COVID has 'devastating' impact on fight against HIV, TB, malaria: Global Fund

PARIS - The COVID-19 pandemic had a "devastating" impact on the fight against HIV, tuberculosis and malaria in 2020, according to a report released by the Global Fund on Wednesday.

"To mark our 20th anniversary, we had hoped to focus this year's report on the extraordinary stories of courage and resilience that made possible the progress we have achieved against HIV, TB and malaria over the last two decades," said Peter Sands, the Global Fund's executive director. 

"But the 2020 numbers force a different focus. They confirm what we feared might happen when Covid-19 struck," he said.

"The impact of Covid-19 on the fight against HIV, TB and malaria and the communities we support has been devastating. For the first time in the history of the global fund, key programmatic results have gone backwards."

There were "significant" declines in HIV testing and prevention services, the fund said.

Compared with 2019, the number of people reached with HIV prevention and treatment dropped by 11 percent last year, while HIV testing dropped by 22 percent, holding back new treatment in most countries.

Nevertheless, the number of people who received life-saving antiretroviral therapy for HIV in 2020, rose by 8.8 percent to 21.9 million "despite Covid-19". 

The impact of the coronavirus pandemic on the fight against TB worldwide had similarly been "catastrophic", the report said.

The number of people treated for drug-resistant TB in the countries where the Global Fund invests dropped by "a staggering" 19 percent, with those on treatment for extensively drug-resistant TB registering an even bigger drop of 37 percent, it said. 

The fund calculated that around 4.7 million people were treated for TB in 2020, around one million fewer than in 2019. 

Interventions to combat malaria "appear to have been less badly affected by Covid-19 than the other two diseases," the report found. 

"Thanks to adaptation measures and the diligence and innovation of community health workers, prevention activities remained stable or increased compared to 2019."

The number of mosquito nets distributed increased by 17 percent to 188 million and structures covered by indoor residual spraying increased by three percent. 

Nevertheless, the Global Fund -- which brings together governments, multi-lateral agencies, bilateral partners, civil society groups, people affected by the diseases and the private sector -- said that its "rapid and determined response to Covid-19 prevented an even worse outcome".

In 2020, the fund disbursed $4.2 billion to continue the fight against HIV, TB and malaria and approved an additional $980 million in funding to respond to Covid-19.

The Global Fund said that since it was set up in 2002, it has saved 44 million lives and the number of deaths caused by AIDS, TB and malaria decreased by 46 percent in countries where it invests.

Agence France-Presse

What is chloroquine and could it cure the new coronavirus?

Could a pair of decades-old, relatively inexpensive drugs be the solution to the novel coronavirus pandemic?

Around the world, countries are expanding access to hydroxychloroquine (HCQ) and chloroquine (CQ), related compounds that are synthetic forms of quinine, which comes from cinchona trees and has been used for centuries to treat malaria.

HQ which is the less toxic of the two, is also used as an anti-inflammatory to treat conditions like rheumatoid arthritis and lupus, purposes it is primarily known for outside the tropics. 

The medicines have shown early promise against the COVID-19 illness in early studies in France and China, which led US President Donald Trump this week to call them a "gift from God" -- even as experts urge caution until bigger trials validate their effectiveness.

Here is what you need to know. 

- Why they might work -

China used CQ on a trial of 134 patients in February, finding it was effective in reducing the severity of the illness, according to officials. 

But these results haven't yet been published. Chinese respiratory expert Zhong Nanshan, who leads a government task force in response to the epidemic, said in a press conference last week that the data would be widely shared soon.

In France, a team led by Didier Raoult of the IHU-Mediterranee Infection, Marseille reported last week they had carried out a study on 36 COVID-19 patients, finding that HCQ drastically reduced the viral load in a group which received the drug.

The effects were especially pronounced when it was used with azithromycin, a common antibiotic used to sweep out secondary bacterial infections. 

What's more, HCQ and CQ drugs have been proven to act against the SARS-CoV-2 virus in lab settings, and a paper published by a Chinese team last week in Cell Discovery offered a potential mode of action.

Karine Le Roch, a professor of cell biology at the University of California, Riverside, explained that both HCQ and CQ are weak bases that elevate the pH of parts of human cells called organelles -- which are analogous to organs in animals -- and which are normally acidic.

This in turn interferes with the virus' ability to enter the cells -- and also seems to block them from replicating once they are already inside.

But, she added: "While it worked in vitro, I am still waiting to see published results of large blind clinical trials demonstrating the efficacy of HCQ in vivo," she told AFP.

- The case for caution -

Promise doesn't mean proof, and the small studies carried out so far amount to "anecdotal" evidence, according to Anthony Fauci, head of infectious diseases at the US National Institutes of Health. 

What's more, a small Chinese study on 30 patients that was also published this month found HCQ was no better than standard care -- meaning treating the symptoms via bed rest, fluids and so on -- adding a note of caution to the discourse.

The only way to know for sure is to carry out randomized clinical trials, scientists say. Such experiments are considered the gold standard in the field but last months or years and involve thousands of patients, often from around the world.

