Disease Dilemans CASE STUDIES ONLY

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CASE STUDIES

  1. CHOLERA, HAITI = Case study of one country which has experienced a natural hazard, such as an earthquake, drought or monsoon rains, and the implications this has on a named disease, such as cholera or typhoid

  2. AIR POLLUTION, INDIA = Case study of one country experiencing air pollution and the impact this has on incidences of cancers (such as lung or bladder). The global and national solutions in dealing with this

  3. MALARIA, ETHIOPIA = Case study of one communicable disease, such as malaria or tuberculosis, at a country scale, either an LIDC or EDC

  4. CANCER, UK = Case study of one noncommunicable disease, such as cardio-vascular

    disease or diabetes, at a country scale, either an AC or EDC

  5. SAVE THE CHILDREN, SIERRA LEONNE = Case study of the role that one NGO has played in dealing with a disease outbreak within one country at national and local level

  6. ATERMISIN (ANTI MALARIA) = Case study of one medicinal plant, such as rosy periwinkle and opium poppy, including their growing conditions, international trade, medicinal importance for disease and sustainable use

  7. GlaxoSmithKline (GSK) = Case study of the global impact of one pharmaceutical transnational, including scientific breakthroughs made, patents, drug manufacturing and their global flows for distribution

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CASE STUDY CHOLERA HAITI (spec 1c)

geographical area covered by the hazard and its influence on the risk and outbreak of disease

Haiti stats

  • carribean country

  • population of 10 million

  • roughly 1 million in the capital Port Au Prince

Hati Eathquake 2010

  • inland eathquake, close to the capital Port Au Prince

    • 7 on MMS

    • 50 plus aftershocks

    • death toll = 100,000 to 160,000

    • 280,000 buildings destroyed

    • shocks as far as cuba (2km from capital)

Cholera outbreak

  • 10 months later in october 2010

  • reports of cholera 60 miles to the north of the capital

  • contamination of the artibonite river 60km north of the capital

    • source of drinking water

    • place of defication

    • first case = in hamlet

  • spread through relocation diffusion due to people fleeing the outbreak

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CASE STUDY CHOLERA HAITI (spec 1c)

environmental factors affecting the spread of disease such as climate, sanitation, water supply and food

first wave

  • massive inland eathqauke, magnitude 7

  • widespread damge to national infrastracture

    • including roads and water systems

  • intial source = artibonite river

    • 320 km long river

    • first signs displayed by communities on the shores of the artibonite river (vibrio colerae entered the river due to Nepeales UN worships sewage entering the river)

    • no reported cases found upstream of the river (e.g in Mirebalais)

    • Mierbealais identified as the source of the disease (where the Nepalese UN workers were stationed)

  • rivers and rice fields aided spread

second wave

  • rainy season caused a second wave

  • Hurricane Tomas led to rapid flooding

    • Hurricane Tomas = November 2010

    • overflowing latrines and further spreading of infected water

  • Hurricane Sandy = November 2012

    • resurgence of cholera infection

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CASE STUDY CHOLERA HAITI (spec 1c)

human factors affecting the spread of the disease such as population density, access to clean water, immunisation programmes

  • hundreds of thousands homeless (due to earthqauke)

    • living in temporary camps or with crowded host families

  • health system has no previous experience of events on this scale, not set up to deal with it

  • weak governance

  • large scale damage to infalstructure (human and enviormental)

    • due to being porrly built

  • only 12% recived piped and treated water

  • only 17% had access to adequate sanitation

  • high prevalnece of malbutrition and blood group O and hydropocholrydia

    • blood group O = more severly ill from cholera

    • hydropocholrydia = insuffiencent HCL in stomach = cant digest food properly = malnourished

