TIME vaccines

This Is How Nigeria Beat Polio

Goodbye to all that: Computer-generated model of a poliovirus
Calysta Images ;Getty Images/Tetra images RF Goodbye to all that: Computer-generated model of a poliovirus

A quarter-century campaign brings the world tantalizingly close to eradicating a disease

It’s easy not to notice a negative. A house burns down on your block and it’s all you can talk about. But a house doesn’t burn down? Where’s the news?

Still, absence can be the stuff of headlines, and that fact has rarely been truer than it is in Nigeria today—where health officials are celebrating a full year without a single case of polio. A polio-free Nigeria means a polio-free Africa, since it was the only country left of the 47 on the continent where the crippling disease was still endemic. The virus, which as recently as 1988 was endemic in 128 countries, crippling 350,000 children per year, has now been cornered in just two places—Afghanistan and Pakistan, and it’s barely hanging on there. Wipe polio out in those last two redoubts and it will become only the second disease in history—after smallpox—to have been vaccinated out of existence.

“We are celebrating the first time ever that Nigeria has gone without a case of polio, but with caution,” said Dr. Tunji Funsho, who leads Rotary International’s anti-polio campaign in Nigeria. “Surveillance takes place in every nook and cranny of this country, even in those areas that have been free for years.”

The victory in Nigeria did not come easy—and it almost didn’t happen at all. For more than a generation, it has been Rotary that has led the drive to eradicate polio, administering vaccinations to 2.5 billion children in 122 countries at a cost of $1.4 billion. With the help of UNICEF, the World Health Organization (WHO), the U.S. Centers for Disease Control, the Bill and Melinda Gates Foundation and other groups, the effort paid off comparatively fast. As long ago as 2003, the virus had been chased out of all but six countries and the global caseload was down to just 732. There was talk of eradication by as early as 2005.

But Nigeria scuttled those plans. In the summer of 2003, Muslim clerics in the country’s northern regions halted all vaccinations, spreading the fiction that the vaccines contained HIV and were designed to sterilize Muslim girls. Quickly, the poliovirus did what all viruses do when they’re given that kind of running room: it spread, and fast. By 2005, cases consistent with the Nigeria strain were appearing in a 16-nation band that stretched as far away as Indonesia, before the outbreak could finally be contained.

“This is a disease that can’t be controlled,” said WHO spokesman Oliver Rosenbauer at the time, “it has to be eradicated.”

While the current victory in Nigeria was a huge milestone, things remained dicey right to the end—again due to politics—when Boko Haram fighters killed nine polio workers and abducted three others earlier this year. But the vaccine program was already too far along for the attacks to reverse things, and as the July 24 anniversary arrived, victory was at last declared—albeit tentatively.

Nigeria is now officially off the list of endemic countries, but the poliovirus can lurk in sewage and elsewhere, and since there can be up to 200 asymptomatic cases of the disease for every paralytic one, there is no telling how many human virus reservoirs are still at large. Only after two more polio-free years pass will Nigeria be declared officially done with the disease.

That leaves Afghanistan and, most troublingly, Pakistan. Currently, there have been only 33 cases of polio recorded worldwide in 2015—28 in Pakistan and 5 in Afghanistan. At the same point last year, those two countries had already had 107 infections, and the Pakistani strain had turned up in at least six other countries.

Progress has been slowed in Pakistan by often-deadly attacks on polio field workers carried out by local Taliban fighters. Since 2012, however, the government has been providing help, committing its military to protecting the vaccinators and recruiting religious leaders to speak out on the moral imperative of ensuring the health of children.

National pride plays no small role too. India—Pakistan’s mortal rival—has not had a case of polio since 2011 and was declared officially free of the disease last year. That the Indians accomplished this in a country with four times the landmass and seven times the population of Pakistan has been galling to many Pakistanis. The dramatic reduction in new infections in Pakistan from 2014 to 2015 has been a point of national pride.

Protecting children should not, of course, be a matter of international bragging rights. It should just be something human beings do. We’re a species smart enough to have invented a vaccine and brave enough to go delivering it in very dangerous places. The effort to eradicate polio has been a halting thing, and we have too often gotten in our own way. But at last, sometimes despite ourselves, we appear to be on the brink of winning.

TIME global health

Here’s How Much More Money Is Needed to Improve Global Health

Outbreaks like Ebola highlight the gaps in the way money is raised and used for protecting people’s health, a new study finds

In a report published in the journal Lancet, researchers point out large gaps in the money raised and dispatched for public health purposes and the medical needs of countries, particularly in the developing world, to keep their populations healthy.

