H5N1

Unravelling the commercial determinants of health

Via The Lancet, an editorial: Unravelling the commercial determinants of health. Excerpt:

In early March, in the wake of the COVID-19 pandemic, nearly 200 people—including former UN Secretary-General Ban Ki-moon—signed a letter strongly criticising pharmaceutical companies for putting a desire to make extraordinary profits before the needs of humanity. Selling publicly funded vaccines, treatments, and tests to the highest bidder resulted in inequities that cost more than a million lives, while private companies made billions of dollars. The signatories called on world leaders to ensure that such an injustice is never repeated.  

The conflict between profits and health equity is not new. The global health community fought for decades to provide access to antiretrovirals for patients with HIV/AIDS in less-resourced settings. Many commercial actors attempt to negatively influence national and international policies, undermine science, or to directly attack individuals calling out their actions. The recent Lancet Series on breastfeeding showed how an extensive network of lobbying by formula milk companies has derailed progress on breastfeeding education. 

This history speaks to the central importance to health equity of the commercial determinants of health, the subject of a Series published in this issue of The Lancet, led by Rob Moodie of the University of Melbourne, along with authors spanning 15 countries and six continents, with the support of the Victorian Health Promotion Foundation of Australia.  

The headline findings are startling: four industries (tobacco, unhealthy food, fossil fuel, and alcohol) are responsible for at least a third of global deaths per year. Yet much of the work to understand the harmful (or beneficial) impact of commercial actors has to date been done in health research silos. Each field faces many of the same tactical battles and strategies without a unified agenda to protect health. There is a lack of consensus across fields of health to define and understand the commercial determinants of health.  

The Lancet Series seeks to remedy this long-standing and complex situation with a consensus definition of the commercial determinants of health (“systems, practices, and pathways through which commercial actors drive health and equity”), a framing to understand commercial entities' impact on health, and a commitment to address its challenges in a holistic way.  

The Series authors set out a bold vision in which governments, commercial actors, and civil society contribute first and foremost to improving health and societal wellbeing. Such a vision is needed urgently. As the second paper in the Series outlines, commercial actors are diverse and many play a vital role in society, but the products and practices of many are having increasingly negative impacts on human and planetary health and equity.  

The Series provides a comprehensive agenda for action, recognising the need for regenerative business models and accountable transparent policies (including an end to commercial actors opposition to health regulation and policies).  

Moodie emphasises that the Series is not anti-business; it is pro-health. There are some notable good models of pro-health-acting businesses. For example, nearly 200 leading financial institutions (which together manage more than US$16 trillion) have signed a pledge to support tobacco-free policies across lending, investment, and insurance. However, although Environmental, Social and Governance frameworks are increasingly used to guide more responsible investment, they still lack specific health indicators.  

Health needs to become a crucial consideration of investor frameworks and global capital markets. Doing so will require the adoption of different economic models, new legislative and regulatory measures, civil society advocacy and accountability, and better corporate social responsibility. Governments must be empowered to encourage businesses to prioritise positive health impacts.  

As Tedros Adhanom Ghebreyesus, WHO Director-General, writes in an accompanying Comment, public health cannot progress without action on the commercial determinants of health. The Lancet welcomes the upcoming WHO Congress and first Annual Report on the commercial determinants of health, especially in helping to address non-communicable diseases. Given their huge unresolved impacts, the commercial determinants of health must be recognised—and funded—as a crucial field of research.

Tanzania confirms first-ever outbreak of Marburg Virus Disease

Via WHO AFRO: Tanzania confirms first-ever outbreak of Marburg Virus Disease.

Brazzaville/Dar es Salaam – Tanzania today confirmed its first-ever cases of Marburg Virus Disease after laboratory tests were carried out following reports of cases and deaths in the country’s north-west Kagera region.  

Tanzania’s National Public Health Laboratory analysed samples to determine the cause of illness after eight people developed symptoms including fever, vomiting, bleeding and renal failure. Five of the eight cases, including a health worker, have died and the remaining three are receiving treatment. A total of 161 contacts have been identified and are being monitored.  

“The efforts by Tanzania’s health authorities to establish the cause of the disease is a clear indication of the determination to effectively respond to the outbreak. We are working with the government to rapidly scale up control measures to halt the spread of the virus and end the outbreak as soon as possible,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa.  

WHO is supporting the Ministry of Health to deploy an emergency team to Kagera to carry out further epidemiological investigations. The emergency team will focus on active case finding in the community and local health care facilities to identify more contacts and provide them with appropriate care.  

While Tanzania has never previously recorded a Marburg case, it has had to respond to other health emergencies including COVID-19, cholera and dengue within the past three years. A strategic risk assessment conducted by WHO in September 2022 showed that the country is at high to very high risk for infectious diseases outbreaks.   

“The lessons learnt, and progress made during other recent outbreaks should stand the country in good stead as it confronts this latest challenge,” said Dr Moeti. “We will continue to work closely with the national health authorities to save lives.”  

Marburg virus disease is highly virulent and causes haemorrhagic fever, with a fatality ratio of up to 88%. It is in the same family as the virus that causes Ebola virus disease. Illness caused by Marburg virus begins abruptly, with high fever, severe headache and severe malaise. Many patients develop severe haemorrhagic symptoms within seven days. The virus is transmitted to people from fruit bats and spreads among humans through direct contact with the bodily fluids of infected people, surfaces and materials.  

There are no vaccines or antiviral treatments approved to treat the virus. However, supportive care – rehydration with oral or intravenous fluids – and treatment of specific symptoms, improves likelihood of survival.