Ten percent of the world’s children aren’t meeting basic global vaccination standards. New data from the World Health Organization (WHO) and UNICEF estimates that in 2016, nearly 12.9 million infants did not receive any vaccinations. This includes the first dose of the DTP vaccine, which is considered to be an essential vaccination for children.

DTP is the three-round vaccination that protects against diphtheria, tetanus, and pertussis, commonly known as whooping cough. According to a release from WHO and UNICEF, this immunization is “one of the most successful and cost-effective public health interventions,” preventing 2-3 million deaths annually.

The data shows that in 130 of 194 WHO member states, at least 90 percent of infants received their full course of vaccinations at the national level. Additionally, 6.6 million infants failed to complete all three doses of the DTP immunization series after receiving their first dose.

Jean-Marie Okwo-Bele, director of immunization, vaccines and biologicals at WHO, said in the release that lack of vaccination can indicate overall health of children in a region.

“These children most likely have also not received any of the other basic health services,” Okwo-Bele said. “If we are to raise the bar on global immunization coverage, health services must reach the unreached. Every contact with the health system must be seen as an opportunity to immunize.”

Getting to 90 Percent

While 86 percent of children received their routine vaccinations in 2016, WHO’s goal is to vaccinate 90 percent of children globally. The number has remained at about 86 percent since 2010, and the new data shows there has not been any improvement in the last year.

This 90 percent coverage target is part of the agency’s Global Vaccine Action Plan, which was endorsed in May 2012 by WHO member states. To meet this goal, WHO says, “an estimated 10 million additional infants need to be vaccinated in 64 countries, if all countries are to achieve at least 90% coverage.”

Immunization Barriers

Vaccinating these additional 10 million children has proven difficult due to politics and location. Eight countries failed to vaccinate at least 50 percent of their infants against DTP. Most of these nations are war-torn countries like South Sudan and Syria, where conflict has resulted in the destruction of hospitals and health centers, making it difficult for vaccinations to reach many areas.

Unsurprisingly, poverty was also shown to impact how well a country’s children were vaccinated. According to the data, poor, urban populations are most at-risk of being under-immunized. This is a global problem, but particularly in “rapidly growing slums in Africa and Asia,” the release reads.

Robin Nandy, chief of immunizations at UNICEF, said in the release that immunization is “one of the most pro-equity” public health interventions.

“Bringing life-saving vaccines to the poorest communities, women and children must be considered a top priority in all contexts,” Nandy said.

Still, foreign aid and other factors have given some nations the ability to break through the poverty obstacle. Okwo-Bele told NPR that poor countries, like Tanzania, have improved their DTP vaccination rates because of their prioritization of immunizations as a national issue.

“[Tanzania] has had the political will to make immunizations a priority, and with foreign health aid, has built a well-organized system to deliver vaccines where needed, with trusted community health workers and reliable refrigeration for vaccines,” according to NPR.

UNICEF and WHO are continuing to research the impact of economic inequality on vaccination.

Avery Anapol

Avery Anapol is a blogger and freelancer for Law Street Media. She holds a BA in journalism and mass communication from the George Washington University. When she’s not writing, Avery enjoys traveling, reading fiction, cooking, and waking up early. Contact Avery at Staff@LawStreetMedia.com.

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In recent years, scientists have been paying a lot of attention to a striking development: the number of infectious diseases has increased considerably. That rise was not just one or two more diseases each year. In fact, over the last 100 years, the number of new infectious diseases discovered each year has quadrupled and outbreaks have tripled. What explains this dramatic increase in new infectious diseases? Read on to find out the answer to this question, how scientists are working to fight diseases, and what the consequences could be if we continue along this same trajectory.

Infectious Disease on the Rise

To begin to understand the rising levels of infectious disease, it is first imperative to understand the common terminology. Four terms, in particular, are used very frequently and require clarification. These terms are outbreaks, epidemics, pandemics, and endemic. An outbreak occurs when the number of cases of a specific disease in a specific community rises above what would normally be expected. Epidemics are, “a widespread increase in the observed rates of disease in a given population.” Pandemics are basically the multinational form of epidemics in that they encompass worldwide outbreaks beyond a particular population. Endemic is decidedly different than the other terms and essentially means a rate of disease that is consistently higher within a given group. These definitions are particularly important for the people treating an outbreak on the ground, as it helps them tune their methods to the reality of the situation. The following video gives an overview of how disease spreads:

Although that rise sounds troubling it is not all doom and gloom. While individual outbreaks are increasing, they are affecting fewer people now than before. Additionally, only a small variety of infectious diseases are responsible for the majority of outbreaks. Furthermore, of these strands, a little over half are zoonosis–diseases that are passed from animals to humans. Even among zoonosis, there are only a few zoonotic diseases that cause most outbreaks. In other words, outbreaks are on the rise but a decreasing number of diseases–passed from animals to humans–account for that rise. The question then becomes, what is leading to the rise in outbreaks?

Factors Leading to the Rise of Infectious Diseases

There are several reasons for this increase, but it starts with us and the actions we take. Many of the recent outbreaks are not new diseases, only new to us as a species. They have been incubating and traveling all across areas like rainforests for tens of thousands of years. However, with human encroachment in the form of farming, mining, housing, etc. people are starting to come into contact with these diseases more often and the results are not always good.

