FT Health: Taking responsibility

Six months after the UN launched a $400m fund to tackle cholera in Haiti, it has raised just $2.7m. Then again, it took six years before the organisation offered a first apology for its role in causing an epidemic of the disease in 2010 that killed at least 9,000 people and affected 800,000.

Genetic analysis has long confirmed the strain was the same one circulating in 2010 in Kathmandu, from where Nepalese soldiers were posted to Haiti. Eyewitnesses at the peacekeeping mission in Haiti observed poor sanitation practices. Detailed research has highlighted concealment to deflect the blame.

The UN long refused to assume responsibility, hid behind legal immunity and even last December still only conceded that “the preponderance of the evidence and the weight of the circumstantial evidence” pointed to the camp as “the most likely source”.

It says it has since learnt lessons about better screening of staff, distribution of antibiotics and vaccines, and tougher surveillance and improved sanitation in its camps. It has also sought to raise money from other donors to improve prevention and treatment, and to consider ways to support affected families.

Yet at a time when the organisation is under intense scrutiny over its governance and faces budget cuts, notably from the US, it should hold its own staff to account and identify resources to help. Haiti is not an easy country in which to operate. But unless the UN takes a little more pain itself, it is no surprise if funders instead turn elsewhere.

Andrew Jack

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Three questions

Tedros Adhanom, candidate for director-general of the World Health Organization.

What is the strongest argument to vote for you rather than the other DG candidates?
 
I am the only candidate with the technical, political, diplomatic and operational experience to revitalise the WHO, and the only one who has designed, implemented and seen the results of a complete health system reform. As Ethiopia’s minister of health, we trained thousands of new healthcare workers, dramatically reduced rates of HIV and malaria, and expanded access to healthcare and family planning for women in a complex, resource-limited environment. 

As chair of the Global Fund, I also oversaw a comprehensive reform effort. As minister of foreign affairs, I dealt with heads of state, reoriented organisations and built consensus. The WHO needs a decisive leader who understands the challenges ministers of health face, can respond to the next pandemic and has a proven track record of implementing comprehensive reforms, overcoming bureaucratic bottlenecks and ensuring stakeholders work together to take on our greatest public health challenges.
 
What is the one activity of the WHO you would scale up and the one you would de-prioritise?
 
I will prioritise universal health coverage because it is one of the best investments in public health, bringing improvements in nearly every other area of healthcare. When you have strong primary healthcare with community engagement and resilient health systems, more children are immunised, more mothers have skilled attendants at birth, more chronic diseases can be prevented or easily treated and disease outbreaks can be detected before they spread. I will de-prioritise administrative, structural and programmatic barriers that would impede the WHO from making universal healthcare the centre of gravity for all the sustainable development goals.
 
What is your response to your critics over political bias in health programming and to Ethiopia's human rights record while you were a minister?

Ethiopia is a vast country of nearly 100m people with diverse ethnic, political and social backgrounds. It is committed to democracy, but our democracy is nascent and our record has not been perfect. As minister of health, I demonstrated a firm commitment to the principle that health is a basic human right by dramatically expanding access to healthcare, even in remote areas, and by making special efforts to provide care for vulnerable populations such as women, children and those living in rural and pastoralist areas.

In my leadership roles at the Global Fund, Roll Back Malaria and UNAids I have worked tirelessly to ensure that the most vulnerable populations have access to healthcare. As the leader of the WHO, I will be a powerful champion for those who are denied access to healthcare for any reason.

Read our interviews with the other two WHO candidates, Sania Nishtar and David Nabarro.

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Chartwatch

Designer sugar Nestlé is one of several food companies tinkering with sugar to make it less damaging to health while preserving its sweetness. Although sales of soft drinks are falling, the opposite is true for sugar-laden foods such as chocolate and cookies. (Guardian)

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News round-up

Aid increases Wealthy countries' aid for overseas development hit a record $143bn in 2016, but this included money for refugees at home. This backgrounder explains how the US spends its aid. (Devex, CFR)

Treating trauma The mental stress suffered by war victims in Iraq and Syria is transforming the way relief workers operate. “Psychological first aid” is the new discipline of spotting more severe cases of distress and ensuring sufferers have access to care. (Devex)

Ebola lessons A US report on west Africa's 2013-16 Ebola outbreak said future crises could be tackled by strengthening health systems in vulnerable areas, engaging communities, and supporting international co-ordination and collaboration. (Cidrap)

Contraception and death rates India averages one maternal death every 12 minutes — the second highest number in the world. This could be cut by a third just by later and better spacing out of pregnancies through increasing access to contraception. The FT reported from India on this last year. (The Wire, FT)

