Banana vendors in Chennai, South India. Credit: McKay Savage/CC-BY-2.0

India’s environmental and food security activists who have so far succeeded in stalling attempts to introduce genetically modified (GM) food crops into this largely farming country now find themselves up against a bill in parliament that could criminalise such opposition.

“Popular opposition to the introduction of GM crops is the result of a campaign launched by civil society groups to create awareness among consumers,” said Devinder Sharma, food security expert and leader of the Forum for Biotechnology and Food Security. “Right now we are opposing a plan to introduce GM bananas from Australia.”

Sharma told IPS that if the BRAI bill becomes law such awareness campaigns will attract stiff penalties. The bill provides for jail terms and fines for “whoever, without any evidence or scientific record misleads the public about the safety of organisms and products…”

Suman Sahai, who leads ‘Gene Campaign’, an organisation dedicated to the conservation of genetic resources and indigenous knowledge, told IPS that “this draconian bill has been introduced in parliament without taking into account evidence constantly streaming in from around the world about the safety risks posed by GM food crops.”

She said that Indian activists are now studying a new report published in the peer-reviewed Organic Systems Journal by Judy Carmen at Flinders University in Adelaide, Australia, showing evidence that pigs fed on GM corn and soy are likely to develop severe stomach inflammation.

“The new bill is not about regulation, but the promotion of the interests of food giants trying to introduce risky technologies into India, ignoring the rights of farmers and consumers,” Sahai said. “It is alarming because it gives administrators the power to quell opposition to GM technology and criminalise those who speak up against it.”

The past month has seen stiff opposition to plans to introduce GM bananas into India by a group of leading NGOs that includes the Initiative for Health & Equity in Society, Guild of Services, Azadi Bachao Andolan, Save Honey Bees Campaign, Navdanya and Gene Ethics in Australia.

These groups are seeking cancellation of a deal between the Queensland University of Technology (QUT) and India’s biotechnology department to grow GM bananas here.

Vandana Shiva, who leads the biodiversity conservation organisation Navdanya, and is among India’s top campaigners against GM crops, told IPS that such food crop experiments pose a “direct threat to India’s biodiversity, seed sovereignty, indigenous knowledge and public health by gradually replacing diverse crop varieties with a few patented monocultures.”

She fears that an attempt is being made to control the cultivation of bananas in India through patents by “powerful men in distant places, who are totally ignorant of the biodiversity in our fields.”

India produces and consumes 30 million tonnes of bananas annually, followed by Uganda which produces 12 million tonnes and consumes the fruit as a staple.

India’s National Research Centre for Banana (NRCB), which has preserved more than 200 varieties of the fruit, is a partner in the GM banana project. Others include the Indian Institute of Horticulture Research, the Bhabha Atomic Research Centre (BARC) and Tamil Nadu Agricultural University.

With so much official involvement there are fears that GM bananas may eventually find their way into nutrition programmes run by the government. “There is a danger that GM bananas will be introduced into such programmes as the integrated child development scheme and the midday meals for children,” Shiva said.

India’s Integrated Child Development Services (ICDS), the world’s largest integrated early childhood programme, began in 1975 and now covers 4.8 million expectant and nursing mothers and over 23 million children under the age of six. Bananas are included as part of the meals served in many of the 40,000 feeding centres.

QUT’s Prof. James Dale, who leads the project, has, in interviews given to Australian media, justified the GM experiment by saying that it will “save Indian women from childbirth death due to iron deficiency.”

According to studies conducted by the International Institute for Population Sciences in Mumbai, more than 50 percent of Indian women and more than 55 percent of  pregnant women in India are anaemic. It is estimated that 25 percent of maternal deaths are due to complications arising out of anemia.

In a Mar. 9, 2012 interview with the Australian Broadcasting Corporation, Dale said, “One of the major reasons around iron is that a large proportion of the Indian population are vegetarians and it’s very difficult in a vegetarian diet to have intake of sufficient iron, particularly for subsistence farming populations.

“India is the largest producer of bananas in the world but they don’t export any; all of them are consumed locally. So it’s a very good target to be able to increase the amount of iron in bananas that can then be distributed to…the poor and subsistence farmers.”

Dale denied in the interview that there were risks to existing Indian banana strains and said because bananas were sterile there is no danger that the genes being introduced will enter and destroy other varieties.

But experts like Shiva have challenged Dale’s claim. She said Australian scientists are using a virus that infects the banana as a promoter and that this could spread through horizontal gene transfer.

“All genetic modification uses genes from bacteria and viruses and various studies have shown that there are serious health risks associated with GM foods,” she stressed, adding that there are safer, cheaper and more natural ways to add iron to diets.

India is the world’s biggest grower of fruits and vegetables with many varieties naturally rich in iron. “Good sources of dietary iron in India included turmeric, lotus stem, coconut, mango (and) amaranth…there is no need to genetically modify banana, a sacred plant in India,” she said.

Attempts by IPS to contact Dale directly and separately through QUT’s press relations department on the risks from horizontal gene transfer and the possible danger to public health failed to elicit any response.

According to Shiva there is a concerted move by food corporations to control important food crops and staples in their centres of origin. “We have seen GM corn introduced into Mexico and there was a determined attempt to introduce GM brinjal in India.”

In February 2010, the then minister for environment, Jairam Ramesh, ordered a moratorium on the brinjal project and his action was seen as a major blow to the introduction of GM food crops in India.

“If the new bill is passed, we could have a reversed situation and projects like GM bananas will be quickly cleared with the backing of the government – and it will only be a matter of time before India becomes a GM banana republic,” Sharma said.

The Supreme Court found naturally occurring segments of DNA "not patent eligible" on Thursday. Credit: Phil Roeder/CC by 2.0

The nine judges of the U.S. Supreme Court ruled unanimously Thursday that naturally occurring DNA, including component parts of that genetic material, cannot be patented.

The decision overturns three decades of practise to the contrary by the U.S. Patent and Trademark Office.

Health and civil liberties groups are celebrating the unusual unanimous ruling, as are consumer protection advocates.

Although the case dealt specifically with questions regarding the “isolating” of genes within the human genome, the judges did not limit their decision to human genetics, meaning the case will have an effect throughout the biotechnology industry.

“A naturally occurring DNA segment is a product of nature and not patent eligible merely because it has been isolated,” Justice Clarence Thomas wrote in the court’s final opinion.