Other human manipulations of the environment are also leading to the rise of infectious diseases. These include seemingly benign activities such as reforestation, animal farming, and even flooding rice patties. Sometimes it can be a combination of human activity and environmental factors, such as when milder winters that are the result of global warming fail to kill off the usual number of pests. In fact, rising temperatures have the potential to be one of the greatest contributors to the continued rise of infectious diseases in the coming years, while ailments such as Malaria, which prosper in warmer climates, may become much more virulent. The video below details how global warming can increase the risk of infectious disease:

Other trends, like urbanization, may also contribute to the rise of infectious diseases. By clumping closer together, the chances of an infection spreading quickly are much higher. This is particularly true when urbanization occurs in poorer countries without effective public health monitoring and preventions systems. Similarly, more travel between countries and regions can introduce infections to places that have never seen them before and it can increase the likelihood that an epidemic becomes a pandemic. Even technology and modern supply chains can present a risk, as processing consolidation may increase the likelihood that contamination spreads.

Resistance to antibiotics and resulting superbugs are additional issues leading to the rising number of infectious diseases. However, this is also a problem for viral infections for many of the same reasons, including over prescription of certain medicines and prescribing the wrong medication for a specific disease. Viruses are especially problematic because they can evolve so quickly that it is impossible to stay ahead of them. The clearest example of this is influenza or the flu which changes from year to year. Along with antibiotics, many sanitation systems are also proving less useful than before. In this case, the issue has more to do with the lack of upkeep in existing public health systems that has led to outbreaks of old diseases such as cholera.

Efforts to Fight Outbreaks

Given this trend, what is being done to stem the tide? Actually, governments began addressing the rise of infectious diseases several years ago. A response was prompted back in 2014, following the outbreaks of MERS and bird flu. That year, the United States, along with dozens of countries and organizations, announced a plan to respond and treat new outbreaks where they start.

Currently, efforts to fight infectious disease in the United States fall under the authority of the Centers for Disease Control, or CDC. Specifically, many of those efforts are housed in the National Center for Emerging and Zoonotic Infectious Diseases or NCEZID. NCEZID focuses on reducing both illnesses and deaths that are associated with infectious diseases. It also strives to be proactive in protecting against the spread of infectious diseases.

At the international level, there is the World Health Organization (WHO). Much like the CDC in the United States, the WHO also focuses on reacting to and fighting epidemics. The WHO acts more like a clearinghouse encouraging individual countries to improve their own existing systems and work to integrate them internationally so a crisis in one country can be handled as effectively by its neighbor if it crosses international borders. When it comes to the spread of infectious disease, the WHO serves as an international monitor to identify and coordinate a response to outbreaks.

Conclusion

Foreseeing and preventing all outbreaks of infectious disease would be impossible. Just last year, for instance, several people in Russia were infected with Anthrax when frozen strains of the disease were released when permafrost melted. While this could easily lead to discussions about global warming, the truth is that it just as clearly exemplifies that it is impossible to anticipate everything. In fact, in some cases, efforts are even seen as misguided or unwanted.

Many recent efforts have focused on identifying and understanding new diseases, like those deep in the rainforest. However, such methods have also been criticized for spending scarce funding to search out new diseases when funds could instead be used for treating known maladies. Although it seems odd to criticize people for being proactive, that might be a fair critique in a world with finite resources. In fact, it might be fair to wonder why people are really that concerned with infectious diseases at all.

This is because non-communicable diseases, like cancer, which cannot be spread from one person to another, kill far more people each year than infectious diseases. However, those diseases also originate within us and frequently have to do with factors that we are less able to control, such as getting older. Conversely, based on the fact that only a few diseases cause most of the outbreaks, infectious disease can be managed and their threat reduced. Thus counteracting the rise of infectious diseases is likely to continue to be a mainstay of health policy both nationally and globally.

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

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Fall has started and along with it comes several long-anticipated events like football season, changing weather, and Thanksgiving. But there’s something else associated with this time of year that no one is looking forward to–flu season. Despite being seemingly innocuous, the flu is one of the greatest scourges in the history of mankind and is still a potent killer. It has also given rise to a billion dollar vaccine industry bent on stopping it.

Read on to find out more about the history of the flu, the flu vaccine, and the business that it has spawned.

The History of the Flu

Human beings have been victims of the flu or influenza for as many as 6,000 years. While no precise date is readily available, it is believed that once humans started to domesticate animals they also started acquiring the flu from them, as many animal species carry flu strains. The name “influenza” originated in eighteenth century Italy where its outbreak was blamed on poor air quality.

Although the existence of the flu has been known for centuries, it is only within the last hundred years that it has been clearly identified. In 1918, a veterinarian actually discovered that a disease found in pigs was similar to one found in humans. In 1928 other researchers proved, through experiments on pigs as well, that the mysterious killer influenza was actually caused by a virus. Still, it was not until 1933 that scientists finally identified the specific virus that caused influenza.

