Gavin Yamey's blog

Open Access to Health and Human Rights

Gavin Yamey — Wed, 23 Jul 2008 01:37:23 -0700

Here’s another important step forward in the open access movement. Under its new editor Paul Farmer (who is often talked about as a future Nobel laureate), the international journal Health and Human Rights (HHR) has become fully open access.

The entire contents are freely available and are published under a progressive copyright license that allows readers to reuse the materials for any legal non-commercial purpose.

Farmer and colleagues, in a message from the editors in the “new look” HHR, explain why they are abandoning the previous subscription-based model:

“In embracing the open-access model, HHR aligns itself with a global movement for the democratization of scientific knowledge production and a more equitable distribution of the benefits of science, particularly in health. HHR’s distinctive contribution to this movement will come through the journal’s systematic linking of conceptual and legal human rights analysis with documentation of concrete, front-line experiences translating rights principles into social change and health progress on the ground.”

Online interactivity, which is a natural complement to open access, will be a key feature of the new HHR. In addition to the core articles in the journal, the HHR website also showcases a section of “Perspectives.” The editors describe these as “web-only features, including policy analyses, issue briefs, and advocacy documents, as well as invited opinion pieces and short essays aimed to stimulate debate on health and rights.”

“Over time,” they say, “the website will also provide links, not only to other online journals and information resources, but to emergent spaces in which communities of practice are organizing to strengthen peer-to-peer learning among practitioners in rights-based health program design and service delivery (for example, the Global Health Delivery Project at Harvard University).”

In the interests of full disclosure, I ought to declare two things.

First, I’m on the editorial board of HHR and have advised the editors on transitioning the journal to open access. They used the terrific Open Journal Systems platform.

Second, the journal has just published a peer-reviewed paper of mine, called “Excluding the poor from accessing biomedical literature: A rights violation that impedes global health.” Here’s an excerpt:

“Through its transition from a subscription-based to an open access journal that publishes materials under the Creative Commons Attribution License, Health and Human Rights joins the knowledge commons movement. The journal now has the opportunity to help catalyze the creation of an online “health and human rights commons” that would be an extremely powerful tool in the worldwide promotion and protection of health as a human right. This commons could, among other things, provide researchers, clinicians, and activists with unfettered access to the data that they need to support their human rights work. It could become a rich public venue for sharing research and policy data, global analysis, discussion and debate, case reports, and experiences from the field.”

HHR has so far posted two responses to my piece, one from Maurice Long of HINARI, who seems deeply upset that I didn’t heap more praise upon the HINARI project (I stated that “HINARI is a step in the right direction,” which is true, but also that it is “a very long way from providing universal open access,” true again). I’ll respond to Maurice’s critique shortly.

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Harms of promoting off-label uses to doctors

Gavin Yamey — Fri, 18 Jul 2008 02:39:33 -0700

The FDA’s recent proposal to allow drug companies to send doctors journal articles about off-label drug use has come under major fire over the last few months.

Back in April, The New York Times, in a news feature in its business section (F.D.A. Plan on Medical Articles Takes More Heat), highlighted the widespread opposition to the proposal. This opposition came from, among others, Public Citizen, New York State’s health commissioner, Representative Henry Waxman (who sent a letter to the FDA outlining his concerns), and the Blue Cross Blue Shield Association, a trade association of 39 major health insurance plans. Needless to say, the pharmaceutical industry supports the proposal.

The proposal includes a set of principles that drug companies are supposed to follow, such as only sending doctors articles that have been peer-reviewed. As Randall Stafford (Stanford University) points out, there are two particularly striking things about the proposal:

“First, manufacturers need no longer limit their promotion of off-label uses to drugs and indications for which they are working toward FDA evaluation; and second, there is no requirement for advance FDA review of the journal articles to be distributed.”

But given that off-label prescribing is widespread in the US, what could be the harm of simply allowing drug companies to promote more of it? That’s a question answered by Andy Gass (University of California Berkeley) and Jennifer Wilson (University of California San Francisco) in a recent editorial in the American Journal of Bioethics (Disclosure: Andy used to work at PLoS as our outreach coordinator).

The authors lay out four potential harms.

First, they say, the selection of articles distributed to physicians by industry is likely to be biased.

