PAHO Director signs cooperation agreement with AECID during official visit to Spain

Oscar Reyes

13 Nov 2023

Santo Domingo.- The National Association of Livestock Producers of Meat (Asocarne) has expressed its deep concern over the Dominican government’s decision to grant permits for the importation of meat from Brazil. Brazil has been declared positive for diseases such as “Foot and Mouth Disease” and has had cases of “BSE or Mad Cow,” while the Dominican Republic is considered free from these diseases.

Enrique de Castro, president of Asocarne, highlighted that the importation of meat from a country with such disease risks poses a significant threat to the entire bovine sector, including meat, milk, and cheese production. This move also jeopardizes the livelihoods of hundreds of thousands of Dominicans who are directly or indirectly dependent on these agricultural activities.

De Castro emphasized that introducing any of these diseases into the Dominican Republic would not only endanger public health but also pose a significant risk to the country’s tourism industry. He mentioned that even a single case of “BSE” on Dominican soil would jeopardize the safety of the entire food system.

The president of Asocarne also pointed out that the Dominican Republic lacks the economic and technical resources to inspect and ensure that imported meat products comply with health and safety standards. He noted that the country has not inspected a single shipment of imported meats in over two decades, deciding to open imports from Brazil even more concerning.

Asocarne estimates that at least 55 meat establishments in Brazil have been authorized to export meat products to the Dominican Republic, with no detailed information provided about the location or types of products approved for import.

De Castro emphasized that the Dominican Republic’s achievements in exporting beef to the United States were the result of years of rigorous processes and investments in structural and procedural adaptations to meet safety standards. The entry of meat from Brazil poses a risk to these efforts and the reputation of Dominican meats.

Asocarne called on the Dominican government to halt the importation process until thorough inspections of Brazilian slaughterhouses, farms, and the entire meat supply chain are conducted. They also requested the establishment of rigorous inspection processes for imported products that could affect the health of the Dominican population.

Furthermore, Asocarne urged the government to demand proof that any outbreaks of diseases affecting cattle in Brazil are reported promptly and that Brazil complies with international trade agreements.

Brazil has faced challenges in various parts of the world, including China, Russia, Thailand, and Arab countries, due to outbreaks of BSE, as noted by Asocarne.

Asocarne’s primary objective is to strengthen animal health in the livestock subsector and promote the development of the bovine sector in the Dominican Republic. They also aim to promote the production and consumption of domestically produced beef. The association brings together producers and companies involved in the meat sector, including those involved in the slaughter, processing, and production of meat products from bovine, pork, and ovine animal species.

Hannah Fegley of Silver Spring, Md., says she spent seven hours on the phone last month — the eighth month of her pregnancy — with insurers, pharmacy benefit managers and half a dozen pharmacies trying to obtain Pfizer’s new RSV shot, called Abrysvo.

The Health 202 is a coproduction of The Washington Post and KFF Health News.

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Respiratory syncytial virus puts up to 2 percent of babies in the hospital each year because their tiny airways don’t tolerate the inflammation. While most recover with supportive care, as many as 300 kids under 5 years old die each year and the majority of them are under 1. A bad case of RSV in infancy can mean a lifetime of asthma.  

Fegley says two of her friends saw their babies land in intensive care last year, a bad one for RSV. So she was eager to get the shot; she has a 4-year-old in preschool who, she says, “brings home every virus.” 

One of KFF Health News’ signature projects is the Bill of the Month, where readers and listeners send us stories about how the U.S. health system is failing them. Often, the problems they encounter connect directly to holes in government policy. Fegley’s story shows how regulators’ recommendations trickle down into a fragmented health system — leaving patients in the lurch.   

The Pfizer vaccine (list price: about $300), confers immunity to the fetus through the mother. As an alternative, the Advisory Committee on Immunization Practices also recommended AstraZeneca’s Beyfortus (about $500), a monoclonal antibody against the virus to administer to babies after birth. Fegley’s obstetrician didn’t carry the vaccine. So she gave Fegley a prescription to get it at a pharmacy, predicting (correctly) that many pediatricians wouldn’t stock Beyfortus.

Pharmacies typically stock RSV vaccines because the CDC also recommends them for people over 60 — a large and lucrative market, even though scientists and public health authorities agree the more obvious use is in infants. There are two different RSV vaccines approved for older Americans: the Pfizer shot, which is also approved for pregnant women, and a GlaxoSmithKline shot that is not. 

Fegley’s insurer uses CVS-Caremark as its pharmacy benefits manager, which of course uses CVS Pharmacy. (Both are part of CVS Health Corp.) And CVS, she discovered, only stocks the GSK vaccine. 

(Is your head spinning yet? Hers was. And she is health-care literate —  a social worker whose husband is a doctor. “We’re told we have choice, but we really do not,” she said.) 

After a phone complaint, a Caremark representative granted Fegley an “override” allowing her to try other pharmacies. She called them, but many said they’d only give the Pfizer shot to people 60 and over.

