Dr Margaret Chan

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Zika Virus – What is the Zika Virus and should we be alarmed?

Check out this excellent introduction to the Zika Virus from Dr Margaret Chan, Director- General of WHO. Why we all need to be very concerned!

Dr Margaret Chan, Director- General of WHO

Dr Margaret Chan, Director- General of WHO

“The Zika virus was first isolated in 1947 from a monkey in the Zika forest of Uganda. Its historical home has been in a narrow equatorial belt stretching across Africa and into equatorial Asia.

For decades, the disease, transmitted by the Aedes genus of mosquito, slumbered, affecting mainly monkeys. In humans, Zika occasionally caused a mild disease of low concern.

In 2007, Zika expanded its geographical range to cause the first documented outbreak in the Pacific islands, in the Federated States of Micronesia. From 2013-2014, 4 additional Pacific island nations documented large Zika outbreaks.

In French Polynesia, the Zika outbreak was associated with neurological complications at a time when the virus was co-circulating with dengue. That was a unique feature, but difficult to interpret.

The situation today is dramatically different. Last year, the virus was detected in the Americas, where it is now spreading explosively. As of today, cases have been reported in 23 countries and territories in the region.

The level of alarm is extremely high.


Arrival of the virus in some places has been associated with a steep increase in the birth of babies with abnormally small heads and in cases of Guillain-Barre syndrome.

A causal relationship between Zika virus infection and birth malformations and neurological syndromes has not yet been established, but is strongly suspected.

The possible links, only recently suspected, have rapidly changed the risk profile of Zika, from a mild threat to one of alarming proportions. The increased incidence of microcephaly is particularly alarming, as it places a heart-breaking burden on families and communities.

WHO is deeply concerned about this rapidly evolving situation for 4 main reasons:
• the possible association of infection with birth malformations and neurological syndromes
• the potential for further international spread given the wide geographical distribution of the mosquito vector
• the lack of population immunity in newly affected areas
• and the absence of vaccines, specific treatments, and rapid diagnostic tests.

Moreover, conditions associated with this year’s El Nino weather pattern are expected to increase mosquito populations greatly in many areas.
The level of concern is high, as is the level of uncertainty. Questions abound. We need to get some answers quickly.”

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WHO multi-country survey reveals widespread public misunderstanding about antibiotic resistance

‘Antibiotics: Handle with care’

‘Antibiotics: Handle with care’

As the World Health Organization (WHO) ramps up its fight against antibiotic resistance, a new multi-country survey shows people are confused about this major threat to public health and do not understand how to prevent it from growing.

Antibiotic resistance happens when bacteria change and become resistant to the antibiotics used to treat the infections they cause. Over-use and misuse of antibiotics increase the development of resistant bacteria, and this survey points out some of the practices, gaps in understanding and misconceptions which contribute to this phenomenon. Find out more about the cause of antibiotic resistance at our new series on antibiotic resistance here.


Almost two thirds (64%) of some 10 000 people who were surveyed across 12 countries say they know antibiotic resistance is an issue that could affect them and their families, but how it affects them and what they can do to address it are not well understood. For example, 64% of respondents believe antibiotics can be used to treat colds and flu, despite the fact that antibiotics have no impact on viruses. Close to one third (32%) of people surveyed believe they should stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment.

“The rise of antibiotic resistance is a global health crisis, and governments now recognize it as one of the greatest challenges for public health today. It is reaching dangerously high levels in all parts of the world,” says Dr Margaret Chan, WHO Director-General, in launching the survey findings today. “Antibiotic resistance is compromising our ability to treat infectious diseases and undermining many advances in medicine.”

The survey findings coincide with the launch of a new WHO campaign ‘Antibiotics: Handle with care’—a global initiative to improve understanding of the problem and change the way antibiotics are used.

“The findings of this survey point to the urgent need to improve understanding around antibiotic resistance,” says Dr Keiji Fukuda, Special Representative of the Director-General for Antimicrobial Resistance. “This campaign is just one of the ways we are working with governments, health authorities and other partners to reduce antibiotic resistance. One of the biggest health challenges of the 21st century will require global behaviour change by individuals and societies.”