Second, “the requirement that information passed on by industry be limited to peer reviewed journal articles may do little, in practice, to ensure the scientific quality of the evidence contained therein.” Or, as Joseph Ross (Mt Sinai School of Medicine), author of a JAMA study on ghostwriting in trial reports on rofecoxib, told the New York Times: “What does it mean to be peer-reviewed… if the company has essentially conceived the article, composed the draft and written the paper?”

Third, say Gass and Wilson, a rapid proliferation of off-label prescriptions, which might plausibly follow from a rapid proliferation of off-label marketing to physicians, could make it more difficult to track drug safety.

Finally, they say, the omission of a requirement that companies pursue approval for the off-label uses they promote “eliminates any incentive for industry to invest in studies beyond those necessary to earn preliminary approval.” The effect of this policy change, they say, could be quite radical. “The FDA might be left out of the regulatory loop for many of the indications for which companies market drugs to physicians.”

Although the American Journal of Bioethics is a subscription based journal, Andy’s time at PLoS naturally made him an open access advocate—so he has retained copyright on the piece (using the Creative Commons Attribution License) and deposited a copy into the freely available eScholarship repository at UC Berkeley.

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Just Saying No to Drug Reps

Gavin Yamey — Tue, 15 Jul 2008 13:46:00 -0700

When we launched PLoS Medicine in October 2004, the editors announced that we would “not to be part of the cycle of dependency that has formed between journals and the pharmaceutical industry.”

Medical journals, we argued, had allowed their interests to become aligned with those of the pharmaceutical industry by printing drug ads, publishing trials designed by drug companies' marketing departments, and making profits on reprints used as marketing tools. In contrast PLoS Medicine, we said, “will not accept advertisements for pharmaceutical products or medical devices. Our open-access license allows free distribution of articles, so PLoS cannot benefit from exclusive reprint sales. And we consider as the lowest priority for publication papers that are simply aimed at increasing a drug's market share without obvious benefit to patients.”

By putting a healthy distance between the journal and industry, we were joining a wider movement of physicians who are “just saying no” to the undue influence of drug companies upon medical practice and research. Some of the highest profile organizations in this movement are No Free Lunch (mission statement: “We are health care providers who believe that pharmaceutical promotion should not guide clinical practice”) and Pharmed Out, an independent, publicly funded project that “empowers physicians to identify and counter inappropriate pharmaceutical promotion practices.”

Pharmed Out has just created a “No Drug Reps Certificate” that you can download, print, and display in your office. The language and message are crystal clear:

“This office does not allow visits from pharmaceutical salespeople because we rely on scientific information, not marketing, to decide what treatment is best for you. This policy also means that we don't provide drug samples. "Free" drug samples cost you money. Samples are only available for the most expensive, most-promoted drugs, and are a tactic to get you to use drugs that may not be the best therapy for you.”

There’s space at the bottom for your signature and the date.

Adriane Fugh-Berman, Pharmed Out’s Principal Investigator, says that the certificate has been downloaded more than 1000 times in 10 days. “A physician in Australia,” she says “asked to substitute "taxpayers" for "you" on the certificate, as the government rather than consumers pays for drugs, so we added a version on the site for countries with a national health system.”

The new certificate has been discussed by some of the major pharma blogs (such as Pharmalot and Peter Rost's blog). “Unexpectedly,” says Adriane “several consumers have told us that they are bringing the certificate to their doctors, or, in one case, "flinging it under the door" of medical students.”

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Peter Hotez Responds to US President's Initiative to Combat NTDs

Gavin Yamey — Fri, 22 Feb 2008 04:01:06 -0800

The following is a statement from Peter Hotez, Editor in Chief of PLoS Neglected Tropical Diseases, and President of the Sabin Vaccine Institute, in reaction to President Bush’s announcement yesterday of a new global initiative to combat neglected tropical diseases.

This initiative will make a total of $350 million available over five years to provide integrated treatment of more than 300 million people in Africa, Asia, and Latin America and target seven major NTDs: lymphatic filariasis (elephantiasis); schistosomiasis (snail fever); trachoma (eye infection); onchocerciasis (river blindness); and three soil-transmitted helminthes (STHs – hookworm, roundworm, whipworm).