The video below gives an overview of the history of the flu:

Types of Flu

Although the flu is commonly referred to as a monolithic thing, it is actually a combination of related viruses. There are two main types of flu virus: H-types and N-types. These letters correspond with genetic markers for two glycoproteins, hemagglutinin (H) and neuraminidase (N), which are the antigens the host of the virus develops an immunity to. Along with these are three major strains: A, B, and C. The A strain is the one that causes major outbreaks that lead to widespread deaths. There is also a D strain, which primarily infects cattle and is not known to harm humans.

The reason why the flu is so deadly is because of its genetic makeup. Since the genetic code of the influenza virus is made of RNA and not DNA, the viruses replicate very quickly and are more prone to mutations. Thus, viruses can change numerous times before a human, for example, can even build up an immunity to the original virus. This is done through two processes. The first is called antigenic drift, and it occurs when mutations change the virus over time eventually making it so immune systems can no longer recognize it. The second is called antigenetic shift, which involves a dramatic change in the composition of the virus, like combining with an animal subtype, which is often the process that leads to pandemics.

The flu generally hits elderly people, those with asthma, pregnant women, and children the hardest. For anyone who has had the flu before, the symptoms are familiar: fever, chills, coughing, sore throat, achiness, headaches, fatigue, vomiting, and diarrhea. The virus is usually transmitted through the air via respiratory droplets, but can also move through physical contact. Some people who get the flu are asymptomatic meaning, while they have the flu, they do not experience the typical symptoms, yet can still get others sick. The flu also triggers several related complications including, pneumonia and sinus and ear infections. It can worsen existing medical conditions such as chronic pulmonary diseases, or cause heart inflammation.

Deadliest Strains

While the flu is perceived as commonplace and not particularly dangerous today, it is still one of the deadliest viruses in human history. During the 16th and 18th centuries, there were a number of massive and deadly outbreaks. Since 1900 there have been four major flu pandemics. The Asian flu lasted from 1957-1958 and killed one to four million people. The Hong Kong flu circulated from 1967-1968 and killed one million people. The third was the Swine flu, or H1N1, which broke out in 2009. The greatest outbreak by far, though, was the Spanish flu that broke out in 1918, right on the heels of World War I. The epidemic killed as many as 50 million people worldwide, more than the war itself.

The accompanying video looks at the deadly 1918 pandemic:

Aside from these major outbreaks, the flu remains a virulent threat. Although it is hard to pinpoint exactly how many people die each year from the flu, the CDC estimates that more than 55,000 people died from influenza and pneumonia in 2015. But that is an estimate and the numbers often vary. An earlier estimate for the flu alone, by the CDC, put the yearly average somewhere between 23,000 and 33,000. The discrepancy is caused by outliers in yearly totals and different strains that respond to the flu vaccine differently.

The Flu Vaccine

If someone catches the flu there is little that can be done for them. Infected people can take over-the-counter remedies and in certain cases can even be prescribed antiviral medications, although many strains of the virus have grown immune to such treatments. Generally, the only way to consistently ward off the flu is by trying to prevent it in the first place with a flu vaccine.

Developing the flu shot has been a long process and one that is still in progress. The first step was on the heels of two important discoveries–scientists managed to grow the flu virus in eggs for the first time in 1931 and were able to isolate the virus itself in 1933. While Louis Pasteur was the first to actually attempt to make a flu vaccine, it was a Soviet researcher in 1936 who developed the first prototype. While this vaccine was used in the former USSR for 50 more years, it had the drawback of using a live strain of the flu.

However, scientists quickly overcame this by finding a new source of the dead, “inactivated” virus to use in vaccines instead. In 1940 a new problem arose as a second strain of the flu was discovered, leading to the bivalent vaccine in 1942, which targeted one A and B strain. The next major step in the development process occurred in 2007 when the source of the virus for vaccines moved from hen eggs to cell cultures, making reproduction and sterilization easier.

On top of the bivalent vaccine, trivalent and quadrivalent vaccines were developed, containing multiple A and B strains. Vaccines typically change each year because the virus itself mutates from season to season, often making old vaccines ineffective. Strains of the virus are actually monitored all year long, with the Northern Hemisphere monitoring what is circulating in the South and vice versa. When the prevailing strains are identified, a vaccine is tailored to them. Additional vaccines with other strains can also be created in emergencies. This system came about as a result of a WHO recommendation in 1973. Since 1999 WHO has issued two sets of vaccine recommendations each year, one for the Northern Hemisphere in February and one for the Southern Hemisphere in September.

The video below explains how the flu shot works:

The Business Side

Developing a flu vaccine and then redeveloping it each year to fight the different strains of the flu virus has been a long and arduous task. An estimated 171 to 179 million doses of the vaccine were created for the United States in 2015 alone. That amounts to a $1.61 billion industry in the United States and roughly a $4 billion one worldwide.

With an industry this large, it is fair to ask whether the pursuit of profits has overwhelmed the pursuit of health. Roughly 44 percent of Americans received the vaccine in 2015 and the shot is considered the best way to fight the flu. But because of the difficulty of matching the vaccine to the dominant strains, it is only 50 to 60 percent effective. Furthermore, there are different types of vaccines sold depending on how many strains the shot will protect against.

