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Ten Major Threats to Global Health According to the World Health Organization

Doc Gumshoe looks at pollution, vaccination, and the WHO's priorities and plans

Way back in April 2018, the World Health Organization issued its Thirteenth General Programme of Work, which attracted a certain amount of notice at the time, but was certainly not treated as front-page news. ย  The GPW 13, as WHO called it, was centered on three ambitious targets โ€“ worthy, but in the view of many, perhaps just a trifle unrealistic. ย  Hereโ€™s how the WHO characterized their targets:ย 

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WHO dubbed their plan โ€œa set of interconnected strategic priorities and goals to ensure healthy lives and promote well-being for all at all ages.โ€ This is WHOโ€™s statement of purpose:

โ€œThe โ€˜triple billionโ€™ goal is a joint effort of Member States, WHO and other partners. WHO has a catalytic role to play in reaching the goals in GPW 13. No single actor operating alone can achieve these goals. Contributions are required from many partners โ€“ principally Member States themselves, but also non-State actors and the WHO Secretariat. Consequently, there is a need for both collective action and accountability, as well as for demonstrating the contribution made to outcomes and impact. In setting these three โ€œ1 billion goalsโ€, WHO is signaling its ambition and extending an invitation to members of the global health community to work with the Organization in order to optimize and implement these SDG-based goals.โ€

Having stated these worthy and ambitious goals, WHO turned its attention to the threats that would have to be overcome, or at least seriously addressed, to ensure healthy lives and promote well-being for all at all ages. As you will see, several of these global threats cover a number of separate individual areas.

WHO obviously ranked the threats according to the size of the population that would be affected by each threat. Thus, the report starts out with a threat (actually, two linked threats) that affect almost every person on the planet.

Air pollution and climate change

โ€œIn 2019, air pollution is considered by WHO as the greatest environmental risk to health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease. Around 90% of these deaths are in low- and middle-income countries, with high volumes of emissions from industry, transport and agriculture, as well as dirty cookstoves and fuels in homes.โ€

WHO then goes on to link air pollution with climate change, the common factor being the burning of fossil fuels. According to WHO, climate change is expected to cause as many as 250,000 deaths per year beginning about 2030.

That link is obvious, but somewhat unpersuasive from the point of view of action. Air pollution is a result of many factors that have little or nothing to do with climate change. There are many pollutants in the air that are not the result of fossil fuels, and some of these are more dangerous than the smoke emitted from the smokestacks of a coal-burning steel mill or electric generating plant, e.g., asbestos.

For example, many people in less-developed parts of the world cook over small, primitive stoves that essentially sit on the floor in poorly-ventilated huts or houses. This means that the air that these people are breathing is heavily polluted, not only with the smoke that these stoves (or sometimes open fires) generate, but by the vapors that are released from the foods that they are cooking. Currently, one of the efforts being made to lessen exposure to such pollutants is the distribution of small, efficient stoves with venting mechanisms that can be adapted to many uses.

It is possible to remove the solid particles that cause disease from the emissions from fossil fuel ignition. Removing the carbon dioxide that causes climate change is another matter altogether. A planet with minimal air pollution but undiminished carbon dioxide emissions is entirely possible. The diseases caused by air pollution would sharply drop in frequency, while the increase in global temperatures would continue.

And, on the other hand, it is also possible to imagine a planet in which carbon dioxide in the atmosphere is maintained at a constant level such that there is no increase in global temperature, but where the air is so polluted that all kinds of diseases thrive โ€“ perhaps something like Manchester, England, in the 19th century.

In short, actions to lessen air pollution will not necessarily address climate change, nor will actions to address climate change necessarily reduce air pollution.

Noncommunicable diseases

โ€œNoncommunicable diseases, such as diabetes, cancer and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people. This includes 15 million people dying prematurely, aged between 30 and 69.

“Over 85% of these premature deaths are in low- and middle-income countries. The rise of these diseases has been driven by five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution. These risk factors also exacerbate mental health issues, that may originate from an early age: half of all mental illness begins by the age of 14, but most cases go undetected and untreated โ€“ suicide is the second leading cause of death among 15-19 year-olds.โ€

The statistic that catches the attention of Doc Gumshoe in this case is the 15 million people dying prematurely, defined as between the ages of 30 and 69. The other 26 million, ages 70 and higher, might be said to have lived relatively normal life-spans โ€“ the Biblical three-score years and ten. But if those major risk factors were effectively addressed, normal life-spans could well increase, perhaps to four-score years and ten. Then, would the deaths of persons between the ages of 30 and 89 then be defined as โ€œprematureโ€?

However, no matter how a normal life-span is defined, there will always be an immense number of people succumbing to those noncommunicable diseases. Or, if not to the trio mentioned by WHO โ€“ diabetes, cancer, and heart disease โ€“ to the next killer that comes along, immortality not having been achieved by the human species, at least as of now. I am not sure whether the deaths of people who have attained a normal life-span and beyond should be considered as a global health threat.

To return to the issue of premature death, the specific risk factors mentioned by WHO certainly require action at the most comprehensive as well as individual level. Among other plans, WHO has an initiative to work with governments around the world to reduce physical inactivity by 15% by the year 2030.

I am dubious whether addressing WHOโ€™s five major risk factors would have much effect in terms of reducing or managing mental illness. In some parts of the world it is neither treated nor even recognized. Itโ€™s estimated (donโ€™t ask me how the estimators arrive at these figures) that in China alone there are about 173 million mentally ill persons, a huge majority of whom are entirely untreated. This is in part due to the stigma that accompanies mental illness. Family members of a mentally-ill person are more likely to attempt to shield that personโ€™s signs of mental illness from observation than they are to seek any kind of treatment. A child or a relative with what would be seen in other nations as clear signs of mental illness is viewed as a source of shame and hidden from observation. Much the same situation exists in other Asian nations and in Africa, with the result that treatment for mental illness is rare.

