Guardian

Delegates examine new threats to human existence at global summit

WITH 951 days left for Nigeria and other developing countries to meet the 2015 Millennium Development Goals’ (MDGs) deadline, new threats to human existence have emerged. From Geneva, Switzerland, CHUKWUMA MUANYA reports on the deliberations at the World Health Assembly, which ends next Tuesday.

OVER  3,000 delegates from the 194 Member States of the World Health Organisation (WHO), including 43 from Nigeria, converged on Geneva, Switzerland last Monday, for the 66th session of the World Health Assembly (WHA), with the theme: “How to ensure the place of health in the post 2015 development agenda.”

They had one important agenda among others: to chart the path for a better health care delivery system in the world and by extension, tackle new threats to human existence, such as the looming pandemic of Non Communicable Diseases (NCDs).

Already, two new viruses that are mutating at frightening levels are of major concern to delegates. They include the Severely Acute Respiratory Syndrome (SARS), 41 cases of which were first detected in the Eastern Mediterranean region last year, and which resulted in 20 deaths; and the first-ever human infection by the H7N9 avian influenza virus, with more than 100 additional cases confirmed in the last three weeks.

Although, recent progress in the treatment and cure of tuberculosis (TB) and malaria has been encouraging, the delegates however acknowledged that this is increasingly being threatened by the spread of the diseases’ resistance to some mainstay medicines. For instance, it was gathered that the spread of antimicrobial resistance is now progressively rendering first-line treatments for TB and malaria useless.

The WHA is the WHO’s supreme decision-making body, which focuses on a specific health agenda prepared by its Executive Board. Nigeria was one of the countries celebrated for her efforts in reducing maternal and child deaths, with the “Save One Million Lives Initiative” and for boosting Routine Immunisation (RI) coverage to 78 per cent in March.

However, the country’s leadership at the Assembly was challenged by India over headship of a Mechanism on substandard/spurious/falsely labelled/falsified/counterfeit (SSFFC) medical products. The Director General of the National Agency for Food Drug Administration and Control (NAFDAC), Dr. Paul Orhii represents the country on that committee. The Guardian learnt that India is opposed to Nigeria heading the Mechanism because it will facilitate Nigeria’s attainment of self-sufficiency in drug production and clear the way for the country’s manufactured drugs to attain WHO- prequalified status.

It was also learnt that Nigeria imports drugs worth close to N160 billion ($1 billion) yearly from India. Besides, the Global Fund, last year, spent over N752 billion ($4.7 billion) on importing drugs delivered for developing countries, with none procured from Nigeria because the country does not manufacture drugs that are prequalified by WHO.

Due to President Goodluck Jonathan’s commitment to global efforts to eradicate the Wild Polio Virus (WPV), Nigeria escaped possible travel restrictions over the continued transmission of the virus and the link of the first virus in Somalia in six years, reported last week, to Jigawa State. Minister of Health, Prof. Onyebuchi Chukwu, told the Assembly that Nigeria is implementing a number of innovative initiatives to fast track the elimination of polio and also designing concrete measures to ensure the safety of all health personnel, both local and foreign.

He revealed that the country also is developing community-based mental care centres, which he admitted had proved to be much better than the hospital-based ones. The Minister said the country is also working on building rehabilitation homes, mainly taking care of people with substance abuse problems. Commonwealth Health Ministers also adopted a legislative framework to empower, protect ad care for persons with mental disorders.

Chukwu told journalists that the country’s mental health laws were out of date. He said: “Now, everybody is talking about mental health. Currently, there has been a draft Bill. The last one was before Independence. So it out of date and this is the reality.”

Nigeria was also one of the countries that stifled the Western agenda to sell lesbian, gay and bisexual (LGB) rights as human rights to health for adoption by the Assembly. Nigeria, a member of the WHA Board, submitted that the issue was not a health matter and cannot be discussed, just as it argued that the country’s position was that such sexual orientation is outlawed.

Nigeria is represented on the WHA Board by the Permanent Secretary of the FMH, Mrs. Fatima Bamidele, and Special Assistant to the Minister of Health on MDGs, Dr. Ngozi Anazodo.

The Guardian gathered that the United States and Europe are using development aids as bait for developing and poor nations to accept gay rights. The US, Thailand and Eastern Meditteranean nations are sponsoring this agenda on the Executive Board of the WHA.

Post 2015 development agenda

After the Millennium Development Goals (MGDs), what next? Chukwu enjoined WHO and its member states to remain committed and continue to intensify current collective efforts to ensure that health remains a priority. He said one way to do this, is to insist that the saying, ‘health is wealth’ takes priority over the notion that ‘wealth is health’.

The Health Minister said women and children’s health, the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), malaria, tuberculosis, the Neglected Tropical Diseases (NTDs), NCDs, human resources for health and universal health coverage must be on the agenda.

Chukwu said Nigeria is accelerating her efforts to ensure the attainment of the MDGs and reminded the Assembly that the government of Nigeria and the African Union will host the Abuja +12 summit in July 2013. He said the Summit, which would focus on the MDG 6 (combat HIV/AIDS, malaria and other diseases) would review the implementation of the Abuja declaration and chart the way forward.

The Nigeria/India rift

On why India is opposed to Nigeria chairing the mechanism, the NAFDAC DG told The Guardian: “The problem with the leadership of the SSFFC is a very delicate position. Once you are there, you are caught between the people who manufacture drugs such as United States and Europe, and the generic manufacturers like India. India feels strongly that Nigeria is now pursuing prequalification of their medicines and think that because of that their market will shrink especially in Africa.

