Healthy Dose July 25, 2011

Top StoryMale Contraceptives Show Promising Gains
كبوت / condoms

Tests are in progress that could lead to major family planning advances. The New York Times reports on some innovations in male contraceptives that could offer safe and effective contraception.

Male contraceptives are attracting growing interest from scientists, who believe they hold promise for being safe, effective and, also important, reversible.

“We have a number of irons in the fire,” said Diana L. Blithe, program director for contraceptive development for the National Institute of Child Health and Human Development. “I think men actually do want to do this.”

While male contraception has been studied before, no method met the stringent safety and effectiveness criteria that female methods do. It was also unclear whether men would use them.

Now, scientific advances are producing approaches that could pass muster. Prompted by women’s organizations, global health groups and surveys indicating that men are receptive, federal agencies are financing research. Some methods will be presented at an October conference sponsored by the Bill and Melinda Gates Foundation.

“Male contraception is a critical area,” said Jenny Sorensen, a foundation spokeswoman. “It doesn’t make sense to not include everyone in the discussion.”

The most studied approach in the United States uses testosterone and progestin hormones, which send the body signals to stop producing sperm. While effective and safe for most men, they have not worked for everyone, and questions about side effects remain.

So scientists are also testing other ways of interrupting sperm production, maturation or mobility.

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Global Health and Development Beat

Cholera – Haiti’s Health Ministry has announced that it recorded 1,000 new cholera cases in the month of June.

MalariaIntegrated Vector Management pilot trials conducted by the Kenya Medical Research Institute from 2007-10 have come back with promising results which may lead to scaled-up application.

Malaria – Due to reports of malaria in Harare, the government of Zimbabwe is raising money for a nationwide assessment to determine malaria-prone areas.

Maternal Health – A year after its implementation, India’s Mother and Child Tracking System is struggling, having only registered 18% of estimated pregnant women.

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The Players

AusAID – Australia’s Foreign Minister, Kevin Rudd, is making a global appeal to increase relief support for the drought in Southern Somalia.

PATH – President Dr Christopher Elias is encouraged by new innovations on the female condom which will be made widely available soon.

UNICEF – Has agreed to provide N292 Million to support health and environmental programs in Niger.

UNDP – Is supporting, with local partners, this week’s Africa Digital Week 2011 in Ghana.

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Buzzing in the Blogs

The debate continues between Owen Barder of the Center for Global development and Dr Kamal-Yanni and Daniel Berman of Oxfam and MSF respectively. In Barder’s latest post, he argues further that incentives must exist for pharmaceutical companies invest further in providing vaccines to the poor.

We do not have to speculate too much about what would have happened if we followed the advice of Dr Kamal-Yanni and Daniel Berman and set the price of pneumo vaccines as low as possible. We can see what happened when vaccines for Hepatitis B and Haemophilus Influenzae Type b (Hib) were developed for use in rich countries. In principle, exactly the same ‘market segmentation’ principles should have applied in these cases. According to the view put by Dr Kamal-Yanni and Daniel Berman the firms could have recovered their investment in rich countries, and sold the vaccines at cost in developing countries. But in practice that didn’t happen: it took at least fifteen years before those life-saving vaccines were available in developing countries.

It does not reflect well on the pharmaceutical industry that these vaccines took so long to be produced for developing countries. But nor does it reflect well on public policymakers who failed to think about the incentives required to get them to do so. Somebody has to bear the costs of getting regulatory approval, sorting out appropriate presentations for developing countries, and building large enough plants for mass production. In some cases, such as pneumo, the vaccine itself may have to adapted. Firms are reluctant to bear these costs if they are unlikely to be able to recover those investment through sales, and if they perceive a risk that their high-price markets will be undercut by imports of low-cost substitutes manufactured for developing countries.

About two million people die each year of vaccine-preventable diseases. Our reluctance to create incentives which make it profitable for pharmaceutical companies to serve these people is not “erring on the side of the poor”: it is erring on the side of ideology at the expense of the poor.

I don’t have an ideological position on the respective merits of the private and public sector: each has advantages and disadvantages. (I do plead guilty to having a bias towards more open, diverse and competitive approaches.) You can make a case for developing medicines mainly in the public sector, based on the idea that the knowledge generated by R&D; is a public good and ought to be free for everyone to share. But that logic applies also to the development of medicines for families in rich countries. I notice that, in practice, most rich countries prefer to engage the resources, innovation and energy of the private sector, working alongside the public and non-profit sectors, in developing and producing new medicines. Perhaps we want this kind of mixed economy because some people doubt that programmes directed by the the public sector alone will be able to deliver these products. I don’t want to live in a world in which we have one level of aspiration for technologies for our own health needs, which we choose to meet by a combination of public and private efforts, and lower aspirations for developing countries in which we rely on programmes funded and managed by the public sector alone. But if we want the private sector to do this work too, we have to set appropriate incentives for them, rather than create conditions in which this cannot be a worthwhile business and then complain about their values when they don’t participate as much as we would like.

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Capital Events

Monday

2:00 PMHow Can Countries Succeed in an “Everyone a Changemaker” World? – CSIS

Tuesday

9:30 AMVoices From Congo: The Road Ahead – Holocaust Museum

2:00 PMAFRICOM: Promoting Partnership for Global Security in Africa – House International Relations Committee

2:00 PMDepartment of State Trafficking in Persons Report 2011: Findings and Recommendations – SAIS

6:00 PMThe Eagle and the Elephant: Strategic Aspects of US-India Economic Engagement – Asia Society

Wednesday

9:30 AMBusiness & Human Rights: Emerging Issue on the Development Horizon – USAID

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By Mark Leon Goldberg and Tom Murphy; Photo Credit