5.b. Top down and bottom up strategies that deal with disease risk and eradication

Question 1

What is GSK?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 1

Major pharmaceutical company in the UK.

Its business is one of the largest in the world.

Question 2

What was GSK’s 2013 turnover?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 2

£23 billion.

Question 3

How many manufacturing sites does GSK own? In how many countries? Where are GSK’s large research development centres?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 3

84 manufacturing sites, 36 different counties, large research and development centres in the UK, USA, Spain, Belgium and China.

Question 4

Acute/ chronic disease treatments counts for what percentage of GSK’s turnover? Where does the rest come from?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 4

Acute/ chronic disease treatments counts for 2/3 of GSK’s turnover, the rest coming from healthcare products and vaccines.

Question 5

In 2014, how many doses of vaccines were administered? What percentage were within the developing world.

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 5

In 2014, more than 800 million doses of vaccines were administered, 80% being in the developing world.

Well-known GSK produced drugs include:

Question 6

GSK produced drugs many well-known drugs. State 2.

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 6

• Amoxicillin: bacterial infections.
• Zidovudine: HIV infections.
• Bendazole: parasitic infections.

These are all on the WHO’s list for essential medicines.

Question 7

GSK complete huge investment in research and development. How many people do they employ each in R+D? How much is spent on researching the new medicines? Are there partnerships?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 7

They employ 13,000 people in research and development - spending £3 billion a year on researching new medicines.

Research and development is completed in partnership with other companies, universities, and research charities.

Question 8

GSK is one of the few researching the treatments for the WHO’s 3 priority diseases. What are they?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 8

HIV/AIDS, malaria, and TB.

Question 9

Why are drugs often so expensive?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 9

As research and development is long and costly, but also common to failure.

Question 10

Why does GSK face problems with demands in LIDCs?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 10

They have weaker economies that are too small to recoup development costs.

However, drugs are urgently needed, and could bring development to these countries.

Question 11

GSK devotes significant research and development resources to the developing world. Give an example.

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 11

Research facility in Spain focuses on TB, malaria, and other tropical diseases.

Question 12

What is GSK’s most recent development?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 12

A vaccine for Ebola, and are currently launching the first effective malaria vaccine.

Question 13

What is GSK’s primary motive?

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 13

Profit is the primary motive.

Question 14

GSK has adapted an ethical policy towards the developing world. State 3 features of it.

(GlaxoSmithKline Case Study: Transnational Pharmaceutical Company)

Answer 14

5% return on each product sold.

3 HIV/AIDS drugs on significant discount.

Granting licenses for cheaper drug alternatives.

Capping price of patented drugs to developing countries to 25% of UK price.

Investing 20% of profits from sales in each developing countries health infrastructure.

Question 15

Currently WHO and other agencies are working to eradicate two diseases, what are they?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 15

• Poliomyelitis (polio).
• Dracunculiasis (Guinea worm).

Both diseases are close to eradication, yet significant pockets of infection remain.

Question 16

WHO has previously attempted to eradicate three other diseases, what were they?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 16

Malaria, hookworm, and yaws.

Question 17

Prior to the development of a polio vaccine in 1952, how many were being killed or paralysed each year?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 17

Killed or paralysed 600,000 people a year.

Question 18

Who developed the polio vaccine? What did he do?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 18

The virologist Jonas Salk.

He chose not to patent his discovery, thus much reducing its cost.

Question 19

The Global Polio Eradication Initiative (GPEI) began when? Who supported it?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 19

1988.

It was supported by WHO, UNICEF, the CDC and other agencies.

Question 20

Was the polio vaccine and eradication attempt successful?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 20

A programme of vaccination had successfully eliminated the disease in the Americas and by 2011 the polio virus was endemic in just three countries:

• Afghanistan.
• Pakistan.
• Nigeria.

Within these countries, the uptake of vaccination to provide immunity for children remains uneven.

Question 21

What created a major setback for the GPEI in Pakistan and Nigeria?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 21

Political instability, and the murder of more than 80 health care workers in recent years by militants, has interrupted vaccination programmes, presenting a major setback for the GPEI.

Question 22

What created a major setback for the GPEI in Afghanistan?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 22

Since 2013, new outbreaks of polio have occurred in war-torn Syria and Iraq, where vaccination and basic hygiene have broken down.

Question 23

In the past, global agencies and governments had assumed universal support for the eradication of a Scourge like polio. However, this has not always been the case. Why?

(Global Polio Eradication Case Study)
(Top-down Approaches: Global Campaigns and Disease Eradication)

Answer 23

Resistance to vaccination programmes, related to political and cultural factors as well as ignorance, provided unexpected challenges to its eradication, particularly in Pakistan and Nigeria.