“Nigeria is the number one buyer of Indian medicines in the African continent. Imagine if Nigeria becomes self sufficient in the supply of these medicines that are also prequalified by WHO. For instance, we are a major recipient of donated drugs procured from India, that are going to developing countries. Imagine, the situation that would require that if you want to donate drugs to Nigeria, you should buy from us (Nigeria) because we have medicines that are prequalified by the WHO.

“Before, our medicines were not WHO-prequalified. The Global Fund and the big players can only buy drugs from among the WHO-prequalified products. But now, we are poised to get that prequalification for more than three companies, hopefully this year, and even more next year. This means that we will become self sufficient in the supply of these medicines and some of these international partners who sell drugs to Nigeria will begin to lose their market share to Nigeria.

“But even more threatening to India is the proximity of Nigeria to some of the countries that are Nigeria’s neighbours, which are also major recipients of donated medicines. This means that Nigeria can begin to sell medicines to some of these companies. So they are not very happy. This is one of the strongest issues, in my opinion.

“Also, we think too independently for their liking. They want somebody who could do their bidding, who they can influence to maybe join the fight against innovative drugs. On the other hand, the innovators, Western countries, want somebody who is flexible enough to join them to fight manufacturers of generics. But we look at the issue of generic medicines purely from the public health perspective not incorporating intellectual property issues that they are concerned with.”

The NAFDAC DG said if Nigerian firms get their medicines prequalified by the WHO, the country would not only access the opportunities associated with donating drugs, by selling medicines that are bought for donation to other countries, Nigeria would also become self sufficient in drug production. “Any country that wants to donate drugs to Nigeria can buy from us and donate to the country,” he said.

Delegates celebrate Nigeria

The Minister of State for Health, Prof. Muhammad Ali Pate, was on Wednesday singled out for special commendation at a high-level side event for ministers and senior participants. The minister was commended for the success of the “Save One Million Lives Initiative,” launched last year by President Goodluck Jonathan, which has so for saved 218,000 lives, and putting one million women on antenatal care.  Jonathan launched the initiative on October 16, last year.

Threat of new viruses and growing drug resistance

Director General of the WHO, Dr. Margaret Chan, in her opening address, warned that although recent progress made in the treatment of tuberculosis and malaria had been encouraging, it was increasingly being threatened by the spread of resistance to mainstay medicines

Chukwu said: “The recent outbreak of H7N9 virus has been of interest to Nigeria because Nigerians travel a lot and of course people also visit Nigeria. About a month ago, we actually sent out alerts from the Nigeria Centre for Disease Control (CDC). Of course as at now, WHO does not think that it should restrict travel, but what we have done is to alert our own people at the Ports particularly at the airport, since it is where people from that part of the world will always come to Nigeria.

“So we have the alert and we are monitoring too. Remember that when we had the avian flu, working with our partners, a lot of laboratories were established in Nigeria. So we are using that capacity to test people who will come with fever that we cannot easily place our finger on. What is important for us is to be vigilant. The symptoms are known but the symptoms are of course symptoms of other diseases.

Tackling NCDs

Chan said the industries contribute to the rise of NCDs. “When public health policies are at cross purposes with vested economic interests, we will face opposition, well-orchestrated and very well-funded opposition,” she said.

Chan said WHO would never be on speaking terms with the tobacco industry. “At the same time, I do not exclude cooperation with other industries that have a role to play in reducing the risks for NCDs. There are no safe tobacco products. There is no safe level of tobacco consumption. But there are healthier foods and beverages, and in some cultures, alcohol can be consumed at levels that do not harm health,” she said.

Chukwu said: “What is enduring is education and enlightenment of the public because if there is no demand there will be no supply. We are working on that. Of course we cannot do it alone, it has to be multi-sectoral. The media has to be a big player in that. The second thing is legislation. For those who will be insistent, there is need to apply sanctions.

“The President is also going to lead the fight against obesity. He has approved in writing that he will flag off the FMH campaign, where he will publicly demonstrate to the Nigerian public on the need for a check up, for your waist to be measured, your height taken and your body mass index (BMI) calculated and then other tests in terms of screening for cardiovascular diseases. In our budget this year, we also have funds to subsidise those tests.”

National Health Bill

The House of Representatives has blamed the Senate for the delay in the passage of the National Health Bill (NHB) and the Bill establishing a Commission on National Health Insurance (NHIC), with more regulatory duties from the existing National Health Insurance Scheme (NHIS).

Chairman House of Representative Committee on Health, Hon. Ndudi Elumelu, told The Guardian: “We are considering the NHB. As a matter of fact, if not for this visit to Geneva for the 66th WHA we would have concluded it. Last week, we considered the Dental Technology. We have passed the NHIC. It is no longer the NHIS, it is now National Health Insurance Commission (NHIC). What we have done is to change the operation of NHIS to now say be a regulator, do not be participating in the service itself, you should regulate the conduct of the providers and the players in the health insurance institution.

“So we have passed it, we have taken it to Senate and we would have expected Senate to just adopt it. But again just like they had done in the NHB, they have started the novo. So we are now going to witness them doing public hearing for that and everything. So, until they complete their process, we probably will not have a conference to agree on areas that maybe different from the once we have passed.”

However, the Minister of Health promised delegates that the National Assembly is currently revising the National Bill, which will be passed into law before the end of this year.

Going forward

The WHO DG said: “Going forward, we must maintain a high level of vigilance. I cannot over-emphasize the importance of immediate and fully transparent reporting to WHO, and of strict adherence to your obligations set out in the International Health Regulations.

“As was the case 10 years ago, the current situation demands collaboration and cooperation from the entire world. A threat in one region can quickly become a threat to all.”