  • riots in Port Au Prince

    • following first round of presidential interests

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CASE STUDY CHOLERA HAITI (spec 1c)

impacts of the disease on resident populations

acute water diarrhoea and vommiting, often leads to life thereatening dehydration

outbreak of cholera from haiti eathquake = most severe in recent history

outbreak due to the El Tor variant strain = more severe illness

first phase of epidemic = 23,587 cases

contamination of wells and surface waters

disease spread through the entire landmass of Haiti

hundreds more cases reported in neighbouring dominican republic

Hurricane Sandy = caused the number of cases to triple overnight

stats

  • 57% of alll global cholera cases reported to the WHO in 2010

  • 53% of all global cholera deaths reported to the WHO in 2010

  • 58% of all cholera cases in 2011

  • 37% of all cholera deaths in 2011

  • total cases = 682,500

  • total deaths = 8,300 deaths

  • 2,300 people hospitalised for cholera every week

  • 40 deaths from cholera per week

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CASE STUDY CHOLERA HAITI (spec 1c)

strategies used to minimise the impacts of the disease at national and international scales

international scale

  • UN repsonse

    • 2 pronged response

      • direct response to save lives

      • halt the spread of the disease

  • aid groups

    • the red cross

      • delivered clean drinking water to 300,000 people living in Port Au Prince

      • built 1,300 latrines

      • treated 18,700 cases of cholera in treatment units in the la piste camp

      • disinfection everyone who came into contact with a cholera patient

    • also launched campaigns focussed on the improtance of boiling or chlorinating water

      • supplied chlorine tabs to rural communities

  • mass vaccination programme (supported by the WHO)

    • positives

      • provides mass vaccination

      • testing os suspected cases rose by 74%

        • 2017 = 21%

        • 2019 = 95%

    • negatives

      • expensive

      • relies on other countries funding and support

      • rural areas are not reached by the vaccines

      • october 2020 = resurgence of cholera

      • 35% have a lack of potable water

      • 65% have no sanitation

national scale

  • medical relief groups

    • direct treatment was implimented via specialised cholera treatments set up

      • set up to relieve the overburdened hospitals

      • mobile meadical units were deployed to more remote regions

        • these programmes were succesful but were overwhelemed with patients

      • oral rehydration centres were set up in smaler communities to help treat patients with less severe symptoms

      • local hospitals and and clinics recieved additinal training in cholera treatment

EVAL OF STRATETGIES

  • successes

    • infection rates plummetted in 2011

    • mortality rates decreased from 10% in October 2010 to 1% un January 2011

  • limitations

    • cholera continues to linger among Haiti’s rural population

      • re emergees every rainy season

        • rekeated to a lack of sanitation

      • only solution is long term access to clean water

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CASE STUDY AIR POLLUTION, INDIA (spec 2a)

India’s air pollution

  • battled says of toxic air

  • AQI os 10x the acceptable limit

causes of air pollution

  1. industry

    • metals, chemicals etc

    • do not follow regulations

  2. motor veichles

    • traffic congestion due to volume of veichles and poor traffic sense

    • slow travelling, burns fuel more ineffectively

      • polutes the air with carbon monoxide sand oxygen oxides

  3. domestic

    • fuel wood

      • low income households

      • release high levels of smoke

  4. power generation

    • inefficient coal, oil and natural gas

    • release harmful substances

  5. education

    • especiall toxic in winter

    • farmers burn crop remittants

      • low wind speed in inwter = high concerntration of pollutants

impacts of air pollution

  • linked to the deaths of over 1 million people

    • linked to the deaths of over 1 million people

      • the most in any country

  • repiratory difficulties and asthma

    • 1.7 times higher in Delhi than in rural areas of India

    • lung function of urvan residents are seriiously reduced

  • indoor air pollution

    • causes around 2 million premature deaths

      • nearly half due to pneumonia

national solutions

  • draft nation clean air programme (NCAP)