Peter Hotez writes:

"The announcement today by President Bush provides great hope to the millions of people worldwide who are deeply suffering from crippling neglected tropical diseases. Many of the afflicted are the world’s poorest citizens who have no where else to turn for treatment. With this announcement, President Bush has sent a strong signal that the United States cares deeply about those who are so often forgotten. This Initiative says that these diseases should be neglected no more.

Neglected tropical diseases (NTDs) are the most common afflictions of people living on less than $2 per day in developing countries. In sub-Saharan Africa, Asia, and tropical regions of the Americas, NTDs are a primary reason for keeping people in extreme poverty due to their adverse impact on child health and development, pregnancy outcome and worker productivity. Just one disease - chronic hookworm infection in childhood - reduces future wage earnings by an extraordinary 43%.

Fortunately, unlike some other global diseases, many NTDs can be effectively treated. In 2005, the leaders of the major public-private partnerships devoted to fighting NTDs, together with a new NTD Department at the World Health Organization, designed a package of drugs known as the “rapid impact package” that treats the seven most common NTDs for a modest 50 cents per person per year. The Global Network for NTD Control now administers these packages throughout the affected regions. In 2007, the partners of the Global Network administered 34 million treatments in Africa.

The announcement today could lead to the treatment of almost 30 percent of the people at risk in Africa for the NTDs. This is an important first step towards the Global Network’s goal of launching a $1-2 billion global NTD fund. Such a fund would provide almost all of the coverage needed for the poorest people in sub-Saharan Africa, as well as the at-risk populations in Asia and the Americas. The NTD fund would be an important topic for the upcoming Group of Eight (G8) meeting in Hokkaido, Japan this summer.

If the President’s Global Initiative is enacted, access to these proven effective treatments could increase ten-fold – saving millions of people from the suffering of these painful and sometimes deadly diseases.

The Global Network and its partners look forward to working with the Administration and Congress in supporting this groundbreaking initiative. It is an investment that not only reduces suffering, but will help lift the world’s poor out of devastating poverty."

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Partnering for Global Health Forum 2008, Guest Blog by Joanna Lowell

Gavin Yamey — Wed, 6 Feb 2008 15:47:26 -0800

PLoS Neglected Tropical Diseases invited Dr Joana Lowell, Project Director at the non-profit Bio Ventures for Global Health, to write a Guest Blog on the upcoming Partnering for Global Health Forum.

GUEST BLOG: Partnering for Global Health Forum 2008, Joana Lowell PhD MPH

How are breakthrough scientific discoveries translated into commercially available drugs, vaccines, diagnostics, or biomarkers? A key step in the creation of most new products is the formation of collaborations and partnerships between biotechnology companies, the pharmaceutical industry, and investors. In areas like oncology, cardiovascular disease, and diabetes, one critical avenue by which innovators connect to potential partners is via formal “partnering meetings.” At these events, companies have the opportunity to present their platforms and pipelines and expand their networks with the goal of ultimately inking a deal.

To date, those working on products for diseases without the potential for blockbuster financial returns – diseases such as African sleeping sickness, Chagas disease, hookworm, and lymphatic filariasis just to name a few – have been left out of the partnering frenzy because there hasn’t been a similar meeting format to support global health initiatives. The Partnering for Global Health Forum, to be held on March 11th and 12th, 2008, in Washington, D.C., aims to fill this void. Co-hosted by BIO Ventures for Global Health (BVGH), a non-profit organization working to harness the assets of the biotechnology industry to address neglected diseases of the developing world, and the Biotechnology Industry Organization (BIO), and sponsored by the Bill & Melinda Gates Foundation, the Forum will bring together “innovators” (companies, research institutes, and academic centers of excellence) who are actively seeking to expand into neglected tropical disease product development with “funders” (product development partnerships, investors, and foundations) in hope of catalyzing partnerships to build a new global health product pipeline.

Innovator presentations will include the Sabin Vaccine Institute (headed by Dr. Peter Hotez, editor-in-chief of PLoS Neglected Tropical Diseases), the Seattle Biomedical Research Institute, and the Infectious Disease Research Institute as well as companies actively engaged in global health product development such as Intercell AG and GlaxoSmithKline. Funder presenters will feature the Bill & Melinda Gates Foundation, the Wellcome Trust, the Drugs for Neglected Diseases Initiative, the Foundation for Innovative Diagnostics, and PATH. Prior to the start of the Forum, all registrants have the opportunity is to schedule 1-on-1 meetings with one another using BIO’s partnering system.

