Disease In Vietnam Funding Speech

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Disease In Vietnam Funding Speech

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Background
Common Diseases
Viet Nam, although considered a developing country, suffers mainly from lifestyle diseases like heart disease,
lung cancer and diabetes. This diagram shows that over 10 years, the top 3 killers in Viet Nam have remained
the same. TB, respiratory infections and road injuries have gone down and chronic obstructive pulmonary
disease, diabetes and Alzheimer’s have gone up. As for infectious diseases, hepatitis, HIV/AIDS, tuberculosis,
avian flu, malaria, dengue, chikungunya and typhoid are the most common. Incidence rates for some of these
are:



A study was undertaken in 2012 – 2013 focusing on dengue and chikungunya at Dong Thap Hospital. The
results came back that out of 131 patients, 101 were diagnosed with dengue and none with chikungunya, even
though just across the border in Cambodia the disease was reported. Avian flu in Viet Nam, although present,
has no data for incidence rates in humans specifically. However, the number of cases reported from 2003 –
2016 is 2746, the highest of any nation.
As for the health situation of Viet Nam in general,
Obviously not all of these diseases can be dealt with at once, so we’ll need to prioritize. Although hepatitis has
the highest incidence rate of all infectious diseases in Viet Nam, it is easily preventable. Vaccines exist,
however Viet Nam being a poor country, does not have the funding to ensure everyone can be vaccinated.
HIV/AIDS also has a high prevalence rate, however its effects are not immediate and therefore not as severely
impacting as tuberculosis is for Viet Nam. So dengue fever and tuberculosis are the 2 issues in Viet Nam that
will be focused one. One will need to be the priority for 2017 and I’m here to present why TB should be that
priority. Three criteria have influenced our decision:
1. Infectiousness: how easily spread
2. Severity of the disease when caught
3. Capacity for intervention