Conclusion

Each year, millions of people are infected with the flu and thousands or even tens of thousands die. It took centuries to identify the virus and much of what we know about the virus was discovered in the last hundred years. Given the nature of the virus and the rate at which it mutates, vaccines often have a hard time keeping up. The international community has developed a sophisticated monitoring system to identify and track new strains of the virus to ensure that vaccines are as effective as possible. But because of the frequent changes, new vaccines must be developed each year, prompting the development of a substantial industry.

Resources

CDC: Deaths and Mortality

CDC: Seasonal Influenza, More Information

WHO: Influenza: Surveillance and Monitoring

NPR: How Many People Die From Flu Each Year? Depends How You Slice The Data

Medical Ecology: Influenza

CNN: Getting a Flu Shot? It may be Better to Wait

The History of Vaccines: Influenza

Medscape: The Evolving History of Influenza Viruses and Influenza Vaccines

CNBC: The $1.6 billion Business of the Flu

Flucelvax: History of the Flu Virus and Influenza Vaccination

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

The post Feeling Okay? The History of the Flu and Flu Vaccines appeared first on Law Street.

The World Health Organization just published a report regarding online junk food advertisements targeted at children, and called for immediate action by policy makers.

The report analyzed the frequency of marketing products targeting children through digital media–finding that children are exposed to these advertisements not only through social media but also on advertisement-based games. Most parents are unaware of the fact that their children are exposed every day to junk food advertisements, which take their toll on kids’ minds, WHO reported.

Researchers pegged food advertisements as a consistent influencer on children’s food choices. Dr. Emma Boyland of the University of Liverpool said,

The food, marketing and digital industries have access to an enormous amount of information regarding young people’s exposure to HFSS (high fat salt or sugar) food marketing online and its influence on children’s behaviour, yet external researchers are excluded from these privately held insights, which increases the power imbalances between industry and public health.

The report attacked the way some video bloggers get paid by junk food retailers to promote their food. According to a U.S. analysis, vloggers are now more influential at promoting brands than films or TV shows because of perceived authenticity.

Some countries such as the United Kingdom have introduced rules to protect children from junk food advertising such as bans during children’s television shows, however, the report said regulation had “failed to keep up with the pace and scope of change in the media.”

UK child obesity hits record high – The number of young children who are classed as obese has risen to a record… https://t.co/my9GPed7jc

— Davalyn Corporation (@DavalynCorp) November 4, 2016

To address these challenges, the report suggested a number of recommendations. WHO recommended states acknowledge their duty to protect children from HFSS digital marketing with statutory regulation and extend existing offline protections online.

The organization is currently reviewing what foods and drinks can be advertised to children in order to compel private internet platforms to remove marketing of HFSS foods.

Bryan White

Bryan is an editorial intern at Law Street Media from Stratford, NJ. He is a sophomore at American University, pursuing a Bachelor’s degree in Broadcast Journalism. When he is not reading up on the news, you can find him curled up with an iced chai and a good book. Contact Bryan at BWhite@LawStreetMedia.com.

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Happy Halloween Law Streeters! Hopefully you survived the gangs of ghosts, ghouls, and goblins this weekend. But if you missed out on any killer articles last week while prepping for your halloween costume, don’t worry we’ve got you covered. ICYMI–check out the top stories from last week below!

1. The World Health Organization Deems Single People Disabled, For a Good Cause

The World Health Organization, one of the world’s leading voices on health policy, is making an interesting change. WHO is set to announce that “single” people who don’t have a child but want one are to be classified as “infertile”–which is defined as a disability. And that may sound strange, but it’s actually coming from a place of progressive good. By doing so, WHO is granting everyone the “right to reproduce” and this move will help heterosexual single men and women, as well as same-sex couples, get equal access to in vitro fertilization. Read the full article here.

2. Haiti’s History of Disappointments: Intervention, Exploitation, and NGOs

Communities in southwestern Haiti were devastated when Hurricane Matthew struck the Tiburon Peninsula on October 4, 2016. Accompanied by rapid winds, heavy rainfall, and subsequent flooding, the Category 4 storm on the Saffir-Simpson scale killed at least 1,000 people, destroyed countless homes, and displaced thousands. Approximately 2.1 million people have been affected, 1.4 million need humanitarian aid, 750,000 need urgent help, and 806,000 are at an extreme level of food insecurity. Haiti, which is roughly the size of South Carolina, was ill-equipped to withstand another natural disaster. For the past six years this Caribbean country has been trying to recuperate from the 2010 earthquake that left more than 200,000 dead (according to Haitian government figures) and wreacked havoc upon a preexisting weak infrastructure. Now history seems to be repeating itself. Read the full article here.

3. Florida Man Sues After Police Mistake Donut Icing for Meth

Donuts can be addictive–but they’re not drugs. That seems like common sense, but unfortunately an Orlando man named Daniel Rushing was arrested late last year because local police mistook dried Krispy Kreme donut icing in his car for meth. Now, Rushing is suing the city for $15,000 in damages due to that arrest, as well as the roadside drug test manufacturer that the police officer used. Read the full article here.

