RotaFlash, December 2013
In late November, Zambia expanded a pilot project that originated in Lusaka district...
Few initiatives in public health have changed the lives of children and families around the world as much as immunization programs. These simple interventions prevented as many as 3 million deaths in 2011 alone. And the successes continue. Each year more and more children have access to lifesaving vaccines, with over 80 percent of children getting all three doses of the diphtheria-pertussis-tetanus vaccine. During the past decade premature death from measles was reduced by 71 percent and from tetanus by more than 90 percent. Polio is on the path to being eradicated. While clearly there is much to celebrate, we in the U.S. Department of Health and Human Services (HHS) and those of us in the global health community realize there is much work still to do.
Vaccine-preventable diseases still account for a quarter of the deaths in children under five. Pneumonia and diarrheal diseases continue to be the leading causes of death in children, and while vaccines exist, they are not widely available in developing countries. Every year 22 million children go without the full benefits of vaccination, and it is the poorest children who are the least likely to receive immunizations. Moreover, vaccines are still unavailable for a number of preventable diseases such as HIV, malaria, and other neglected diseases.
Recognizing that infectious diseases do not respect international borders, the HHS Global Health Strategy notes that immunizations are a fundamental part of both disease prevention and of protecting the health of people here at home. This global awareness is why one of the goals of HHS’s National Vaccine Plan is directed towards “global prevention of death and disease through safe and effective vaccination.” However, developing and disseminating vaccines cannot be done by one agency alone. Our successes come from our close partnership with other U.S. departments and agencies, non-governmental organizations, international organizations, and the governments of other countries.
The development of a vaccine for meningococcal A meningitis is a prime example of one of these successful partnerships. Meningitis is a terrible disease killing one in ten people two days of the first sign of symptoms, and those who do survive are often left with permanent hearing loss, mental retardation, seizures, paralysis, or infection requiring amputation. A partnership between HHS, the U.S. Agency for International Development (USAID), the Bill & Melinda Gates Foundation, the Michael & Susan Dell Foundation, the GAVI Alliance, the United Nations Children’s Fund (UNICEF), PATH, and the World Health Organization led to the development of MenAfriVac™. This is the first vaccine developed specifically for African populations and is affordable to low- and middle-income countries at less than 50 cents a dose (compared to more than $80/dose of other meningitis vaccines). It also is the first meningitis vaccine that can be used on infants and is expected to create immunity that lasts at least ten years. MenAfriVac™ is saving lives in African countries where meningitis epidemics have ravaged populations for a century. While we are proud of this success story, going forward, we need to create more opportunities for this type of collaboration.
Another key part of working towards ending preventable deaths is debunking myths about the supposed dangers of vaccinations. Around the world, hundreds of thousands of children are denied lifesaving vaccinations because of the scientifically disproven but still widespread belief that certain childhood vaccinations could lead to autism. We have also seen global immunization efforts derailed by unfounded rumors. For instance, in Nigeria stories that the polio vaccine was a Western ploy to spread HIV and sterilize Muslim girls led to a mass boycott that resulted in a rash of new infections in the country and spread of the virus to a dozen other countries, as far away as Indonesia. This is unacceptable. Overcoming these mistaken beliefs has become an integral part of our work towards global vaccine access. Until we reach the day when no lives are lost to vaccine-preventable diseases, we will aggressively continue to develop new and improved vaccines and ensure they are available to everyone in every country.
Photo credit: PATHRead more
It’s been a year since the United States joined UNICEF and the governments of Ethiopia and India in a bold pledge to end preventable child deaths within a generation. Last week marked the first anniversary of the Child Survival Call to Action, which has since spurred a rejuvenated global movement under the banner “Committing to Child Survival: A Promise Renewed.” In the past year, 174 governments pledged to redouble efforts for children. More than 200 civil-society organizations, 91 faith-based organizations, and 290 faith leaders from 52 countries signed their own pledges of support.
In the Rayburn House Office Building yesterday, members of Congress, PATH, the U.S. Agency for International Development’s (USAID’s) flagship Maternal and Child Health Integrated Program, the US Fund for UNICEF, and partner organizations celebrated the global commitment and the progress made so far. We also reminded ourselves of how critical it is to sustain this momentum because, to borrow the words of Anthony Lake, UNICEF’s executive director, “The story of child survival over the past two decades is one of significant progress and unfinished business.”