    • closing of brick kilns

    • raising parking fees in cities

    • stopping hotels from using coal and firewood

    • banning garbage burning

  • two weeks clean air campaign

    • feb 2018

    • checking viechles pollution

    • inspecting power plants

    • raising awarness

    • improved education

    • electric veichles encouraged via tax insentive

    • lower fares for electric busses

  • artificial rain

    1. clouds are ubjected with salts like silver or potassium idiodide through air or generators in the ground

    2. salt water acts as a catalyst to combine water droplets in clouds

    3. water droplets convert into snowflakes and while falling reach the melting point

    4. causing rainfall

  • doesnt always work as atmopsheric conditions have to be exactly right

    • have to be the right amounts of moisture and humidity in the clouds to allow for ice nuclei to form

    • salt particles also have to be sprayed into the right type of cloud

      • only works for clouds that grow vertically and not clouds that grow horizontally

  • artificial rain project carried out in 2 phases

    • 1st phase = covers 300 km2

    • implimented on 20th november

  • rainfall may help to wash away particle matter in the atmopshere

    • generates cleaner and more breathable air

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CASE STUDY MALARIA, EHTIOPIA (spec 3a)

environmental and human causes of the disease

  • climate (temperature, rainfall and humidity)

    • altitude and climate = most important

    • ehtiopian highlands = over 2,500 metres high = malaria free

    • african vector species = long lifespan and strong human biting habit

      • why 90% of the worlds malaria patterns are in African

    • climatic conditions that increase the number and survival of mosquitoes

      • high rainfall (leads to stagnant water)

      • high humidity

      • high temperatures

  • poverty

    • risk of malaria is higher fro households in a lower socio economic bracket

      • unable to take measures to reduce the risk of transission

        • use of mosquito nets and anti malaria sprays

  • living conditions

    • construction and material of walls, roof and floor of the house

      • bricks = may limit contact with the moquito vector and reduces infection

    • main source of drinking water

    • time taken to collect water

    • toilet facilities

    • availablity of electricity

    • area of living

      • individuals migrating from an area of low malaria cases to an area of high malaria cases have low immunity

        • leads to a higher risk of developing malaria

  • agriculture and irrigation schemes

    • season popultation movements between the malaria free highlands and the agricultural lowlands

    • timing coincides with teh harvest and planting tiem adn the rainy season

      • time of peak trasmission in lowlands

    • harvesting often continues after sunset

      • when mosquitos are more active

      • some migrant workers sleep in the fields overnight

    • irrigation projects have expanded the breeding habitats for mosquitos

      • in the Awash Valley and Gambella province

      • due to construction of canals, micro dams and ponds, and the cultuvation of rice

  • access to healthcare

    • limited number of health institutions

    • ineffective distrubition of medical supplies

    • disparity between rural and urban areas

    • access to healthcare services v difficult

    • 50% of population lives over 10 km from the nearest health facility

      • usually in regions with poor transporation infrastructure

    • efforts to comabt the diease are limited due to

      • shortage of trained personnel

      • shortage of vector control supervisors

      • shortages of drugs and lab supplies

      • weak surveillance systems

      • shortage of field logistics

      • shortages of spray pumps

      • operational finances are inadequate

    • all related to the wealth and level of development in Ethiopia

      • high rates of treatment failure for the two main types of malaria

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CASE STUDY MALARIA, EHTIOPIA (spec 3a)

prevalence, incidence and patterns of the disease

over 75% of Ethiopia is Malarious

45 million out of Ethipia’s 68 million inhalbitants are estimated to be at rism of malaria