He noted that U.S. patent legislation “permits patents to be issued to ‘[w]hoever invents or discovers any new and useful…composition of matter,’ but ‘laws of nature, natural phenomena, and abstract ideas’ ‘are basic tools of scientific and technological work’ that lie beyond the domain of patent protection”.

The court did, however, leave open the possibility of patenting synthetic or “complementary” DNA, artificial copies of DNA that are either separated or constructed in a lab and allowed to evolve on their own.

The biotech industry has long argued that stringent patent protection is needed for companies to feel comfortable spending the significant capital required to fund related research and development.

Others have suggested that allowing such patenting actually quashes innovation by limiting competition, while also pointing to the significant federal money that is often available for such research.

Still, the ruling will likely affect and potentially void thousands of patents on “isolated” genetic material taken out over the past decade or more, though experts say the legal process will now be required to move through each patent on a case-by-case basis. Isolated DNA is genetic material excised from chromosomes but not otherwise altered.

According to current estimates, about 40 percent of the human genome is currently covered in some way by patents.

Product of nature

“The court’s decision today represents a straightforward application of the ‘product of nature’ doctrine, which holds that a product of nature cannot be patented,” Sandra Park, a senior staff attorney with the American Civil Liberties Union (ACLU), a watchdog group, told reporters after the ruling.

“Maybe a product required great ingenuity to discover, but a product of nature needs to remain as part of the storehouse of knowledge.…This is a simple question but with profound consequences, and from our perspective this ruling is a victory.”

The ACLU has been involved in this case since 2009, when it helped bring a lawsuit on behalf of plaintiffs suffering from breast cancer who found themselves at the mercy of a U.S. company that had patented two genes linked to breast and ovarian cancer. Researchers working for that company, Myriad Genetics, isolated those genes and then developed tests for mutations based on the research.

“These patents here tied up all uses of those particular genes, so if you found a better way to do this testing, you couldn’t do it,” Jaydee Hanson, a policy analyst at the Centre for Food Safety, a Washington advocacy group, told IPS.

“In that way, this is a revolutionary change, and makes clear that the U.S. Patent Office has not understood what the Constitution says as relating to the patenting of naturally occurring things. This is very important, and we will be working hard to disallow Congress from trying to pass any new law suggesting that you can indeed patent DNA.”

In the initial lawsuits, plaintiffs argued that Myriad was able to charge exorbitant prices for the tests and that its patents disallowed competing labs from working with those genes in any way.

“Genes are not being held hostage by private corporations any longer,” Lisbeth Ceriani, a breast cancer survivor and original plaintiff in the case, told reporters Thursday.

“If you’ve been adopted or don’t know your medical history – say, if your parents are from other countries – up until today Myriad had been able to design the criteria for who should take their test, as opposed to doctor or patients. So I’m incredibly relieved, as something that’s been going wrong for more than a decade has finally been corrected.”

Moral obviousness

Medical experts are suggesting that the court’s decision will now have an immediate impact on public health, given that Myriad’s methods – and similar research based on isolated DNA – will be able to be put into broad clinical practice and subjected to further study.

Yet the implications of the ruling will almost certainly be felt beyond the confines of human health.

“Part of the significance of this ruling is that the judges did not specify that the decision applies only to human DNA, so this will now cover the whole range of DNA,” the Centre for Food Safety’s Hanson says.

“Many of the patents out there today are of other mammals, animals, plants and microorganisms. In fact, we’ve recently seen some decline in the number of human patents being issued, but large numbers of other patents are still being issued.”

He also notes that the decision has brought the United States somewhat more in line with legal precedent on this issue elsewhere, particularly in Europe.

“European patent law has set morality as a standard, so some countries have made restrictions on what is patentable gene sequence because it might be immoral to exclude people from being able to engage in certain testing or research,” he says. “In effect, the court has come down on the side of both the U.S. Constitution and moral obviousness.”

Still, those on the losing side of Thursday’s decision are suggesting that they are relieved the ruling did not go farther.

“I’m not fully happy with opinion, but it could have been much worse,” Greg Dolin, a co-director at the University of Baltimore School of Law’s Center for Medicine and Law who formally supported Myriad Genetics in the case, said in a press conference hosted by the Federalist Society, an association of right-wing attorneys.

“Luckily, the court did not undercut the biotechnology industry,” Dolin said. “It took a cautious step, but ultimately didn’t do too much damage – though that remains to be seen, in how the decision is applied to future cases.”

Jordi Muñoz began building drones as a hobby in 2007 and is now a founding partner of a fast-growing company in the field. Credit: Courtesy of Jordi Muñoz

Unmanned aerial vehicles (UAVs), better known as drones, have earned a bad reputation due to their controversial use by the United States in its “war on terrorism”, yet they have almost unlimited potential as tools for scientific research.

The word “drone” is most commonly associated with the remotely piloted and heavily armed aircraft that are used by the United States to strike down suspected terrorists, but have also caused a great many civilian deaths in countries like Afghanistan, Pakistan, Somalia and Yemen.

However, more than 40 countries around the world either deploy or manufacture drones, according to reports consulted for an article published by IPS.

These unmanned airplanes and helicopters are used for such diverse purposes as drawing maps, exploring the ocean floor, measuring temperature or pollution levels, monitoring weather phenomena, and the surveillance of high-risk areas or archaeological sites.

Last month, the U.S. space agency NASA sent drones into the plume of the Turrialba volcano in Costa Rica to study its chemical composition.

“The technology is emerging, the first applications have just barely begun. Society itself has learned to accept drones beyond their military uses, because they have seen the different ways they can be used. It’s just a matter of time” until they become more widely developed and used, said young Mexican entrepreneur Jordi Muñoz, co-founder of 3D Robotics, a pioneer in the manufacture of drones in Mexico.

His story mirrors the evolution of drones, which he began to build in 2007 with the help of 500 dollars provided by U.S. physicist Chris Anderson.

“He gave me the money purely on trust. It was the best 500 dollars I ever invested. I decided to build a drone. I was developing the automatic pilot and I went on Google to look for information when I came across a forum. I went in, registered, and saw that they were posting things about homemade drones,” recalled Muñoz, who is currently finishing a degree in computer engineering at the University of California, Berkeley in the United States.

The forum was DIY (“Do It Yourself”) Drones, an online community created by Anderson in 2007 as a space for hobbyists who build their own UAVs to share experiences, electronic codes and component maps.

