The New York Times, October 2015
"What if there were a remedy that could save more children...
Last year, I had somewhere in the ballpark of fifteen colds (and that’s a conservative estimate). Just to plan ahead, I’m penciling into my 2014 calendar several colds over the next few months. You see, my son is in daycare. Need I say more?
When my son was in his first few months of life, I blogged about how breastfeeding likely helped him stave off a severe stomach bug going around in our family. Since then, he has hit the one year mark and his many months in the germ-infested environs of daycare (and my single-handed support of the facial tissue industry) have underscored for me the importance of yet another facet of disease prevention—herd immunity.
Herd immunity is when a significant portion of a population is vaccinated against a disease, which helps indirectly protect others around them that are not immune by disrupting the chain of infection. Studies have shown that vaccinating children in particular can be beneficial for building herd immunity because they are often main transmitters of disease. Even major child killers like pneumococcus and rotavirus (the leading causes of pneumonia and severe diarrhea, respectively) are two examples for which this is true.
My son’s daycare center is a good microcosmic example of how easily and efficiently disease spreads in settings where frequent person to person contact occurs. Sniffles and coughs pass between children and adults like wildfire there. But, despite the number of runny noses (or my own runny nose for that matter), I often find myself relieved that the illnesses that seem to circulate on a regular basis at the daycare are, by and large, mild.
Most of the children are lucky to be done with or well into their vaccination series for many serious childhood diseases (e.g., pneumococcus, rotavirus, measles, diphtheria, pertussis, polio, etc.) The children in the class that may not be up to date on their shots are lucky too because the vaccinated kids form a sort of protective bubble that reduces everyone’s chance of exposure. Although mild illnesses like colds still get passed around, vaccines and herd immunity are hard at work shielding our children (and us) from many serious pathogens.
Since I live in the United States where vaccines are readily accessible, I can only begin to imagine how scary parenthood would be if my son and his peers did not have access to vaccines. But, for millions of parents around the world, especially in low-resource countries, they don’t have to imagine. In these settings, too many children grow up in overcrowded and unsanitary conditions with little or no access to vaccines and health care—a perfect staging ground for diseases to take hold and spread. And as a result, too many die. Pneumonia and diarrhea alone kill nearly two million children combined each year, and the major causes of both are vaccine preventable.
Having experienced firsthand the efficiency with which disease travels among the children and adults at my son’s daycare, I have gained an even more fervent appreciation for vaccines and their multifaceted ability to protect directly and indirectly against serious childhood diseases. The sniffles that my son and I have passed back and forth to each other, though annoying, seem like blessings when juxtaposed with the fearful possibilities if we did not live in a well-vaccinated community. Herd immunity is just one of many compelling reasons why vaccination is so critical to public health in high- and low-income countries alike. As my young son gets older and starts begging me not to make him get shots at the doctor’s office, I’m going to be strong and hold my ground because this is one area where I don’t want him to get separated from the herd.
Photo credit: PATH.Read more
USAID released a comprehensive Nutrition Strategy on their website for public comment on December 20, 2013. The design of a USAID nutrition strategy recognizes the essential role that nutrition plays in individuals’ and countries’ development and is a benchmark toward the development of a broader U.S. government nutrition strategy. USAID’s efforts to improve nutrition are critical to success of the U.S. government’s ability to advance global development, particularly in the areas of ending preventable child deaths, improving health, driving greater progress against hunger and food insecurity and promoting resilient communities.
I am particularly excited and encouraged to see the recognition of the multi-sectoral nature of nutrition in this strategy. Specifically, the inclusion of WASH as an illustrative action for IR 1.3 Increased availability and access to high quality nutrition-sensitive services and commodities (pg. 14-16) demonstrates this important pathway through which investments in the WASH sector contribute to the goal of improving nutrition outcomes.
The three high-level goals to be addressed through the USAID nutrition strategy—child stunting, wasting, and women’s anemia—are critical to reducing preventable child deaths and increasing child survival. Thereis clear and resounding evidence that WASH is one of the most effective ways to reduce child mortality, bolster resilience to disease and ensure healthy development. USAID plans to prioritize actions in this sector as well as both nutrition-specific and -sensitive interventions.
