Satisfied Anopheles mosquito after a blood feed. CDC

The path to a viable malaria vaccine is a step closer with the publication of interim results of a vaccine trial conducted in 11 sites in sub-Saharan Africa. The vaccine trial, known as RTS,S, recruited over 15,000 infants, and comprised a broad collaboration between academics, industry and government partners under the guidance of the PATH Malaria Vaccine Initiative. The trial found the majority of its funding from the Bill and Melinda Gates Foundation; Bill Gates, co-chair of the Foundation, commented that “A vaccine is the simplest, most cost-effective way to save lives. These results demonstrate the power of working with partners to create a malaria vaccine that has the potential to protect millions of children from this devastating disease”.

These results refer to reductions in malaria risk for 6,000 children aged 5 to 17 months in the 12 months after vaccination. After 3 vaccinations, the trial showed 56% reductions in risk of clinical malaria and 47% reductions for severe disease. Malaria risk reductions were additional to the protection from use of bed nets, and while impressive, it is clear that even by halving the risk of malaria, this vaccine alone will not control the disease. Other interventions will continue to be necessary if, and when, this malaria vaccine is licensed for use. Andrew Witty, CEO of GlaxoSmithKline (GSK), who produced the vaccine, added that “the addition of a malaria vaccine to existing control interventions such as bed nets and insecticide spraying could potentially help prevent millions of cases of this debilitating disease”.

Malaria is a disease which has continued to challenge the health of vulnerable children mostly in sub-Saharan Africa and news that RTS,S steps closer to becoming a licensed vaccine is welcome. The cost of this potentially viable malaria vaccine has been considered as an integral part of vaccine development. GSK emphasizes its commitment to ensure that a licensed RTS,S malaria vaccine will reach poor and vulnerable individuals, with assurance from Witty that “GSK remains committed to further research into malaria and most importantly, to ensuring that this vaccine will reach those who need it”.

Over recent years, there has been increased emphasis on addressing malaria as an important public health challenge. Tsiri Agbenyega, a principal investigator of the trial and Chair of the Clinical Trials Partnership Committee, said that “Renewed interest in malaria by the international community, and scientific evidence such as that we are reporting today, should bring new hope that malaria can be controlled.”

The infection, caused by a parasite transmitted from the bite of an infected mosquito, continues to kill an estimated 781,000 people, and cause 255 million illnesses, each year. However, year on year, reductions in the burden of disease have been reported. With continued successful control and new tools to prevent malaria, the RTS,S vaccine results bolster hopes that the disease could, within decades, be eradicated.

Congo River passing Kinshasa

River flows which are nutrient rich and powerful can lead to cholera outbreaks according to a new study published in the American Journal of Tropical Medicine and Hygiene. The researchers found that increased river discharges, often occurring simultaneously with increased temperatures in coastal water, led first to transient increases in phytoplankton blooms which were in turn associated with cholera outbreaks.

“Finding an association between sea surface temperatures and cholera outbreaks should not lead us to conclude that with global warming cholera will definitely go up” commented lead author Shafiqul Islam of Tufts University. “If river flows are more turbulent, if droughts are more severe, if flood is more severe, cholera is more severe”. The positive relationship between phytoplankton blooms and river discharges could make predicting the effects of global warming on the spread of cholera even more complex according to the research team. The study underscores a “complex ecology associated with cholera” said Peter J. Hotez President of ASTMH. “But cholera may not have direct linkage with rising sea surface temperatures”.

The impact of these new findings on tackling the ongoing cholera outbreaks in Haiti and the Democratic Republic – which have caused illness in more than 400,000 people combined – will be limited. Describing the relevance of this study to the situation in Haiti and DRC, Hotez commented “cholera seems to be gaining a foothold in more places than it used to be. We used to see shorter outbreaks, but in Africa, and now in Haiti, we’re seeing nationwide epidemics lasting months or more than a year. We obviously need to be taking a different approach”.

Advocates like Partners in Health have continued to call for a different approach to cholera in Haiti particularly since the 2010 earthquake. In Haiti cholera is thought to have killed nearly 5,000 people since the epidemic began in October 2010. A global reflection on the environmental epidemiology of cholera may inform future early warning disease systems, but it remains clear that the extended cholera outbreaks in Haiti and DRC reflect the fragility of these nations, rather than turbulent river flows and phytoplankton blooms.