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

The post ICYMI: Best of the Week appeared first on Law Street.

The World Health Organization, one of the world’s leading voices on health policy, is making an interesting change. WHO is set to announce that “single” people who don’t have a child but want one are to be classified as “infertile”–which is defined as a disability. And that may sound strange, but it’s actually coming from a place of progressive good. By doing so, WHO is granting everyone the “right to reproduce” and this move will help heterosexual single men and women, as well as same-sex couples, get equal access to in vitro fertilization.

Dr David Adamson, one of the authors of the new standards, explained the motivation behind the language and policy change to the Telegraph, saying:

The definition of infertility is now written in such a way that it includes the rights of all individuals to have a family, and that includes single men, single women, gay men, gay women.

It puts a stake in the ground and says an individual’s got a right to  reproduce whether or not they have a partner. It’s a big change.

It fundamentally alters who should be included in this group and who should  have access to healthcare. It sets an international legal standard.  Countries are bound by it.

The rule will be sent out to every health minister next year–although it’s unclear at this point how it could actually substantively affect law or policy from country to country.

However, there are plenty of people who disagree with the new standards. One concern stems from pro-life activists, who worry that it’s an overreach. Josephine Quintavalle, from Comment on Reproductive Ethics, said:

This absurd nonsense is not simply re-defining infertility but completely sidelining the biological process and significance of natural intercourse between a man and a woman. How long before babies are created and grown on request completely in the lab?

There are also concerns from some doctors who work with in vitro fertilization that it’s creating a political matter out of a personal decision made by couples.

Concerns aside, it’s an interesting approach in the name of equality. And we don’t know how it will actually pan out, the rule will be sent out to every health minister next year–it’s unclear at this point how it could actually substantively affect law or policy from country to country. As for the U.S., a Department of Health spokesperson told the Telegraph that it would consider the change for the U.S., but nothing was guaranteed.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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The World Health Organization’s director general, Margaret Chan, recently warned her executive board and the world that the Zika virus is posed to “spread explosively” throughout North and South America this year. Another WHO officer suggested that three to four million new infections are likely in that time frame.

The Zika virus, (pronounced ZEE-kuh) named after the Ugandan forest where it was first discovered, is transmitted by mosquitos. When Brazil reported its first case of Zika in 2015, it marked the first instance of the illness in the Western Hemisphere.

While the illness poses a threat to the countries it affects, the Zika virus isn’t much of an immediate concern for people living in the United States. The Aedes mosquito which carries the virus is native only to parts of Florida, and prefers the warmer climates of South America and Mexico. A person who is infected with Zika by a mosquito may experience a mild fever, a skin rash, and conjunctivitis, lasting up to a week. At first glance, Zika’s symptoms are indistinguishable from and not much more threatening than influenza.

This map shows how over time, the virus has moved from mosquito populations across oceans.

MAP: The spread of the Zika virus http://t.co/4vFT5ok6R0 pic.twitter.com/L3FPytZqts

— Post Graphics (@PostGraphics) September 21, 2015

Zika’s effects, however, are more than skin deep. For one, many countries with inadequate health services may see symptoms worsen. But the far more concerning result of these infections is the effect of the virus on the next generation. Many doctors share concerns that the children of mothers who have contracted Zika during pregnancy are born with a condition known as microcephaly. The connection between the virus and the condition was only made recently, as doctors in Brazil found the virus in the placentas of affected children, and in one autopsy of a baby who died.

Microcephaly, literally meaning “small head,” is a birth defect/condition in which stunted or abnormal development of the brain during gestation causes a child to be born with a smaller head than is healthy. Children born with microcephaly often experience developmental delays, difficulties with coordination and balance, and mental retardation, among various other physical ailments, according to the Mayo Clinic.

The main prevention advice being dispensed by health organizations like WHO is to avoid mosquito exposure by using mosquito nets and insect repellent. One doctor went as far as to instruct women in affected areas to not get pregnant, and women of child-bearing age who may have children are advised against traveling to these areas.

This level of attention is reminiscent of the Ebola scare of from 2014 to 2015, and word of such a widespread outbreak leaves many wondering if they should be fearful for their health. A recent Center for Disease Control report that a dozen travelers returning to the United States had the Zika virus further fanned the flames of concern.

The ramifications of an outbreak as large as WHO is predicting could be heartbreaking–if any the millions of affected women become pregnant, their children are at great risk of conditions which would lower their quality of life. President Barack Obama has urged the rapid development of vaccines and treatments  for Zika infections among American doctors, but the fate of millions will rest on careful prevention and hopefully, medical advances.

Sean Simon

Sean Simon is an Editorial News Senior Fellow at Law Street, and a senior at The George Washington University, studying Communications and Psychology. In his spare time, he loves exploring D.C. restaurants, solving crossword puzzles, and watching sad foreign films. Contact Sean at SSimon@LawStreetMedia.com.

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Monday, President Obama announced what he has noted as the “biggest, most important step we’ve ever taken” in the fight against climate change. He introduced America’s Clean Power Plan, aimed toward a reduction in greenhouse gas emissions from the nation’s coal-burning power plants.