USAID is also committed to making the design of this strategy as inclusive as possible and held a public consultation yesterday with over 100 participants from the nutrition community. The receptivity and enthusiasm of USAID’s senior officials during this consultation process was promising and demonstrated how important it is to work together as one to combat malnutrition globally. To take a quote from the draft strategy, “the chance to come together as a dynamic and diverse global nutrition community [and work] towards a vision bigger than what any one organization or sector can achieve alone.”
The future of nutrition lies in the growing recognition that we must harmonize our efforts to have a truly great impact. This strategy offers a great opportunity to continue moving forward in that direction.
Photo credit: Heng Chivoan
Reposted from the PATH blog.
As I watched the historic launch of rotavirus vaccines in Bamako, Mali, yesterday, I was reminded of an anxious time in my life more than a decade ago. I sat between two small beds in a hospital room in Seattle, where my daughter, 1, and my son, 6, were both receiving intravenous (IV) fluid for serious diarrhea. As a physician, I knew that rehydration with IV fluids is a simple and potentially lifesaving intervention. As a mother, I was worried.
Fortunately, my children were able to return home with me the following day, fully recovered. I was grateful that the hospital was an easy 15-minute drive from my home and that advanced medical care was readily available.
Had I been a mother in Mali, I may not have been so fortunate—one or both of my children could have died from diarrhea. Mali is one of the poorest countries in the world. Mothers, fathers, and other caregivers often have to travel great distances over difficult terrain to reach health facilities. Depending on the location, IV therapy may not be available for their children. Lack of access to care is one reason more than 90 percent of diarrhea-related deaths occur in young children in countries with few resources.
Rotavirus is the most common cause of severe and fatal diarrhea in young children worldwide. In Mali, it kills more than 7,200 children each year and hospitalizes many more. Vaccination against rotavirus as part of a comprehensive approach to prevent and control diarrheal disease is the best way to protect infants from rotavirus disease and reduce its burden. In many countries that have introduced rotavirus vaccines, scientific studies have shown swift and significant declines in hospitalization and deaths due to diarrhea, as these tables on our Rotavirus Vaccine Access and Delivery website show.
While this is not my first visit to Mali, it is certainly the most gratifying. Yesterday’s momentous occasion is the culmination of more than seven years of hard work by a dedicated Malian team, my colleagues at PATH, and many other partners who paved the way for distribution of these lifesaving vaccines in Mali and in other low-resource countries.
In 2005, I joined PATH’s Rotavirus Vaccine Program, a partnership with the World Health Organization (WHO) and the US Centers for Disease Control and Prevention that was funded by the GAVI Alliance, which helps increase access to immunization in poor countries. We worked with rotavirus vaccine manufacturers and in-country partners to design and execute clinical trials of rotavirus vaccines in Africa and Asia, including here in Mali. The strong evidence generated from these trials was pivotal to the 2009 WHO recommendation that all countries introduce rotavirus vaccines into their childhood immunization programs.
Mali is the 20th GAVI-eligible country and the 53rd worldwide to introduce rotavirus vaccines into its national immunization program. While this is cause for celebration, there is a lot more work to be done. Many children still don’t have access to the lifesaving benefits of rotavirus vaccines. While 14 countries—13 of them in Africa—plan to introduce rotavirus vaccines with GAVI support in the next two years, more than 15 other GAVI-eligible countries have yet to apply for rotavirus vaccine support. In addition, numerous middle-income countries, where childhood diarrhea is a huge problem, have yet to include rotavirus vaccines in their national immunization programs.
The incredible positive health effects and related reduction in health costs due to the introduction of rotavirus vaccines is one of the most remarkable public health achievements of the past decade. Mali’s decision to proceed with rotavirus vaccine introduction despite recent devastating political and social turmoil underscores the country’s commitment to the health and lives of its children. Mali’s leadership should inspire other countries to take action in the fight against rotavirus and help ensure that all children worldwide have access to these lifesaving vaccines.Read more
Vaccination is a public health heavyweight—and essential in any successful strategy to knock out deadly childhood diseases. Today we present some of the prize-fighters in that effort: our very own Vaccine Development colleagues.
