My new story on the emergence of a dangerous new form of antibiotic resistant bacteria in India, and how commercial concerns may be complicating efforts to tame it, appears in this week’s Foreign Affairs. Check it out at Foreign Affairs. Also out: a nifty audio slideshow from my trip to India, on the website of the Pulitzer Center on Crisis Reporting, which kindly provided funding for my reporting. Listen and watch here.
This is the first of a series of reports on NDM-1 bacteria, bugs endowed with the ability to resist not only commonly used antibiotics but the last-resort IV antibiotics used only in hospitals. NDM-1 first emerged in New Delhi (and is, controversially, named after the city) and has since spread to over 35 countries, primarily in the bodies of medical tourists. I recently returned from a trip to New Delhi, and filed this report for The Atlantic and the Pulitizer Center on Crisis Reporting, which funded my trip. Photos, video, an audio slideshow, and more stories in Foreign Affairs and Le Monde Diplomatique are forthcoming. Stay tuned.
I’ll be talking about my article on private interests in global health on NPR’s “To The Point” today, live at 11 am PT, 2 pm ET. Economist Daniel Altman and Center for Science in the Public Interest’s Bill Jeffrey will be joining, too. Check here for a station list or to listen now.
In this piece, I look at how major private industry–oil and gas companies, the fast-food industry, and Big Pharma–are transforming the global health agenda. In sum: it’s not good. The story is the product of about 6 months of research, supported by the Investigative Fund of the Nation Institute. Check it out here. “How Private Companies Are Transforming the Global Health Agenda: A New Era for the World Health Organization,” by Sonia Shah, Foreign Affairs.com, November 9, 2011
October 23, 2012. 12:30 pm. “The Body Hunters: Big Pharma’s Quest for Miracle Drugs and its Impact on the Health and Human Rights of the Poor.” Q&A to follow. Open to the public. Frederick Community College, Frederick, MD
My review of the Soderbergh film “Contagion,” where I consider the public health implications of the blockbuster movie, is now up at The Lancet. Check it out here.
September 25, 2012. 11:30 am. Wartburg College Convocation address, “The Science and Politics of Malaria.” Waverly, IA.
Alex Perry, of TIME magazine, shadowed millionaire investor-turned-malaria activist Ray Chambers, the UN Special Envoy for malaria, as he attempted to blanket the continent of Africa with treated bednets, and then wrote this short book about it, which I reviewed for The Wall Street Journal. It was a difficult review to write, because while I admire Perry as a reporter, I had many objections to the way he talks about malaria. I could only fit in a few in the review. Here’s the link.
The LLIN—“long lasting insecticide treated net”—is actually not very long lasting, after all. Years ago when I first started learning about them, I was told by experts that they were meant to last 3-5 years. That’s longer than older model nets, but for a disease as pernicious as malaria it is really not particularly long at all. Many of the most avid net distributors and fundraisers have tended to sideline this rather salient fact. Well, now good evidence has emerged that these nets indeed last for three years—and three years only—throwing into question the very idea that “nets save lives.” Perhaps the mantra should be “nets delay malaria for a few years.” Between January 2007 and July 2008, the incidence of malaria among the people of Dielmo, Senegal ran to around 5.45 per 100 person-months. This village has been studied by the Pasteur Institute since 1990, when they started systematically testing the blood of people with fever for malaria parasites. People there get about 258 bites from infected mosquitoes every year. In 2008, LLINs were distributed, and incidence dropped dramatically, to just .41 per 100 person-months. Two and a half years passed. And then the nets stopped working. Malaria spiked back up to 4.57 per 100 person-months, nearly the same level as it was before the nets were distributed. And all those little kids who’d been sleeping under them—now a bit older—started getting sick with malaria. Generally, malaria cases in endemic areas are concentrated in pregnant women and children under five years old. Older children and adults, having acquired some immunity to the malaria parasite, generally don’t get as sick, and few die of malaria. Except in Dielmo, where researchers were actively surveilling the population, testing people with fevers for malaria. There, most of the rebound in cases in 2010 occurred in adults and children who were 10 years old or older, suggesting that these individuals had been stripped of their acquired immunity during the years when the nets protected them from exposure to malaria. Indeed, when the researchers analyzed local Anopheles gambiae mosquitoes, they found the telltale kdr mutation, which confers resistance to pyrethroid insecticides, of the kind used in nets. The frequency of that gene in the local mosquitoes increased from just 8 percent in 2007 to 48 percent in 2010. (The nets were samples and checked for insecticidal activity and holes and the like and were found to be intact.) So, was anyone’s life saved? What was the (ahem) net effect of all those nets? For more, see: Jean-Francois Trape et al., “Malaria morbidity and pyrethroid resistance after the introduction of insecticide-treated bednets and artemisinin-based combination therapies: a longitudinal study,” The Lancet Infectious Diseases, In Press, Corrected Proof, Available online 17 August 2011, ISSN 1473-3099, DOI: 10.1016/S1473-3099(11)70194-3.