The Hindu Business Line, January 2015
Jack Sim, sanitation champion and founder of the World...
The brilliant scientists of PATH’s Enteric Vaccine Initiative (EVI) conduct clinical trials for vaccine candidates against bacterial forms of diarrheal disease. Next month, they will launch a trial for a Shigella vaccine in Bangladesh.
EVI team members have spent countless hours preparing for this moment. We sat down with Nicole Bauers to talk about her role in the process, her love affair with infectious disease research, and her hobbies outside the office.
Nicole, you are the Clinical and Regulatory Coordinator for the Enteric Vaccine Initiative at PATH. What does that mean?
Basically, this means I handle the regulatory requirements once a vaccine candidate is ready for a phase 1 human clinical trial. This includes trial protocol development, data management, data monitoring, and logistics.
That sounds like a lot of work!
I love it. I love seeing the data results in real time, rather than just at the beginning and the end of a trial. And I love new studies and dealing with the daily challenges that come my way.
I recently traveled to Bangladesh to do a practice walk-through of a Shigella vaccine clinical trial, which is EVI’s first clinical trial in a developing country. There are a lot more obstacles to planning a clinical trial overseas, like obtaining the proper licenses and necessary regulatory documents. We also needed to handle the logistics of shipping the vaccine in dry ice so they wouldn’t spoil.
When we got to Bangladesh, we learned that the vaccines were there, but stuck in customs. We had to wait for two days while the vaccines sat in a box of ice in the airport – so close, yet so far! We were so happy when we finally got the vaccines that we took a picture of it. Thankfully, our test of the vaccines showed they had survived the trip halfway around the world, plus a two-day waiting period in customs, in a box of dry ice. This is good news for a potential Shigella vaccine introduction in Bangladesh, where the Shigella disease burden is high.
So, enteric diseases, eh? Was it love at first sight?
I seriously love diseases. After studying biology in undergrad, I enrolled in an MPH but missed the nitty-gritty micro-science stuff, so I ended up getting a Masters in Science in Emerging Infectious Diseases. For my Masters practicum, I spent a month in rural Panama collecting information on viruses there. That’s when I knew I wanted to do down and dirty field work. Later on, when I worked at a contract research organization, I learned more about clinical trials. At that point, my knowledge grew beyond diseases and I learned about vaccine development work. Now I know I want to stay in this field.
What do you enjoy most about working at PATH?
I feel so proud when I think about the fact that EVI has sponsored the most clinical trials in the Vaccine Development Program at PATH. I get emotional when I think about what we’ve accomplished.
Everyone here is so nice and everyone is brilliant. I’m always star-struck because I feel like I work with celebrities. John Clemens introduced himself to me in a meeting and I thought, “I know who you are! I’ve read all your manuscripts! I’ve tested your vaccine!” It was like I had met Tom Cruise. It makes me wonder, who will be the next generation of enteric vaccine celebrities?
Nicole Bauers, perhaps?
I would love to be the Tom Cruise of enteric vaccines.
When you’re not building your enteric vaccine celebrity status, what do you do for fun?
I’m a pretty active person, so I enjoy working out. Since college, I’ve done running, yoga, and karate, and I’ve recently taken up fighting.
… Fighting? Like, with boxing gloves?
Yes – boxing and Muy Thai. I got into it because I’m obsessed with UFC [United Fighting Championship]. I have my second fighting match this weekend. I don’t think I should show my fighting videos around the office anymore; my team was concerned for me because I wasn’t wearing headgear.
In case you were curious -- Nicole owned that fighting match.
Be afraid, infectious diseases. Be very afraid.Read more
Budgets and deficits. Fiscal cliffs and recessions. It’s hard to find a good-news story about the economy right about now. Most of us feel like putting our money in our mattress and calling it a day. But here at DefeatDD, we have just the cure: a feel-good story about health, children, and economics that can make everyone smile.
