Health Minister calls on Africa to ensure quality and safe medicines

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Mr Kwaku Agyeman-Manu, the Minister of Health, has called for stronger collaboration and networking among African countries, to sustain the momentum for the harmonisation of the processes for medicine registration and regulation to safeguard the health of the people.

This, he said, would save the continent of the challenges of having to deal with cross-border transfer of fake medicines and other substandard pharmaceutical products, which have huge negative impacts on health systems as well as on patients.

Speaking at the third Biennial Scientific Conference on Medical Products Regulations in Africa on Monday in Accra, Mr Agyemang-Manu said although significant strides had been made over the years to enhance and modernise the regulation of pharmaceutical manufacturing and product quality across the world, the drug registration system in Africa remained complex and varied.

The two-day conference being organised by international stakeholders with support from the Government of Ghana, the West African Health Organisation (WAHO) and the New Partnership for Africa's Development (NEPAD) is on the theme: “Sustaining the Momentum for Regulatory Harmonisation in Africa”.

The delegates attending the conference include key stakeholders made up of regulators, policymakers, academia, the scientific community, private sector and civil society from across Africa.

The participants are discussing and contributing towards the future of medicine regulation and harmonisation in Africa, which affects both industrial and regulatory aspects, as well as the aspirations of civil society and its wish to benefit from best practice and best medicine.

While welcoming the delegates to the conference, Mr Agyemang-Manu noted that the African Medicines Regulatory Harmonization (AMRH) initiative, currently being run by the countries had some ongoing pilot projects aimed at improving national regulatory processes and that when that was completed, it would go a long way towards meeting the goal of regulatory harmonization and convergence.

The Minister, however said in the absence of that, each country was presently invoking their own separate audit and assessment processes, and many of them dealt with regulatory issues independently, which meant that manufacturers had to make formal registrations in every country, and each country’s regulatory agency would assess whether the drug was right for its market or not.

Mr Agyeman-Manu said this, almost guarantees the fact that Africans would be the last to benefit from new drugs launched onto the international market.

He said: “what is needed is a single agency, which could do all these work once, rather the current duplication, and then allow applicants and individual countries to benefit from it without having to reinvent the wheel”.

He emphasized that the harmonisation of the processes for medicine regulation had been on the drawing table for far too long and that time was overdue, for countries to unite their resources and strengthen their networking systems to make that dream a reality.

The Sector Minister said there was also the need to double efforts at building strong systems that would guarantee the quality and safety of all pharmaceutical products, while reducing duplication of functions, and also minimising the timing for registration processes.

Dr Agama Margaret-Anyetei, the Head Division, Health, Nutrition and Population at the African Union Commission, said the conference would serve as a platform for stakeholders to brainstorm on the role of ethical and regulatory approval of clinical trials of new medicines, as well as neglected tropical diseases.

She said African leaders and Heads of States have agreed to establish the proposed continental body known as the African Medicines Agency by 2018, to regulate medicines and strengthen systems along the value chain to protect the health of the people.

Mrs Delese Mimi Darko, Chief Executive Officer of the Food and Drugs Authority, said “we are working as individual countries to harmonise our systems, our procedures, our processes and we have already started”.

She explained that the member countries in the ECOWAS sub-region had already started working towards the harmonisation processes, citing Ghana, Nigeria, Sierra Leone, Liberia and The Gambia, as among the countries to harmonise the way things were done.

Revealed: how robots have saved lives of 500 men in London battling deadly prostate cancer

London surgeons today hailed the pioneering use of robots in saving a record number of men from one of the UK’s deadliest cancers.

More than 500 men with advanced prostate cancer have had the diseased tissue removed this year by the £1million machines at University College London Hospitals.

Surgeons say robot-assisted surgery - which is quicker, safer and carries fewer side effects - has been a “game changer”. 

