The devastating Ebola epidemic in West Africa is the result of a perfect storm: dysfunctional health services as the result of decades of war, low public trust in government and Western medicine, traditional beliefs and even denials about the cause or existence of the virus, and burial practices that involve contact with contagious Ebola-infected corpses. There are now five affected West African countries: Guinea, Liberia, Nigeria, Sierra Leone, and most recently, Senegal. Ebola has killed around 2000 and infected more than 3500, with over 40% of cases occurring within the past few weeks. The World Health Organization (WHO) predicts that 20,000 may become infected. This fast pace of Ebola's spread is a grim reminder that epidemics are a global threat and that the only way to get this virus under control is through a rapid response at a massive global scale—much stronger than the current efforts.
Author: Peter Piot
Death in old age is inevitable, but death before old age is not. Except where HIV or political disturbances predominated, mortality rates have been decreasing for decades, helped by sanitation, health care, and social changes. Even in low-income countries, at current death rates, three-quarters of newborn infants would survive to age 50, and half would survive to age 70. If disease control keeps progressing and economic development proceeds, then within the next few decades—except where disasters or new epidemics supervene—under-50 mortality should fall to less than half of today's 15% global risk, and under-70 mortality should be less than one in six.
Authors: Richard Peto, Alan D. Lopez, Ole F. Norheim
The development field needs to be more serious about gender inequities and women’s empowerment. By ignoring gender inequities, many development projects fail to achieve their objective. And when development organizations do not focus on women’s empowerment, they neglect the fact that empowered women have the potential to transform their societies. I also review the Gates Foundation’s record on gender and propose some approaches to improve it.
Author: Melinda French Gates
The global health landscape looks more promising than ever, although progress has been uneven. Here, we describe the current global burden of disease throughout the life cycle, highlighting regional differences in the unfinished agenda of communicable diseases and reproductive, maternal, and child health and the additive burden of emerging noncommunicable diseases and injuries. Understanding this changing landscape is an essential starting point for effective allocation of both domestic and international resources for health.
Authors: Jaime Sepúlveda, Christopher Murray
Although coverage rates and health outcomes are improving, many poor people around the world still do not benefit from essential health products. An estimated two-thirds of child deaths could be prevented with increased coverage of products such as vaccines, point-of-use water treatment, iron fortification, and insecticide-treated bednets. What limits the flow of products from the producer’s laboratory bench to the end users, and what can be done about it? Recent empirical research suggests a crucial role for heavy subsidies.
Author: Pascaline Dupas
Discussion on global health in both the academic and the public domain has focused largely on research, capacity building, and service delivery. Although these efforts along with financial commitments from public and private partners have contributed to a broader appreciation and understanding of global health challenges, the reflection of global health in academic training has largely been lacking. However, integrative models are beginning to appear.
Authors: Patricia Garcia, Robert Armstrong, Muhammad H. Zaman
As countries strive toward universal health coverage, mobile wireless technologies—mHealth tools—in support of enumeration, registration, unique identification, and maintenance of health records will facilitate improved health system performance. Electronic forms and registry systems will enable routine monitoring of the coverage of essential interventions for individuals within relevant target populations. A cascading model is presented for prioritizing and operationalizing the role of integrated mHealth strategies.
Authors: Garrett Mehl, Alain Labrique
More of the world’s population has access to cell phones than to basic sanitation facilities, a gap that can only be closed if the engineering and international aid communities adopt new approaches to design for scarcity and scalability.
Authors: Deb Niemeier, Harry Gombachika, Rebecca Richards-Kortum
Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial.
Authors: A. Ager, G. Burnham, F. Checchi, M. Gayer, R. F. Grais, M. Henkens, M. B. F. Massaquoi, R. Nandy, C. Navarro-Colorado, P. Spiegel
Planning, implementing, and evaluating interventions against infectious diseases depend on the nature of the infectious disease; the availability of intervention measures; and logistical, economic, and political constraints. Infectious diseases and vaccine- or drug-based interventions can be loosely categorized by the degree to which the infectious disease and the intervention are well established. Pertussis, polio, and measles are three examples of long-known infectious diseases for which global vaccination has dramatically reduced the public health burden. Pertussis vaccination was introduced in the 1940s, polio vaccination in the 1950s, and measles vaccination in the 1960s, nearly eliminating these diseases in many places.
