In today’s world of “Big Data”, it seems hard to believe that less than one third of all births and over two thirds of all deaths are still not recorded around the world. For all intents and purposes, births and deaths that are not recorded don’t count – and that is a big problem. In the words of Nandini Oomman and co-authors put it so eloquently in a recent commentary in the Lancet:
Functioning vital registration systems are global public goods that help with the collection, storage, retrieval, and analysis of accurate population and demographic data to support development policy and monitor health outcomes, particularly for maternal and child health. However, without strong vital registries, individuals do not have legal documentation of their own personhood, citizenship, and all associated rights; national policy makers do not have necessary data for resource allocation and planning; and the international community does not have evidence to monitor development progress against global benchmarks—eg, the Millennium Development Goals.
For far too long the excuse has been a lack of resources, but I really don’t buy this argument. Chris Murray once told me that India had a functioning vital registration system in place up until the 1920s when it was neglected and became non-functional. It seems that collecting data on people, even vitally important data, has been neglected and ignored by national and international policy makers. This study of maternal mortality declines in Sri Lanka – one of my favorite papers, ever – documented cause of deaths in the late 1940s, which was only possible due to the excellent data systems that were in place in that country nearly a century ago.
Last week a big conference on civil registration and vital statistics (CRVS) systems was held in Bangkok. It appears that momentum is building to put such systems into place around the world. But concerted efforts will be needed to be put into place to make this a reality. Donors have a big role to play. As consumers of global health data, it is not unreasonable that they should also be expected to pay for a big part of it, but not in one-off data collection systems as they do now. CGD’s proposal to build data into its cash-on-delivery scheme seems like a good way to go – but there are other good ideas out there. The power of mobile phone technology is also making it easier, more effective, and cheaper to collect data from many locations and this should be further enforced in the context of vital registration systems.
Vital registration systems are vitally important to global health. It is about time that they get the attention they deserve.Share on Facebook
Not only is artemisinin one of the most important drugs in our arsenal for fighting diseases globally – it is also the most interesting. A derivative of the wormwood plant, artemisinin’s anti-malarial properties were discovered thanks in part to the Vietnam war and Mao Zedong. The history of this drug reads more like an excerpt in the history of international relations rather than the history of medicine. Due to resistance that developed to quinine, artemisinin – in combination with other medicines – has become the drug of choice in most countries against malaria today.
In particular during the early years of the scale up of big-push initiatives to address malaria, the fact that we needed to cultivate and harvest wormwood plants in order to produce artemisinin was rate limiting and an unpredictable process. Demand outstripped supply and supply could be unreliable due to factors such as the weather. In addition, the long lead time and intensity of the cultivation process continues to contribute to the relatively higher costs of ACTs today.
It seems that this is about to change. I learned that as of today, and thanks to the efforts of PATH’s OneWorld Health, Sanofi, and other partners, we now have the ability to produce synthetic versions of artemisinin which can be produced in about 3 months, can be more readily scaled, and can be produced in a much more controlled fashion. This is a remarkable milestone in the fascinating history of this drug.
I’ve heard others say that a Nobel prize should be awarded to recognize the importance of the discovery of this drug – which has done so much to improve human health. It now seems that a new chapter, and new players, might also get to share in this prize if that in fact occurs.Share on Facebook