Eight daily posts on global health dismal failure
Below is the first post in a series of eight with the intention of sharing my position vis a?vis global health. They can be summed up as:?
"The meaning of life. Coming?full circle with global health. Testimonial: Personal successes but dismal global health failure."
As you will see, it is quite clear?and based on my specific expertise (of which I provide eight examples: in schistosomiases, intestinal schistosomiasis, intestinal nematodiases, amebiasis, malaria, HIV/AIDS, Chagas disease, COVID-19) and experience working and living?many years in Europe, Africa, Asia, South America, Oceania, and the United States.?
Hopefully, it will be eye-opening to some, thought-provoking to others, and action-triggering to many.??
My assessment has not changed in more than four decades: the weak link in global health is not health but global*. The fact that humans are unable to eradicate so many transmissible diseases reflects poorly on their capacity to survive as a species in the short term (considering the geologic time scale). Hence, the fundamental relevance of existentialism.
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*I drew attention to the highly dysfunctional state and inefficiency of global health in my article: “Global health: What stands behind the name, a global mess?", published on 25 October, 2015: https://www.dhirubhai.net/pulse/global-health-what-stands-behind-name-mess-yann-meunier/
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Ci-dessous se trouve le premier d’une série?de huit posts avec l'intention de partager?ma position sur la santé?mondiale. Ils peuvent être?résumés?ainsi:?
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"Le sens de la vie. La boucle est bouclée avec la santé?mondiale. Témoignage: Succès?personnels?mais échecs?cuisants pour la santé mondiale".?
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Comme vous pourrez?le constater,?elle est claire, nette et précise?et?basée?sur mon expertise spécifique (dont je donne huit exemples: dans les bilharzioses, la bilharziose?intestinale, les nématodoses intestinales, l'amibiase, le paludisme, le VIH/SIDA, la maladie de Chagas, la COVID-19) et expérience?ayant?travaillé et vécu?de nombreuses années?en Europe,?Afrique, Asie, Amérique?du Sud, Océanie, et aux Etats-Unis.
J'espère?que ce sera une prise de conscience pour certains, suscitera la réflexion pour d'autres et incitera?à l'action pour beaucoup.
Mon bilan n'a pas changé depuis plus de quatre décennies: le maillon faible?dans la santé mondiale n'est pas santé mais mondiale. Le fait que les humains sont incapables d'éradiquer?tant de maladies transmissibles met en doute leur capacité à?survivre en tant qu'espèce à court terme (considérant l'échelle du temps géologique). D'où la pertinence fondamentale de l'existentialisme.
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*J’ai attiré l'attention sur l'état hautement dysfonctionnel et l'inefficacité de la santé mondiale dans mon article: “Global health: What stands behind the name, a global mess?”, publié le 25 Octobre 2015: https://www.dhirubhai.net/pulse/global-health-what-stands-behind-name-mess-yann-meunier/
Abaixo esta a primeira postagem de uma série de oito com a inten??o?de compartilhar minha?posi??o?sobre a saúde global. Elas podem ser resumidas asim:?
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"O sentido da vida. Fechei o ciclo com a saúde?global. Testemunhal:?Sucessos pessoais mas fracassos?terríveis?para a saúde?global".?
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Como vocês poder?o constatar, ela é muito clara e baseada sobre minha perícia específica (do que eu dou oito exemplos: nas esquistossomoses, na esquistossomose intestinal, nas nematodioses?intestinais, na amebíase, na malária, no VIH/SIDA, na doen?a de Chagas, na COVID-19) e experiência trabalhando e vivendo?muitos anos na Europa, áfrica, ásia, América do Sul, Oceania, e nos Estados Unidos.
Espero que isso seja uma revela??o para alguns, instigante para outros e desencadeara a??o para muitos.????
Minha avalia??o n?o tem mudado em mais de quatro décadas: O elo fraco na saúde global n?o é saúde mas global. O fato que os humanos s?o?incapazes de erradicar?tantas doen?as?transmissíveis p?e em dúvida?a capacidade deles de sobreviver como espécie?a curto prazo (considerando a escala do tempo geológico). Portanto, a importancia fundamental?do existencialismo.?
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*Eu chamei aten??o sobre o estado altamente disfuncionante e a ineficiência da saude global no meu artigo: “Global health: What stands behind the name, a global mess?”, publicado no dia 25 de Outubro 2015: https://www.dhirubhai.net/pulse/global-health-what-stands-behind-name-mess-yann-meunier/
I- Schistosomiases
Treatment
1980
Assessment of 35972 RP (Oltipraz*): A new antischistosomal compound against Schistosoma hematobium, S. mansoni and S. intercalatum. ACTA Tropica, 1980, 37, 271-274 (Y. Meunier with M. Gentilini, B. Duflo and D. Richard-Lenoble)
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2023
WHO
Schistosomiasis affects almost 240 million people worldwide, and more than 700 million people live in endemic areas.
