some of the “most extraordinary interventions that are making a huge difference for bottom billion people who make no money, and at the same time they are having a huge potential impact on reducing poverty and conflict in low-income countries,” Hotez said.

The next challenge, panelists agreed, is to educate the public and the Congress about what we’re getting for that approximately $130 million annual investment. “The intimate relationship between disease and national security interests is an argument that needs to be better articulated than it has been to date,” Hotez said, and include how we are working to meet all the goals of the president’s Global Health Initiative, and take infectious disease research at WRAIR and link it to overseas labs.

“There’s no question that our U.S. servicemen and women rely on the work these laboratories perform,” said panelist J. Stephen Morrison, PhD, director of the Global Health Policy Center at CSIS, who issued a new report entitled The Defense Department’s Enduring Contributions to Global Health in late June. The global health benefits that are spread beyond the immediate target client base – diagnostics, vaccines, therapies, new knowledge – they’re a best buy… There’s not a lot of money going into these laboratories relative to the output, he said.

Some examples in the CSIS report of DoD contributions to global health include:

• in Thailand, the first successful HIV/AIDS vaccine trial,


• the demonstrated efficacy of Malorane, primaquine, and weekly tafenoquine to treat and prevent malaria,


• lab research that resulted in the first vaccine for Japanese encephalitis virus (JE),


• the first identification of new strains of dengue fever in Peru.

However, “The labs are under-resourced and under-acknowledged, within the DoD, on the Hill and in broader society,” Morrison said. He then outlined what is needed moving forward, including recommendations for modest adjustments in funding levels to create a balance where core research can be fulfilled, much better communication between levels [of government], better outreach to Congress and core constituencies, and cultivating champions to speak in support of them.

“All those steps can be achieved in the near and immediate term,” Morrison said.

Health in the Horn of Africa

Health in the Horn of Africa: a collective response needed
The Lancet, Volume 378, Issue 9791, Page 541, 13 August 2011

"In 1984, the world said 'never again' to famine in Ethiopia. But, 27 years later, famine has revisited the Horn of Africa. Between July 20 and August 3, the UN declared famine in five regions of Somalia. The disaster is expected to spread to all eight regions of the country in 4—6 weeks and is likely to persist until at least December this year.

A famine can be declared only when at least 20% of households in an area face extreme food shortages with a limited ability to cope; acute malnutrition rates exceed 30%; and the death rate exceeds two deaths per day per 10 000 people. Deemed the “worst humanitarian disaster” in the world by António Guterres, the UN High Commissioner for Refugees, it has threatened the lives of 12 million people, and more than 29 000 children younger than 5 years—nearly 4% of children in Somalia—are estimated to have died. Malnutrition was already prevalent in about half of all children younger than 5 years who arrived at UN camps in Somalia, which made them especially susceptible to the complications of diarrhoea and measles. According to WHO, the number of people becoming infected with measles and waterborne diseases is growing at an alarming rate, and cases of severe diarrhoea in Kenya and Ethiopia are a serious concern. Furthermore, hundreds of thousands of refugees from Somalia have fled to neighbouring countries, in particular Kenya and Ethiopia, and the ongoing refugee crisis has raised the risk of diseases associated with crowding such as measles, diphtheria, pertussis, acute respiratory infections, meningococcal disease, and tuberculosis. Additionally, humanitarian organisations reported that women in the refugee camps faced a drastic increase in sexual violence, which has put them at high risk of contracting HIV/AIDS.

The UN is stepping up deliveries of food aid in famine-affected areas, and WHO has led an emergency measles and poliomyelitis vaccination campaign, together with the provision of vitamin A and deworming tablets targeting children younger than 5 years on the Somali—Kenya border. However, in view of the extremely fragile health systems and poor sanitation in these countries, the vicious cycle of hunger, ill health, and poverty makes the situation even more intractable.

There are many factors underlying the famine. The drought, the worst in 60 years, is the initiator of the tragedy. More than 95% of Africa's agriculture is rain-fed, and is therefore susceptible to climate change. On top of that, Somalia faces a security crisis as a result of political conflicts, civil war, and anarchy, which has meant that most of its people have lived in an extremely precarious state since its last national government collapsed in 1991. As the economist William Easterly once commented on Ethiopia's struggles with famine over the past quarter-century: “It's not the rains; it's the rulers.” The toxic politics should perhaps be regarded as the major culprit; the famine is more of a man-made disaster than a natural one.