“I started to post videos, write code, and document and publish what I was doing,” Muñoz told Tierramérica*. His work caught the attention of Anderson, the editor-in-chief of Wired magazine until this past January and now the young Mexican’s partner in 3D Robotics.

The company does not sell UAVs for military use. The vehicles are designed in the southwest U.S. city of San Diego and assembled across the border in Tijuana, Mexico. They receive between 100 and 150 orders daily from clients in the United States, Brazil, the United Kingdom, Australia, Germany, Israel and Japan.

3D Robotics currently employs 60 people and hopes to expand its staff to 100 by the end of the year. Since its founding in 2009, the company has earned around 10 million dollars through sales and received another five million from three U.S. funds that provide financing for tech firms.

“In 2013 we want to professionalise all of our products. There have been huge advances, everything has now been greatly simplified, and we want to make drones easy to use. But we need engineers to write code, for manufacturing,” said Muñoz.

Working on the basis of open licensing, a network of engineers around the world work together to improve codes and develop more advanced products.

In 2012, Muñoz was chosen as one of the top ten innovators under 35 in Mexico by Technology Review, which is published by the Massachusetts Institute of Technology.

A drone is equipped with a high-speed processor, battery, GPS receiver, compass and sensors like an accelerometer and gyroscope. Unmanned planes can fly for up to three hours, and helicopters for half an hour. Connected to a modem, they can transmit real-time data in a range of up to 60 kilometres.

In Mexico there are no regulations on the use of drones, although the government uses them to fight drug trafficking, some companies use them to supervise construction, and universities use them for scientific research.

At the Center for Research and Advanced Studies of the National Polytechnic Institute (CINVESTAV), three researchers are building prototypes for surveillance and security, with an eye towards commercial production.

“We lost a bit of time. If we had done it five years ago, we would be on a par with other countries. It wasn’t given much importance, so there was no research. We have a great deal of potential, above all because the students we are training start out with a more advanced awareness,” Hugo Rodríguez, a mechatronics researcher at CINVESTAV, told Tierramérica.

“The models will continue to improve, and we will gain experience by solving new problems. We could have a marketable prototype within a short time, with trained human resources,” said Rodríguez, who has a doctorate in automation and signal treatment from the University of Paris XI.

Since 2007, the centre’s specialists have designed a four-engine plane, two fixed-wing aircraft and two helicopters, and have experimented with their automatic controls.

“As this work continues to develop, a marketable technological application could emerge. We’ve been approached by companies, but we didn’t have a prototype ready yet,” said Rodríguez.

Seven students have graduated with Master’s degrees in mechatronics since 2007, and two Master’s degree candidates and two doctoral candidates are now working on this initiative.

Although the commercial use of drones is currently prohibited in the United States – they are only permitted for scientific or recreational uses – the government is preparing to integrate them into the national airspace in 2015. The Federal Aviation Administration (FAA) estimates that as many as 30,000 non-military UAVs will be in the sky by the end of the decade, for a range of different purposes.

A recent study, “The Economic Impact of Unmanned Aircraft Systems Integration in the United States”, predicts that in the first three years of integration, more than 70,000 jobs will be created.

The study, published in March by the Association for Unmanned Vehicle Systems International (AUVSI), an industry group, estimates that between 2015 and 2017, the economic impact of drone integration will be greater than 13 billion dollars and could reach 82 billion by 2025, in terms of revenues earned by manufacturers and suppliers from the sale of new products as well as “the taxes and monies that flow into communities and support the local businesses.”

* This story was originally published by Latin American newspapers that are part of the Tierramérica network.

HIV-positive children in Muhanga, a village in Rwanda. Credit: Aimable Twahirwa/IPS

A first-time ranking of 54 top research universities in the United States and Canada has found that a miniscule percentage of funding goes to neglected diseases, despite the outsized influence that public universities play in developing medicines for illnesses often ignored by the private sector.

According to the University Global Health Impact Report Card, released Thursday, less than three percent of research funding at these 54 universities went to neglected diseases in 2010. This includes not only the tropical illnesses, such as Chagas disease and sleeping sickness, but also paediatric HIV/AIDS, malaria and multi-drug-resistant tuberculosis.

Altogether, more than a billion people globally suffer from these diseases, primarily in poor communities, according to data provided by the Universities Allied for Essential Medicines (UAEM), an international student coalition that carried out the research for the report card. Further, around 10 million people a year are said to die because they are unable to access required medicines, many of which are simply too expensive for them to purchase.

“We often hear from students in university labs who really want to focus on these issues but find that the same resources aren’t available to them as in more traditional areas of study,” Bryan Collinsworth, UAEM executive director, told IPS.

“This is not just about bringing in more grant funding – though that’s huge – but also about universities taking more concrete steps to say they’ll support this area of focus. For instance, hiring more faculty in these areas, making sure students have more fellowships in both the field and lab on these issues, and perhaps officially establishing a centre to ensure a specific focus.”

Indeed, 15 of the universities studied had created such a centre, and 10 of those succeeded in offering higher funding for neglected diseases, Alex Lankowski, a BostonUniversity student that participated in the UAEM research, told IPS.

Over the past three decades, some 1,556 new drugs were created, UAEM reports, but only 21 – less than two percent – were for neglected diseases.

“Universities are non-profit institutions operating in the public interest, heavily funded by government grants – meaning taxpayer-funded sources – so students know this means they have a special responsibility to serve the public good,” Rachel Kiddell-Monroe, president of the UAEM board, said Thursday at the report card’s unveiling.

“Universities regularly position themselves as places of learning, operating for the good of the world. Unfortunately, leading research institutions are not living up to their missions … So, students are demanding that these schools start taking concrete steps.”

The UAEM ranking does not focus solely on neglected diseases. Rather, it uses some 14 metrics to look more broadly at whether academic institutions are investing in research that addresses the health of poor communities worldwide.

This includes how those schools are licensing any research discoveries for commercial development, particularly whether they are doing so in socially responsible ways that ensure that related products will be affordable in developing countries. It also includes looking at university programming aimed at creating a subsequent generation of global health practitioners, as well as analysing the extent to which those attempts include a focus on low-income countries and quality of health worldwide.