Obama said Monday from the White House:

Today after working with states and cities and power companies, the EPA is setting the first ever nationwide standards to end the limitless dumping of carbon pollution from power plants…Washington is starting to catch up with the vision of the rest of the country. 

Essentially, America’s Clean Power Plan is a set of environmental rules and regulations that will focus on pollution from the nation’s power plants, setting limits on power-plant carbon emissions for the first time. The goal of the revised Clean Power Plan is to cut greenhouse gas emissions from U.S. power stations by nearly a third within 15 years. The measures will place significant emphasis on wind and solar power with other renewable energy sources, transforming America’s electricity industry. Obama said on Monday: “we’re the first generation to feel the impact of climate change and the last generation that can do something about it.”

The most aggressive of the regulations require existing power plants to cut emissions 32 percent from 2005 levels by 2030, an increase from the 30 percent target proposed in the draft regulation. The new rule also demands that power plants use more renewable sources of energy like wind and solar power. Under the plan, the administration will require states to meet specific carbon emission reduction standards, based on their individual energy consumption. The plan also includes an incentive program for states to get a head start on meeting standards with early deployment of renewable energy and low-income energy efficiency. Obama said in the video:

Power plants are the single biggest source of harmful carbon pollution that contributes to climate change. Until now, there have been no federal limits to the amount of carbon pollution plants dump in the air.

President Obama also claims that the plans will lead to lower energy bills in the future for Americans, create jobs in the renewable energy sector, and ensure more reliable energy services.  Power plants account for roughly 40 percent of U.S. emissions of carbon dioxide–the most common greenhouse gas that contributes to climate change. Regardless of these benefits, there are still many critics that are opposed to this new plan. 

Many Republican opponents dispute the existence of global warming, questioning whether or not humans are to blame for the issue. Critics also claim that the plan will bring an unwelcome increase in electricity prices. Opponents in the energy industry believe that president Obama has declared a “war on coal.” Power plants powered by coal provide more than one third of the U.S. electricity supply. Many states plan to fight the new regulations, with Senate Majority Leader Mitch McConnell urging states not to comply with the plan in a letter to all fifty governors. Vice President of  Communications for the National Mining Association Luke Popovich stated: 

This plan is all pain and no gain. That’s why state leaders across the country are coming to the same conclusion — that we should not sacrifice our power system to an unworkable plan built on a faulty interpretation of the law.

However those that are arguing against the new plan appear to be overlooking the benefits it can bring. According to the World Health Organization, research in Italy suggests that 4.7 percent total of mortality, or 3,500 deaths annually in a population of 11 million, are caused through cancer and respiratory and cardiovascular diseases attributed to air pollution. Many argue that reducing green house gas emissions doesn’t hurt the economy, but can in fact benefit the economy by saving businesses and consumers money, as well as improving public health.

It is unclear how this new plan will develop during President Obama’s remaining time in office, as well as the presence it may or may not have as campaigns begin to really take off. But, it’s certainly a big move in the right direction.

Angel Idowu

Angel Idowu is a member of the Beloit College Class of 2016 and was a Law Street Media Fellow for the Summer of 2015. Contact Angel at staff@LawStreetMedia.com.

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The World Health Organization (WHO) recently announced that Cuba is the first county in the world to eliminate mother-to-child transmission of HIV and syphilis.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” Dr. Margaret Chan, the WHO director-general, said in a Tuesday press release. “This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation.”

Preventive treatment for mother-to-child transmission of HIV and syphilis is not 100 percent effective, so the WHO defines elimination as a reduction of transmission to a level that it no longer constitutes a public health problem. So the country must demonstrate that it has seen less than 50 infections from this particular route of transmission per 100,000 live births for at least one year. Cuba has surpassed those requirements. In 2013, only two babies were born with HIV and five with syphilis. Officials claim that this recent milestone shows that an end to the AIDS epidemic is possible, and that they expect more countries to seek validation from the WHO.

There are 16 million women worldwide who are living with HIV, and each year, about 1.4 million of them will get pregnant. The risk of passing the virus to the child is only around 1 percent if anti-HIV drugs are provided during phases of potential infection, which span through the pregnancy until breastfeeding. However if completely untreated, the risks are much greater, with a 45 percent chance of the child being infected during one of the pregnancy stages. Even though syphilis does not receive as much attention, infection during pregnancy and the absence of antibiotics can lead to stillbirth or neonatal death.

In order to reduce the mother-to-child transmission rate, the WHO and Pan American Health Organization began to work with Cuba and other countries back in 2010. The initiative worked to improve testing and treatment for these infections, caesarian deliveries, prenatal care, and breastfeeding substitutes. Some of their services also include prenatal care. Maternal and child health programs are integrated with HIV and STD programs. Similar services, which are a part of Cuba’s universal health system, are being implemented in a number of other countries to help work toward the global target of less than 40,000 new infections annually.

Worldwide, the number of children born with HIV dropped to 240,000 in 2013 from 400,000 in 2009, the WHO reported. In order to reach the target of no more than 40,000 new child infections in 2015, officials say more efforts will be needed around the world. But while Cuba may have been the first country to receive the WHO validation, that does not mean other countries have not reach elimination status. According to the Pan American Health Organization’s Director Carissa Etienne, it’s likely that the U.S. and Canada have already eliminated mother-to-child transmission of both of these infections, but haven’t sought validation.

