NPR, May 2015
Chienge, Zambia, has become the first district in southern Africa to end open defecation, with...
Schools are cosmopolitan meccas for all types of bacteria and viruses. Whether in the United States, Haiti, Malaysia, or Angola, schools are breeding grounds for a dangerous mix of recurring gastrointestinal illness. The sheer amount of children with underdeveloped immune systems situated in a small space, sharing food, materials, and sanitation facilities makes for a public health perfect storm.
Recent statistics from UNICEF demonstrate that “more than 40 percent of diarrhea cases in schoolchildren result from transmission in schools rather than homes.” Accordingly, the impact of diarrhea and gastrointestinal illness on education is direct. Students that lack access to adequate sanitation facilities, soap for hand washing, and potable water to drink in schools are exposed and vulnerable to fall sick with parasite infection and diarrheal disease. These students then miss critical school days, which is exacerbated within education systems that are already underserved and underperforming. UNICEF also presents a solution to the public health perfect storm in schools that it recognizes: “Hand washing practiced in facilities such as day-care centers and primary schools reduces cases of diarrhea by 30 percent.” WASH in Schools, otherwise known as water, hygiene, and sanitation services, are therefore an important service to building a healthy and productive student body.
WWR Program Manager and Director explain the benefits of drinking and handwashing stations in the schools and how they are not only for the students but that in each school, there is one for the community as well.
World Water Relief focuses on implementing WASH in Schools projects in Haiti and the Dominican Republic to create a hygienic, healthy, and safe learning environment. Our projects feature safe water, hand washing, and improved sanitation that represent an immense opportunity to reduce the diarrheal illness that millions of students battle every day. To ensure long-term impact and sustainability of our projects, we especially focus on ensuring that kids bring their lessons beyond the typical classroom. From engaging students to sing songs about water in the classroom, to teaching parents to practice hygiene at home, to teachers being a role model and washing their hands with students side-by-side, we believe that long-lasting impact occurs when students, teachers, and their parents are all involved. Instead of seeing the school environment as a dangerous breeding grounds for bacteria, we must embrace the opportunity that this platform provides by improving appropriate WASH infrastructure to vastly improve the overall health and productivity of students around the world.
-- Ben Seidl, Program Director, World Water Relief
Photo credits: World Water ReliefRead more
Dr. Mark Alderson is the director of the pneumococcal vaccine project at PATH. Since 2006, his team has been advancing the development of vaccines tailor-made to protect the world’s poorest children from pneumonia—a disease that, together with diarrhea, claims more than two million lives each year. We sat down with him to get insights into strategies that could be child survival game-changers for the future.
As the global health community mobilizes around an integrated strategy to take on the top two infectious diseases threatening children today—pneumonia and diarrhea—what is important to know about pneumonia?
Pneumonia is the leading cause of child deaths worldwide, killing roughly 18 percent of children under age five. Multiple causes of pneumonia exist, but the most common and deadliest is the pneumococcus bacterium, responsible for close to half of the cases of pneumonia in children. Overall, investment in an integrated strategy that combines vaccines, treatments, clean air, and proper diagnosis can bring pneumococcus and other causes of pneumonia under better control—with even greater improvements for child survival if further integrated with diarrhea control efforts.
What is being done to prevent pneumococcal disease and how is the project that you direct contributing?
On the vaccine front, two licensed pneumococcal vaccines exist for young children. They are quite effective against 10 and 13 of the more than 90 varieties of pneumococcus. Groups like the GAVI Alliance have made remarkable progress in helping low-resource countries introduce these vaccines relatively quickly. However, there is still an urgent need for inherently more affordable and broadly protective vaccines targeted to children in the developing world where most of the pneumococcal deaths occur, and this is where our project is advancing the development of new vaccines.
Why are additional vaccines needed and what does an ideal pneumococcal vaccine for the developing world look like?
Current pneumococcal vaccines save many lives, but are not designed to cover all pneumococcal varieties. They are also difficult for low-resource countries to afford without substantial help. An ideal new vaccine would be easy to make, inherently affordable for even the poorest populations, and offer broad coverage across all pneumococcal varieties.
What’s an example of a vaccine currently in development that could achieve this goal?
We’re particularly excited about the potential of a novel killed pneumococcal whole cell vaccine that we’ve been working on in partnership with Boston Children’s Hospital. This vaccine has been effective in preclinical models and recently completed a Phase 1 clinical trial designed to demonstrate safety and immunogenicity. This whole cell vaccine targets proteins common across all pneumococcal varieties and should be very affordable. If it pans out the way we hope, it could eventually be the standard in the developing world.
Who needs to come together to make a vaccine like this possible?
In advancing a novel vaccine designed for the developing world, rather than for the industrialized world, we are treading on new territory and need a lot of people to come together. We started with a small number of development and research partners, but will need to bring in other collaborators such as manufacturers, regulatory authorities, international organizations, and target countries as we move forward.
