US moves under Trump can undermine global healthcare successes, says top German public health researcher in Bengaluru | Bangalore News

Dr Bärnighausen, was in Bengaluru to deliver the Heidelberg lecture on ‘Novel Interventions for Population Health’ at the National Institute of Mental Health and Neurosciences on Monday. He expressed concerns over healthcare-linked developments in the US causing “grave danger to public health globally.”

“The HIV programme has been one of the great successes of global public health programs. It is a true success story. Millions of people who were infected who would have otherwise died are surviving because of the program. When you are on HIV treatment (Antiretroviral therapy or ART) you now live to almost normal life expectancy,” Dr Bärnighausen told The Indian Express.

“It is currently under threat because of the Trump administration disbanding and abandoning USAID. We are unclear what will happen but the disruption that has already taken place will manifest itself in lives lost and prevention of onward transmission of HIV infections – because when you are virally suppressed you no longer transmit to someone else,” he said.

With the cocktail of drugs required for the Antiretroviral Therapy of HIV infections being highly expensive, it can be afforded by people in the worst affected countries in Africa and Asia only on account of the subsidising of the medicines by US aid agencies.

“It is very efficacious and has been effective in real-life health systems. The major player here globally has been the United States via its presidential emergency fund for AIDS relief – through the US President’s Emergency Plan for AIDS Relief or PEPFAR and through global initiatives,” Dr Bärnighausen said. “With the US potentially moving out, the programme will need to be very well managed in order not to cause major long-term losses of life,” he said.

One of the areas of interest in population health research for Dr Bärnighausen has been ‘establishing the causal impacts of large-scale global health interventions – such as HIV treatment, HIV prevention, and childhood vaccination – on health, economic and social outcomes’ apart from finding innovations to improve public healthcare systems.

“We are finding ourselves in a peculiar situation. It is a major disruption in a programme (HIV treatment) which in the history of public health programmes – outside measles and other vaccines – has been one of the highly successful public health and life-saving interventions,” he pointed out.

US political developments and conspiracy theories around vaccines

Another area of concern for global public healthcare on account of the political developments in the US is the presence of people who have woven conspiracy theories around vaccines (US Secretary of Health Robert Kennedy Jr) in the US administration.

“It is really irresponsible to make public statements and take action aligned with those statements which suggest that there is no safe and effective vaccine. We have many, many safe and effective vaccines and they have saved millions and millions of lives over the decades,” Dr Bärnighausen said.

“Now there is a grave danger to public health globally,” he added.

“The standard vaccines and also the Covid-19 vaccines are safe and effective by the standards of medicine. They have been tested vigorously and put through efficacy trials. We know their safety profile. Of course, every medicine that works in some people can cause side effects in some people but they are extremely rare for the commonly used vaccines,” he said.

‘Measles has a herd immunity rate’

A recent outbreak of measles reported in a county in Texas in the US indicates that the community had not reached the herd immunity mark which prevents the spread of the disease, the professor of medicine at Heidelberg University stated.

“It is just in the news that there is a measles outbreak in Texas. I think measles has a herd immunity rate. So, an immunity rate, which by proxy means that 62 per cent of the community would have to be vaccinated to prevent the spread of the infections. It is a community-level concept and phenomenon,” Dr Bärnighausen said.

“If there is a measles outbreak anywhere then it means that a significant number of people in the community are not vaccinated – otherwise the disease will not transmit in a community. Once there is transmission and an outbreak it would mean that two in five people in that community have not been vaccinated against measles,” he said.

“These are unnecessary potential deaths that can follow since measles can be deadly. There are also long-term morbidities associated with measles. In many global communities measles is the most common cause of blindness and deafness. It can cause major long-term disability in children because they are not protected. It threatens lives,” he pointed out.

The director of the Heidelberg Institute of Global Health said that the global effort to tackle the Covid-19 crisis in 2020-21 will be viewed as a major success in terms of medicine when viewed through the lens of history, although there will still be criticism of the public health efforts to tackle the disease.

“It was the great success of our colleagues – the discovery scientists in medicine. We never had a vaccine faster. Within one year we had the nearly perfect and efficacious vaccine. It was actually BioNTech, the German company, and we had tests equally quickly. So the biological preparedness of the scientists was amazing in retrospect,” Dr Bärnighausen said.

“What was less successful – and context matters here because it was different in different parts of the world – was the public health approaches to working with communities and getting it right and convincing people to get the safe and effective vaccine, wear masks and not to go to school when there is a lockdown,” he indicated.

“In retrospect – this is probably at a very high level – and we do not have the answer because we have not done research on it since it was an emergency response. Data is still accumulating. My hunch is that in the history of medicine written some 20 years from now people will say it was a massive success of the biological scientists and a failure of the public health response in varied ways across the world,” the professor of medicine said.

“There were different types of things that went wrong. One is that the public trust and participation was often lower than what it should have been in free societies if public health was the only aim,” he pointed out.

“In many regards government policies probably went somewhat too far and lockdowns lasted too long in many places. They were too extreme. The mask usage was not necessary if you were on a bicycle and no one else was on the road. The public health response to some degree – in the form of the lockdowns, mask wearing, social distancing was overdone in retrospect. At the time, policymakers probably correctly took a risk averse stance,” he said.

The director of the Institute of Global Health at the Heidelberg University — one of the oldest universities in the world dating back to the 1300s — is looking at conducting global research, including in India, on public health interventions for controlling the pandemic of non-communicable diseases like diabetes, cardiovascular diseases, and hypertension.

“We are working on the science of intervention for public health and planetary health. We are very broad in our interests. We are currently in India and working with partners and institutes, like the Public Health Foundation of India, on the pandemic of chronic multi morbidity that we are all suffering from in many communities after the age of 40,” he said.

“We suffer from not one but three diseases on the average (diabetes, hypertension and heart problems),” Dr Bärnighausen said.

“We are very interested in chronic multi morbidity and ways to fight it by addressing risks at their source – which ranges from lifestyle – the way we eat, sleep and move in this world to environmental pollution and extreme heat to things that we can maybe change if we are correctly motivated from how the urban environment is built – where are the parks, the places for exercise and relaxation,” the population health researcher said.

“India is of course the world’s most populous country which has had such a rapid economic trajectory which is very likely to result in the factors that lead to the rapid increase of chronic multi-morbidity,” he added.  “We would like to work with Indian partners on this global agenda and in a global network it leads to comparative insights on what has worked in Germany, in India, in the US, in Africa,” he said.