So what do Cuba’s recent medical advances mean for the United States now that a relationship has been formed?

Cuba has one of the most advanced medical biotechnology industries in the world and invests heavily in the production of new treatments and medications. The Cuban biotech industry is said to hold around 1,200 international patients, and markets pharmaceutical products and vaccines in more than 50 countries–but not in the United States. For the 26 million people in the United States who have diabetes and the 80,000 Americans who suffer from diabetics amputations a year, this has significance. Because of the government’s continuous funding, Cuba has developed a safe and effective medication that reduces the risk of amputation by 78 percent.

This is just one example of how Americans can benefit from all of Cuba’s medical advances. Cuba’s medical prowess is impressive–eliminating HIV and syphilis transmissions are just one example of its potential. Even with the new relationship recently announced, Cuba and the United States have a lot of work to do to improve their relationship. But hopefully this new relationship will encourage Cuba to share its medical advances, and improve health worldwide.

Angel Idowu

Angel Idowu is a member of the Beloit College Class of 2016 and was a Law Street Media Fellow for the Summer of 2015. Contact Angel at staff@LawStreetMedia.com.

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Counterfeit drugs pose both domestic and global threats, presenting serious health risks worldwide. Although the issue is most prevalent outside the United States, Americans aren’t immune to the illegal market’s reach, as there have been far-reaching counterfeit drug cases in the U.S. As a result, there’s been a large effort to combat the problem in America. Read on to learn more about the proliferation of counterfeit drugs, and what’s being done to stop them.

What are counterfeit drugs?

According to the World Health Organization (WHO):

Counterfeit medicine is one which is deliberately and fraudulently mislabeled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging.

The issue was first addressed in the 1995 WHO Conference of Experts on Rational Drug Use in Nairobi, Kenya. Since then, the market has expanded, but preventive measures have also multiplied. Most counterfeited drugs consist of antibiotics, hormones, analgesics, steroids, and antihistamines. In all, counterfeit drugs are divided into six categories: products without active ingredients (32.1 percent of counterfeits), products with incorrect quantities of active ingredients (20.2 percent of counterfeits), products with wrong ingredients (21.4 percent of counterfeits), products with correct quantities of active ingredients but with fake packaging (15.6 percent of counterfeits), copies of an original product (1 percent of counterfeits), and products with high levels of impurities and contaminants (8.5 percent of counterfeits).

The FDA believes the growth in the counterfeit drug market may be due to the escalating costs of prescription drugs, advanced technologies to develop counterfeit drugs, and the anonymity and ease of the internet.

Health Risks

The severity of the risk factors for any specific counterfeit drug will vary. Generally, they can actively cause unexpected side effects, an allergic reaction, the worsening of the existing medical condition, and/or prolong treatment periods.

A counterfeit drug that substitutes an inert substance for the active ingredient will not improve a person’s medical condition. For example, the main ingredient in Lipitor (a commonly counterfeited drug in the U.S.) is atorvastatin. Its purpose is to lower high cholesterol and triglyceride levels, and therefore reduce the risk of stroke and heart attack. If a patient believes he/she is taking atorvastatin, but in fact is consuming an inert substance, the consequences could be deadly. Even worse, in some cases, not all substituted or added substances are inert, but are instead hazardous.

 U.S. and Global Statistics About Counterfeit Drugs

The international counterfeit drug market amasses $200 billion a year. Internet sales make up $75 billion of that market. Most counterfeits are made in China and India. In the United States, 80 percent of counterfeit medicine is brought into the country from outside.

The WHO estimates that up to ten percent of the drugs sold internationally are counterfeit. In some countries this number can reach up to 50 percent. Developed countries that have strict regulations and institutions like the FDC, are estimated to sell less than one percent of counterfeit drugs. However, the United States has seen its share of highly publicized cases. With a few exceptions, the United States counterfeit market is generally focused on “lifestyle” drugs like diet, erectile dysfunction, and hair growth pills.

The counterfeit market is growing in the U.S. In 2014, an estimated 60 various Pfizer products were being counterfeited compared to just 20 in 2008. One of the most popular counterfeited pharmacy items is ChapStick. China reported holding 1,300 alleged counterfeiters and confiscating $362 million worth of counterfeit product in 2013.

According to the WHO, an estimated 200,000 people die a year due to “ineffective, fake, and substandard malaria drugs” that don’t eliminate parasites from a person’s system. To make matters worse, the fake drugs often contain a smaller dosage of the active ingredient than necessary. Thus the fake drug cures symptoms without curing the disease and fuels drug-resistant strands.

Counterfeit Drugs in the U.S.

A counterfeit maker of Avastin, a cancer drug, accessed the U.S. supply chain in 2012. This was the first major exception to the notion that counterfeits in the U.S. were limited to lifestyle drugs. Undetected, doctors and purchasing managers for oncology clinics “bought and administered the counterfeit medicines to their patients.”