Professor John Kelly, clinical lead for urology at UCLH at Westmoreland Street hospital, said: “Although [conventional] surgery removes the cancerous tumour, patients are left with life-changing after-effects like incontinence and impotence, which can be devastating.

Success: Consultant Greg Shaw with patient David Ferris (Jeremy Selwyn) 

Success: Consultant Greg Shaw with patient David Ferris (Jeremy Selwyn) 

“Robotic surgery has changed that - it gives us the precision to remove the cancerous tumour, preserving the tissues and functions around it. It gives men their lives back after prostate cancer.”

Prostate cancer is the most common cancer in men and the second biggest killer in men after lung cancer, causing 11,300 UK deaths a year.

The number of operations carried out by UCLH is expected to exceed 600 by the end of the year, the most ever performed by a NHS hospital in a year. 

It is double the number carried out across north and east London, west Essex and Hertfordshire before UCLH became the specialist uro-oncology centre for the region in 2015.

Surgeons say the centralisation of services has enabled to be offered to more men at risk of dying from the disease.

 Londoner with 'aggressive' cancer in successful op

The Evening Standard was invited to watch as a Londoner with “aggressive” prostate cancer underwent robotic surgery.

David Ferris, 66, an activist and political researcher, said he was “absolutely comfortable” to undergo the procedure, carried out by UCLH consultant urological surgeon Greg Shaw and his surgical team.

Mr Ferris, who lives in Soho, is one of the new generation of prostate cancer patients who was offered an MRI scan ahead of a biopsy.

This enables the painful biopsy procedure - which involves repeatedly inserting a needle into the prostate to gather evidence of the tumour - to be targeted at suspicious areas rather than “shooting in the dark” across the entire gland.

“I was told the two options were either to have the prostate removed or that I could have radiation and hormone treatment,” Mr Ferris said.

“The recommendation was that I should go for the former and, having considered it, it seemed to me that made absolute sense.

“About two years ago, my PSA was getting higher and various tests were done. We found out, as is commonly the case, I had prostate cancer but it was a very slow-growing thing and the sensible thing was not to do anything about it.

“You are then monitored periodically. About six months ago, it was discovered that my prostate cancer was growing rather aggressively.”

Cancer was found to be “bulging out” on left side of his prostate, towards the nerves - which were likely to have to be severed in the process.

“The first priority is always to remove the cancer, said consultant surgeon Prasanna Sooriakumaran. “The second is to preserve continence and potency. The robot allows most surgeons to get great results more easily.”

Mr Shaw said the operation was a success and Mr Ferris was heading home today.

The two Da Vinci robots are in use six days a week. 

Greg Shaw, a consultant urological surgeon who performs three robotic operations a day, said: “When it comes to specialist treatment, it makes sense for the resource to be concentrated. 

“I think it can only have positive outcomes for the patients and the level of care that they get.”

Greg Shaw operates the robot used to treat prostate cancer patients (Jeremy Selwyn)

Greg Shaw operates the robot used to treat prostate cancer patients (Jeremy Selwyn)

The hospital, formerly the Heart Hospital, performs prostate surgery previously carried out at hospitals such as Whipps Cross, Homerton, North Middlesex, Queen’s in Romford and Princess Alexandra in Harlow. The reconfiguration is part of a NHS cancer “vanguard” to promote best practice.

Consultant surgeon Prasanna Sooriakumaran said: “No centre in the UK has done 500 robotic prostatectomies in one year before. Patients come from deep dark Essex all the way into UCLH, and from as far north as Stevenage. 

“We have a catchment of about 14 smaller local hospitals that have stopped doing prostatectomy and they send their cases to us. 

“Rather than having 50 surgeons doing 500 cases, you have five surgeons doing 500 cases. Both Greg and I do about 150 to 200 a year. As a group we do 550. The average surgeon in the UK does 39.”

The increase in workload had been driven by the ageing population - men are now dying from prostate cancer because of a reduction in smoking and heart disease - and the capacity to do more, and more complex, surgery.

