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Uganda revises cattle treatment to protect humans from sleeping sickness
POLICY AND PEOPLE
WHO executive board addresses poverty and bioterrorism HO plans to step up its campaign for a huge increase in health spending in developing nations, Director-General Gro Harlem Brundtland told the Executive Board meeting on Jan 14. But as well as focusing on concerns such as poverty, WHO needed to prepare for newer threats such as the deliberate use of anthrax and smallpox agents, she said. “Alert and response mechanisms still need to be strengthened, especially with respect to chemicals and threats involving the food and water supply chain”, Brundtland told the 32member board. Specifically Brundtland urged the board to recommend to May’s World Health Assembly (WHA) to retain existing stocks of the variola virus—held at the CDC in Atlanta and at a Russian facility in Siberia—until further notice. In 1999 the WHA authorised the retention of the variola virus stocks until “not later than 2002” to allow for further study into smallpox, which was declared eradicated worldwide in 1980.
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and aiming to provide vaccines to 74 poor countries “blazed a new trail”, Brundtland said. But on the Board’s sidelines, the UK’s Save the Children Fund and the London School of Hygiene and Tropical Medicine raised concerns about GAVI’s strategy and pharmaceutical company involvement. The report, New Products into Old Systems: GAVI from a country perspective, was based on research in Mozambique, Ghana, Lesotho, and Tanzania. “Ghana was given 10 days to decide whether or not to accept a new high-tech vaccine, without any evidence that it was actually needed. Their decision more than doubled the annual costs of its immunisation programme”, it said. “Although this funding gap will initially be covered by GAVI, with only 5 years of commitment from donors, the long-term sustainability of the programme is questionable”, it said. Both GAVI and the pharmaceutical industry rejected the criticism.
But in the wake of the anthrax attacks in the USA and fears that states such as Iraq or North Korea may have obtained smallpox virus samples, the Bush administration decided to keep its stocks for possible use in new vaccines or treatments. The bioterrorism scare prompted a policy rethink at WHO. As The Lancet went to press, the Board was due to endorse the recommendation of the advisory committee on variola virus research to preserve the stocks in the USA and Russia. The WHA should “review the progress of the research in 2–3 years time”. The board was also expected to back the calls of WHO’s Commission on Macroeconomics and Health for a dramatic increase in health sector spending in developing countries—US$66 billion by 2015—an investment forecast to boost economic growth six-fold (see Lancet 2001; 358: 2133). The Global Alliance for Vaccines and Immunisations (GAVI), a public-private partnership sponsored by computer software giant Bill Gates
Clare Kapp
Uganda revises cattle treatment to protect humans from sleeping sickness gandan veterinary authorities are formulating a policy to treat cattle in transit for trypanosomiasis as one of the measures to protect human beings from sleeping sickness. The Director of Animal Resources, William Olaho Mukhani, said that in areas where trypanosomiasis is endemic veterinary officials would not issue movement permits to cattle traders before their animals had been treated. Mukhani said the policy would have to go through the Cabinet for approval, a process that may take many months, but his office had already instructed veterinarians to begin the treatment immediately. “Veterinarians are already implementing it but we need to put it in a policy so that it is something binding. A policy is better so that we have something legal to fall back to”, he said. Trypanosomiasis, a disease that tsetse flies can transmit between cattle and human beings, has been endemic in southeastern and northwestern Uganda for two decades. In human beings the disease is known
as sleeping sickness while in cattle it is nagana. According to a survey done in late 2001, 8% of the cattle in southeastern Uganda have the microscopic bloodbourne parasites but many of them do not show symptoms.
Rights were not granted to include this image in electronic media. Please refer to the printed journal. More pressure on farmers?
Olaho said farmers would meet the cost of treatment. A dose costs between US$0·50 and US$1, while the unit price of mature cattle averages US$100. The pronouncement comes 4 months after the publication of a paper linking the spread of sleeping sickness in Uganda to massive restocking of cattle (see Lancet 2001; 358: 625). Since the mid-1990s traders have ferried large numbers
THE LANCET • Vol 359 • January 19, 2002 • www.thelancet.com
Panos Pictures
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of cattle from southeastern Uganda to the eastern district of Soroti. Farmers in Soroti desperately needed to buy the cattle to replace their herds that had been rustled by hostile members of the Karimojong ethnic group. But in the process they took infected cattle, which then became sources of infection for human beings. Records in the Ministry of Health indicate that for the past 3 years Soroti, which was previously free of sleeping sickness, has been reporting at least 60 cases annually. But doctors say this is an underestimate since many patients do not report to the government treatment centre. The Ministry of Health officer in charge of vector-borne diseases, Dauson Mbulamberi, welcomed the move by veterinary authorities. He said efforts by medical workers to control sleeping sickness would be frustrating without their veterinary counterparts. “When our veterinary colleagues were not with us in the field we were making very little progress in reducing the human disease”, he said. Charles Wendo
239
For personal use. Only reproduce with permission from The Lancet Publishing Group.