The multi-country survey included 14 questions on the use of antibiotics, knowledge of antibiotics and of antibiotic resistance, and used a mix of online and face-to-face interviews. It was conducted in 12 countries: Barbados, China, Egypt, India, Indonesia, Mexico, Nigeria, the Russian Federation, Serbia, South Africa, Sudan and Viet Nam. While not claiming to be exhaustive, this and other surveys will help WHO and partners to determine the key gaps in public understanding of this problem and misconceptions about how to use antibiotics to be addressed through the campaign.

Some common misconceptions revealed by the survey include:

Three quarters (76%) of respondents think that antibiotic resistance happens when the body becomes resistant to antibiotics. In fact bacteria—not humans or animals—become resistant to antibiotics and their spread causes hard-to-treat infections.

Two thirds (66%) of respondents believe that individuals are not at risk of a drug-resistant infection if they personally take their antibiotics as prescribed. Nearly half (44%) of people surveyed think antibiotic resistance is only a problem for people who take antibiotics regularly. In fact, anyone, of any age, in any country can get an antibiotic-resistant infection.

More than half (57%) of respondents feel there is not much they can do to stop antibiotic resistance, while nearly two thirds (64%) believe medical experts will solve the problem before it becomes too serious.

Another key finding of the survey was that almost three quarters (73%) of respondents say farmers should give fewer antibiotics to food-producing animals.

To address this growing problem, a global action plan to tackle antimicrobial resistance was endorsed at the World Health Assembly in May 2015. One of the plan’s five objectives is to improve awareness and understanding of antibiotic resistance through effective communication, education and training.

KEY FINDINGS OF THE SURVEY BY COUNTRY

Barbados (507 face-to-face interviews)

Only 35% of respondents say they have taken antibiotics within the past six months—the lowest proportion of any country included in the survey; of those who have taken antibiotics, 91% say they were prescribed or provided by a doctor or nurse.
Fewer than half of respondents (43%) have heard of the term ‘antibiotic resistance’; and fewer than half (46%)—less than any other country in the survey—believe that many infections are becoming increasingly resistant to treatment by antibiotics.
Only 27% of respondents agree with the statements ‘Antibiotic resistance is one of the biggest problems the world faces’ and that ‘Experts will solve the problem’—the lowest proportion of all participating countries for both questions.

China (1,002 online interviews)

57% of respondents report taking antibiotics within the past six months; 74% say they were prescribed or provided by a doctor or nurse; 5% say they purchased them on the internet.
More than half (53%) of respondents wrongly believe that they should stop taking antibiotics when they feel better, rather than taking the full course as directed.
61% of respondents think, incorrectly, that colds and flu can be treated by antibiotics.
Two thirds (67%) of respondents are familiar with the term ‘antibiotic resistance’ and three quarters (75%) say it is ‘one of the biggest problems in the world’.
83% of respondents say that farmers should give fewer antibiotics to animals—the highest proportion of any country in the survey.

Egypt (511 face-to-face interviews)

More than three quarters (76%) of respondents say they have taken antibiotics within the past six months, and 72% say they were prescribed or provided by a doctor or nurse.
55% of respondents incorrectly think that they should stop taking antibiotics when they feel better, rather than taking the full course; and more than three quarters (76%) wrongly believe that antibiotics can be used to treat colds and flu.
Less than one quarter (22%) of respondents have heard of the term ‘antibiotic resistance’—the lowest proportion of any country included in the survey.

India (1,023 online interviews)

More than three quarters (76%) of respondents report having taken antibiotics within the past six months; 90% say they were prescribed or provided by a doctor or nurse.
Three quarters (75%) of respondents think, incorrectly, that colds and flu can be treated with antibiotics; and only 58% know that they should stop taking antibiotics only when they finish the course as directed.
While 75% agree that antibiotic resistance is one of the biggest problems in the world, 72% of respondents believe experts will solve the problem before it becomes too serious.