Progress: dramatic drop in child deaths
The number of children under age five who die each year has dropped from nearly 12 million in 1990 to less than 7 million in 2011. Translated another way, every day 14,000 children who would have otherwise died now live to see their fifth birthdays.
Particularly heartening is the progress made in countries that have carried some of the heaviest burden of child mortality. Nine countries, from Bangladesh to Cambodia to Rwanda, reduced their under-five mortality rate by 60 percent or more.
How far these countries have come is a testament to the unwavering commitment and sustained efforts of governments, the public and private sector, donors and nonprofits, civil-society groups, and communities. Other factors underpinning this global progress are impressive gains made in the research and development of medical technologies, improved ways of delivering health services, and bold new thinking in how we overcome roadblocks and speed up innovation for health equity.
Unfinished business: 7 million children
Today, almost two-thirds of child deaths are caused by diseases and conditions that rarely take a child’s life in wealthy countries, including diarrhea, malaria, tetanus, and measles. These deaths are also concentrated in a small number of countries—more than four-fifths occur in sub-Saharan Africa and South Asia. This health inequity is deepened by poverty, violence, political fragility, and social disparity.
As the tremendous progress to date has shown, these are not insurmountable factors—but overcoming them requires ongoing cross-sector collaboration, multi-intervention solutions, and investment in innovative approaches.
Innovating health technologies
I joined PATH as head of its Drug Development program just under a year ago because I saw how global health organizations are driving many of the transformative innovations needed to achieve big goals like the Child Survival Call to Action. For more than 30 years, PATH and our partners have advanced innovative health technologies to protect children from devastating illnesses, make childbirth safer, and provide families with tools for a healthy life. Tools like a vaccine against meningitis A developed specifically for Africa, which has been introduced in ten countries and protected more than 103 million people from epidemic meningitis. Or tools like vaccines for rotavirus and pneumonia, which have been introduced in 14 GAVI-eligible countries, or a feeding technology that ensures that premature babies and those with a cleft palate can access lifesaving breast milk.
On the first anniversary of the Call to Action, I feel even more convinced of the importance of research and development of innovative health technologies to fight against the leading causes of child death. This is why at PATH we are currently working on solutions to tackle the top child killers, like diarrhea, on many fronts. We are developing new drugs to shorten the severity and duration of diarrhea before it becomes fatal, while also working to improve the effectiveness of proven diarrhea therapies like oral rehydration solution. PATH is also working on new vaccines against the leading causes of diarrheal disease, helping countries increase access to existing vaccines for both rotavirus and pneumonia, developing and delivering safe water treatment and storage products, and advancing health devices, such as a user-friendly product design for amoxicillin dispersible tablets to treat pneumonia.
The road ahead
Yesterday’s briefing is a reminder of the critical value of sustained commitment to our children. It is an opportunity to emphasize the power of innovation for child health and get inspired by the momentum behind the current efforts to create effective health solutions.
Among other factors, development of innovative health technologies and new methods to deliver these solutions to the people who need them will continue to drive the current momentum forward toward our common goal of ending preventable child and maternal deaths. Because access to necessary vaccines, drugs, basic medical and maternal care, clean water, and adequate nutrition should not be marked by a line of health inequity.
June 14 marked the 1 year anniversary of the Child Survival: Call to Action. One year ago, leaders committed to ending preventable child deaths. Learn more about A Promise Renewed.Read more
On June 8, Prime Minister David Cameron hosted a Hunger Summit, Nutrition for Growth: Beating Hunger through Business and Science, to highlight the issue of hunger and undernutrition ahead of the G8 Summit in Belfast. The summit brought together business leaders, scientists, governments and civil society organisations to find a meaningful solution to the problem of hunger and undernutrition worldwide.
