Tomorrow Global

…finding the future of global health and development

Tomorrow Global - …finding the future of global health and development

Greening Development

Carbon dioxide recently reached 400 parts per million in the atmosphere. Carbon dioxide, released by vehicles and electricity generation, is the main gas believed to cause climate change. The number 400 is important because scientists believe carbon dioxide concentrations have not been this high for at least 3 million years, before humans evolved.

Why should the development field care? While rich and middle income countries are responsible for most of the emissions (left image), the poorest and most vulnerable countries (right image), the ones we seek to serve, are the least equipped to deal with climate shocks. Floods, droughts, deforestation, and desertification can displace populations, impact agriculture, introduce new diseases, and change existing ones.

 

Maps distorted to represent emissions (left) and poverty (right). Maps by Duncan Clark and Robin Houston for the World Bank’s Apps for Climate challenge last year.

Maps distorted to represent emissions (left) and poverty (right). Maps by Duncan Clark and Robin Houston for the World Bank’s Apps for Climate challenge last year. Check out more of these awesome maps

The environmental and development fields often seem separate and disconnected. Sure, sustainability is a development buzzword, but it usually refers to financial sustainability, not environmental sustainability. There has been attention on climate change mitigation and adaptation, including the World Bank’s Apps for Climate challenge that these maps came from, and the International Climate Fund, set up by the UK government to “to help the world’s poorest adapt to climate change and promote cleaner, greener growth.” Still, development and environmental efforts could be better integrated. Some green projects, such as solar energy or composting toilets, are motivated by limited local infrastructure rather than environmental concerns. Protecting our only planet should be more intentional.

Beyond targeting large amounts of money towards environmental efforts, there are plenty of opportunities to implement greener practices on an everyday basis. The development field can develop a greener culture. Think back on the past year: How many proposals, budgets and reports have you printed out? How many disposable plates and utensils and water bottles have you used? How many miles have you traveled by plane or car or boat? (Maybe you complained about too many bumpy roads and flights, while secretly beaming with pride at achieving elite airline membership status?)

1 - Blister Packs

Blister packs help keeps medicines clean and dry, but also create extra waste. (Photo Credit: Cat Sidh)

On a programmatic level, how often are environmental impacts considered? I recently learned of a community health program that was working on improving its supply chain of medicines. Pills were initially dispensed in large pill bottles, and staff repackaged pills for dispensing to patients. They switched to individual blister packs to save the staff time and improve hygiene. Blister packs also keep pills dry, which is particularly important for moisture-absorbing chemicals like zinc.  However, no thought was given to the environmental impact of using disposable blister packs. Community health workers were trained to recognize and not dispense expired drugs, but there was no plan for proper disposal of expired drugs. Without proper disposal infrastructure, disposed drugs could easily enter the local water system and affect wildlife and humans. This is a problem seen in the US as well, where traces of antibiotics, hormones, mood stabilizers, and other drugs have been found in tap water. Don’t get me wrong. We should aspire to the highest quality of healthcare for everyone, including unexpired, clean and effective drugs. However, I do think that the environment effects should be considered at all stages.

What do you think? Are your programs taking the environment into account? How can the development field be greener?

Looking at the future: 5/21/2013

This week, the Taliban renounces war on anti-polio workers, climate change displacement is mapped, WHO approves a synthetic source of artemisinin, and inequality increases.

Taliban renounces war on anti-polio workers-(The Telegraph) The Taliban has ended its war on polio-vaccination workers and admitted immunization is the only way to protect children from the disease, its leadership said in a statement issued today.

Climate disasters displace millions of people worldwide-(The Guardian) I”m not sure if this is true, but according to The Guardian, more than 32 million people fled their homes last year because of disasters such as floods, storms and earthquakes – 98% of displacement related to climate change.

WHO approves synthetic source of artemisinin-(SciDev Net) A genetically engineered source of the chemical required to make antimalarial drugs has received WHO approval, paving the way for improved access to affordable treatment against malaria in developing countries.

Inequality rising in wake of crisis-(OECD Insights)According to this report, the world is getting more unequal. Some people and organizations want to bring inequality front and center for for the next round of the Millennium Development Goals.