Indonesia (1,027 online interviews)

Two thirds (66%) of respondents report having taken antibiotics in the past six months; 83% of respondents say they were prescribed or provided by a doctor or nurse.
More than three quarters (76%) of respondents know that they should only stop taking antibiotics when they have taken all of them as directed, but 63% incorrectly think they can be used to treat colds and flu.
84% of respondents are familiar with the term ‘antibiotic resistance’ and two thirds (67%) believe that many infections are becoming increasingly resistant to treatment by antibiotics.

Mexico (1,001 online interviews)

Three quarters (75%) of respondents report having taken antibiotics within the past six months; 92% say they were prescribed by a doctor or nurse; and 97% say they got them from a pharmacy or medical store.
The majority of respondents (83%) accurately identify that bladder/urinary tract infections (UTIs) can be treated with antibiotics, but 61% wrongly believe that colds and flu can be treated with antibiotics.
89% of respondents in Mexico say they have heard of the term ‘antibiotic resistance’ and 84% believe many infections are becoming increasingly resistant to treatment by antibiotics—a higher proportion than any other country included in the survey on both questions.

Nigeria (664 face-to-face interviews)

Almost three quarters (73%) of respondents report taking antibiotics within the past six months; 75% of respondents state they were prescribed or provided by a doctor or nurse; 5% say they bought them from a stall or hawker.
More respondents in Nigeria than any other country included in the survey correctly identify that antibiotics do not work for colds and flu (47%), however 44% of respondents think they do.
Only 38% of respondents have heard of the term ‘antibiotic resistance’—the second lowest proportion of all the countries surveyed.

Russian Federation (1,007 online interviews)

A little more than half of respondents (56%) report having taken antibiotics within the past six months; the same proportion (56%) say their most recent course of antibiotics was prescribed or provided by a doctor or nurse—the lowest proportion of any country included in the survey.
Two thirds (67%) of respondents incorrectly think colds and flu can be treated with antibiotics, and more than one quarter (26%) think they should stop taking antibiotics when they feel better rather than taking the full course as directed.
Awareness of the term ‘antibiotic resistance’ was high among respondents at 82%.
71% think antibiotics are widely used in agriculture in their country and 81% say that farmers should give fewer antibiotics to animals.

Serbia (510 face-to-face interviews)

Fewer than half (48%) of respondents say they have taken antibiotics within the past six months; 81% say they were prescribed or provided by a doctor or nurse.
The majority of respondents (83%) accurately identify that bladder infections/UTIs can be treated with antibiotics, but more than two thirds (68%) wrongly believe that colds and flu can be treated with antibiotics.
Only 60% of respondents in Serbia have heard of the term ‘antibiotic resistance’ and only one third (33%) think it is one of the biggest problems the world faces.
81% of respondents say that farmers should give fewer antibiotics to animals.

South Africa (1,002 online interviews)

65% of respondents say they have taken antibiotics within the past six months; a higher proportion of people than any other country included in the survey (93%) say their last course of antibiotics was prescribed or provided by a doctor or nurse, and 95% say they had advice from a medical professional on how to take them.
87% of respondents know they should only stop taking antibiotics when they finish the course of treatment—a higher proportion than any other country included in the survey.
The same proportion (87%) of respondents—and again more than any other country in the survey—recognize that the statement ‘It’s OK to use antibiotics that were given to a friend of family member, as long as they were used to treat the same illness’ is false. It is a practice which can encourage the development of resistance.

