Pharma Boom in Emerging Markets

While the pharmaceutical market for the US stagnates, IMS Health forecasts 14% to 15% growth in the so-called emerging markets, or what they call pharmerging markets. I think they need some help coming up with a better buzzword--something that rolls off the tongue more easily. Which syllable do you stress most? FAR-merging? How far is that merger? Who said anything about mergers? But I digress. The larger point still stands:

Rapid Expansion of "Pharmerging" Markets. The pharmerging markets of China, Brazil, India, South Korea, Mexico, Turkey and Russia are forecast to grow at a combined 14 - 15 percent pace to $105 - $115 billion. Along with the pharmaceutical industry's increased focus on these high-growth markets, these countries are benefiting from greater government spending on healthcare and broader public and private healthcare funding – which is driving greater access to, and demand for, innovative medicines.

Related Post: Growing market for malaria drugs

Kaiser Foundation Launches News Service

Kaiser Family Foundation to start non-profit news service - San Francisco Business Times:: "The Kaiser Family Foundation, a Menlo Park-based nonprofit, said Wednesday it plans to start an independent news service to report on the U.S. health-care system and “the increasingly urgent political and policy debates surrounding it.”

Lancet Series on China's Health

The special series in the Lancet on health system reform in China is fully available online, after free registration. See also Lancet's special online focus on China here.

Lancet is being a good global citizen in providing this material free of charge but navigating their web site continues to be something of a challenge.

Also, reading between the lines, it seems the rivalry between Harvard's Lincoln Chen and Bill Hsiao continues apace. Chen is co-author of four articles in the series while Hsiao does not appear at all.

Both men are experts on health care systems in general and China in particular. Chen often starts the conversation by focusing on health care workers while Hsiao begins with entire systems. Seems like you might want both views.

Logging Malawi Video

They say logging your own video helps you understand better how to shoot video in the first place. I sure hope that’s true. I’ve been logging my video of Malawi nurses for days on end now and find myself yelling at the computer screen every now and then “Hold the shot! Hold the shot!” Fortunately, I seem to slow down and hold my shots better in the later videos.

Logging video means you write down a description of the action in different sequences, what people are saying and the time code from the video so you can easily jump to it if you need it.

Today I finished a whole series on Nurse Grace Nyirongo as she gives malaria medication and checks temperatures on the pediatric ward at Embangweni Mission Hospital and talks about her life and work.

It’s all in preparation for writing scripts that will combine different video sequences with photos and audio. It’s time-consuming work and, frankly, a bit tedious. But it’s allowing me to relive the trip to Malawi and revisit my deep respect and admiration for the men and women who work in the hospitals I visited.

Pandemic Flu Ethics at Seton Hall

Seton Hall Law School in Newark, New Jersey will be hosting a symposium on October 23-24, 2008, to examine the legal, ethical, and public policy issues related to developing a pharmaceutical response to an influenza pandemic. Panels will explore issues related to the development and approval of vaccines and antiviral drugs, both before and during a pandemic; the allocation of vaccines and antiviral drugs in situations of scarcity; and issues related to international equity.

Wonder if they will take up the ethics of withholding flu vaccine from North Korea, Iran and other countries the U.S. considers rogue states?

Meanwhile in Niger

Still haven't heard from an independent source about yesterday's post on malnutrition in Maradi, Niger. But the video below gives you a sense of conditions in Niger. It's from a new series on global health called ‘Survival’ that is currently airing on BBC World News.

The focus in the Niger piece is on what's going right in the battle against various neglected tropical diseases. And it features local villages distributing medications in places where there aren't enough nurses and doctors to do so.

What's Really Going On in Niger?

There's malnutrition in Niger and then there are the arguments about malnutrition in Niger, which is turning into a "he-said, she-said" fight between Issa Lamine, the health minister of Niger, and Marie-Pierre Allié, President of Médecins Sans Frontières (MSF)France.

Yesterday, Lamine accused MSF of exaggerating ongoing malnutrition problems in the Maradi region. Today Allié said in a press teleconference that the situation is worse than the government is willing to admit. "Despite all their efforts, the health care staff in the hospitals and health centers I visited cannot respond to the influx of malnourished children," Allié said, after returning from a visit to the Maradi region of Niger.

The government of Niger suspended MSF's operations back in July. Allié says another group, Action Contre la Faim, was given the boot in August.

The stakes are particularly high this time of year when food stocks are traditionally low before the harvest begins.

Allié took pains to say the MSF has worked with the Niger government before and she praised the government's past successes against malnutrition. But she was baffled by the latest setback and particularly worried to hear a government leader saying, "If MSF is not present, then there is no malnutrition in the area. MSF is creating malnutrition.”