Global influenza pandemic

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โ€œThe world will face anotherย influenza pandemicย โ€“ the only thing we donโ€™t know is when it will hit and how severe it will be. Global defenses are only as effective as the weakest link in any countryโ€™s health emergency preparedness and response system.

“WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are involved inย global surveillance and response.โ€

Whether or not there is a global influenza pandemic depends on the proportion of people who have received an influenza vaccine. Of course, at present the flu vaccine is only as effective as the best guess as to which strains of the influenza virus will be the most menacing in the coming season, and, as we know, those best guesses can be considerably wide of the mark.

However, as reported in the previous Doc Gumshoe epistle, โ€œShort Bits for a Short Month,โ€ a universal flu vaccine is in the works. The maker, a UK biotech called hVivo, has just posted very positive Phase 2b results which strongly suggested that their vaccine, for now called FLU-v, would confer resistance to any strain of flu that had any one of four conserved immunoreactive regions. Since these regions are conserved regardless of whether the virus mutates, the vaccine would continue to be effective for much longer that the duration of effectiveness of the current generation of vaccines.

But even if a universal flu vaccine should become available, โ€œavailableโ€ means different things in different parts of the world. In the highly-developed world we inhabit, I would venture that a majority of the populace would be vaccinated โ€“ a larger proportion of the populace than is now vaccinated with the seasonal vaccine. But that proportion would diminish steeply in the less-developed parts of the planet.

WHOโ€™s emphasis with regard to the probability of another global influenza pandemic seems to be on response rather than prevention. That is certainly reasonable given the effectiveness of the current flu vaccines. In our part of the world, many of us get the current flu vaccine. Moreover, weโ€™re confident that if, perchance, we nevertheless contracted influenza, we have excellent doctors and hospitals standing by to restore us to health. That is not the case in many parts of the world, and WHO is rightly attempting to focus attention on that issue.

Fragile and vulnerable settings

โ€œMore than 1.6 billion people (22% of the global population) live in places where protracted crises (through a combination of challenges such as drought, famine, conflict, and population displacement) and weak health services leave them without access to basic care.

“Fragile settings exist in almost all regions of the world, and these are where half of the key targets in the sustainable development goals, including on child and maternal health, remains unmet.

“WHO will continue to work in these countries to strengthen health systems so that they are better prepared to detect and respond to outbreaks, as well as able to deliver high quality health services, including immunization.โ€

WHO lists drought, famine, conflict, and population displacement as โ€œchallengesโ€ without mentioning another issue which is strongly linked to those four challenges. That issue is population growth, which is poorly controlled in those same parts of the world, and certainly contributes to conflict and population displacement, and likely also to famine. I can certainly understand any reluctance on the part of the World Health Organization to point to population growth as an underlying cause of some of those issues, since they would then be vulnerable to the charge that they are โ€œblaming the victim.โ€ Yet several of the โ€œchallengesโ€ they cite will be difficult or impossible to meet without some form of population control.

Antimicrobial resistance

โ€œThe development of antibiotics, antivirals and antimalarials are some of modern medicineโ€™s greatest successes. Now, time with these drugs isย running out. Antimicrobial resistance โ€“ the ability of bacteria, parasites, viruses and fungi to resist these medicines โ€“ threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.

“Resistance toย tuberculosisย drugs is a formidable obstacle to fighting a disease that causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin โ€“ the most effective first-line drug โ€“ and 82% of these people had multidrug-resistant tuberculosis.

“Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement aย global action planย to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.โ€

The emergence of pathogens that are resistant to antimicrobials is not a mystery. Those nasty little microbes are simply behaving according to the principles of evolution. Like all living creatures, microbes โ€“ whether pathogenic or not โ€“ mutate as they reproduce, meaning that the offspring are not absolutely identical to the parents. Microorganisms reproduce by dividing, and making copies of the parental DNA. But those copies are not always perfectly accurate. Sometimes the errors in transcription mean that the offspring are defective, and when that happens, the offspring do not survive. But sometimes the errors in transcription give those offspring a survival advantage. Thatโ€™s what sometimes happens when the microbes are exposed to an antimicrobial. Some of the pathogenic microbes may develop a characteristic that enables them to fight off the antimicrobial. When that happens, those mutated microbes have a clear survival advantage. As succeeding generations of microbes are exposed to the antimicrobial, the microbes without that mutation get killed off, while the mutated microbes live and reproduce. Those mutated microbes may then spread to other hosts, and eventually, a new breed of microbes that are resistant to a particular antimicrobial or to a group of antimicrobials becomes a threat to the community.

There are many ways that resistance to antimicrobials occurs. It should be noted that because antimicrobial resistance is, in a certain sense, completely normal, it will continue to occur, no matter how careful we are in the employment of antimicrobials. However, there are certain actions that especially favor the creation of resistant pathogens, and those should be avoided.

One is failing to complete the full course of a prescription. When little Timmy develops a cold and is taken to the pediatrician, the pediatrician may prescribe an antimicrobial for Timmy, to be taken for a certain number of days. But then, when Timmy feels just fine after just one day on the drug, his mother doesnโ€™t give him any more pills and puts the container back into the medicine cabinet. Chances are Timmy now harbors some resistant pathogens. If Timmy had continued taking his medicine, itโ€™s possible or even likely that the resistant pathogens would also have been wiped out, because resistance is not an absolute. Sometimes it works to hit them again. However, when Timmyโ€™s mother stops the drug, the resistant little bugs live on in Timmy, perhaps doing him little or no harm. But then, in a few weeks, Timmyโ€™s grandmother comes to visit, and Timmy passes on his resistant pathogen to that enfeebled elderly lady…

Another is the indiscriminate use of a drug for prophylaxis in a large population. For example, newborns in India are routinely treated with antimicrobials, and sometimes these antimicrobials are the latest, most effective antimicrobials available, which are already being manufactured generically shortly after their introduction. In this case, the widespread use of these drugs is compensation for the inadequate sanitation that prevails, but itโ€™s hard to imagine a practice that more effectively fosters resistance to antimicrobials.