Since the 1980’s, when more than 36,000 children a day were dying of preventable causes such as pneumonia, diarrhea, and malaria, the health community –civil society organizations, governments, and donors – have successfully worked to almost halve that number. While the three decades of progress has been remarkable, this means that more than 19,000 children are still dying each day from the same causes.
Where is the good news, you ask? It happens that our arsenal of proven, cost effective solutions to save children’s lives is ever stronger. We know what to do and we know how to do it relatively cheaply. Antibiotics for pneumonia treatment are less than one dollar per dose. Oral rehydration salts (ORS) and dispersible zinc tablets for diarrhea treatment are also less than one dollar. Vaccines to prevent against these deadliest of killers are considered a “best buy” in health. Furthermore, we’re effectively deploying community health workers and village volunteers, and are taking advantage of child health days to ensure that children are receiving care in their homes and communities.
During a recent interview, UNICEF’s Anthony Lake said that improving access to these lifesaving interventions isn’t just the “right” thing to do; it is also the smart thing to do. It’s basic economics. With improved access to prevention and treatment interventions, children are healthier and more productive. They are able to stay in school longer, more consistently, and they keep learning. This, in turn, is good for national economies. To quote Dr. Lake, “healthy children are good for business.”
See! Good news! Here at DefeatDD, this is music to our ears. Healthy children are good for families, communities, schools, businesses, nations – essentially our world. But our work isn’t over yet. There are still 6.9 million children who will die before we can reach them with lifesaving preventions and treatments. As we work to end preventable child deaths and ensure that all children are able to contribute to their families, communities, and countries, we remain focused on what we know works: immunizations to prevent diarrhea and pneumonia, bed nets to prevent malaria, access to clean water, improved sanitation, and handwashing, access to quality ORS, zinc, amoxicillin, and antimalarials. Our tools are strong and proven.
Innovations in technology and delivery systems, and improvements in access to quality health care at the community level continue to drive our progress. As the countdown to 2015 and the Millennium Development Goals draws closer, we have a steep road ahead. Luckily, there is one fiscal measure we’re pretty confident about: investing in today’s children for tomorrow’s future is good for business.
Photo credit: PATH.Read more
On March 15, the UK will celebrate Comic Relief, one of the landmark dates in the calendar for raising public awareness of the effects of poverty, disease and instability in the developing world. From now until then, children and adults up and down the country will mark the event by participating in a series of fundraising activities, ranging from the physically demanding to the fun and inventive. Monies raised by Comic Relief go to support a huge range of worthwhile causes both in the UK and internationally. One of the international priorities for this year is to raise public awareness of rotavirus, the most common cause of diarrhoeal disease, and to promote various methods of preventing its effects.
Comic Relief will doubtless provide an excellent opportunity for the general public to learn more about the devastating effects of diarrhoeal disease in the developing world. However, for organisations like PATH, WaterAid and Tearfund, the human cost of diarrhoeal disease remains an everyday reality. While the condition is considered unpleasant and inconvenient in developed countries, and treatment is largely taken for granted, diarrhoea remains the most common cause of childhood illness in the developing world and is responsible for the deaths of almost 2,000 children every day.
In many countries access to clean water, sanitation and hygiene (WASH) remains a persistent problem. It is staggering to think that approximately 90% of diarrhoeal disease deaths are caused by the lack of this basic human need. Diarrhoeal disease also plays a significant role in persistent problems of malnutrition, with the World Health Organisation estimating that around 50% of cases of malnutrition are caused by repeated diarrhoea or intestinal nematode infections caused by unsafe water, poor sanitation and insufficient hygiene. This, in turn, can lead to stunted growth and impairment to future cognitive development, conditions which will have a detrimental impact on any child’s chances of succeeding in education, becoming fully economically active or raising a healthy and productive family of their own.
The great tragedy is that diarrhoeal disease is largely preventable. Improving access to WASH can play a huge role in preventing the condition and vaccines against rotavirus are also available and highly effective. Alongside treatment with oral rehydration solution (ORS) and safe and healthy feeding processes, improved WASH and access to rotavirus vaccines are helping to save millions of lives around the world. A concerted effort to increase the scale and reach of these existing interventions could, over the next five years, see diarrhoeal disease mortality reduced by 78-92%.