Assessment
After 43 years, with all the means at our disposal beside mass preventive measures (for example: trematode parasites or competitor snails to get rid of the intermediary host, access to safe water, improved sanitation, hygiene education, behavior change) as well as mass curative treatment and the enormous amount of money (poured into a pierced-bottom barrel) spent on this group of diseases, they should have been eradicated.
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
II- Intestinal nematodiases
Treatment
1980
A new broad-spectrum anthelminthic compound: Flubendazole*. Presentation of 125 cases. Gaz. Med. Fr., 1980, 38, 5444-5446 (Y. ?Meunier with M. Danis, A. Datry and M. Gentilini)
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2023
CDC
Example: Ascariasis
An estimated 807 million–1.2 billion people in the world are infected with?Ascaris lumbricoides?(sometimes called just?Ascaris?or ascariasis).
Assessment
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After 43 years, with all the means at our disposal beside mass curative treatment, for example:
Individually
Hygiene education, regarding food and fecal hygiene: washing hands with soap and water before handling food, washing, peeling vegetables and fruits before eating, not defecating outdoors.
Collectively
Protecting soils from animal manure used as fertilizer, effective sewage disposal systems
and the enormous amount of money (poured into a pierced-bottom barrel) spent on this group of diseases, they should have been eradicated.
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Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the ways it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
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III- Amebiasis
Treatment
1980
Ornidazole for the treatment of amoebiasis and giardiasis (oral and parenteral administration). Volume of the 10th International Congress on Tropical Medicine and Malaria. Manila, Philippines, 1980.?(Y. Meunier with H. Felix)
1982
New antiparasitic medications. Théorie et Pratiques ?Thérapeutique, March 1982, (14):45-49 (Y. Meunier)
2022
Journal of Infection and Public Health
Amebiasis is the third parasitic disease, after malaria and schistosomiasis, causing death in the world. Approximately 500 million people have been annually affected worldwide from which about 10% were infected by?E. histolytica?and the rest by other non-pathogenic?Entamoeba?species. Based on?global burden of disease?study, amoebiasis is responsible for more than 100,000 annual deaths worldwide and 2.2 million disability-adjusted life years (DALYs)
Assessment
After 42 years, with all the means at our disposal beside preventive measures (for example: improved sanitation, hygiene education, behavior change) and curative treatment (active on cystic form to prevent transmission) and the enormous amount of money (poured into a pierced-bottom barrel) spent on this disease, it should have been eradicated.
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
IV- Intestinal schistosomiasis
Treatment
1981
Treatment of intestinal schistosomiasis: Assessment of oxamniquine. Presentation of 173 cases. Med. Mal. Infect., 1981, 12, 665-670. (Y. Meunier with M. Gentilini, M. Danis, P. Petit, G. Brucker, V. Vernand-Neisson, J.P. Arnaud).
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2019
WHO
200.000 people die yearly of the two forms of the disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997417/#:~:text=A%20WHO%20estimate%20cites%20over,annual%20deaths%20from%20Schistosomiasis%20alone.
2023
WHO
The two forms of Schistosomiasis affect almost 240 million people worldwide, and more than 700 million people live in endemic areas.
https://www.who.int/health-topics/schistosomiasis#tab=tab_1
Assessment
After 43 years, with all the means at our disposal beside mass preventive measures (for example: trematode parasites or competitor snail to get rid of the intermediary host, access to safe water, improved sanitation, hygiene education, behavior change) and mass curative treatment and the enormous amount of money (poured into pierced-bottom barrel) spent on this disease, it should have been eradicated.
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
领英推荐
V- Malaria
Epidemiology
1981
M.D. Dissertation Contributor
Plasmodium falciparum Malaria Epidemiological Problems - Regarding a Parisian Case Seemingly Autochthonous. Cecile Chatap, Lariboisiere Saint-Louis Faculty of Medicine, Paris, 1981.
Treatment
M.D. Dissertation Advisor
Treatment of drug resistant malaria: A clinical trial with mefloquine in Paris. Dominique Mathe, Saint-Antoine Faculty of Medicine, Paris, 1984
The disease
1985
Malaria. For the “Centre International de l’Enfance”. English, French, and Spanish versions available (Y. Meunier).
2021
WHO
·?In 2021, there were an estimated 247 million cases of malaria worldwide.
·?The estimated number of malaria deaths stood at 619 000 in 2021.