Under these parametres – the data for which comes only from self-reported, publicly available sources – some of the world’s highest-profile universities fare poorly. Out of 54 schools listed, for instance, 15 are given “D” ratings, including the Massachusetts Institute of Technology (at 39th), New YorkUniversity (40) and ColumbiaUniversity (45).

By deadline, none of these schools had responded to request for comment for this story.

Clear challenge

Kiddell-Monroe notes that global health is no longer the sole prerogative of the United Nations or private foundations. Rather, universities are “increasingly a site of key research and development in medicine – a role that is only set to increase,” she says. “For this reason, we need to examine the impact they’re having and hold them to account.”

Researchers have estimated that up to a third of new medicines are developed within the university system, including at least a quarter of current HIV/AIDS treatments.

“Universities play a huge role, yet we really need to consider this role a bit more carefully,” Dr. Unni Karunakara, international president of Medecins Sans Frontieres (MSF), a humanitarian group, told reporters Thursday.

“It is a problem not only when universities are failing to conduct research on diseases that afflict the developing world. But further, when a university discovers a lifesaving new medicine and licenses it to a drug company in such a way that developing world patients can’t afford – that impedes global health.”

Karunakara notes that Glivec, the anti-cancer drug whose renewed patent was recently denied by the Supreme Court of India, was developed largely through research done in universities. It was subsequently priced out of the market in developing countries, however, when the drug was licensed to the Swiss pharmaceutical company Novartis.

“If universities make commitments to prioritise low-income communities, we can go a long way towards improving global public health,” Karunakara says. “Universities have a big role in making sure their research is translated into affordable medications for people in developing countries.”

The study does turn up some mixed data in this regard. For instance, 21 of the universities reported having come up with standards for socially responsible licensing, while more than half of research licenses are “non-exclusive” – though that figure drops to around a third for medical technologies.

Further, “Self-reporting universities rarely seek to patent their technologies in developing countries, at least within the first year of disclosure, meaning that generic drug manufacturers could develop affordable developing-world medical products from these discoveries without fear of patent restrictions,” a report accompanying the report card states.

“Even in the emerging BRICS economies (Brazil, Russia, India, China, South Africa), universities sought patents on new technologies less than 9% of the time, and less than 2% for all other low- and middle-income countries.”

Still, “provisions to promote global affordability in exclusive licenses” were found to be “exceedingly rare”, being included less than 11 percent of the time.

Together, these statistics present a “clear challenge” to universities, MSF’s Karunakara says: “As institutions dedicated to the public good, now is the time for them to step up and play a major role in improving health worldwide.”

“Treatment is available in many other parts of the world, but no one knows whether or not it is working,” Marcelo Wolff, an infectologist who studies HIV/AIDS at the University of Chile, told IPS.

In this South American country, “coverage extends to nearly everyone living with HIV,” added Wolff, who won a Richard and Hinda Rosenthal Award this year, which recognises innovative research that has made a notable contribution to improved clinical care in the field of internal medicine.

A red ribbon, the global symbol of the fight against AIDS. Credit: Gary van der Merwe CC BY-SA 3.0

Officially, some 22,000 people are living with HIV/AIDS in Chile, although the real number could be between 40,000 and 70,000, Wolff said.

“It is estimated that there are two to three undiagnosed people for every diagnosed person,” he said, “which means the total would be between 0.3 and 0.4 percent of the population over the age of 15” in this country of 16.5 million people.

The approach involves a monitoring system in 32 public healthcare centres around the country, which makes it possible to take timely measures addressing the specific needs of each case.

The monitoring is carried out by the Chilean AIDS Cohort (ChiAC), established by a team of professionals like Wolff, who joined a multidisciplinary and non-governmental network, SIDA Chile (AIDS Chile), founded in 2003.

“Knowing about what is happening to the people being treated is the main novelty,” Wolff said. “And the Chilean AIDS Cohort has been able to study that: the survival, morbidity and hospitalisation rates, and labour and social reinsertion.”

The same monitoring system is used for all patients taking the life-extending antiretroviral drugs, to evaluate the results of the therapy.

The data generated is used to inform policy-making. And specific measures can be taken to adapt the therapy to local conditions, based on the results. The information gathered also contributes to global assessments of the spread of HIV/AIDS.

“Results from developed countries and poor nations have traditionally been published, but there were few evaluations from the large group of middle-income nations, and the Chilean AIDS Cohort has provided that,” Wolff said.

Law 19,779, approved in December 2001, guarantees the rights of all Chileans to prevention, diagnosis, control and treatment, and safeguards the free and equal exercise of other rights and freedoms of those living with HIV/AIDS, expressly prohibiting discrimination in access to education, work and healthcare.

In addition, the “universal access of explicit guarantees plan”, which guarantees the right to treatment, with specific guidelines, was expanded to those living with HIV/AIDS.

And the “national programme of expanded access to antretroviral therapy”, in effect since 2001, ensures access to the latest treatment options for all patients.

As a result of the alliance between the government’s national programme and the Chilean AIDS Cohort, “mortality has been reduced by more than 80 percent, and the rate of hospitalisation has gone down, which has made it possible for people to take up their day-to-day lives again.

“Among our patients, we have achieved results comparable to those of developed countries,” he said.

Based on this joint effort, the social and economic conditions of those living with HIV/AIDS have improved, said Manuel Jorquera, the coordinator of the AIDS advocacy group Vivo Positivo. “There is more timely treatment, and it is guaranteed, along with the free monitoring,” he told IPS.

These benefits are tangible for Martín (not his real name), a 36-year-old journalist who was diagnosed with HIV four years ago.

“It was difficult to digest at first, but I had the support of several of my friends who are also living with HIV and who have managed to deal with the disease really well,” he told IPS.

Although HIV/AIDS remains underreported, a higher proportion of cases are now documented. Since the first cases were detected in this country in 1984, the highest AIDS (six out of 100,000 people) and HIV (9.6 out of 100,000) notification rates were recorded in 2011, according to the Health Ministry’s Epidemiology Department.

The evolution of HIV/AIDS in Chile is in line with global trends that reflect a 20 percent reduction in the number of new infections worldwide and a 17 percent increase in the number of people living with HIV in 2011, compared to 2001, when the AIDS epidemic was at its height.

There are 34 million people living with HIV/AIDS worldwide, according to the latest global report, published by UNAIDS Tuesday Nov. 22.

But not every aspect involving HIV/AIDS has been solved in Chile.

