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Humanity Will Continue to Live an Inferior Life Than What is Possible Until the Two Halves: All Individuals in Them: That Make It are Absolutely Fundamentally and Jubilantly Equal at Liberty
 

 

Year Gamma: London: Wednesday: October 18: 2017
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Dr Margaret Chan: Director-General of the World Health Organisation July 2006- June 30: 2017
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

|| June 30: 2017 || ά. Today is the last day that she is spending at the WHO Headquarters bidding goodbyes and saying thank yous and picking little things and a card or two, a little gift here and a little something there and soon it will be time to take leave. And there will be suppressed tears and broken voices being dictated to settle quickly. Dr Margaret Chan finishes her second term as the Director-General of the World Health Organisation today. The Humanion wishes her and her family well and hopes, as the following piece suggests, that the World and the World Community will find a role for her to play for the world and world humanity in the future. For what is most important to remember is not just what she has been able to do over the last ten years but what that ten years have taught her and how that has made her millions times more capable, more wise, more insightful, more skilled and more determined to seek and strive without ever having to just simply give up, than how she was, despite being a most capable professional, a pioneer-leader in her field, when she had gone to start her first day of the fist term as Secretary-General of WHO. And all that she has learnt and become cannot simply be let go for the World an World Humanity will get infinitely benefitted by that what Dr Chan has learnt and become over the those ten years of wonderful service to the world and world humanity. The Humanion: June 30: 2017

 

 

 

 

 

 

 

 

 

 

 

 

 


 

The Humanion The World Must Create a New Role for This Dr WHO: For Dr Margaret Chan as She Takes Leave After Leading the World Health Organisation for Ten Years: She Has Not a Role But a Home at The Humanion

|| May 22: 2017 || ά. This was first published on World Malaria Day 2017, April 25: Today is World Malaria Day. The World Health Organisation: WHO has published the chapter on Malaria from the Director-General of the Organisation, Dr Margaret Chan's Report Ten Years in Public Health 2007-2017. The Humanion publishes it as a tribute to the ten most challenging but equally most-high-achieving years in the history of the World Health Organisation and of the World, led by Dr Margaret Chan. And as a call for the world to not become complacent and carry on the fight against Malaria until it is defeated fully and for good. Dr Chan will end her term this year, which will be soon. Here, as before, The Humanion reiterate its call upon the World and the World and International bodies to not let go of Dr Chan and must find a sphere and space for her to continue the works she has been doing in the last ten years.

May be it is time, Dr Chan is given a new international role, the role, that does not exist yet. The Humanion calls upon the UN Secretary-General, the UN itself as well as all other Major World Bodies Such as the European Union, African UNION, ASEAN, OPEC and Including all the Major International and World Banks and Agencies to combine forces and Create a New Position, combining the Sustainable Development Goals, Health Inequalities and Ending Hunger, Malnutrition and Poverty as well as Advancing Women's Rights and Economic and Educational Empowerment. These are all areas where Dr Chan has developed into but could not do much for mostly they went outside her direct bound from a WHO-perspective. The world must create a position and space to not to let go of Dr Chan for she has too much to give to the World and World Humanity. Readmore

 

Dr WHO: Dr Margaret Chan at the 70thh Annual World Health Assembly 2017: May 22-31



|| May 22: 2017 || ά. Dr Margaret Chan, the Secretary-General of the World Health Organisation:WHO has addressed, for the last time as the Head of the Organisation, the 70th Annual World Health Assembly, that is taking place on May 22-31 at the Palais des Nations in Geneva, Switzerland. In her speech, Dr Chan said: Madame President, Excellencies, honourable ministers, ambassadors, distinguished delegates, friends and colleagues, ladies and gentlemen: I thank Member States for the trust shown when you appointed me as your Director-General more than ten years ago. I promised to work tirelessly, and have done so, but never got tired of the job, in the best and worst of times.

When I took office, I also promised that I would hold myself accountable for the Organisation’s performance. This month, I have issued a report tracking how public health evolved during the ten years of my administration. The report sets out the facts and assesses the trends, but makes no effort to promote my administration. The report goes some way towards dispelling the frequent criticism that WHO has lost its relevance. The facts tell a different story. The report covers setbacks as well as successes and some landmark events. Above all, it is a tribute to the power of partnerships and the capacity of public health to take solutions found for one problem and apply them to others.

As just one example, it took nearly a decade to get the prices for antiretroviral treatments for HIV down. In contrast, thanks to teamwork and collaboration, prices for the new drugs that cure hepatitis C plummeted within two years. This is the culture of evidence-based learning that improves efficiency, gives health efforts their remarkable resilience, and keeps us irrepressibly optimistic. We falter sometimes, but we never give up. Excellencies, ladies, and gentlemen, As I speak to you, the political and economic outlook is much less optimistic than it was when I took office in 2007.

That was before the 2008 financial crisis changed the economic outlook from prosperity to austerity almost overnight, with effects on economies and health budgets that are still being felt. That was before acts of international terrorism and violent extremism became commonplace, before the word “mega-disaster” entered the humanitarian vocabulary, before seemingly endless armed conflicts caused the largest population displacements and flights of refugees seen since the end of World War II.