What has to happen to ensure access for children in low-resource countries?
Our long-term strategy is to get the vaccine licensed in a high-burden, low-resource country and then gain World Health Organization prequalification that will enable procurement of the vaccine in the developing world. We go through careful partner selection and negotiation processes to ensure alignment of global access goals with our partners. We also work with developing-country manufacturers that can make vaccines available to underserved populations at a low price.
As we look forward to new developments in vaccines, what key opportunities do you see for tackling pneumonia and diarrhea now?
Children get a lot of vaccines now, so one of the things we can do is find ways of integrating pneumonia and diarrhea vaccine strategies into routine immunization programs. Beyond vaccines, leveraging common resources for improving access to treatment, clean air, and sanitation is critical. So is continuing to build public awareness that these are the top killers of kids and that the recipe for success is to tackle them together, with equal vigor.
For more information:
-- Learn about the GAPPD, the new global strategy by WHO and UNICEF to simultaneously tackle pneumonia and diarrhea.
Photo credit: Richard FrancoRead more
We can prevent 95% of deaths from diarrhea and 65% of deaths from pneumonia by scaling up cost-effective interventions. How cool is that? That was the bottom line from US AID’s briefing about the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD). Speaking at the event, Samira Aboubaker of the World Health Organization (WHO) invoked US President Obama’s campaign slogan, “yes, we can.”
So, the next challenge is to turn yes, we can into yes, we will.
While the GAPPD from UNICEF and WHO maps out the key steps that are needed, it will be up to national governments to actually take those steps. They will need the help of civil society organizations (CSOs), nongovernmental organizations (NGOs), donors, multilateral institutions, and the private sector. CSOs and NGOs have an important role in keeping attention on the GAPPD and its implementation. Because the effort now shifts to what will change within countries of high burden, PATH partnered with World Vision International to compile an Advocacy Tool Kit for our colleagues and allies working in country.
We hope the toolkit will help CSOs, NGOs, and other advocacy groups or individuals to advocate for the successful implementation of the GAPPD. In addition to concrete tips and tactics, it includes links to useful resources, and templates for creating effective materials tailored to local needs.
When our team first heard rumors that the work was underway on the GAPPD, we were quite excited. You might find that strange and suggest we need a bit more excitement in our lives (and you might be right) but what an opportunity to focus attention on these two leading killers of children under five and the solutions needed to significantly reduce the death and illness they cause. And it turns out, we’re in good company with the over 100 organizations and pediatric societies expressed their enthusiasm by signing the statement of support.
We know from our work in Cambodia and Kenya, among other places, that governments are eager to bring together the right package of solutions to protect children from diarrhea and pneumonia. We are excited that advocates everywhere can use the GAPPD and the Advocacy Toolkit to bring these ideas to the countries and communities most in need.Read more
This week, we celebrate integration. Though it is intrinsically at the heart of what we and our partners do in addressing myriad global health challenges through thoughtful, efficient strategies, today integration is particularly at the fore. For the very first time, there is a global plan to simultaneously take on the two diseases killing more than 2 million young children each year: pneumonia and diarrhea.
The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), released today by the World Health Organization (WHO) and UNICEF, provides the latest strategies and evidence needed to reduce death and illness from the two leading killer diseases among children. Beyond integration across the two diseases, the GAPPD is an opportunity to meld global and local agendas, giving national governments a comprehensive tool to determine the specific plans, investments, and partners needed to address the unique needs of their countries and achieve the greatest health impact for their citizens.
Global prioritization can only make a difference if it spurs complementary urgency among national governments where diarrhea and pneumonia still claim far too many lives. Engagement among national officials, health ministers, civil society, the private sector, donor agencies, multilateral institutions, and vulnerable communities is an ideal reflection of the GAPPD’s integration of prevention and treatment strategies and its combined focus on diarrhea and pneumonia.
Through integration, the GAPPD pairs prevention with treatment, pneumonia with diarrhea, and applies several proven interventions like ORS and zinc to pursue the greatest possible impact for children worldwide.
Clinical workers from Cambodia to Kenya know well that neither diarrhea nor pneumonia occurs in a vacuum. These diseases are often linked in a vicious cycle that exploits weakened immune systems struggling to overcome co-infections and threatened by basic environmental perils. By the same token, the good news is that many of the solutions needed to fight pneumonia and diarrhea are complementary. The GAPPD provides a framework to protect children, prevent disease, and treat those who do become sick using proven interventions that we know work against both diarrhea and pneumonia, like vaccines, proper nutrition, safe water, sanitation, and integrated case management.
PATH is working to integrate our work related to diarrhea and pneumonia across a range of countries and platforms to contribute to this critical global health priority, aligned with the GAPPD framework. Specifically, we will be partnering with governments, international organizations, private-sector entities, and others to maximize utilization of critical interventions proven to reduce illness and deaths from these killers of children – and holding ourselves accountable for achieving clear results.