Martín said that in his company people do not “officially” know he is gay, although “many suspect it.” What they definitely do not know, he said, is that he is HIV-positive and receives antiretroviral treatment at a public hospital.

“I have a totally normal lifestyle,” he said. “I go to work, I go out with my friends. But not even my mother knows I am infected. It would just destroy her.”

His fears are not unfounded. Despite the advances made at the level of public policies in Chile, deep-rooted discrimination persists, which exacerbates the fear of having an AIDS test.

“People feel the real fear of suffering from discrimination once it is known that they are infected,” Wolff said.

In his view, the most important challenge “is to keep people from being infected,” and to do that, “prevention campaigns must be much more direct than they have been.”

In addition, he said, “we have to try and diagnose everyone who is living with HIV/AIDS, and extend treatment to them.”

But to do that, the stigma surrounding the disease must be fought, he added.

Dengue patients at Cambodia's National Paediatric hospital. Credit: Erika Pineros/IPS

Public health experts in Cambodia are unenthused by reports of trials for a dengue vaccine conducted in neighbouring Thailand, saying it will be too costly for those who need it most – children in the least developed and developing countries.

“Of course, they cannot come out with a vaccine that costs 20 cents,” Dr. Philip Buchy, head of the virology unit at the Pasteur Institute of Cambodia, told IPS.

Buchy was referring to the Paris-based pharmaceutical company Sanofi SA’s dengue vaccine efficacy trials, the results of which were published in the British medical journal Lancet, this month.

Dr. Stephen Bjorges, leader of the vector-borne disease team at the World Health Organisation (WHO) in Cambodia, agrees. Even if Sanofi succeeds “funds would need to be mobilised” to cover the cost of inoculating children in Cambodia, he said.

A dengue epidemic that raged through Cambodia during the first eight months of the year landed more than 30,000 people in hospital, the majority of them children.

According to the Lancet report, Sanofi’s vaccine offers some protection against three of the four serotypes of the dengue virus – about 30 percent against serotype one and from 80 to 90 percent against serotypes three and four.

However, Sanofi’s vaccine does not protect against serotype two, which was circulating in the study area during the trial, giving the vaccine an overall efficacy rate of 30.2 percent, the report said.

Large-scale phase-3 trials are underway on 31,000 children and adolescents in Latin America and Southeast Asia, Sanofi said in a press statement timed with the release of the Lancet report.

According to the Reuters news agency, the company has already invested more than 430 million dollars in a new factory in France to produce the vaccine.

WHO’s Bjorges said that if the phase 3 trials proved the vaccine was effective, its initial market likley would be tourists from wealthy nations and the military, a view Buchy agrees with.

Buchy doubted, however, that an effective vaccine was around the corner. “The vaccine is not for tomorrow,” he said. “Dengue epidemics still have good days ahead of them.”

Still, both doctors expect increasing investment in vaccines and vaccine-related research as global warming expands the range of the mosquito that transmits dengue into southern Europe and the United States.

Developed countries are beginning to factor the costs of dengue treatment into their long-range healthcare budgets, while pharmaceutical companies have identified a potentially lucrative, emerging market, Buchy said. “Global warming is providing a shortcut for vaccine research.”

“Interest in vaccines is going to grow exponentially now that there is some success with a vaccine,” Bjorges said.

The European Union provided more than 10 million dollars for three dengue-related research projects in Southeast Asia earlier this year, including one in Cambodia to investigate the role that asymptomatic carriers play in transmission, Buchy said.

“If we can identify a gene that is protective this may allow us to develop drugs for treatment and vaccination,” he added.

Funding for prevention and control of epidemics in poor countries remains scant, however. The budget for Cambodia’s national dengue control programme is about 500,000 dollars, most of it provided by the Asian Development Bank.

Bjorges says one reason for the lack of funding for prevention and control is that it has shown little success. “Dengue control is 50 years old and everything that has been thought of has been tried.”

Breeding sites have to be eradicated weekly in order to prevent the mosquito that transmits the virus from emerging from its larvae, and this requires changes in human behaviour that have proven difficult to sustain on a weekly basis, Bjorges explained.

Another problem may be that those who allocate global health funds rely on short-term cost-benefit models, Bjorges said. They are under pressure to produce quick, quantifiable results for the funds they allocate, and dengue prevention and control projects do not fit these models, he explained.

Buchy was less pessimistic about the possibility of changing human behaviour. “Behaviour change is possible, but it requires more investment in education.”

Buchy’s view is echoed by Prof. Duch Moniboth of Cambodia’s National Pediatric Hospital that treated 1,673 children for dengue in the first seven months of this year. “There is not enough education about dengue – how to prevent infection and how to eradicate breeding sites.”

New research, however, suggests that dengue is far more prevalent in Cambodia than previously calculated, underscoring the need for increased investment in prevention.

The disease is underreported partly because Cambodia’s dengue surveillance system relies on data from state-run hospitals and charitable children’s hospitals. Cases treated at private hospitals and clinics are not reported to the health ministry.

Charitable hospitals treating dengue patients in Cambodia have been pleading for donations after being inundated with patients in May. The National Paediatric Hospital has been relying on nursing students to treat children who spill into the hallways and the foyer around the main stairwell.

The hospital receives a mere 20 dollars per patient, regardless of how long the child stays, Moniboth said. On average, doctors receive monthly salaries of about 125 dollars, while nurses are paid about 75 dollars, he said.

With such meager funding for healthcare what is needed is a cheap vaccine, Moniboth said.

Pakistan needs affordable solutions to reducing maternal deaths. Credit: Zofeen Ebrahim/IPS

“I can’t imagine life without misoprostol,” says Dr. Azra Ahsan, a gynaecologist and obstetrician who has, for more than a decade, been using the controversial drug to stop women from bleeding to death after delivery.

Originally intended for treating gastric ulcers misoprostol has since 2000 been gaining in popularity for its ability to induce labour and stop post partum haemorrhage (PPH).

“I knew that it can save women from dying long before 2009 when it was registered for use in Pakistan,” said Ahsan, a member of the government’s National Commission on Maternal and Neonatal Health.

WHO guidelines advocate the use of misoprostol against PPH, while the International Federation of Gynaecology and Obstetrics (FIGO) suggests using the drug in situations where regular ‘uterotonic’ drugs like oxytocin and ergometrine are not available.

