Times of India, May 2013
A pivotal clinical study of India's first indigenous rotavirus vaccine...
It is with a quiet sense of hopefulness and excitement that I look ahead to the next couple of years as we hear about the growing impetus of African countries preparing to introduce rotavirus vaccines – it sounds almost like a building crescendo or drum roll to me. The first notes started when South Africa introduced rotavirus vaccine in 2009, next came Morocco in 2010, and since July 17, 2011, Sudan has been immunizing its children against rotavirus. Today, the GAVI Alliance announced it will provide funding for 16 countries to introduce rotavirus vaccines, 12 of them in Africa. Rotavirus vaccines reached Sudan, the first GAVI-eligible country only two years after WHO’s recommendation for universal introduction. Now, Angola, Burundi, Cameroon, Congo Republic, Djibouti, Ethiopia, Ghana, Madagascar, Malawi, Niger, Rwanda, and Tanzania are lined up to introduce next year and in 2013. The crescendo is building in other regions as well: Armenia, Georgia, Moldova, and Yemen.
In one sense the years seemed to have passed so quickly, since I began researching rotaviruses in the 1980s at a Black African hospital in apartheid South Africa. In the three decades since, in partnership with a small but dedicated team of African colleagues, we have developed an understanding of the epidemiology and burden of rotavirus throughout the continent. We’ve demonstrated the terrible burden of rotavirus illness and death in Africa, where rotavirus kills more children per capita than anywhere else; and we’ve demonstrated the effectiveness and the public health impact that the vaccines will have in these same populations of young children. Yet the toll of childhood deaths in Africa – and other regions - has not waited for us to generate this information, and perhaps more than 5 million young children in Africa have died over the last 20 years.
Now we pass the torch to others to implement these life-saving vaccines in countries with the highest needs: to national governments to find the will to introduce the vaccines; to GAVI and the international community to find the means to pay for and deliver them; to vaccine manufacturers to produce enough vaccines and make them affordable for all who need them; and to the immunization officers and nurses who will give them – drop by precious drop – to infants in immunization clinics scattered across Africa, the Middle East, Eastern Europe, and Asia.
Looking back over 30 years now, I am honored to have been involved. And looking ahead to the next few years, it is with this quiet sense of hopefulness, this building sense of excitement that I can today envision a new generation of healthy African children playing in the sun and the red-brown earth of this magnificent continent, free from the misery of severe diarrhea.
--Born and raised in Southern Africa, Dr. Duncan Steele is a globally recognized rotavirus expert and PATH’s senior advisor for diarrheal disease.
For more information:
-- What is rotavirus? You should know -- you've probably had it!
-- How do we know rotavirus vaccines work?Read more
This week, the leaders of the world descended upon New York City for the 66th Session of the United Nations (UN) General Assembly, and many related high-level meetings and events. The hustle and bustle in New York is always energizing to me, but this week was unlike any of my previous visits. I may not have had the coveted badge to get anywhere even close to the UN buildings, but I attended and participated in several side events and conversations that painted a clear picture that the global community is joining forces, finding ways to leverage existing platforms, and partnering in new ways to chart a path forward for the improved health and well-being of women and children around the world.
This global gathering in the big apple included the second-ever UN High level meeting on a health topic (since the UN Special Session on HIV/AIDS 10 years ago) – non-communicable diseases .It also marked one year since the Secretary General launched his Global Strategy for Women’s and Children’s Health. Now more than ever we need coordinated approaches that address the well-being of women and children and engage actors across development sectors for greater impact. A report that was recently released by a group of six leading aid agencies, Join up, Scale up, sheds light on several real-life examples where progress has been accelerated through coordinated and integrated approaches. This joined up approach is of course not without challenges, which include policy barriers and a lack of flexible funds to program in more integrated ways, but such coordinated programming is often more responsive to the actual, holistic health and wellness needs of individuals, communities and developing nations. It seems clear that not only is increased leadership and support of this approach needed, but the lessons learned by the authors of this report can and should be applied as the world’s leaders work to move forward to address increasing burdens of non communicable diseases such as cancer and diabetes, especially in low and middle income countries. Together this means we must treat people instead of treating individual diseases and we must continue to collaborate across sectors.