Foreign Policy maps the U.S. military’s presences in Africa-(Foreign Policy) The United States have a handful of troops helping the French in Mali, but that’s just a drop in the bucket of the U.S. military’s presence in Africa, which has been quietly building for the last decade.

DoD and Global Health: Time for a Dose of Development Realism-(Center for Global Development) Kate Almquist Knopf of The Center for Global Development lists 6 problems with the Department of Defense getting involved in global health.

Rebranding Again: The future (and past) of HIV terminology

When we spend more time arguing over, memorizing, and exploiting the latest buzz words in HIV than we spend learning about the cultural and societal contexts in which we’re fighting the pandemic…well, we have a problem.

Recently a colleague forwarded me an artfully-written piece by Gary Dowsett, which brings light to some of the problems with branding and promotion of biomedical prevention for HIV, including treatment as prevention and ‘test and treat.’  Mr. Dowsett rightly points out that the stir, the buzz, the frenzy caused by these legitimately-exciting-but-not-silver-bullet developments can sometimes do as much harm as they do good.   Noting that “the hyperbolic discourse absorbing current HIV debate…reveals yet again the longstanding tendency for HIV politics to swamp the world of practice and encourage us to lose sight of all we have learned in 30 years of pandemic,” Dowsett encourages us to remember the complex cultural and social contexts in which all of our HIV interventions take place.  The piece is a reminder to think carefully about how we use the power of words to prioritize and promote, and to avoid over-generalization and replacement of complex realities with catchy terms.  If you haven’t already clicked on the link above, do it now – this is assigned reading to go along with this post.

A little over a week later, I happened to receive an email from a second colleague who works on a range of global health issues – not only HIV – asking my thoughts on using the term ‘MARPs’ (most-at-risk populations).  She cited UNAIDS guidance that someone had sent her – specifically, she quoted this bit from the 2011 Terminology Guidelines:

most at risk (don’t use)
Terms such as ‘most-at-risk adolescents’ (MARA), ‘most-at-risk young people’ (MARYP), and ‘most-at-risk populations’ (MARPs) should be avoided because communities view them as stigmatizing. It is more appropriate and precise to describe the behaviour each population is engaged in that places individuals at risk of HIV exposure, for example unprotected sex among stable serodiscordant couples, sex work with low condom use, young people who use drugs and lack access to sterile injecting equipment, etc. [Note: definition clipped here for this post]

I assured her that, indeed, the world was moving away from MARP and towards the use of the newest buzz-phrase: key populations.  And so, now we will say key populations when we write about people who inject drugs, sex workers, men who have sex with me, etc.  And what’s the problem with that?

The problem is exactly what’s gnawing at Dowsett is his piece: we’re using evolution of wording, pure semantics, to make ourselves feel like we’ve made progress.

We’re not using the term ‘MARPs’ anymore because communities view it as stigmatizing.  There are a small handful of things about this that leave me with a skeptical expression on my face:

  1. Communities find it stigmatizing?  Really?  All communities?  All communities feel the exact same way about this term?  What a coincidence.  Let’s move on to something that no one finds stigmatizing.  That will probably be pretty easy to do. (Excuse the heavy sarcasm…)
  2. Does anyone really believe that it’s the terminology itself that’s stigmatizing?  Can we have seriously convinced ourselves that the term MARPs is what stigmatizes the populations we work with, and not the ongoing human rights abuses; the discrimination they face in accessing basic health services; and even the way that we, while we’re squabbling about what terminology is en vogue today, ignore some of their most basic needs and desires?  Is it not a sign of the way that we compartmentalize and ignore the populations we’re supposed to be helping as we go about our Very Important Work writing reports and attending endless meetings on How Very Well We’re Doing? (Excuse the capitalization for emphasis – it seemed to work better than sarcasm for this point…)
  3. And what, after all, is it about this that makes it so stigmatizing for all of these communities that are being lumped together?  Is it that drug users don’t like to be associated with sex workers, and vice versa?  Is it that men who have sex with men don’t like to have their heightened risk because of sexuality lumped in with the ‘chosen’ actions of sex workers and drug users?  Essentially, is this not just a case of some communities stigmatizing others and not wanting to be described as being in the same group, even though the term MARP was supposed to be a judgment-neutral way of talking about risk, not risk behavior?
  4. Finally, does anyone really think that a woman is going to be happier being referred to as ‘a woman who occasionally sells or exchanges sex for food while her husband is engaging in migratory labor during which he buys sex under the influence of alcohol and occasionally injects drugs using unclean equipment’ than if we refer to her as a woman (or group of women) most-at-risk of acquiring HIV?*  While I agree with Dowsett’s point about not generalizing to such a degree that we lose all sense of separate identity, surely there has to be a balance and some discretion.