In May 2012, a counterfeit version of Teva Pharmaceutical’s Adderall 30 mg tablets entered the market. The FDA labeled the counterfeit “unsafe, ineffective, and potentially harmful.” The counterfeit version did not contain the active ingredients dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amephtamine sulfate. Instead, it contained ineffective ingredients tramadol and acetaminophen. The original product is orange and peach in color with markings, while the counterfeit is white and devoid of any markings. Entering the counterfeit market for Adderall was probably seen as a lucrative opportunity, as Adderall is on the FDA’s drug shortage list, which means that it is dispersed only when available.

The drug Procrit, used to treat anemic patients with “cancer and other serious diseases,” had a large counterfeit scare in 2013. FDA investigators found three fake batches bearing three different lot numbers and expiration dates. The fake medicines contained a clear liquid with no active ingredient and two life-threatening strains of bacteria. Not only was patients’ anemia going unchecked, but already-weak patients were consuming potentially deadly bacteria. The FDA dispersed a warning to the public and provided ways to check the authenticity of the product.

Precautions to Avoid Counterfeit Drugs

There are ways to help ensure that patients and customers purchase legitimate prescription drugs. Most counterfeited drugs are sold through the internet. The National Association of Boards of Pharmacy investigated 10,000 pharmaceutical sites and found that only three percent of the sites appeared “to be in compliance with pharmacy laws and practice standards.”

Internet sites to be avoided include those outside the United States; those that don’t offer a physical address; those that don’t display a license by the applicable state board of pharmacy;  those that don’t provide a licensed pharmacist to answer questions; and sites that don’t require a prescription. Consumers should also look for the Verified Internet Pharmacy Practice Sites (VIPPS) seal. There are over 30 online pharmacies that display this seal, which was created by the National Association of Boards of Pharmacy to combat sites selling counterfeit drugs.

Consumers must also be cautious when inspecting the packaging of their product by looking for altered or unsealed containers or any physical differences in the appropriate packaging or product appearance. A change in taste and side effects could signal counterfeits as well.

 Actions Against Counterfeit Drugs

In 2012, the United States and 110 other countries participated in INTERPOL’s Pangea sting operation. The operation resulted in:

11,000 illegal online pharmacies being shut down, the removal 19,000 ads for fake drugs on social media sites, the seizure of 9.4 million doses of phony medicines…Google agreed to spend $50 million annually over the next five years to crack down on advertising for illegal online pharmacies.

Pharmaceutical companies also have their own internal investigations to fight against counterfeit medicines. For example, one method is similar to fingerprinting. Pfizer designed an infrared spectrometer that analyzes a product’s chemical bonds. Every drug has unique “reflected and absorbed wavelengths.” A graph will produce peaks and valleys–like a fingerprint–depending on the ingredients and their quantities. Those in the Pfizer lab can superimpose fake “fingerprints” over the real ones on the computer and note the differences. Further testing with X-ray diffraction can show exactly what ingredients the fake is composed of.

In 2014, Eli Lilly, an Indianapolis-based pharmaceutical company, invested $110 million in creating traceable, unique stamping codes for all of its products sold globally. The stamping codes will allow the company to trace each product from manufacturing facility to patient, and combat fakes.

The Legal Side of Drug Counterfeiting

The Prescription Drug Marketing Act of 1987 (modified in 1992) effectively closed off the United States supply chain. The law directly aimed at protecting American consumers and avoiding counterfeit drugs by providing legal safeguards. It “provides that prescription drug products manufactured in the United States and exported can no longer be reimported, except by the product’s manufacturer.” It also provides uniform standards for all distribution channels including hospitals and wholesalers.

The Food and Drug Administration Safety and Innovation Act was enacted in July 2012. It granted the FDA new and enhanced powers to regulate prescription drugs and combat counterfeit drugs in the U.S. The FDA, for example, can now “administratively detain drugs believed to be adulterated or misbranded, and the authority to destroy certain adulterated, misbranded, or counterfeit drugs offered for import.”

The 2013 Drug Quality and Security Act “outlines critical steps to build an electronic, interoperable system to identify and trace certain prescription drugs as they are distributed in the United States.” Pharmaceutical companies must implement a tracking system by 2015 and tag serial numbers to each singular unit sold in the U.S. by 2017.

Conclusion

The counterfeiting of medicines is not a problem secluded to developing countries. Without proactive enforcement, counterfeit drugs could erupt in the United States. It is a highly lucrative industry for the black market. Pharmaceutical companies and consumers alike need to be responsible with prescription drugs, as the potential health risks can be deadly. This is a global problem that requires global cooperation.

Resources

Primary

FDA: Counterfeit Drugs, Questions and Answers

CDC: Counterfeit Drugs

FDA: Counterfeit Drugs

Additional

Nova Next: Cracking Down on Counterfeit Drugs

CBS News: Your Anemia Drug May Be Fake

Fierce Pharma: Lilly Steps up War on Counterfeits With $110M Serialization Program

HRF: 20 Shocking Counterfeit Drug Statistics

Medscape: Counterfeit Version of Adderall Unsafe, Ineffective, FDA Warns

PhRMA: Counterfeit Drugs

National Center for Biotechnology Information: The Prescription Drug Act of 1987

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

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