The international community is also to blame for responding too slowly and neglecting its responsibilities in this preventable disaster. Despite the forecasting of the crisis from the Famine Early Warning Systems Network since November, 2010, the first aid flight did not arrive in Somalia until 8 months later. The UN issued its first appeal on July 20, and by August 3, the appeal was only 44% funded, with an additional US$1·4 billion still required to cover unmet needs. The USA, Europe, and other wealthy donors waited until pictures of starving children and desperate women made the evening news to hand over funds. China, Africa's second largest trading partner after the USA, merely said it would pay “close attention” to the disaster, and only pledged a modest $14 million of food aid on August 5, after US House minority leader, Nancy Pelosi, urged the country to do more.

In an era of advanced agricultural productivity and transportation networks, it is unacceptable that a famine has happened. It is even more unfortunate that Africa is still “a scar on the conscience of the world”, as former UK Prime Minister Tony Blair said 10 years ago. More and longer-term investments in agriculture and health in Africa are needed alongside a collective global response. Notably, China, which experienced one of the largest famines of the 20th century and yet has harnessed 7% of the planet's arable land to feed 20% of the population, should be more of a leader here and show that it has an interest in the welfare of Africa's people. Such a humanitarian disaster must never be allowed to happen again."

Mubarak on trial

Yesterday marked the start of yet another historic event in Egypt, the trial of former president Hosni Mubarak. Throughout the morning - a time of day when normally, during Ramadan, few Egyptians would even be awake - the country was glued to live coverage of the trial on Egyptian state television. Even in the office, most people snuck off either to the cafeteria or to the gym, the two places within the compound that have televisions, to follow the news.

Highlights of the first day of the trial:

1. Mubarak showed up. (Most people expected the court to issue an exception that would allow him to stay in the hospital in Sharm el Sheik instead of being transferred to Cairo.)


2. The trial was not postponed. (Even once Mubarak showed up, many expected the trial to be dismissed or postponed, especially since it was to begin on the third day of Ramadan.)


3. "After roughly an hour of lawyers who represent protesters making demands, including one who claimed that Mubarak had died in 2004 and been replaced by an imposter, presiding Judge Ahmed Rifaat has ordered all lawyers to take their seats." (I'm not even kidding. I couldn't have made that up if I'd tried!)

For more (serious) news on the start of the trial and peoples' reactions in Egypt, read more here.

Friday of (Dis)unity

This past week’s protests in Tahrir Square were planned as the “Friday of Unity”, in which various political factions and parties would come together to present a united front in support of social justice, economic reform, judiciary changes, rights for the families of those who were killed in the revolution and other demands that have been heard repeatedly over the past five months. Instead, this day of protest proved to be the most divisive to date as conflict erupted not between the protesters and the military or police, but within the protesters themselves.

As tens of thousands filled Tahrir Square on Friday, Islamic groups - such as the extremely conservative Salafis and the relatively moderate Muslim Brotherhood - took to the square and outnumbered secular, moderate and liberal groups who have led the protests for the past five months. Familiar calls for justice and reform were overwhelmed by new demands for an Islamic state governed by sharia law. The show of might by these Islamist groups was so strong that many of the other groups who were meant to be involved in the protest left the square in the early afternoon, claiming that the day had been hijacked.

Some wonder if this Friday of (dis)unity is a sign of growing division and discontent in Egypt, as rifts between conservatives and liberals, military and civilians, Muslims and Christians, etc. seem to be deepening. For now, only time will tell.

Continued revolution

When I was in the States in May of this year, I felt like I got a hard time from several people because I hadn't followed-up my last post about Egypt with a message that all is well. For those of you who are included in this group, all is well with my day-to-day life here in Cairo. I go to work, visit tourist sites, socialize with friends, shop, worship at church and go about the rest of my life just as I did before the revolution.

However, for the people of Egypt, all is not well. Protestors have continued to take to Tahrir Square each week since the revolution began. There has been "Save the Revolution Friday", "Friday of Cleansing", "Second Friday of Anger" (the first was January 28), "Friday of Retribution", "Revolution First Friday" and so the list goes on and on. The majority of these protests have been small, peaceful demonstrations by various factions who are unsatisfied with the transitional military government that has been in power since President Hosni Mubarak stepped down in February. However, there have still been spats of violence between protestors, "thugs" from the old regime, police and military forces.

Each week, it seems, the government must give in to one of the protestors' demands in order to keep peace in the square (and, for that matter, in the country). Interim policies have been put in place and government officials have been replaced numerous times. Just this week, nearly 600 senior police officers were fired. Still, the people are growing more and more impatient with the slow pace of change and the lack of prosecution against corrupt politicians and brutal police from the old regime.

The next few months should remain eventful - Former President Hosni Mubarak is set to go on trial on August 3; parliamentary elections are to take place in September; presidential elections are to occur before the end of the year.

While the degree of violence that overtook Cairo in late January is long gone and the situation is nothing like the crises taking place in Libya, Syria and Yemen, the Egyptian revolution is far from over. In fact, some say it's just beginning.