Infectiousness + Trends
The infectiousness criterion is composed of 3 parts: how easily the disease can be spread, how widespread
the issue is and what trends of case rates show. For this section, both were equally infectious, but dengue
showed more uncertain trends.
Dengue is a vector borne disease, carried by Aedes Aegypti mosquitos. An infected mosquito then bites a
human, transferring the disease, where another mosquito can bite that human and become infected. And so
the cycle continues. TB is an air borne disease, spread when an infected person coughs, sneezes or talks. The
germs are then inhaled by another person and usually after “long-term” contact (ie. not just passing in street)
they will carry the disease. In terms of spreading and contracting the disease, dengue and TB are equally as
contagious.
Dengue has 2 main places of concentration – the Mekong Delta region and urban areas. The Mekong Delta
has a high average annual rainfall of 1303mm/ year and temperature of 28OC, making it an ideal breeding
ground for mosquitos. The specific mosquito that transmits dengue is fairly unique in its feeding habits. It bites
mainly in areas with concentrations of people and during the day, so even more people are affected. With
global warming, these rainfall figures, along with dengue cases are likely to increase. TB on the other hand,
can occur anywhere throughout Viet Nam – rural and urban areas. Factors of higher concern for TB include
malnutrition, which reduces the ability of the immune system to resist the disease, living in poverty, which often
means poor healthcare and which leads to poor housing which often has bad ventilation, allowing the bacteria
to concentrate and spread. Viet Nam’s poverty rate has fallen 7.2% in 4 years, slowly making TB less
prominent for those reasons. Most poverty-stricken areas are in northern Vietnam, so there is an increased risk
of TB occurring there. So for the extent of each disease’s location, dengue is slightly more concentrated into
one area.
The 2015 incidence rate for dengue is 106/100 000, however, already Viet Nam has reported a 97% increase
on this figure for 2016 as of July, due to a strong El Nino year, providing more grounds for mosquito breeding.
TB on the other hand, had an incidence rate of 137/100 000 in 2015 and ranks at 12/22 for the highest burden
countries with TB, 14/27 for multidrug-resistant TB too. TB has a higher incident rate, but only by 31/100 000, a
fair difference, however this difference can vary depending on the weather (making dengue higher or lower).
As this graph shows, 2014 compared to the 4 years before it was a fairly low year for dengue, but 2015 had a
massive increase in cases.
This graph shows that TB has been on a steady decline since at least 2006 and according to this trend, should
be under control in coming years. This one also shows the mortality trend for TB and that too is a steady
decline. The prevalence rate of TB falls on average 4.6% annually and incidence falls around 2.6% annually.
So TB and dengue are much the same in infectiousness, except that dengue has slightly more concentrated
localities and TB has a slightly higher incidence rate. As for trends in infectiousness, dengue seems to be on
the rise and TB is on a clear decline.
Severity + Trends
Severity of each disease consists of the intensity of symptoms and their mortality rates. TB was considered to
be the worse of the 2 for mortality and dengue worse for trends.
Symptoms of tuberculosis when active, include:
– A persistent cough for more than 3 weeks, in some cases coughing up blood or sputum
– Chest pain
– In some cases: fatigue, weight loss and loss of appetite, chills, fever and night sweats
TB is primarily a “lung disease” where the bacteria essentially tear up the tissue, hence many chest related
symptoms.
Dengue fever symptoms can include any of the following:
– Fever
– Fatigue
– Intense headache (especially behind eyes)
– Muscle + joint pain
– Loss of appetite
– Vomiting
– Diarrhea
– Abdominal pain
– Rash
– Minor bleeding
If DHF, dengue hemorrhagic fever develops symptoms may also be:
– Areas of blood under the skin
– Acute shock, possible collapse
Both are results of internal bleeding.
In 2015, the mortality for TB in Vietnam was 1.1/100 000. For dengue in 2015, there were a total of 61 deaths,
making the rate 0.065/100 000.
Dengue mortality trends show a slow decline from the 90s until 2009, where the mortality rate was around
0.1% or 100/100 000, again showing that the dengue morality rates are slowly declining.
Mortality rates for TB are reducing by 4.4% each year.
Since TB and dengue have similar symptom severity, the main dividing factor is mortality rate. So in terms of
severity, TB seems needier of funding. But as for trends, dengue is.
Capacity for Intervention
This criterion is based on what is currently being done to prevent each disease and what could be done in the
future to further reduce their impact. It was decided that TB has the most that can be done to prevent it, given
that funding is available.
Tuberculosis can be cured with a series of drugs in usually about 6 months, after 2 weeks of which, a TB
patient will no longer be infectious. However, for multidrug-resistant TB, a 2-year procedure must be
undertaken, during which the patient should be hospitalized and several side-effects can come as a result such
as schizophrenia. In 2011, Viet Nam had a 56% detection rate, below the world target of 70% but has cure
rates of 92%, well above the world target of 85%. Viet Nam has also managed to beat the global average of
50% cure rates for drug-resistant cases by 25% in 2016.
The center for disease prevention and control (CDC), lists ways that TB can be reduced within a healthcare
system:
– Co-ordinate with local and state health departments
– Advertise respiratory hygiene (coughing and sneezing hygienically)
– Test health-care workers for TB
– Educate health-care workers about how to prevent it