“We’re currently completing the final steps needed to offer the maternal RSV vaccine and hope to make it available at our pharmacies soon,” said Matt Blanchette, a CVS Health spokesman representing Caremark and the pharmacy. “Patients should check with their insurer to confirm if the vaccine is covered by their individual plan.”

One smaller pharmacy said by phone it had a dose for Fegley, but when they checked her insurance at the counter, it was denied. She filled out forms to get a shot at both Costco and Walgreens. Denied. 

She didn’t want to pay $300 or more for the shot out-of-pocket because she knew that under Obamacare, most insurers must cover all ACIP-recommended vaccines free of charge. So how can it be so hard to obtain a shot that the FDA and CDC say can save babies’ lives? Let us count the ways.

• One: The Affordable Care Act gives insurers more than a year after a new vaccine wins ACIP’s stamp of approval to start covering it. 
• Two: To keep costs down, pharmacies try to get deals on similar products by contracting with just one drugmaker. GSK didn’t finish its application to the FDA for approval to give its shot to pregnant women.
• Three: Many pharmacies don’t like giving pregnant women shots, fearing liability.
• Four: Both obstetricians (for the Pfizer shot) and pediatricians (the monoclonal antibody) have a hard time stocking such expensive medicines  — particularly with insurance reimbursement uncertain.

“Cost is the big issue,” said Steven Abelowitz of Coastal Kids, a big California group practice. “For us, it was a tough, risky decision: We’ve spent millions to order batches and we don’t know if we’ll get reimbursed,” he said. “Smaller practices just don’t have the money.”

There’s a happy-ish ending: This month, a Caremark representative left Fegley a voice mail saying she had an override to get the Pfizer vaccine at Costco for $105 out of pocket. If she wanted it free, the rep added, she should contact her husband’s employer. 

With some resentment, she says, she paid for the shot.

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USA.- The Valneva group’s chikungunya vaccine has received approval in the United States, marking the first vaccine against this mosquito-borne viral disease in the Americas.

Chikungunya infection typically presents with symptoms such as fever, joint pain, and sometimes a rash. Severe joint pain can persist for an extended period, even years.

Over the past 15 years, there have been at least 5 million recorded cases of chikungunya virus infection, making it an emerging global health threat, according to the FDA.

The highest risk of infection is in tropical and subtropical regions of Africa, Southeast Asia, and parts of the Americas since late 2013.

The vaccine, administered in a single dose, contains an attenuated version of the chikungunya virus, a commonly used technique in vaccine development. Common side effects include headaches, muscle aches, fatigue, and occasionally nausea, with rare cases of more severe reactions.

Before this vaccine, there were no approved vaccines or antiviral treatments for chikungunya, a disease whose name originates from the African Makonde language, meaning “to bend over in pain.”

Chikungunya is transmitted by mosquitoes, requiring a vector for transmission, and individuals typically develop lifelong immunity after recovering from the disease.

Valneva has also submitted an application for authorization to the European Medicines Agency (EMA).

The transformation of the building will see an additional 70 to 80 bed spaces, which will take the bed count past 260.

Dr Tufton, who was touring the facility on Thursday, told the Jamaica Observer that the ministry had not done enough for the hospital structure.

"The focus of the tour and the discussion is around how we will improve the infrastructure here at Sav hospital," Dr Tufton admitted.

"Truthfully, we haven't done as much as we'd like to for the hospital infrastructure in the parish of Westmoreland, so we now have a new management team. We have a team that is ready to lead the process."

In October, the chief medical officer for the hospital Camille Lewin stated that they were in a "real crisis" as bed spaces were lacking.

"Our hospital has a capacity of 190, this month we're at 284, plus five babies. Last weekend we got to 291," Lewin explained then.

Dr Tufton revealed that the COVID-19 outpatient facility will be transformed into wards.

He, however, pointed at one challenge that lies ahead.

"The challenge there is how do we relocate the outpatient clinics which are now in the COVID wards?"

He said they will seek to re-engage the municipality to seal that arrangement once more.

Meanwhile, Deputy Mayor Ian Myles said he, too, is excited for the upcoming plans for the hospital.

"Today is a great day for the parish of Westmoreland. Westmoreland has been in the news, especially this hospital, for quite some time now for overcrowding. With the minister just announcing that we are going to see expansion and upgrade to this facility, that in itself sends chills through my body," Myles expressed.

Many medications can affect your oral health. In addition to prescribed and over-the-counter drugs, vitamins, minerals, and herbal supplements can also cause oral health issues. Many of the common adverse effects of medication use that are seen in the oral cavity are dry mouth, abnormal bleeding of the gums, gingival enlargement, and soft tissue reactions. However, these side effects can be minimised by good oral hygiene practices, including regular brushing with a fluoridated toothpaste and flossing.

Some common oral side effects include:

Dry Mouth: Antihistamines, blood pressure and heart medications, antidepressants and other drugs can cause a decrease in saliva, leaving your mouth prone to soft tissue inflammation, pain and infection. Tooth decay can also develop, and chronic dry mouth can create problems for people who wear dentures. Alleviate dry mouth by drinking more water or using sugarless lozenges or gum to stimulate the flow of saliva. Artificial saliva or, in some cases, medication may be recommended by your dentist or physician.