That was before the alarming frequency of attacks on health facilities and aid convoys made a mockery of international humanitarian law. We condemn all these attacks on health care facilities and workers. According to reports consolidated by WHO, more than 300 attacks on health care facilities occurred in 2016 in 20 countries, with the majority documented in the Syrian Arab Republic.
We are also seeing how a world full of threats can toss out deadly combinations, like the dual threats from drought and armed conflict that have brought famine to parts of Africa and the Middle East on a scale never experienced since the United Nations was founded in 1945.

The world was fortunate that the 2009 influenza pandemic was so mild. The world is fortunate that the new viruses that emerged to cause MERS in 2012 and human cases of H7N9 avian influenza in 2013 are not yet spreading easily from person to person. But they have the potential to do so and we dare not let down our guard. The world was less fortunate with Zika, an outbreak that WHO continues to monitor closely. The world was not at all fortunate with the 2014 Ebola outbreak that utterly devastated the populations of Guinea, Liberia, and Sierra Leone. This was West Africa’s first experience with Ebola, and the outbreak took everyone, including WHO, by surprise.

WHO was too slow to recognize that the virus, during its first appearance in West Africa, would behave very differently than during past outbreaks in central Africa, where the virus was rare but familiar and containment measures were well-rehearsed. But WHO made quick course corrections, brought the three outbreaks under control, and gave the world its first Ebola vaccine that confers substantial protection. This happened on my watch, and I am personally accountable.

I saw it as my duty, as your Director-General, to do everything possible to ensure that a tragedy on this scale will not happen again. History will judge whether the new emergencies programme has given the world a stronger level of protection. Ultimately, health systems with International Health Regulations core capacities must be strengthened in your countries to detect unexplained deaths much earlier. This is critical for improving global health security to protect our common vulnerability.

Last week, the Democratic Republic of Congo confirmed a new Ebola outbreak near the border with the Central African Republic. This is the country’s eighth Ebola outbreak. In its last outbreak, which coincided with the West Africa outbreak, DRC interrupted transmission within six weeks. Despite enormous logistical challenges, discussions engaging DRC continue about possible use of the new vaccine to augment the response.

The Ebola outbreak in West Africa had a number of spillover effects which can be judged more immediately. During the outbreak, WHO acquired extensive experience in facilitating R&D for new medical products, but poor coordination lost too much time. To speed things up, WHO and its partners finalized an R&D blueprint in 2016.

By setting up collaborative models, standardised protocols for clinical trials, and pathways for accelerated regulatory approval in advance, the blueprint cut the time needed to develop and manufacture candidate products from years to months. The expert consultations that designed the blueprint led to the establishment of the Coalition for Epidemic Preparedness Innovations, announced in January 2017 with initial funding of nearly $500 million.

The Coalition is building a new system to develop affordable vaccines for priority pathogens, identified by WHO, as a head-start for responding to the next inevitable outbreak. The world is better prepared but not nearly well enough.

Excellencies, ladies, and gentlemen: The relevance of WHO’s work is demonstrated in many ways, some more visible than others. The chronology of the HIV, tuberculosis, and malaria epidemics shows direct links between WHO changes in technical strategies and turning points in the disease situation. WHO also made scientific breakthroughs more democratic by translating findings into a public health approach that works everywhere, even in extremely resource-constrained settings.

Relevance is readily apparent when WHO endorses a new medical product, and partners find ways to fund it, or issues a position paper on a new vaccine. Many national immunization programmes will not introduce a new vaccine until WHO has issued its formal seal of approval. Such approval triggers actions by Gavi, the Vaccine Alliance, to scale up access dramatically.

The prequalification programme is now firmly established as a mechanism for ensuring that the quality, safety, and efficacy of low-cost generic products match those of originator products. For example, by the end of 2016, WHO had prequalified more than 250 finished pharmaceutical products for treating HIV-related conditions. This stretches the impact of funding agencies, like the Global Fund, in significant ways.

The relevance of WHO was most dramatically demonstrated during last month’s global partners meeting on the neglected tropical diseases. Participants assessed, and celebrated, ten years of record-breaking progress that promises to eliminate many of these ancient diseases in the very near future. This is one of the most effective global partnerships, also with industry, in the modern history of public health.

The fact that, in 2015, nearly one billion people received free treatments that protect them from diseases that blind, maim, deform, and debilitate has little impact on the world’s geopolitical situation. The people being protected are among the poorest in the world. But judging from the massive amount of media coverage, which included entry into the Guinness World Records for the most medication donated, this was a success story that the world was hungry to hear.

Less visible relevance comes from the way WHO has built a safety net that encircles the globe in the form of thousands of laboratories specialized in the surveillance and diagnosis of priority pathogens, hundreds of collaborating centres, and a vast network of scientific boards and strategic advisory groups. I thank the scientific institutions in your countries for contributing to the work of WHO. No other health agency has this degree of technical expertise ready-to-hand.

Excellencies: The resolutions you adopt also shape the health situation, especially by raising the profile of neglected problems. For example, the comprehensive mental health action plan, adopted in 2013, definitively took mental health out of the shadows and into the spotlight. Likewise, beginning in 2010, viral hepatitis appeared as a stand-alone agenda item at three sessions of the World Health Assembly, contributing greatly to the international priority now given to this disease.

But the strongest call for action comes from high-level political commitment. This happened in 2011, when the United Nations General Assembly adopted a political declaration on noncommunicable diseases and again in 2016, when a political declaration gave full attention to antimicrobial resistance. Both political declarations responded to a crisis in ways that triggered broad-based urgent action to find solutions.

