Today marks the first birthday of the Global Congenital Syphilis Partnership (GCSP) whose mission is to accelerate the elimination of congenital syphilis. To coincide with the partnership’s first birthday, GCSP member Dr. Jeffrey D. Klausner, Professor of Medicine and Public Health at the University of California, Los Angeles, is today issuing a call to arms entitled “The sound of silence: missing the opportunity to save lives at birth”.
Syphilis has plagued the most infamous and famous men in history: Hitler, Oscar Wilde, Van Gogh, Al Capone, Manet, Henry VIII, Napoleon, Picasso, Tolstoy, Shakespeare, Schubert and Gauguin are all thought to have suffered from it. Today the face of syphilis is not of an artist or a tyrant, or even of a man. Today the face of syphilis is of a baby silenced by premature death, that hasn’t even had the chance to lead a life of any such potential.
Despite its former ubiquity it is not widely known that today syphilis affects more pregnant women than HIV and kills over 400,000 babies every year. At a cost of less than US$1 (UK£0.70) for a test and treatment with a single dose of penicillin, congenital syphilis can easily be eliminated.
Syphilis’ relationship to HIV is also not widely known. Dr. Jeffrey D. Klausner says, “In mothers with both syphilis and HIV, syphilis greatly increases the spread of HIV from the mother to an unborn child. The world has been slow to act on the great opportunity to save babies’ lives using the very same infrastructure set up to prevent the mother to child transmission of HIV.”
With more pregnant women around the world accessing antenatal care and HIV testing and treatment to prevent the spread of HIV (PMTCT) to their babies, integrating syphilis testing into existing antenatal care services could be one of the most cost effective ways of getting closer to achieving Millennium Development Goal (MDG) four to reduce child mortality. Klausner highlights that an estimated 90% or more cases of congenital syphilis infections remain undetected and untreated, which emphasises the need for increasing the availability of testing and treatment.
In recognition of this, in June 2012, the World Health Organization (WHO) updated its syphilis elimination strategy by formally twinning it with the elimination of mother to child transmission of HIV. This change came about soon after the Bill and Melinda Gates Foundation-funded and London School of Hygiene & Tropical Medicine-led project, which successfully piloted a rapid syphilis test kit in hard-to-reach areas of high prevalence countries including Zambia, Tanzania, Uganda, China, Peru, Brazil and Haiti. As a result, all seven pilot countries adopted point-of-care syphilis testing into their prenatal screening programmes.
Since the partnership’s inception, much has been done to build on this breakthrough. Several of the pilot countries have secured donor funding to scale up the use of point-of-care syphilis tests for prenatal screening. The WHO has published an investment case for eliminating mother-to-child transmission of syphilis to mobilise resources. The private sector is increasingly beginning to engage with GCSP members to develop and roll out test kits, and alternative, social business models to increase access to testing are being explored. GCSP member, Universidad Peruana Cayetano Heredia’s School of Public Health, is developing and testing a model for enhancing rapid and sustainable uptake of point of care tests for prenatal screening using social and business innovation.
Founding GCSP member Dr Rosanna Peeling, Professor and Chair of Diagnostics Research at the London School of Hygiene & Tropical Medicine, who co-led the successful initial syphilis test kit research said “We’ve found a way to detect syphilis rapidly and to work with governments to incorporate rapid testing and treatment into policy. We now even have a dual combination HIV- syphilis testing kit. With the partnership as a platform, what we need now are the funds and the will to enable innovative delivery of these lifesaving tools.”
In countdown to the 2015 Millennium Development Goals, the partnership is redoubling its efforts to ensure testing and treatment can be the right of every pregnant woman, not just those in the developed world. The GCSP wants policy makers, donors, governments and the health community globally to move congenital syphilis out of the academic domain and into every level of maternal and child health policy and programmes, so that congenital syphilis can one day be relegated to the history books. GCSP member Klausner says, “It’s not evidence or a safe, effective treatment that have been lacking in the effort to end this centuries-old scourge. The missing elements are political will, advocacy and private donor investment. What will it take? Is anyone listening to the sound of silence?”
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This press release is reprinted by Alanna Shaikh out of an obscure sense of guilt. It does not represent the opinions of Alanna Shaikh or any of her employers.
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