We will, for example, be building on our work in Cambodia, where about 9,100 children under the age of five die from pneumonia every year, and 2,300 die from diarrhea,integration is already at work.Since 2005, PATH has helped Cambodian officials implement clinical and community interventions that integrate diarrhea and pneumonia control, particularly in rural communities where child deaths are highest. Policy changes at the national level are cascading to provincial, district, and village levels, and empowering volunteers and caregivers to spark change and achieve lasting impact. During a one-year demonstration project, village health volunteers trained through the project hosted more than 450 mother classes, reaching more than 11,000 pregnant women and caregivers with lifesaving messages on pneumonia and diarrhea prevention and treatment. In parallel, Cambodia’s national investment provides a model for the translation of integrated policies into action plans and interventions in other vulnerable communities.
Mothers’ classes in rural Cambodian communities brought messages of diarrhea and pneumonia prevention and treatment directly to families. In a pilot project that is now expanding nationwide, PATH reached more than 11,000 caregivers.
With support secured from the world’s leading health authorities, the call now shifts to national governments to translate this global framework into reality in the clinics and communities that battle childhood diarrhea and pneumonia every day. The GAPPD offers guidance on tapping into the strengths of national programs that already combine diarrhea and pneumonia interventions; on clarifying roles, responsibilities, and accountability across ministries, sectors and partners; and on dedicating resources to reduce health inequality and reach those in greatest need.
In addition to our commitment to working at country level to ensure access to life-saving diarrhea and pneumonia interventions, we also are helping to turn the action plan into health impact. For example, PATH and World Vision International developed an advocacy toolkit for in-country NGOs and CSOs. GAPPD messages, advocacy actions, and template materials (press release, brief, letter) can be tailored for each country context.
Today’s launch of the GAPPD with its complementary resources is a reminder of the crucial value of collaboration and integrated efforts: Global and local officials must work together. Stakeholders such as civil society and the private sector must work together. Governments must engage health workers who must in turn work with their communities, so that diarrhea and pneumonia can be overcome… together.
-- Steve Davis, President and CEO, PATH
Photo 1: PATH/Hope Randall
Photos 2 and 3: PATH/Heng Chivoan
Steve Davis headshot: Auston James
This past Friday was World Water Day and an opportunity to celebrate the excellent work being doing to promote water, sanitation and hygiene (WASH) in the developing world. The UK has played a leading role in making WASH a priority for international development funding and the Government’s commitment to doubling the number of people reached by WASH by 2015 sets an ambitious target for us, and other developed nations, to follow.
While much progress is undoubtedly being made, great inequality of access still remains with too many communities reliant on unclean water and inadequate sanitation facilities, whilst simultaneously employing poor hygiene practices. One of the biggest concerns about this inequality is the prevalence of diarrhoeal disease. This is of particular concern in Africa and Asia, where eighty percent of diarrhoea related child deaths occur. Staggeringly, around 80 children die every hour from diarrhoeal disease, making it the second largest killer of children under five worldwide, after pneumonia, and the most common cause of childhood illness. It is worth reflecting that in Britain we consider the condition little more than inconvenient.
Effective methods to both prevent and treat diarrhoeal disease exist and are being rolled out across the developing world. Improving access to WASH is a vital stage in this process. However we must also utilise all available tools to prevent and treat the condition, including vaccines, antibiotics, oral rehydration therapy (ORT), exclusive breastfeeding and zinc and other micronutrients. UNICEF estimates that combining all of these into one single package of care would cut deaths due to diarrhoea by around 60 percent.
This strategy of integrating care is gaining significant momentum in the development community, particularly in light of constrained public finances. In the vaccines sector, we are already seeing the benefits of integration in vaccine effectiveness and delivery. Vaccines are far less effective in environments where WASH access is poor and infrastructure development is becoming a key part of vaccine roll-out. Without adequate cold chain storage facilities and serviceable roads, it is extremely difficult to ensure that effective vaccines against a number of preventable diseases reach children in rural areas.
As Co-chair of the All Party Group for Child Health and Vaccine Preventable Diseases, I have met with a number of the leading organisations in the WASH sector to establish how integrated packages of care can work on the ground. The theme for this year’s World Water Day is Water Cooperation and we continue to support our partners at WaterAid, Tearfund and PATH in calling on the Government to make cooperation and integration key priorities for future development policy. By working together and joining up our efforts, we can significantly reduce diarrhoeal disease, and other preventable conditions, and make substantial progress on attaining our Millennium Development Goal targets for improving child and maternal health.
-- Lord Avebury, Co-Chair of the UK's All Party Parliamentary Group for Child Health and Vaccine Preventable Diseases
Photo credit: Gareth Bentley/PATH.Read more