SciDev.Net

This paper proposes a model to provide better access to fairly priced antiretroviral (ARV) drugs for HIV-infected people in poor countries, while also safeguarding the interests of ARV manufacturers.

The authors explain what governments and brand and generic companies are doing to increase the availability of ARVs in developing countries, taking examples from Brazil, Canada, China, India, the United States and Thailand. They also discuss the implications of creating more South–South partnerships to produce and market ARVs; and the impact that the UNTAID–Clinton Foundation coalition has had on lowering ARV prices in developing countries.

The authors recommend an incentive-based strategy that includes international donors bulk-purchasing generic ARVs, individual governments providing financial relief packages for generic companies, and the WHO brokering negotiations between brand and generic companies.

This series of commentaries and research articles — published by The Lancet, the Peking University Health Sciences Centre and the China Medical Board — addresses China's major health challenges, strategies and future. It has been produced by a group of 63 scientists from 10 countries with Chinese scientists making up two-thirds of the authors.

The research papers give scientific evidence on key health issues including the emergence and control of both infectious and chronic non-infectious diseases in China as well as the performance of China's healthcare system.

Authors of the series' commentaries further discuss a range of topical issues affecting China's health system, including the state of biomedical science and technology (see 'Progress in Chinese biomedicine a massive challenge'), medical research ethics, the lessons learnt from China's schistosomiasis control programme and the challenges the country faces in controlling HIV/AIDS.

The authors of this article analysed simulation results from a regional climate model for the northern Indian Ocean to predict likely changes in the strength and frequency of tropical cyclones in the Bay of Bengal from 2041–2060.

They find that rising concentrations of greenhouse gases will lead to more frequent cyclones in the region, particularly during the post-monsoon period. In addition, the number of intense cyclones and storm surges will increase. These results are consistent with other trend analyses that show intensification of cyclones in the bay during the last century.

But the research described in this paper only deals with simulations from one future climate scenario. To obtain better regional climate projections, the authors suggest it is necessary to examine simulations from more scenarios.

The authors of this article use satellite data to examine trends in the maximum intensities that cyclones can achieve during their lifetimes.

Results from previous analyses of tropical cyclone trends have been questioned due to a lack of consensus regarding data reliability. Moreover results have not been matched to theory because the focus has mainly been on changes in mean tropical cyclone statistics.

In this article, the authors conclusively show significant increases in the maximum wind speeds achieved by the strongest cyclones across all ocean basins except the South Pacific Ocean, with the largest increases occurring over the North Atlantic and northern Indian Oceans.

These findings are consistent with the idea that as seas warm, cyclones become more intense because the ocean has more energy that can be converted to tropical cyclone wind.

This series of five articles outlines new challenges and unsolved problems since the journal's last series in 2005. The first article ([189kB]) predicts the disease burden and economic losses that developing countries would face from chronic diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. In the 23 countries that the authors incorporated into a model, chronic disease was responsible for 50% of the disease burden in 2005. If no action is taken, they say, about US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. The second article ([105kB]) looks at how to scale-up strategies to fight chronic diseases in developing countries. The authors review evidence to identify which methods are cost-effective and financially feasible, and therefore ready to be scaled-up.

Tobacco control, salt reduction (both of which are detailed in the series' third paper ([177kB])), and a multidrug strategy to treat individuals with high-risk cardiovascular disease (see an in-depth look in paper four ([220kB])) are prime candidates for scaling-up. What effect improving health systems has on the level of chronic diseases should be properly evaluated, say the authors. For some health interventions, such as preventing or controlling diabetes, there is little cost-effectiveness data for low or middle-income countries, but their scientific effectiveness is so compelling that countries should consider how best to incorporate them. The final paper ([92kB]) is a call to action to incorporate existing interventions into healthcare programmes, which in 2005 was costed at US$5.8 billion.

1990 saw the first major effort to estimate the main causes of illness and the biggest killer diseases in different countries. The data are important for public-health officials to allocate their resources wisely but also for feeding into estimates to plan for the future. Importantly, these need to be regularly updated to ensure that health programmes are still going in the right direction. This paper updates the 1990 study and offer predictions up to 2030.

The most forceful change in disease trends is in developing countries, with the proportion of people affected by non-communicable diseases set to increase. Proportionally, the number of people with infectious diseases is set to fall, though not when it comes to HIV/AIDS.

Because the authors also rely on predicting socio-economic development trends, they created best-case and worst-case scenarios for economic growth. In the pessimistic scenario, by 2030, the three leading causes of illness will be HIV/AIDS, depression, and ischaemic heart disease; in the optimistic scenario, road-traffic accidents will replace heart disease as the third leading cause.