As Co-Chairs of the APPG for Child Health and Vaccine Preventable Diseases we are delighted that the Hunger Summit will bring international development issues to the attention of world leaders at the G8. Although the focus of the Hunger Summit is on nutrition, it is important that we don’t lose sight of other important interventions like improving access to water, sanitation and hygiene (WASH), vaccines and medicines in the fight against child mortality. It is also vital that we recognise the effectiveness of integrating these interventions to provide lasting solutions to development challenges.
With these issues in mind, the APPG hosted a parliamentary event on June 5 to discuss the value of integrated health interventions in development policy and to better understand the relationship between WASH and undernutrition. We invited experts in nutrition policy and members of the NGO community, including WaterAid and Action Against Hunger, to provide an overview of the issue to an audience of senior parliamentarians.
Amongst the attendees were Baroness Northover, the Government’s Spokesperson for International Development in the House of Lords; Sir Tony Cunningham, Shadow Minister for International Development; and the Chairs of the APPGs for Water and Sanitation in the Third World and Agriculture and Food for Development, Bill Cash and Lord Cameron, demonstrating the strong interest of Parliamentarians from all parties in this vital issue.
The issue is a particularly timely one, with the WHO and UNICEF having recently published their Global Action Plan for Pneumonia and Diarrhoea. The action plan recommended that the integration of healthcare, WASH and nutrition interventions would play a key role in any attempts to end preventable deaths from pneumonia and diarrhoea by 2025. With the WHO estimating that 50% of cases of malnutrition worldwide are caused by repeated bouts of diarrhoea, and around 90% of diarrhoeal deaths thought to result from inadequate access to WASH, it is increasingly perverse and ineffective to address each of these issues in isolation.
It is hugely appropriate that the Hunger Summit should coincide with the UK’s Presidency of the G8. The UK has long been a leading voice in the international community for driving forward international development and public health policy. From setting an ambitious target to reach 60 million people with WASH by 2015 to developing mechanisms for improving access to effective vaccines, the UK has been at the forefront of the push to end global poverty and eradicate preventable diseases. The APPG will continue to support the Government’s efforts on development policy and to promote integration as a key theme for any new post Millennium Development Goal Framework.
Photo credit: PATHRead more
According to UNICEF, diarrhea is a leading cause of death in children under the age of five. It causes more deaths than AIDS, malaria, and measles combined. Diseases caused by diarrhea are most often spread through person-to-person contact or fecal-oral transmission, which can be combated by washing hands thoroughly with soap and water. According to a study reported by the CDC, this simple act can reduce nearly 50% of diarrheal diseases by removing bacteria, parasites, and viruses from the hands. Seems like a simple, inexpensive solution right? But what does this look like on the ground?
As a Community Health Educator living in a rural village in northern Peru with the Peace Corps, I saw first-hand the barriers to this simple solution. Although, unlike many places around the world, this community was blessed with sufficient clean water, access to small “tiendas” or shops that sold soap, and rudimentary education on how and why to wash hands, diarrhea was still one of the leading health issues. Why?
While lack of comprehensive education was certainly a contributing factor, the largest obstacle turned out to be converting conditioned behaviors to new, healthier habits. Thankfully, after two years immersed, I was able to find ways to creatively and consistently engage community members, and here are a few things I found particularly helpful.
1. Start education young, especially in schools
Younger students are naturally more receptive to change, and are typically eager and willing to participate in educational activities. I worked with professors at the local elementary school to integrate hygiene and handwashing education into daily lesson plans via songs, pictures, art, dancing, photographs, and stories. Partnering up with the local health post, we were also able to celebrate Global Handwashing Day (October 15) with demonstrations, games, and giveaways.
Leading a handwashing demonstration at the elementary school on Global Handwashing Day.
Showing how our hands can look clean but still carry harmful bacteria during an afterschool club meeting at the elementary school.
2. Incorporate handwashing into any and all activities
During house visits, I always feigned dirty hands and asked to wash them, checking to see if mothers had water and soap on hand while giving a complimentary demonstration. When invited over for lunch (which happened more times than I can count), I always offered to help cook and used it as opportunity to remind mothers to wash hands before cooking and always insisted the whole family wash their hands with me before sitting down to eat. As part of an income-generating project, I also hosted baking classes, and used it as another way to promote the benefits of handwashing.
Washing our hands before sitting down to lunch.