  • malaria risk is not evenly distrubuted through the country

    • highest risk = western lowlands

      • due to high temp and humidity throughout the year

      • trasnmission is in line with the rainy season

    • eastern lowlands = malaria confined to the river valleys

      • due to arid climate

    • central highlands = 25% are malaria free

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CASE STUDY MALARIA, EHTIOPIA (spec 3a)

socio-economic impacts of the disease

  • 2016 = almost 3 million cases causing roughly 5,000 deaths

  • malria transmission peask twice per year

    • from septemher to december

    • and from april to may

    • coincides with the major harvesing seasons

  • serious consequences on economy and food production in Ethiopia

  • malaria causes people to take times off of work

    • slows economic growth

    • reinforces the cycle of poverty

    • reduces the potantial growth rate by 1.3% per year in some African countries

    • lost production in sub-Saharan Africa due to malaria = $12 billion a year

  • cost to health services is 40% of the national health expnediture

    • accounts for 10% of hospital admissions

    • accounts for 12% of health clinic visits

  • school absensces due to malaria reduces the learning capacity of students

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CASE STUDY MALARIA, EHTIOPIA (spec 3a)

direct and indirect strategies used by government and international agencies to mitigate against the disease and respond to outbreaks

international strategies → WHO

  • WHO global technical strategy for malaria 2016 - 2030

    • technical framework for all malaria endemic countries

    • intended to guide and support regional and country programmes

      • work towards malaria control and eliminiation

    • sets ambitious but achievable global targets

    • reduce malaraia case incidences and mortaliy rates by 90% by 2030

  • the global malaria programme

    • coordinates WHO’s global efforts to control and eliminate malaria by

      • setting, communicating and promoting the adoption of evidence based norms, technical strategies and guildlines

      • keeping independant score of global progress

      • developing approaches for capacity building, system strengthening and surveillnace

      • idenitifying threats to malaria control and elimination as well as new areas for action

  • the sustrainable development goals (SDG)

    • proposes to

      • reduce malaria cases and death rates by atleast 90% by 2030

      • eliminate malaria in 35 countries bu 2030

    • Ethiopia is one of the countries targeted fro the elimination plan

      • encompasses 3 major pillars

        • ensure universal acccess to malaria prevent, diagnosis and treatment

other countries

  • the U.S. President’s malaria initiative (PMI)

    • led by USAID

    • implimented together with the US centres for disease control and prevention (CDC)

    • delivers cost effecrive life saving malaria interventions

    • technical and operational assistance to support Ethiopia since 2008

      • decrease child death rates by 55%

      • through investments totalling $441.5 million

    • supported IRS campaigns (indoor residual sprays)

      • targetted 44 high malaria buden districts

      • protefcted 1,334,868 residents

      • trained 2,675 individuals to deliver safe and effective IRS

      • almost 16 million ITNs distrubuted (insecticide treated bed nets)

national strategies (goverments)

  • the national malaria elminiation program (NMEP)

    • 5 year national strategic plan for 2021-2025

    • goals by 2025:

      • reduce malaria morbitity and mortality by 50% from 2020

      • achieve 0 inidgenous in districts with less than 10 annual parasite incidents

      • prevent reintroduction of malaria in dsitricts reporting 0 indigenous malaria cases

      • achieve adoption of appropriate behaviour and practices towards antimalaria intervention in 85% of households living in malaria endemic areas

NGOs (national and local)

  • established in 2003 → Malaria consortium

    • one of the world leading NGOs in the prevention, control and treatment of malria

    • in Ethiopia they work in the southern region by:

      • strengthening vector managment (including through comunity based IRS)

      • training health extension works and district health management on IRS planning and monitoring

      • repairing damged spray pumps

      • idenitify and mapping breeding sites of malaria carrying mosquitoes

      • train female volunteers to deliver health education

      • organising annual malaria campaigns on enviromental management

      • treat permanent breeding sites with chemicals

direct strageties

  • measures to eradicate mosquitoes

    • periodic spraying of dwellins with insecticides

    • mamageing the eviroment to destroy breeding sites

indirect stragies

  • mass publicity campagins

    • minimise potential mosquito breeding sites

    • provide early diagnosis and tretament of malaria

      • within 24 hours of the onset of fever

    • distrubuting insecticide treated bed nets to all households in infected areas

success?