Haiti has faced renewed cholera outbreaks since the 2011 rainy season in spring – and disease transmission has been most closely associated with poor sanitation. Of Partners in Health’s work in Haiti, Paul Farmer, UN Deputy Special Envoy to Haiti, reflected “we’re working as hard as we can, we’re saving a lot of lives, but we can’t replace public water systems”. The lack of functional sanitation infrastructure, and the lack of policy and engagement with this issue, lies at the core of a cholera problem. Well-established methods of disease prevention and treatment for cholera have existed for decades, even centuries in the case of the former.

Pumphandle bringing cholera deaths to 19th century London

Rather than river flows, robust evidence suggests the Haiti cholera outbreak emerged from South Asia brought to the country by UN peacekeepers after the devastating quake. Cholera outbreaks along the River Congo in DRC have intensified in recent weeks and a 7% case fatality rate has been reported, according to WHO. Fears remain that the disease could spread to Kinshasa. While the river flows may play a role in spreading the bacteria along the River Congo, the fear that these river flows meet large populations with inadequate safe water is the source of greatest concern. Elevated coastal water temperatures may have contributed to the spread of these cholera epidemics, but it is the woeful sanitation systems which have held a tight grip to cholera’s hand in Haiti and DRC.

“Virtually nobody who drinks clean water gets cholera” added Farmer. In fragile states like Haiti and DRC, a treatable cholera infection is encouraged to blossom into a public health crisis, reflecting the most extreme chronic and systemic failures of nations to place value on the health of their people. Treating the acute symptoms of cholera alone cannot resolve the chronic and intractable problems of poverty, policy and political will.

Tsetse fly

The  recent launch of new initiatives on helminth diseases and HIV/AIDS drugs for infants by the Drugs for Neglected Diseases initiatives led me to wonder about the broad burden of neglected diseases. One such is the benign sounding sleeping sickness disease which, carried by the tsetse fly, still today causes devastating human deaths. Another is the disease known as elephantiasis that causes people to suffer from debilitating swollen limbs and genitals as a result of thread like worm infections.

Swollen limb from Elephantiasis

World Health Organisation (WHO) defines human African trypanosomiasis (sleeping sickness) and lymphatic filiarisis (elephantiasis) as just two among 17 neglected tropical diseases that viciously affect at least one million people each year, leaving debilitating illnesses and deaths in their wake for sufferers and families. Referring to the 17 neglected tropical diseases, WHO comments that these diseases “thrive in impoverished settings, where housing is often substandard, environments are contaminated with filth, and disease-spreading insects and animals abound”.

Neglected tropical diseases are endemic infections in 149 countries and territories, varying in their source of infection from viral, to bacterial and protozoal origins. The burden of these diseases adds to the already heavy burden of respiratory tract, diarrhoeal, HIV, tuberculosis and malaria infections that make up the top 5 global infectious disease killers, additionally considered as neglected diseases.

Knowledge about how prevent and treat many neglected diseases is not lacking; instead, the intimate relationship that they share with poverty shapes their opportunities to infect, maim and kill. These diseases have not been specifically neglected by robust health systems, but rather poverty and failure to implement proven solutions has driven their neglect for centuries. So neglected tropical diseases define a neglect which accompanies many other aspects of daily life for poor people in modern day tropical countries.

“Cities are growing and growing but without infrastructure of sanitation… Do we need more research on that?” Peter Piot, Director of the London School of Hygiene and Tropical Medicine asks rhetorically. “I doubt it. We need more on the how to do it” he considers. Emphasising the lack of well implemented solutions, Kevin De Cock, Director of the Centre for Global Health at the US Centres for Disease Control, adds “underlying social and developmental factors like inadequate access to water and sanitation, or to adequate living conditions – often dismissed as “old problems” – have been frustratingly difficult to address”.

As of October 2010, with the publication of their first report ‘Working to overcome the global impact of neglected tropical diseases’, WHO has considered controlling these diseases to be a feasible goal. For Piot “the ‘so-called’ neglected tropical diseases are nearly fully funded, except for basic research”. At the World Health Assembly meeting in May 2011, the feasibility of controlling and eliminating neglected tropical diseases was re-affirmed with resolutions on the progress towards eradicating guinea-worm disease (dracunculiasis). Reflecting on advances made, De Cock comments “a number of neglected tropical diseases, including onchocerciasis and lymphatic filariasis, are currently being controlled or are close to being eliminated because of mass drug administration”.