And another is the use of antimicrobials in animals, not to counter any particular disease that may affect the animals, but simply as a prophylactic measure, to keep them growing nicely for human consumption. Those antimicrobials may wind up in the food we eat and also in the water supply.

Antimicrobial resistance also threatens the development of new drugs, in a roundabout way. When a new antimicrobial is introduced, prudent medical practice may suggest that the new agent be held in reserve, as the backup drug in case the older, more widely-used drugs prove to be ineffective. Thus, a pharmaceutical company spends billions to launch a new antimicrobial only to find that it doesnโ€™t get used as a first-line drug. That discourages further development. And it doesnโ€™t help when the new antimicrobial is quickly copied elsewhere and used indiscriminately.

Ebola and other high-threat pathogens

“In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which spread to cities of more than 1 million people. One of the affected provincesย is also in anย active conflict zone.

“This shows that the context in which an epidemic of a high-threat pathogen like Ebola erupts is critical โ€“ย what happened in rural outbreaks in the past doesnโ€™t always apply to densely populated urban areas or conflict-affected areas.

“At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focused on the growingย challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a โ€œYear of action on preparedness for health emergenciesโ€.

WHOโ€™s R&D Blueprintย identifies diseases and pathogens that have potential to cause a public health emergency but lack effective treatments and vaccines. This watch list for priority research and development includes Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.”

WHO is correct when it states that the context in which these disease outbreaks occur is critical. The Ebola outbreak currently taking place in the Democratic Republic of Congo, which had resulted in 907 cases and 568 deaths by the beginning of March, has become far more difficult to treat than it otherwise could be because of the attitude of the populace in which the outbreak is happening. The outbreak is taking place is in the war-torn north-eastern part of the country, bordering Rwanda, South Sudan, and Uganda. The people in the area do not entirely understand the way Ebola is transmitted, and in particular they are unaware of the extreme danger associated with the bodies of persons who have died of the disease. They have burial customs meant to honor the spirit of the victim, and they deeply resent the interference of authorities in their carrying out of burial customs. The authorities, on their part, have little sympathy for these customs, and have developed a reputation for riding rough-shod over the locals as they impose strict sanitary rules on all matters Ebola-related, especially contact with the sick and the corpses of victims.

Thus, the aid teams are regarded as enemies by the local people, and the efforts of the aid team to curb the disease by whatever means are frustrated by the very people whom these measures are intended to help. Dr Joanne Liu, president of Doctors Without Borders, was recently quoted as saying โ€œEbola responders are increasingly seen as the enemy. In the last month alone, there were more than 30 different incidents and attacks against elements of the response. The existing atmosphere can only be described as toxic.โ€

The Ebola vaccine has helped to some degree. More than 80,000 people have been vaccinated, but aid workers have been criticized as to why some persons have been vaccinated, while others seeking vaccines have been turned away.

Aid teams may also be confused with semi-military groups that have nothing to do with fighting the Ebola outbreak. For example, in two areas of Congo, residents were barred from voting in the election, supposedly because of concerns about the spread of Ebola. However, residents of those areas concluded that being barred from voting had nothing to do with Ebola and everything to do with influencing the outcome of the election.

A similar situation obtains in Nigeria with regard to polio vaccines. Iโ€™ll describe it in detail below, when we discuss Vaccine Hesitancy, as WHO politely calls it. However, the situation in the Congo underscores the reality that combating disease is vastly different in different areas of the world, and it requires skill and understanding in many spheres besides health care.

Weak primary health care

“Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life.

“Primary health care can meet the majority of a personโ€™s health needs of the course of their life. Health systems with strong primary health care are needed to achieve universal health coverage.

“Yet many countries do not have adequate primary health care facilities. This neglect may be a lack of resources in low- or middle-income countries, but possibly also a focus in the past few decades on single disease programmes. In October 2018, WHO co-hosted aย major global conference in Astana, Kazakhstan at which all countries committed to renew the commitment to primary health care made in the Alma-Ata declaration in 1978.

“In 2019, WHO will work with partners to revitalize and strengthen primary health care in countries, and follow up on specific commitments made by in theย Astana Declaration.โ€

On this subject, Doc Gumshoe presents the seal of approval to the World Health Organization. Primary care is indeed primary when it comes to meeting the health needs of individuals anywhere in the world. A Doc Gumshoe diatribe, entitled โ€œLooking Out for Your Own Well-Being,โ€ which posted on April 20 of 2018 was dedicated to the importance of primary care. An important source for that posting was the work of an advocate for primary care named Barbara Starfield. Hereโ€™s a small quote from that piece:

โ€œThe Starfield paper reviews a colossal amount of evidence about the effects of primary care on health.ย ย  The more than six hundred references provide three types of evidence on those interrelations.

  • Studies that demonstrate that health is better in areas with more PCPs.
  • Studies that demonstrate that individuals who receive health care from PCPs are in better health.
  • Studies that demonstrate that the specific characteristics of primary care, as defined above, are associated with better health.โ€

Starfield also refers to the surprising improvements in the health of the Cuban population since the nation began emphasizing community health workers. Regardless of the many seriously negative results of the Castro regime, the Cuban health system has been a remarkable success, such that both infant mortality and life expectancy in Cuba are now superior to those health indices in most of the rest of Latin America, and nearly on a par with those in the US.