Patients are able to go home the following day, compared with five days in hospital for conventional “open” surgery. The aim is to treat all patients within 18 weeks of a referral from their GP.

The latest version of the robot, the Da Vinci Xi, has been in use in several London hospitals, including the Royal Marsden and Guy’s, since 2015. 

The surgeon “drives” the robot with his hands and feet, manipulating its tiny scissors and pliers inside the patient. 

An internal 3D camera displays instantaneous images to the surgeon’s high-definition console. The robot’s six arms are inserted through small cuts in the patient’s abdomen.

Mr Shaw said: “We are at the start of this technology. It’s only going to get better.”

Africa’s e-health start-ups rise, but not all are mobile-first based

ICT use in healthcare provision in Africa is not actually mobile-first despite the number of e-health start-ups accelerating, a new report released last week shows.

This is contrary to popular assumptions that a majority of them do leverage on use of mobile gadgets to reach their target audience.

Start-ups tracked in the High Tech Health: Exploring the African E-health Startup Ecosystem Report 2017, revealed that only 44 per cent of the e-health ventures sampled are mobile-based despite popular belief in the power of the gadget to reach those in far-flung areas of the continent.

Kenya, Nigeria and South Africa are early hotspots for e-health entrepreneurs, but research shows a rise in start-ups with substantial communities of e-health innovators emerging in Uganda, Ghana, Egypt and Senegal.

The report examined data on e-health start-ups across 20 countries in Africa gathered by Disrupt Africa - a firm that studies continent’s tech start-ups and investments initiatives - between January 2015 and September 2017.

The research found 115 firms active in Africa but that not all opted for the mobile phone as a first choice.

Its findings showed that a majority do not necessarily choose phones as a delivery channel, but Kenyan start-ups still do prefer the device, with 73 per cent of these using mobile them to reach their customers.

Areas where mobile delivery is particularly crucial include maternal health and emergency responses.

“This is a timely piece of research, as more and more e-health ventures enter the market and investors take note. We all know that digital health start-ups are playing a pivotal role in increasing access to quality healthcare across Africa, but for the first time this report gives an oversight of what is happening, where, and the form innovation is taking in the health space,” said Tom Jackson, co-founder of Disrupt Africa.

In the last three years, Africa’s e-health start-ups have raised investment in excess of Sh1.957 billion ($19 million).

In Kenya, four have managed to raise Sh39.098 million ($379,600). Two of these, Totohealth and SophieBot, managed two funding rounds each. The other two to raise funding are ConnectMed and Deaf Elimu.

Ventures such as Totohealth uses the mobile technology to help reduce maternal and child mortality and detect developmental abnormalities in early stages.

The platform enables mothers and fathers to receive targeted and personalised messages timed at their child’s age or stage of pregnancy.

These messages are able to highlight any warning signs in a child’s health/development, equip them with knowledge on nutrition, reproductive health, parenting and developmental stimulation.

Another venture SophieBot, is a mobile application that tackles the issue of young people not being able to access verified and curated information around sexual and reproductive health (SRH).

The solution helps relieve the awkwardness surrounding discussions and discourse SRH, particularly in the conservative African setting.

Healthcare professionals say telemedicine, e-health and m-health are examples of disruptive technologies that can effectively and affordably deliver healthcare services to the most remote areas of the continent.

Some solutions allow patients to access consultations with medical professionals via video link. Licensed practitioners are available for same-day consultations, and can provide prescriptions, sick-notes, and referrals. For doctors, the service allows them more flexibility and control over their work hours.

According to this year’s Kenya’s economic survey report, there has been an upward trend in most of the ICT indicators over the last five years.

Mobile-cellular penetration rate, internet and mobile money subscriptions stood at 85.9 per cent, 58.8 per cent and 70.5 per cent in 2016 from 85.4 per cent, 54.2 per cent and 60.6 per cent in 2015.