While the global dilemma grows between high-income countries’ provision of financial support for lower-income countries with rapidly growing economies like Brazil, Russia, India and Brazil, the poor in these developing country superstars remain marginalized and disproportionately affected by neglected diseases of poverty. “Health in general requires more funding, and global health needs global financing” affirms De Cock. “This is especially true for some important areas that have been neglected, such as sanitation”. Prioritizing the control of neglected tropical diseases in endemic countries will inevitably mean effectively implementing known health interventions like sanitation. Piot considers that “because of AIDS there has been a real interest in funding for global health” and adds that “collateral benefits” could ensue for neglected diseases. Ensuring that this collateral benefit opportunity is grasped for neglected tropical diseases requires collaboration and “HIV, polio, and malaria programs offer an entry point for other interventions at the community level” advises De Cock.

Global health advocacy to combat neglected diseases has been highlighted by the Millennium Development Goals, and a spotlight shines brightly on the top 5 killer infectious diseases; it would seems that with globalization, a global political imperative to tackle neglected diseases effectively is growing. After increasing the pledge made by the Bill and Melinda Gates Foundation towards delivering vaccines with the Global Alliance for Vaccines and Immunization (GAVI), Bill Gates reflects that tackling neglected diseases through vaccination programs is cost effective and “helps countries to get to a point where they will be self sufficient”.

“It’s a question of values” considers Gates. As such, provision of sustainable and substantial health benefits for citizens globally, and progress towards prevention of neglected tropical diseases could herald social and economic progress. Governments from the 149 countries and territories whose citizens suffer disproportionately from these diseases, are now being challenged to meet the new aspirational values of equity and partnership that high-income global health donor players are increasing throwing their way. By working with high-income partners and ensuring public health as a policy and implementation priority for their citizens, there is opportunity for endemic country governments to act as powerful advocates for neglected tropical disease prevention and control.

Potential future collaborative approaches to global health which integrate health systems could benefit neglected tropical diseases, making these diseases an integral part of the health systems strengthening packages endorsed by global donors and endemic country authorities. But in order to gain health benefits, sincere reflection on why existing methods have not been implemented to combat diseases must inform collaborative approaches to health system strengthening. Without reflection and collaboration at all levels, diseases could remain neglected, while both established and new interventions continue along the same neglectful route as the diseases which they seek to eliminate.

An additional global pandemic imperative for control, elimination and deeper understanding of neglected tropical diseases underlines the self-interest benefits for high-income countries. De Cock observes “we never know which ones could become global threats… we have to be ready to diagnose, investigate, and respond to them wherever they occur”.

The report examined global funding for 31 neglected diseases including HIV/AIDS, tuberculosis, malaria, pneumonia, diarrhoeal diseases and dengue, and 134 product areas including drugs, vaccines, diagnostics, microbicides and vector control products. Funding for HIV, TB and malaria was maintained or increased, but their piece of the funding pie dropped from 77% in 2007 to 72% in 2009. Diarrhoeal diseases, dengue and kinetoplastid infections increased their share to above 5%, but diseases like leprosy, trachoma and rheumatic fever maintained small shares of global research and development investment.

“More funding is vital and encouraging to see” commented report author Mary Moran, Director of Policy Cures, “but it’s just as important that the funds are spent wisely and well.” Calling into question the big funding dollars for HIV/AIDS, tuberculosis and malaria, Moran described there were “random drivers to the spread of funding [that were] almost never driven by analysis of what’s needed.” Widely available and comprehensive cost benefit analyses for neglected disease reductions have been limited, and there are currently no systems to help funders decide which investments are likely to generate the highest health returns. But Joe Cerrell, Director of The Bill & Melinda Gates Foundation’s European Office, argued that for defining global health priorities, there was “more than randomness; a lot of analysis and more method to the madness.” The predominance of HIV/AIDS, tuberculosis and malaria as leading global health priorities over the last 2 decades has come about, considered Moran, as a result of “a lot of not very carefully thought out strategies.”

US organisations provided close to 70% of all global funding for neglected disease research and development in 2009; the G-FINDER report draws attention to the National Institutes of Health and the Bill & Melinda Gates Foundation as funding leaders. The UK was the second largest donor country, providing 7% the majority of its global funding from the Department for International Development, the Wellcome Trust and the Medical Research Council. The current report was able to provide no information on funding from China, which has a long history of dealing with neglected diseases and is fast becoming the world’s second largest economy.

“The pie has gotten bigger” added Moran, but there has been a “move away from making products and back to basic research.” For David Reddy, CEO of Medicines for Malaria Venture, the report’s findings highlighted funding reductions of 9% to non-profits like MMV, and cause concern. “We help to ensure the money is focused on the area which will deliver the most benefits” argued Reddy, “now is not the time to stop funding.”

