After 30 years, @WHO finally begins pushing single-use syringes

Yesterday, the WHO officially updated its injection safety recommendations to call for the widespread adoption of single-use syringes, as well as a reduction in unnecessary injections (e.g., administering medications orally if they do not need to be injected):

A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with hepatitis B virus, up to 315 000 with hepatitis C virus and as many as 33 800 with HIV through an unsafe injection. New WHO injection safety guidelines and policy released today provide detailed recommendations highlighting the value of safety features for syringes, including devices that protect health workers against accidental needle injury and consequent exposure to infection.

Transmission of infection through an unsafe injection occurs all over the world. For example, a 2007 hepatitis C outbreak in the state of Nevada, United States of America, was traced to the practices of a single physician who injected an anaesthetic to a patient who had hepatitis C. The doctor then used the same syringe to withdraw additional doses of the anaesthetic from the same vial – which had become contaminated with hepatitis C virus – and gave injections to a number of other patients. In Cambodia, a group of more than 200 children and adults living near the country’s second largest city, Battambang, tested positive for HIV in December 2014. The outbreak has been since been attributed to unsafe injection practices.

WHO is urging countries to transition, by 2020, to the exclusive use of the new “smart” syringes, except in a few circumstances in which a syringe that blocks after a single use would interfere with the procedure. One example is when a person is on an intravenous pump that uses a syringe.

Setting aside my horror that repeat use of non-sterile needles in still a thing in healthcare facilities here in the US, I saw this as a positive move on WHO’s part and assumed that the “smart” syringe referred to in the press release and several headlines was something only recently developed. After all, injection drug use has been the primary driver of HIV and hepatitis infections in Eastern Europe and Central Asia for years, and it is a significant component of the epidemics in southeast Asia and China’s Yunnan province as well.

Imagine my chagrin when I came across this piece from the Guardian‘s Global development professionals network. It tells the story of Marc Koska, the British inventor of the K1 single-use syringe, who has apparently been trying – unsuccessfully – to get the global health community to jump on this bandwagon…for 30 years.

Using existing technology Koska came up with a syringe that falls apart after one use, and sold his first one in 1997. Even though he’s sold more than 4 billion auto-disable syringes since, he has been repeatedly frustrated in his attempts to make the world aware of the problem caused by reusable syringes. “It’s been a very frustrating journey. Thirty years to get WHO turned around. Thirty years to get the manufacturers turned around. You’ve got too many parts to expect it to be a three year journey.”

“There is a very basic reason why it hasn’t happened and that is because the manufacturers haven’t had a market,” he argues. “If the manufacturers could sell a product and it was identified where they were going to sell it and who was going to pay for it, they would make it.

“Today, [WHO Director Margaret] Chan is a hero, but I think the next chapter might be just as challenging as the first bit,” he says.

“My gut feeling is that the ministries of health will be most resistant, because they’ve been saying for so long that they don’t have a problem of reuse in their countries. They’re never going to say that ‘we’ve got a terrible problem with hepatitis C because I can’t be bothered to buy enough syringes’. So now ministers have got to change their position and say, from Tuesday, we’re only going to buy auto-disable syringes.”

The frustrations of market forces blocking the development or widespread adoption of critically-needed global health resources is an old hat to most in the field, but this seems particularly egregious…WHO really should have caught on much sooner.

Note: This was cross-posted to my own professional blog.

John Oliver takes on Big Tobacco in Last Week Tonight

Many thanks to Dr. Don Zeigler, who passed this on through APHA’s Trade and Health Forum listserv. In a recent episode of Last Week Tonight (har), John Oliver explains how the tobacco industry is compensating for the fall in smoking rates here in the US by utilizing impressively convoluted international legal tactics and taking its business to developing countries in its usual style – shady as hell. The video is long (about 18 minutes), but is seriously worth every second.

Tips for students and young professionals embarking on their first international health experience

Guest blogger: Geoffrey Horning

As members of the APHA and specifically as students in the International Health section, none of my colleagues find the thought of living and working overseas all that strange. In fact, they quite often find the thought exciting, intriguing and something they aspire to do. Many of us, myself included, already have work experiences outside of American borders. In this two part posting, I thought I would share a little of the perspective that I have developed as a “westerner” currently working in the Middle East and North Africa.

On November 11th 2011, I boarded the first of three flights from St. Louis Missouri that would ultimately land me in Riyadh, Kingdom of Saudi Arabia. News media, YouTube and the rest of the internet do not do Saudi Arabia justice, but I thought I had some idea of what to expect from my previous travels…I was wrong. Here are some of the things I’ve learned about living in another culture, and especially one completely different from your own.

