The Hindu, April 2014
This op-ed from a leading Indian newspaper highlights India's breakthrough...
I’ve always had a soft spot for revolutionary people and ideas, so it’s not surprising that my favorite part of USAID’s Every Child Deserves a 5th Birthday briefing was a nod to the work of Jim Grant (Executive Director of UNICEF from 1980-1995) and his commitment to child health that saved countless lives. It reminded me that child health efforts in which I play a small role tell a story that’s been decades in the making.
Like the beginning of all revolutionary biographies, when Jim Grant articulated his vision to tackle preventable child deaths with simple solutions, like ORS and breastfeeding promotion, people told him it couldn’t be done. But he would not be swayed. “Imagine if 120 jumbo jets filled with children crashed today,” he said. Worldwide child mortality numbers conveyed a “silent emergency,” but one he knew could be solved with simple solutions.
In the end, his commitment saved the lives of 25 million children. The progress has been remarkable, but of course, the story can’t be over yet. Children in poor countries are still more than twice as likely to die from preventable causes; for example, 80% of deaths from diarrhea occur in Africa and Southeast Asia. The children who need these simple solutions most are counting on us to finish what Grant started. Between efforts that laid the foundation and new technologies at our disposal, like rotavirus vaccines, we are better positioned to finish the job now than at any other moment in history.
With the tools and the know-how, all we need is the political will. And nothing ignites political will like the revolutionary spark of many passionate voices. You can join the movement by uploading your 5th birthday photo on USAID’s website and making a wish for the children of the world. By working together, we can help ensure that this story has a happy ending. What could be happier than more 5th birthdays?
-- Hope Randall, Child Health Communications Associate for defeatDD at PATH. You can find her 5th birthday photo here.
For more information:
-- Video: Diarrhea is the second leading killer of children worldwide. To defeat it, we need to talk about it!Read more
My experience generating evidence to support the introduction of rotavirus vaccines began in 2006 when I started working on a PATH team conducting Phase 3 clinical trials investigating the performance of rotavirus vaccines in Africa and Asia. In these trials, we hoped to gather evidence aiding the World Health Organization (WHO) in deciding whether rotavirus vaccines should be recommended for global introduction. Evidence from these Phase 3 trials indicated that the vaccines worked—and that they held major promise in relieving the burden in countries with high rotavirus mortality. We presented this evidence to the WHO which subsequently issued a global recommendation. Our team was elated to know that our work would have a global impact in keeping kids healthy. Ten years following the failed Rotashield vaccine experience, a rotavirus vaccine would finally be available to the children in developing countries!
However, the global recommendation by the WHO did not mean immediate introduction in developing countries. Ongoing issues that had to be addressed included securing financing and creating awareness. After all, rotavirus is not like HIV, TB, or malaria. Most people do not know what rotavirus is or why it is so important to prevent the resulting dehydrating and deadly diarrhea and vomiting.
Now only three years following the conclusion of the last trial, Ghana, one of the countries that participated in the rotavirus vaccine trials, introduced rotavirus vaccine (and pneumococcal vaccine—the first country in Africa to simultaneously introduce both) into their routine Expanded Programme on Immunization system! Starting today, April 26, rotavirus vaccines will be included in the routine immunization program throughout Ghana. It has been a long time in coming, and now all children in Ghana will have access to an intervention preventing the dehydrating and deadly effects of rotavirus.
At the conclusion of the clinical trial in Ghana, back in 2009, I remember traveling to the study site for a closing ceremony in one of the study communities. The primary study investigator in Ghana and tireless rotavirus vaccine advocate—Professor George Armah of the Noguchi Memorial Institute for Medical Research—wanted to make sure we reached, and thanked, the entire study population of 2,200 participants. During the closing ceremony, it was evident how happy community members and mothers were in knowing they contributed to global knowledge regarding the use of the rotavirus vaccine in Ghana. The celebration was joyous and uplifting, with presentations by the study staff and community, as well as singing and dancing. Celebrations similar to this one were coordinated by Professor Armah and his team for each of the study areas. In addition to investigators like Professor Armah, who are able to translate science to practice by emphasizing community relationships, these trial communities and past trial participants are the reason that the vaccine will now be available to children through the routine immunization system in Ghana. For this reason, it is these same communities, the ones that participated in the trials, that I am most excited will have access to the vaccine.
Professionally, I feel privileged to have worked with top researchers worldwide in generating the evidence driving rotavirus vaccine introduction in developing countries. Personally, as a mother, this achievement means that the health benefits my 8 month old son experiences from recently completing his rotavirus vaccine series will be experienced by children in Ghana. I am hopeful that more developing countries will decide to make use of the GAVI financing mechanisms to introduce rotavirus vaccines, thereby reducing the risk of diarrheal disease morbidity and mortality among young children in other countries. It is long overdue for children in developing countries to experience the preventative health benefits of rotavirus vaccines. This is especially important in countries where access to care for dehydration resulting from diarrheal illnesses is limited; prevention is primary. No mother in any country should ever lose a child to this preventable disease.
