Dr Maria P. Neira, Director CPE
It is a fact that existing health technology for prevention, diagnosis and treatment, if appliedglobally, would lead to a dramatic reduction in the burden of communicable diseases. Fewdiseases deserve the highest possible priority as their morbitity and mortality are high and asthey disproportionately affect populations that are living in poverty. Some diseases areneglected either because their global burden is relatively low, or the mortality attributed tothem is low. However, these neglected diseases represent a very high burden in terms ofdisability and social stigma in communities that are among the poorest in the world.
By definition, these diseases do not receive high political commitment, international interest,investments from the research community. Interventions targeted to control these diseasesneed innovative approaches and the role of WHO is crucial in ensuring that priority does notmean exclusivity. How can we ensure that vital health care are accessible to all the peoplethat need them – regardless of their income, regardless of the health conditions they aresuffering from, regardless of the country they live in?
For too many of the world’s poor people – those with an income of one or two dollars a day –nothing very much has changed at all. It is essential to recognise that if we are to achieve thegoal of more equitable access to good quality health care, everyone has a role to play. It iseasy for diversity to appear as an obstacle to progress. Our main challenge is to turn diversityinto creativity.
Improving access to existing technology
Drugs are not a commodity like any other. Ensuring access to health care is one of the majorresponsibility of WHO. Access to drugs is part of this responsibility. Not just for one set ofhealth conditions, but for all. A key component of this responsibility is the creation ofpartnerships between the private and public sector, bilateral aid agencies and otherorganizations, that are committed to effective action. Strategic alliances where key playersjointly develop strategies and mobilize the resources to implement them on the necessaryscale are crucial.
Despite the availability of free and effective treatment for a number of communicable diseasesmany obstacles still need to be overcome in order to improve access to diagnosis and treatment.
The most important ones are:
§ poor geographic coverage of health services in the most endemic countries;§ limited community awareness concerning the availability of treatment, and prejudice
towards sufferers which often lead to tragic consequences such as late diagnosis, highdisability rates and low cure rates.
Improving access to treatment is a complex issue requiring innovative solutions based on localrealities. Such improvement helps to overcome weak health care infrastructures, lack of trainedpersonnel, prejudice, stigma and poor awareness. Forging alliances with partners, despite theirpossible different ideological backgrounds, is the only way to overcome existing obstacles in thefield in an attempt to improve patient access to treatment in a sustainable manner.
Public-private partnerships are therefore proving to be successful to address the agenda fortargeted communicable diseases. Drug donation is one of the key elements can play a key rolefor time-limited elimination programmes such as lymphatic filariasis and leprosy
Examples of successful partnerships
Novartis, the pharmaceutical industry partner in the Global Alliance to Eliminate Leprosy, hasa long tradition of collaboration with the Leprosy Programme. It developed the two key productsused in multidrug therapy (MDT) - Clofazimine and Rifampicin. At the initiative of WHO,Novartis conducted the first clinical trials to establish the use of Rifampicin on a once-monthlybasis, the cornerstone of multi-drug treatment. It also designed and field tested the calendarblister packs which help simplify logistics and improve patient compliance.
Since 1986, the Novartis Foundation for Sustainable Development has been involved in fieldprogrammes in a number of countries aimed at improving patient access to treatment and itcollaborates with local authorities, WHO and non-governmental organizations. The Foundationhas developed innovative and practical approaches, such as field-based disability care and socialmarketing.
In August 1999, Novartis signed a Memorandum of Understanding with WHO in which itpledged to provide to WHO adequate quantities of the drugs used in MDT for the treatment ofall patients in the world from 2000 until the end of 2005. In addition, Novartis provides WHOwith the necessary funds for the shipment of the drugs and for independent quality control; it alsomaintains buffer stocks in order to respond to fluctuations in demand for the drugs used and tocover emergency requests from endemic countries. The Novartis Foundation for SustainableDevelopment continues to actively support efforts to improve awareness of leprosy and accessto diagnosis and treatment.
Lymphatic filariasis is primarily a disease of the poor because of its frequent prevalence inremote rural areas and disfavoured peri-urban and urban areas; filariasis patients are physicallyincapacitated and cannot work nor lead a normal life. The economic burden of lymphaticfilariasis is enormous, due to the decreased ability to work during acute inflammatory attacks,lowered capacity due to chronic disease and the loss of family income to pursue costlytreatments, which most of the time are ineffective.
A global coalition has been forged among many organizations, each with a different mandate butall having a common goal: to tackle the wide-ranging and complex process of science andpractice that will result in the elimination of lymphatic filariasis as a public health problem fromthe world.
A significant step was taken in 1997 when the World Health Assembly passed a resolutioncalling for '.the elimination of lymphatic filariasis as a public health problem.'. Following this,WHO began developing a coalition to eliminate the disease.
The following year the coalition was given a powerful boost when GlaxoSmithKline (formerlySmithKline Beecham) announced its commitment to form a unique private-/public-sectorcollaboration with WHO to support the global programme to eliminate lymphatic filariasis, bydonating albendazole (one of the drugs used against lymphatic filariasis) free-of-charge as longas necessary. The two organizations pledged to work together closely to undertake this massiveinternational public health effort. Subsequently, Merck & Co., Inc. pledged to expand its ongoingMectizan® Donation Program for onchocerciasis to cover treatment of lymphatic filariasis in allAfrican countries where the two diseases occur together. The donation will enable countrieswhich are in need, but which are without the necessary resources, to acquire the drugs and topursue their national elimination programmes.
This drug donation triggered a process that has continuously evolved since its inception. In 2000alone, GlaxoSmithKline provided 34 million tablets of albendazole, through WHO, and Merckand Co., Inc. provided ivermectin, to Ghana, Nigeria and Tanzania lymphatic filariasisprogrammes.
The partnership has since broadened to include 35 organizations from various sectors of societysuch as public and private sectors, academia, government bodies and NGDOs. The GlobalAlliance to Eliminate Lymphatic Filariasis can now envisage the elimination of the disease asthe focus of a widely beneficial public health intervention organized through existing orstrengthened national health infrastructures.
Individually, none of these organizations can eliminate lymphatic filariasis; but by workingtogether, and working through the Ministries of Health in the endemic countries, it can beachieved. Not all partners will work in each country, but, together, will cover all the affectedcountries and will have a positive impact on many millions of lives. It is planned to cover 40million people in 2001 and so far 15 million persons have already been reached.
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DA DECLARAÇÃO DE INCONSTITUCIONALIDADE DO ART. 273, DO CÓDIGO PENAL OU RECONHECIMENTO DA ATIPICIDADE MATERIAL DO FATO, ANTE A INEXISTÊNCIA DE RESULTADO JURÍDICO Por Bruno Haddad Galvão, Defensor Público do Estado de São Paulo O artigo 273, do Código Penal, foi introduzido pela Lei 9.677, de dois Assim como outras leis, tais como a de n.° 8072/90 e 8930/94, referida lei foi