A small levy on airplane tickets sold in Europe is providing money for desperately needed – but neglected – areas of health care in HIV, TB and malaria. Unitaid, administered by WHO in Geneva, uses funds from the levy and contributions from the Gates Foundation and others, to focus on developing TB drugs for kids. Currently all that is available for kids is the guesswork involved in cutting adult pills down to size. Working with the TB Alliance, a nonprofit that funds drug company research, they are pursuing the development of pediatric pills that are scientifically-based, safe, effective, and don’t taste yucky. Unitaid hopes to seek approval in 18 months and if granted, market the drug in two years. Watch Brenda Waning, PhD., MPh, is coordinator of Market Dynamics at UNITAID.
Dr. Lee B. Reichman has real-world experience with public panic over controllable but scary health issues. He is a world-renown authority on tuberculosis, founding executive director of the New Jersey Medical School Global Tuberculosis Institute and co-author of Timebomb, the story of the 1990s TB outbreak in New York City.
Reichman spoke Tuesday at the National Press Foundation’s Journalist to Journalist training on lung health issues in Barcelona. Afterwards he answered questions about Ebola, quarantines and TB. This is an edited version of his remarks.
Q: Should we quarantine for Ebola?
A: I’m not sure we know what the situation is. More unfortunately the politicians have taken over while the scientists are dismayingly sitting on the sidelines and watching. Very recently the governors of New York (Democrat Andrew Cuomo) and New Jersey (Republican Chris Christie) said we’re going to quarantine everyone for 21 days who had exposure to an Ebola patient in the three at-risk countries in Africa. They were doing that until a very outspoken nurse, who was hospitalized at my hospital in New Jersey, said this is absurd, there is nothing wrong with me, and all the scientists got on the bandwagon and said there’s no reason to hospitalize this person. Plus it’s going to discourage people who are going to go and do good overseas and do good for these people…
And both governors – Cuomo and Christie -- backed down and I hope they are very embarrassed because it was really a black mark. It shows how politicians try to make hay out of a scientific situation and sometimes get burned, which they deserved.
Q: Can we expect more quarantines?
A: Depends on what the situation is. Tom Frieden, the respected scientist and director of the Centers for Disease Control, took care of tuberculosis (policy) in New York and India. He became the spokesman on Ebola and was giving scientifically correct answers on Ebola, but they weren’tpolitical answers. It’s like the question of whether you can get Ebola on the subway (from someone who somehow bleeds on you and you have an open cut) -- that’s so absurdly unlikely, but people don’t understand the likelihood. I’m usually asked about that likelihood with TB, can you catch TB in the subway? The answer is not NO, but the answer is, “YES, but it is more likely the subway will crash.” We need to educate the (non-scientific) in risk assessment.
Q: Are there lessons from tuberculosis that can be applied to Ebola?
A: We recognized 20-30 years ago that tuberculosis was a problem but that it was an infrastructure problem. So we fixed the infrastructure that had been allowed to deteriorate, plus they had to do new imaginative things. (For example,) they found there was a lot of TB transmission in Riker’s Island jail in New York, so they had to have special cells with non-recirculating air, purified air for people who came in with TB symptoms, and this whole situation cost a billion dollars… a billion dollars to turn around an epidemic where if they had kept the infrastructure going they wouldn’t have had to spend that much money…
The lesson for all of us with TB, with Ebola is that we must have an infrastructure that does surveillance, does preventive activities so that when something happens – Ebola, or SARS, or H1N1 – we can deal with it without getting hysterical and reinventing the wheel … then eventually it will stop being a front-page story and we can go back to football.
Lee Reichman is the founding executive director of the New Jersey Medical School Global Tuberculosis Institute. From 1971-1974 he served as director of the NYC’s Bureau of Tuberculosis Control and Assistant health Commissioner. He is also the co-author of the popular book, Timebomb, the Global Epidemic of Multidrug Resistant Tuberculosis (2001).
Bob Meyers is president emeritus of the National Press Foundation.
The $3 billion electronic cigarette industry is morphing so quickly it is difficult for scientists and regulators to keep up, according to tobacco expert Myra Wisotzky.
E-cigarettes were invented in China in the last decade and since then 466 brands of e-cigs in 7,764 unique flavors have been produced, she said. E-cig use among young adults and teens doubled from 2008 to 2012.
Wisotzky told National Press Foundation fellows at the J2J Lung Health conference that e-cigs have evolved tremendously in the last four years.