Vaccine hesitancy

“Vaccine hesitancy โ€“ the reluctance or refusal to vaccinate despite the availability of vaccines โ€“ threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccinationย is one of the most cost-effective ways of avoiding disease โ€“ it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.

Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.

“The reasons why people choose not to vaccinate are complex; aย vaccines advisory groupย to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.

“In 2019, WHO will ramp up work to eliminateย cervical cancerย worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped inย Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.โ€

WHO is pussy-footing here. Yes, it might be politically unwise to label the people who refuse to their kids vaccinated with a less flattering term, like โ€œvaccine deniers,โ€ or โ€œanti-vaxers,โ€ but thatโ€™s what they are. These folks will cite their reasons, such as the myth that vaccinations cause autism. I am not going to go into detail on that subject other than to state that the myth is founded upon a deliberate outright lie by Andrew Wakefield, a former doctor who has since lost his license for falsifying that data. Lancet, the journal in which that falsehood was published, also retracted the article in which Wakefield made that phony claim.

But vaccine deniers have a range of reasons for refusing vaccination. Some are hard to argue with, like religious objections, although as far as I know none of the major religious groups has a stated objection to vaccinations. A more general objection is that vaccines arenโ€™t 100% reliable, so why bother with a vaccine? Many of these illnesses that vaccines supposedly protect you from are no big deal, they say. Measles and mumps? An excuse to stay home from school. Besides, hardly anyone gets measles any more, say the deniers.

Up to a point, those vaccine deniers are right. Hardly anyone โ€“ in developed parts of the world โ€“ gets measles and mumps any more. Just like no one gets small pox or polio. But that isnโ€™t because the disease-causing pathogens have vanished. Itโ€™s because of a phenomenon that doesnโ€™t get much attention โ€“ a phenomenon called โ€œherd immunity.โ€ Stated simply, the fact that so many people have been vaccinated against certain diseases means that those nasty pathogens havenโ€™t found hosts. Herd immunity will protect one unvaccinated child in a classroom of vaccinated kids, and will even compensate for the incomplete effectiveness of a vaccine .

But if the percentage of the unvaccinated start to grow, that presents a risk, to the unvaccinated and the vaccinated alike. An instance of that risk has occurred in Rockland County, New York, where (as I write this) there are 156 cases of measles, in an area where measles had been eradicated. Authorities think that the origin of this outbreak was immigrants from Israel. Although there is no specific doctrinal injunction against vaccination in Orthodox Judaism, some of the adherents have an objection to vaccination and claim exemption on religious grounds. As they put it, โ€œif God wants you to get the measles, who are we to interfere?โ€

In an effort to contain the spread of this measles outbreak, Rockland County has issued a ban on unvaccinated children in all public places. This ban has been decried as being anti-Semitic. And it will certainly be difficult to enforce.

However we look at it, the measles outbreak in Rockland County underlines the difficulty facing WHO in overcoming โ€œvaccine hesitancy.โ€

Not to forget what happened to the health workers trying to vaccinate children in Nigeria a couple of years ago. They were attacked and killed by Boko Haram, based on the proclamation of a local Iman that the mission of these health workers was really to render the Muslim population of Nigeria sterile.

At least, that will not happen in Rockland County.

Dengue

“Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades.

“A high number of cases occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease.

“An estimated 40% of the world is at risk of dengue fever, and there are around 390 million infections a year. WHOโ€™sย Dengue control strategyย aims to reduce deaths by 50% by 2020.”

Mosquito-borne diseases are a major threat to people almost everywhere on Planet Earth, and climate change will put billions more at risk for these diseases. Dengue is just one of the many diseases carried by mosquitoes, which have been characterized as the creature most dangerous to the human race. Others include malaria, West Nile virus, chikungunya, yellow fever, filariasis, tularemia, and several types of encephalitis, among others. More recently, Zika has come under the spotlight as a threatening mosquito-borne disease.

WHOโ€™s statement about Dengue gives precious little information about how, exactly, are they planning to reduce deaths by 50% by the year 2020. Or is that just an โ€œaim?โ€

Some of the proposals regarding control of mosquito-borne diseases are ingenious, but a bit far-fetched, in my view. One of them is to introduce a strain of genetically-engineered mosquitoes that would breed infertile offspring, so that eventually, the entire mosquito population would become infertile and die out. Another is to figure out how mosquitoes detect humans by their smell, and generate something that foils that means of detection. As my sainted mother used to say, โ€œWeโ€™ll just have to wait and see.โ€

HIV

“Theย progress made against HIVย has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment), and providing access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection).

“However, theย epidemic continuesย to rage with nearly a million people every year dying of HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died. Today, around 37 million worldwide live with HIV. Reaching people like sex workers, people in prison, men who have sex with men, or transgender people is hugely challenging. Often these groups are excluded from health services. A group increasingly affected by HIV are young girls and women (aged 15โ€“24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite being only 10% of the population.

“This year, WHO will work with countries to support the introduction of self-testing so that more people living with HIV know their status and can receive treatment (or preventive measures in the case of a negative test result). One activity will be to act on new guidance announced In December 2018, by WHO and the International Labour Organization to support companies and organizations to offer HIV self-tests in the workplace.”

HIV is now eminently treatable. Most recently, a study has reported that monthly injections treat HIV as effectively as daily pills. The proponents of this treatment suggest that showing up at a clinic once a month for a shot is more private than picking up your supply of HIV medications at your local drugstore. Whether true or not, this is one more step in bringing a deadly infection under control. The injections combine two drugs โ€“ rilpivirine (Edurant, from J&J) and ViiV Healthcareโ€™s cabotegravir. Also, you may have read that for the first time, a patient with HIV has been completely cured. As it happens, he received a bone-marrow transplant from a donor who was totally immune to HIV, so that particular treatment modality isnโ€™t going to be an option for most people with HIV.