With increasing pressure on global financial resources, and a move towards more conservative funding strategies, non-profits which co-ordinate neglected disease product development, and neglected diseases alike, must plan to prove their value for money more strategically than ever.

In the absence of the better living conditions, higher nutritional standards, rising incomes and increased access to adequate healthcare that benefited older people in developed countries, South Asian adults can expect to live for 64 years and continue to remain in poverty. Suffering their first heart attacks 6 years earlier than adults in other parts of the world, heart disease has become the leading cause of death for adults in the region (which includes Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka). The report’s co-author Michael Engelgau, considers these disease burdens “especially hard on poor people… [who] find themselves caught in a poverty trap where they can’t get better and they can’t work”. Reductions in poverty have not kept pace with increasing life expectancy in South Asia; with increasing age increasing rates of non-communicable diseases have also arrived.

Risks factors such as low birth weight in infancy, tobacco use, obesity, high blood pressure and high cholesterol all remain significant challenges for South Asian countries, as do many of these same factors in developed countries. The report aims to provide some framework for policies to tackle the challenges; to plan, prevent and control the impact of non-communicable diseases by measures to strengthen health systems and effectively implement tobacco advertising bans. It serves to emphasise the situation of “rising inequality” according to Michel Rutkowski, World Bank’s South Asia Director for Human Development, in which “a growing share of the population [ages] unhealthily; and with health systems that are failing to adjust to people’s needs”.

Number 5. Swine Flu; Where Are You Now?

H1N1 aka Swine flu managed to establish itself globally as a common cause of influenza for this year’s flu season, now constituting around 20% of flu causing influenza A viruses. As a result, the risks of severe flu symptoms have become higher this season for people with underlying health problems and pregnant women. True, the H1N1 pandemic didn’t cause nearly as many fatalities as feared by worst predictions, but the impact of the H1N1 virus which infected so many, and so quickly, is balanced by the usually mild resulting flu. All the swine flu hullabaloo of 2009 and 2010 now seems overblown, but swine flu did highlight that there is much to learn in readiness for future pandemics.

Number 4. A Good News Year for Malaria & HIV/AIDS

Welcome reductions in the numbers of deaths resulting from malaria and HIV/AIDS were announced in 2010. In addition, new preventative tools were proven against HIV/AIDS, including repeated application of a protective vaginal gel and preventative drug treatments and the largest malaria vaccine trial is currently underway. These elements, and more besides, offered hopeful glimmers that controlling, and reducing the impact, of these pandemics is possible. While the good malaria news is tinged with fears that resistance to effective anti-malarial artemisinin drugs could spread, with the year on year reductions in malaria related deaths, eliminating the disease has become a feasible possibility for many experts. But when it comes to cash, controlling malaria looks likely to be more cost effective than eliminating it.

Number 3. On Track with MDGs?

With 5 years remaining before the 2015 Millennium Development Goals (MDGs), most targets are admittedly far off track. 2010 marked a year of review for MDGs. World leaders, academics, advocates and celebrities gathered at the Millennium Summit in September to affirm their commitment to the MDGs and consider the progress. Reductions towards MDGs have been made in the fatality rates for some diseases, but substantial reductions in childhood and maternal mortality rates leave MDG goals as distant hopes. Throughout the year, there was reflection on whether to continue with the current MDG roadmap or to take a new route after 2015, when most MDGs will fail to be met.

Number 2. A New Vaccine to Prevent Meningitis in Africa

A new meningococcal vaccine ‘MenAfriVac’, designed specifically to meet the needs of African countries, was introduced in December in Burkina Faso. Meningitis caused around 90,000 cases and 7,000 deaths in Africa’s ‘meningitis belt’ in 2009. The MenAfriVac project aims to vaccinate 300 million people in Burkina Faso, Mali and Niger by 2015, but completion will require an additional $475 million in funding. With the new vaccination tool and the extensive collaborations already developed, eliminating this devastating disease from Africa has become tangible.

Number 1. Disease After Disaster

2010 was a year for natural disasters and a stark warning about the diseases that may follow in their wake.

The start of the year was marked with earth shattering devastation in Haiti, a country already chronically impoverished and lacking in effective infrastructure. The warnings of water borne diseases and other diseases were given heed, but the post –quake challenges proved too much for so many helping hands. After killing nearly 300,000 people within days, the 2010 Haitian earthquake continued to inspire unsanitary and unsafe living conditions for the millions of displaced Haitians. Cholera cases and deaths were confirmed in October and the bacterial source of Haiti’s cholera epidemic is suspected to have been imported; the disease has so far resulted in 3,333 deaths.

