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  • br In the past decade Brazil has achieved

    2019-06-01


    In the past decade, Brazil has achieved considerable progress in malaria control, with 140 000 cases reported in 2015, the lowest numbers since 1980. Part of this success has been attributed to the establishment of a large network of around 3000 diagnostic and treatment units for malaria. A remarkable feature is that these services are provided for free as part of the public universal health-care system (Sistema Único de Saúde [SUS]) and cover rural and riverine areas in the Amazon region—where more than 83% of malaria transmission occurs. Populations in these areas have a low density and reduced level of mobility, and in spite of the high coverage for malaria-associated diagnosis and treatment by the SUS, scarce access to health care and other public services, characterising the precarious social conditions and relative neglectof malaria in this region, a situation unfortunately shared with other Latin American countries. In the absence of a consistent presence of the state, a creative and original acute fever surveillance system based on the use of a red flag has been put in place (figure). This consists of hoisting a red flag (or piece of red cloth) in front of a household if an inhabitant presents fever or other malaria-associated symptoms. Whenever a SCR7 health-care worker roaming their catchment area observes a red flag, they stop at that household, fill the notification form with the data from the febrile person, and collect a blood sample for malaria diagnosis through either microscopy (done at that location\'s health post) or rapid diagnostic test. If the test is positive, the species-specific treatment is provided following the national guidelines. Such a system has contributed to partly overcome the problem of large distances to health facilities, which impairs efficiency of case detection in the region, and enabled more than 60% of malaria cases to be treated within 48 h of fever onset.
    I read with great interest the open letter published on Dec 9, 2016 in to solicit the ideas and views of candidates for WHO Director General on advancing the research and development (R&D) of diagnostics, medicines, and vaccines of public health importance. I have high regard for civil society\'s advocacy to address big challenges in global health. There have been significant efforts and commitments by WHO Member States and non-state actors to develop and deliver affordable, effective, safe, and quality health products for diseases that disproportionately affect developing countries and vulnerable populations and remain poorly addressed owing to market failures. These efforts include the Report of the Commission on Intellectual Property Rights, Innovation and Public Health addressing key access barriers, the TRIPS agreement allowing the use of compulsory licenses, the report of WHO\'s Consultative Expert Working Group on Research and Development, the recommendations of the UN Secretary General\'s High Level Panel on Access to Medicines proposing a deal to close the gap between health innovation and access, and a call to double the funding for R&D to US$6 billion per year. The recent global doubling of oral cholera vaccine supply demonstrated the critical role of public-private partnerships. WHO has developed a global strategy and work plan to improve monitoring, coordination, and funding for health research and development. It also established the Global Observatory on Health Research and Development to monitor, consolidate, and analyse relevant information on health research activities, particularly related to diseases affecting the poor. Furthermore, WHO carries out demonstration projects with the intention of delinking the price of the final product from the cost of the R&D. It laid out options for sustainable financing of a voluntary R&D pool fund which will soon be discussed by its governing bodies. Despite these encouraging efforts and the momentum built, I agree with the authors that the gap has not yet been addressed. As already indicated in my I am committed to accelerating research and innovation along a continuum from basic science and discovery to the development pipeline for diagnostics, medicines, and vaccines and the operational research necessary to optimise their use. I intend to intensify the ongoing dialogue and efforts including exploration of alternative mechanisms as well as translation of already existing and new commitments into action with a great sense of urgency. I will champion increased investment, national capacity strengthening and robust public-private partnerships to drive these actions. I will listen to partners offering creative ideas and innovations towards common goals.