More however needs to be done, particularly if we are serious about meeting the Millennium Development Goal commitment to reduce child mortality by two thirds by 2015, and the UK has a leading role to play. As Co-Chair of the All Party Parliamentary Group for Child Health and Vaccine Preventable Diseases, I am particularly concerned by the problem of diarrhoeal disease. The All Party Group strongly endorses the Government’s commitment to reaching 60 million people with WASH by 2015 and we would encourage the Government to look further into a full and comprehensive, integrated package of interventions, which includes WASH, vaccines, medicines and nutrition, which can be rolled out to prevent diarrhoeal disease and its terrible effects.
Comic Relief may be the one day of the year when the whole of the UK recognises the problems of the developing world. It is however for Governments, healthcare practitioners, policy makers, NGOs and civil society partners to dedicate the rest of the year to resolving these problems. As the debate about the post-MDG future moves ever closer, discussions about the value of integrating preventative healthcare measures must go hand-in-hand.
Photo credit: PATH/Gareth Bentley.Read more
[Dad joke alert] “Yesterday, I swallowed some scrabble tiles by mistake. The next time I go to the toilet, it could spell disaster”. Bit of a stupid joke, I apologise, but the dubious function it performs in this blog is to show how what you put into your mouth is an important factor in what comes out the other end. This might sound a little obvious, but a healthy diet is a key determinant in the health of your gut and consequently whether or not you suffer from diarrhoea.
A child who is undernourished is at a higher risk of suffering from diarrhoeal disease – and diarrhoeal disease kills more children than AIDS, malaria, and measles combined. Undernourished children are at risk of suffering from diarrhoea because the lack of nutritious food doesn’t give the gut what it needs, and because the lack of nutritious food damages their immune system’s ability to fight off infections. To complete the picture, when children are suffering from diarrhoeal disease they are less able to absorb nutrients into their body. So diarrhoea is both a symptom and a cause of under-nutrition.
I recently went to visit Kinshasa, in the Democratic Republic of Congo (DRC), to talk to a range of people about what is being done to tackle the incredibly high level of child under-nutrition there. Currently, 43%, or about 5.5 million children, under the age of five are chronically undernourished. As part of a research project we are asking about how governments in fragile and conflict-affected states are combating the under-nutrition crises in their countries.
In countries suffering from persistent conflict and instability, nutrition is not always seen as a governmental priority. Government departments like health and agriculture which could, with sufficient budget and focus, make a real difference on child malnutrition just do not have the wherewithal to make it happen.
A refreshingly honest, if depressing, reason for this lack of government urgency was given to us by a Member of Parliament: they had decided to prioritise the defence budget; they want to deal with the conflict in the east of the country before they had the space to deal with human development issues like health and nutrition.
The conflict in the Kivus in the east of the country is forcing people to flee from some of the most fertile land. This means that cultivation and harvest is disrupted, significantly depressing yields and leading to scarcity and higher prices. In turn, lack of access to fertile land and therefore food exacerbates the conflict. However, conflict is largely restricted to the east, with the majority of the country relatively peaceful. Even in these non-conflict contexts, agricultural investment is low and undernutrition extremely high; these areas are largely forgotten, especially by the development community.
This leads to a really key question: should undernourished children be a higher or lower priority than dealing with an ongoing conflict in a restricted area of the country? We in the development community have isolated ourselves from difficult questions like this – our role is to care about the undernourished child. But the government of a country dealing with a long-term and protracted conflict feels like it has to make these difficult choices.
During the last resettlement programme for combatants in the east of the Democratic Republic of Congo, there was an attempt to help demobilised soldiers to settle on land as farmers; however it was not well managed, and ex-soldiers found themselves with no land and nothing to do – many of them simply went back to fighting and the conflict became worse. This was a lost opportunity, both for the conflict and for nutrition.