And, the kicker, UNAIDS itself suggests that we use the term key populations because, “the term ‘key populations’ or ‘key populations at higher risk of HIV exposure’ refers to those most likely to be exposed to HIV or to transmit it.“  You see that?  Most likely to be exposed.  Not most at risk.  Big difference.  (And we’re back to sarcasm…) Even the people writing the rules can’t figure out a way to effectively banish all of the ‘used up’ words when defining the new ones.

I don’t mean to indite solely UNAIDS for this – they’re just part of a very big room full of global partners who are all playing this same game.  But we all – UNAIDS included – need to assure that we spend time thinking about why we’re in such a rush to reinvent terminology and create frenzies about the next not-quite-silver-bullet tool.

When we feel tempted to harness the power the the English language to get everyone’s attention, perhaps we can stop and ask ourselves: Is there really a need for change, or does this change just allow us to sweep past failures under the carpet and move on with less guilt?  In the end, changing words doesn’t change our future, or our past, and it has the potential to distract from the real messy, complicated, and challenging work that we still have to do.

…and changing terminology won’t save us from failure.

A Future Without Antibiotics – 16/05/2013

Hello everyone!

Here is your weekly update on global antibiotic resistance. We welcome your feedback on these posts, and feel free to add any news you come across!

News

One in 12 hospital patients carries antibiotic-resistant superbug – CTV

More than 2890 hospital patients in Canada are infected with a so-called “superbug” at any one time, according to new Canadian research, which also found that most infections were acquired in a health-care facility. 4.2% of patients were carriers of or infected with methicillin-resistant Staphylococcus aureus (MRSA), 0.5% with vancomycin-resistant enterococci (VRE), & 0.9% with Clostridium difficile. In total, 1 in 12 adults in hospital either carried or was infected by one of the three superbugs, which are resistant to most antibiotics.

WHO launches regional programme to tackle drug-resistant malaria – The Hindu

The World Health Organisation announced a $400 million programme to combat a resistant strain of malaria that has emerged in South-east Asia in recent years. The programme, which has already received around one-third of the required funding, will seek to prevent the spread of a falciparum parasite that has become resistant to artemisinin-based combination therapy (ACT), the global standard treatment for the disease.

Malaria resistance – it’s in the parasite’s genes – Sarah Boseley | Guardian

Scientists from the Wellcome Trust Sanger Institute and Oxford University have been using genomic sequencing to try to get a step ahead in Cambodia, where the first resistance to a number of antimalarials has been found. In their paper published in Nature Genetics, they say that successive global waves of antimalarial drug resistance have originated in western Cambodia, including the most common form of chloroquine resistance and the most common forms of clinically significant pyrimethamine resistance and sulfadoxine resistance. This is where artemisinin resistance was also first seen - the scientists found not one strain of artemisinin-resistant parasite in western Cambodia, but a number of them.

The antibiotic bubble – a quest for continued antibiotic effectiveness – Steve Brozak | Forbes

Brozak outlines the investments of several companies into new antibiotics and outlines the current crisis: ”[a]ccording to the Infectious Disease Society of America, just one organism, methicillin resistant Staphylococcus aureus, better known as MRSA, kills more Americans every year than the combined total of emphysema, HIV/AIDS, Parkinson’s disease, and homicide.”