And HIV can be quite effectively prevented, through what is known as pre-exposure prophylaxis, or PrEP. About 380,000 people globally are on PrEP, mostly in North America.

The differences in HIV prevalence around the world are colossal. Of the more than 37 million people infected with HIV on the planet, nearly 23 million are in sub-Saharan Africa, the largest concentration being in the southern tip of the African continent. In Botswana, for example, 22.8% of the population between 15 and 49 was infected with HIV. In South Africa, that proportion was 18.8%. Those proportions in Europe, North and South America, and most of Asia were around 1%.

A principal obstacle to the treatment of HIV is cost. In more developed areas, ways have been found to provide HIV medications to many people who would otherwise not be able to afford them. In spite of the efforts of WHO and other international organizations, getting HIV treatment to persons in the less-developed part of the world has proved to be extremely difficult, primarily because of cost.

Another obstacle to treatment is the stigma attached to HIV. In some countries, admitting to being HIV-infected is tantamount to admitting to being homosexual, which is unacceptable in many places. Therefore, HIV-infected persons are more likely to keep their condition secret, and also more likely to spread the disease to others.

One of the obstacles to treating HIV in the regions where it is most prevalent is that in those same regions, the general conditions of life are far from optimal, to say the least. Poverty, sometimes extreme poverty, is common. And the view of the populace is frequently antagonistic to health-care workers who are focusing their attention on one particular disease that may preferentially affect a segment of the populace that the majority holds in low regard. So, a not uncommon reaction is, โ€œWhy are you bothering with those no-goods when the rest of us, upstanding members of our community, are also in need of medical attention?โ€

The challenges to WHO in this particular endeavor are enormous. Itโ€™s almost an understatement to call them challenges. Obstacles might be a better word. WHO is certainly to be commended for taking them on.

* * * * * * *

At my college reunion back in 2004, I heard Kofi Annan (then the UN Secretary General) proclaim that it was the plan of the United Nations to end global poverty by the year 2015. The statement elicited applause, but at the same time, expressions of skepticism. Your friend Doc Gumshoe feels the same way about WHOโ€™s โ€œtriple billion goal.โ€ I am not sure whether to bow my head in admiration of the WHO program or lift my eyebrows in skepticism. Perhaps a little of both.

It is certainly true that the health problems facing us are global and need a global approach. My skepticism is primed by the sense that a major part of that global approach is lacking in specifics. Their somewhat grandiose โ€œtriple billion goalโ€ seems meant to get the politicians on board. And indeed, the politicians have to be gotten on board for anything major to be accomplished. But a huge part of the work has to be carried out with a much more granular focus โ€“ not only on the diseases that threaten global health, but on the people threatened by those diseases.

So Iโ€™m tossing this out to you, esteemed denizens of Planet Gumshoe. Tell me what you think. What should we โ€“ can we โ€“ actually do? Very best to you all, Michael Jorrin, (aka Doc Gumshoe)

[ed note: Michael Jorrin, who I dubbed โ€œDoc Gumshoeโ€ many years ago, is a long-time medical writer (not a doctor) who opines on topics in health and medicine for our readers a couple times a month. He does not typically discuss investments directly, but has agreed to our trading rules. All of hisย past columns and commentary can be found here.]

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hedy1234
hedy1234
April 2, 2019 11:53 am

IMO

1. We should insist on children being vaccinated in order to gain admittance to PUBLIC schools. Not vaccinated, then learn at home or go to private schools.

2. We should insist on all immigrants being vaccinated as a condition of entry into this country.

3. Employers should be allowed to discriminate in hiring if you cannot prove you have been vacinated.

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2getrisbetr
2getrisbetr
April 2, 2019 12:38 pm
Reply to  hedy1234

It makes sense that the outbreak of measles in California would somehow be connected to not inoculated coming across the border.

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money tree
money tree
April 4, 2019 9:20 pm
Reply to  2getrisbetr

Oddly, it is usually upper middle class parents who at private schools and charter schools who get exemptions for their kids from vaccines. Their are lots of studies about this phenomena lately. I live in such a region with a high lack of vaccinations and we have had lots of whooping cough outbreaks.

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viktor69
Irregular
April 6, 2019 12:22 pm
Reply to  money tree

I’ve been vaccinated against whooping cough when I was a kid but still got it last year (at 48 years of age), apparently the vaccine wasn’t for life or provide 100% protection. Due to an initial misdiagnosis in Boston have taken antibiotics quite late and have suffered for almost 6 months

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Stan
Stan
April 2, 2019 12:41 pm
Reply to  hedy1234

Re 2. I believe there already are vaccination requirements for immigrants. When I immigrated from U.K. in 1952, it was smallpox, TB, and a few others I donโ€™t remember

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Ken Shonk
Member
Ken Shonk
April 2, 2019 5:44 pm
Reply to  hedy1234