Excellencies, ladies, and gentlemen: I regard the 2010 World Health Report, on Health systems financing: the path to universal coverage, as the most influential publication issued during my administration. It launched what is now a movement towards universal health coverage and inspired the 2012 UN General Assembly resolution that paved the way for inclusion of UHC in the Sustainable Development Goals. Our actions under the 2030 Agenda for Sustainable Development must be guided by the 5 Ps: people, planet, peace, prosperity, and partnership.

The recommendations that I most want to see implemented are those made by the Commission on Ending Childhood Obesity. Childhood obesity is the most visible, and arguably the most tragic, expression of the forces that are driving the rise of NCDs. It is the warning signal that bad trouble, in the form of more heart disease, cancer, and diabetes, is on its way. The initiatives we all most want to succeed are those for the eradication of polio and guinea worm disease. For both, the world has never been so close. We must keep up our efforts to make eradication a reality.

The trend that most profoundly reshaped the mind-set of public health was the rise of chronic noncommunicable diseases. This shift in the disease burden called for a move away from the biomedical model of health and its emphasis on curing diseases to a much broader approach based on prevention.

I regard Every Woman Every Child as the most game-changing strategy during my administration. Its adoption by the UN in 2010 captured financial support in the billions of dollars and launched a number of initiatives aimed at implementing its recommendations. Maternal and child deaths dropped dramatically.  The related WHO Commission on information and accountability for women’s and children’s health added greatly to the culture of measurement and accountability. As set out in this year’s World Health Statistics report, nearly half of all deaths worldwide now have a recorded cause of death. This is huge progress. I thank all countries that have made a special effort on this front.

The most contentious issue was access to medicines, especially when intellectual property and the patent system were perceived as barriers to both affordable prices and the development of new products for diseases of the poor. The negotiations that led to the establishment of the Pandemic Influenza Preparedness Framework were tense, to say the least, but ultimately successful, as were those that led to the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property.

Fortunately, several new initiative and public-private partnerships are contributing to both objectives. One example is the new Global antibiotic research and development partnership, launched last year by WHO and the Drugs for neglected diseases initiative:DNDi. This is a needs-driven R&D initiative initially focused on the development of new antibiotics for treating sepsis and sexually transmitted infections, most notably gonorrhoea. The partnership aims to promote access and to ensure that prices are affordable.

Earlier this month, WHO announced the launch of a pilot project for prequalifying biosimilar medicines, a step towards making expensive cancer treatments more widely available. WHO is also working with partners on a model for the fair pricing of pharmaceuticals. The rationale is obvious: universal health coverage depends on affordable medicines. No country on this planet can hope to treat its way out of all the diseases affecting their populations.

Excellencies, ladies, and gentlemen: I will conclude with some brief advice that you may wish to consider as you continue to shape the future of this Organisation. WHO stands for fairness. Continue to make reductions in inequalities a guiding ethical principle. What gets measured gets done. Continue to strengthen systems for civil registration and vital statistics and continue to make accountability frameworks an integral part of global health strategies. Scientific evidence is the bedrock of policy. Protect it. No one knows whether evidence will retain its persuasive power in what many now describe as a post-truth world.

Vaccine refusals are at least one reason why the tremendous potential of vaccines is not yet fully realized. The current measles outbreaks in Europe and North America should never have happened. Push for innovation. Meeting the ambitious health targets in the Sustainable Development Goals depends on innovation. Innovation that uses country experiences can be frugal and transformative. For example, the R&D partnership that gave Africa its meningitis A vaccine has transformed the lives of millions of people.

Safeguard WHO’s integrity in all stakeholder engagements. The Framework for engagement with non-state actors is a prime instrument for doing so. Many other UN agencies are following WHO’s lead with this framework. While ministries of health are our principle partners, the multiple determinants of health demand engagement with non-health sectors, communities, and partners, businesses, and civil society organizations.

Listen to civil society. Civil society organisations are society’s conscience. They are best placed to hold governments and businesses, like the tobacco, food, and alcohol industries, accountable. They are the ones who can give the people who suffer the most a face and a voice. Above all, remember the people. Behind every number is a person who defines our common humanity and deserves our compassion, especially when suffering or premature death can be prevented.

Excellencies, ladies, and gentlemen: This is the last time I will address the World Health Assembly. I thank Member States for the privilege and honour of serving this Organisation. I have done so with humility, but also with great pride. I thank my Regional Directors for their wise counsel and their support for WHO reform and my wonderful staff at headquarters, in the regional offices and in countries, where the impact of our work matters most. Last but not least, I thank my husband, David and my family for love and support. David, thank you for listening. Thank you.
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Whatever Your Field of Work and Wherever in the World You are, Please, Make a Choice to Do All You Can to Seek and Demand the End of Death Penalty For It is Your Business What is Done in Your Name. The Law That Makes Humans Take Part in Taking Human Lives and That Permits and Kills Human Lives is No Law. It is the Rule of the Jungle Where Law Does Not Exist. The Humanion

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Dr WHO: A Dr Margaret Chan Leading the World Offensive Against Malaria: A Decade of Malaria Retreating: But It Must Be Made Run Faster to Hide Without Finding a Hiding Place


|| April 25: 2017 || ά. Today is World Malaria Day. The World Health Organisation: WHO has published the chapter on Malaria from the Director-General of the Organisation, Dr Margaret Chan's Report Ten Years in Public Health 2007-2017. The Humanion publishes it as a tribute to the ten most challenging but equally most-high-achieving years in the history of the World Health Organisation and of the World, led by Dr Margaret Chan. And as a call for the world to not become complacent and carry on the fight against Malaria until it is defeated fully and for good. Dr Chan will end her term this year, which will be soon. Here, as before, The Humanion reiterate its call upon the World and the World and International bodies to not let go of Dr Chan and must find a sphere and space for her to continue the works she has been doing in the last ten years.

