Innovation in Medicine

Transcription

1 8 th session of Budapest International Model United Nations Innovation in Medicine Introduction The medical profession dates back millennia. Back in the 400 BCE lived the ancient Greek physician Hippocrates, the father of medicine, to whom the Hippocratic oath is attributed, by which physicians promise to offer beneficial treatment to the best of their abilities and to do no harm; a version of this oath is still used today. In the 2400 years since then, medicine has come a long way. The first hospitals were established by in the 4th century CE, the first pharmacies in the 8th, and the concept of quarantine was born in 1377 as an aftermath of the plague. We have left behind blood-letting and introduced anesthesia. Since the end of the 18th century we started vaccinating people thus eradicating some of history s largest killers. Recently, immunization programmes have been carried out in different regions of the world, reporting important reductions in morbidity and mortality. However, in spite of the ground-breaking discoveries and technological development, only smallpox has been eradicated worldwide, while many other vaccine-preventable diseases still lead to millions of deaths each year. Nowadays,the main aim is to effectively combat noncommunicable diseases (heart disease and stroke emerging as the world s number one killers), to deal with food insecurity and famine, as well as to address outbreaks, emergencies and crisis. WHO at a glance, here. 1 General Overview After the WW2, countries of the world sent delegations to San Francisco to negotiate the creation of the United Nations. Among various topics, diplomats acknowledged the need for a global organization to oversee global health. Such, the Constitution of the World Health Organization 2 was approved in 1946 and came into force two years later, on April the 7th Today, 194 countries are members of the WHO. The Organization entertains close partnerships with other UN bodies, state governments, donors, academia, non-governmental organizations and the private sector. It has offices in more than 150 countries and operates 6 Regional Offices.

2 WHO is financed by the Member States, each having their contribution calculated and agreed upon based on the nation s wealth and population. However, more than three quarters of the financing comes from the voluntary contributions from Member States and partner organizations. Major works conducted by the WHO include, among other: coordinating mass campaigns against communicable diseases via the global disease-tracking services The Special Programme for Research and Training in Tropical Diseases 3 (today, 5 out of the 8 diseases it was created to tackle, have been nearly eradicated) the 12-year global vaccination campaign that led to the worldwide eradication of smallpox in 1979 The Global Polio Eradication Initiative, 4 which has determined a decrease in polio cases by more than 99% and has been paving the way for a polio-free world (today, 4 out of the 6 Regions are certified polio-free) reaching the Millennium Development Goals on Health by 2015 (special regards to MDGs 4, 5 5, 6 6 7) declining the global under-five-mortality rate (under 10 million since 2006) setting global targets to prevent and control non communicable diseases reaching the Sustainable Development Goals on Health by 2030 (special regards to SDGs 2, 8 3, ) Member States agreed on the International Health Regulations 11 (the revised version from 2005, entered into force in 2007), to prevent and respond to severe public health risks likely to cross borders and affect people worldwide. Please see the links & relations attached in this section. You can find more information on the programmes and projects of the WHO here. 12

3 Case study - West African Ebola virus epidemic The virus was first described in 1976 and discovered in two local-scale outbreaks of haemorrhagic fever that occurred in the Democratic Republic of the Congo (then, Zaire) and the territory now part of South Sudan. The outbreak was the most widespread case of the Ebola virus in history. It caused major loss of life and had a negative impact on the socioeconomics of the Western African region, the most affected nations being Guinea, Liberia, and Sierra Leone. The first case was reported in December 2013: a one-year-old boy living in the village of Meliandou, Guinea. The spread of the infectious disease is thought to involve bats and, incidentally, the boy and his family were living near a large colony of Angolan free-tailed bats. However, later research showed that the virus was not found in any of the bats tested. Unfortunately the early cases were diagnosed as different conditions, so the disease spread for months before being recognised as Ebola virus. By the time the WHO reported the major public health risk, Ebola had spread to neighboring Liberia and Sierra Leone, with minor outbreaks occurring elsewhere. The failure to control the epidemic and the delays in adequate response can be traced to the conditions of extreme poverty, shortage of medical staff and supplies, dysfunctional healthcare systems and deficiencies of the local political administrations. The epidemic caused significant mortality (case fatality rate reported at slightly above 70%, while the rate among hospitalized patients was close to 60%). Small outbreaks occurred in Nigeria and Mali, and isolated cases were reported in Senegal, Italy and the United Kingdom. Moreover, secondary infections of medical workers (caused by imported cases) occurred in the United States and Spain.