Your proposed actions are a violation the Nurenburg Code of 1948 to which the USA is signatory. Since no vaccine has ever undergone a double blind placebo controlled trial with a blank placebo (comparison to another vaccine does not qualify) or involve following the health outcomes for more than a year (several for no more than one day while other FDA approved medication typical involve 3-6 year schedule of trial with an inert placebo), or had the long term health consequences of a vaccinated population compared to the hearth outcomes of a healthy unvaccinated population, all vaccines are experimental under the Nuremburg Codes standards. Ah, yes the CDC says vaccines are Safe and Effective. If you repeat the mantra often enough (as per Goebels), most, including you, will believe it. It the mantra is true, then why did the Supreme Court rule in 2011 that vaccines are “unavoidably dangerous” and why did Congress in 1986 and the Supreme Court in 2011 extend complete immunity to vaccine manufacturers and why has the Vaccine Court paid out $4 billion in vaccine injury claims, and why, last year, were there nearly $1 trillion in compensation claims filed with the Vaccine Court, and why NIH failed to file, ever since 1986, any why does VAERS report 420 dealths related to the flu vaccine; and why did a recent peer review publication (April, 2018) demonstrate that in young women aged 30-35 vaccinated with the HPV vaccine have increases in cervical and other cancer rates relative to previous cancer rates in this population group, and why are the SIDS rate of the US the highest in the developed world, and why is the USA 78th in the world in the death rate of women in the one year following birth, and if vaccines have had children in the USA healthy, why do 54% of those under 18 in the USA have a chronic health condition that is likey to be life-long; why did 54% of the freshman class entering Emory University have chronic health conditions with chronic gastrointestinal problems, autoimmune diseases, and diabetes the most common; why does the HepB vaccine given to infants in their first hours contain 200 mcg of aluminum (the same as the adult HepB vaccine) rather than a dose that is adjust for the average baby’s body weight (assuming a 3.0 kg average birth weight, 200 mcg is 66x the EPA limit for intraperidonally administered aluminum – a known neurotoxin that in industrial exposures is linked to nervous system demylinating disorders and for which high levels have been found in exploratory small samples of autistic children’s, Parkinson’s patients, and multiple schlerosis patients). Please read Dr. Yehuda Schoenfelds’ book “Vaccines and Autoimunity” or the recently published book “Aluminum Toxicity”. Your ignorance is showing as is Doc Gumshoe’s. So on a more personal note, my spouse who has MS, got the flu shot on her doctor’s recommendation and over my objections. As a consequence she develop a severe skin itch (no rash) which which compels her to scratch until she bleeds – yes one of the class of people Dr. Schoenfeld recommends not get vaccines is people with existing autoimmune conditions and those with low Vit D levels (probably 30% or more of the US population and 90+% of the US population of sub-Saharan African origin). She has both. I challenge you to educate yourself, and just reading CDC and NIH mantra publications doesn’t represent an “education”. There ara at least 157 peer-reviewed scientific publications linking vaccines with autism alone though the most common adverse reactions are gastointestinal issues. Just remember only 1% to maybe 10% of adverse vaccine reactions more severe than injection site reactions are reported to VAERS. This means that there have been at least 4250 deaths related to the flu vaccine, possibly as many as 42,500.

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terry christenson
Guest
terry christenson
April 2, 2019 10:35 pm
Reply to  Ken Shonk

KS- Thank you for the summary of evidences concerning the more negative side of vaccinations. Such presentations are all too rare.

robbie
Guest
robbie
April 3, 2019 12:17 am
Reply to  Ken Shonk

I don’t understand why there has to be forced vaccinations instead of individual choice. If vaccines are so effective, then why are the vaccinated so afraid of those who are not vaccinated. Each side can take their own risks.

ET69
Member
ET69
April 7, 2019 12:50 pm
Reply to  robbie

Did you read Doc Gโ€™s answer ? โ€œHerd immunityโ€

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Ray
Member
Ray
April 7, 2019 2:32 pm
Reply to  ET69

You don’t get “herd immunity” from vaccines. ONly from exposure to the germ, for multiple reasons. Look up the data; not, Opinion, which is most often not given for free… & for sale to the highest bidder…

storm
April 12, 2019 9:43 am
Reply to  robbie

One could make the same argument about requiring seat belt use. We all pay for your freedom to allow your head to go through the windshield with increased insurance costs and taxes to support you in your disability.

With the benefits so great and the risks so low, any thinking person would volunteer for vaccination. Unfortunately, simple statistics are beyond many people.

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Ray
Member
Ray
April 12, 2019 2:42 pm
Reply to  storm

Unfortunately, you give no “data”, only “opinion”. If your opinion is correct, “informed” consent (read: Package insert & Federal Vaccine court findings…) will lead to intelligent action… Why is the vaccination rate lowest in places like “los Alamos” with the highest population with advanced degrees (PHD,s…)?

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markmhere
Irregular
markmhere
April 5, 2019 9:30 am
Reply to  Ken Shonk

Ken Shonk, your response is very informative! Are you in the medical field ?

Juan Villegas
Guest
Juan Villegas
April 7, 2019 8:03 am
Reply to  Ken Shonk

Dear Kenk,

You are citing several publications, would you care to either share a link or share a better citation (authors and year) so that we can analyze value of such sources.I am afraid that your initial affirmation is profoundly wrong, not only there are such randomized trials (but with and without placebos, since for a good part of time you could inoculate viruses to persons during trials), but they have been carried in different sectors of population to account for different features, both genetic and fenotypic. Here-under you can find some studies that show very broadly how:

For starter have a read of the 18th century studies of Sir Edward Jenner on Small Pox:
http://www.gutenberg.org/files/29414/29414-h/29414-h.htm
You ll see how he actively carried random control trials, that is effectively inoculating patients with small pox to prove his point.

Or check the text of Voltaire about the development of inoculation of Smallpox by the Circassians. http://www.circassianworld.com/new/history/miscelleneous/1202-circassian-medicine.html

Now more modern ones, this here is for Measles testing between twins:
https://www.ncbi.nlm.nih.gov/pubmed/2871241

This one is for rubella on seronegative women
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)12031-6/fulltext

If you don’t trust the US medical publications, try visiting studies from the Tropical Disease Institute in Antwerp, or just try any European medical society. Don’t trust them, check studies from the National University of Mexico or from any part in Latin America, plenty of vaccines especially for tropical diseases have been developed there. Don’t trust them either, check anywhere else about vaccine research, just make sure to google “vaccine research” not “vaccine conspiration”.