-- Kristen Lewis is a Clinical Research Officer for Vaccine Development, PATHRead more
You probably already know the shocking reality—more than 1,200 children under age five die from rotavirus each day—that’s more that 450,000 each year! What you might not know is that many of these deaths can be prevented by using rotavirus vaccines. Vaccination offers the best protection against severe rotavirus diarrhea, and rotavirus vaccines are saving lives in countries where they are in use.
This is why I am so excited about important news in “Rotavirus Vaccines for Children in Developing Countries”, a special supplement to the journal Vaccine, published this week. The supplement analyzes evidence from scientific studies that examine how rotavirus vaccines work in developing countries that contribute to 95% of the global death toll from rotavirus. The studies demonstrate that rotavirus vaccines are safe, proven, and cost-effective and are projected to save more than 2.4 million lives by 2030 in developing countries. The supplement also reports that rotavirus vaccines significantly reduce serious rotavirus disease in rural settings, where children often die from rotavirus infection because their mothers can’t reach medical care in time to access lifesaving rehydration treatment for their infants.
PATH has a longstanding commitment to maximizing the impact of rotavirus vaccines in low-resource settings and accelerating their access to children most in need. Just five years ago, the World Health Organization (WHO) lacked sufficient scientific evidence about rotavirus vaccines to recommend their global use. PATH’s Rotavirus Vaccine Program (RVP), a partnership between PATH, the Centers for Disease Control and Prevention, and WHO, funded by the GAVI Alliance, set about to change that and bring rotavirus vaccines to the developing world—to the kids who need them most urgently. It was this mission that motivated me to join PATH after having spent my career focused on vaccine policy and performance in US populations. RVP worked with rotavirus vaccine manufacturers to conduct clinical trials in Africa and Asia to help WHO assess their effectiveness in those populations.
In June 2009, informed in large part by the clinical trials sponsored by RVP and its partners, WHO recommended that rotavirus vaccines be introduced in all countries around the world. Remarkably, just two years later, Sudan became the first African country to introduce rotavirus vaccines into its national immunization program with GAVI-support.This week, two more GAVI-eligible countries, Yemen and Ghana, will roll out rotavirus vaccines. That brings the total to seven GAVI-eligible countries to date, with several more expected to introduce rotavirus vaccines by 2013.Typically, it takes 10 to 15 years for new vaccines to reach developing world populations—this speed of introduction is unprecedented.
RVP’s journey wasn’t always easy—conducting rigorous scientific studies in real-world, low-resource environments was challenging. But this was where the rotavirus burden was most dire, the loss of life most acute, and the potential benefit most profound. With dedicated and inspiring partners in countries like Bangladesh, Ghana, Mali, and Malawi, the RVP team developed a deep appreciation of the realities faced by these countries.
While this supplement is RVP’s culminating publication, PATH’s dedication to helping children in developing countries access rotavirus vaccines and identify ways to enhance rotavirus vaccine performance in low-resource settings is unwavering. PATH continues RVP’s work as part of the GAVI-supported Accelerated Vaccine Introduction initiative Technical Assistance Consortium (AVI TAC) and the Bill & Melinda Gates Foundation-supported Rotavirus Vaccine Impact (RVI) project. In addition, PATH is collaborating with emerging-country manufacturers to advance new rotavirus vaccines for the developing world. During RVP’s tenure, I served as Clinical Director, and I am looking forward to continuing to support PATH’s rotavirus work under AVI TAC and RVI. It is an exciting time to be working in the field of rotavirus vaccines!
-- Dr. Kathy Neuzil is the incoming Director of the Vaccine Access and Delivery Global Program at PATH and co-editor of the “Rotavirus Vaccines for Children in Developing Countries” special supplement to the journal Vaccine.
For more information:
-- This week is the World Health Organization's first ever World Immunisation Week. To celebrate, Ghana will be the first country to simultaneously introduce vaccines against its two biggest killers: pneumonia and rotavirus. Follow the conversation on Twitter with the hashtag #vaccineswork.Read more
“A mother and child wait for you to return home” and put your commitments into action was the challenge from Liberian President Ellen Sirleaf Johnson to delegates at the Ministerial meeting of "Sanitation and Water for All" (SWA) on Friday. She couldn’t be there in person but her words still carried the passion and authority she has for water and sanitation.
Friday, April 20th, was the 2nd Ministerial meeting of SWA, the global partnership that does what it says on the tin – working towards universal access for sanitation and water. Tearfund, alongside others, campaigned for the creation of this global partnership to increase the political and financial priority needed to deliver the basic right of access to water and sanitation for everyone. Since the partnership’s launch in 2010 it has grown in size and strength. On Friday, an unprecedented amount of finance, water/sanitation, health and development Ministers met from nearly 40 countries to demonstrate how they are committed to change and pushing sanitation and water higher up the global as well as national agendas.
