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    • Vaccines for rotavirus and cholera the two

    2019-06-17

    Vaccines for rotavirus and cholera—the two diseases with the highest child mortality rates and a significant fraction of the global diarrhoeal burden—are at preliminary stages of implementation. The use of vaccination as a global primary-prevention strategy can also be rapidly strengthened with the help of an early-warning system, by planning of targeted delivery in vulnerable populations. A systematic synthesis of hydroclimatic understanding with microbiological and epidemiological evidence of pathogen transmission pathways will also create a necessary platform for identification of effects of global climatic and environmental changes on disease dynamics. In addition to investment in medicinal development, ORS distribution, and WASH infrastructure, there is tremendous potential in the use of the vast and freely available climate and satellite remote sensing datasets and space and time information on the MCC950 sodium cost underlying processes behind diarrhoeal disease outbreaks. Without the inclusion of such information, we cannot accurately assess population vulnerability or the public-health response capacity of affected regions, nor can we harness the potential of early-warning systems. Climatic and environmental surveillance systems can successfully monitor affected and vulnerable regions over large swathes of territory and identify hotspot areas with useful lead time to intervene.
    Meetings of health ministers from the five BRICS countries (Brazil, Russia, India, China, and South Africa) have produced two joint statements in less than a year: the Delhi Communiqué (Jan 12, 2013) and the Cape Town Communiqué (Nov 7, 2013). Both statements bode well for global tuberculosis control. The Delhi Communiqué underscores the principle of equity and focuses on populations who are most affected by the disease. The Cape Town Communiqué emphasises promotion of consortia of researchers to collaborate for clinical trials of drugs and vaccines, strengthening of access to affordable, high-quality, effective, and safe medicines, and delivery of high-quality health care. These approaches are in agreement with the overall approach of tuberculosis elimination strategies, which foster innovation within well managed systems and through bold policies (eg, for infection control, rational drug use, and mandatory case notification). With decreases in incidence and mortality, progress in tuberculosis control has been evident. However, several challenges persist, including tackling of multidrug-resistant tuberculosis (which has emerged because of widespread access and use of tuberculosis drugs over the past decades), and replacement of old, inadequate methods for diagnosis, treatment, and prevention with new, rapid methods. Changes in the global political economy also call for adjustments to financing of global tuberculosis control. Half of the high-tuberculosis-incidence countries that were classified as low income in 2000 are now in the middle-income category, and more are expected to join this group by 2020 (). The five BRICS countries, which account for 25% of global gross domestic product, 30% of global land area, and 45% of the world\'s population, also bear about 45% of the world\'s burden of tuberculosis and more than 60% of the burden of multidrug-resistant tuberculosis. This finding is not surprising; four-fifths of people who survive on less than US$2 a day are estimated to live in middle-income countries. BRICS and other middle-income countries with a large burden of tuberculosis should also have the resources to tackle the disease. The global response to tuberculosis needs to be rebalanced. In view of the present and future requirements of global tuberculosis control, a sustained fight against tuberculosis now needs enhanced investments on at least three fronts. First, continued international financing is necessary to further support the lowest-income countries in sub-Saharan Africa and elsewhere with necessary resources and technical assistance; a handful of fragile states need special attention and full support. Second, the BRICS and other middle-income countries should continue to enhance domestic health investments, while benefiting from nuanced international financing during a transition period towards full self-reliance in tuberculosis care and prevention. Third, far larger investments (including from BRICS countries) are needed to boost research, development, and introduction of new drugs, diagnostics, and vaccines, without which tuberculosis elimination cannot be achieved.