Malaria during pregnancy a risk factor for stillbirth

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Expectant mothers in the five counties that are hardest hit by the malaria outbreak are at risk of having stillbirths.

Authors of a new study published in the Lancet Global Health estimate that in Africa, between 132,000 and 221,000 stillbirths per year (between 12 to 20 per cent of all stillbirths) are as a result of malaria in pregnant women.

Researchers reviewed 59 studies and found that in nearly 20 studies the odds of stillbirth increased by 1.47 in pregnant women who were diagnosed with and treated for malaria. In over 30 studies, the odds of stillbirth after a malaria diagnosis and treatment increased by 1.81. Malaria in the placenta increased the odds of stillbirth by 1.95.

The risk of stillbirth was influenced by the intensity of malaria transmission. The risk of stillbirth was double in areas that are low-to-intermediate malaria endemic as compared to moderate-to-high malaria endemic areas.

Low levels of protective immunity in pregnant women result in more severe clinical manifestations of malaria, including higher densities of placental infections in settings with more sustained levels of transmission.

As infection becomes less common because of decreasing transmission, the clinical severity of those infections, including the risk of stillbirth, might increase.

A RISK FACTOR

Malaria is likely to remain a risk factor for stillbirth in the foreseeable future due to reductions in protective immunity thatmight shift the burden of malaria in pregnancy more widely across all gravidae rather than being concentrated in first and second pregnancies.

Therefore, even in areas where transmission has decreased considerably, protection of pregnant women from malaria will remain crucial

Globally, most stillbirths are preventable. An estimated 2·6 million third-trimester stillbirths occur annually, and over 90 per cent of these stillbirths result from modifiable medical conditions. Such disorders include chronic non-communicable diseases such as obesity, hypertension, and diabetes; obstetric conditions such as advanced maternal age and post-term pregnancies; and infections such as syphilis.

Stillbirths occur at the highest rates in southern Asia (25·5 per 1000 births) and sub-Saharan Africa (28·7 per 1000 births).

Malaria in pregnancy has devastating consequences for the developing foetus, resulting in preterm delivery and intrauterine-growth retardation, and is believed to be a major contributor to spontaneous abortions and stillbirths.

This is a hidden burden of malaria mortality, because stillbirths are not captured in standard estimates of infant and under 5 mortality.

Investment in strategies to enhance the uptake and effectiveness of malaria prevention during pregnancy can help increase perinatal survival rates and reduce stillbirths in malaria endemic areas.

 DISEASE ON DECLINE

Prevalence of malaria declined from 40 per cent in children aged 2 to 10 years between 1900 and 1929, to 24 per cent between 2010 and 2015.

The peak in the late 1900s has been attributed to excessive rainfall and the emergence of chloroquine resistance which was used to treat malaria.

Previous global initiatives have contributed to an unprecedented decline in infection since 2000, though reduction has not occurred uniformly throughout the continent, leaving large parts of West and Central Africa with high transmission rates.

According to the researchers one in four children still carry the malaria parasite and there are areas of the continent that haven’t changed much in the last three decades.

Therefore, if insecticide and drug resistance becomes established, or excessive rainfall hits Africa again, malaria will revert in large parts of Africa to the high levels we saw in the 1990s.

The researchers argue that there is need for new tools in the low-income and high malaria burden areas of Africa, where gains in malaria reduction have stalled.

The team identified several challenges facing malaria control, including emerging insecticide and drug resistance, and inadequate funding plans for replacing long-lasting insecticide-treated nets.

The African region carries disproportionately high levels of infection risk, with over 90 per cent of malaria cases and 92 per cent of malaria deaths according to the 2016 WHO World Malaria Report. This requires quick diagnosis and treatment to avert deaths.

Are Stem Cells The Future Of Medicine?

Physicians still have much to learn about how to more effectively utilize stem cells in their practice for the benefit of their patients.