First Things First: Know your surroundings and be aware of your situation at all times. The last thing I want to do is scare you or encourage you to stay inside. Neither of those things is necessary, and in fact they are both counterproductive. However, it is important for your safety that you remain alert. Failure to do so can make you the target of groups looking to exploit your naivety, whether it be for a simple street hustle, unlicensed taxi ride that keeps getting more expensive, bribes or more nefarious robbery and kidnapping. Always make sure someone knows where you’re going and when you will be back, register with your embassy in the countries you’ll be visiting, and always keep an eye on a possible exit.

Roll with the punches: Nothing is what it seems, you are a foreigner, a stranger in a strange land, and you learn daily. If you crave the stability of familiar things, this is going to be rough. Every time you think you’ve figured something out, it changes, or more likely, you realize you were just wrong about your previous assumptions. When you laugh things off, or regroup and try a different approach, when you finally realize the “punches” aren’t directed at you and in fact are simply cultural differences — then you’ve made it.

Know the Law-BEFORE you arrive: Two of the “silliest” things I see here are people who have no knowledge of the laws, and worse, people who flagrantly violate the laws and then expect a United States Passport to get them out of trouble. This doesn’t work; it understandably annoys the State Department, and reflects poorly on all of us from your home country. Please follow the law of the land.

Know your health status-and respect it: Consider any medical conditions that you have that require specialized treatments and or medication. Do a quick internet search and see what you have to do in order to get those treatments or those prescriptions filled in the host country. Never, stop taking a medication without a doctor’s advice. Items of specific concern are analgesics/painkillers which may be considered illegal narcotics where you’re headed and psychotropic medications that may just not be available. If you have a history of cardiac problems, it would behoove you to look into the state of cardiac care in the country and region you’re going to.

Learn the language: A vast majority of people in Saudi Arabia are already bi or tri-lingual. English, French, and of course Arabic are commonly known. My Arabic is probably best described as “atrocious”, and the Saudi dialect of Arabic can be quite a bit different from Modern Standard Arabic, which is what you’ll usually get from a language program. That being said, I know enough to get around, and it helps. Start working with it from day one. Your supervisors, co-workers, cashiers, waiters, driver and hotel bellman all speak two or three languages; you might want to go ahead and try to catch up. It’s appreciated.

Check your privilege at the customs counter: The idea of “privilege” is a contentious topic in modern day America. However you feel about it, I assure you that it exists. You’ll see it up close as you process through customs and immigration the first time, and you will probably realize that you have more travelling money in your wallet than some of the people in that line make in a month. If a customs officer recognizes that you’re American/Canadian/British (i.e. “Westerner”), he might pull you out of line and take you to the front, bypassing the 100 people in front of you. Don’t argue with this man – but don’t act like you deserve it. If you’ve been recruited as I was for your abilities in a specific area, then prove it through your performance, but do not act as though you deserve it just because your first moments of life were in a Western hospital. As you learn, as time goes on, you’ll figure it out. Keep the great aspects of your home country and culture, leave the rest: Remember, you just became an unofficial ambassador!

Hurry up and wait: Life in the United States and other Western nations is often a little more: go! go! go! than it is elsewhere in the world. Whether you call it the “rat race” or “climbing the corporate ladder” or what have you, many parts of the world don’t do this. Time is more fluid here, and as an example, work starts at 8 for me which, means I arrive between 7:30 and 8:30. For the first year, I was vigilant about being on time. Now I make sure I’m within reason, which is what my co-workers do. This is what makes me part of the group, rather than an outsider. Learn to interpret signals, take things as they come, and just relax. You might find that you really enjoy the more relaxed pace.

Watch what you say, watch what you write: You should be culturally sensitive anyway, but sometimes it takes a little bit to figure out what’s culture and what’s not. I actively wrote a blog the first 18 months I was here; I really enjoy going back and reading it now, as I can see my development and change over the months and year. There’s nothing wrong with doing this, and I actually encourage it. The reason I gave it up was the time commitments of work and school, not fear of Saudi government intervention. That said, it is always a good idea to be aware of what you say. Not every country in the world, including some western ones, recognizes your “right” to say whatever happens to pop into your head today. Insulting a nation’s government or royal family may be illegal, insulting the culture is poorly regarded, and insulting the state religion and/or proselytizing is treated as blasphemy and can be punished severely. If you make it public, anyone can read it.