In July and August, around one fifth of Pakistan was under water; over 1,700 deaths occurred and millions were displaced by the floods. In post-flood Pakistan, efforts to control rates of illness and death from water borne, and other diseases are ongoing. Ongoing surveillance and treatment for disease has so far proven successful in reducing the risk of severe disease and death. Sporadic outbreaks of cholera have been confirmed, but to date widespread outbreaks of cholera, watery diarrhoea, measles and malaria have all been averted.

Cholera outbreaks also occurred in Central Africa, over 40,000 cases and 1,879 deaths have been confirmed in Cameroon, Chad, Niger and Nigeria.

In the new decade, the challenges of public health and infectious disease will bring varied narratives; especially so when natural disasters, lack of coordination and ineffective governance provide a wholesome culture for the re-emergence of fatal epidemics. The twenty teens will also bring new challenges for more affluent countries, particularly as obesity ‘epidemic’ leads the way to cancer and chronic illness.

Here’s To A Healthy New Year!

In case you missed them, some 2010′s successful HIV highlights include news of new prophylactic, preventative interventions which have not only shown great promise, but because they are based on already widely used drugs, could also be close to making their real world debut beyond clinical trials. A vaginal gel trial showed that pre-exposure prophylaxis to an existing HIV drug can reduce the risk of infection by around 40%. Another study showed that daily dosing of a different anti-retroviral drug taken prior to HIV exposure can also reduce the risk of HIV infection by over 40%. People who are HIV positive can now expect to live longer with regular highly active antiretroviral therapies (HAART). Studies have shown that instead of expecting death 10 years after being diagnosed HIV positive, adults with HIV can expect to live for over 22 years after an HIV infection diagnosis and children also live longer. There is also, always, promise of new generations of effective anti-viral treatments. The Pope has suggested that the Catholic Church might not have a problem with condoms being used solely to prevent HIV. And with bans lifted, HIV positive people are now able to travel into the USA and China. To top all of this, international data published by UNAIDS have shown year on year significant declines in key numbers: fewer people are acquiring new HIV infections, fewer people are dying from AIDS and more people are gaining access to treatment.

So perhaps the time has arrived to realistically think of a world without AIDS? For the developed world, this is feasible. For developed countries, HIV is fortunately and fast becoming an infection to be treated, rather than a feared, deathly disease. Though some legal travel restrictions have been removed against HIV positive people by global powers, stigma, as well as legalised national and international discrimination remains an ever present hurdle for many who are HIV positive. The new optimistic mood should remain cautious; without caution, optimism could mean a less urgent approach to the ongoing pandemic and the stigma which surrounds it.

Global data on infection and numbers of deaths are indeed moving in the right direction. The peak global devastation of HIV/AIDS happened in the late 1990s; AIDS was announced, in 1995, as the America’s number one killer of people aged 25 to 44. Today 33.3 million people remain infected with HIV, 2.6 million still acquire the infection each year and 1.8 million people still die annually of AIDS  We can combat the changing genetic nature of the virus efficiently with changing, but targeted, combination treatments. But left untreated, HIV remains a virus that will still kill 99% of infected people within 10 years; 10 million people who need treatment are left untreated.

There is room for optimism that HIV/AIDS can be beaten as new interventions are developed, and as older, well known interventions are better implemented; there is reason, and need, to celebrate our successes. But in battling this global pandemic which gripped a whole generation with speed and ease, implementing what works is proving to be perhaps the most difficult challenge against HIV/AIDS.

December 1st  is World AIDS Day.

Photo by NASA Goddard Photo and Video

The UN-World Bank report ‘Natural Hazards, UnNatural Disasters: The Economics of Effective Prevention’ launched today in Washington DC; the 2 year effort by 70 experts emphasizes that “prevention pays but you do not always have to pay more for prevention”. Commenting on the report, Michel Jarraud, World Meteorological Organization Secretary-General says “warning people of impending hazards saves lives and livelihoods” and that the report shows “more can be done to take full advantage of technological advances in predicting weather”.

Yearly global losses as a result of natural disasters could reach $185 billion by 2100; the effects of climate change are estimated to add at least $28 billion to these annual losses. The report describes simple, common sense measures to be taken in order to prevent death and destruction as a result of earthquakes, hurricanes and flooding. The measures outlined for disaster-prone countries include making information about risks and hazards readily available, improving land rights, encouraging investment in safer structures, prioritizing maintenance of transport infrastructure and significantly improving early disaster warning systems.