The WHO has provided its own estimates of how non-communicable diseases are set to rise in developing countries. These authors pool data from national registries and international databases to compare data on the differing burden from individual diseases. They outline the risk factors associated with the diseases.

The main three killers are cardiovascular disease, diabetes, and cancer. The paper ranks different types of cancer by how many people in developing countries they kill (lung and breast cancer are the deadliest) and also ranks diabetes prevalence by country (India, followed by China, has the highest prevalence).

To tackle these diseases, say the authors, people need to look closely at the risk factors in their life – eating healthily and exercising can do much to reduce the chances of getting one of these diseases.

Cardiovascular diseases are set to rise dramatically in developing countries, partly because of an increase in risk factors for the diseases, which include diet, physical activity, smoking. The authors looked at cardiovascular disease risks such as being overweight or obese, systolic blood pressure, and total cholesterol, and related them to national income, food purchase constraints, and urbanisation. Body mass index (BMI) and cholesterol increased as national income increased, then flattened, and eventually declined. BMI also rose with increasing urbanisation.

The authors suggest that cardiovascular disease risks will increasingly be concentrated in low-income and middle-income countries. Thus, preventing obesity should be considered a priority in these countries, along with measures to control blood pressure, cholesterol, and tobacco use.

This document presents the proceedings of a conference at the Royal Netherlands Academy of Arts and Sciences in December 2001. The conference papers deal with themes relating to the role of scientific research in the development of Northern countries and the need for North–South research cooperation. They document the experiences of research cooperation involving, among others, India, South Africa and a number of East African countries. Several papers deal with innovation and scientific cooperation, with case studies.

Researchers looked at global patterns of antibiotic resistance to assess how best to tackle the problem. They looked at three geographically separated, and culturally and economically distinct countries — China, Kuwait and the US: the theory was that if these very different countries had different patterns of resistance, a country-specific approach could still work: if the patterns were similar, a coordinated international response would be needed.

China had the fastest growing rate of increasing resistance, followed by Kuwait and then the US. The authors note that surveillance data are urgently needed to clarify the scope of the problem. Despite the paucity of data, preliminary data show China is doing worst — resistance of SPN (Streptococcus pneumoniae) to erythromycin is 73 per cent, compared with 23 per cent in Kuwait, and its MRSA levels are at 90 per cent

The authors say that although these countries have different trends at the moment, increasing globalisation means this might not last long. Also needed are better methods of data aggregation and analysis of how resistance is transmitted across national boundaries.

The first of this two-part series looks in detail at how antibiotic resistance affects the treatment of different types of illnesses — those that attack the gut (such as salmonella or cholera) and respiratory system (such as the tuberculosis bacterium), and the bacterium that causes gonorrhoea.  Treating these diseases in developing countries is increasingly difficult because the cheap antibiotics that were once effective are growing to be useful against bacteria that have developed resistance. These changes are pushing up treatment costs in developing countries. Drug-resistant tuberculosis, for example, is more expensive to treat than the non-drug-resistant type.

Free registration is required to view this article.

The second half of this series focuses on action needed to contain antimicrobial resistance. It outlines the risk factors that can lead to resistance emerging and spreading, particularly in developing countries: using poor-quality drugs or inadequate infection control in hospitals, for example. The article outlines strategies to stop the problem getting worse but points out that developing countries differ widely in the state of their healthcare systems and their resources, so a one-size-fits-all model is not useful.

The authors emphasise the importance of education of the public and of medical practitioners because otherwise the only information available to most healthcare professionals is from pharmaceutical companies that may not fit government or local priorities. In developing countries, unsanctioned providers are a particular problem because they might give people counterfeit or substandard antibiotics that can fuel resistance.

Free registration is required to view this article.

Good prescribing practices are important in tackling antibiotic resistance, and diagnostics are key to ensuring good practice. Knowing who not to treat is as important as knowing who to treat. The article reports on analyses by the Global Health Diagnostic Forum of the Bill & Melinda Gates Foundation to assess how many lives could be saved by better diagnostics for six major illnesses, including malaria and tuberculosis. The researchers assessed the technical issues associated with implementing the diagnostic tests in developing countries for three classes of laboratory infrastructure — none, minimal, or moderate to advanced.

They found that for acute lower respiratory infections, syphilis, gonorrhoea, chlamydia and TB, outcomes could be much improved if tests were sent to sites with minimal or no laboratory infrastructure. In these types of settings, the practicality of obtaining a specimen is important. For example, obtaining a blood sample correctly to test HIV viral load is almost impossible where there are no laboratory facilities. Using sputum to test for TB has similar issues because of the impracticability of the sample medium. Thus, new biomarkers might be needed to test for diseases with specimens different from those currently used. Combination tests that look for a range of infectious organisms in one sample would be useful in resource-poor settings.