May be it is time, Dr Chan is given a new international role, the role, that does not exist yet. The Humanion calls upon the UN Secretary-General, the UN itself as well as all other Major World Bodies Such as the European Union, African UNION, ASEAN, OPEC and Including all the Major International and World Banks and Agencies to combine forces and Create a New Position, combining the Sustainable Development Goals, Health Inequalities and Ending Hunger, Malnutrition and Poverty as well as Advancing Women's Rights and Economic and Educational Empowerment. These are all areas where Dr Chan has developed into but could not do much for mostly they went outside her direct bound from a WHO-perspective. The world must create a position and space to not to let go of Dr Chan for she has too much to give to the World and World Humanity.

And she has so much to work for and inspire the world's women, particularly, the younger generations. Call that position or office what you may, but Dr Margaret Chan has shown, she has the 'powers' of a 'Dr Who' because she believes in making a difference and in the fact that we can and must seek to make a difference. Call her whatever you may, call her the Change Maker, the Imaginactioneer, the Voice of the Voiceless Multitude. Such a voice the world and world humanity need to speak for them in the areas we have mentioned.

And add to all these organisations, a collective of countries made of, say, Australia, Brazil, China, France, Germany, India, Japan, United States of America, United Kingdom and Russia or invite the entire G8 and G20, who may be invited and encouraged to offer an initial goodwill fund to this new initiative, which is essentially a development fund with specific areas of action, with set objectives, that are absolutely short term in terms of completion but long term in terms of their impacts and roles in the locality. Nothing is impossible but so much desperation cannot just be left to continue to cause havoc and suffering to millions of lives.

And how would this office work? It will take a block of countries, the poorest and work with these countries, their governments, parliaments and the entire civil societies and support them in these areas, identifying the most urgent tasks, targeting the most pressing areas and initiate actions from all concerned. This work will be done in a three-year period, for which a set of objectives will have been set at the beginning, against which, the three years' success will be measured. So that that it continues to work with one block of countries, achieve sustainable change and results and leaving the countries with the momentum the office goes to the next block of countries.

An example, say, country A Block: to have enough primary schools established so that all primary age children have a school to go to. How much money that requires in all aspects of the project, not just the building of the schools, how much the government can afford to invest in this project, how much the civil society can generate from within the countries, how much existing international funding can be made available to this project from the parts of these governments, how much more is needed and how much this office can offer and how much it can seek to generate from the international arena. Put all that into action and at the end of the three year period, the countries will have all the necessary primary schools done and ready to enrol chilren.

Further, this office is the main 'spending' authority of these projects, meaning corruption is beyond reach of these funds. All the funds committed from within a country, including the government's investment comes to this office, from which payments are made by this office. This essentially means an ad-hoc UN-backed little portable government has been set up within these countries with the active support, participation, engagement and involvement of the governments of these countries. It exists in a set of countries, within the set time frame, with its set out objectives and it seeks to achieve these and having done so leaves to another place to do the same with, by and for them. Every three years, this office achieves some tangible, real and evident results, that will continue to make and effect positive change.

And despite the complex organisation of setting it up, officially, it is a UN office, supported by all the UN mechanisms so that its legitimacy, authority and command is beyond doubt and its management systems must be absolutely transparent: in short, every penny spent must the capable of being shown to have been done so, where, how, when, why with evidence. ω.

Whatever Your Field of Work and Wherever in the World You are, Please, Make a Choice to Do All You Can to Seek and Demand the End of Death Penalty For It is Your Business What is Done in Your Name. The Law That Makes Humans Take Part in Taking Human Lives and That Permits and Kills Human Lives is No Law. It is the Rule of the Jungle Where Law Does Not Exist. The Humanion

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Dr Margaret Chan on the World Malaria Day: April 25: Malaria: Retreat of a Centuries-Old Scourge

|| April 25: 2017: Dr Margaret Chan Writing || ά. On the World Malaria Day, today, the World Health Organisaiton:WHO has published the chapter on malaria from Dr Chan's Report Ten Years in Public Health 2007-2017: Energised in 2007 by a call for malaria eradication, the world united around a new agenda to control and eliminate this ancient scourge. Better drugs and diagnostics emerged, and WHO-driven policies led to free insecticide-treated bed nets, prequalification of new drugs and treatment only after diagnosis to prevent drug resistance. Malaria deaths dropped 62% from 2000 to 2015, and WHO set an ambitious global technical strategy for malaria through 2030, built from the efforts of more than 400 experts from 70 countries.  In 1969, the World Health Assembly adopted a carefully worded resolution that effectively ended the Global Malaria Eradication Programme launched in 1955.