Doctors like Ahsan are dismayed at moves to get WHO to reverse its listing in April 2011 of misoprostol among essential medicines that “satisfy the healthcare needs of the majority of the population” and are  “available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford.”

Findings of scientific studies published in the August issue of the Journal of the Royal Society of Medicine are being cited in suggesting that WHO should “rethink its recent decision to include misoprostol on the essential medicines list.”

Allyson Pollock, who led the study, stated that there is insufficient evidence to suggest that misoprostol works in preventing PPH. Instead, she urges poor countries to improve primary care and prevent anaemia to lower the risk of haemorrhage following delivery.

Ahsan, however, says that in Pakistan some 80 percent of pregnancy cases end up with the mother’s uterus failing to contract naturally after delivery, calling for the use of uterotonic medicines to reduce bleeding.

“Nearly 27 percent of maternal deaths in Pakistan are caused by excessive blood loss after childbirth,” Ahsan explained to IPS.

According to the latest Pakistan Demographic and Health Survey (2006), Pakistan’s maternal mortality ratio stands at 276 for every 100,000 live births, and is among the highest in South Asia.

Bleeding, the leading cause of maternal deaths worldwide, is defined by the WHO as blood loss greater than 500 ml following a delivery.

The fact that misoprostol is also misused in Pakistan – and other developing countries like Brazil – to induce abortion cheaply, has added to controversies over the drug.

“I don’t care if people think it is used, misused or even abused…I know it saves mothers from dying,” says Ahsan.

Unlike other uterotonics, misoprostol has the advantage that it does not need refrigeration for storage and can be easily administered orally by trained birth attendants, Ahsan said.

A joint statement by FIGO and the International Confederation of Midwives states: “… in home births without a skilled attendant, misoprostol may be the only technology available to control PPH.”

Zulfiqar Bhutta, head of women and child health at the Aga Khan University, Karachi, and member of the independent expert review group for maternal and child health to the United Nations secretary-general, agrees with Pollock that misoprostol needs to be evaluated more robustly.

“But I wouldn’t throw out the baby with the bath water yet,” Bhutta told IPS. “There is a need to increase its use in the right circumstances and also carefully monitor misuse. It is no magic bullet and should not lead to complacency in provision of essential maternal services,” he said.

“I think the point of the paper published recently is to try and separate  science from messianic zeal,” says Bhutta who is also co-chair of ‘Countdown to 2015’, a global scientific and advocacy group tracking progress towards the U.N. Millennium Development Goal Five pertaining to maternal health.

“Misoprostol is promising and we should do our best to evaluate its safe use,” said Bhutta. “But, there are people in Pakistan who are recommending large scale distribution to families for use in all births. Will this be cost-effective or indeed safe?”

Pollock’s study has stirred international concern. International Planned Parenthood Federation’s Upeka de Silva told IPS in an e-mail that if WHO withdraws misoprostol, it would mean “countless women will be denied life-saving care and forced to suffer pregnancy-related complications which are entirely preventable.”

“We are fully aware that all studies have limitations and that continued research on best practices for maternal care is needed,” de Silva said.

“However, for the purposes of meeting the urgent needs of women, particularly in rural, underserved communities, we are confident about being guided by the abundant literature and expert evidence supporting the safety and effectiveness of misoprostol for multiple reproductive health indications,” de Silva said.

Further, she said: “The increasing number of clients provided with safe abortion services, treatment for incomplete abortion and PPH through clinics run by our member associations is further evidence that misoprostol should remain available and accessible.”

“It’s alright to stir confusion sitting in cushy offices, but the ground reality in Pakistan is quite different,” said Ahsan. “The conditions we work under are very, very constrained…let’s not forget the hot temperatures and long power outages (causing refrigeration failure).”

This year’s floods, one of the worst in Philippine history, destroyed a staggering 57 million dollars worth of crops, pushing  this climate vulnerable country to implement disaster risk reduction measures.

“We used to schedule our harvest season around the wet and dry months. But now you can never tell,” says Teresita Duque, a rice farmer in the Nueva Ecija province of the Central Luzon region, the ‘rice granary’ of the Philippines.

“The sky suddenly darkens, and the rains just fall,” Duque, who uses native rice varieties and eco-fertiliser on her farm, told IPS in an interview in Manila.

Monsoon rains enhanced by Typhoon Haikui near China had already been drenching Luzon, the Philippines’ main island, for several days when, from Aug. 6-7, nearly two months worth of rain fell on Metro Manila and several provinces in Luzon.

At least 95 people perished in the ensuing floods and landslides, with nearly a million others forced to evacuate their homes.

As the Philippines tries to emerge from years of agricultural backwardness and attain food self-sufficiency, farmers, non-government organisations (NGOs) and government agencies are trying to map out strategies that can mitigate the effects of weather patterns gone wild.

Scientists at the International Rice Research Institute (IRRI), a non-profit agricultural research centre based in Los Banos, Laguna, believe that a flood resistant variety of rice, dubbed ‘submarino’ for its ability to withstand two weeks of submergence, could be one answer.

Last year, when typhoons Nessat and Nalgae devastated Central Luzon, farmers who had planted ‘submarino’ were able to harvest their crops even after their paddies had been submerged for nearly a week.

Glenn Gregorio, senior scientist and plant breeder at IRRI, told IPS that several ‘climate-change ready’ rice varieties, including drought-resistant varieties, are being developed at the institute.

“When you talk about floods in the country, you often see images of urban areas with cars floating and people stranded on their rooftops, but the farmers are really the worst affected,” Gregorio told IPS in a telephone interview.

The farmers’ group ‘Sarilaya’ agrees that while agriculture in the Philippines needs to adapt to climate change, it is best to stick to naturally resilient native varieties rather than go in for hybrids developed in laboratories.

Sarilaya workers say that hybrid varieties are dependent on expensive chemical-based fertilisers which, in the long run, ruin the soil and harm the health of farmers and communities.

“Extreme weather patterns are making the agricultural sector more vulnerable than ever before,” said Pangging Santos, advocacy officer at Sarilaya that works to empower farmers like Duque. “What used to be considered normal is no longer normal.”

“There are many different native varieties that still need to be tested, but the experience of our farmers shows that native varieties are more sustainable than hybrid varieties in the long run,” Santos told IPS.