Despite recurrent outbreaks of pandemic infections such as SARS and, most recently, Ebola, donors have committed less than a third of the estimated $3.4 billion that is needed to maintain a strong pandemic preparedness system, according to the World Bank. Overall, donor countries have spent only half of the $6 billion that the World Health Organization says is needed to maintain global public health.

What’s lacking, the study authors say, is a more focused system for investing in global health that emphasizes programs designed to achieve certain public health functions, such as vaccinating a particular population or corralling antibiotic resistance or the spread of multi-drug resistant tuberculosis. It’s an approach championed by philanthropic organizations such as the Bill & Melinda Gates Foundation, the organization that funded the study. Part of the funding conditions of its programs include specifying outcomes and a timeframe for achieving them.

“For example, countries like China and India would substantially benefit from market shaping to lower drug prices and increased international efforts to control multi-drug resistant tuberculosis,” Dr. Marco Schaferhoff, association director of SEEK Development in Germany and one of the co-authors of the report, said in a statement. “At the same time…donor countries should also ensure that vulnerable and marginalized populations in middle-income countries, such as ethnic minorities who suffer discrimination, refugees, and people who inject drugs, receive sufficient support.”

TIME Disease

South Korea Authorizes Prison Time for MERS Patients Who Break Quarantine

Quarantine tent in Seoul, South Korea
Chung Sung-Jun—2015 Getty Images Visitors wearing masks walk in front of a health advisory sign about the MERS virus at a quarantine tent for people who could be infected with the MERS virus at Seoul National University Hospital on June 2 in Seoul, South Korea.

The country is in the midst of the worst outbreak ever seen outside of Saudi Arabia

South Korea tightened quarantine restrictions on patients at risk of being infected with Middle East Respiratory Syndrome virus, declaring that those who defy orders or lie about their potential exposure are now subject to prison terms.

Health officials announced that violators could face up to two years in prison and a fine of 20 million won, or approximately $18,000. Currently, defying quarantine can result in a fine but not a jail sentence.

The new law, which grants greater authority to public health investigators, does not take effect for another six months. The latest tally for the disease reached 181 confirmed cases and 31 confirmed deaths since the outbreak began last month.

[New York Times]

TIME health

How the Gates Foundation Aims to Cut Childhood Mortality in Half

Filling bellies: Melinda Gates and the Gates Foundation are going after one of the leading killers of babies
J. Countess; Getty Images Filling bellies: Melinda Gates and the Gates Foundation are going after one of the leading killers of babies

Jeffrey Kluger is Editor at Large for TIME.

A new grant will go straight after a leading killer of kids under five: undernutrition

Correction appended, June 3

There are a lot of ways to think about child mortality—most of them not very pretty. You can think of the 6.3 million children every year who never live to see their fifth birthday. You can think of how that breaks down to the loss of 17,260 babies every day, day after day, for 365 days.

But you can also think that those terrible numbers are exactly half of what they were in 1990, meaning that last year, 6.3 million children who would not have seen age five did. Most of that extraordinary progress has been made by controlling, treating or vaccinating against preventable diseases like cholera, measles, pneumonia and malaria. Now, the Bill and Melinda Gates Foundation proposes to slash the child mortality rate in half once more, announcing a plan to invest $776 million over the next six years to advance one of the most primal and important health interventions of all: giving kids enough to eat.

Death by starvation or undernutrition can be hard to track, because while it’s not always the proximate killer, it’s often the accomplice. Expose a well-nourished child and an undernourished child to, say, the measles virus and it’s no mystery which one of them has a better prognosis.

“Estimates are that in about 50% of all of the remaining under-five deaths, nutrition played at least a significant role,” said Melinda Gates in a conversation with TIME.

The Foundation aims to change that in a lot of ways—little of which will involve the old bags-of-rice-offloaded-at-the-airport model. Emergency supplies can fill gaps in times of natural disasters, but they are, as Gates calls them, downstream strategies—sustainable only as long as the supplies keep flowing from generous benefactors. Upstream strategies involve putting systems in place so that generous benefactors are eventually not needed.

Part of the new strategy will involve providing seeds and the know-how for planting and harvesting such bulked-up crops as golden rice, the super banana and the fortified sweet potato. These and other GMO foods have caused all manner of controversy in the developed world, but people like the Gates focus on the increased vitamin A in such crops, which builds skin, teeth, bones and soft tissue and has anti-oxidant properties.

Instruction will also be given in no-till agriculture and drip-irrigation, which conserve both water and soil. Research stations will be opened in targeted areas to increase public awareness of both the existence of the crops and the best ways to raise them. And a special effort will be made to put this knowledge at the disposal of the family member who is likeliest to make the best use of it: the mother.