In general, physicians and patients alike believe that stem cells are the future of medicine. According to Roger Pedersen, Professor of Regenerative Medicine and Director of the Anne McLaren Laboratory for Regenerative Medicine at the University of Cambridge, it is possible that stem cells will even be used to replace drugs (see “Stem Cells: The Future of Medicine?”[1]. However, Pederson points out that stem cells don’t fit the typical pharmaceutical business model, which is structured around putting medicines in people, “because [stem] cells are alive and can replicate inside the patient.” Consequently, according to Pederson, we may find that stem cells are even more powerful and flexible than we imagined.”

A Japanese researcher, Nobel laureate Shinya Yamanaka, collected genes from mature adult skin tissue and reprogrammed them to become “‘pluripotent,” which is a stem cell characteristic that means a cell is able to differentiate into multiple types of cells (see “iPS cells and reprogramming: turn any cell of the body into a stem cell,” Sept. 15, 2015, www.eurostemcell.org)[2]. This conversion process, referred to as “induced pluripotent stem cells” (iPSCs), means that we can take adult cells from a person with a particular disease, turn them into iPSCs, and then induce the iPSCs to turn into different types of body cells. In commenting on Yamanaka’s iPSC findings, Pedersen says we can essentially “make any cell turn into any other type of cell and in effect move through wormholes in developmental time” to produce such things as a pancreas from skin tissue.” As a result, “the petri dish becomes an avatar of the patient” whereby medicines can be identified “that will improve the condition of cells in the patient without having to take cells out of the petri dish and put them back in the patient.”

Nevertheless, if the future of medicine is using stem cells to develop patient specific medicines or tissues in a laboratory then how can we benefit from using such stem cells in a clinical practice today? Currently, the two most common means for harvesting “stem cells” from a patient are by having a procedure done to obtain either blood from bone marrow or fat from liposuction. Both of these procedures are invasive and come with their own inherent risks. They each take anywhere from 1-2 hours to perform and require recovery time post-procedure. Unfortunately, neither of these procedures provides pluripotent stem cells, such as those needed for diverse tissue differentiation in a laboratory. Rather, these procedures produce mesenchymal cells, which work well for cardiovascular and orthopedic conditions because these tissues are the end organ targets for mesenchymal cells. However, they do not work well for other germ cell layer target organs, such as those produced from endoderm (incl., pancreas, liver, lungs) and ectoderm (incl., nervous system, skin).

Fortunately, there is a lesser known but more viable means for obtaining real pluripotent stem cells that merely involves a blood draw. In 2005, a study published in Minerva Biotechnologica identified stem cells in the blood (see “Adult-derived stem cells,”, Vol. 17, No. 2:55-63 (2005)[3]. In other follow-up studies, scientists showed that such cells could, in fact, be used to regenerate not only heart tissue, but brain, lung, and pancreas as well. What’s most interesting is that these cells were found to be increased when subjects ingested a blue-green algae product. This was initially demonstrated in a 2007 study where the level of pluripotent stem cells was shown to increase in equine blood after 6 hours from the initial dose (see “Totipotent Stem Cells are present in the Blood of Adult Equines,” Keystone Symposium (2007)[4]. These same stem cells were also found to be increased in the blood of humans by using the same algae product as used in horses.

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In 2010, a clinical protocol was developed for harvesting, concentrating, reconstituting, and administering pluripotent stem cells obtained from autologous blood (see “Method of Stimulating and Extracting Non-embryonic Pluripotent Cells from Mammal Blood and Using Reconstituted Pluripotent Cells to Treat Disease Including Chronic Obstructive Pulmonary Disease,” Royal et al., USPTO Application Number 13362993 (2011)[5]. Initially, the protocol was used in the treatment of COPD patients because such cells could not only be given via intranasal, intravenous, intraspinal, and intravenous routes but nebulized as well. One of the initial COPD patients came from Houston, Texas where she was in a physical therapy group with 11 other COPD patients. Today, she is the only living survivor from the group and continues to receive a stem cell treatment biannually. While she still has COPD, the third leading cause of death in the United States that kills over 130,000 Americans annually, her oxygen saturation rates remain in the high 90’s.