While long-term plans for malaria eradication were kept on the table, the resolution frankly admitted the failures and setbacks encountered during implementation of the global eradication strategy and shifted the responsibility for moving forward to national public health organizations. The campaign succeeded in eliminating malaria from many parts of the world, but no major gains were made in sub-Saharan Africa, the historical heartland of this disease. The goal of defeating malaria was replaced by the more realistic ambition of holding the disease at bay. In Africa, the malaria situation deteriorated to the point that its only positive feature was stability: things could hardly get any worse.

Interest in malaria control revived in 1992, when the government of the Netherlands hosted a ministerial conference on malaria, co-sponsored by WHO. The conference, attended by senior health leaders from 65 countries, aimed to map out plans for a renewed assault on malaria that acted on lessons from the past. Participants at the conference regarded the fight against malaria as a fight against poverty that demanded better coverage with essential health services. In Africa, WHO estimated that malaria killed one out of every 20 children in rural areas before their fifth birthday and was the most prevalent illness in young adults, sapping productivity and eroding prospects for development. The conference adopted a World Declaration on the Control of Malaria, which was endorsed by the World Health Assembly the following year.

The window of political will and financial resources began to open when WHO established the Roll Back Malaria partnership in 1998, with the goal of cutting malaria deaths in half by 2010. The window opened even wider in 2000, when targets for turning the malaria epidemic around were included in the Millennium Development Goals. However, midway into Roll Back Malaria’s drive, signs were clear that its targets would be missed by a longshot.

By 2004, the malaria burden was still expanding as the biggest obstacle to development in a large number of countries, especially in sub-Saharan Africa. In that part of the world, only 02% of children were sleeping under an insecticide treated net. Though childhood deaths from other causes were declining, deaths from malaria were rising.

Malaria parasites had again exercised their uncanny ability to develop resistance to virtually any single chemotherapeutic agent administered on a large scale. Drug-resistant strains of Plasmodium falciparum, which causes the most lethal form of the disease, had swept through the African continent, rendering the first-line treatment, chloroquine, nearly useless. The newer artemisinin-combination therapies were highly effective but, at twenty times the price of older drugs, were beyond the reach of most national control programmes. Despite the renewal of ambitious targets, the overall situation looked bleak.

By 2006, the numbers were large, round, and deeply familiar: 3 billion people at risk in 109 malarious countries and territories and around 266 million cases annually, leading to nearly 750 000 deaths. Unrealistic goals?

In October 2007, malaria experts were stunned when, at a malaria forum in Seattle, Washington, Bill and Melinda Gates uttered a forbidden word in back-to-back speeches calling for the eradication of malaria. The WHO Director-General stepped up to support that goal, further fanning the shockwaves. Reactions were sharply divided. Some cautioned against setting unrealistic goals that were doomed to crash and burn in the absence of new breakthrough tools, most notably a vaccine.

Others pointed to recent reductions in malaria cases and deaths of 50% and even higher in a handful of African countries with small populations and excellent coverage with available interventions. That, they said, was evidence of what could be achieved with existing tools. They argued for elimination goals in groups of neighbouring countries that could gradually shrink the malaria map.

As they further argued, more ambitious coverage targets could bring a more ambitious R&D agenda in their wake, especially if supported by the deep pockets of the Bill and Melinda Gates Foundation. Contrary to the expectations of many, that was precisely what began to happen.  A move towards more ambitious coverage turned out to be the preferred way forward for governments in endemic countries, WHO, and the many international partners joining the malaria assault. The will to tackle malaria now had a focused goal: a massive scale up of existing interventions, and most especially, of coverage with insecticide treated nets. In 2008, the UN Secretary-General called for universal access to malaria interventions.

As malaria in Africa affects the poorest of the poor, often living beyond the reach of formal health services, efforts to scale up coverage began with a paucity of reliable data to pinpoint hotspots, assess the effectiveness of different interventions, and establish benchmarks for measuring progress. Nonetheless, some tantalizing evidence was beginning to emerge.

In 2008, WHO recommended that insecticide treated nets be distributed at heavily subsidized prices or no cost to users and on a massive scale. That recommendation ended a long debate. One side argued that the best route to sustainable supplies was through local manufacturing, with nets sold at a subsidized price. Besides, as the argument went, people tended to value and use correctly items for which they had to pay. The other side argued that, for people mired in poverty, no price, however low, was affordable. Nets must be distributed at no cost.

WHO’s recommendation for massive free distribution of nets coincided with two welcome trends. First, more and more African heads of state were taking charge of the malaria response, sometimes leading to an elimination effort in groups of neighbouring countries. Second, the money was rolling in. International funding commitments for malaria control increased from around $300 million in 2004 to $1.7 billion in 2009, largely from such sources as the Global Fund, the World Bank Booster Programme, the US President’s Malaria Initiative, and other agencies.

But national and international efforts still had a very long way to go. As set out in the 2008 World Malaria Report, surveys showed that supplies of insecticidal nets were sufficient to protect only around 26% of people in 37 African countries. Even worse, only 3% of children with fever were being treated with artemisinin-combination therapy. The impact of policy coherence

With massive scale up of coverage with free insecticidal nets now an agreed programmatic goal, the dam broke. Within a year, sufficient insecticidal nets had been delivered to protect nearly 580 million Africans. An estimated 75 million Africans living in high transmission zones were further protected by indoor residual spraying. The trend continued. WHO estimated that the number of nets procured in just the two years between 2008 and 2010 was sufficient to protect 73% of the 800 million people considered at risk.  Access to diagnostic tests was also rapidly growing, especially following the advent of rapid tests that could quickly detect malaria right down to the community level.