The Forum will also feature panels and talks on topics such as new incentives to draw industry investment in global health, lessons learned from existing partnerships, and innovation in the developing world. On March 12th, Senator Sam Brownback (R, Kansas) will deliver a keynote address on Priority Review Vouchers, a novel incentive included in last year’s FDA reauthorization act to attract industry initiative to global health. Additional confirmed speakers and panelists include Dr. Anthony Fauci, director of National Institute of Allergy and Infectious Diseases, Margaret McGlynn, president of Merck Vaccines and Infectious Diseases, and Dr. Solomon Nwaka, manager of genomics and discovery research at WHO/TDR.

To those interested in neglected tropical diseases, a major value of the Forum will be that many of the key players from multiple networks will all be in one place for two days of focused discussions. The Forum will also benefit from the diverse expertise of its sponsor and hosts: BVGH’s work to leverage industry’s assets and capabilities to address neglected tropical diseases; BIO’s extensive expertise running business development and partnering meetings; and the Gates Foundation’s deep knowledge of the health needs in developing countries.

More detailed information about the Forum, including the program and schedule, can be found here. The deadline for early registration is February 22nd, 2008.

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Guest Blog: Fostering Research Ethics Infrastructure in the Developing World/Transition Societies

Gavin Yamey — Fri, 18 Jan 2008 15:23:56 -0800

PLoS Medicine invited Joseph Millum of the Department of Bioethics, National Institutes of Health, USA, and Sandra Realpe of the Council on Health Research for Development to report on the Eighth Global Forum on Bioethics in Research.

Fostering Research Ethics Infrastructure in the Developing World/Transition Societies: A Report on the Eighth Global Forum on Bioethics in Research Joseph Millum, Sandra Realpe

A principal line of defence against unethical health research is the oversight provided by a research ethics committee. With appropriate support, independence, and expertise it can ensure the protection of human research participants while facilitating socially beneficial research. Research ethics committees (RECs) or Institutional review Boards (IRBs) have now been established across much of the world. Nevertheless, as the amount of research conducted in the developing world and transition societies increases, concerns remain about the effectiveness of the ethical oversight these host countries currently provide. These concerns formed the focus for the eighth meeting of the Global Forum on Bioethics in Research (GFBR), which met to discuss how to foster research ethics infrastructure in the developing world and transition societies, and the ethics of mental health research.

The GFBR is a partnership of organizations with an interest in promoting ethical international health research. Its annual meetings provide a platform for discussion between the various stakeholders in health research collaborations between developing and developed countries. These include scientists and ethicists from these countries, community representatives, policy-makers, and research sponsors and funders. The meetings assist the trans-global sharing of information about building research ethics capacity, and discussion of emerging ethical issues in health research. The eighth meeting was held on June 27–29, 2007 in Vilnius, Lithuania. Its 130 participants came from 48 different countries. Seventy per cent were from developing or transition economy countries.

Challenges in establishing research ethics infrastructure In their keynote address, Ruth Macklin (Albert Einstein College of Medicine) and Florencia Luna (Latin American University of Social Sciences (FLACSO)) laid out the challenges they saw in establishing an effective research ethics infrastructure, and proposed actions to meet them. First, many countries lack effective regulations to govern research. International guidelines might be expected to be helpful to RECs in these cases. But the array of guidelines require considerable interpretation and provide conflicting recommendations on crucial issues. Macklin and Luna called for the harmonization of these guidelines and for a halt on the production of new guidelines. Second, ensuring adequate ethical review remains a challenge. Research institutions and government bodies should provide RECs with the needed financial and administrative support to function effectively and independently. Third, ethical research can only be assured if REC members and researchers get appropriate training in ethics. And sustainable training capacity will be achieved only by training people who can then teach research ethics. Finally, the adequacy of researchers’ consultation with participants remains an issue. Informed consent documents from industry are often focused more on avoiding legal liability than conveying information, and the consent process is frequently flawed. Further, though community involvement in research may be enjoined, it is often attempted in the most cursory manner.