4

5 The number of cases peaked in October 2014, when the WHO declared the outbreak a Public Health Emergency of International Concern. Research for the development of an effective vaccine for the Ebola virus disease began in December. The WHO Secretariat evoked an unprecedented response to the outbreak, deploying thousands of technical experts, support staff and medical equipment. In addition, mobilizing foreign medical teams were mobilized and mobile laboratories and treatment centres were set up. Starting with January 2015, cases there began to decline gradually, following the commitment of substantial international resources. Médecins Sans Frontières had a very large presence in the most-affected countries. The large-scale epidemic ended as of late 2015, but still sporadic cases were reported. In August 2015, WHO held a meeting to work on an initiative called "The Comprehensive Care Plan for Ebola Survivors", aimed at optimizing clinical care and social well-being. In March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak. Nevertheless, subsequent flare-ups occurred for an additional 3 months. As of May 2016, WHO and respective governments reported a total of 28,616 suspected cases and 11,310 deaths (a total rate of 39.5%). The outbreak left around 17,000 survivors of the disease, many of whom report postrecovery symptoms, named Post-Ebola Syndrome, often so severe that they require medical care for months or even years. What may raise concern nowadays is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later. In December 2016, the WHO announced that the trial period of the rvsv-zebov vaccine appeared to offer protection from the strain of Ebola responsible for the West Africa outbreak. The vaccine has not yet had regulatory approval, but stockpiles have been made. You can find more information regarding the Ebola virus disease here. 13 The WHO response, Ebola Strategy - preparedness, alert, control, and evaluation, can be consulted here. 14 Innovative medicine: Questions that arise today Throughout history, advances in medicine have been made through experimentation on both animals and humans. For instance, in 1796, Edward Jenner injected a 9-yearold boy with cowpox after observing that those who contracted cowpox appeared not to develop smallpox, a deadlier version of the disease. He turned out to be right, and the practice of vaccination was born, but what if he hadn t been?

6 The term experimentation on humans invokes images of totalitarianism, with starving children being subjected to immeasurably painful procedures in concentration camps. In spite of these regrettable events, experimentation of new medicine on consenting adults is still very much practiced today. In fact, it is a necessary step in order to decide whether a particular pill does what it is supposed to. There are a variety of regulations which pharmaceutical companies have to abide by when conducting such testing; there are similar but less stringent regulations for animal testing. Are these regulations sufficient? What must we do to ensure that adequate ethical consideration be given when testing new medicine? This page 15 summarizes human experimentation quite well. Addiction has become an important topic in recent years. Many of the medicines that are widely available have addictive properties and are actively used by addicts today. Examples include Percocet, Demerol and Vicodin, all painkillers. Problems can arise even when these medicines are taken with prescription: severe withdrawal symptoms such as fever and depression can occur once the patient stops taking the medicine. What can we do to prevent addictions to medicine? Conclusion The leading causes of death (among accidents and violence) are the Ischaemic heart disease, Stroke and lower respiratory infections. Together, these three accounted for 18.2 million deaths globally in These diseases have remained the leading causes of death in the last 15 years. Various forms of cancer, HIV and tuberculosis are close behind. And while finding a single, universal cure for cancer has been deemed impossible, we are still coming up with new cures and new medicine for treating various different diseases on a regular basis. How can we find these cures while keeping ethical questions about experimentation and addiction in mind? Appendix A: Country profiles You can find some specific information regarding the country you are representing here, 16 however you are encouraged to look at other sources as well. Country classification from the United Nations (2014) to be found here. 17 Appendix B: Definitions of key terms Communicable (disease) = infectious; transmitted from person to person or from animals to persons - tuberculosis, malaria, yaws, syphilis and leprosy and others Eradicate = to remove completely, to eliminate

7 Flare-up = a sudden appearance or worsening of the symptoms of a disease or condition Immunize = to give (someone) a vaccine to prevent infection by a disease Morbidity = a diseased state or symptom: ill health Mortality = the proportion of deaths to population Non communicable (disease) = chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors - diabetes, cancer, chronic lung disease and others Outbreak = a sudden rise in the incidence of a disease Public health = the health of the population as a whole, especially as monitored, regulated, and promoted by the state. Tropical diseases = infectious diseases that thrive in hot, humid conditions, such as malaria, leishmaniasis, schistosomiasis, onchocerciasis, lymphatic filariasis, Chagas disease, African trypanosomiasis, and dengue. Links 1 WHO at a glance: 2 Constitution of the World Health Organization: 3 The Special Programme for Research and Training in Tropical Diseases: 4 The Global Polio Eradication Initiative: 5 SDG 2: 6 SDG 3: 7 SDG 6: 8 MDG 4:

8 9 MDG 5: 10 MDG 6: 11 International Health Regulations: 12 Information on the programmes and projects of the WHO: 13 Information regarding the Ebola virus disease: 14 The WHO response, Ebola Strategy - preparedness, alert, control, and evaluation: pdf?ua=1&ua=1 15 Human experimentation: 16 Country-specific information: 17 Country classification from the United Nations (2014): classification.pdf Should you have any questions, do not hesitate to contact us at who@bimun.hu. Please also submit your position papers of about words to the same address by March 18th.