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Key Documents

Healthcare poses a complex challenge for developing countries, interweaving problems of science, health and development.

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Displaying 1-20 of 80 key documents

African AIDS vaccine programme for a coordinated and collaborative vaccine development effort on the continent

Source: PLoS Medicine

This paper, written by an international team of researchers, documents the work of the African AIDS Vaccine Programme (AAVP). It highlights the programme's impacts, successes and challenges, and looks to where the AAVP is heading.

The AAVP, supported by the WHO and UNAIDS, is a network of African HIV vaccine stakeholders that promotes a coordinated approach to developing HIV vaccines and making them available on the continent. It operates through collaborative centres located at key institutions across Africa.

Programme members work on crucial issues including regulation; ethics, laws and human rights in clinical trials; biomedical research; country-based strategic planning; and communication and media.

The authors outline the AAVP's achievements to date, highlighting its success in expanding training and infrastructure specific to HIV vaccine development. They suggest that AAVP could offer a way for African stakeholders to influence the global agenda for HIV vaccine research and development.

Expanding priorities — confronting chronic disease in countries with low income

Source: NEJM | January, 2007

Cardiovascular disease accounts for 30% of deaths worldwide and 10% of all years of healthy life lost to disease, and the figures are nearly as high in developing countries — 27 per cent and 9 per cent respectively. This compares with 10% of lives lost worldwide from HIV/AIDS, TB and malaria put together (12% in developing countries). So why have donors not invested as heavily into tackling non-communicable chronic diseases as they have with infectious ones? The authors of this article suggest several reasons: infectious diseases are in some ways easier to solve by a vaccine or drugs so it might seem sensible to use precious funding this way; Western donors may want to see epidemics contained quickly to avoid global spread; pictures of small African children dying of AIDS are more heartrending than a middle-aged man with hypertension, even if that man is supporting a large family; there is a myth that chronic diseases are more costly to prevent than infectious ones. This last issue is one that should be tackled strongly to spread awareness that low-cost methods can have an enormous effect on chronic diseases.

Therapeutic vaccination for chronic diseases: a new class of drugs in sight

Source: Nature Reviews | January, 2004

Vaccination for infectious diseases is a vital method of prophylaxis, and has transformed modern medicine. By contrast, research into vaccines against chronic diseases has been less successful, in part because of the increased complexity involved.

In this opinion piece, the authors outline the prospects for the development of chronic disease vaccines. These might not need to rely on the traditional method of inducing the body to produce antibodies, but rather on introducing monoclonal antibodies against specific proteins — this has so far worked well against Crohn's disease and rheumatoid arthritis.

The authors outline key hurdles in developing a successful therapeutic vaccine. Safety and efficacy are two obvious ones, but there is a third that is unique to vaccines for chronic diseases. Because these vaccines would block bodily chemicals — such as cytokines or hormones — it would not be acceptable for a vaccine to induce a life-long block (unlike a malaria vaccine, for example, where a lifelong block would be ideal).

These might be particularly useful in developing countries, say the authors. Because prophylaxis with vaccines is already a familiar concept, there should be no problem with patients' compliance, and judicious partnerships between public and private organisations could mean the vaccines are produced cheaply.

Wellcome Focus on antibiotic resistance

Source: Wellcome Trust | July 2005

A mix of factsheets, opinion pieces and case studies on antibiotic resistance in developed and developing countries, the publication looks at the history of antibiotics, the development of resistance and possible ways of combating it. Some of the pieces look at how medical staff cope with resistance, particularly MRSA, in hospitals. The editorial emphasises the need for consumers to play their part, and urges people not to take the benefits of antibiotics for granted. The issue of antimicrobials in animals is covered because of growing evidence that resistant bacteria can spread from animals to humans.

Antibiotic resistance in Africa: discerning the enemy and plotting a defense

Source: Africa Health | March 2003

This background piece to understanding antibiotic resistance in Africa is written in accessible language. It outlines the scale of the problem in Africa (bacterial infections cause 45 per cent of deaths) and the commonest types of infections — tuberculosis, respiratory illnesses and sexually transmitted infections.

It addresses problems of antibiotic resistance specific to African populations: the heavy burden of community-acquired infections; the limited range of first-line antibiotics and varying availability of second-line drugs (often vital against resistant bacteria); the hidden costs from longer hospital admission times and more expensive drugs needed to treat resistant pathogens.