Sudan (518 face-to-face interviews)

More than three quarters (76%) of respondents report having taken antibiotics within the past six months; 91% say they were prescribed or provided by a doctor or nurse.
62% of respondents incorrectly think they should stop taking antibiotics when they feel better—more than any other country included in the survey—and 80% think antibiotics can be used to treat colds and flu. Both of these statements are incorrect. These are practices which encourage the development of antibiotic resistance.
94% of respondents agree that people should use antibiotics only when prescribed, and 79% believe that antibiotic resistance is one of the biggest problems the world faces—the highest percentages on both questions of any of the countries where the survey was undertaken.
Viet Nam (1,000 online interviews)

71% of respondents state they have taken antibiotics within the past six months; three quarters (75%) report they were prescribed or provided by a doctor or nurse.
86% of respondents think that the body becomes resistant to antibiotics (whereas in fact it is bacteria)—a higher proportion than any other country included in the survey.
83% think that many infections are becoming increasingly resistant to antibiotics.
70% of respondents think that antibiotics are widely used in agriculture in their country and almost three quarters (74%) agree that ‘antibiotic resistance is one of the biggest problems the world faces’.

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Noncommunicable diseases prematurely take 16 million lives annually


Lupus Awareness Month

Lupus Awareness Month

Urgent government action is needed to meet global targets to reduce the burden of noncommunicable diseases (NCDs), and prevent the annual toll of 16 million people dying prematurely—before the age of 70 – from heart and lung diseases, stroke, cancer and diabetes, according to a new World Health Organization report.

“The global community has the chance to change the course of the NCD epidemic,” says WHO Director-General Dr Margaret Chan, who today launched the Global status report on noncommunicable diseases 2014. “By investing just US$1-3 dollars per person per year, countries can dramatically reduce illness and death from NCDs. In 2015, every country needs to set national targets and implement cost-effective actions. If they do not, millions of lives will continue to be lost too soon.”

The report states that most premature NCD deaths are preventable. Of the 38 million lives lost to NCDs in 2012, 16 million or 42% were premature and avoidable – up from 14.6 million in 2000.


Nearly five years into the global effort to reduce premature deaths from NCDs by 25% by 2025, the report provides a fresh perspective on key lessons learned.

Premature NCD deaths can be significantly reduced through government policies reducing tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity, and delivering universal health care. For example, in Brazil the NCD mortality rate is dropping 1.8% per year due in part to the expansion of primary health care.

But the report calls for more action to be taken to curb the epidemic, particularly in low- and middle-income countries, where deaths due to NCDs are overtaking those from infectious diseases. Almost three quarters of all NCD deaths (28 million), and 82% of the 16 million premature deaths, occur in low- and middle-income countries.

“Best buys” to reduce the burden

The WHO report provides the baseline for monitoring implementation of the Global action plan for NCDs 2013-2020, aimed at reducing the number of premature deaths from NCDs by 25% by 2025. Outlined in the action plan are nine voluntary global targets that address key NCD risk factors including tobacco use, salt intake, physical inactivity, high blood pressure and harmful use of alcohol.

“Our world possesses the knowledge and resources to achieve the nine global NCD targets by 2025,” says Dr Oleg Chestnov, WHO’s Assistant Director-General for Noncommunicable Diseases and Mental Health. “Falling short of the targets would be unacceptable. If we miss this opportunity to set national targets in 2015 and work towards attaining our promises in 2025, we will have failed to address one of the major challenges for development in the 21st century.”

The report provides “best buy” or cost-effective, high-impact interventions recommended by WHO, including banning all forms of tobacco advertising, replacing trans fats with polyunsaturated fats, restricting or banning alcohol advertising, preventing heart attacks and strokes, promoting

breastfeeding, implementing public awareness programmes on diet and physical activity, and preventing cervical cancer through screening. Many countries have already had success in implementing these interventions to meet global targets.

Examples of regional and country “best buy” successes listed in the report:
• Turkey was the first country to implement all the “best-buy” measures for tobacco reduction. In 2012, the country increased the size of health-warning labels to cover 65% of the total surface area of each tobacco product. Tobacco taxes now make up 80% of the total retail price, and there is currently a total ban on tobacco advertising, promotion and sponsorship nationwide. As a result, the country saw a 13.4% relative decline in smoking rates from 2008 to 2012.
• Hungary passed a law to tax food and drink components with a high risk for health, such as sugar, salt and caffeine. A year later, 40% of manufacturers changed their product formula to reduce the taxable ingredients, sales decreased 27% and people consumed 25-35% fewer products.
• Argentina, Brazil, Chile, Canada, Mexico and the USA have promoted salt reduction in packaged foods and bread. Argentina has already achieved a 25% reduction in the salt content of bread.