However, the report also emphasizes that the poorest, most vulnerable countries and individuals have, and will continue to face, the heaviest burdens from natural disasters. An estimated 3.3 million deaths have occurred as a result of natural disasters between 1970 and 2010, almost 1 million of these deaths occurred as a result of drought in Africa. For World Bank Group President Robert B Zoellick “This report presents necessary evidence and a compelling case for our client countries to reduce their vulnerability to natural hazards so that they can develop in a sustainable and cost effective way”.

Individuals in wealthier countries will likely be shielded from the worst effects of natural disasters, largely due to the fact that many measures and systems suggested for disaster-prone developing countries are already in place. However, the report also considers that while poor and middle income countries will suffer most, the worst devastations as a result of natural disaster are not predestined.

‘Natural Disasters, UnNatural Hazards’ calls for new innovative infrastructures which are low-cost and multipurpose; crucially these new infrastructures should be designed so as not to introduce new risks. As examples of infrastructures, the report sites schools in Bangladesh that become cyclone shelters and roadways in Malaysia which act as drains. These and other practical lessons from this report are welcomed by Nobel Laureate Amartya Sen, who praises this “excellent piece of work with really practical lessons that will influence the way disasters are handled – and indeed prevented”.

The report’s team leader Apurva Sanghi suggests that while growth in cities will expose more individuals to risk of disaster, this growth could also mean growth in income, greater adaptability and less vulnerability to natural disasters. “A rise in vulnerability is not inevitable, if cities are well run. We will have disasters even without climate change. Doing a better job in preventing them today will help us deal with tomorrow’s challenges.”

With an increase in funding from £7.8 to £11.5 billion over the next 4 years, DFID has promised to become a leaner administrative body. It’s not yet clear where these additional UK funds will be directed within DFID, but the UK government body hopes to use the extra money to “honour international aid commitments to support the MDGs.” The 8 MDGs work towards dramatic global reductions in poverty, improvements in education and improvements in health; they will meet their deadlines in 2015.

Reductions in childhood and maternal mortality are important indicators of MDG improvements. They are key goals which have been incorporated into several targets, but both are “currently the furthest off-track.” The increase in international aid spending is projected to save the lives of “at least 50,000 women in pregnancy and childbirth”, and “250,000 newborn babies.” The increased aid is also predicted to “improve the impact of British development in conflict countries… with a particular focus on Afghanistan and Pakistan.”

According to the World Health Organisation, British adults can expect to live for 80 years. Adults in Afghanistan and Zimbabwe have the lowest adult life expectancy at 42 years, with premature deaths often due to preventable causes. As a result of such disparities DFID considers that “development spending represents value for money in tackling global issues such as disease, migration, conflict and climate change and promoting economic stability and global prosperity.”

Although marked improvements have been made in many countries toward achieving MDGs, countries like Zimbabwe present a considerably grim example of life expectancy, in particular for women and children. “There are around 100 children dying every day in Zimbabwe, mostly of preventable causes” were recent comments on the current public health situation in Zimbabwe from UNICEF representative to Zimbabwe, Peter Salama. “Zimbabwe must be one of the few countries where maternal mortality has not only not declined since the MDG baseline year (1990), [but] it’s actually doubled.”

“Only a few goals are likely to make their targets, most goals are going to fall short of their global target in South East Asia and Sub-Saharan Africa” stated Professor Jeff Waage, Director of the London International Development Centre, during a recent review of MDG progress. So while some countries, like Thailand, will probably reach many of the 2015 MDG targets, for many more, these goals will remain far distant aspirations and highlight arduous journeys toward improvement. Zimbabwe and Afghanistan are countries where the road to achieving MDGs is growing longer and more precipitous.

Recent reports of global reductions in the rates of maternal and child mortality have inspired optimism. However, while childhood mortality rates are showing improvements globally, for maternal health MDGs in general “we’re way behind targets” admitted Professor Waage.

Thailand, Zimbabwe and Afghanistan all tell of how international aid is an essential prerequisite for improvement in many developing countries. However, they also show that without sustained local political support, at government and community level, reaching globally defined targets will be near impossible.

If international development goals are to be met, ongoing, cooperative commitments which cement partnerships between developed and developing country leaders are crucial. Pro-active support at the highest political levels is vital to ensure that the “right thing to do” brings “value for money” together with the heralded improvements for all.