Diabetes danger The disease is a much bigger killer in the US than previously thought. A separate study confirmed the theory that eating fresh fruit leads to much lower risk. (Washington Post, PLoS)

Pharma battle Bain and Cinven were the victors in the €4.1bn battle for Stada, the German pharma group and maker of generic versions of drugs such as Viagra. The deal is the largest private equity acquisition of a publicly traded European company in four years. (FT) 

2017 blockbusters Eight new $1bn-dollar-plus drugs are set for market this year. Roche’s Ocrevus for multiple sclerosis tops the list with a projected $3.3bn. (Clarivate Analytics)

Sound scans Living in a noisy city sharply increases your risk of hearing damage yet we compound this by jacking up our personal headphones ever higher — and the problem can remain hidden until it is too late. In response, UK scientists are using MRI scans to examine the parts of the hearing system that connect to the brain. (The Conversation) 

Facial recognition Smartphones are gradually replacing chunky scanners for facial analysis with apps such as Face2Gene which can analyse photos and identify potential medical conditions. Data for non-white populations are sorely lacking. (Stat)

Going the whole hog Smithfield, the world's largest pork producer, is expanding its role in supplying pig parts for medical uses. The US market for by-products used for medical, pet food and non-food purposes is worth more than $100bn — and that is not including the potential for animal-to-human transplants. (Reuters)

Up in smoke The tobacco industry lost its last legal attempt to avoid strict new packaging rules in the UK. From May 20, all cigarettes must be sold in drab standardised packets without any graphical branding. (Guardian)

Spice fears Good news on tobacco was balanced by worries over the use in UK cities of “spice”, a generic name for a range of synthetic drugs formerly classed as “legal highs” but now illegal. They can induce a zombie-like state and cause hallucinations, psychosis, muscle weakness and paranoia. (BBC, FT, BMJ)

Mark Wainberg, HIV pioneer The Canadian HIV/Aids researcher who died this week was as known for his advocacy on behalf of those affected by the disease as he was for his scientific contributions. (Medscape)

Care crisis Family problems in Japan — one of the world's fastest ageing societies — are driving some to murder. The number of those aged 65 or older is set to rise from 26.6 per cent in 2015 to 38.4 per cent by 2065. (WSJ)

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Best from the journals

Public v private South Asia is the only region in the world where health expenditure fell between 2000 and 2006 and strong growth in the private sector could hamper efforts to reach universal coverage. (BMJ)

Trumping Science The US decision to reinstate the ban on aid to international organisations that support abortion — the so-called Mexico City policy or “global gag rule” — ignores scientific evidence and will actually lead to an increase in terminations. (NEJM)

Barefoot patients Many Ugandans with painful swelling and ulcerating sores were infected not — as initially thought — by the parasitic worms typically causing elephantiasis, but by long-term exposure to irritating soil minerals absorbed while walking barefoot. (AJTMH)

Cancer climbs Childhood cancers have risen substantially in recent decades. Between 2001 and 2010, 140 in every million under-14s were affected and 185 in every million aged 15-19. A separate study of survival rates from childhood leukaemia showed wide discrepancies across countries. (Guardian, Lancet)

Pollution problems Air pollution killed 4.2m people in 2015, up from 3.5m in 1990. The problem is most serious in countries with poor and ageing populations such as China and India. Theresa May, the UK’s prime minister, warned that toxic air was Britain's fourth largest health risk behind cancer, obesity and heart disease. London is introducing the world’s first ultra-low emission zone. (The Lancet, Mayor of London)

Parkinson's promise Reprogramming brain cells could help in the cure for Parkinson's disease by changing them into cells resembling dopamine, a chemical that acts as a messenger to the brain and whose loss causes the disease. (Independent, Nature)

Measuring wellbeing David Cameron, the former UK prime minister, said in 2010 that making people happy should be a key aim of government, as it helps increase productivity as well as improving health. Wellbeing can also influence elections: politicians tend not to get the credit if it improves but are punished if it declines. (BMJ)

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Podcast of the week

How US healthcare became big business. Why is it that more competition in the pharmaceutical industry drives prices up rather than down? Interview with Elizabeth Rosenthal of Kaiser Health News. (NPR Fresh Air, 36m)

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In case you missed it

FT Health Last week's edition

Previous editions can be found on our Facebook page. 

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Coming up

Vaccines, an FT Health report, is published on Wednesday April 19. Read last year's edition.

Latest news www.ft.com/health and @FT_Health

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Final thought

The language of health “Confined to a wheelchair” — or “freed by a wheelchair”? “Defect” or “anomaly”? With so much medical jargon defined by a top-down or patronising approach, is it time for a re-evaluation of what is and isn't acceptable? (BMJ).