Sarilaya runs a farming school and model eco-farms in Northern Luzon where farmers learn how to make their own organic fertiliser. Farmers are taught to make pesticides from locally available ingredients instead of buying costly chemical-based insecticides and sprays.

Duque said where she used to spend at least 223 dollars on farm inputs for one cropping, she now spends less than 16 dollars, mostly on organic fertiliser and pesticides.

“We need to change our mindsets about climate change strategies and look at long-term sustainability,” said Santos.

Sarilaya’s strategy of promoting organic farming is in line with the United Nations Food and Agriculture Organisation (FAO)’s vision of ‘climate-smart agriculture’.

Hideki Kanamaru of the Climate, Energy and Tenure Division of the FAO says climate-smart agriculture is about sustainably increasing productivity. It is also about adaptation and mitigation by reducing greenhouse gases from agricultural production without compromising on food security.

Kanamaru introduced FAO’s vision during a symposium held in February by the Philippines department of agriculture, which was attended by policy makers, scientists and practitioners from the Asia Pacific Economic Cooperation nations and select organisations.

The essence of FAO’s climate-smart farming is careful use of natural resources such as land, water, soil and genetic material as well as good practices that include conservation agriculture, integrated pest management, agro-forestry and sustainable diets.

While the government is providing free rice seeds and crop insurance to farmers in Luzon – where crops have been severely damaged by floodwaters and heavy rains – the country’s climate change commission admits that it may be too late to meet this year’s rice harvest targets.

In 2010, the Philippines topped the list of rice importers when it bought up 2.5 million tonnes of rice. While determined efforts towards self-sufficiency have brought the figure down to 860,000 tonness in 2011, plans to drop imports further have gone awry.

The national climate change action plan says that sensitivity to weather fluctuations “will greatly affect the country’s production and have a domino effect on our target of self-sufficiency by 2013.”

The plan notes: “The Philippines, being archipelagic and because of its location, is one of the most vulnerable to the impacts of climate change…ranking highest in the world in terms of vulnerability to tropical cyclone occurrence.”

When President Benigno S. Aquino III signed into law the People’s Survival Fund (PSF), on Aug. 17, by amending the Climate Change Act of 2009, it was not a moment too soon.

“As we have seen clearly over the past few weeks, there is a pressing need to financially support disaster prevention efforts of local government units,” said Senator Loren Legarda, the driving force behind the 2009 law, at the launch of the PSF.

Worth 23 million dollars annually, the PSF will finance adaptation programmes and projects based on the National Strategic Framework on Climate Change. The fund may be augmented by donations, endowments, grants and contributions.

“The signing of the law signifies the president’s commitment to better prepare the country for erratic weather patterns and climate change,” said Elpidio Peria, convenor of Aksyon Klima, a coalition of 40 civil society organisations working on climate change.

Aksyon Klima released this month an e-toolkit (www.aksyonklima.com) for mainstreaming disaster risk reduction and climate change adaptation and helping local governments plan for extreme weather.

*With Art Fuentes

Parents wait anxiously outside a Phnom Penh hospital. Credit: Mike Hodgkinson/IPS

Parents wait anxiously outside a Phnom Penh hospital. Credit: Mike Hodgkinson/IPS

Health experts are blaming high malnutrition levels for an outbreak of hand, foot and mouth disease (HFMD) that has killed more than 54 children in impoverished Cambodia since April.

On Wednesday, Cambodia closed all kindergartens and primary schools to stop spread of the Enterovirus-71 (EV-71) believed responsible for the outbreak of HFMD.  The closure will affect 121,300 pupils in pre-schools and 2.14 million pupils in primary schools, education officials said.

HFMD typically affects infants and children and is spread through contact with the mucus, saliva, or faeces of an infected person and epidemics are known to break out in the region during the rainy season.

Cambodia first began surveillance for the epidemic last week, but lab tests are yet to determine whether the cause is actually the EV-71 virus,  although it was found in most of the children who died.

“We are getting samples (for testing) every day,” Dr. Philippe Buchy, chief of biology at the Pasteur Institute, in Phnom Penh, told IPS. He added that the institute does not receive the complete case record of each patient in order to be able to classify it as ‘mild’ or ‘severe’.

Dr. Sok Touch, director of the Cambodian health ministry’s Communicable Disease Department, said “there were no new severe cases like we saw at Kantha Bopha,” referring to a Swiss-funded hospital in Phnom Penh where the majority of the children died between April and the end of June.

Sok Touch said mild forms of the disease were seen in “several provinces” and there could be hundreds of cases that escaped detection because of the country’s poor public health resources.

Cambodia has no “baseline” for measuring the mortality rate from HFMD because the disease is not on the country’s surveillance list, the health official said.

According to Buchy it is impossible to detect the mortality rate because the severe form “had not been seen here before.” He added that the ratio of deaths to cases was high but it was likely – as in other countries in the region – that the deaths were a small proportion of all cases.

“It’s something we have been expecting for a few years,” he said, adding that the number of cases is probably underreported. His lab had developed the capacity to detect EV-71 about two years ago in response to reports of outbreaks in neighbouring Vietnam.

Sok Touch said it was not until last week that the health ministry began working with the World Health Organisation (WHO) to incorporate surveillance for the severe form of HFMD.

A joint-investigation by the health ministry and the WHO found the EV-71 virus – one of the known causes of HFMD – present in the majority of cases reported.

“It was the first time the virus had been detected in a lab in Cambodia,” said Dr. Nima Asgair, team leader of the WHO’s emerging diseases unit in Cambodia.

Most of the children died within one day of hospitalisation and were   malnourished or suffering from other chronic conditions prior to contracting the disease, the joint investigation found.

According to Joel Conkle, nutrition specialist with the United Nations Chidren’s Fund (UNICEF), “malnutrition affects 40 percent of Cambodian children, which makes them more susceptible to being severely affected by outbreaks of infectious disease.”

The country has the third highest rate of child malnutrition among members of the Association of Southeast Asian Nations, Conkle said, adding that “28 percent of children below five years of age are underweight and 40 percent are too short for their age”.

Hidden hunger, which refers to vitamin or mineral deficiency, was also a concern in Cambodia as more than half of all children under the age of five – the demographic most susceptible to HFMD – are anaemic, primarily due to lack of iron, Conkle said.

“Anaemia is something that affects almost all children in Cambodia; nearly nine out of 10 children in the country are anaemic at one year of age.”