Research

ARMOR study shows multi-drug resistance continues to be a challenge – Healio

The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study to date has looked at 455 isolates from 25 clinical sites, according to a poster byWolfgang Haas, PhD, and colleagues at theAssociation for Research in Vision and Ophthalmology meeting. Four-year results of the ARMOR study showed that a number of isolates are resistant to common ophthalmic antibiotics, and methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci isolate resistance to multiple ophthalmic drugs remains high.

Receptor proteins could hold clues to antibiotic resistance in MRSA – Sam Wong | Health Canal

Scientists at Imperial College London have identified four new proteins that act as receptors for an essential signalling molecule in bacteria such as MRSA.

Looking at the future: 5/14/2013

This week, Google captures how humans are changing the planet, carbon dioxide levels are at an all time high,  drug resistant malaria is being mapped, and more.

Development progress according to time-lapse google maps-(The Atlantic) Google released an “interactive timelapse experience” that allows users to explore millions of satellite images captured over the last quarter-century — 25 years of immense growth and destruction. “We believe this is the most comprehensive picture of our changing planet ever made available to the public,” Google said in a statement.

Carbon Dioxide level passes long-feared milestone -(NY Times) The amount of the gas in the air has not been this high for at least three million years, and scientists believe the rise portends large changes in the climate and sea level.

C-Sections Deliver Cachet For Wealthy Brazilian Women-(NPR) Brazil has one of the world’s highest rates of cesarean deliveries: Some 80 to 90 percent of women in private hospitals in the country give birth via cesarean section. In some hospitals that number climbs to 99 percent.

Drug Resistant Malaria Tracker-(IR Mapper) IR Mapper consolidates reports of insecticide resistance in malaria vectors onto filterable maps to inform vector control strategies.

Cancer Vaccines Get Price Cut in Poor Nations- (NY Times) The two companies that make vaccines against cervical cancer announced Thursday that they would cut their prices to the world’s poorest countries below $5 per dose, eventually making it possible for millions of girls to be protected against a major deadly cancer. Glaxo declined on Wednesday to disclose its manufacturing costs, but noted that it had always been in first place on the Access to Medicines index, which was introduced in 2008 to measure how well pharmaceutical companies get their goods to the poor. A company representative said it would not make a profit on the vaccine at the new price.

A Future Without Antibiotics – 9/05/13

Hello everyone! Here is your media round-up of developments in antibiotic resistance. We are also constantly updating our online tracker of affected diseases and bacteria.

News

Superbugs invade American supermarkets – Environmental Working Group

A new report reveals that antibiotic-resistant bacteria are present in the meat products sold in American supermarkets and can trigger foodborne illness and infections that are difficult to treat. Samples collected in 2011 revealed significant amounts of the superbug versions of salmonella and Campylobacter, which together cause 3.6 million cases of food poisoning annually. 53% of raw chicken samples were tainted with a resistant form of E. coli.

Drug-resistant TB cases on rise in north India, reveals PGI research – Indian Express

One person dies of Tuberculosis every minute in India. The problem is equally severe in Chandigarh and adjoining areas where the prevalence of Multi Drug Resistance Tuberculosis (MDRTB) is as high as 9%. The prevalence of MDRTB was very high in newly diagnosed cases: 9%, as compared to WHO-reported figures of 3-5%. However, in previously treated patients, the prevalence was 27%, as these patients stop taking drugs in between and bacteria becomes resistant to available drugs. Overall, Multi Drug Resistance Tuberculosis was observed in 17% cases, and of all TB patients, 20% were found to be HIV positive.

Drug resistant bacteria in the prehospital environment – Kenny Navarro | EMS1

A number of multi-drug resistant organisms represent a threat to EMS professionals and their patients. Resistant strains can spread from the treated individual to others in the surrounding environment, and epidemiologists can often trace these infections back to improper infection-control procedures including inadequate hand-washing techniques, inadequate cleaning of the patient care environment, or inadequate decontamination of patient care equipment. Some groups are at higher risk for community-acquired infections than others. These include athletes, children in day care centers, military recruits, prisoners, IV drug abusers, patients in extended care facilities, and anyone who comes into contact with recently hospitalized people, especially ICU or surgical patients.