The challenges for establishing an effective research ethics infrastructure vary from place to place. The panel discussion following the keynote heard presentations from Africa, China, North and Latin America, and Europe on their region’s particular challenges. The speakers emphasized the wide variation in research ethics capacity not only between but within these regions. As Douglas Wassenaar (University of KwaZulu-Natal) noted, “Africa’s capacity in training and infrastructure varies from the best to amongst the most under-resourced in the world.”

Operationalizing research ethics review

In discussion, the shortage of funding for ethical oversight was the topic most frequently raised by the participants. This shortage may reduce the ability of RECs to thoroughly review protocols and not to resort to “rubber-stamping,” it reduces the monitoring of on-going research, and it hampers REC independence. In the absence of government funding, participants were torn about whether for-profit RECs should be allowed and whether they would be practical in resource-poor settings. Some thought that alternative incentives for REC participation were needed, such as protected time or professional recognition. Another proposal was that ethics approval should be a condition for research trials to be registered through the WHO’s new trial registry portal. If prospective trial registration was then a pre-condition for publication or regulatory approval, this would be a spur to provide the resources needed for ethical review.

With regard to the conflicts of interest that emerge during research, discussants were particularly concerned about the sponsors of research paying for ethics review and recruitment payments made to researchers. In both cases, procedural precautions are needed. If sponsors are to fund ethics review, then they should not be able to pick their REC. And while payment to researchers is acceptable, it should not be directly tied to the number of subjects they recruit.

Another set of key issues concerned the acquisition and dissemination of information. To facilitate capacity building, information is needed on what research ethics capacity currently exists—including local and regional RECs, data safety monitoring boards, and ethics training programmes—and what is needed. Existing systems for research oversight would benefit from better communication, both across RECs and between RECs and other bodies, like regulatory authorities.

Models for research ethics training

Organizers of ethics training programs from Nigeria, China, the Czech Republic, and Costa Rica presented and assessed training projects from their countries. Two sub-sessions developed further lessons from ethics training practice: the first a market-place in which about twenty teachers demonstrated their pedagogical practice, and the second presentations from student participants in ethics training programs.

Mental health research

The Forum’s special emphasis was on the ethics of mental health research. Rodrigo Salinas (Chilean Ministry of Health) gave a plenary address on problems with research trials sponsored by pharmaceutical companies. He argued that a combination of publication bias and carefully constructed studies allows researchers studying psycho-active drugs to get the answers they want. For example, studies of drugs sometimes bias results through the careful selection of exclusion criteria for research participants. These exclusions tend not to be mentioned when the drugs are marketed. Salinas also highlighted the trend towards “disease mongering,” whereby conditions once considered normal are turned into psychiatric illnesses. For instance, he cited research which suggested that a million Australians suffered from a novel ailment called “social disorder.” Salinas argued that more critical examination of the social value of psychiatric research is needed. This, he said, is a job for RECs.

Discussants struggled with the definition of mental illness and were concerned with the criteria used to diagnose mental disorders, particularly where they lacked biomedical markers. They also voiced concern about the lack of expertise in mental health among REC members. They suggested that specialized RECs could take on mental health protocols, or that REC members could receive subject-specific training. Similarly, mental health researchers might benefit from more ethics training. Though it was acknowledged that many people with mental disorders retain the capacity to consent, a number of questions emerged about research on people whose capacity was diminished because of their illness. Discussants emphasized the need for research into mental disorders and the value of still including people in research where they are likely to benefit from it. This is particularly important where the available mental health care resources are very limited, which is frequently the case in the developing world.

Moving forward

The meeting provided a unique opportunity for participants who might not otherwise have communicated to share information, expertise, and best practices on the development of research ethics infrastructure. It showed that there are common challenges across the world in optimising the ethical oversight of research, including specialized areas, like mental health research. It also highlighted some solutions, such as acquiring and disseminating data on regional research ethics capacity, creating systems for communicating information on research ethics, and providing resources and making institutional changes to minimise conflicts of interest and allow RECs to operate independently.

The next GFBR is scheduled for December 2008 in Auckland, New Zealand. It will focus on ethical issues related to research on indigenous and vulnerable populations.

Full information on the Eighth Global Forum on Bioethics in Research, including the keynote presentations, is available online.

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The Unlikely Tale of Hospital-Acquired Infections, Clothing and Faith: Guest Blog by Prof. Aziz Sheikh

Gavin Yamey — Wed, 26 Dec 2007 09:10:47 -0800

England's Secretary of State for Health has announced that from January 2008, hospital staff must wear "bare below the elbows" attire. Professor Aziz Sheikh, recently appointed to PLoS Medicine's Editorial Board, discusses the implications of the announcement.