More than 1.27 million cases of mild and severe cases of HFMD have been detected in China in the first six months of this year with 356 deaths, compared to slightly more than 711,300 cases last year, according to the WHO.

It was also reported that the number of cases had tripled in Singapore, from 871 cases last year to more than 26,000 cases in the first six months of this year, but in both countries the numbers had peaked in June and were declining, according to a WHO Jul. 13 update.

Virologists are carrying out molecular studies of the virus to determine if the virus found in Cambodia is a new genotype of EV-71.

Bouchy said it would take another two weeks or so to identify the EV-71 genotype found here, and a few weeks longer to map out its full genome. “At this point it is impossible to know whether the virus detected here is more virulent,” he said.

The emergence of a new, more virulent form would be particularly dangerous in Cambodia where children are vulnerable to infectious diseases due to their poor health, health experts say.

“These children are already not in good shape,” the Pasteur Institute’s Bouchy said. “What we have observed in China and other countries is that the (HFMD) patients were coming from very poor backgrounds,” he added.

Public health experts are taking a two-pronged approach, calling for strengthening of the country’s fragile public health system as well as encouraging enhanced sanitation at households and improving children’s  diets.

“Building the capacity of service providers in public health centres and hospitals is an important component of strengthening and improving the health of children in rural Cambodia,” UNICEF’s Conkle said.

“But there are also simple things that can happen at the household level to improve child health. Hand-washing with soap and feeding young children a better diet could help to make children healthier and less susceptible to outbreaks of infectious diseases,” he added.

About a third of Cambodia’s population of about 15 million people continues to live on less than one dollar a day, which makes improving diets for children a major challenge.

Researcher David Still has found a way to contain the pathogens in human waste in order to use it as a fertiliser. Credit: Yuven Gounden/IPS

As South Africa grapples with reducing its sanitation backlog, scientists seem to have found a way to reduce the build up while simultaneously combatting the country’s food insecurity. The solution? Safely using human waste as fertiliser.

Although almost 11 million South Africans have been served with basic sanitation since 1994, more than 13.3 million people had not yet accessed basic sanitation services by 2008, according to the country’s Council for Scientific and Industrial Research.

But in addition to this, South Africa’s pit latrines are filling up faster than their expected design life, according to the Water Research Commission (WRC).

“Only one third of municipalities have a budget to maintain on-site sanitation. If pits fill up, all the hard work that was done to address the sanitation backlog will be wasted. Why not use faecal sludge (FS) to address the growing problem of food insecurity by planting fruit trees? Or use the sludge to cultivate trees for fuel or paper production?” asked WRC researcher David Still. The result was the formation of the project titled “What happens when pit latrines get full.”

“It is clear that in our country the use of vacuum tankers is not always a solution because of access problems, and also because of the foreign objects found in pit latrines,” he said.

Human excreta or FS have valuable nutrients such as Nitrogen, Phosphates and Potassium and the average person excretes enough of this per year to sufficiently fertilise 300 to 400 square metres of crops.

However, using FS as a fertiliser can be hazardous because of the pathogens it contains, especially if it is used for surface spreading and where edible crops are cultivated. There is also a risk that the FS could contaminate groundwater.

“We looked at the possibility of harnessing the nutrient value of the sludge whilst containing the hazard posed by the pathogens until they died off,” said Still.

In order to find a way to contain the pathogens in the FS, research was conducted on two pilot sites, one in Umlazi and the other in Karkloof, in KwaZulu-Natal, South Africa. The local municipality and the South African Paper and Pulp Industry (SAPPI) respectively own the sites used.

Still and his team discovered that by burying the FS in pits and planting on top of it, pathogens were contained and eventually died off.

Trenches of about 0.75 metres in depth were dug and partly filled with FS of varying volumes. Two control sites where no FS was added were also monitored. The trees in the area were monitored for growth and volume those planted above the FS showed significant growth and volume, “as much as 80 percent”.

In order to test for the presence of FS pathogens, the researchers searched for the eggs of the large roundworm, a hardy parasite. If the eggs were found, it meant that the FS still contained pathogens and was harmful.

“Analysis of sludge extracted at periodic intervals indicated that no roundworms could be found after a period of 30 months after burial in the ground,” Still said.

Sfundo Nkomo, an engineer with Partners in Development, tested for microbes at the Umlazi site.

“One has to monitor the situation because of the risks involved. It is clear that the technology works and that the plants have nice dark green leaves. Of the nine rows of planted trees, those with the sludge treatment were bigger and better developed.”

Groundwater near the entrenchment sites was also monitored to determine whether the sludge affected water quality. At the Umlazi site, which is flat and sandy with deep soils, no impact was observed. However, at the site near Karkloof, which is sloping with shallow soils, a small increase in nitrate concentrations in the groundwater immediately after rainfall was observed.

It showed researchers that sites selected for deep row entrenchment should ideally be flattish and have deep soils.

Lindiwe Khoza’s house in Umlazi was selected as a test site. The sludge was buried in the ground here and citrus and peach trees were planted on top.

“The fruit grows much faster and it seems to be tastier and juicier than fruit bought at supermarkets. We now enjoy fruit from our own garden,” a delighted Khoza told IPS through a translator.

The land management programme leader at Sappi Forests, Giovanni Sale, said that they had also seen a marked increase in tree growth in the areas where deep row entrenchment was used.

“This improvement in tree growth, however, unfortunately does not make up for the very high site preparation. Land preparation costs were in the region of thirty times more than conventional forestry practice. Therefore, the economics alone do not make this a viable commercial practice at present,” Sale said.

He added that if the local municipality were to start a deep row entrenchment project on their own land, and crop it with plantation trees, Sappi would assist.

“Sappi would be in a position to offer superior planting stock, technical assistance and a market for this timber. If the municipality were to adopt this practice and if smaller volumes of sludge are buried at regular intervals using labour, a small work force could be kept busy,” he said.
He did add that it was “a once-off experiment.”

Jay Bhagwan, the director of Water Use and Waste Management at the WRC, said that deep row trenching could provide both food and fuel security for communities.

“Communities can grow fuel wood trees or fruit trees according to their requirements. Plant growth and fruit development are greatly improved with the application of the sludges. The technology has enormous potential. Making sanitation work also raises such exciting possibilities for smart management of our resources,” Bhagwan said.

According to Still, providing sanitation is not about building more toilets. “It is about managing sanitation smartly.”