New sex ‘superbug’ may be more infectious than AIDS – Business Standard

A resistant gonorrhoea strain, HO41, was discovered in Japan two years ago in a 31-year-old female sex worker who had been screened in 2009. Though no deaths from HO41 have been reported, efforts to combat it must continue.

Research

Biosensor detects antibiotic resistance – Health24

A new technological collaboration between Keesler Air Force Base and Dr Vitaly Vodyanoy at Auburn University has yielded a method to test for antibiotic resistance in 10-12 minutes. The technology specifically targets drug-resistant Staphylococcus and takes advantage of bacteriophages, simple viruses that can target and kill bacteria. A bacteriophage, when combined with specific antibodies, can be used to produce a physical colour change in a sample that indicates antibiotic resistance.

The future of disease: the brutal intersection of diabetes and TB

needle

It is tempting to think of non-communicable diseases as somehow replacing the old ones. In keeping with the old view of epidemiological transition, we envision HIV as passing the death torch to heart disease, polio giving way to asthma in ruining the lives of children. The truth, unfortunately, is worse than that. The growing epidemic of NCDs isn’t taking the place of anything. It’s adding on and mixing in. NCDs and infectious diseases, in fact, often exacerbate each other. The intersection of tuberculosis and diabetes is one painful example.

People with diabetes have a risk for tuberculosis infection 2-3 times that of people without diabetes. As a result, diabetes is much more common among people infected with TB than it is in the general population. (a good general review of diabetes and TB can be found here.) Compounding the issue, people with diabetes have a higher risk of dying during TB treatment, or facing treatment failure.

TB drugs, especially second-line drugs, can be difficult for people with diabetes to manage. Side effects such as nausea and loss of appetite are very challenging when trying to closely manage blood sugar. In patients with limited income, it may be nearly impossible to pay for both diabetes and tuberculosis drugs.

It is already extremely difficult to control tuberculosis. Current approaches are barely keeping the disease in check, and the number of drug-resistant TB patients is growing. When you combine that with increasing rates of diabetes, the results aren’t pretty. More diabetes will mean more TB. It will also tend to mean more drug-resistant TB. People with diabetes who don’t respond to TB treatment – or quit because of side effects or cost – are likely to develop resistant forms of the disease.

This has implications for health policy. In its diabetes and TB framework, the WHO recommends that people diagnosed with diabetes should be tested for TB, and vice-versa. In a broader sense, the destructive force of diabetes and TB – and the exacerbating effect many NCDs are likely to have on the existing disease burden – increase the importance of supporting a health systems approach to care. Better screening, effective health care financing, and well-trained providers will help to fight all kinds of infection and disease.

(photo credit: Jill A. Brown)

HIV Treatment: Progress just keeps rolling along…

One thing has been reliable in recent years: we’re always making progress on HIV treatment.
(Image credit: www.lgbtmap.org)

A few weeks ago I wrote a piece that was a bit of a downer, rounding up some depressing news from the realm of prevention.  And while I haven’t seen anything recently that has flipped my mood on how well we’re preventing HIV (in fact, this week another vaccine trial failed), there has been some good news trickling in on treatment.

  • Since I got my start in HIV working on clinical trials, I can’t help but mention that we’re seeing some good news on the types of treatment available for fighting HIV.  When raltegravir, the first integrase inhibitor, was approved in 2007, it opened a new class of antiretrovirals.  This meant increased treatment options for people whose virus had developed resistance to other classes of drugs, and a new, tolerable option for treatment naive individuals.  And now, we’re on the verge of adding a second integrase inhibitor, dolutegravir, which could be taken once daily.  In addition, a whole new class of ‘boosting’ medication is being developed to play a role similar to ritonavir, which has long been the only thing available to make protease inhibitors more effective; in short, a new boosting drug might mean more effective options for people who are intolerant to some of the current regimens.  While it will take time for all of this to be widely available in the international realm, the good news is that Cobicistat trial is ongoing in a range of countries, including the US, Mexico, the Dominican Republic and Thailand, meaning that results should more easily translate to the international setting if the drug is proven to be a viable alternative.
  • Perhaps more to the taste of the global health crowd, we’ve also got some good news on how we administer treatment to adults, specifically for child-bearing women.  If you still weren’t convinced from an ethical standpoint that women who give birth should have 100% access to ARVs even after pregnancy, new evidence from Malawi reinforces the concept of “Option B+,” which allows women who are pregnant or breastfeeding to start on ARVs regardless of CD4 count (a major barrier for some women who would be clinically indicated but do not have access to a laboratory that can do CD4s).  This option also allows women to stay on medication for their lifetime (not only until the risk of transmission to fetus/infant has passed), and early results have show retention comparable to the national average.
  • And, finally, some more good news on how we get treatment to people – particularly, children.  A study from China shows high retention and low mortality on the country’s free pediatric treatment program, and is a resounding ‘yes’ to the question of whether to scale-up early, accessible treatment for children.  Though the data aren’t without their weaknesses, there’s power in numbers, and rarely does anyone have larger numbers to share than China.  Additionally, there’s some good news about the long-term cardiac effects of ARVs on children: an optimized regimen seems to be protective against the effects of HIV on the heart.  With so many unknowns about the effects of life-long treatment, this is just one more concern to strike off the list of  concerns about long-term, consistent use of ARVs in kids.