After much anticipation and advocacy it was a day to celebrate and I was able to hear first hand the commitments made. Donor governments stepped up to the bar and the UK government led the way by announcing it is doubling the amount of people it intends to reach with access to water and sanitation from 30 to 60million people by 2015. Two new donor governments, the US and Australia, joined the partnership and called on other donors to do the same. The US also pledged $1 million to SWA’s support to the most off-track countries.
A somewhat less "glitzy" announcement but equally important came from Japan. They committed to improve the targeting of their funding to the people most in need. This was in response to the findings of a new report highlighting how globally, only 50% of aid for WASH goes to the countries most in need and only 26% on basic services. Japan is the largest bilateral donor for WASH and yet the majority of their funding is spent on larger infrastructure projects. So, if Japan does really does make a step change, it could make a huge difference to the most poor and vulnerable.
Developing country commitments include:
-- The Kenyan Minister for Water and Irrigation, Charity Ngilu, reflected that “the missing link in Africa is lack of access to water” and responded pledging that a further 20 million people would gain access to drinking water and sanitation by 2015.
-- Benin committed to increasing its budget allocations for 2013-2014 by 100% per year for basic sanitation
-- Burkina Faso promised to eradicate open defecation by 2015.
That’s just a snippet of the commitments. However, as with all such endeavours, there is never time to sit back and celebrate for too long. There were also some sobering reminders of why everyone had gathered. The Minister for Rural Rehabilitation and Development from Afghanistan was open about their shockingly low levels of sanitation coverage at only 5% of the population. The room went tangibly quieter as Nigerian Finance Minister, Ngozi Okonjo-Iweala, shared her personal story of contracting hook worm from poor sanitation in villages as a young lady and receiving life saving treatment years later.
Underlining President Johnson’s call at the beginning, ex Ghanian President and now Chair of SWA, John Kufour, reminded delegates, “We’ll be judged by our actions and not our words”. As civil society, we’ll be working hard to ensure the commitments turn into action and the mother and child are no longer waiting.
-- Sue Yardley, Senior Public Policy Officer, Tearfund
For more information:
-- Learn about other meeting highlights and join the conversation at #SWA4All on Twitter.
Photo credit: WaterAidRead more
In Mandwa and Anji villages, approximately 100 kilometers from Nagpur (Maharashtra, India), several families have taken to two simple practices. One, fixing plastic taps to the earthen pots in which they store drinking water and/or adding a few drops of hypochlorite solution to stored water.
Says the Government Accredited Social Health Activist (ASHA) of Mandwa village, Rajni Harke, “Up to three years ago, it was a very common practice for women and children to scoop water from the pots with their hands. Today, most of the families here also put two drops of chlorine in the approximately 10 liters of the earthen pot and they are able to consume the same for the day.’’
Although Maharashtra has access to safe drinking water at village level, high morbidity and mortality due to diarrhea in rural areas is still high. Dr. Pradeep Deshmukh, Professor at the Mahatma Gandhi Institute of Medical Sciences (MGIMS) points out that coliform (a type of bacteria) levels were considerably higher in household water containers than in the original source water.
Under the Community Led Initiatives for Child Survival (CLICS) program that was supported by USAID and Aga Khan Foundation, the village health committees (VHC) purchased plastic faucets and bottles of sodium hypochlorite solution from a wholesale market and made it available at subsidized rates at village level. The cost of fitting a plastic faucet to earthen vessel and that of a 50 ml hypochlorite solution (4-6%) bottle was fixed at Rs 15 each (around US 30¢).
The intervention was promoted through the network of village level community based organizations (CBOs) and village health workers (VHWs) were also trained in fitting faucets and teaching mothers regarding use of hypochlorite solution.
A follow-up study across 10 villages of Primary Health Centre, Anji looked at 144 households which used either faucet-fitted earthen vessel to store drinking water or used sodium hypochlorite solution (SH) for keeping drinking water safe and 213 neighborhood control households from the same locality who used neither of the methods, and found that by using these methods, the community would prevent about 22 per cent cases of diarrhea.
In Anji, Sumitra Rajendra Vasule and Sudha Suresh Dehare are very clear in their minds about the benefits of this intervention. “We understand that this helps us prevent episodes of gastroenteritis. I remember how difficult it was to look after my 80-year-old mother-in-law, when she had such an episode some years ago.”
Sudha says, “Now all household members know that they should not put their hands in the earthen vessel. Earlier, the summer seasons in these villages always had episodes of diarrhea. I would say 75 per cent of illnesses have come down because of being careful about our drinking water.”
--Sushmita Malaviya, communications officer in Delhi for PATH’s Vaccine Development Program
For more information:
-- India makes strides in diarrhea treatment by adding zinc to oral rehydration therapy (ORT) kits.
-- Learn about PATH's Safe Water Project and their microfinance efforts in India.
Photo credit: PATHRead more