To direct this rapid growth towards the selection of quality-assured products, WHO established a testing programme in 2008 to determine the comparative reliability of new tests coming on the market. A detailed checklist to aid procurement was also introduced to add another layer of quality control. Again, the results were impressive. At the turn of the century, fewer than 5% of suspected malaria cases reported in Africa were confirmed by a diagnostic test. By 2010, the worldwide figure had grown to 76%, with the largest increase in sub-Saharan Africa.

By 2010, the situation had improved so much that WHO could issue a new policy recommendation: treatment should be given to suspected malaria cases only after a diagnostic test had confirmed infection. That policy change had three dimensions. First, by ending the blanket administration of artemisinin-combination therapy to every child with a fever, WHO hoped to reduce selective pressure on the parasite and thus delay the development of resistance. Second, excluding malaria in children with fever would increase the prospect of prompt and effective treatment for the many other common diseases that killed young children in Africa. Finally, the recommendation was made feasible by some very good news: most cases of childhood fever, even in Africa, were no longer caused by malaria.


The impact of all these improvements was dramatic. By 2010, reductions in malaria cases of more than 50% were being reported in 43 of the 99 countries with ongoing transmission, with downward trends recorded in an additional 8 countries. The epidemic’s iron brake on African development that had stubbornly persisted for centuries was losing its grip.

WHO strengthened its policy-making architecture even further. In 2010, WHO initiated an extensive review of its policy-making process for malaria control and elimination. The aim was to establish a more rigorous, efficient, and transparent process that would allow for timely responses to the ongoing challenges faced by national malaria programmes.

Following the recommendations of an external advisory group, a Malaria Policy Advisory Committee was established in 2011 to provide independent advice to WHO on all policy areas related to malaria control and elimination. This strengthened policy-setting architecture repositioned WHO as the credible international public health authority on malaria policy, guidance, and technical support in malaria-endemic countries.

Since establishment of the new architecture, WHO has issued more than 15 policy recommendations on issues ranging from the use of seasonal malaria chemoprevention in the Sahel sub-region in Africa, to advice on how to estimate the longevity of insecticidal nets, to a warning about the risks of scaling back vector control in areas where transmission has been reduced.  By 2010, the world had embraced an ambitious plan for scaling up malaria control that progressed towards country-by-country and regional elimination, with the ultimate goal of global eradication. A meeting was held in Washington, DC to refine a research agenda to underpin the eradication goal.

Participants agreed on a multi-pronged approach that included health systems, operational research, and monitoring and evaluation in addition to the basic and applied sciences. A false assumption that the epidemiology and pathophysiology of malaria were fully understood contributed to the failure of the first eradication effort. Scientists were determined to get things right this second time around.

The meeting was attended by the WHO Director-General, who had argued for more aggressive malaria control since the start of her administration. In her remarks at the close of the week-long event, Dr Chan thanked participants for putting so much smart science in the service of a disease that affects the very poor, but reminded them that no single technical breakthrough in any single area would be sufficient to eradicate a disease as complex and tenacious as malaria.

Even a highly effective vaccine, she said, would need to be supported by the simultaneous use of drugs, vector control, and good monitoring and evaluation delivered by well-performing health systems. Good will – and innovation – kick in

Public health is replete with good will and a creative desire to innovate, especially when doing so might change a situation where a child was dying from malaria every second of every day. In 2008, the UN Secretary-General appointed Ray Chambers, an American business entrepreneur, philanthropist, and humanitarian, as his first Special Envoy for Malaria. Articulate and compelling, Mr Chambers undertook his role with passion, contributing to the visibility of malaria, understanding of its impact, and above all the need for funding. Also in 2008, at the request of its Member States, WHO launched the first of what would become annual World Malaria Days as awareness-building events.

Part of that awareness was a keen appreciation of the need for new tools. Several public-private partnerships were established to develop new products for malaria control, including the Medicines for Malaria Venture, the Malaria Vaccine Initiative, the Innovative Vector Control Consortium, and a malaria project supported by the Foundation for Innovative New Diagnostics, which aims to develop high-quality affordable diagnostic tests for diseases of the poor.

But one existing tool also needed innovation to maximize its impact. Though increases in coverage with insecticidal nets were nothing less than spectacular, access to artemisinin-combination therapies remained disappointingly low in most African countries. In 11 of 13 countries surveyed in 2009, fewer than 15% of children with fever were treated with these superior life-saving medicines. Data from that same year further showed that countries were receiving less than half of needed treatments. Annual joint tenders issued by WHO and UNICEF for multi-source generic treatments meeting international quality standards led to more quality products on the market, but supplies were still inadequate and prices were still too high for most national control programmes.

Apart from high prices, the barriers to better access were numerous and difficult to break down. Procurement required exceptionally long lead times. Artemisinin and its derivatives are manufactured from the leaves of the sweet wormwood, or Artemisia annua, plant. Cultivation, extraction, processing, and manufacturing of the final product require at least 18 months. Manufacturing and quality control are especially complex operations. The raw plant materials vary greatly in quality; impurities must also be removed. Artemisinin and its derivatives are chemically unstable, a characteristic that accounts for their superior antimalarial activity but adds to the challenge of manufacturing a consistently high-quality product. Finished products can deteriorate easily, creating special demands for packaging and storage.