Question 24

What is Mauritius? Where is it?

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 24

A small island state in the Indian Ocean.

Question 25

When did malaria become endemic to Mauritius? What happened as a result?

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 25

Mid-19th century, and in 1867 an epidemic killed 1 in 8 of the island’s population.

A major government-backed campaign to eliminate malaria was launched between 1948 and 1951.

Question 26

Spraying buildings and the breeding sites of mosquitoes with DDT reduced mortality rates from malaria from what?

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 26

Reduced mortality rates from malaria from 6 per 1000 in 1943 to 0.6 per 1000 by 1951.

This allowed WHO in 1973 to announce that malaria had been eliminated from the island.

Question 27

WHO in 1973 announced that malaria had been eliminated from the island. What changed this? What happened?

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 27

2 years later, Cyclone Gervaise hit Mauritius.

In the aftermath of the disaster, migrant workers employed in reconstruction reintroduced malarial parasites to the island.

At the same time the destruction caused by the cyclone provided new breeding opportunities for malarial mosquitoes.

Question 28

What happened to Mauritius in 1982? What was done?

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 28

A malaria epidemic forced the government to embark on a second elimination campaign.

• Spraying of mosquito breeding sites and indoors resumed.
• Predatory fish that feed on mosquito larvae were introduced.
• Mass administration of the anti-malarial drug, chloroquine, to the population.

Question 29

Since 1998 the government has taken steps to prevent the reintroduction of malaria. Outline ‘passenger screening’ as a method.

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 29

Rigorous passenger screening has been implemented at the international airport; currently 175,000 passengers per year are screened comprising potential carriers of disease, such as arrivals from malaria-endemic countries and those showing symptoms of fever.

These people are kept under surveillance by health workers for up to 4 months, during which time blood samples are taken and analysed.

Question 30

Since 1998 the government has taken steps to prevent the reintroduction of malaria. Outline ‘insecticide spraying’ as a method.

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 30

Insecticide spraying, both indoors and outdoors, continues throughout the island, with particular attention to mosquito breeding sites and the residences of migrant workers.

Question 31

Has the Mauritius malaria eradication (second wave) been successful?

(National Eradication of Malaria in Mauritius)
(Top-down Approaches: National Campaigns and Disease Eradication)

Answer 31

Government efforts to prevent reintroduction have proved highly effective: with only 1 imported case of malaria being seen since 1997.

Question 32

In Ghana in West Africa, the Guinea worm eradication programme partnered with who? What was this in order to do?

(Guinea worm eradication programme In Ghana in West Africa)
(Bottom-up (grass roots) Approaches: Local Campaigns and Disease Eradication)

Answer 32

Partnered with the Ghana Red Cross women’s clubs to reduce the transmission of Guinea worm.

Question 33

The innovative Guinea worm eradication programme involved what?

(Guinea worm eradication programme In Ghana in West Africa)
(Bottom-up (grass roots) Approaches: Local Campaigns and Disease Eradication)

Answer 33

Teaching women volunteers how the Guinea worm is transmitted and how transmission can be prevented.

The volunteers then visit villages and educate local communities.

Question 34

In the past volunteer teaching was invested in males, and met with limited success. Why?

(Guinea worm eradication programme In Ghana in West Africa)
(Bottom-up (grass roots) Approaches: Local Campaigns and Disease Eradication)

Answer 34

This was because men frequently work outside villages and it is mainly women who are responsible for sourcing water and its use for household consumption.

Women were able to appreciate the value of filtering drinking water and avoiding contamination of water sources by people already infected with the parasite.

Question 35

Outline the responsibilities of women volunteers in Ghana.

(Guinea worm eradication programme In Ghana in West Africa)
(Bottom-up (grass roots) Approaches: Local Campaigns and Disease Eradication)

Answer 35

Monitoring, identifying and reporting all new cases of Guinea worm

Ensuring that those infected did not contaminate water sources.

Distributing, checking and replacing water filters that remove water fleas (Guinea worm vectors) from drinking water.

Identifying water sources used by the community and requiring treatment with larvicides.

Question 36

Was the ‘grass roots’ Guinea worm eradication programme successful? What supports this?

(Guinea worm eradication programme In Ghana in West Africa)
(Bottom-up (grass roots) Approaches: Local Campaigns and Disease Eradication)

Answer 36

Proved highly successful, and the Guinea worm has been effectively eradicated from Ghana.

WHO reported that in 1989 there were more than 179,000 cases.

By 2010 the country reported its last indigenous case of the disease.