  • malaria related deaths in those under 5 fell by 81% in 5 years

  • malaria related admissions in those under 5 fell by 73% in 5 years

  • Ethiopia has achieved the development goal to halve mortality rate from malaria

  • Ethiopia has reduced the burdne of malaria faster than in most sub Saharan African countries

  • however

    • Ethiopia still account for 6% of global malaria cases

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CASE STUDY CANCER, UK (spec 3b)

social, economic and cultural causes of the disease

  • lifestyle factors

    • some cancers due to occupational and enviromental hazards

      • e.g radiation, pollution, toxic chemicals etc

    • most due to lifestyle factors

      • obesity, poor diet, lack of excercise, smoking and alcohol abuse

      • since 1970s cancer rates have risen

        • 23% in men

        • 43% in women

      • e.g. skin cancer has increased due to the risk of sun bathing and sun beds due to a desriable tanned look

      • opportunities for sunbathing have increased due to growing wealth and affordable package holidays

      • this is despite eveidence of risks of skin cancer

  • increasing wealth and associated standard of living

    • increasing weath = changes in diet

      • a preference for mest, dairy products, fast food and ready meals

      • linked to an increase in bowel cancer incidences

    • increasing diet = more alchahol = more oral, throat and liver cancer

  • lack of excercise and changes to diet (more sedentary lifestyles)

    • driven a rise in obestiy and a subsequent rise in risk of cancer

    • despite a decline in smoking it is still the biggest cause of cancer in the UK

      • nearly 1/5 of all cancer cases diagnosis every year are realted to smoking

  • inherited

    • inherited cancer genes

      • hereditary

      • due to a mutation in an egg or sperm cell

      • cancer suspecibility genes

      • much less common than cancers related to life style factors

      • most canceers develop due to an interaction between genes and the enviroment

  • age

    • ageing = fundermental factor in the development of cancer

    • cancer incidences dramatically increases with age

      • most likely due to a risk from a build up of risks

      • risk accumulation

      • cellular repair mechanisms tend to be less effective as a person grows older

  • culture

    • infroms lifestyle differences

      • e.g practices that dertmindes diet, excercise, weight norms, work enviorments, soical activity and health patterns

      • plays a major role in health promotion and maintenance

  • wealth

    • since the 1990s there have been lower survival rates of individuals in more deprived areas

      • diagnosis

      • treatment

      • worse genral health

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CASE STUDY CANCER, UK (spec 3b)

prevalence, incidence and patterns of the disease

  • 367,000 new cases year

  • roughly 1,000 new cases every day

  • breast, prostate, lung and bowel cancer = 53%

  • 36% each year diagnosed in people aged 75 and over

  • roughly 450 cancer deaths every day

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CASE STUDY CANCER, UK (spec 3b)

socio-economic impacts of the disease

  • cancer deaths result in the loss of:

    • caregivers for children

    • older realtives

    • partners

    • friends

  • deprive communities of vital volunteers

    • volunteer losses have a combined annual value of £236 million

  • removed large numbers of productive employees for from the labour force

    • 50,000 people of working age loose their lives to teh disease

    • in 2014 these individuals could have contributed £585 million to the UK economy

    • across the rest of their working lives they coukd have contributes £6.8 million

  • over 5% of NHS health budget is dedicated to cancer

  • Macmillan cost = £570 per cancer patient

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CASE STUDY CANCER, UK (spec 3b)

direct and indirect strategies used by government and international agencies to mitigate against the disease

international strategies

  • 2017 → the World Health Assembly passed the resolution Cancer Prevention and Control through and integrated approach (WHA70.12)

    • urges goverment and WHO to achieve the target specified in the Global Action Plan and 2030 Un Agenda for Sustainable dveelopment to reudce premature death

      • WHO collborates with other UN organisations to

        • easiest to learn 5 strategies

          1. increase political commitment for cancer prevention and control

          2. coordinate and control research on carcinogens and the causes of cancer

          3. monitor the cancer burden

          4. identify cost effective strategies for cancer prevention

          5. strengthen health systems at national and local levels to deliver care and cure for cancer patients (including improving access to cancer treatments

national strategies

  • the NHS long term plan (LTP)