Also your number on publications is wrong, there is only 1 peer reviews publication that effectively links vaccination with autism and their results haven’t been able to be recreated by peers in other labs (also the paper was withdrawn after some years). By 2009 at least 20 independent peer reviewed studies had studied the relation between vaccines and autism finding no possible correlation between them.
https://academic.oup.com/cid/article/48/4/456/284219

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ET69
Member
ET69
April 7, 2019 1:00 pm
Reply to  Ken Shonk

You make the classic mistake of thinking that correlation = causation…..it does not.
Example, If there are more accidents when butterflies are in abundance. Do butterflies cause accidents?

storm
April 12, 2019 9:30 am
Reply to  Ken Shonk

Ken,
You have obviously spent a great deal of your life’s capital coming to your position that the moneygrubbing medical establishment is intent on removing your personal choices to their financial gain. Or perhaps to demonstrate their power over you. You are obviously young and sure in your evaluation of the situation. Since there is a remote possibility you are capable of considering that there is another possible explanation, I will offer you two examples. Growing up in the fifties, one of the real fears was contracting polio. Watching someone living in an iron lung because they were incapable of breathing for themselves or walking with crutches because their deformed legs could not support their body was enough to instill fear. You have been spared this experience because Dr. Salk’s vaccine pretty well eliminated the threat of polio. I suppose you could argue that some people getting polio was somehow a positive thing but I saw it as devastating.
My wife spent her career in deaf education. Deafness can be a result of the fever attending measles and mumps. She observed a marked reduction in the deaf population over her tenure partly due to the eradication of mumps and measles. Again, you can debate the value of reducing the number of deaf people. Perhaps you think that more people consigned to the silent world is a good thing.
There is a risk involved in receiving immunizations. My granddaughter was one of those with a violently negative reaction. I feel that the negative experience of a few is far outweighed by the benefits to the multitudes. If you are not aware of the consequences of the diseases being protected against, then you will feel that you deserve the right to experience them firsthand. Invoking the Geneva conventions is a stretch.

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Ray
Member
Ray
April 12, 2019 11:27 pm
Reply to  storm

I hope you are aware that the first Polio vaccine was outlawed in multiple states (of USA) because it caused so much Polio… I suspect you are not aware of the many Polio victims who were cured through administration of enough ascorbate (vitamin C)…. Of course hundreds of times the RDA would have no notable effect on any illness… Thousands of times the RDA is a start… (easily attained by intravenous administration, as discovered by NIH when they found it caused apoptosis of human cancer cells & no harm to normal human cells… decades ago & published 1 time in the NY times back then… Data, not opinion…

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sbb
Member
sbb
April 3, 2019 2:39 pm
Reply to  hedy1234

re (3.)-
How about allowing, in states legal, for a job candidate to test positive for cannabis, if they can show they’ve been vaccinated?
Some small incentive/positive reinforcement for the fringe to come out of the cold, and it would get cannabis users to visit a Primary Care facility for a check up.

alf
Member
alf
April 2, 2019 12:33 pm

WHO shot themselves in both feet on item number 1. Global ‘warming’, ‘change’, ore whatever has absolutely no scientific evidence that man is doing anything at all. Global ‘warming’, ‘change’ etc has been scientifically wrought by political shenanigans to ‘make the data fit’. Look to all the third world nations that are doing the thumping on drums to get YOUR money. OH Yeah, I forgot to mention that ALGORE is of the ‘religion’ of everything south of the border so is hitting the drum too, and getting more wealthy.

big tuna
April 2, 2019 12:50 pm

Ever speak with an antivaxer- they hop right to freedom of choice (strange how this same group doesn’t have same opinion on abortion and don’t believe in medicare for all, that’s some kind of socialist plot from Comrade Sanders). Dont even speak about flourinated water….

I have heard some different vaccination strategies for young children:
1. space out the vaccines so all not @ one time
2. go to a high turnover vaccination site to avoid thimersol preservative or ask if they have thimersol free vaccines

As far as genetically causing extinction of a species I’m always kind of hesitant to the chain reaction of unanticipated consequences. Road to hell paved with good intentions.

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Ken Shonk
Member
Ken Shonk
April 2, 2019 6:01 pm
Reply to  big tuna

Fluorine is a known neurotoxin as well as a bone toxin and is linked to osteosarcoma. Teeth are made of hydroxyapatite, not fluoroapatite. Even when fluoride is available, the body makes hydroxyapatite to mineralize teeth. Fluoride, however, disrupts iodine metabolism and when the thyroid make T4 and T3 containing fluorine/fluoride (or bromide/bromine) instead of iodide, the hormone fails to work as it is suppose to. Rampant hypothyroidism in the US even when TSH is normal is the consequence. Your ignorance of nutritional chemistry is appalling never mind that a fluoridated water supply is a violation of the Nurenberg Code of 1948 since there is no informed consent. Futher, the original tests of a fluoridated water supply were made with the addition of fluoride as sodium fluoride. Current practic uses fluorosilicic acid for which there have never been any studies so that is FDA violation. In addition, there is no quality control of this chemical, most of which is imported from China and likely contaminated with toxic metals as are much of the food, drug precursor chemicals, and supplements imported from China.

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docdill
docdill
April 3, 2019 12:11 am
Reply to  Ken Shonk

Oh NO

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big tuna
April 3, 2019 9:24 am
Reply to  Ken Shonk

I’m ignorant and I vote- gotta love this country.

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Jim Thomas
Guest
Jim Thomas
April 2, 2019 8:50 pm
Reply to  big tuna

“antivaxer- this same group doesnโ€™t have same opinion on abortion and donโ€™t believe in medicare for all, thatโ€™s some kind of socialist plot…”
Just for the record, here in Canada we have our share of “antivaxers” but we have no laws concerning abortion (they couldn’t agree on any acceptable compromise, so gave up trying years ago) and we certainly have medicare for all at no charge to the patient, ever.
Just to clarify.

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steve
Member
steve
April 2, 2019 12:55 pm

WHO has also said that stress is “the health epidemic of the 21st century.”

