Transcript of WHO podcast - 1 February 2007
Executive Board wrap-up and neglected disease makes a comeback after 40 years
Iain Simpson: You are listening to the WHO podcast for the first week of February. I am Iain Simpson.
In this episode:
- WHO Executive Board tackles key health issues;
- Director-General announces a high-level consultation on polio eradication; and
- yaws, a forgotten disease making a devastating comeback - what can be done now to bring it back under control.
The WHO Executive Board ended its session this week after seven days of intensive discussion. The board meets twice a year to debate key global health issues and set policy for the Organization. This time, it reached agreement on polio, tuberculosis, health systems, avian and pandemic influenza, and smallpox. The new WHO Director-General Dr Margaret Chan opened the board meeting on a personal note.
Dr Margaret Chan: Today is my 19th day in office as Director-General of WHO. I was deeply honoured by the trust you placed in me in November and have kept one of my earliest promises. I am working tirelessly.
Iain Simpson: She went on to highlight a long-time threat to public health, especially in Africa.
Dr Margaret Chan: One disease on our agenda costs us immense suffering in all our regions, but does its greatest harm in Africa. This is malaria. Africa is home to the most efficient mosquito vector and the most deadly form of parasite. In Africa, there is no malaria season; transmission occurs year-round.
Iain Simpson: Dr Chan then went on to talk about what she called one of WHO's most important areas of unfinished business - the effort to eradicate polio.
Dr Margaret Chan: Here is the key question: are we now in a position to overcome the operational and financial obstacles? I believe we need to assess the country-level operations very carefully to ensure that we can indeed interrupt transmission globally. I have decided to convene an urgent high-level consultation on this issue, which will take place in this very room from 27 to 28 February.
Iain Simpson: She said the consultation will agree new milestones for progress towards eradication in the four remaining endemic countries.
Iain Simpson: A neglected disease with a nearly forgotten name is back in the news this week. Yaws is a disease which eats away at the skin, cartilage and bone of its victims who are mostly children. Following a global-control programme that almost eradicated it more than 40 years ago, today yaws is back and is afflicting growing numbers of people in poor, rural and marginalized areas of Africa, Asia and South America. Dr Kingsley Asiedu is a WHO expert on yaws. I asked him first to explain exactly what yaws is.
Dr Kingsley Asiedu: Yaws is a skin disease. And normally, it starts as a bump on the skin. Without treatment, it can spread all over the body. It is painful and the bump ulcerates and can become bigger and bigger. It can heal on its own on and off, but without treatment, it can also lead to severe disabilities, severe bone involvement, and also unfortunately, it can even destroy the nose, leading to disfigurement and stigma.
Iain Simpson: So what causes it? How does it spread?
Dr Kingsley Asiedu: It is transmitted from person to person through the contact with the liquid that comes out of the ulcers of the infected person. So it is human-to-human transmission, basically.
Iain Simpson: And how can it be prevented? Can it be prevented, or can it just be treated?
Dr Kingsley Asiedu: Since it is human-to-human transmission, treating infected persons will interrupt the transmission of the disease, but there is no prevention like a vaccine to prevent one from getting the disease.
Iain Simpson: Why is yaws back in the news now, because it is a disease that most people have perhaps never heard of?
Dr Kingsley Asiedu: It is an old famous disease. A lot of work was done to bring yaws under control and near eradication led by WHO and UNICEF. There were massive campaigns between 1950 and 1970, and this brought the number of cases down by 95%. But then everybody thought "ok, the 5% will take care of itself".
Iain Simpson: So there was a big control programme in the 1950s, and it was quite effective, but not quite effective enough?
Dr Kingsley Asiedu: It was considered very successful. It is considered one of the achievements of WHO in its lifetime, but why we didn't finish the 5% of cases is the issue. And since it is a human-to-human transmission, definitely, if there is a pool of infected people, with population movements, with population growth this would lead to increase in number of cases, and this is what we are beginning to see.
Iain Simpson: So, is there a simple reason why it is making a comeback? Is it just because not enough attention has been paid over the last few years?
Dr Kingsley Asiedu: There's not enough attention paid, and the conditions for persistence and resurgence of the disease existed, I mean, they didn't change. And unfortunately, again, even the knowledge on yaws, I'm sure many people today if you ask them about yaws, they will not be able to tell what it is. So the knowledge required to even diagnose and treat cases and implement control measures at the country level does not exist as of today.
Iain Simpson: So, can anything be done now to improve the situation?
Dr Kingsley Asiedu: Recently, also last year, India, which was one of the three countries in the Southeast Asia region, announced that it has not seen any new case since 2004. So, if India has money to do it, I hope that other countries have money to do it.
Iain Simpson: Dr Kingsley Asiedu, a WHO expert on yaws.
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