The government of the DRC with the help of the international community really must find a way of prioritising childhood undernutrition; not just to deal with the injustice but for pragmatic reasons as well. Without dealing with the underlying causes of the conflict, they will never see a lasting peace; those underlying causes include lack of access to food and the land to grow it on. Furthermore, good nutrition is central to the development of a healthy workforce, necessary to help a country grow its economy.
For instance, it has been shown that poor nutrition can make people 10% less productive, and it is estimated that Bangladesh has lost over $1 billion because of undernutrition.
The Government of the Democratic Republic of Congo is rightly concerned about the conflict in the east, but it simply cannot tackle the conflict while ignoring the nutrition crisis. The two problems are linked and neither will be solved through simply investing in the army.Read more
"The antibodies in your breast milk have prevented any serious illness.” At those words from the pediatrician, I pulled my head out of my hands, astonished.
There I was doubled up in the corner of the doctor’s office with a 104°F fever, a mask covering my face, and the worst stomach virus I had ever had. Yet, my two-month old son, who had been exposed to the same gut-wrenching bug, was lying on the exam table smiling and cooing. It seemed impossible that this tiny baby, whose immune system was not yet fully developed, could stave off what my mature immune system could not. I had taken my son to the doctor because I was worried that his symptoms (some slight diarrhea, vomiting, and loss of appetite), would snowball into the same severe gastrointestinal symptoms I was experiencing. But, as the doctor explained, my breast milk was not only providing all of the nutrients and fluids that my son needed to grow and thrive, it was also protecting him from getting really sick.
The truth is I shouldn’t have been so surprised. I make my living as a global health communicator at PATH where talk about disease prevention is routine. We communicate widely about the importance of tools such as vaccines, medicines/treatments, clean water/air, AND breastfeeding as essential components of an integrated strategy for controlling some of the world’s leading child killers, including pneumonia and diarrhea. I knew well how antibodies that help me fight disease can pass to my son through my breast milk. But, despite my awareness, I was seeing the power of breastfeeding in action through a “new mom” lens and could hardly believe my eyes.
Here, in the United States, we are used to having ready access to a whole suite of tools for helping our children make it to adulthood. We have the vaccination and treatment resources to protect our children from many life-threatening infectious diseases, including diarrhea and pneumonia. We have clean water and sanitation systems that run to virtually every household, preventing the spread of water-borne illnesses. The stoves in our well-ventilated homes most often use resources other than fossil fuels, keeping the air our children breathe clean and avoiding harmful air contaminants that can be contributing factors to pneumonia and other respiratory complications. While easily accessible for us, these resources are often out of reach for children in the developing world. As a result, too many children die because they cannot access or afford the interventions that could have saved their lives.
Breastfeeding is one of few tools that mothers around the world already have in their arsenal to protect their children from disease, no matter where they live. It provides ideal nourishment that prevents malnutrition, assists in the development of children’s immune systems, and enables the transfer of disease-fighting antibodies from mother to child. When direct vaccination is not an option, breastfeeding is a good way for infants to receive at least some immunity to some diseases in the critical early months of life, including several causes of pneumonia and diarrhea. When clean water and sanitation are unavailable, exclusive breastfeeding can also help children avoid exposure to diarrheal and other diseases caused by contaminated water.
Reflecting on how I was able to help my son fight off a strong stomach bug by breastfeeding, I feel a sense of empowerment and solidarity with mothers around the world. This is something we can do naturally with great benefit to our children. Here in the United States, getting my son to the doctor took a phone call, a five minute drive, and a nominal co-pay to my insurance. In other parts of the world, mothers travel long distances at great financial hardship to get their children to the care they need. Sometimes they arrive too late. Some mothers have no access to health care at all. In an ideal world, all children would have access to the highest standard of health care, which includes the full suite of disease prevention and treatment tools. While obstacles to this access are not going away any time soon, I am reassured that breastfeeding is at least one lifesaving tool inherently capable of crossing the geographic and socioeconomic divide.Read more