The Unlikely Tale of Hospital-Acquired Infections, Clothing and Faith: Guest Blog by Professor Aziz Sheikh

In response to ongoing public and parliamentary concerns about the frequency with which patients acquire infections whilst in hospital, Alan Johnston, England’s Secretary of State for Health, recently announced a range of new measures aimed at reducing risk of transmission of methicillin-resistant staphylococcus aureus (MRSA) and clostridium difficile (C. Diff) infection. Included amongst these were guidelines on dress code for hospital staff and students that are posing an important though completely predictable concern amongst some minority faith members of staff and their employing organisations. As of January 2008, hospitals will require staff to adopt a ‘bare below the elbows’ attire, this being predicated on the belief that such measures will reduce the risk of transmitting infections via contaminated sleeves, cuffs, cufflinks and watches.

Whilst none within the medical profession would disagree about the importance of reducing hospital-acquired infections, particularly now that we better understand the appreciable morbidity and mortality associated with such iatrogenic infections, there are at least two important difficulties posed by this new measure.

First, there is, as the Department of Health itself notes, no clear evidence linking clothing below the elbows (or indeed any other aspect of clothing such as ties and white coats which are similarly being banned) and risk to the health of patients. This is made particularly clear by the systematic review on uniforms and microbiological contamination and infection, commissioned by the Department of Health, to inform this new policy change.[1]

Second, certain sectors of the medical profession may find this new dress requirement particularly difficult to conform to. For example, many Muslim and Orthodox Jewish women believe that it is important that they cover their forearms (i.e. to the wrist) and this new requirement will therefore prove problematic to such students and healthcare professionals from these faith groups.[2][3]

Anecdotal evidence suggests that this issue is already causing medical schools, hospital trusts and the affected students/professionals alike a good deal of concern and this is if anything likely to intensify as the new advice is set to be enforced next month. The ramifications of this guidance should however have been completely predictable and would surely have been picked up had the Department of Health followed their own guidelines on undertaking race equality assessments of policy decision to ensure that there is no inadvertent discrimination.

Given that the need to place public interests over and above personal interests is well recognised within the ethical frameworks of most religious traditions, most practitioners would probably have found some way of accommodating this requirement, whilst at the same time remaining true to their faith tradition.[4]

What is particularly challenging in this specific case however is the lack of evidence underpinning this new guidance, making it difficult to justify on either scientific or religious grounds.

Aziz Sheikh
Professor of Primary Care Research & Development
Division of Community Health Sciences
University of Edinburgh

References

1. Wilson JA, Loveday HP, Hoffman PN, Pratt RJ. Uniform: an evidence review of the microbiological significance of uniforms and uniform policy in the prevention and control of healthcare-associated infections. Report to the Department of Health (England). J Hosp Infect 2007; 66(4): 301-7.
2. Sheikh A, Gatrad AR (eds.). Caring for Muslim patients (2nd ed). Oxon: Radcliffe, 2007.
3. Spitzer J. Caring for Jewish patients. Oxon: Radcliffe, 2007.
4. Gatrad AR, Sheikh A. Medical ethics and Islam: principles and practice. Arch Dis Child 2001; 84(1): 72-5.

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Power to the People

Gavin Yamey — Fri, 21 Dec 2007 15:35:09 -0800

I'm enormously excited to hear that the People's Open Access Education Initiative is taking off. PLoS will do all it can to support this project, which aims to "to build public health capacity in low- to middle-income countries, using open education resources freely available on the Internet."

For example, the initiative has already used PLoS Medicine's child health collection in its course module on child mortality.

In the December 2007 issue of the Bulletin of the World Health Organization, Richard Heller and colleagues, all of whom are involved in peoples-uni.org (the other name for the initiative), explain how the open source movement inspired them to provide online public health e-learning for free.

Such e-learning could, they say, help to train the global public health workforce of the future. India alone, for example, is going to need 10,000 graduates with a masters in public health over the next 10 years, yet the country's universities don't have the capacity to train all of them.

In a recent phone call with Richard Heller, he outlined his long term vision for peoples-uni.org, which is to eventually offer an accredited online masters in public health.