“Fifty percent of all farmers in Africa are women,” says Gates. “And research shows that every extra dollar a woman gets is 90% likelier to be put back into the family than a dollar a man gets. We want to put women at the center of this.” Expanding wireless access is another key part of the program, allowing farmers—men or women—to have ready access to commodity prices, so they can sell their crops at the top of the market.

Women are central in other ways too. Good nutrition starts before a baby is born, and most health experts believe it is the first 1,000 days—from conception through age two—that make the greatest difference in long-term physical and intellectual development. That means educating young women and adolescent girls about proper diet before they get pregnant, and encouraging breastfeeding after birth.

The Foundation will also be pressing to get government and religious leaders to climb on board—or at least get out of the way. “We need governments to impose the regulations needed to get the most out of nutrition programs,” says Gates. “We can do that by showing them the evidence. Brazil, for example, has gotten its malnutrition rate down by 80%. So we show that data and say, ‘Now it’s up to you to decide.'”

And while Taliban extremists have tried to block polio vaccination efforts in Pakistan, that kind of deadly obstructionism is hardly true of all parts of the Muslim world. “Nigeria has a high Muslim population and they have said ‘We will help you,'” Gates says,—and not just in matters directly related to food. “The Koran allows for family planning and we can get that message out.”

For now, the Foundation’s funds will be concentrated in five critical spots: India, Ethiopia, Nigeria, Bangladesh and Burkina Faso. That money will be supplemented by even more. The Gateses’ grant frees up $180 million in partial matching funds from the U.K.’s Department for International Development. The European Union, meanwhile, has pledged a whopping €3.5 billion by 2020 to battle child malnutrition.

That’s a big number—but it comes from a bloc of 28 nations. The Gates grant comes from a couple with a foundation and a mission. If that mission includes saving 17,260 babies every 24 hours, well, that’s a pretty fair day’s work.

Correction: The original version of this story misstated the amount of money the Bill and Melinda Gates Foundation is investing. It is $776 million.

Read next: Here’s What’s on Bill Gates’ Summer Reading List

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TIME Infectious Disease

Bill Gates Thinks This Is the Deadliest Threat to Humankind

Bill Gates, co-founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, speaks at a breakfast meeting with the theme "Dialogue: Technology Innovation for a Sustainable Future" during the Boao Forum For Asia Annual Conference 2015 in Qionghai city, south Chinas Hainan province, 29 March 2015.
Cui hao—Imaginechina/AP Bill Gates, co-founder of Microsoft and co-chair of the Bill and Melinda Gates Foundation, speaks at a breakfast meeting with the theme "Dialogue: Technology Innovation for a Sustainable Future" during the Boao Forum for Asia Annual Conference 2015 in Qionghai city, China's Hainan province, on March 29, 2015

He says it could kill tens of millions

In the next 20 years, is it likely that nuclear war, gigantic earthquakes or asteroids could kill 20 million people? Bill Gates doesn’t think so.

But he did tell Vox that such numbers could be felled by a major outbreak of disease — something the 59-year-old billionaire believes has a “well over 50%” chance of happening in his lifetime.

“The Ebola epidemic showed me that we’re not ready for a serious epidemic, an epidemic that would be more infectious and would spread faster than Ebola did. This is the greatest risk of a huge tragedy,” Gates said, claiming that a serious epidemic could kill more than 10 million people a year.

Read more at Vox

TIME global health

Man Dies of Rare Lassa Fever in New Jersey

He had recently returned from traveling in Liberia

A man died of a rare African virus in New Jersey Monday after recently returning from Liberia, officials confirmed.

The man died of Lassa fever, a virus that causes hemorrhagic symptoms but is very different from Ebola, the Centers for Disease Control and Prevention said. Lassa fever is only fatal for 1% of those who are infected, while Ebola can be fatal for 70% of those infected without treatment. Lassa fever is also much harder to spread from person to person (it’s usually picked up from rodent droppings). About 100,000 to 300,000 Lassa fever cases are reported in West Africa every year, resulting in about 5,000 deaths.

The man with Lassa fever had arrived at JFK airport from Liberia on May 17, and went to a hospital the following day complaining of fever, sore throat and tiredness, officials said. At that time, he did not say he had been traveling in West Africa, and he was sent home the same day. On May 21 his symptoms worsened and he returned to the hospital, at which point he was transferred to a facility equipped to deal with viral hemorrhagic fevers. The patient was in “appropriate isolation” when he died Monday evening. The CDC is working to compile a list of people who may have encountered the patient while he was sick, and they are monitoring close contacts for 21 days to see if they develop the virus.

TIME ebola

WHO Has Acknowledged the Failings of Its Ebola Crisis Response

Health workers walk inside a new graveyard for Ebola victims, on the outskirts of Monrovia, Liberia on March 11, 2015.
Abbas Dulleh—AP Health workers walk inside a new graveyard for Ebola victims, on the outskirts of Monrovia, Liberia on March 11, 2015.

