World Health Organization Initiative Research Articles

Development of New Tuberculosis Vaccines: A Global Perspective on Regulatory Issues

In May 2005, the TB Vaccine Initiative of the World Health Organization (WHO) Initiative for Vaccine Research convened a working meeting of regulators, investigators, and clinicians from developing and developed countries involved in tuberculosis (TB) vaccine regulation and research (see Text S1 for a list of participants). The purpose of the meeting was to specifically discuss the regulatory challenges for testing and introducing investigative TB vaccines into countries where the disease is endemic.

Recent World Health Organization initiatives for antimicrobial resistance control

The World Health Organization (WHO) overseeing of antimicrobial resistance (AMR) containment issues in the last decade has varied in intensity. From 1999 onwards, concerted focus from the WHO led to the development of a multi-disciplinary framework for AMR containment at a country level. However, implementation of the WHO Global Strategy for the Containment of Antimicrobial Resistance (the Global Strategy) was overtaken first by events in the USA in 2001 and later by related and other bio-security issues. By 2003, loss of funding and a restructured WHO saw AMR initiatives curtailed. Interest in AMR at the WHO has been recently rekindled and it is hoped that renewed attention will again be focused on this issue by the WHO and its member states.

International Push Under Way To Improve Drug-Trials Data

International Push Under Way To Improve Drug-Trials Data

What Role for Inactivated Poliovirus Vaccine in the Eradication Endgame?

The 15-decade drive to control and eradicate polio through immunization [1] has benefited from the availability of 2 excellent vaccines, the inactivated poliovirus vaccine (IPV) of Salk and colleagues, licensed in 1955, and the live attenuated oral poliovirus vaccine (OPV) of Sabin, licensed in 1961. The 2 vaccines have complementary advantages, and both have played—and continue to play—important roles in polio control. IPV has been used primarily in developed countries with good sanitation and temperate climates, whereas OPV has been the primary weapon in the World Health Organization (WHO) initiative to eradicate polio from the developing world [2, 3]. The introduction of IPV in the United States and other high-income developed countries was followed by a sharp decline in polio incidence, but IPV was gradually replaced by OPV in the early 1960s, with only The Netherlands, Nordic countries, and some Canadian provinces continuing exclusive use of IPV. OPV offers the promise of global polio eradication because of its efficient induction of intestinal immunity, ease of administration, suitability for mass immunization campaigns, and lower cost. Great strides have been made toward the goal of global polio eradication, with the apparent eradication of wild poliovirus type 2 in 1999 [4]; the highly localized endemic circulation of wild poliovirus type 3 to pockets in southern Afghanistan, northern India, and northern Nigeria; and the dramatic progress in the control of wild poliovirus type 1 in Egypt and southern Asia (updates are posted on the WHO Web site, http://www.polioeradication .org/). The incidence of polio has declined from an estimated 350,000 cases in 1988 to 1948 cases in 2005. However, wild poliovirus type 1 from reservoirs in northern Nigeria, where polio immunization had been interrupted in 2003 and 2004, spread to 18 previously polio-free countries in 2003‐2005, from Guinea in the west, to Yemen and Somalia in the Horn of Africa, to Indonesia at the southeastern edge of Asia, resulting in a steep increase in the number of cases last year [5]. Nationwide mass immunization campaigns with OPV have rolled back polio in most of these countries, but outbreaks continue in Indonesia, Somalia, and Ethiopia, while northern Nigeria remains an active reservoir for poliovirus types 1 and 3.