“Initially they looked like cigarettes, only disposable. Now there are rechargeables, you can plug them into USB ports to charge them up, there are pen-sized, and tanks with a bigger battery with a bigger rush of nicotine and great big plumes of smoke,” she said. Wisotzky is a technical adviser on tobacco to the International Union Against Tuberculosis and Lung Disease.
She said the evolving e-cig technology is heavily targeted at youth. “This is for the younger generation that loves tech stuff.” As are those flavors: Gingerbread man, fruity pebbles, root beer, vanilla cupcake – many of which advertise “zero calories” to appeal to weight watchers. Some are sold in a 5-pack of primary-colored e-cigs that looks remarkably like a famous brand of crayons.
Science and safety research lag far behind the e-cig industry.
Are they safer than smoking tobacco? “They are definitely safer than smoked cigarettes but how safe we don’t know,” she said.
Can e-cigarettes become a gateway to smoking by hooking young people on nicotine? Or, are e-cigs helpful as a way to quit smoking? “The jury is still out on that, it’s not clear.”
What are governments doing? The U.S. government is moving slowly, on a regulatory track. Some governments, like Singapore, have banned e-cigs.
Are e-cigs less harmful than regular cigarettes? “Yes, they deliver less toxins than most cigarettes. But we don’t know the long-term effects.” And she said particles from the vapor could lodge deeper in a user’s lungs than regular cigarettes.
Wisotzky also said e-cigs are a distraction from other forms of tobacco. “It’s a foot in the door for the tobacco industry to be legitimized and we will keep an eye on it, but the main killer is tobacco smoking.”
Joe Camel and the Marlboro Man are now expats. While smoking is declining in the United States, it is on the rise across the globe – along with deaths related to tobacco.
A snapshot of the tobacco toll:
· 5.4 million deaths are attributed to tobacco each year. That’s 13,400 people per day.
· There are more tobacco deaths than AIDS (2.1 million), tuberculosis (1.6 million) and malaria (900,000) combined.
· Every day 80,000 to 100,000 young people begin to smoke.
· 50 percent of men in developing countries smoke vs 35 percent of men in first-world nations; women consistently smoke less.
· 494,000 acres of forest are cut to cure tobacco each year.
Presented by Drs. Rana J. Singh and Tara Singh, both advisers to the International Union Against Tuberculosis and Lung Disease
As tuberculosis rages, the intense focus on Ebola presents a quandary for health-care experts who have been trying for years to put a dent in TB’s toll. It is a teaching moment even amid the fear and hysteria, they told the National Press Foundation.
Here is what three TB experts said Monday in interviews with NPF:
Dr. E. Jane Carter, current president of the International Union Against Tuberculosis and Lung Disease and an associate professor at Brown University:
Ebola is an opportunity to explore the link between epidemics and poor health systems, she said. "I think we have a real opportunity in looking at why Ebola came out of West Africa. The issue was the weakness of health care and the health-care systems for those countries. This has direct implications on all health care but particularly I think also TB,” Carter said.
“What we really need to do to improve global health is to improve access to care and to strengthen health-care systems globally. I hope that we are going to be able to walk away from the Ebola epidemic in West Africa with that clear message. A strong health-care system preexisting would have taken care of this issue and it would not be a global issue now."
The U.S. government’s response has been focused on “fear and hysteria,” she said. Her recommendation? “They should take a breath. What is the science? What do we need to fight this?”
Dr. Lucica Ditiu, executive secretary of the STOP TB Partnership. Ditiu tried to put Ebola into context of the against the centuries-long battle with TB.
“You know, the reality is that we are scared now of Ebola (which is spread through cointact), but you know MDR-TB is spread through air so … as long as we breathe, we are all at risk of inhaling that and getting infecting with MDR-TB,” she said.
Ditiu noted the Ebola death toll of 5,000 people since last spring. “But I will dare to say that the world will pay this price sooner or later on MDR-TB as well. Because … just in South Africa alone there are 5,000 cases of tuberculosis dying a month just in one country.
“I really hope that this cold shower that Ebola is giving to all of us about the health systems being unable to cope with this will [help us] learn on how to deal with big issues like MDR-TB that will become even bigger … than Ebola one day.”
Dr. Mario Raviglione, director of global TB for the World Health Organization called the Ebola epidemic “a human tragedy.”
“What we understand is that people in Sierra Leone, Liberia or Guinea (who) have been working as district coordinators for tuberculosis have … essentially shifted their priority towards containing Ebola,” he said. He noted that technicians are afraid to analyze Ebola samples for fear of getting the illness and that people are staying away from hospitals for the same reason.
“So every program, every activity is being in a way touched by the Ebola crisis over there and the sooner this is solved and faced the better it will be for every other health program in that part of the world,” Raviglione said.