“Our current systems ... simply have not coped”

Top leaders at the World Health Organization (WHO) have admitted to being “ill prepared” to handle the Ebola outbreak and released a comprehensive list of agency failings as well as suggested reforms they and global policymakers must realize moving forward.

“We can mount a highly effective response to small and medium-sized outbreaks, but when faced with an emergency of this scale, our current systems — national and international — simply have not coped,” said WHO Director-General Margaret Chan, Deputy Director-General Anarfi Asamoa-Baah and the organization’s regional directors in a joint statement dated April 16.

The statement listed eight lessons WHO learned from the crisis, including “communicating more clearly what is needed.”

The statement also articulated nine remedies WHO must undergo to better handle large outbreaks in the future — such as intensifying “our advocacy with national authorities to keep outbreak prevention and management at the top of national and global agendas,” as well as establishing a “Global Health Emergency Workforce” and a contingency fund.

In a separate “situation report” dated April 15, WHO said there were 25,791 suspected Ebola cases in Guinea, Liberia and Sierra Leone with 10,689 deaths.

TIME global health

Swine Flu Outbreak Kills 700 in India

Students wearing masks to prevent getting infected by Swine
Pacific Press—LightRocket/Getty Images Students wearing masks to prevent getting infected by Swine flu in Allahabad, India on Feb. 18 2015.

A total of 11,000 people have been infected

A serious outbreak of H1N1 has struck in India, causing more than 700 deaths in the last eight weeks.

More than 11,000 have been infected with the disease commonly known as swine flu, Boomberg reports. The outbreak is thought to be the worst the country has seen since 2009. Infections have seemed to gain momentum over the last week, with the total number of cases doubling since Feb. 11.

While the government said Thursday that there was plenty of medicine available to treat H1N1, hospitals have reported shortages—potentially due to individuals stockpiling the drug as the outbreak worsens.

[Bloomberg]

TIME Cancer

Lung Cancer Now Kills More Women Than Breast Cancer in Developed Countries

The lingering effects of the tobacco epidemic are partly driving the shift

For years, breast cancer has been the leading cause of cancer death among women in developed countries, but according to a new report on the incidence of cancer worldwide from the American Cancer Society, lung cancer now surpasses it.

A combination of early breast cancer detection efforts and the lingering effects of the tobacco epidemic drove the shift, says lead report author Lindsey Torre, an American Cancer Society researcher. The study, which was published in CA: A Cancer Journal for Clinicians and used data from 2012, reported that lung cancer killed 209,000 women in developed countries in 2012, while 197,000 women died of breast cancer.

“We know now that in a lot of developed countries among women, smoking is on the decline,” says Torre, noting that new lung cancer infections today are the result of habits formed decades ago. “The good news is that we can probably expect to see these lung cancer mortality rates peak and start to decline as times go by.”

Read more: The Cancer Breakthrough With Big Implications

The report emphasized the growing incidence of cancer in the developing world. Lung cancer was the leading killer of men in developing countries and breast cancer the leading cause of death for women.

In part, these growing numbers can be attributed to an aging population, a trend that is affecting the world at large. And as the developing world continues to westernize, people in developing countries are increasingly likely to smoke, be overweight and rarely engage in psychical activity, Torre says.

“We’re seeing the burden of cancer shift to developing countries, so they’re taking on an increasing portion of the global cancer burden,” she says.

Cancer killed 8.2 million people worldwide and 1.6 million in the United States in 2012.

TIME China

9 out of 10 Chinese Cities Fail Pollution Test

China Smog Air Pollution Jilin
ChinaFotoPress/Getty Images Smog arrives at the banks of the Songhua River due to low temperatures in Jilin Province, China on Jan. 22, 2015.

Only eight of 74 cities monitored met national standards

Nearly 90% of Chinese cities failed to meet government pollution standards last year, according to the country’s environment ministry.

Although only eight of 74 cities monitored were found to meet national standards, the country’s Ministry of Environmental Protection said the results were an improvement over previous years, Reuters reports.

The country declared a “war on pollution” last year and has since taken steps to reduce the use of coal and eliminate factories that don’t meet certain standards.

Read more: Watch This Haunting Seven-Minute Film About China’s Insane Air Pollution

The government has said that meeting its own standards could take up to 15 years. The city of Beijing, for instance, had an average atmospheric pollutant reading of 93 micrograms of particulate matter per cubic meter last year — almost three times the state-determined standard of 35 micrograms per cubic meter.

China—the world’s largest polluter— produces a quarter of the world’s carbon dioxide emissions.

[Reuters]

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