Gum tissue overgrowth: Also referred to as "gingival hyperplasia", gum tissue overgrowth is associated with anti-seizure medications, immunosuppressant drugs such as those taken by organ transplant patients and calcium channel blockers taken by heart patients. Studies suggest that gum tissue overgrowth can be controlled if meticulous oral hygiene is started at the same time or before medication is taken. Tissue overgrowth can complicate oral hygiene. Sometimes, a gingivectomy (a procedure used to remove excess tissue) may be necessary.

Soft-tissue reactions: Oral sores, inflammation or discolouration of the soft tissue can result from taking medications prescribed for blood pressure control, immunosuppressive agents, oral contraceptives and some chemotherapeutic agents. Your dentist may recommend an oral hygiene programme to limit the discomfort associated with such side effects.

Abnormal bleeding: Reduced blood clotting is a result of aspirin and prescribed anticoagulants, like heparin or warfarin. These medications are prescribed to treat strokes or heart disease, but can cause bleeding problems during oral surgery or periodontal treatment. If you're having dental treatment, talk to your dentist about these medications, especially if the dental procedure involves bleeding.

Tooth discolouration: Intake of tetracycline products when teeth are developing can cause permanent staining in those teeth. Cosmetic dentistry techniques like veneers, crowns, bonding procedures, or, in some cases, bleaching may be used to lighten teeth with tetracycline stains.

Oral candidiasis: Certain inhaler medications used for asthma may lead to a yeast infection in the mouth. Rinsing your mouth out with water after using an inhaler can help prevent this side effect.

Preventing oral health problems

Some suggestions include:

• Avoid fizzy soft drinks, which are highly acidic and can erode tooth enamel. Drink fluoridated tap water instead.

• Cut back on sweet or sticky foods such as biscuits or popcorn.

• Chew sugar-free gum to encourage a steady flow of saliva.

• Pay careful attention to your tooth brushing and flossing habits. Brush your teeth thoroughly at least twice a day and floss once a day. Be gentle when cleaning your teeth to avoid damaging the gums.

• If your medication is acidic, rinse your mouth with water after taking it and avoid brushing your teeth for at least 30 minutes.

• Visit your dentist at least once or twice a year.

• Ask your doctor, dentist or pharmacist about the medicines you take and if they may affect your dental health.

•Minimise your intake of alcohol.

• Consider quitting smoking. Speak to your doctor or dentist about support available to help you quit.

• If you have a drug or alcohol dependence problem, consider talking to your doctor about support services or entering a drug treatment programme.

Your doctor and dentist may offer further self-care suggestions. Follow the suggestions carefully.

Dr Sharon Robinson, DDS, has offices at Dental Place Cosmetix Spa, located at shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica, School of Oral Health Sciences. She may be contacted at 876-630-4710. Like their Facebook page, Dental Place Cosmetix Spa.

Better communication between the island’s numerous health-care providers is required to improve the quality and administration of patient care.

This was the view shared by Ian Weithers, President of the Barbados Association of Radiographers, as he spoke to media personnel during Saturday’s opening ceremony for the Barbados Association of Radiographers and the Barbados Health Information Management Conference 2023. The conference was held at the O2 Beach Club and Spa, Dover Beach, Christ Church.

Weithers said COVID-19 was an eye-opening experience for the medical community, with access to patient information and other data proving challenging despite the need for it.

“In the past, everyone managed their own information, and sometimes it would be difficult when one is dealing with patient records and information to get information from another area. With the advancement of technologies we are now beginning to share information a whole lot better, which obviously means better management of patient care,” Weithers said.

“There are still a lot of gaps in information sharing. A lot of gaps for instance in care, the continuum of care. We need to get that better if patients are supposed to be better treated, and we get success with all of the other things that we are doing.”

Meanwhile, Minister of State in the Ministry of Health and Wellness, Dr Sonia Browne, also shared similar sentiments, stating that Government and medical organisations need to work together to remove data silos and other inefficiencies within the system to better improve patient care.

“Images of disparities in access, inefficiencies in the provision of care, and absence of supporting quality mechanisms, compartmentalisation of care does not allow for the provision of services from the systems perspective. It breeds inefficiencies in the use of resources and maximisation of funds,” Browne said.

“Additionally, the health-care industry has long been grappling with the challenge of hidden data silos; these data silos make it more difficult for organisations and health-care professionals to exchange information smoothly, which impedes care coordination and ultimately affects patient outcomes.”

Government and medical organisations work together to remove data silos and other inefficiencies within the system to better improve patient care, Bowne said.

She also revealed that the Ministry of Health and Wellness in 2022, with support from the Pan American Health Organization (PAHO) did an assessment of Barbados’ Information Systems for Health (IS4H), to develop a short and medium term work plan for the national level. Findings from this assessment will be used in short order to better streamline a number of services on the island.

(SB)

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