Patients are assigned at random to either receive the drug under investigation or a placebo, and the studies are "blinded" meaning the participants and their doctors are unaware which group they are in, to further reduce bias.

Overhyping medicine can have several unintended effects, warn experts.

"One of the unintended consequences are drug shortages of chloroquine, for people that need to manage their rheumatoid arthritis, for example," Peter Pitts, a former commissioner of the Food and Drug Administration told AFP. 

A few countries are taking a cautious approach. Spain, for example, announced Monday said that "until further notice" these arthritis and lupus patients would be given priority access to the drug.

French Health Minister Olivier Veran meanwhile said the compounds can be used only to treat the most severe cases of COVID-19.

Another problem is that people may try to self-medicate. A US man from Arizona died this week after ingesting a form of chloroquine intended to fight aquatic parasites. 

- Side effects -

Several countries have now embarked on clinical trials, including the United States, where one began in New York this week.

Italy is carrying out a trial on 2,000 people, while scientists are also awaiting the results from bigger trials in China.

But while the drugs are being rolled out for compassionate use, it is critical to bear in mind safety precautions.

About one percent of people are at high risk of blackouts, seizure or even sudden death from cardiac arrest because of heart rhythm issues they may themselves be unaware of, Michael Ackerman, a genetic cardiologist at Mayo Clinic told AFP.

Medical teams must therefore perform electrocardiograms to inform their risk analysis before using these medicines, he said.

"All focus is placed on the hope for therapeutic efficacy of these medications, without any reasonable amount of respect, not fear, but respect for what the potential side effects of these very powerful medications are," said Ackerman.

source: news.abs-cbn.com

Multidrug-resistant malaria spreading in Southeast Asia: study

LONDON - Strains of malaria resistant to two key anti-malarial medicines are becoming more dominant in Vietnam, Laos and northern Thailand after spreading rapidly from Cambodia, scientists warned on Monday. 

Using genomic surveillance to track the spread of drug-resistant malaria, the scientists found that the strain, known as KEL1/PLA1, has also evolved and picked up new genetic mutations which may make it yet more resistant to drugs.

"We discovered (it) had spread aggressively, replacing local malaria parasites, and had become the dominant strain in Vietnam, Laos and northeastern Thailand," said Roberto Amato, who worked with a team from Britain's Wellcome Sanger Institute and Oxford University and Thailand's Mahidol University.

Malaria is caused by Plasmodium parasites which are carried by mosquitoes and spread through their blood-sucking bites.

Almost 220 million people were infected with malaria in 2017, according to World Health Organization estimates, and the disease killed 400,000 of them. The vast majority of cases and deaths are among babies and children in sub-Saharan Africa.

Malaria can be successfully treated with medicines if it's caught early enough, but resistance to anti-malarial drugs is growing in many parts of the world, especially in Southeast Asia.

The first-line treatment for malaria in many parts of Asia in the last decade has been a combination of dihydroartemisinin and piperaquine, also known as DHA-PPQ. Researchers found in previous work that a strain of malaria had evolved and spread across Cambodia between 2007 and 2013. This latest research, published in The Lancet Infectious Diseases journal, found it has crossed borders and tightened its grip.

"The speed at which these resistant malaria parasites have spread in Southeast Asia is very worrying," said Olivo Miotto, who co-led the work.

"Other drugs may be effective at the moment but the situation is extremely fragile and this study highlights that urgent action is needed," he said.

source: news.abs-cbn.com

Indonesia's quake-hit Lombok battles with malaria, 137 infected

MATARAM, Indonesia - A malaria outbreak has infected at least 137 people in Indonesia's West Lombok after the island was rocked by a series of earthquakes in recent months, an official said Sunday. 

The quakes and aftershocks since July have killed about 500 people and forced hundreds of thousands into evacuation shelters or tents. 

As a result the number of malaria cases is twice as high as in the same period last year, prompting the West Lombok government to declare a health emergency.

Among the 137 infected are babies and pregnant women. 

The government has taken steps to prevent the disease from spreading such as taking blood samples, distributing mosquito nets and fogging.

Amaq Aniyah, 65, was diagnosed with malaria after feeling unwell for a week. 

His house was destroyed by a 6.9 magnitude quake in early August and since then he has been living in a tent. Paramedics have given him a mosquito net. 

"Ideally we should give mosquito nets to everyone but because we only have a few, we have to be selective," said paramedic Farlin, who like many Indonesians goes by one name. 

The head of West Lombok regency, Fauzan Halid, told AFP they only have 3,000 mosquito nets but need about 10,000. 

Declaration of a health emergency will allow West Lombok to seek 3.4 billion rupiah ($230,000) in aid from the provincial and central government to tackle the crisis. 

Indonesia's rainy season is expected to start next month, raising fears malaria-carrying mosquitos could breed in stagnant water. 

str-rws/sm

source: news.abs-cbn.com

Bill Gates to give $500 million for malaria, other diseases

WASHINGTON - US philanthropist Bill Gates on Sunday announced he will donate over $500 million to fight malaria and other infectious diseases in the developing world, saying the Ebola outbreak is a call to action.