This increased global partnership and collaboration from governments, the private sector, NGOs and concerned citizens is encouraging, but we still have a lot of work to do in order to meet the Millennium Development Goals and to rise to the challenge of a growing burden of chronic diseases. I am sure I’m not alone in saying that my hope is that, when we gather in New York again five years from now, the momentum will have carried us towards real impact and lives saved around the world.
-- Ari DeLorenzi, Advocacy Associate, PATH
For more information:
-- What do joined up programs look like in the field? Join up, Scale up highlights examples from 17 countries.
-- It's all about partnerships. Just ask the members of the Health/WASH Network.Read more
Each year new challenges surface across the water, sanitation, and hygiene (WASH) sector, yet with proven solutions these challenges are solvable. The problem is sometimes the proven solutions need a technological leg-up. Let’s be clear, technology alone is not the solution, but it is improbable to think that implementing non-profits along with the community and local government can fix all of the WASH problems of the world sustainably without a little help from technology.
For hundreds of years, technologies such as rainwater harvesting and boiling water as a form of household water treatment have been effective and efficient locally implemented solutions. However, these approaches are having a hard time keeping up with population growth, as resources become increasingly scarce. In contrast, as access to technological- like mobile phone – increases, there may be a place for new innovations and technologies. When more people in the world have a cell phone than a toilet, it may be time to re-evaluate how we look at the largest global public health crisis.
I am excited to see the World Bank, in coordination with international and local partners, is bringing a new group of people to the table – computer programmers –to give the WASH programs and projects around the world a techie boost. October 21-23 will be the first global WaterHackathon held simultaneously in eight cities around world. including Bangalore, Cairo, Kampala, Lima, London, Nairobi, Tel Aviv, and Washington DC. The WaterHackathon will be a marathon of brainstorming and developing where software developers and designers collaborate to create new tools for solving issues related to access to clean drinking water and adequate sanitation as well as other water challenges. The “hackers” will work with WASH subject matter experts who have predefined problems that could use a techie solution.
-- Elynn Walter, WASH Sustainability Director, WASH Advocacy Initiative
For more information:
-- Learn about innovative programs that combine safe drinking water with other health interventions in a new report, "Join Up, Scale Up: How integration can defeat disease and poverty."
-- Not a computer programmer? Become an advocate! Join the Health/WASH Network.Read more
Call it what you will: joining up or combining interventions, integration or disaggregation. Whatever you call it, it is essential to achieving the Millennium Development Goals and to alleviating poverty and disease. We can’t agree more with Antonio Monteiro, former President of Cape Verde and recently appointed Nutrition Advocate for West Africa, that integration makes good common and fiscal sense, both of which are rightly held in high esteem by citizens who hold their governments accountable for effective programming. Most importantly, it saves lives.
Despite the fact that this concept seemed obvious to most of us, we – and our partners – noticed a troublesome gap in the way we communicated this message: we lacked a compilation of practical examples to serve as evidence that integration is successful. Even more practically, we lacked a resource that answered the question, “What does integration look like in the field?” This gap came up repeatedly, and it was during some meetings last year with our partners across the pond that we were inspired to work together to try to fill the gap. Thus, the seeds were planted for what would become our new report, “Join up, Scale up: How integration can defeat poverty and disease.”
The report illustrates successful models of integration on both the interventions level and the government level. Just as disease and poverty solutions need to be “joined up” to realize the greatest impact, governments must work with civil society organizations and community leaders to “scale up” these successes. The recommendations in the report provide a road map for donors and policymakers to implement integrated programs.
One case study in the report features PATH’s diarrheal disease control program in Kenya. The pilot program integrated treatment interventions, like oral rehydration therapy (ORT) corners, with preventive measures, like hygiene education and safe drinking water. The innovative approach proved successful and influenced Kenya’s Ministry of Health to launch official policy guidelines on the prevention and treatment of diarrheal disease. Work is now being done on the local level to continue to raise awareness of the integration approach. Florence Weke-sa, deputy mayor of Kimilili in Western Kenya, is thrilled with the program’s work there, saying, “Do not do this work in silence. Work with local leaders. Shout about it. Make a loud noise.”
In just a few weeks, we’re going to make a loud noise at the UNC Water and Health Conference. Alfred Ochola, Primary health coordinator for PATH’s diarrheal disease control program in Kenya’s Western Province, will bring his on-the-ground perspective of the field work to the workshop, “Collaborating for WaSH and Health: Case Studies for Cost-Effective and Integrated Promotion.” We hope to see you there, but if you can’t make it, you can follow us at @defeatDD for the latest updates from the event.