    • published in january 2019

    • key ambitions = by 2028

      • 55,000 more people will survive their cancer for 5 years or more

      • 75% of people with cancer will be diagnosed at stage 1 or stage 2

    • includes

      • improving national screening programmes

      • give people faster access to diagnostic tests

      • invest in cutting edge treatments and technologies

      • making sure more patients can benefit from precise, personalised treatments

      • plans to

        • lower the age for bowel screening

        • introduce new forms of cervical cancer screening

        • extent lung health checks

        • create rapid diagnostic centres across the country

          • so patients displaying cancer symptoms can be diagnosed in as little as a day

        • introduce faster doagnosis standards

          • ensure patients either have a ruling out or diagnosis of cancer within 28 days

  • better health campaign

    • public health england launched a major new adult health campaign

      • use opportunities provided by covid 19 to emphasise the importance of healthier lifestyles

        • support individuals on their weight loss journey

        • provides advice and support for quitting smoking, drinking less and looking after their mental health

NGO (national and local)

  • cancer research UK

    • worlds largest independent cancer research charity

    • conducts research into the prevention, diagnosis and treatment of disease

    • provides information about cancer and

    • runs campaigns aimed at raising awareness

    • ambition is to accelerate progress and see 75% of people surviving cancer within the next 20 years

    • four key areas focussed on

      • help prevent cancer

      • diagnose it earlier

      • develop new treatents

      • optimise currents treatments by personalising them to make them more effective

    • investing an additional £50 million a year intp new funding schemes for researchers

      • encourage collaboration and innovation

      • support research tackling some of the biggest scientific challenges in cancer research

indirect strategies

  • emphasise changes in lifestyle and cancer prevention

  • education and health compagins informing the public of the dangers of smoking, excessive drinking and unbalanced diets

    • to reduce the incidence of preventable cancers

direct strategies

  • investment in advanced medical technology (e.g more precise forms of radiotherapy) and diagnostic methods (e.g. endoscopy for early diagnosis and intervention)

    • mass screening for breast, cervical and bowel cancer is already well estbalished and highly effective

  • survival rates could be fruther reduced by reducing waiting times between diagnosis and treatment and giving more support to GPs

success?

  • cancer survival is improving and has double in the last 40 years in the UK

  • however total number of diagnosises are rising BUT cancer mortality is falling

  • net survival rates have increased by 22% in 20 years

  • for men and 19% for women

    • 2010 survival rates = 67% for men

    • 2010 survival rates = 74% for women

  • this has been driven by a combination of earlier detection and diagnosis, and advances in treatment

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CASE STUDY SAVE THE CHILDREN IN SIERRA LEONNE (EBOLA) (spec 4a)

role played in dealing with a disease outbreak within one country at national and local level

  • ebola epidemiology

    • a diseasse thta causes internal / external bleeding

    • 2 to 21 day incubation period

    • spread by close contact with organs and sharing of bodily fluids

    • 50% fatality rate

  • how the 2014 epidemic occurred

    • infected by blood or mucus from one of the infected fruit bats

      • started from a little boy whos family hunted

    • people fleed as deaths began

      • liberia, sierra leonne and guinea effected

      • declared an epidemic in august 2014

  • impacts of the ebola epidemic

    • 14 thousand confirmed cases

    • nearly 4 thousand deths

    • june 2014 all schools were closed due to the spread of ebola

    • 13th october 2014, the UN stated that 40% of farms had to be abandoned

    • WHO reported, 129 cases in healthcare workers and 95 deaths

    • ebola epidemic grew, damged healthcare systems and led tp increased deaths from other communicable diseases