– Clean and sterilize equipment properly
– Management of patients with suspected TB
– Available and timely lab testing and results
– Develop an infection control plan
– Allow ventilation to reduce concentration
– Educate patients to cover cough
– Use of more effective surgical masks
The white shows what Viet Nam currently definitely employs and the red is definitely in need of improvement.
Ventilation as well as overcrowded hospitals contribute to the spread of TB in Viet Nam.
Viet Nam currently co-ordinates over 1000 neighborhood health clinics, whose role in TB is to ensure that
every patient reports to take their pills in front of a nurse and get their “yellow card” signed. There are currently
60 rapid diagnostics machines throughout the 64 provinces, however that number needs to be doubled in order
to achieve Viet Nam’s goal of having prevalence rates at 20/100 000. Their current program director, Dr.
Nguyen Viet Nhung said earlier this year “Our TB program is cost-effective and has great impact, but I always
emphasize that this is a preliminary success. We need to sustain it.” Currently the program spends $26 million
a year, but needs to spend at least $66 million to really control TB. The current problem is that $19 million of
program funding comes from foreign donors, mainly the US, whose commitment ends in 2017. While TBcontrol
is a primarily government funded initiative, dengue prevention relies more on international
organizations.
Dengue fever cures are still not available. No medication exists that can cure the disease, however a vaccine
licensed DengVaxia is currently being trialed in labs. The scientists behind the research hope that by 2020, the
vaccine will be able to reduce morbidity caused by dengue by 25% and motility by 50%. But as dengue has 4
closely related strains, called serotypes, the vaccine would ideally have to target all of them. As of now, the
only prevention for dengue is vector control. This involves actions such as:
– Using insect repellent
– Eliminating mosquito breeding grounds
– Using mosquito nets
– Wearing long clothing
– Using small fish in still water to eat mosquitos and larvae
– Closing doors and windows
Eliminate Dengue: Challenge Vietnam was set up in 2006 and the organization focusses on 2 areas –
mosquito population monitoring and introducing Wolbachia into that population. Wolbachia is a bacterium that
prevents mosquitos from developing the dengue virus in their system and spreading it to humans. It also
shortens the life span of those with it. The first mosquitos to be released in Viet Nam with Wolbachia were on
Tri Nguyen Island. In 2015, the organization began research in Nha Trang city and has plans to expand the
program into the rest of Viet Nam.
Since dengue is a disease that currently only has vector control and its research still being undertaken, for this
criterion, tuberculosis is the disease with the highest capacity for intervention. Viet Nam has the program in
place, it just needs the attention and funding.
Recommendation
To make the final decision, the criteria were weighted depending on the impact they have.
1. Severity – if millions of people were dying from a specific disease, that clearly shows that it would need
to be prioritized, because saving lives is essentially the purpose of this funding. This is ranked above
capacity for intervention as, in serious cases of disease, any kind of funding helps whether for research
or better facilities
2. Capacity for Intervention and trends– if the disease has no or very limited ways to prevent or control it,
there’s really no point in funding it for the purpose of intervention. However, if there are ways to stop the
spread and severity of a disease, then obviously there’s a great emphasis on this criterion. And if a
disease shows trends of great decline or stability without the need for international funding, then there
wouldn’t be much point in selecting it based on that.
3. Infectiousness – If 2 diseases are equally as needy based on the first 2 criteria then the rate at which it
spreads and how widely it can spread will be considered.
The following table uses a scale of 0 – 10 to compare the 2 diseases. 0 = no signs of that criterion at all, 10 =
all signs of the criterion.
Infectiousness + Trends
3
Severity + Trends
1
Capacity for
Intervention: 2
Overall
Dengue Fever 7 6 5 5 4 27
Tuberculosis 7 1 6 2 9 25
Even though this table shows that dengue is the one to focus on this is just theory. The end results are very
close. Viet Nam is already doing as much as it can to combat both diseases, but TB has the most potential
benefit from being priority in 2017. So capacity for intervention is the real deciding factor. So overall, it is
recommended that focusing on TB is the priority for 2017.
Source Annotation
World Health Organization
(WHO)
– Good for some of the country’s health background, disease
information, outbreaks
– Very reliable international organization
Centers for Disease Control
and Prevention (CDC)
– Background information on diseases
– Very reliable government site
International Association for
Medical Assistance to
Travelers (IAMAT)
– Reports of outbreaks in each country and what should be done to
prevent catching that disease
– Very strong international organization providing a network of English
speaking doctors around the world for travelers
World Databank – Good for the health and other indicators of development
– Gets data from several international organizations
– Had data for almost all topics and was no earlier than 2014
National Center for
Biotechnology Information
(NCBI)
– Mainly used for capacity for intervention, and some statistics,
journals and reports on recent studies for things like vaccines, cures
– US government funded organization dedicated to advances science
and health by providing access to biomedical and genomic information

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