Actually, Lamine's anti-aid agency stance sounds a lot like what I've gleaned from the Internet about a Norwegian documentary called "Sultbløffen" (or "The Hunger Bluff") that aired in March of 2008. The gist of the documentary is that aid agencies undermine local agricultural efforts and exaggerated the extent of the Niger famine in 2005 to justify their own existence. I hesitate to mention it since I haven't seen it, don't speak Norwegian and all the references to it I can find are suspiciously identical as well as identically vague as to who was behind the documentary.

If you've been to Niger recently, please share your thoughts on what's behind this unusual standoff.

Related post: Meanwhile in Niger

Science Looks at Plumpy'Nut Patent

As part of a larger piece in Science on whether Plumpy' Nut should be used to prevent malnutrition as well as to treat it, Martin Enserink takes a separate look at the patent controversy. I wish the piece was longer (and suspect Enserink does too) but it's a great introduction to the topic--well worth reading if you have access to Science online or a good library.

As regular readers know, I've followed this controversy for almost exactly a year now. (See two key posts here and here.) I even started a separate blog devoted just to Plumpy'Nut and patents while at Harvard when the parameters of my fellowship did not allow me to write freelance pieces. (I quickly learned public health experts don't want to become journalists in their own right.) So I applaud any attention this issue gets from traditional media.

Two data points I want to remember from Enserink's excellent article:

". . . Nutriset and the French Institute of Research for Development obtained patents for Plumpy’nut that last until 2018 and are valid in Europe, North America, and about 30 African countries. Nutriset has threatened lawsuits to keep others—including Compact in Norway and MSI in Germany—from selling similar pastes. . . ."

and

". . . the patent [IS NOT] valid in many malnutrition hot spots, including India . . . "

As I learned in my own reporting, Enserink says it's unclear the Plumpy' Nut patent could withstand a challenge.

But I was most intrigued by what Michael Golden, the developer of an older non-patented nutritional supplement, had to say. Golden told Enserink that

"the pressure should not be on Nutriset but on the French government; [Golden] hopes that France’s foreign minister, Bernard Kouchner, a physician who helped found MSF in 1971, will intervene."

Back to the Usual Suspects?

The great promise of the web is that it can take you beyond your usual circle of friends or sources of information. That ability, along with a few other things, is what really drew me to the web as a way of covering global health news. If most big media outlets treated international news as completely separate from health news, at least there was an alternative.

But it looks like we're swinging back toward centralization of media sources. In a story that's mostly about the declining popularity of Technorati and Bloglines, Nick Carr has some very trenchant insights into the growing centripetality of the web.

Investing in Africa's Private Health-Care Biz

Big meeting in Washington, D.C. on Nov. 20-21 to see how US companies can make money investing in the health care systems of African countries.

According to conference organizers, "Over the next decade, $25 to $30 billion in new investments will be needed in health care assets, including hospitals, clinics, and distribution warehouses, to meet the growing health care demands of sub-Saharan Africa. It is estimated that the market for health care will more than double by 2016. With a total health expenditure of $16.7 billion in 2005, roughly 60 percent—predominately out-of-pocket payments by individuals—was financed by private parties, and about 50 percent was captured by private providers."

Read more about the US-Africa Private Health Sector Forum at the Corporate Council on Africa website.

Update: CGdev.org has a good Dec. 9 post, with worthy links, on the public-private debate (via Jon at GlobeMed, in the comment feed)

Keeping Science a Secret

Two new transparency issues in global health news, on pandemic flu vaccine and scientific candor at US government agencies. For an example of how lack of transparency in one small area (say credit swaps) can spread around the world, see the current financial crisis.

Discouraging News on Infant Mortality in US

When staying in place means falling behind. The Centers for Disease Control releases new statistics on infant mortality in the U.S.

Key point: "Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the United States′ infant mortality rate from 2000 to 2005."

Look East, Young Idealist

Polymeme is fast becoming my new favorite source for news beyond the echo chamber. Today's gem, from the Financial Times: "Crisis marks out a new geopolitical order."

There's no doubt economic power is shifting eastwards, as Philip Stephens says. And, I would argue, along with that shift goes the power to set the agenda in global health.

US: No Vaccines for North Korea, Sudan, Other Rogue States

Official U.S. policy denies vaccines against bird flu, dengue fever and other deadly viruses to pariah states like North Korea, Iran, Cuba and Syria. This little-known 10-year-old policy, outlined in a must-read report from Robin McDowell of the Associated Press,

"could makes it harder to contain an outbreak of bird flu among chickens in, say, North Korea, which is in the region hardest hit by the virus. Sudan and Iran already have recorded cases of the virus in poultry and Syria is surrounded by affected countries. Cuba, like all nations, is vulnerable because the disease is delivered by migratory birds."

Effect Measure takes the story one step further in comments about information hoarding and siloing. As the AP points out, the Centers for Disease Control didn't even know the vaccine embargo is official policy. Given the nature of pandemics, which are no respecters of borders, CDC would have presumably opposed the policy on scientific grounds.