While progress in treatment can’t make up for short-comings in prevention (after all, ‘treatment as prevention’ is just one aspect of a combination prevention approach), it is nice to have some good news now and again – and with important decisions like the PEPFAR re-authorization looming, the more evidence we have on how to better invest treatment dollars, the better.

—

For anyone who remembers my piece from a few months ago on some creative new ways to look at progress in HIV programming, this recently-published article on the limits of community viral load (CVL) may be of interest.  This article does a good job highlighting some of the problems with using CVL as an indicator for how well treatment is contributing to prevention efforts; at the same time, I do maintain that CVL can be an important tool for telling us how well we’re systematically treating the people who are on treatment.  As a commenter on my original post pointed out, CVL doesn’t tell us anything about the people we’re not reaching – but (my thoughts –>) CVL taken together with other measures on how well we’re doing reaching people and getting them on treatment could go a long way to giving us a clear picture of our HIV response.

A Future Without Antibiotics – 2/5/2013

Here is your weekly roundup of news on antibiotic resistance. We also have our google spreadsheet where we’re tracking antibiotic resistance in several diseases and bacteria, and we invite you to contribute if you have any news we’re not tracking.

News

Parasite ‘resistant to malaria drug artemisinin’ – Rebecca Morelle | BBC

New drug-resistant strains of the parasite that causes malaria have been identified by scientists. Researchers found parasites in western Cambodia that are genetically different from other strains around the world. These organisms are able to withstand treatment by artemisinin – a frontline drug in the fight against malaria.

A new life for a deadly disease – Thomas Levenson | The New Yorker

[Antibiotics have] been available for almost sixty years. But not for seventeen desperately ill people in the Eastern Cape province of South Africa whose fate suggests that we may not enjoy our sense of invulnerability in the face of TB—and other infectious diseases we’ve conquered—for that much longer. Those afflicted suffer from a strain of tuberculosis that seems to resist every drug available to treat it. Seventeen is a tiny number, but the question those desperately ill people embody is whether we will do what is necessary to keep their numbers so small.

‘Potential to spark a global pandemic’: Wild animals in Botswana found resistant to antibiotics – Take Part | Richard Conniff

A new study on the mongoose reveals antibiotic resistance in humans has spread to animals in southern Africa. The fact that wildlife have been exposed, and have multi-drug resistance, and in fact are resistant to every drug that we tested is frightening,” says one of the researchers. The new evidence that humans can also pass on antibiotic resistance has implications for a broad range of wildlife, because mongoose is a common prey species for African wild dogs, leopards, lions, birds of prey, and many other species.

Drug-resistant bacteria reach UK – Hawick News

A “new superbug” could make antibiotics redundant, according to The Daily Telegraph. It reported 37 cases of patients having surgery in India or Pakistan and returning to the UK with infections that do not respond to antibiotics. The research behind these headlines has identified a range of bacteria (such as salmonella and E. coli) that have developed resistance to many powerful antibiotics, including the carbapenem antibiotics usually reserved for severe infections. This new resistance is due to the bacteria carrying a gene that produces an enzyme called NDM-1.