It should be noted that in spite of the foregoing patient success, the use of stem cells for clinical applications is in its infancy. Physicians still have much to learn about how to more effectively utilize pluripotent stem cells in their practice for the benefit of their patients. Such knowledge includes not only using the most appropriate source for harvesting real stem cells but in improving the means of attracting those stem cells to where they are needed and facilitating their differentiation. As more physicians implement the use of pluripotent stem cells in their practice, such as those obtained from autologous blood, we can begin accumulating the objective data needed to validate stem cells in the present and advance stem cell science into the future.

by Daniel F. Royal, DO, HMD, JD
Turtle Healing Band Clinic, Las Vegas, NV

Body clock scientists win Nobel Prize

Credit: GETTY IMAGES

Credit: GETTY IMAGES

Three scientists who unravelled how our bodies tell time have won the 2017 Nobel Prize for physiology or medicine.

The body clock - or circadian rhythm - is the reason we want to sleep at night, but it also drives huge changes in behaviour and body function.

The US scientists Jeffrey Hall, Michael Rosbash and Michael Young will share the prize.

The Nobel prize committee said their findings had "vast implications for our health and wellbeing".

A clock ticks in nearly every cell of the human body, as well as in plants, animals and fungi.

Our mood, hormone levels, body temperature and metabolism all fluctuate in a daily rhythm.

Even our risk of a heart attack soars every morning as our body gets the engine running to start a new day.

The body clock so precisely controls our body to match day and night that disrupting it can have profound implications.

The ghastly experience of jet lag is caused by the body being out of sync with the world around it.

In the short term, body clock disruption affects memory formation, but in the long term it increases the risk of diseases, including type 2 diabetes, cancer and heart disease.

"If we screw that system up we have a big impact on our metabolism," said Prof Russell Foster, a body clock scientist at the University of Oxford.

He told the BBC he was "very delighted" that the US trio had won, saying they deserved the prize for being the first to explain how the system worked.

He added: "They have shown us how molecular clocks are built across all the animal kingdom."

The trio's breakthroughs were on fruit flies, but their findings explain how "molecular feedback loops" keep time in all animals.

Jeffrey Hall and Michael Rosbash isolated a section of DNA called the period gene, which had been implicated in the circadian rhythm.

The period gene contained instructions for making a protein called PER. As levels of PER increased, it turned off its own genetic instructions.

As a result, levels of the PER protein oscillate over a 24-hour cycle - rising during the night and falling during the day.

Michael Young discovered a gene called timeless and another one called doubletime. They both affect the stability of PER.

If PER is more stable then the clock ticks more slowly, if it is less stable then it runs too fast. The stability of PER is one reason some of us are morning larks and others are night owls.

Together, they had uncovered the workings of the molecular clock inside the fly's cells.

Dr Michael Hastings, who researches circadian timing at the MRC Laboratory of Molecular Biology, told the BBC: "Before this work in fruit flies we really didn't have any ideas of the genetic mechanism - body clocks were viewed as a black box on a par with astrology."

He said the award was a "fantastic" decision.

He added: "We encounter the body clock when we experience jet lag and we appreciate it's debilitating for a short time, but the real public health issue is rotational shift work - it's a constant state of jet lag."

Bill and Melinda Gates Grade the World’s Health

Bill and Melinda Gates speaking at their foundation headquarters in Manhattan last year. They will present a sort of report card of global health, called “Goalkeepers,” at the United Nations General Assembly this week. CreditSeth Wenig/Associated Press. 

Bill and Melinda Gates speaking at their foundation headquarters in Manhattan last year. They will present a sort of report card of global health, called “Goalkeepers,” at the United Nations General Assembly this week. CreditSeth Wenig/Associated Press. 