  • ROLE OF SAVE THE CHILDREN IN SIERRA LEONNE

    • 80 bed ebola treatment scentre

      • treated over 280 people

      • discharged 145 survivors

    • training community health wrokers to spread the word of signs and symptosm of ebola and how to prevent transmission

      • 530,000 people reached with targetted messages

    • reunification of children and orphans with family

      • 194 so far

    • support community workers on a house to house campagin educating people about ebola

  • LONG TERM AIMS OF SAVE THE CHILDREN IN SIERRA LEONNE

    • planning to work with the goverment to ensure that education is accesible for all children by setting up school subsidies and scholariships for those whove lost realitives to ebola

    • strengthening the health system

      • providing additional qualified staff espsiecally in rural clinics that have been abandoned by staff fearful of ebola

    • preventing child labour an exploitation through educating parents, carers and communities

    • providing better access to family planninga and educating girls on their rights

  • EVALUATION OF THE ROLE OF SAVE THE CHILDREN

    • negatives

      • small scale

        • however the people it does help it does so effectively

      • relies on funding so can stop at any time

      • limited power

      • cannot address the root cause

        • can only minimise impacts

      • dangerous for workers

        • lomits the number of volunteers

    • positives

      • direct and personal aid

      • can address societal norms

      • helps aftermath

      • can provide long term support

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CASE STUDY OF ARTERMISININ, ANTI MALARUA DRUG (spec 5a)

including growing conditions, international trade, medicinal importance for disease and sustainable use

  • plant source

    • artemisia annua plant

  • medical uses

    • anti malarial drug

  • growing conditions

    • temperate climate

    • 13 to 29 degrees celcius

    • frost tolerant

    • 600 to 650 mm of rainfall

    • soil pH of 6 to 8

    • seedlings are grown in nurseries snd transplanted into fields

    • plants are ahrvested

    • leaves are dried and sent tp facilities where atermisinin is extracted

    • cultivation of Atermisia annua takes 6 months

    • manufacturing takes 2 to 5 months

    • needs high temperatures during post harvest

    • handling can damage the quality

    • after harvesting the artetemissin content of the leaves will decreases

    • the value of the raw material can be lost after 6 to 12 months of storage

    • china and vietnam provide 70% of the raw plant materials

    • east africa provide 20% of the raw plant materials

    • lowered mortality from malaria by 70% within 2 years

  • international trade

    • market frice has fluctuated between $120 and $1,200 between 2005 and 2008

    • novartis provide ACT drugs at cost on a non profit basis

      • still more expensive than atlernative malaria treatments

  • medicinal importance for disease

    • atermisin is isolated from the plant artermisia annual

      • sweet workwood

    • WHO has reccommend atermisinin combination therpaies (ACT) to be the first line therapy for malaria worlwife

      • these treaments are now standard worldwide

      • the WHO says rhese treatments have saved more than 3 million lives since 2020

    • the medicianl value of this plant ahs been known to the chinese for atleast 2,000 years

  • sustainable use

    • world market for artemisinin products has grown rapidly

      • however not all of it meets the right standard

      • urgent need to promote better cultivation

    • the availability of ACTs falls short of what is needed

      • 600 milion people needing ACTs

      • 82 million people reciveing the treatment

    • 2007, WHO published cultivation guidlines for the use of artemisinin annula, to improve the quality and promote sustainability

    • clinical evidence for artermisinin wad first reported in 2008 by SE Asia

      • confirmed by cambodia, vietnam and myanmar in 2014

    • in 2011 the WHO stated that resistance to arteminisinin could unravel national malaria control programmes

    • high yield varieties of arteminisinin are being prpduced by the university of york

      • through molecular breeding techniques

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CASE STUDY OF GlaxoSmithKilne (GSK) (spec 5b)

including scientific breakthroughs made, patents, drug manufacturing and their global flows for distribution

  • stats (use to show the scale)

    • world’s sixth largest pharmaceutical company

    • 99,000 employees worlwide

    • operate in 92 countries

    • delivered 1.7 billion medicines (in 2021)