Universal Access to Antiretroviral Therapy: When, Not If

The global HIV/AIDS pandemic poses the greatest global health challenge in recent history. Effective large-scale treatment of the several million infected individuals has appeared to present an almost insurmountable task. An ambitious global approach to this challenge was developed by the World Health Organization (WHO) by 5 program in 2003 with the goal of providing treatment to 3 million affected individuals in low- and middle-income countries by the end of 2005. Although the immediate goal of the by 5 program has not been achieved 1500000 Africans are now receiving antiretroviral therapy (ART). This initial WHO initiative has been of tremendous value in shifting the international emphasis from if to when universal access to antiretroviral treatment can be achieved. An additional thoughtful analysis of the essential elements of an effective approach to worldwide scale-up of ART was presented by the Institute of Medicine in early 2005. (excerpt)

Essential newborn care training activities: 8 years of experience in Eastern European, Caucasian and Central Asian countries

There is still an alarming gap in neonatal healthcare and outcome between Western and Eastern European countries and the former USSR countries in particular. Most of the causes of neonatal mortality and morbidity can be prevented or managed by simple cost-effective interventions aimed at improving quality of healthcare, health system organisation and family and community participation. Training of health professionals and health policy-makers in the field of essential neonatal care and breastfeeding promotion is one of the cornerstones of the World Health Organization (WHO) initiatives Making Pregnancy Safer (MPS) and Promoting Effective Perinatal Care (PEPC) - the latter specifically tailored to the European Region - aimed at ensuring safe pregnancy and childbirth through ensuring the availability, access and use of quality skilled care. After 8 years of experience of training in essential neonatal care, positive changes in planning for and delivering neonatal care are taking place, even in challenging contexts, and this model of intervention should be further implemented in the region.

The World Health Organization initiative on implantation research

Recognizing that the currently available contraceptive options represent a limited choice for women, contraceptive research and development programs have identified the process of implantation as a promising area for investigation. Contraceptive methods that prevent implantation and can be taken on a once-a-month basis appear to be an attractive option for many women in a variety of settings. A recently completed 5-year, international, collaborative research programme — conducted by the World Health Organization with financial support from the Rockefeller Foundation — has identified a number of promising leads for once-a-month method development and the more promising of these leads are being actively followed up in collaboration with the pharmaceutical industry.

Levocetirizine improves quality of life and reduces costs in long-term management of persistent allergic rhinitis

Allergic Rhinitis and its Impact on Asthma in collaboration with the World Health Organization initiative reclassified allergic rhinitis, like asthma, by duration and severity. The Xyzal in Persistent Rhinitis Trial is the first large, long-term clinical trial studying patients with persistent rhinitis as defined by Allergic Rhinitis and its Impact on Asthma. Two primary objectives were defined: comparison of the Rhinoconjunctivitis Quality of Life Questionnaire overall score and Total 5 Symptoms Score (rhinorrhea, sneezing, nasal congestion, and nasal and ocular pruritus) over a period of 4 weeks between levocetirizine 5 mg and placebo. Secondary endpoints included similar evaluations at 1 week and 3, 4.5, and 6 months, summary scores for a general health status questionnaire (Medical Outcomes Survey Short Form 36), a pharmacoeconomic assessment, comorbidities, and a safety evaluation. The Xyzal in Persistent Rhinitis Trial was a 6-month double-blind, placebo-controlled, multicenter, multinational trial in 551 patients. Adults with persistent rhinitis sensitized to both grass pollen and house dust mite were randomized to receive levocetirizine 5 mg/d or placebo. A total of 421 patients completed the full study. Levocetirizine significantly improved both the Rhinoconjunctivitis Quality of Life Questionnaire overall score and the Total 5 Symptoms Score from week 1 to 6 months (all P values <.001). Medical Outcomes Survey Short Form 36 summary scores were also improved in the levocetirizine group compared with the placebo group. Treatment cessation because of lack of effect, comorbidities, and overall costs of disease, and comorbidities per working patient per month (160.27 vs 108.18) were lower in the levocetirizine group. Levocetirizine was shown to improve quality of life and symptoms and to decrease the overall costs of the disease over the 6-month treatment period.

D.A. Henderson: acting globally, thinking locally.