We’re grateful for the opportunity to join voices with our great partners on this project: Action Against Hunger, Action for Global Health, End Water Poverty, Tearfund, and WaterAid. And we look forward to working with you, too, to send the message to donors and governments: join up, scale up, and save lives!Read more
Rivann and I are on way to Baray Health Center in Kampong Thom province to observe and speak with health center staff and Village Health Support Group (VHSG) members. We’ll learn from them the effects of childhood pneumonia and diarrheal disease in their villages and how integrated training on the two biggest killers of children is crucial in improving the health of their communities. VHSG are volunteer village health workers in Cambodia who educate community members on pertinent health issues and also refer patients to seek proper care at health centers or hospitals. This training is especially important, as every year in Cambodia, about 9,100 children under the age of five die from pneumonia and 2,300 die from diarrhea.
Driving in the direction of the health center, our car turns down a dusty road lined with open-air family-run eateries and pharmacies. Looking out the window, Rivann exclaims, “Wow! Look at all those people outside of the pharmacy!” I look to where she is pointing, and we drive by a pharmacy where there are several families sitting either on the dirt floor or on plastic chairs under the hot sun waiting for a consultation with a pharmacist to receive treatment for their illness. In Cambodia, many people first seek care from pharmacies and drug sellers before going to the health centers, and by the time they seek proper care, it is often too late. Many people, especially children, die from illnesses including pneumonia and diarrhea because they did not go to the health center soon enough.
We finally arrive at Baray Health Center, where one of the PATH-supported VHSG trainings is underway. Rivann and I enter the Youth Resource Room, a sunny, medium-sized room covered with white tiles and health education posters on nutrition, reproductive health, and first aid. Several shelves line the room with magazines and books, and a couple of VHSG browse the materials during the lunch break.
It is here that we meet with Chea Yeksim, Vice Chief of Duan Tom village in Baray operational district. Sitting on the cool, white titles, I ask Ms. Yeksim questions in English and as Rivann translates into Khmer, it is obvious from Ms. Yeksim’s animated responses how important this training is to the work of the VHSG.
“During the four years that I have been Vice Chief of my village, pneumonia and diarrhea among children are the biggest health issues. Many children in the community, especially the children under the age of five make up a lot of the cases,” Ms. Yeksim tells us.
“Why do you think that is?” I ask.
“Many parents do not have the knowledge about the two illnesses, and they prefer to go to a private pharmacy where they get medicine right away and while yes, it does stop the illness for a short time, many of the children continue to get pneumonia and diarrhea again and again. The pharmacists and the parents don’t know how to prevent the child from getting sick again and they certainly don’t know the symptoms of when a child has a cold versus when the child has pneumonia.”
I nod vigorously and quickly scribble down Rivann’s earlier observations about the crowded pharmacy down the street in the margins of my notebook.
Ms. Yeksim continues, “Many families spend a lot of money on medicines that do not prevent and properly treat their children. If parents knew the signs of these illnesses and when to bring them to the health centers to get proper care, many children would not have to die. Good health also means families have to spend less money on medicines that don’t work, and helps reduce their poverty.”
Ms. Yeksim tells us about a young boy who lives across the street from her home, whom she believes has pneumonia. “The boy’s chest is as large as this picture,” pointing to a photo in the training manual. “I will bring back what I’ve learned from this training, so that good nutrition, proper hygiene and sanitation, and what symptoms to look for if a child has pneumonia and diarrhea will be taught to my village. These simple steps can prevent both illnesses. If families knew what the symptoms were and brought their children to the health center right away, many children would not need to get so sick.”
In September we will go out with the VHSG members to observe them training the mothers of their villages about childhood pneumonia and diarrhea. We will meet and speak with the families whose lives have been affected by these illnesses and learn how simple, proven interventions are instrumental in saving their children’s lives.
-- Gizelle V. Gopez is the Program Associate for PATH’s Cambodia Country Program and enjoys collecting, sharing, and learning from the experiences and stories of the people she meets in the country.
This blog is part of a series. To read more, visit:
-- In Cambodia, Rising Flood Waters Bring Rise in Diarrheal Disease
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