Bill and Melinda Gates handed the world a report card last week, assessing its progress on 18 global health indicators: infant mortality, AIDS, vaccine use, smoking rates and so on.

Called “Goalkeepers,” the report was a huge statistical effort, three years in the making, aimed squarely at the world leaders gathering at the United Nations General Assembly this month. To draw extra attention to it, the Gateses will hold an awards dinner and a public release this week featuring former President Obama.

In a series of recent interviews, they delivered several messages.

Progress has been great, but donor fatigue could be lethal to millions who could easily be saved. Only the United States is rich enough and generous enough to lead, and private charities, including theirs, cannot possibly coverthe deep cuts in global aid that President Trump has proposed.

Health journalists are sunk in negativism, they say, focusing on failures in a sea of global health successes.

In conversation, Mr. Gates displays such a deeply impressive grasp of the science fueling the discoveries he underwrites, and of the politics of the countries where they are deployed, that one forgets he was once a software geek.

At 61, he could speak with the avuncular magniloquence of a professor emeritus; instead, he layers on supporting data like a star pupil seeking an A-plus. He rebuts skeptical inquiries and insists on teaching from his own syllabus — and on flicking his own birch switch.

The report card will be issued annually, Mr. Gates said. He gave himself only a C+ on the first draft, promising sharper analytics in the future.

He isn’t actually handing out grades to the world’s health authorities — but is sending them home with a note for mom. Your kid has real potential but is becoming a discipline problem.

In some areas, like infant mortality, he considers the progress made “pretty miraculous.” In 1990, more than 11 million children died before their fifth birthday; now, fewer than 6 million do.

AIDS deaths have plummeted since 2004, and malaria deaths since 2005. Rates of childhood stunting, mothers dying in childbirth, and the miseries wrought by rare tropical diseases all have gone steadily down.

In poor countries, vaccine use is way up, though only about 75 percent of children get all the shots they need. More people have toilets these days.

Progress in other areas has been slower. Smoking is down, but tobacco companies are fighting back. Contraceptive availability is up, but almost half the women who want birth control still lack it.

Access to basic health care is up, according to the new report. But the gap between rich and poor countries remains vast, because too much money goes to top hospitals instead of rural clinics.

One key finding: Most of the progress was not bought by donors, but came organically as hundreds of millions of people scrambled out of the most abject tiers of penury.

In 1990, 35 percent of the world lived below the international poverty line (currently $1.90 a day); now, only 9 percent do. Most of the great leap upward was in just two economic powerhouses: China and India.

The report’s scarier themes lie in its projections for the next 15 years.

Assuming economic progress continues, improvements in most health categories will churn dutifully on, or at worst plateau. But since the 2008 economic crisis, donors have been losing their will to give.

If that persists, the report says, chaos threatens. H.I.V. infections could double, returning to levels not seen since the 1990s. And malaria could climb back to the peak hit in 2005.

H.I.V. and malaria are particularly vulnerable to fluctuations in funding because they are concentrated in Africa, where economic progress has been slower than in Asia or Latin America and where birthrates remain high, producing a big pool of potential victims each year. Malaria has a history of rebounding as soon as pressure is eased; both the mosquitoes and the parasites quickly evolve resistance genes.

The world’s birthrate is now peaking — probably forever — at about 134 million babies a year. “But it’s mind-blowing how much the shift in where kids are being born makes things hard for us,” Mr. Gates said.

Keeping infants alive gets tougher when they are born in lands with civil wars, dirt roads and healers who reject Western medicine.

Surprisingly, the new report was not a reaction to Mr. Trump’s threats to slash the foreign aid budget by 32 percent.

According to Dr. Christopher J.L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, which gathered the data, it was initiated three years ago because Mr. Gates feared the world was losing its focus on health.

“Goalkeepers” refers to a metric that the world ignores but the Gateses do not: the targets periodically set by the United Nations, namely the 2000 Millennium Development Goals and the 2015 Sustainable Development Goals.