These are some tips to get you started in your planning process, In my next post, I’ll talk a little bit about the steps to cultural adjustment that you’ll be taking, as well as give some real life examples of people who’ve been both successful and failed miserably in their transitions.


Geoffrey Horning is an Emergency Medical Services (EMS) Training Consultant at the Al-Ghad International Colleges for Applied Health Sciences in Riyadh, Kingdom of Saudi Arabia. His expertise is in EMS/Fire and EMS/Fire Training with specialization in HazMat and Disasters. Geoff’s objective within the Department of Academic and Educational Affairs is to improve and assure the quality of the educational processes and thereby provide the best possible learning environment for students and faculty alike. A veteran of the United States Marine Corps, Geoff is simultaneously working on his MPH at the George Washington University which he will be complete in August 2015.  

Lancet reminds us to include health in #humanrights analysis

This should go without saying, but it is always nice when a respected, high-impact journal reminds us that health should be a central consideration in every human rights discussion and “necessary component of resilient human security.” In its most recent issue, British health journal Lancet published an editorial on HRW’s World Report 2015, lauding it for drawing attention to health-related human rights failures around the world while expressing disappointment that it “did not identify health as a core element in its analysis”:

In his opening essay, HRW’s Executive Director, Kenneth Roth, writes, “The world has not seen this much tumult in a generation…it can seem as if the world is unravelling”. Indeed, this 656-page report is a grim read in a year marked by extensive conflict and extreme violence. But when one delves deeper, there is a hidden story that often does not make the headlines. That story is the health dimension of human rights. Viewed through the lens of health, the report contains several compelling and disturbing themes.

The editorial noted numerous examples in the report of attacks on healthcare facilities, both in conflict zones and in the areas of West Africa struck by the Ebola outbreak, as well as spotlights on gender-based violence, a dearth of mental health services, targeted killings and persecution of health workers, and inadequate access to palliative care. While the report contains valuable analysis, the editorial contends that it does not go far enough in incorporating health as a human rights foundation:

This latest HRW report is an important call to arms to protect health as a fundamental human right. It is a pity that HRW did not identify health as a core element in its analysis, not only as part of a comprehensive package of human rights protections but also as a necessary component of resilient human security. Their analysis should prompt all governments and international health organisations to reflect carefully on their actions to make health a core responsibility and right of all citizens.


Note: This was cross-posted to my own professional blog.

Disney, measles, and parents’ choice not to vaccinate: Who’s to blame?

Guest bloggers: Brittany Seymour and Rebekah Getman

The recent challenges surrounding childhood vaccinations in the United States have received notable attention in both popular and scientific press, illustrating a spectrum of parental concerns and resultant attitudes ranging from vaccine hesitancy to outright refusal. The current measles outbreak traced to Disneyland has contributed to the highest number of US measles cases in fifteen years and resulted in the Centers for Disease Control and Prevention’s release of an official CDC Health Advisory in January this year. Over half of the individuals who have come down with the illness are unvaccinated; of those, more than 80% are old enough to receive the MMR vaccine but have not, leading many states to reevaluate their personal belief exemption policies. Unsurprisingly, this now multi-state outbreak has reignited the emotional debate over vaccine safety, efficacy, and policy in mainstream and social media. While vaccinations are likely one of the most prominent health debates in the United States right now, health officials are increasingly battling unfounded controversy regarding several of public health’s greatest achievements.  The field that is tasked with controlling global disease epidemics is now up against what have been dubbed “digital pandemics:” the far-reaching, rapid spread of unrestricted, scientifically inaccurate health information across the Internet through social networks.

Researchers at Harvard University recently studied this phenomenon over another common public health intervention: community water fluoridation. A lobby to end fluoridation pushes on in communities across America, despite more than 3,000 studies confirming its safety and benefits. The researchers’ findings indicate that, similar to the anti-vaccination community, a small but vocal and very tightly knit network is driving the anti-fluoridation lobby. A well-known social theory describes individuals in the world as connected by six degrees of separation, and Facebook’s one billion users are four degrees separated; the study found that individuals in the anti-fluoride community are separated by a mere two degrees. Often, highly connected networks develop a strict set of norms and values, and any person or information in violation of those norms, such as scientifically accurate pro-fluoride information, will be quickly rejected, making rational discourse nearly impossible. The researchers also traced online social conversations about fluoride through the network. Members of the anti-fluoride network frequently shared and cited scientific studies to back their arguments; however, in more than two-thirds of conversations, the actual study cited was buried two or three links away from the online discussion, or was not reachable at all. This is concerning because, under these circumstances, the risk of evidence becoming misrepresented or misinterpreted likely increases with each link that takes readers further away from the source.