The AIDS epidemic is linked to the problem – the HIV virus weakens people’s immune systems making them more susceptible to bacterial infection. In addition, antibiotics used prophylactically in AIDS patients to prevent opportunistic infections are also used for a wide range of bacterial infections, making it more likely that the pathogens will develop resistance.

Another problem is the sale of antibiotics by unsanctioned providers, who might give incorrect information about how to take the drugs. They frequently sell poor-quality or even counterfeit drugs that don’t cure the patient but encourage bacterial resistance.

Consumers need to be made aware of their own responsibilities, says the article, but ultimate responsibility lies with the healthcare providers in instituting and maintaining treatment programmes.

WHO factsheet on antimicrobial resistance

Source: WHO | January 2002

The factsheet outlines the problem of antibiotic resistance detailing the causes, consequences and factors that encourage the spread of resistance. It is ideal for people wanting a snapshot of the problem from WHO's perspective, although for more detailed information see the WHO global strategy for containment of antimicrobial resistance.

International Compilation of Human Subject Research Protections

Source: Office for Human Research Protections, U.S. Department of Health and Human Services | 2007

This Compilation lists the human subjects research legislation, regulations or guidelines for 79 countries, the European Union and the Commonwealth of Independent States, and several international organisations. It was developed for IRBs/Ethics Committees, researchers, funding agencies and others involved in international research with the aim of helping these groups familiarise themselves with the laws, regulations and guidelines of countries in which research will be conducted. A description of the methods used to collect and update the information is included.

Lancet special issue on HIV/AIDS

Source: The Lancet | August 2006

This special issue is a large collection of opinion pieces, research and review articles, and news features that highlight the advances in knowledge and challenges to the treatment and prevention of HIV/AIDS, including articles on randomised trials of promising HIV drugs.

It also includes a look at the preventive potential of microbicides and prophylactic HIV drugs. Another key issue covered is the patients' right to access to HIV treatment, and the barriers to treatment that people face if they are migrants or from socially excluded groups such as injecting drug users.

One weapon that those fighting HIV long for is an effective vaccine, and researchers outline the scientific and policy challenges of developing an HIV vaccine. The issue of paediatric HIV/AIDS cases is also discussed.

H5N1 avian influenza: timeline of major events

Source: World Health Organization | April 2007

This timeline details reported cases of bird flu in both animals and people from the first recording of the virus in China's Guangdong Province in 1996 onwards.

The document also highlights milestones in bird flu research, such as the October 2005 finding that the deadly 1918 pandemic virus shares characteristics with the H5N1 virus, and the March 2006 research that explains why H5N1 does not yet easily infect people.

The timeline also shows the geographical spread of the virus from Asia — especially South-East Asia — through central Asia, Europe, the Middle East, and Africa. The timeline is periodically updated — check the World Health Organization's avian influenza website for the latest version.

The knowledge basis of Africa – Status and perspectives

Source: Globelics | 2005

This paper maps African countries' knowledge base through patent applications and publications. It shows South Africa as academically, and technically, the strongest country of the continent. The number of publications is growing in other African countries, but patenting remains limited all-round.

The paper ends on a positive note, arguing that African countries already possess the basis for knowledge-driven development.

CDC Q&A on bird flu

Source: Centers for Disease Control and Prevention | 2006

This set of questions and answers, prepared by the US Centers for Disease Control and Prevention (CDC), focuses on the threat that bird flu poses to public health. It also covers the spread of avian influenza in birds and other animals. The questions cover symptoms of infected birds and humans, and how to protect people against infection. They also outline factors that could trigger an influenza pandemic, and the measures needed to prepare for it.

CDC bird flu factsheet

Source: Centers for Disease Control and Prevention | February 2006

This fact sheet was prepared by the Centers for Disease Control and Prevention (CDC), which is part of the US government's Department of Health and Human Services. It gives some good background information about flu viruses and virus subtypes, putting the H5N1 virus strain into context. It also briefly outlines the threat bird flu poses to human health, and the status of research into drug treatments and human vaccines.

WHO avian influenza factsheet

Source: World Health Organization | February 2006

Compiled by the World Health Organization (WHO) media centre, this fact sheet provides an overview of avian influenza in birds and humans. It explains why H5N1 is of particular concern, how it affects birds, and the role that migratory fowl play in spreading the disease, before focusing on the implications for human health. Its extensive section on the clinical symptoms of H5N1 in humans was produced with input from physicians with experience of treating patients.