Zimbabwe: The agony of multi-drug resistant TB – Christopher Mahove | AllAfrica

Zimbabwe is grappling with multi-drug resistant tuberculosis (MDR-TB) which has become a major health problem, as patients fail to respond to the traditional first-line TB drugs. According to the Ministry of Health and Child Welfare, cases of MDR-TB nearly doubled last year from 156 in 2011 to 244 cases. This was despite the fact that notifications for ordinary TB drastically declined from 47 000 in 2010 to 38 367 in 2012.

Doctors warn that antibiotic-resistant strain of gonorrhoea could be ‘worse than AIDS’ – Daily Mail

An antibiotic-resistant strain of gonorrhoea known as HO41 has so far proved resistant to current antibiotic treatment and so it has been placed in the superbug category.  ‘This might be a lot worse than AIDS in the short run because the bacteria is more aggressive and will affect more people quickly,’ Alan Christianson, a doctor of naturopathic medicine told CNBC.

Related: The rise of antibiotic-resistant gonorrhoea has prompted treatment changes in Ontario, where the disease is spreading

Research

Gene sequencing helps identify drug-resistant malaria – Rebecca Summers | New Scientist

Researchers have pinpointed three sub-populations of the malaria parasite Plasmodium falciparum that appear to be a major force in drug resistance. The findings could help efforts to track the spread of resistant malaria in future.

Researchers reverse antibiotic resistance in superbugs – Charlotte Hsu | Medical XPress

A protein complex found in human breast milk can help reverse the antibiotic resistance of bacterial species that cause dangerous pneumonia and staph infections, according to new University at Buffalo research.

San Francisco: The Newest International Development Hub

golden gate There is a lot of excitement in the San Francisco Bay Area over a new Linkedin group – BAIL: Bay Area International Listserv. Finally a resource to find international development jobs out here! The group has really taken off – over 400 members in the last couple of weeks with over 50 jobs posted.

When I moved back here in 2011 after being in the field I never thought I’d be able to find something. I imagined my return home would be a rest stop before moving back to DC or NYC. But there is amazing work to be done here on the left coast.

Beyond the attractions of one of the cooler cities in the US,  I think there’s also a lure to the fact that we embrace and believe that our big ideas – in any and all sectors, including international development – could be the next revolutionary thing.  We’re not encumbered by the same USG and UN inspired bureaucracy you see back East. And to use a popular buzzword – there’s an intrinsic innovative spirit in the work we do as a result to our proximity to Silicon Valley’s tech giants.  We have loft open space offices in slighty sketchy neighborhoods, start-up vibes, and a frenetic drive to understand how technology and development intersect. We’re not business as usual in international development. At the same time some of the most respected NGOs, like the Asia Foundation and CARE have offices in San Francisco.

Whatever your flavor of development –  traditional, grass-roots, foundation, social enterprise – you can find it out here. For those of you contemplating coming out West, please do – we’d love to have you. Here’s a list of some of the bigger players:

Traditional style NGOs: Asia Foundation, Equal Access, Tetra Tech DPK, ReSurge,  and sub-offices for CARE, IRC, Relief International, RTI, and Camfed

Grantmaking, Philanthropy and Foundations: Global Fund for Women, Women’s Funding Network, Google.org, Cisco Foundation, eBay Foundation, Adobe Foundation, Mulago Foundation, Omyidar Network, Foundation for Sustainable Development (also does training), Hewlett Foundation, Packard Foundation, Skoll Foundation, Silicon Valley Community Foundation, Good Ventures, and Humanity United

Edgier California Style NGOs and Social Enterprises: Samasource, Inveneo, Kiva, Architecture for Humanity (named one of the 100 top NGOs!), Room to Read, Skoll Global Threats, Net Impact, Living Goods, d.light, Komaza, Benetech, Global Exchange, and TechSoup Global

Consulting/Advisory Firms: The Fritz Institute, Nexant, Dalberg Global Development Advisors, and Business of a Better World

I’m sure I’ve missed a ton, so add to the list in comments!

(Photo Credit: Salim Virji)