Making Flu Pay in China

Starting in 2012, Sanofi-Aventis will start selling regular flu vaccine in China from a factory it is building in the southern city of Shenzhen (the provincial capital of Guangdong, located near Hong Kong). Given the latest spate of bad news on food safety in China, there's bound to be a lot of scrutiny about on the quality of their manufacturing process--from the farms that provide the eggs for growing the virus to whatever adjuvents they may or may not use. And let's not forget Guangdong's unfortunate history with SARS.

Melamine Scandal Hits Europe

France recalls tainted sweets and biscuits from China. Between the ongoing melamine scandal and rising fuel costs, my money is on rising fuel costs to reshape the global food business. Robert J. Samuelson had a good explainer in the Washington Post last December. See also the Economist's End to Cheap Food.

New DFID Blog

There's a new blog from three intrepid field workers at the British Department for International Development. So far, it fits the anti-poverty label best but as befits folks on the ground they're not being rigid about the categories.

Worst Case Scenario

Scary thought. The U.S. Centers for Disease Control starts monitoring influenza activity in October. Imagine what would happen if the world suffered a pandemic flu in the midst of the current credit crisis.

Not saying it will happen. Just imagine it.

Makes you realize the need to continue funding global health and development initiatives in the midst of the inevitable downturn.

Not saying that will happen either.

Jobs: Global Health Policy Director

An unnamed global health non-profit with a budget of $20 million is looking for a policy director. Location: Northeastern US. Salary up to US $135,000.

Blogs, Fellowships, Rights and Global Health

Karen Grepin wants you to know about new post-doc fellowships for global health at Duke University.

Jon Shaffer explores whether healthcare is a right.

I plan to study Tara Smith's paper in PLOS Biology on "Advancing Science through Conversations: Bridging the Gap between Blogs and the Academy." I have found that the same reticence that academics have about joining the global conversation permeates the global health community as well.

How Wars End

Jeb Sharp looks at Iraq through the prism of the American Civil War, as part of her amazing radio series for PRI on "How Wars End".

This 12-minute segment blew me away. It carefully covers the ground most American kids learned in grade school and then, bam, before you know we're going from Appomattox and the American Reconstruction to reconstruction in Iraq.

Most impressive of all, it leaves you thinking, "Wow, why didn't anyone make that connection before?"

You can also read the transcript but the audio had a much greater impact on me.

Here's a taste:

Sharp: Ayers thinks the messy struggle that followed the war is one reason Americans cling to the story of Appomattox. He says the gentlemanly handshake between two great generals gives us the illusion of a clean ending.

Ayers: “We just love that story, not thinking about days after that Abraham Lincoln's assassinated, two years after that military reconstruction begins, a decade after that Reconstruction finally comes to an end. Americans are most uncomfortable with the period of Reconstruction of anything else in our history, because it's not a story, it doesn't have any kind of shape to it, it just kind of explodes.”

Sharp: After the invasion of Iraq, Ayers was dismayed that in all the public debate over post-war reconstruction in 21st century Iraq, no one bothered to look at post-war reconstruction in the 19th century American South. After all, it involved many of the same elements: military occupation, democracy-building and economic development. But administration officials and pundits alike ignored it.

Conflicting News on Malawi's Maize

Something doesn't add up. Malawi is enjoying bumper maize crops according to James Morgan at the BBC. And yet the hunger season was already starting in northern and southwestern Malawi in August when I was there.

Global Health And Polymeme

Ethan Zuckerman has put me on to an intriguing news site called polymeme.com, which uses OpenCalais to "help you discover intelligent content that lies beyond the usual echo chambers of tech news, celebrity gossip or American politics."

Although there are other compound categories like "green and energy," there is still no category for global health. Just the tried-and-true-and ultimately not very informative "health" category.

As I've written before (here, here and here), the ways the traditional media and now the cybermedia define categories means that global health often falls between the cracks.

But maybe that just means there's an untapped opportunity for enterprising global healthalites. At any rate, Polymeme is intriguing enough that I'm going to check it out over the next few days.

Wall Street Down; Africa Up?

We'll see how long this trend lasts.

"For the first time, Africa's economic growth is sustaining an upward trend amid a global economic downturn induced by the financial crisis, high fuel and commodity prices and the immediate impact of measures against climate change." (The East African)

Nobel for AIDS Virus Discovery

Bob Gallo loses out to Luc Montagnier and Francoise Barre-Sinoussi in the Nobel sweepstakes. Harald zur Hausen shared the prize for his work linking human papilloma virus to cervical cancer.

Transparency in Global Health

Is this the start of a much-needed groundswell for greater transparency and accountability in global health? Data/ONE, UK Aid Network and others have launched a campaign calling on health, development and international aid organizations to Publish What You Fund.