Handwashing demonstration with a group of mothers before we begin a class on healthy eating and nutrition.
3. Celebrate the small wins
Changing habits is hard and each time one of my students or mothers remembered to wash their hands without a reminder, displayed proper hand-washing techniques, or offered me soap and water when I entered their home, I made sure to respond with a positive attitude and lots of encouragement. It can be easy to get discouraged, but every individual you reach is worth commemorating as you are inspiring generations of healthier kids to come. Celebrate it!
Posing with a mother who just won the hat she’s wearing by properly demonstrating handwashing techniques learned from one of my classes!
For great tips, activities, games, and information on handwashing, please see:
-- Brit Schneider lived in northern Peru as a member of the Peace Corps from September 2010 until November of 2012. She is currently pursuing a career in health and environmental education with underserved Latino populations.Read more
From Mukuyu Basic Middle School in Mazabuka, Zambia, to Boston University in Massachusetts, United States, all teachers want to see their students thrive -- and use their knowledge to make the world a better place.
Every year, at this time, I get very emotional. As a teacher nothing gives me more joy than seeing my students walk up to that podium and get their hard earned diplomas. The energy in their stride tells the world that they are ready to climb any dreadful mountain of challenge, failure, and frustration. The raw optimism of the speeches, original or recycled, and a healthy dose of “go change the world” get me really pumped up about doing just that. Yet, I also worry at this time every year. Are we really doing our bit to enable students to change the world?
We give our students plenty of debt, but do we give our students the tools to break the barriers of status quo? While I am certain that the students today are certainly willing to tackle “impossible” problems, I am concerned that they don’t know about the problems that have made life impossible for hundreds of millions. Solving these problems will affect not just those in New York but also New Guinea.
Biomedical engineers are a strange and an eclectic bunch. Some get motivated by the fundamental questions, some are interested in creating the next best technology for the biggest health challenges, and some want to see their technologies translated into the field, today. There is no shortage of health problems in the world, and some have every single criterion to get the heart of a good old nerdy biomedical engineer pumping. Pneumonia is at the top of that list. There are challenges in finding new and more precise biomarkers, questions about making better diagnostics and above all opportunities to save countless lives in a very, very short time. But somehow we are not telling our students the pneumonia story. We are not encouraging them to create solutions, at the fundamental or applied level, about the leading killers of children around the world. I am not arguing that everyone should be looking at solutions to solve the pneumonia challenge, but what I am arguing is that we are not doing a good enough job in motivating our students about a problem that is within our reach, that has all the essential ingredients of a complex yet solvable problem.
The problem on our end starts with awareness. I have asked over 500 students, what is the number 1 killer of children in the world? They start with HIV, malaria, malnutrition –no one has ever gotten this question right. Once I show them the data, they are amazed, appalled, and at the same time intrigued about why we still have this problem, and why kids from Congo to Pakistan to Papua New Guinea die of such a preventable disease.
Second, students follow the paths of their teachers and mentors in choosing projects and research topics, but there is very little research activity among my colleagues in addressing this global challenge. Part of it lies in few funding opportunities and part is rooted in the same lack of awareness. There are research grants out there, somewhere, but the researchers are unaware of them, or the grants come with bureaucratic hoops that many do not consider worth their time to apply.
Finally, the very few students, who by sheer determination, work on this problem and come up with a new tool or solution find new and often fatal problems in raising capital in countries with no insurance and little venture capital activity. Lack of mentorship does not make this problem particularly easy either.
The deadly cocktail of these problems in our teaching, research, and mentorship means that our students may never tackle the problem that is begging for their attention. Our best resource—the minds and passion of our most gifted students—is not being applied to diagnose, manage, and stop a preventable disease before it takes the lives of another million children this year.
Despite all of this, I am optimistic because the conversation has started in the corridors, classrooms, and labs. More importantly, it has started on the Twitters, Facebooks, and Tumblrs of the world. We just need to sustain it. This is the season to celebrate both the past and the future. The students have earned their diplomas and are ready to bend the arc of the future towards a healthier world. We, as teachers and mentors, will find them to be fully capable of doing their part, if we are ready to do ours.Read more