David Spader
Guest
David Spader
April 7, 2019 9:50 pm
Reply to  steve

Is there a vaccination for that?

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Tom M
Member
Tom M
April 2, 2019 2:02 pm

Well, lets just bury the stats on vaccines and believe they cause no harm. Do you know that if your child dies shortly after being vaccinated, and being otherwise healthy, that the medical system will refuse to do a check for any problems with vaccines during an autopsy? How is it that there were many diseases from the 1600’s-1800’s that virtually disappeared and there were no vaccines for them? As living conditions improved, so did health. How come Big Pharma doesn’t allow anyone to debate the vaccine issue? Are they always right about every drug they produce and sell? Hardly. So if your child happens to be vaccinated, and you believe it will protect them, they why do you care if there are children who are not vaccinated? There would be no threat to your children. Anti-vaxxer all the way and it should be the parents choice and responsibility they accept. Like the liberals always say, free choice is what we’re all about. Hmm.

As to several outbreaks of measles, in some cases 30% of those who got sick was from having the vaccination itself. No one ever will say that. It’s always that there is an epidemic of some kind so that Big Pharma can rush in the vaccines. Worldwide flu epidemics? More fear mongering to get people to rush out and get poked.

As to countries with sick and poor, just look to the governments and the power hungry leaders of those countries. Venezuela is the perfect example with a socialist government which treats the people like dirt. That country is sitting on one of the largest oil reserves in the world which if allowed to be further developed could mean an influx of wealth to the country.

Climate change…we have it every single day. Better hope it isn’t a cold spell we are in for over the next few decades because then you will have millions of deaths because of food shortages.

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pretax
pretax
April 2, 2019 4:46 pm

I know little about any of this but kudos to you for separating conservation and climate change!

Ken Shonk
Member
Ken Shonk
April 2, 2019 4:57 pm

Climate change? The earth’s climate has always changed, sometimes very rapidly. For example, there was a 4 year period duaring the Younger Dryas when the global mean temperature as indicated by oxygen isotopes in the Greenland ice cores warmed by 4deg C – this was due to the burning of fossil fuel? Yes, of course according to WHO’s logic. The real control on global climate change are changes in the ozone layer, in particular depletion both natural (passive vs explosive VE>5 volcanism and solar proton events (solar flares)) and now man caused (CFC’s). CO2 has little impact at current levels. Phanerozoic CO2 levels have been as high as 7000 ppm (current 405 ppm, 1850 281 ppm) and as low as 180 ppm (plants die below 130 ppm so higher life on earth narrowly missed extinction at least once). CO2 is essential to the survival of most carbon-based higher life forms. Current CO2 levels are close to the lowest they have ever been. Several recent studies have indicated that instead of increased desertification, the increased CO2 levels have resulted in a 10% to 15% increase in the earth’s biomass and in agricultural productivity. If CO2 level are pushed back to 281 ppm, food production will drop 10%, potentially leading to mass starvation of 700,000,000 people. First rule of populations is: The population expands (and contracts) with the available food supply (ie. Ireland and the potato faminea or Grand Canyon deer popultions in the 1920’s as examples). Please go to:WhyClimateChanges.com for the real story from Dr. Peter Langdon Ward (USGS retired) for some real science.

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Rich
Rich
April 2, 2019 7:20 pm

I agree with much of Ken Shonk’s p0stings. I am not anti vaccination but feel a more rational approach is needed–not the recommended 69 shots by age 18!
Big Pharma must be fearful or very greedy by pushing for such heavy handed laws being proposed in requiring vaccinations. We need to very careful in protecting our individual freedoms in this area. Let’s not let this be another lost freedom.

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docdill
docdill
April 3, 2019 12:09 am

Thank you on agreeing that climate change is multifactorial,

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Derek Hasdell
Guest
Derek Hasdell
April 3, 2019 9:06 am

Huh.No mention of radio isotopes dusting the air land and water, progressively depleting our biosphere which keeps us alive.
No mention of toxic food additives or glycophosphate;
and of course no mention of Agenda 21,depopulation.
Insect dies offs, less pollination of the food plants, equates
food shortages,riots and war…hey and for the kicker why not add 5 G,gaurenteed to bust the bonds of the amino acid chains in our dna.

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Braulio
April 3, 2019 9:38 pm

So, we have doc gumshoe and stock gumshoe. I just grasped this. Was wondering how Travis had such a good handle on medical topics. Iโ€™m slow I guess. Thoughts on GH as an Investment?

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Ray
Member
Ray
April 4, 2019 12:29 am

How do you dismiss the statements & documentation provided to Congressman Posey, by Dr. William Thompson of the CDC? Very similar to the Tuskegee experiment; where up until a few decades ago, the same CDC prevented Black men from receiving life-saving syphilis treatment till death. Of course the difference this time is black boys under 36months are the victims, & there is a cover-up this time as the Dr. (still at he CDC) testifies. I guess it is less OK to discriminate this century.

Earnest
Member
Earnest
April 7, 2019 12:46 pm

When it comes to healthcare and primary care in particular I as a retired healthcare professional have only one prescription. SOCIALISM. We need to nationalize the entire health, (sic) care system and that means Big Pharma, Insurance Companies and Hospitals et al.
Since these institutions have already made billions ,(or trillions?), on the people of this earth I say nationalize them WITHOUT compresation. Health care should be a โ€œRightโ€.

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mblauvelt
mblauvelt
April 10, 2019 10:55 pm

Worth reading:
Immunologist Tetyana Obukhanych: Unvaccinated Children Pose โ€œNo Extra Danger to the Publicโ€
https://thinkingmomsrevolution.com/an-open-letter-to-legislators-currently-considering-vaccine-legislation-from-tetyana-obukhanych-phd-in-immunology/

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