"In a partnership across the global and digital divides, the People’s Open Access Education Initiative (http://peoples-uni.org) has been established to embrace three aspects," write Heller and colleagues. "First, identifying open-access materials linked to the competences required to tackle public health problems, with subsequent modifications to the materials by teachers and students to reflect local issues. Second, teaching through online facilitation by volunteers in conjunction with members of local universities. Third, accrediting learned competences."

Recent developments, says Professor Heller, have included the launch of a pilot of a course module on maternal mortality which enrolled 36 people from 8 countries and was oversubscribed. The UK Royal Society of Health has offered considerable support, a UK Management Group and an International Advisory Group have been formed, and a number of people have volunteered to join the initiative.

"In order to keep costs low and to ensure sustainability, volunteerism is a key to the development and success of the initiative," says Professor Heller. If you are interested in volunteering, please contact him through the web site.

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SciDev.Net Features PLoS NTDs Study

Gavin Yamey — Fri, 21 Dec 2007 15:00:52 -0800

As Frédéric Tangy and colleagues explain in their recent study in PLoS Neglected Tropical Diseases, "The development of an affordable pediatric vaccine that could provide long-term protection against all four dengue serotypes remains a global public health priority."

With this priority in mind, they tested a new candidate vaccine in mice, a candidate created using the measles vaccine. In their study, a measles vaccine vector expressing a secreted dengue virus antigen from serotype 1 induced in mice durable serotype-specific virus-neutralizing antibodies.

As reported in a news feature in SciDev.Net, a hugely valuable resource on science and technology for global development, the "encouraging results mean the researchers will now test a similar candidate vaccine, this time 'tetravalent' — targeting all of the four types of the virus."

Frédéric Tangy, quoted in the news feature, said: "We are now performing repetition of the experiments and evaluation of the effects of the vaccine in vitro on human dendritic cells."

"The next step will be to confirm these results in macaque [monkeys], the standard model for dengue evaluation before human clinical trials."

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Health as a human right: what role do health professionals play?

Gavin Yamey — Fri, 9 Nov 2007 15:44:56 -0800

Interested in the intersection between health and human rights? A new book on this topic has been published online, and the scope is impressive: maternal mortality, social determinants of health, neglected diseases, mental health, and global politics.

The book, "Exclusion and the Right to Health: The Role of Health Professionals," is in Spanish, but each chapter has a summary in English.

It arose from an extraordinary meeting last year in Lima, Peru to discuss the role that health professionals can play in promoting health as a human right. The meeting was organized by Peru's Civil Association for Health and Human Rights Education (EDHUCASalud) and the International Federation of Health and Human Rights Organisations (IFHHRO).

I was lucky enough to attend and had the privilege of hearing talks by, among others, Paul Hunt (the UN's Special Rapporteur on the Right to the Highest Attainable Standard of Health), Paul Farmer, Alicia Yamin, and David Gordon.

Paul Hunt has described his mandate as: "First, to raise the profile of the right to health as a fundamental human right. Second, to clarify what the right to health means. Third, to suggest ways in which the right to health can be made operational."

In the opening keynote address at the meeting in Lima, he explained how he is invited by national governments to specifically report on health and human rights issues in these countries.

He was asked to report, for example, on neglected tropical diseases in Uganda. During the keynote (and in an article archived by the Human Rights Centre at Essex University), Professor Hunt outlined how looking at these diseases through a “rights lens” led to a number of observations that had policy implications.

These included the importance of developing an integrated health system (vertical interventions, he said, have a role to play but must be designed to strengthen, not undermine, an integrated health system) and the crucial role of village health teams to identify local health priorities.

I was intrigued to hear that in January 2006 he was invited to visit Sweden. Given this country's impressive record on human rights and on equitable health care delivery, would there be anything to report upon? Hunt's report does consistently commend Sweden, but he also found some areas of concern.

For example, he found a shortage of "research and knowledge focusing on the health of the Swedish Sami," the indigenous people of Northern Scandinavia. He recommended the establishment of a Sami health research center, and also suggested that "the Government consider establishing a body within the Ministry of Health with national responsibility for oversight of Sami health."

In the interests of full disclosure, I should add that I have authored one of the book's chapters, on neglected tropical diseases, based on a talk that I gave at the meeting.

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