WHO that girl? Infection prevention in Geneva
Hi – welcome to my first newsletter.
I am writing it for people who have an interest, but probably aren’t experts, in global health news, stories and policy. I have built a career working in health and epidemiology publishing, so I am privileged to have access to the conversations, conferences and research which impact our health outcomes globally.
There are things the professionals in this field have stored in their heads as casual knowledge, which I consistently find shocking, fascinating and important. I thought I could share this with others who might also find it shocking, fascinating, and important.
WHO that?
A couple of weeks ago, I headed to Geneva to attend the World Health Organization’s international meeting on implementation of the global action plan and monitoring framework on infection prevention and control (IPC). As snappily titled as anything in the healthcare world. The plan supports their Global Strategy on IPC and provides actions, targets and a means of measurement to support WHO member states in improving their IPC at national-, local- and healthcare facility-level.
I’m not just showing off here, although it was very cool to be at WHO HQ. This is an important development for global health: as your nan might have said, prevention is better than cure, and Tedros & co. in Geneva agree.
Infection prevention and control
As a discipline, IPC focuses on controlling infectious diseases in, or caused by, healthcare systems or facilities. We like to grumble, but here in the UK we are fortunate to have a developed healthcare system which is incredibly well-resourced by global standards. We also, theoretically, have a fairly functional government (I know I know Liz Truss) and one eye on preventative healthcare.
It will surprise nobody to discover that this is not the case in a lot of the world. Issues such as understaffing, overcrowding of patients, and fewer resources such as trained microbiologists or diagnostic tools means that diagnosing and then introducing basic interventions is challenging.
There are some incredible examples out there of the creative, clever ways people in resource-poor settings try to keep their healthcare centres safe for patients and the wider public, dealing with problems we barely have to consider in wealthier countries. One innovation which stays with me is from a neonatal ward Zimbabwe. The team conducted studies which found that staff education and turnover was a huge problem, leading to babies becoming infected. They worked with a team from UCL in London to develop an app called Neotree.
Neotree guides healthcare workers to perform the correct checks on admission and discharge of babies from neonatal wards, and provides clinical management support as they care for the babies. This technology helps plug the knowledge gap when there is staff turnover, or when the IPC expert (who often serves several hospitals) is elsewhere. So far it has been used in the care of over 24,000 babies in Malawi and Zimbabwe. If you are interested, you can support Neotree here.
Another example comes from India, where tuberculosis (TB) hospitals produce a huge amount of sputum (the stuff you hoick up from your lungs when you have a chest infection) full of dangerous TB bacteria. Yes, TB hospitals treating people with ‘consumption’ still exist. TB, consigned for a long time in wealthy countries to the pages of Victorian literature, has made a huge global resurgence, for complicated and political reasons – no doubt more on this in future newsletters.
Anyway, in one hospital in Delhi patients were together producing 30–35 litres of the stuff each day. Too much for your regular autoclave (heat and pressure sterilising machines), so researchers experimented with using industrial microwaves for the job. Not a perfect solution, but a clever one in a setting where resources are tight and you are dealing with many litres of deadly bacteria.
The bigger issue
A bigger issue than 35 litres of infectious sputum?
Well, yes. Something I enjoy about infectious disease specialists is that they will help you put things in perspective. For example, recently I was being anxious about climate change to a colleague, and she matter-of-factly replied that by the time sea levels rise, we’d probably all be dead from currently preventable illnesses due to antimicrobial resistance anyway. Which didn’t make me feel better, but does lead us nicely to the reason IPC is particularly important right now, why WHO are upping their focus and organisation in this area, and why policymakers must respond (hint for policymakers: it saves both lives and money).
Antimicrobial resistance (AMR) hits the headlines from time to time, as in this excellent Times article from Ben Spencer. It describes the phenomena of various pathogens (viruses, bacteria, fungi and parasites) developing resistance to antivirals, antibiotics and other medicines, which makes infection harder to treat and control.
There are a variety of ways in which pathogens become resistant, but ultimately these organisms learn how medicines work, and then evolve to evade our efforts. For a long time, enough new types (or ‘classes’) of antimicrobials were being discovered and developed that doctors would simply switch to another class should they find that a prescription didn’t work. However, there have been almost no new classes discovered since the 1980s, and a ‘dearth of creativity in the area’ has meant development has stagnated as pharmaceutical companies turn their attention elsewhere.
The impact on us is already huge: a Lancet study estimated that 4.95 million deaths were associated with bacterial AMR in 2019, and some estimates put mortality in the tens of millions without intervention. Certainly, a future of AMR is a future where we cannot safely have c-sections and other surgeries, where the common diseases we hoped we could resign to the past (TB, plague, syphilis) make a comeback, and suddenly your regular chest infection or UTI becomes impossible to treat. I would be immensely disappointed if, after a lifetime of battling them, it’s a UTI which gets me in the end, but that’s the way things are going.
The WHO IPC Framework
Various alternatives to antimicrobials are being developed, but currently we don’t have a globally accessible, reliable and cheap solution. (One interesting area of study is bacteriophages, viruses which attack bacteria, a route investigated in the Soviet Union while the West invested in antimicrobials, but no time for more on that today!).
Which is where prevention plays a vital role. WHO is increasing its focus on IPC, arguing that ‘every infection prevented reduces the need for and use of antimicrobials’, and reserves drugs for only the worst cases. The Global Strategy calls on policymakers to ensure that legal and accountability frameworks are in place to enforce implementation of IPC programmes. Most importantly, IPC programmes and monitoring need sustained funding and staffing – never something a politician likes to hear, but ultimately the savings in term of quality of life and expenditure are huge. A recent study from Scotland estimated at healthcare-associated infection cost the NHS across the UK £774 million each year in hospital bed days alone.
It is vital that policymakers take note and pick up the WHO recommendations, to save healthcare systems money and resources, but also to take a step towards fighting AMR, which truly is one of the greatest threats facing us.
A call for corrections!
I hope you enjoyed this first Substack. I am not a health professional, I am a writer and publisher working in the field, and I want to communicate these issues to a wider audience. I welcome feedback, corrections, more information! Please feel free to send me a message or leave a comment if you have thoughts or suggestions on making this a better resource for all.
What else have I been up to?
I read, watch, listen… here’s what I’ve enjoyed these past few weeks, I hope you enjoy it too!
Vagabonds!
By Eloghosa Osunde
The debut novel from Nigerian artist and writer Eloghosa Osunde, Vagabonds! weaves together stories of the outsiders - non-conformists and society fashion designers, politicians and criminals, queer and trans folk - of Lagos as they dance to rhythms of repression and freedom set by the God of the city and his watchers.
Osunde has a particular ability to portray of the love and self-love of those who are ostracised politically and socially due to who they are; truly touching, wildy surreal at times and always heartfelt and humorous.
Marie le Conte
She’s a great writer. I’m just unashamedly going to fangirl now.
I’d not really understood the purpose of a substack (why would I send a newsletter? I’m a person, I don’t have any news of note and I can whatsapp my sister directly if I see a good cat or Nicholas Cage has a new movie out), but Marie’s newsletter opened up the potential to me - a substack can be serious and light, playful and personal or professional, just obsevations from the week or something which really needs to be said.
I look forward to it popping into my inbox, and I always learn something. In fact, Vagabonds! was a recommendation she made here on substack.
You too can look forward to it popping into your inbox by subscribing to her substack here:
Thank you!
OK, well, that’s the first substack written and sent, I guess, at this stage, to nobody. Well done for getting this far if you indeed exist, dear reader, and see you again next time!