Additional problems were market-related. The supply of treatments was highly fragmented, with a huge and lucrative market in the private sector, typically beyond the control of national regulatory authorities. The high price of medicines lured the producers of counterfeit products and cheaper monotherapies to flood the market, raising deep concern that these products would hasten the development of drug resistance. The long lead time from cultivation to finished products contributed to a notoriously unstable supply chain, with supplies and their prices fluctuating wildly in what has been called a “bullwhip effect”. A year of oversupply was typically followed by a year of dire shortages with a high risk of stock outs. The uncertainty of future demand gave pharmaceutical companies little incentive to expand production.

One solution came in 2010 with publication of the WHO guide to good procurement practices for artemisinin-based antimalarial medicines. Through its concise 16-step checklist, the manual covered all aspects of the procurement cycle, from selecting the best products, through defining product specifications and inviting tenders, to post-shipment quality control and the detection of variations.

In improving access to both diagnostic tests and medicines, the WHO prequalification programme played a decisive role, especially given the very low demand for antimalarial medicines and diagnostic tests in countries with stringent regulatory authorities. The situation improved significantly. The number of manufacturers of quality-assured artemisinin-combination therapies grew from a single company in 2006 to nine prequalified generic manufacturers in 2013.

Together, they produced 22 prequalified patient-friendly fixed-dose combinations and two prequalified paediatric formulations. In addition to insecticidal nets, WHO recommended three preventive interventions for use in parts of Africa with high transmission of Plasmodium falciparum malaria. One policy recommendation covered the use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of pregnant women. A second covered the preventive treatment of infants.  In 2012, WHO recommended the seasonal chemoprevention of malaria in areas with highly seasonal malaria transmission as an additional approach to control. Implementation of the recommendations required more frequent contact with health services, which is always a problem for diseases that predominantly affect the rural poor. For example, the recommendation for the preventive treatment of pregnant women required that drugs be administered at each of four antenatal care visits.


To improve access to treatment, the Special Programme for Research and Training in Tropical Diseases, or TDR, had a tailor-made solution based on scientific understanding of why good drugs, good diagnostics, and good preventive strategies fail to have a proportionate impact on tropical diseases in poor countries. In 2009, TDR published the results of a three-year multicentre experimental study designed to test whether community-directed distribution, which had successfully delivered ivermectin to 75 million rural Africans at risk of onchocerciasis, could also distribute other priority interventions, including insecticidal nets and medicines for the home-based management of malaria.

When malaria interventions were delivered using the community-directed strategy, coverage with both nets and treatments more than doubled , at lower costs than with conventional delivery systems. The results further showed that 77% of children in the seven study sites received artemisinin-combination therapy within 24 hours following the onset of fever.

Moving forward, the approach holds great promise as a platform for the integrated delivery of services, aligned with the core principles of primary health care and the ambition of reaching universal coverage. The best news yet: 6.8 million lives saved

The way so many partners and innovative approaches kicked in to break down the barriers to ever-higher coverage was emblematic of an initiative that looked destined for unprecedented success.  By 2013, 79 of the 88 endemic countries had adopted artemisinin-combination therapies as the first-line treatment for Plasmodium falciparum. The purchasing of treatments increased dramatically, from 11 million treatment courses in 2005 to nearly 400 million in 2013. At that time, generic treatments accounted for 73% of purchases by UNITAID, a drug-purchasing facility that draws substantial and sustainable resources from a levy on airline tickets..

Another milestone was reached in 2013. For the first time, the number of diagnostic tests supplied to Africa for use in the public sector exceeded the number of treatments administered. The test-before-treat strategy was clearly working to conserve treatments and hopefully prolong their effective market life.

In terms of net distribution, 2014 was the strongest year ever, with more than 189 million nets delivered to countries in sub-Saharan Africa, bringing the total number of nets delivered to that region since 2012 to 402 million. Not surprisingly, deaths from malaria in sub-Saharan Africa dropped by 54% compared with the situation in 2000.

In 2014, WHO estimated that 670 million fewer cases and 4.3 million fewer deaths occurred between 2001 and 2013 globally than would have occurred had the incidence and mortality rates seen in 2000 remained unchanged. Another new estimate was equally compelling: from 2000 to 2014, reductions in malaria cases in sub-Saharan Africa saved countries an estimated $900 million – money that would otherwise have gone to malaria case management. Mosquito nets contributed to the largest savings, followed by artemisinin-based combination therapies and indoor residual spraying.

But the 2016 World Malaria Report brought the best news yet. Data in the report showed – beyond any shadow of a doubt – that the MDG target for halting and beginning to reverse the incidence of malaria had been met. Between 2000 and 2015, the rate of new malaria cases declined globally by an estimated 41%. Over the same period, the global malaria death rate fell by 62%. Equally important, an increasing number of countries had moved towards malaria elimination.

Between 2000 and 2015, six countries were certified by WHO as malaria free. An additional 11 countries met the criteria of zero indigenous cases for three years or more and were awaiting official certification of malaria-free status by WHO. All previously endemic countries that eliminated malaria prevented reestablishment of the disease. Elimination is considered especially important in areas of South-East Asia with low malaria incidence but high rates of drug resistance.