They had said that it couldn't be done-the worldwide eradication of smallpox. To hear D.A. Henderson tell it, the job of leading the World Health Organization's initiative to conquer the disease in the 1960s and 1970s rather fell into his lap. In fact, he describes each of the posts that he has held with great modesty, beginning with his military service at the Centers for Disease Control and Prevention all the way through his assignments as Dean of Public Health at Johns Hopkins, Associate Director of the Office of Science and Technology Policy in the Executive Office of the President, and more recently as Director of the Office of Public Health Preparedness under Secretary Thompson at the Department of Health and Human Services. Confronted with enormous challenges in terms of public health initiatives, Henderson describes each assignment as a matter of communicating with the people he works with and the people that he serves, and drawing on their insights to devise strategies for accomplishing the task at hand. With bioterrorism posing one of the major public health concerns to face the United States and the world, it's gratifying to know that someone with Henderson's track record and wide-ranging expertise is paying attention and making sure that medical and government officials are preparing to respond to the threat. Again and again, Henderson appears to have the knack for showing up in the right place at the right time with just the right idea.

Violence and health: the United States in a global perspective.

Violence is a public health problem that can be understood and changed. Research over the past 2 decades has demonstrated that violence can be prevented and that, in some cases, prevention programs are more cost-effective than other policy options such as incarceration. The United States has much to contribute to-and stands to gain much from-global efforts to prevent violence. A new World Health Organization initiative presents an opportunity for the United States to work with other nations to find cost-effective ways of preventing violence and reducing its enormous costs.

Critical Care: a good scientific citizen just got better

Critical Care: a good scientific citizen just got better

Addiction: A global public health challenge for nurses

With expanded technologic and communication resources there is growing awareness worldwide of the public health problems caused by alcohol, tobacco, and other drug use, misuse, abuse and addiction. Trends vary by culture and region but use of tobacco and alcohol is almost universal and is associated with high rates of mortality and morbidity. While nurses have not universally embraced the prevention and treatment of substance‐related disorders as their province, this is changing as a function of organisations, World Health Organization (WHO) and national initiatives, and the strengthening of nurse education. Actions to promote consensus, identify and review competencies for nurses must consider national and cultural variations, traditions of social change and the need for evidence‐based practice. Collective action by nurses in newly formed and existing organisations, which focus on addictions prevention and treatment, have resulted in initial professional steps. Such progress can be facilitated if achieved in the context of larger international policies and initiatives and in collaboration with members of other professional disciplines.

Ocular chlamydial infections: pathogenesis and emerging treatment strategies.

Chlamydiae cause a spectrum of diseases in multiple organ systems, and chlamydial infections of the eye lead to sequelae varying from mild conjunctivitis to blindness. This paper reviews current concepts in the pathogenesis and management of ocular chlamydial infections. Trachoma, the leading cause of preventable blindness in the world, is compared with other ocular chlamydial diseases to underscore key concepts in chlamydial pathogenesis. Emerging treatment strategies are discussed in the context of chlamydial pathogenesis and the World Health Organization initiative to eradicate trachoma by 2020.

The global burden of mental disorders.

Recent data on the burden of mental disorders worldwide demonstrates a major public health problem that affects patients, society, and nations as a whole. Research must be done to find effective ways to deal with the increasing burden of mental disorders. Given the growing evidence that mental disorders are disorders of the brain and that they can be treated effectively with both psychosocial counseling and psychotropic medications, intervention packages could be developed to deal with the increasing burden. Such packages should be tested for real-world effectiveness and their cost-effectiveness should be demonstrated to guide policymakers to choose from among many other non-mental health interventions. The transportability and sustainability of intervention packages should be studied in public health research and a link between efficacy, effectiveness, cost-effectiveness, generalizability, and sustainability should be demonstrated. The World Health Organization's initiative on the World Mental Health 2000 Survey will provide the first basic epidemiologic data. Together with other data, the initiative will provide solid evidence for including mental disorders into essential treatment packages. In this way, parity can be achieved for mental disorders and mental health can be mainstreamed into health and public health practice.