The former Microsoft CEO told the 63rd annual meeting of the American Society of Tropical Medicine and Hygiene in New Orleans that his Gates Foundation is committing more than $500 million in 2014 "to reduce the burden of malaria, pneumonia, diarrheal diseases, and an array of parasitic infections that are leading causes of death and disability in developing countries," a statement said.

Gates also said that in addition to that pledge, his foundation has boosted its annual funding for malaria by 30 percent.

Gates described the Ebola epidemic that has killed more than 4,900 people in West Africa since the beginning of the year as a "critical moment in the history of global health," and said the world's largest outbreak of the hemorrhagic fever underscores the need for stronger efforts to stay ahead of disease threats such as drug-resistant malaria and dengue fever.

"The Ebola epidemic has shown, once again, that in today's interconnected world, health challenges anywhere create health challenges everywhere -- and the best way to overcome those challenges is to dedicate ourselves to the great cause of reducing the global burden of infectious disease," Gates said in his prepared remarks.

The Gates Foundation announced in September a $50-million commitment to help scale up efforts to contain the Ebola outbreak.

The more than $500 million announced Sunday includes over $150 million to the PATH Malaria Vaccine Initiative to advance development of next-generation malaria vaccines, and $29 million to the Clinton Health Access Initiative to support malaria elimination efforts in Southern Africa and the Greater Mekong Sub-region of Southeast Asia.

Gates said the rise in resistance to effective malaria drugs in Southeast Asia should serve as a warning, that better research and development is needed to "stay ahead of the natural evolution of infectious diseases."

Other grants announced by Gates include $49 million to PATH Vaccine Solutions to develop new vaccines and combinations of vaccines against bacterial causes of diarrhea, and $18 million to the University of Maryland for studies in Mali, Kenya and Gambia on the impact of rotavirus vaccines on child health.

Other grants aim to help eradicate neglected infectious diseases, including $60 million toward finding treatments for a disfiguring diseases sometimes known as elephantiasis (lymphatic filariasis) as well as sleeping sickness (human African trypanosomiasis), and black fever (visceral leishmaniasis).

Gates said that eradicating malaria by the middle of this century is "both a necessary objective and an attainable one."

What is needed are single-dose complete cures for malaria, more sophisticated diagnostics and a next-generation malaria vaccine, as well as more widespread and precise use of bednets, he said.

"We must remain committed to the eradication of malaria," Gates said.

"Small steps won't get the job done. History shows that the only way to stop malaria is to end it forever."

source: www.abs-cbnnews.com

Experimental malaria vaccine shows early promise

LONDON (Reuters) - British scientists have developed an experimental malaria vaccine that may have the potential to neutralize all strains of the most deadly species of malaria parasite.

Results from very early tests of the vaccine in mice and rabbits show it induces an antibody response able to halt many strains of the P. falciparum parasite, the form that causes almost all of the 655,000 malaria deaths worldwide each year.

The researchers, whose work was published in the journal Nature Communications on Tuesday, plan to take the vaccine into early stage human trials in two to three years, but it may be a decade or more beyond that before it is fully developed.

"Vaccines against malaria are notoriously difficult to develop," said Adrian Hill of Britain's Oxford University, who worked on the vaccine research team.

This vaccine builds on work published last month by the same team, who pinpointed a single receptor for a protein called RH5 that is critical for the malaria parasite to gain entry into red blood cells where it multiplies and spreads.

The researchers said in November they thought that by blocking this process, they could halt the disease in its tracks - and Tuesday's results confirm their thinking.

"What's exciting about RH5 is that we've shown that antibodies against this protein have so far knocked down every parasite we've been able to test in the laboratory," Simon Draper of Oxford's Jenner Institute, who also worked on the study, said in a telephone interview.

"We haven't found one yet that the vaccine isn't able to stop."

Malaria is a mosquito-borne parasitic disease that killed around 655,000 in 2010 according to latest World Health Organisation data. The vast majority of malaria deaths are among children and babies in sub-Saharan Africa.

The blood stage of the parasite's life cycle begins when it invades human red blood cells, and it is this stage that is responsible for malaria illnesses and deaths.

Scientists have been working for decades on trying to develop an effective vaccine against the disease, but this has proved particularly tricky because the parasites' antigens - the target of vaccines - tend to be genetically too diverse.

Researchers say RH5 doesn't show this diversity, making it a particularly good target for a vaccine to exploit.

British drugmaker GlaxoSmithKline published data in October showing its experimental vaccine, RTS,S, halved the risk of children getting malaria in a large trial in Africa, making it likely to become the world's first licensed malaria vaccine.

Other teams of researchers around the world are also working on other approaches to a malaria vaccine.

Experts agree that wiping out the disease - a goal the scientific community says could be achieved in the next few decades with the right tools - will need a vaccine that is more effective than RTS,S.

"Unlike RTS,S, which aims to stop the parasite getting into the liver, this RH5 vaccine is trying to kill the parasite in the blood," Draper explained. "So it may be possible that the RH5 vaccine could complement RTS,S."

"Ultimately we don't know until we test our vaccine in humans whether it will be more efficacious than RTS,S. But these data on RH5 are some of the most exciting in the field at the moment."

source: mb.com.ph