By 2016, WHO could revise its estimates upward: between 2001 and 2015, a cumulative total of 6.8 million lives were saved due to reductions in malaria mortality, which is testimony to the commitment of governments supported by the efforts of multiple partners on multiple fronts – an enormous victory for families, communities and countries.

In May 2015, the World Health Assembly approved WHO’s Global technical strategy for malaria 2016–2030, a 15-year blueprint for all countries working to control and eliminate malaria. The strategy set ambitious but attainable targets for 2030, including reducing malaria case incidence and death rates by at least 90%, eliminating malaria in at least 35 countries, and preventing the reintroduction of malaria in all countries that are malaria free.

The global technical strategy marked the first malaria strategy endorsed by the World Health Assembly since 1993. It resulted from the collective effort of more than 400 malaria experts from 70 countries and consultations in seven regions. In June 2015, the Global Malaria Programme was restructured to better respond to the challenges outlined in the global technical strategy.

With the target of reducing malaria cases and deaths by at least 90%, the world is clearly moving into an era that wants to see no child die from a mosquito bite anymore. The malaria experience supports one further conclusion: investment in health development works.

In 2016, WHO announced a significant breakthrough. The world’s first malaria vaccine, approved by the European Medicines Agency the previous year, is set to be piloted in three countries in sub-Saharan Africa beginning in 2018. The vaccine, known as RTS,S, has been shown to provide partial protection against malaria in young children. It will be evaluated as a potential complement to the existing package of WHO-recommended malaria preventive, diagnostic, and treatment measures. The benefits of the vaccine are expected to be greatest in areas with high transmission of Plasmodium falciparum malaria and associated high child mortality.

Though the eradication of malaria remains the ultimate goal for WHO, endemic countries, and their multiple partners, the way ahead is not an easy one for a disease as complex and tenacious as malaria. The burden, though diminished, remains huge. Worldwide, malaria caused 212 million new cases and 429 000 deaths in 2015. In Africa, an estimated 43% of people at risk of malaria do not have access to the core WHO-recommended vector control tools, namely insecticide treated nets and indoor residual spraying. Significant coverage gaps undermine the effectiveness of WHO recommendations for the protection of the two most vulnerable groups: pregnant women and infants.

The fear of further spread of resistance to artemisinin continues to haunt control programmes. The resistance of mosquitoes to insecticides is another significant worry. Since 2010, 60 countries have reported mosquito resistance to at least one class of insecticides used in nets and indoor spraying. Of these, 50 reported resistance to two or more classes of insecticides.

These and other challenges will need to be addressed in the same spirit of determination, ingenuity, and global solidarity that has brought so much progress and saved so many millions of lives, in the recent past.
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The Humanion Humanity of the Year 2016: Angela Merkel: Aung San Suu Kyi: Hillary Clinton: Jeremy Corbyn: Dr. Kanayo Nwanze: Dr Margaret Chan and Professor Peter Piot

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Our Seven Joint Humanity of the Year 2016 are persons, human beings, remarkable for their services to humanity, in their relevant field and arena of work and who have shown courage, strength, determination, resolute conviction and faith in seeking to rise to the challenge without losing any ground in relation to their faith, belief and choice in goodness that is the essence of what humanity is about and in doing the good, in seeking to do good, they seek to do, despite and regardless of the adversity they face, the criticism, the attacks and vilifications, the sustained and continuous abuses thrown on their paths, to most of them, and the barriers and obstacles they needed to overcome, they have shown the undefeatable human spirit, essence, steel so that these all stand out as beacons to the world: to encourage, to inspire, to empower, to connect and to bring together that what humanity is; without goodness that does not exist and without it there is no humanity for than we are only physiology of nothing but biology. Readmore

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Earth

 

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Moon

 

The Lake Eden Eye

 

 

 

 

The Window of the Heavens Always Open and Calling: All We Have to Do Is: To Choose to Be Open, Listen and Respond

 

 

 

Imagine a Rose-Boat

Imagine a rose floating like a tiny little boat on this ocean of infinity
And raise your soul-sail on this wee-little boat and go seeking out
All along feed on nothing but the light that you gather only light
Fear shall never fathom you nor greed can tempt nor illusion divert
For Love you are by name by deeds you are love's working-map

 

 

Only in the transparent pool of knowledge, chiselled out by the sharp incision of wisdom, is seen the true face of what truth is: That what  beauty paints, that what music sings, that what love makes into a magic. And it is life: a momentary magnificence, a-bloom like a bubble's miniscule exposition, against the spread of this awe-inspiring composition of the the Universe. Only through the path of seeking, learning, asking and developing, only through the vehicles and vesicles of knowledge, only through listening to the endless springs flowing beneath, outside, around and beyond our reach, of wisdom, we find the infinite ocean of love which is boundless, eternal, and being infinite, it makes us, shapes us and frees us onto the miracle of infinite liberty: without border, limitation or end. There is nothing better, larger or deeper that humanity can ever be than to simply be and do love. The Humanion

 

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The Humanion Online Daily from the United Kingdom for the World: To Inspire Souls to Seek

At Home in the Universe : One Without Frontier. Editor: Munayem Mayenin

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First Published: September 24: 2015