The first sharply emphasized poverty and health. But the latter comprise 169 targets for everything from reducing overfishing to bringing clean energy and decent jobs for all — they have an “I-want-a-pony-too” air about them.

The world prefers simple goals, like declaring war on smallpox. But war talk has stung Mr. Gates. Calls for an “AIDS-free generation” – all the rage six years ago — were “premature,” he said, and he was “embarrassed” by claims that malaria could be eliminated by 2015.

He prefers “Microsoft-type thinking” to set realistic goals. “People expect a certain degree of honesty,” he said. “They want to know, do Bill and Melinda track this stuff?”

Essentially, he is tracking the world’s pursuit of his own goals as he helps it reach them.

In early interviews, Mr. Gates refrained from criticizing Mr. Trump but gave the clear impression that he believed Congress would ignore most of the president’s proposed cuts. Congress appears to be doing just that.

To hear Mr. Gates tell it, even the staunchest backers of an America First ideology, which he called “selfish,” succumb to his fusillades of data.

Before Stephen K. Bannon, the president’s chief strategist, resigned, Mr. Gates met him in the White House. “He said, ‘Africa has always been a mess,’” Mr. Gates said. “I went through the numbers on its progress with him. He was impressed.”

The new report’s weakness is that it cannot, for example, foretell how many more Ugandans would die of AIDS if American donations dropped 20 percent, in the way that the Congressional Budget Office can calculate how many Americans will lose insurance under a particular health care bill.

There are too many unpredictables in global health. A country would not just brutally take 20 percent of its H.I.V. patients off treatment, Mr. Gates noted. It might cut its military budget; it might try to stretch supplies of the drugs it got, triggering shortages.

Buried in the graphics-heavy report are some fun anecdotes that show how ingenuity can be just as important in the field as money.

In Ethiopia, for example, pregnant women were given a special stretcher to help them reach birth clinics; they had feared regular stretchers because villagers carried away on them usually died.

And an imam in Senegal described how he got other imams to accept birth control: by citing a saying from the Prophet Muhammad implying that children should be born about two years apart.

 

NHS checks 'should be done at shops and stadiums'

CREDIT: SCIENCE PHOTO LIBRARY

CREDIT: SCIENCE PHOTO LIBRARY

Vital health checks should be carried out in shops and at football grounds to diagnose people at risk of heart attacks and strokes, NHS chiefs say.

NHS England and Public Health England are urging the novel approach to get more people to come forward for the over-40s checks programme.

Only half of those eligible in England end up getting the regular checks.

Firefighters could even carry them out or refer patients while they do home safety checks, they say.

The health checks were introduced to spot the early signs of conditions such as dementia, diabetes, heart disease and strokes.

They look for conditions such as high blood pressure and cholesterol.

But because of the large numbers not taking part in the scheme, there are an estimated 5.5 million people with undiagnosed high blood pressure alone.

The health chiefs believe if everyone entitled to the checks, which are offered at least every five years up to the age of 74, got them, 9,000 heart attacks and 14,000 strokes could be prevented over the next three years.

The checks - organised by council public health teams - are normally done by GPs.

But a number of local authorities have started exploring new ways to carry them out.

In Cheshire, firefighters have been funded to start engaging people about their health and referring them on to services that can help.

In other areas, health staff have offered the checks in public places, including supermarkets, sports grounds and outside schools.

Dr Matt Kearney, from NHS England, said: "We know that much more can be done in communities across the country to prevent thousands of needless deaths each year due to strokes and heart attacks.

"Some parts across the country have already started to use non-traditional ways - and places - to carry out simple health checks, with encouraging results."

Duncan Selbie, chief executive of Public Health England, said he hoped it would lead to greater awareness about the risk of high blood pressure, the "invisible killer".

"We want people to be as familiar with their blood pressure numbers as they are with their credit card PIN or their height," he added.