Despite containing some clinical terms, it is easy to read, and would be useful to anyone wanting a comprehensive summary of the threat that bird flu poses to human health. It is also available in Arabic, Chinese, French, Russian and Spanish.

Intellectual property, Intellectual Property, Drug Regulation, and Building Product Innovation Capability in Biotechnology: The Case of Hepatitis B Vaccine in Korea

Source: Innovation Strategy Today | 2005

This paper analyses the development of South Korea's hepatitis B vaccine industry. In particular, it examines how intellectual property and drug and vaccine regulations affected the industry's development.

Growth of South Korea's hepatitis B vaccine industry was supported by joint ventures allowing the acquisition of foreign knowledge, the potential market for the vaccine and the availability of skilled manpower. Also vital to the process were improvements in South Korea's regulations, which brought them more into line with international standards. The authors show that South Korea's success has policy implications for other countries. To reach the higher stages of innovative development in the biomedical industry, they say, developing countries examine R&D in the public and private sectors, high manufacturing standards, national and international distribution systems, intellectual property systems and regulatory systems.

Susceptibility of Plasmodium falciparum to antimalarial drugs

Source: WHO | September 2005

In this report, the World Health Organization (WHO) warns that vigilance is needed to prevent drug-resistant malaria arising from the widescale introduction of artemisin combination therapies (ACTs) for malaria. More than 50 countries have now adopted ACTs, and they must closely monitor the effectiveness of these drugs and check for the emergence of resistance, the report concludes. Patients should receive only WHO-approved high-quality medicines to minimise the risk of resistance emerging, and should be encouraged to complete their treatment courses. The report outlines the WHO's commitment to helping establish stardardised laboratory procedures, and strengthening resistance monitoring networks.

The Causes and consequences of HIV evolution

Source: Nature Reviews Genetics | January 2004

This review, although aimed primarily at a scientific audience, is a clearly written account of how HIV is believed to have evolved over the past 40 or so years since its spread to humans from apes. The authors argue for the importance of widespread monitoring of how HIV continues to change genetically, as it moves from person to person and within infected individuals, so as to help control drug resistance and design effective vaccines against HIV.

South Africa — blazing a trail for African biotechnology

Source: Nature Biotechnology | October 2004

Based on data from 28 interviews among scientists, this commentary describes in clear terms how the health biotechnology industry is thriving in South Africa, nurtured by a confidence among scientists that arose originally with the development of mining and arms industry during the apartheid regime. With the emphasis on serving local needs, particularly the development of new drugs and vaccines for HIV/AIDS, South Africa is providing a shining example of how other developing countries can follow suit.

Integrating HIV testing into immunological studies of non-HIV-related diseases

Source: Nature Immunology | May 2005

This Commentary describes the increasing ethical dilemmas now being faced by researchers in areas with high incidence of HIV/AIDS, as they investigate immune responses to non-HIV/AIDS diseases such as malaria. Studies of immune responses require an HIV test to check whether the research volunteer is likely to have impaired immunity, which means that clear ethical guidelines are now needed to govern whether or not such research programmes need to include provisions for voluntary counselling and testing, and other services for HIV/AIDS treatment and care.

Introducing new vaccines into developing countries: obstacles, opportunities and complexities

Source: Nature Medicine | April 2005

With over 350 vaccine candidates against 88 different pathogens, including HIV, now in development in academia and industry, this commentary, written for a broad audience, provides a broad overview of the current trends that will determine which candidates are most likely to reach the poor in developing countries. These include obstacles such as poor vaccine coverage with existing vaccines and a skewing of the vaccine industry away from producing vaccines against diseases that predominantly affect poor developing nations, and new organisations, funding initiatives and incentives, such as public private partnerships, that are now helping to overcome these obstacles.

Antiretroviral treatment for HIV infection in developing countries: an attainable new paradigm

Source: Nature Medicine | December 2003

This commentary outlines in clear terms the justification for making antiretroviral drugs accessible on a large scale in developing countries, noting particularly that antiretroviral drugs are now affordable, available, and cost-effective when provided in conjunction with prevention measures, and that viral resistance can be controlled.

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