Authors: M. Elizabeth Halloran, Ira M. Longini
This Perspective focuses on the future of the Pandemic Influenza Preparedness (PIP) Framework, which was initially established to promote the fair sharing of public health–related pandemic influenza samples between countries. We examine the changes that need to be made to address the growing likelihood that genetic sequence data might be shared instead of physical virus samples, as well as the need to expand the PIP framework’s scope and to improve its fairness.
Authors: Lawrence O. Gostin, Alexandra Phelan, Michael A. Stoto, John D. Kraemer, K. Srinath Reddy
The African continent continues to bear the greatest burden of malaria and the greatest diversity of parasites, mosquito vectors, and human victims. The evolutionary plasticity of malaria parasites and their vectors is a major obstacle to eliminating the disease. Of current concern is the recently reported emergence of resistance to the front-line drug, artemisinin, in South-East Asia in Plasmodium falciparum, which calls for preemptive surveillance of the African parasite population for genetic markers of emerging drug resistance. Here we describe the Plasmodium Diversity Network Africa (PDNA), which has been established across 11 countries in sub-Saharan Africa to ensure that African scientists are enabled to work together and to play a key role in the global effort for tracking and responding to this public health threat.
Authors: Anita Ghansah, Lucas Amenga-Etego, Alfred Amambua-Ngwa, Ben Andagalu, Tobias Apinjoh, Marielle Bouyou-Akotet, Victoria Cornelius, Lemu Golassa, Voahangy Hanitriniaina Andrianaranjaka, Deus Ishengoma, Kimberly Johnson, Edwin Kamau, Oumou Maïga-Ascofaré, Dieudonne Mumba, Paulina Tindana, Antoinette Tshefu-Kitoto, Milijaona Randrianarivelojosia, Yavo William, Dominic P. Kwiatkowski, Abdoulaye A. Djimde
Antibiotic effectiveness is a natural societal resource that is diminished by antibiotic use. As with other such assets, keeping it available requires both conservation and innovation. Conservation encompasses making the best use of current antibiotic effectiveness by reducing demand through vaccination, infection control, diagnostics, public education, incentives for clinicians to prescribe fewer antibiotics, and restrictions on access to newer, last-resort antibiotics. Innovation includes improving the efficacy of current drugs and replenishing effectiveness by developing new drugs. In this paper, I assess the relative benefits and costs of these two approaches to maintaining our ability to treat infections.
Author: Ramanan Laxminarayan
A global map of health R&D activity would improve the coordination of research and help to match limited resources with public health priorities, such as combating antimicrobial resistance. The challenges of R&D mapping are large because there are few standards for research classification and governance and limited capacity to report on R&D data, especially in low-income countries. Nevertheless, based on developments in semantic classification, and with better reporting of funded research though the Internet, it is now becoming feasible to create a global observatory for health R&D.
Authors: Robert F. Terry, José F. Salm, Claudia Nannei, Christopher Dye
Evolution of Ebola virus over time | Orbits don't forget their chaotic pasts | Scheduling hydrogen release from water | Regulating nitric oxide production | Compressive, ductile ceramic nanolattices | Moral homeostasis in real life vs. the lab | Patterns of life in the ocean wave | Practice makes perfect — or does it? | All-optical magnetic state switching | Top-down rather than bottom-up change | Manipulating a defect in diamond | Origin of fish pigment cell for pattern | Sheltered black hole seeds grow faster | Immune cells and bugs make a sugary coat | Origin of the spine lies in a worm | Response to pathogens is in the genes | Costa Rican birds of a feather lost together | Making sure leftover light gets in
Legacy of a storm | Giving bacteria the old one-two…three-four | Flu survivors are an inflammatory club | The spinning heart of the Einstein Cross | New titanosaur unearthed in Argentina | Shining light on precision time-keeping | A complementary refill? Yes, please! | Collaborating on assessments
Profiles of T cell responses display genetically influenced interindividual variation.
Authors: Chun Jimmie Ye, Ting Feng, Ho-Keun Kwon, Towfique Raj, Michael T. Wilson, Natasha Asinovski, Cristin McCabe, Michelle H. Lee, Irene Frohlich, Hyun-il Paik, Noah Zaitlen, Nir Hacohen, Barbara Stranger, Philip De Jager, Diane Mathis, Aviv Regev, Christophe Benoist