When the team from PATH’s Vaccine Development Program (which houses defeatDD) gathered together late last year, we asked a few of them to take a moment and reflect on their motivations. What 2013 milestone made them most proud? What does 2014 have in store? And why did they choose a career in global health?
As team members weighed in, their answers brought new insight into our colleagues’ personal passions as well as their scientific ventures. We call this collection “Voices of Vaccine Development,” and you’ve got a ringside seat. We hope you enjoy viewing these personal perspectives as much as we enjoyed gathering them!
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Insufficient supply and high prices are major factors that can delay the availability of lifesaving vaccines in low-income countries—sometimes for decades following their adoption by wealthy countries. Shortening these timelines and improving accessibility for populations that natural market forces often leave behind takes a collective effort from an intricate web of partners along the vaccine development continuum. Luckily, we know someone who is an expert at building partnerships.
Meet Linda Nyari, director of the commercialization and corporate partnerships team for PATH’s vaccine development program, which advances the development of new, affordable vaccines for low-resource countries. Her team of business and legal professionals is responsible for shaping the strategic partnerships that steer a new vaccine’s journey from the laboratory to saving the life of a child in need. We sat down with her to get a behind-the-scenes look at what it takes to set these partnerships up for success.
How does your team help make vaccines accessible for underserved populations?
As a nonprofit organization, PATH doesn’t have its own vaccine development laboratories. So for us to accelerate access to new vaccines for our target populations, we have to collaborate with various partners that can develop, manufacture, and distribute the vaccines appropriately. These partners include nonprofit organizations like universities and research institutions, and commercial partners like vaccine manufacturers, biotechnology, and multinational pharmaceutical companies. My team negotiates the agreements to work with these partners—the legal written word that describes how the parties are going to work together. We put provisions in place (such as appropriate license rights or price structures) that keep doors open for the vaccine to become available for underserved populations, while also building in protections to help our partners be successful.
What does success look like?
The objective of our work is to enable a vaccine to be commercially sold at a price that is affordable and sustainable for low-resource countries and to ensure an appropriate supply of the vaccine so that it can be introduced into those countries. Since our work is integral to the partnerships required to achieve these objectives, we engage throughout the entire vaccine development process from preclinical research through to product registration. Critical to success is ensuring the sharing of data, which can help advance a specific vaccine or the larger vaccine development field. A catch phrase that is often used for what we’re trying to accomplish through this body of work is ‘global access.’
What is in it for the partners?
Due to perceived difficulties in achieving a return on investment, vaccine developers with good ideas are often reluctant to pursue a vaccine primarily needed in low-resource countries if the countries could have difficulty paying for it. Others may simply need assistance to develop the vaccine or to enter developing-world markets. Our program incentivizes companies to pursue such vaccines by providing donor funds to support the work and technical expertise to help successfully move the development forward.
To take a product forward and actually sell it, you need a champion, and usually that’s a for-profit company (either in the developed or developing world). So, we’re saying to such partners that they can move forward with whatever business strategy they want in the developed world, as long as the technology is made affordable and accessible for public-sector markets in low-resource countries. Overall, we try to make it a win-win for both sides. If it’s too skewed, you can’t have a successful relationship.
Are there any success stories that you can share?
In the fight against deadly childhood diarrhea, solid relationships with strong partners have helped us near the point of seeing more than one new rotavirus vaccine being successfully developed. We’re also advancing vaccine development against the leading causes of bacterial diarrhea—enterotoxigenic Escherichia coli and Shigella—for which no vaccine currently exists. In this case, the developed-world market for such vaccines is not big enough to attract large pharmaceutical companies, but vaccines against these pathogens are greatly needed in the developing world. So through our partnerships with smaller biotech companies and research institutions, we’ve seen a broadening of awareness and the value put on such vaccines, which will hopefully lead to a positive vaccine development success story.
What do you find inspires you about your work?
A positive for me is marrying science, law, and business. Providing the business and legal expertise in support of finding a vaccine that is beneficial for children in low-resource countries makes for what I’ve always considered to be both meaningful and interesting work, particularly because the outcome is not how much profit can be achieved, but rather how society can benefit. It’s how quickly we can facilitate the development of a safe and efficacious vaccine that we can introduce where it’s most needed. I am proud to be a part of that effort.
Photo credit: PATHRead more