Working on the ground in more than 150 countries, WHO is helping develop and share “best buy” solutions so that they can be implemented more widely. WHO is also helping countries understand the dimensions that influence NCDs outside the health sector, including public policies in agriculture, education, food production, trade, taxation and urban development.

Meeting global targets

Though some countries are making progress towards the global NCD targets, the majority are off course to meet the 2025 targets. While 167 countries have operational NCD units in the ministry of health, progress on other indicators has been slow, especially in low- and middle-income countries.

As of December 2013[1] only:
• 70 countries had at least one operational national NCD plan in line with the Global NCD action plan
• 56 countries had a plan to reduce physical inactivity
• 60 countries had national plans to reduce unhealthy diets
• 69 countries had a plan to reduce the burden of tobacco use
• 66 countries had a plan to reduce the harmful use of alcohol
• 42 countries had monitoring systems to report on the nine global targets
NCDs impede efforts to alleviate poverty and threaten the achievement of international development goals. When people fall sick and die in the prime of their lives, productivity suffers. And the cost of treating diseases can be devastating – both to the individual and to the country’s health system.

From 2011-2025, cumulative economic losses due to NCDs under a “business as usual” scenario in low- and middle-income countries is estimated at US$ 7 trillion. WHO estimates the cost of reducing the global NCD burden is US$ 11.2 billion a year: an annual investment of US$ 1-3 per capita.

High rates of death and disease, particularly in low- and middle-income countries, are a reflection of inadequate investment in cost-effective NCD interventions. WHO recommends all countries move from commitment to action, by setting national targets and implementing the “best buy” interventions starting in 2015.

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Deaths from Malaria dramatically reduced!


Malaria treatment? Jesuit's Bark

Malaria treatment? Jesuit’s Bark

The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World Malaria Report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.


Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Moving towards elimination

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.

In 2013, two countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another four countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

Fragile gains

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under five years of age and infants.

In addition, resistance to artemisinin has been detected in five countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.

While funding to combat malaria has increased threefold since 2005, it is still only around half of the USD 5.1 billion that is needed if global targets are to be achieved.

“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”

Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.

Gains at risk in Ebola-affected countries

At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the three countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.

Given the intense malaria transmission in these three countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.

Note to editors

Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.

Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.

The World Malaria Report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.

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Drowning claims the lives of 372,000 people each year say WHO.


Young people at greater risk of drowning

Young people at greater risk of drowning

According to the World Health Authority drowning is in the top ten causes of death in children and young people across the globe.

Indeed they say that 372,000 die each year because of drowning. According to the World Health Organization’s first Global report on drowning entitled “preventing a leading killer”. (Note to the WHO – have you heard of capitals? Try ’em you will make more sense).

The core finding include:-

o 50% of drowning deaths are among those aged under 25 years. Under 5s are most at risk.
o Males are twice as likely to drown than females
o More than 90% of drowning occurs in low- and middle-income countries

“Efforts to reduce child mortality have brought remarkable gains in recent decades, but they have also revealed otherwise hidden childhood killers. Drowning is one. This is a needless loss of life. Action must be taken by national and local governments to put in place the simple preventive measures articulated by WHO.” according to WHO Director-General Dr Margaret Chan.

Of course as with anything produced by tax-payer funded bodies “Something must be done”!


In fact in this case the ideas are reasonably sensible and include:-

a) installing barriers to control access to water
b) providing safe places such as day care centres for children
c) and the obvious but overlooked teaching children basic swimming skills and training bystanders in safe rescue and resuscitation. Indeed some studies suggest only 50% of children can swim.

So do you teach your children swimming? Is there anything else you would add to this list? Please feel free to share in the comments section below.

Thanks in advance!