Dr. Francis Kwesi Nkrumah, Emeritus Professor, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, spoke about "Health Challenges Facing Africa in the 21st Century." He was the first speaker at this year's World Health Week, presented by the Committee for International Medical Education Experiences and the Vanderbilt School of Medicine and School of Nursing. (photos by Dana Johnson)
Dr. Seth F. Berkley, president and CEO of the International AIDS Vaccine Initiative, talks with Dean Steven G. Gabbe at Tuesday’s presentation.
Nkrumah outlines health challenges for Africa in 21st century
by Nancy Humphrey
Africa is a continent of highs and lows — an unacceptably high infant and maternal mortality rate and a generally low life expectancy.
Dr. Francis Kwesi Nkrumah, a prominent pediatrician and emeritus professor at the Noguchi Memorial Institute for Medical Research at the University of Ghana, Legon kicked off Vanderbilt University School of Medicine’s World Health Week on Monday, March 24. Nkrumah’s speech was titled “Health Challenges Facing Africa in the 21st Century.”
World Health Week is a weeklong series of speakers and events, sponsored by the Committee on International Medical Education and the Vanderbilt Schools of Medicine and Nursing.
Nkrumah served as director of the Noguchi Memorial Institute for Medical Research from 1990 to 1998, and has served as an advisor on several World Health Organization Consultative Groups. He and Vanderbilt’s Dr. Peter F. Wright, professor of Pediatrics, were residents together in Boston and have worked together on several WHO committees, he told the audience of students, faculty and staff.
“The major health challenge facing African countries is learning how to increase the ability of individuals, households and communities to reduce suffering and premature death at a much faster rate,” Nkrumah said.
In a continent of 800 million, the life expectancy continues to fall as the HIV infection keeps spreading.
In nine southern African countries there is an HIV prevalence rate of 10 percent or more. A projected life expectancy rate of 48 by the end of 2001 would have been 58 in the absence of AIDS. By 2010-2015, the life expectancy rate is projected to fall to 47. Without AIDS it would have been 63. There are other health threats that contribute to the decline in life expectancy — drug resistant infections, malaria and tuberculosis, and a rise in cardiovascular diseases, hypertension, diabetes and mental illness.
HIV and AIDS is the leading cause of mortality and morbidity in the African region, especially in Sub-Saharan Africa where there were 3.5 million new cases of HIV infection in 2001. The total number of people living with HIV/AIDS in Africa is now 30 million. In several African countries, the number of residents living with HIV/AIDS is more than 10 percent. There were more than 2.3 million deaths from AIDS in Africa in 2001 and the number is rising, Nkrumah said.
The disease has also taken a social toll.
There are more than 12 million orphans in Africa, children whose parents have died from HIV/AIDS.
“These children were left in need of love, care and support. This disease has unleashed a tragedy of unimaginable proportions,” he said.
The number of cases of malaria also continues to grow. There are more than 300 million infections and 1 million deaths a year from malaria. About 17 percent of those cases are in children under 5 and account for 20 percent to 25 percent of all childhood deaths in Africa, Nkrumah said. The number of cases of tuberculosis has nearly tripled, with nearly 1.6 million new cases of active tuberculosis diagnosed each year, and more than 600,000 deaths annually. Also, more than 3 million children die annually from vaccine-preventable diseases. In several countries, 15 percent of the children die before their fifth birthday.
World Health Week began in 1988 and is intended to provide exposure to international health issues to students, faculty and the general public. It is also designed to demonstrate to students the opportunities of using a medical degree in an international setting.
More funding needed for AIDS vaccine
by Bill Snyder
Developing a safe and effective AIDS vaccine is not only an enormous scientific challenge, it is a political and social one too, the president and CEO of the International AIDS Vaccine Initiative told a Vanderbilt audience on Tuesday.
Despite a “dramatic increase” in spending on AIDS vaccine development since 1994, last year’s expenditures were only about 2 percent of total spending on AIDS worldwide, said Dr. Seth F. Berkley, a specialist in infectious disease, epidemiology and international health.
The U.S. commitment — about $450 million — represents only about a half percent of what the nation spends annually on all health-related research and development. “It is an infinitesimally small piece of the pie, and yet (AIDS) is perhaps the worst disease since the Black Plague of the 14th century,” he said.
Berkley’s talk was part of World Health Week 2003, presented by the Committee for International Medical Educational Experiences and the Vanderbilt Schools of Medicine and Nursing.
Why hasn’t the United States and the world committed more to developing an AIDS vaccine? Scientific barriers are only part of the story, Berkley said.
For one thing, people with AIDS rallied successfully for a greater government emphasis on developing effective treatments for the disease — drugs that could hold the virus at bay in their bodies and extend their lives. As a result, “vaccines became less and less of a priority,” he said.
The U.S. government also has been very cautious about AIDS vaccine development due to safety concerns, and that has discouraged investment by private industry. “We don’t accept risk at all,” Berkley explained. “We want bigger and bigger trials … We want post-marketing surveillance.” And thus it takes 15 years to bring a product to wide-scale efficacy testing.
Meanwhile, more than 70 million people have been infected with the human immunodeficiency virus, which causes AIDS, and 15,000 new infections occur every day, he said. The life expectancy in heavily hit African nations like Botswana has dropped dramatically as a result.
Part of the problem is that AIDS is primarily a sexually transmitted disease that disproportionately affects developing countries. “Take a look at the amount of effort right now (in the United States) on anthrax vaccines,” Berkley said. “If (the AIDS virus), God forbid, mutated into an airborne-spread organism, we would work 24 hours a day, seven days a week (on a vaccine).”
The vaccine initiative, which Berkley co-founded, is a global effort aimed at speeding the development of AIDS vaccines. Government agencies, companies, universities, foundations and other groups from 22 countries are involved in the effort. More information can be found on the organization’s Web site, www.iavi.org.
“The critical goal, without compromising safety at all, is to compress every aspect of vaccine development … down to the absolute minimum, which is probably something like five years,” Berkley said.
“We have to make AIDS vaccines everyone’s priority,” he said. “We have to accelerate the science, and we have to prepare now for success … It isn’t going to happen by itself.”