    • delivered 767 million vaccines (in 2021)

  • 3 main buisnesses within GSK

    • pharamaceuticals

    • vaccines

    • consumer healthcare (over the counter medicine, e.g. ibuprofen)

  • scientifc breakthroughs (HIV AND VACCINES)

    • predescor company to GSK developed the first medicinal treatment for HIV in 1987

    • their work in malaria vaccines was use in 8 african nations, found to reduce malaria cases by 50% in children age 5 to 17 months

      • could save african nations up to $12 billion in healthcare costs

      • worlds first malaria candidate vaccine

    • have created over 20 vaccines

      • include meningitis, shingles, flu and manu more

    • 4 in 10 children recieve a GSK vaccine each year

    • limitation = doesnt treat root cause of issues (e.g sanitation)

  • global health / drug manufacturing

    • ambition = to positively impact the health of 1.3 billion in low and lower middle income countries over the next 10 years and reduce the impact of antimicrobial resitance (AMR)

    • develop trasformative and lower cost products and technologies to prevent and treat diseases

      • specfically focussed on ones that disproptionally impact people in low and lower middle income countries and diseases that have an AMR potential

    • largest research and development pipelines

    • some diseases tragetted are malaria, tuberculosis and neglected tropical diseases

    • support hundreds of projects worldwide to strentghen local health services for people with HIV

    • work with two other pharmaceutical companies to research cures for HIV

    • develops country specific pricing strategies

      • lower income countries, vaccines = cheaper to allow a wide spread effect

    • without action by 2050 AMR could ahve caused up to 10 millions dearhs per year

    • GSK were ranked first in the 2020 AMR benchmark report

      • they are working on new approaches to tackling resistance

      • as well as devloping new genrations of antiiotics and vaccines specifically targetted at amtibiotic resitsant infections

    • positives = wide scale impact, focuss on neglected diseases, focus on lower and middle income countries, provide treatments at lower costs

  • patents

  • patent = only the pharamaceutical company that holds that patent is allowed to manufacture, marker and profit from the drug

    • GSK aims to make it easier for manufacturers in porrer countries by not filing patents

      • prevent poorer countries being priced out of buying vaccines

    • GSK holds around 4000 international patents on many drugs and compounds cerucial to the tretament of HIV and aids

    • GSK became part of the medicine patent pool

      • allows redistribution of drugs under gerneric named to make drugs more affordable

      • UN backed initiative

      • hoping to expand the MPP to cancer treatment

        • GSK has proposed to licence its anti canceer drug to the anti cancer drugs patent pool

        • more oncologists = speed up cancer treatments

  • global flows of distribution

    • manufacturing sites and R and D (research and development) centres in 36 countries

    • 12 vaccine manufacturing sites

    • distributes 2 million vanccines daily to 160 countries

    • 2009, worked with WHO and health authorities to ship 50 million doeses of the swine flu vaccine (H1N1) to developing countries

    • 2013 → £5 million inesvtment from the welcome trust to support its open approach to discovering and devloping new treatments for low income countries

    • 2019 → invested $28 million in more than 50 clinical studies across the country

  • save the children partnership (2013 to 2022)

    • combining GSKs manufacturing expertise with save the childrens grassroots (bottom up) opperations

    • merges commercial aspect of resources with the distribution to the most vulnerbale children

    • 5.9 million children under 5 die from preventable causes evry year → aims to reduce this

    • partnership specifically focusses on

      • improvinga ccess to healthcare for most vuknerbale

      • training and eqipping health workers in the poorest countries

      • devloping child friendly medicines

      • work at global and local levesl to call for stronger child health policies

    • impacts of partnership

      • 2.98 million children reached across 46 different countries since 2013

      • 114,000 children under 5 are now fully immunised

      • 282,000 children have been treated for diarrhoea, malaria or pneumonia

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