The researchers’ findings support the theory that highly connected social networks, and not science or evidence, are driving digital pandemics of health information on openly accessible Internet sites. In the digital information age, scientific fact is only one piece of the complex health decision-making process. When capable, intelligent parents encounter the sea of voices online while researching how to make optimal decisions for their children’s health, of course they become concerned with what surfaces to the top of their Google search. The Harvard study suggests that perhaps we need to stop blaming parents for choosing not to vaccinate their children or for lobbying to end fluoridation in their communities, an approach that only alienates parents with questions and shuts down dialogue. Moreover, corrective scientific information inserted into existing social communities without respect for norms and values, even if in response to misinformation, runs the risk of insulting those not readily convinced solely by the prevailing science, an ultimately detrimental approach.  Rather, additional research is needed to discover new, social health communication strategies that are more inclusive and acknowledge social networks’ differing belief systems. Digital pandemics are a part of our current, connected reality. Rather than fight against this trend (which may prove impossible), public health communication approaches must empower and partner with parents so that the voices of expertise, evidence, and experience are the ones they trust, and share within their networks, once again.

Getman HeadshotRebekah Getman is the Senior Program Manager for Education at the Harvard Global Health Institute, tasked with creating and implementing multi-disciplinary curriculum for students that supplements their in-classroom learning. These curricula combine global health knowledge with other disciplines to provide students with a broad lens through which to study and assess global health interventions.

SeymourHeadshotBrittany Seymour is an Assistant Professor of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology and the Inaugural Harvard Global Health Institute Fellow. Her research includes interdisciplinary global health curriculum development and pedagogy, capacity strengthening for oral health delivery systems in resource-challenged regions, and digital information transfer and impacts on health.

The Dark Side of Chocolate: A Story of Child Slave Labor in West Africa’s Cocoa Plantations

With the holidays approaching, I can’t help but notice one of my favorite sweets making an appearance in almost every store I visit. Chocolate is an indulgence most of us in America can’t consider living without. However, after joining the team at the international non-profit, United Aid for Africa, I was motivated to take a second look at how and at what cost, we get our chocolate.

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Band Aid 30: Celebrities Strike Again

Over the weekend the song These Days by UK pop group Take That made it to number one on the UK Official Singles Chart. So why is that good news? Because the song took the number one spot from Band Aid 30’s Do They Know It’s Christmas?

Do They Know It’s Christmas? was first released in 1984 to raise money for the famine in Ethiopia. It was re-recorded twice (first in 1989 and then again in 2004) to raise more money for famine relief. The latest version was released last month and has undoubtedly caused a lot of controversy as it aims to respond to the Ebola outbreaks in West Africa.

While the celebrities involved may have had good intentions, their delivery is shoddy and the result is a condescending attempt at charity. Do They Know It’s Christmas? portrays West Africa as a single, poverty-stricken country in peril. The sensationalist message the title, imagery, and lyrics send is that Westerners need to save Africa because it is a place of famine and disease without any joy or hope. The lyrics read:

There’s a world outside your window and it’s a world of dread and fear
Where a kiss of love can kill you
And there’s death in every tear
And the Christmas bells that ring there are the clanging chimes of doom
Well tonight we’re reaching out and touching you
Bring peace and joy this Christmas to West Africa
A song of hope where there’s no hope tonight

The lyrics alone are insulting and erroneous, but coupled with the video, the whole thing is so patronizing. I’m utterly appalled that the producers of the music video decided to show footage of a female Ebola patient being removed (practically dragged) out of her house as the opening scene. How is that okay? Did they get her consent? Was her family involved? Also, the lack of transparency around donations and proceeds is problematic. Money is being kept in the Band Aid Charitable Trust, but the website doesn’t provide any information on exactly how the money will be disbursed and used.

As someone who has suffered a heartbreaking personal loss to Ebola I support all awareness, aid, and relief efforts, but I cannot comprehend how this whole thing came together and I’m quite disappointed in all the celebrities involved. They had the potential to do much better. They could have used their fame and influence to create something like Africa Stop Ebola which provides accurate educational information and gives all proceeds to Medecins Sans Frontieres (an organization that has been on the front lines of the Ebola outbreaks since March). But then again, celebrities and development don’t usually mix well, right? Share your thoughts below.

P.S. – check out this Band Aid 30 spoof created by the Norwegian Students’ and Academics’ International Assistance Fund