The World Health Organization initiative on noma.

Oro-facial noma is a worldwide scourge in a context where the World Health Report 1998 gives a global incidence of 140,000 cases, a prevalence in 1997 of 770,000 persons surviving with heavy sequelae. The background and the five steps of the WHO oral health programme to control noma including: (i) ensuring training and awareness on early diagnosis and treatment for each public health structure, (ii) raising awareness and informing populations, (iii) promoting epidemiological research, (iv) promoting aetiological research, (v) setting up an African regional centre for the treatment of after-effects, are developed in this paper.

A Risk-Based Approach to Health Criteria for Radon Indoors - Report on a WHO Initiative

Abstract The World Health Organisation (WHO), Regional Office for Europe, organised a meeting of a working group on indoor air quality in Eilat, Israel, from 28 March to 4 April 1993. The aim was to develop a risk-based approach to health criteria for radon indoors. The group reviewed the latest epidemiological data from occupational and non-occupational radon exposure, animal experiments and dosimetry. The Group issued 14 conclusions and 23 recommendations on radon related risk to health, on risk management and risk communication. In summary, radon was confirmed as a human carcinogen. Indoor radon exposures resulting in individual risk exceeding 10-3 per year are to be considered as severe and risk reduction programmes implemented. Guidance on risk management and communication is offered to national authorities.

Empowering family and friends: a new approach to the secondary prevention of addiction

This paper presents a typology and transactional model of how close relatives cope with excessive drinking, drug-taking or gambling in the family. These are illustrated with four examples taken from a series of research projects in which relatives have been interviewed to understand better how they react and respond. Such information is the groundwork for a World Health Organization initiative to help primary health care workers respond to the needs of relatives. The philosophy behind this initiative, and the steps that primary health care workers might take, are outlined. It is proposed that such workers can help close relatives to find the best coping methods in their circumstances, and that this approach might constitute an important, and hitherto neglected, form of secondary prevention.

World news

Russia Millions of doses of vaccines to ward against an outbreak of childhood diseases are being sent to the former Soviet Union under a World Health Organization initiative.

WHO initiative

In recent years, the countries of central and eastern Europe, the Baltic States, and the newly-independent countries (established in place of the former Soviet Union), have experienced a much heavier burden of cancer as compared to other subregions of Europe. This appears to be the result of a decline in the standard of health care services, environmental neglect and the high prevalence of health-damaging behaviour, smoking in particular. Their anti-cancer potential falls short of their needs. The existing and still widening gap between what are considered best and worst patterns, practices and prospects in cancer control in Europe has posed a challenge to both the World Health Organization (WHO) and the international cancer community. On WHOs initiative, a group of major European cancer organizations is determined to use their considerable potential, both moral and scientific, in supporting national efforts in all possible ways in those countries that need progress. Recently, WHO has initiated an all-European alliance with the intention of narrowing the gap between what are regarded as best and worst patterns, practices and prospects in cancer control in Europe.

Advances in Cancer Pain Management

Undertreatment of cancer pain remains a worldwide problem. World Health Organization (WH0) and national initiatives are addressing this important issue and several significant, recent advances have been made. There has been more widespread adoption of the WHO method for relief of cancer pain, which is based on a three step analgesic ladder and regular, around-the-clock oral medication. Until recently, many countries have not allowed oral morphine, but there is now more widespread availability of oral preparations of this drug. Epidural administration of morphine and other analgesics is being employed successfully in selected patients. The importance of using anti-inflammatory agents, especially the nonsteroidal anti-inflammatory drugs (NSAIDs) is being more widely recognized. There is an increased awareness of the importance of differentiating nociceptive and neuropathic pain. Tricyclic antidepressants and anticonvulsants are often effective in the latter, and good experience with the use of local anesthe...