WHO executive board addresses poverty and bioterrorism HO plans to step up its campaign for a huge increase in health spending in developing nations, Director-General Gro Harlem Brundtland told the Executive Board meeting on Jan 14. But as well as focusing on concerns such as poverty, WHO needed to prepare for newer threats such as the deliberate use of anthrax and smallpox agents, she said. “Alert and response mechanisms still need to be strengthened, especially with respect to chemicals and threats involving the food and water supply chain”, Brundtland told the 32member board. Specifically Brundtland urged the board to recommend to May’s World Health Assembly (WHA) to retain existing stocks of the variola virus—held at the CDC in Atlanta and at a Russian facility in Siberia—until further notice. In 1999 the WHA authorised the retention of the variola virus stocks until “not later than 2002” to allow for further study into smallpox, which was declared eradicated worldwide in 1980.
W
and aiming to provide vaccines to 74 poor countries “blazed a new trail”, Brundtland said. But on the Board’s sidelines, the UK’s Save the Children Fund and the London School of Hygiene and Tropical Medicine raised concerns about GAVI’s strategy and pharmaceutical company involvement. The report, New Products into Old Systems: GAVI from a country perspective, was based on research in Mozambique, Ghana, Lesotho, and Tanzania. “Ghana was given 10 days to decide whether or not to accept a new high-tech vaccine, without any evidence that it was actually needed. Their decision more than doubled the annual costs of its immunisation programme”, it said. “Although this funding gap will initially be covered by GAVI, with only 5 years of commitment from donors, the long-term sustainability of the programme is questionable”, it said. Both GAVI and the pharmaceutical industry rejected the criticism.
But in the wake of the anthrax attacks in the USA and fears that states such as Iraq or North Korea may have obtained smallpox virus samples, the Bush administration decided to keep its stocks for possible use in new vaccines or treatments. The bioterrorism scare prompted a policy rethink at WHO. As The Lancet went to press, the Board was due to endorse the recommendation of the advisory committee on variola virus research to preserve the stocks in the USA and Russia. The WHA should “review the progress of the research in 2–3 years time”. The board was also expected to back the calls of WHO’s Commission on Macroeconomics and Health for a dramatic increase in health sector spending in developing countries—US$66 billion by 2015—an investment forecast to boost economic growth six-fold (see Lancet 2001; 358: 2133). The Global Alliance for Vaccines and Immunisations (GAVI), a public-private partnership sponsored by computer software giant Bill Gates
Clare Kapp
Uganda revises cattle treatment to protect humans from sleeping sickness gandan veterinary authorities are formulating a policy to treat cattle in transit for trypanosomiasis as one of the measures to protect human beings from sleeping sickness. The Director of Animal Resources, William Olaho Mukhani, said that in areas where trypanosomiasis is endemic veterinary officials would not issue movement permits to cattle traders before their animals had been treated. Mukhani said the policy would have to go through the Cabinet for approval, a process that may take many months, but his office had already instructed veterinarians to begin the treatment immediately. “Veterinarians are already implementing it but we need to put it in a policy so that it is something binding. A policy is better so that we have something legal to fall back to”, he said. Trypanosomiasis, a disease that tsetse flies can transmit between cattle and human beings, has been endemic in southeastern and northwestern Uganda for two decades. In human beings the disease is known
as sleeping sickness while in cattle it is nagana. According to a survey done in late 2001, 8% of the cattle in southeastern Uganda have the microscopic bloodbourne parasites but many of them do not show symptoms.
Rights were not granted to include this image in electronic media. Please refer to the printed journal. More pressure on farmers?
Olaho said farmers would meet the cost of treatment. A dose costs between US$0·50 and US$1, while the unit price of mature cattle averages US$100. The pronouncement comes 4 months after the publication of a paper linking the spread of sleeping sickness in Uganda to massive restocking of cattle (see Lancet 2001; 358: 625). Since the mid-1990s traders have ferried large numbers
THE LANCET • Vol 359 • January 19, 2002 • www.thelancet.com
Panos Pictures
U
of cattle from southeastern Uganda to the eastern district of Soroti. Farmers in Soroti desperately needed to buy the cattle to replace their herds that had been rustled by hostile members of the Karimojong ethnic group. But in the process they took infected cattle, which then became sources of infection for human beings. Records in the Ministry of Health indicate that for the past 3 years Soroti, which was previously free of sleeping sickness, has been reporting at least 60 cases annually. But doctors say this is an underestimate since many patients do not report to the government treatment centre. The Ministry of Health officer in charge of vector-borne diseases, Dauson Mbulamberi, welcomed the move by veterinary authorities. He said efforts by medical workers to control sleeping sickness would be frustrating without their veterinary counterparts. “When our veterinary colleagues were not with us in the field we were making very little progress in reducing the human disease”, he said. Charles Wendo
239
For personal use. Only reproduce with permission from The Lancet Publishing Group.