The researchers also highlight the importance of taking into account cultural and social sensitivities when designing interventions – blood sampling is not always accepted in some regions of the world, for example.

This study outlines the findings of the 2003 TIMSS for the participating Arab countries, namely, Bahrain, Egypt, Jordan, Lebanon, Morocco, the Palestinian National Authority, Saudi Arabia, Syria and Tunisia. TIMSS is a study of cross-national achievement in mathematics and sciences for fourth and eighth grade students since 1959.

The report provides useful data on each of the participating countries, and compares Arab and international average scores. It includes data on average achievement scores, resource availability, access to computers, the number of curriculum hours designated, teacher characteristics and credentials, and classroom characteristics and instruction quality.

The study finds that while most Arab countries lag behind the international averages, a few have made progress since the last exercise in 1999. It also highlights interesting aspects of this difference and suggests measures to improve student achievement. The document is especially useful for educators in Muslim countries seeking credible data and analysis on student achievement.

This scientific article provides an insight into the status of public research in genetically modified (GM) crops in Egypt, Kenya, South Africa and Zimbabwe in 2004.

The authors document 54 transgenic 'events' — specific instances of genetic transformation — across the four countries. They identify work to develop GM strains for 20 crops, including cotton, maize, potatoes, sugar cane, tomatoes and wheat. South Africa is shown to be a particularly important centre for biotech research, accounting for 28 out of the 54 events examined.

The authors call for a simplified system to facilitate regulatory approval of GM crop trials and commercial releases across the continent as a whole and suggest measures to encourage inter-institutional links and South–South collaborations.

This research article, by Rosemary Wolson at the University of Cape Town, assesses South Africa's biotechnology policies, reviewing three major initiatives — the national research and development strategy, biotechnology strategy and proposed laws to govern intellectual property rights derived from publicly funded research. Wolson explains the origins, goals and implementation of each.

The projects aim to create a coordinated strategy for promoting biotechnology in South Africa. Wolson concludes that the efforts are an encouraging sign of governmental commitment, but notes the continuing challenge of integrating the individual projects into a coherent framework. This may depend on promoting social networks to catalyse innovative industries.

She calls for the government to encourage more private enterprise and investment while remaining committed to basic research.

This article is useful to anyone hoping to understand the policy framework for biotechnology in one of sub-Saharan Africa's key scientific and industrial powers.

In this research article, Victor Konde of the University of Zambia argues that industrial biotechnologies can improve food security in Africa through improved livestock feeds and vaccines, as well as biotechnological pesticides, fertilisers and herbicides. He adds that biotechnology can also help farmers process crop and livestock products for new markets.

But Africa must first overcome a number of key challenges, says Konde — including restrictions on agricultural exports, weaknesses in scientific capacity and investment, and a lack of diplomatic strength to effectively promote its interests in international negotiations.

The author proposes ways for African policymakers to encourage biotech enterprise and investment, collaborative and interdisciplinary research, strategic alliances and public–private partnerships.

This research article assesses the potential for biotechnological approaches to overcome major pests, diseases and weeds undermining food security in Africa. The eight authors review three major constraints — parasitic weeds and herbicide-resistant grasses, insect pests, including those carrying plant diseases, and mycotoxins that damage stored grains.

They note that biotechnological solutions to some of these are already being explored, such as insect resistance in maize, but they say that others, like the control of parasitic weeds, will require longer-term study. The authors argue that these should be prioritised in public research programmes and supported by the private sector through donations of useful genes and technologies.

Their methodical discussion helps identify key priority areas for crop biotech research in Africa. This article will be useful to policy analysts, decision makers and research managers working in the field.

These proceedings from the 2006 World Congress on Industrial Biotechnology and Bioprocessing broadly focus on the development of new biotechnology and bioprocessing industries, including biofuel crops.

Although they give a predominantly developed world perspective, they may be of interest to developing countries examining the potential of GM crops or other agricultural biotechnologies for producing energy or industrial compounds to address their own priorities and needs.

The discussions range across scientific, technical, economic and political topics. The section on feedstocks for bioprocessing is particularly interesting as it considers the potential for creating new molecules from plants, biomass harvesting and processing to produce energy.

This issue of the African Technology Development Forum Journal highlights technology transfer in Africa. In particular, it looks at the different ways technology is transferred to and from Africa, and how these vary across the continent. It discusses international organisations' role in agricultural technology transfer and examines how both international and local public-private partnerships can help transfer technology in all sectors of the economy.