Assessment
After 37 years, with all the means at our disposal beside mass treatment (for example, preventive treatment, insecticide-impregnated bed nets, remanent aerosol insecticide sprays, common insecticide sprays, repellents, mosquito traps, larvicidal products, fish praying on larvae, sterilized anopheles females) improved sanitation, drainage of stagnant water bodies and marshes, behavior change, wearing proper clothing in the evening and the enormous amount of money (poured into a pierced-bottom barrel) spent on this disease, it should have been eradicated.
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
VI- HIV/AIDS
A- Diagnosis
1984
O que se deve fazer quando se suspeita do diagnóstico de síndrome de imunodeficiência adquirida? Revista da Sociedade Brasileira de Medicina Tropical 17: 107-108, abr-jun. 1984 (Y. Meunier)
B- Treatment
1985
Traitement de la pneumocystose pulmonaire (PCP) dans le syndrome d'immunodéficience (SIDA): Le cotrimoxazole peut être continue malgre les effets secondaires qui regressent souvent?spontanément. Volume of the “Reunion Interdisciplinaire de Chimiothérapie Anti Infectieuse, Paris, France, 1985 (Y. Meunier, W. Rozenbaum, B. Duflo. M. Danis, M. Gentilini).????
2021
UNAIDS
·?38.4 million [33.9 million - 43.8 million] people globally were living with HIV
·?1.5 million [1.1 million - 2.0 million] people became newly infected with HIV
·?650 000 [510 000–860 000] people died from AIDS-related illnesses
·?28.7 million people accessed antiretroviral therapy
·?84.2 million [64.0 million - 113.0 million] people have become infected with HIV since the start of the epidemic.
·?40.1 million [33.6 million - 48.6 million] people have died from AIDS-related illnesses since the start of the epidemic.
Assessment
After 41 years, with all the means at our disposal beside mass preventive measures (for example: PrEP, condoms, sexual education, behavior change) and curative treatment and the enormous amount of money (poured into a pierced-bottom barrel) spent on this disease, it should have been eradicated.
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
VII- Chagas’ Disease
Public Health Programs: Personal Example
1977
Title
·?Epidemiological study of Chagas’ disease: Detection of triatominae in house wall and floor cracks
Place
·?Favela in Rio de Janeiro, Brazil
Position
·?Medical student at the Federal University of Rio de Janeiro (UFRJ)
Duration
·?1 year
Scope
Thousands of dwellers in the favela.
Results
·?Presence of parasitic vectors in several houses
·?Screening of the inhabitants for the disease
·?Spraying of a remanent insecticide on the walls
·?Filling the cracks and holes in the walls and in the floors and repainting the walls
2007
WHO
It announced a renewed strategy to eliminate Chagas disease in the Americas by 2010.
“New global effort to eliminate?Chagas?disease. Partners set out strategy against the “kissing bug” disease.”?
www.who.int/mediacentre/news/releases/2007/pr36/en/?index.html.
2021
WHO
About 6 to 7 million people worldwide were estimated to be infected with T. Cruzi and the disease was found in 21 continental Latin American countries.
“Chagas’ Disease.?https://www.who.int/news-room/fact-sheets/detail/chagas-disease-(american-trypanosomiasis).”
Assessment
After 44 years, with all the means at our disposal beside mass preventive measures (for example: remanent insecticides, aerosol insecticides, improved housing, behavior change, blood donation and transfusion, organ transplantation, and mother-to-baby transmission control) and curative treatment and the enormous amount of money (poured into a pierced-bottom barrel) spent on this disease, it should be under control (and any reemergence nipped in the bud via an adequate network of sentinel posts).
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.
VIII- COVID-19
Public Health Programs: Personal Example
2021
Title
·?Management of an outbreak in an electronics plant
Place
·?Calamba (Manila suburb) in The Philippines
Time
·?September and October
Position
·?Expert consultant hired by Eutelmed for ST Microelectronics
Duration
·?About 2 months
Scope
·?Protection of about 8,000 employees and their families
Outcomes
·?Total and rapid containment of the outbreak
·?No lock in of employees
·?No production interruption
2023
WHO
16 March
6,873,477 deaths worldwide.
Assessment
After 3 years of pandemic the morbidity and mortality toll is abysmal. The economic, psychological, social consequences are awful. Will all the means that were or should have been at our disposal (first, masks and PPEs, social distancing, isolating and quarantining, travel limitations, targeted and specific lockdowns, then treatments and vaccines) we should have been able to contain the disease not mitigate it as we are still doing. We never were proactive and are still reactive.
Drastic change is needed in global health, and it starts with leadership, vision, and framing. I look at it the way it should have been, the way it ought to be, and the way it can be and say why and why not. I think out of the box because I am out of the box.