RotaFlash, April 2016
Two years after we first met ColaLife in Lusaka, Zambia, we welcomed them to Seattle. The city didn’t disappoint: ColaLife founder Simon Berry lamented a forgotten raincoat upon his introduction to typical Northwest weather; and he even garnered his own stern warning from a local police officer after jaywalking. (We do not jaywalk in Seattle.)
Simon and DefeatDD chatted over coffee, Seattle's own beverage of choice, catching up on ColaLife’s accolades and lessons of the past two years.
ColaLife has grown quite beyond its original concept of transporting anti-diarrhea kits in the empty space of Coca-Cola crates, hasn’t it?
Yes, through our trial, we learned that the most important thing is not the space in the crates, it’s the space in the market. But the original concept has a lovely logic: Coca-Cola gets everywhere, medicines don’t; put the medicine in the crate, and it gets there too. But when we really drilled into it, we learned that actually it’s incredibly naive. The ratio of demand for bottles of Coca-Cola would never match the ratio of the kits filling up all that space. That would be 10 kits for every 24 bottles of cola!
It was quite difficult to walk away from that original idea, but we had to. Because that concept, the crate-centered design, really captured people’s imaginations. The awards we’ve won based on that are incredible, and they’re even beyond the health sector – product design of the year, packaging design of the year. But the trial is actually telling us that fitting in the crates is not what’s most important, in terms of getting the kits in people’s homes.
However, the doors might not have opened without that original concept, so it was ultimately important. And we learned so much about distribution and working with shop owners. And in some certain circumstances, in the future, the crate design might work. Imagine a humanitarian crisis: a cholera outbreak isn’t going to stop Coca-Cola trucks. Just for a month you could put the kits in the crates, flood the market. So it could have a role, but it’s not the sustainable approach.
In addition to a change in the kit’s design, what would you say are the one or two key lessons you’ve drawn from the trial?
When we initially engaged partners, we focused on public/private partnerships at the global level. But as we’ve implemented the distribution and sales, we found that grassroots public/private partnerships were most important: the partnership between the retailers in the community and the government-run health centers. We couldn’t do this without the Ministry of Health at our side.
On our latest trip, we went to a district I’d never been to before. There were 150 meters between the health center and the shop. Underneath the tree, outside the shop was a woman with a very sick child. She had two ORS sachets from the clinic and 4 tablets in a clear plastic bag. And in her other hand, she had a Kit Yamoyo. The clinic had said, “Here is the medicine, but also go and get a Kit Yamoyo from the shop.” That was a public/private partnership at work.
Another lesson is about respecting local systems. If you are going to intervene, do it in a way that strengthens local systems rather than undermines them. Don’t make yourself indispensable. As a foreign body, quite literally, we should be a transient presence. It’s no good if the whole thing depends on ColaLife because when ColaLife leaves, the whole thing is going to collapse. But because we’re not part of the local system, we can leave. The product is in the market, it’s being produced locally. Any wholesaler or distributor can ring up our local manufacturer and order the kits.
What have been the biggest highlights in being involved with this project and seeing it grow?
Every week, something amazing happens. Little kids drinking ORS or wanting to drink ORS from our kit – that is the highlight. Mothers love it. We inquired deeply into what they thought of the kit, whether they would buy another one, etc. And we didn’t get a single negative response. From mid-line (6 months into the trial) to end-line, we asked people if they thought the kit was affordable. At mid-line, it was a respectable amount; by end-line, that had doubled. People would buy it again and they thought it was valuable.
In October, we’d just started the trial and went out to one of the districts. We spoke to a woman whose child had diarrhea, since April, she said. The clinic had given her ORS each visit, and she gave it to the child, but the child never fully got better. And then she had gotten the kit, with zinc. And there the child was—running around, being naughty, doing everything a small child should do.Read more
In two short weeks, my daughter will turn one year old. Looking back at her newborn photos, I wonder how this year went by so quickly. How could that wrinkly creature who could scarcely open her eyes or control her little limbs now be this squawking, nearly walking toddler? A solid and healthy tyke today, she seemed so delicate and breakable back then. It’s no wonder my anxiety ran amok! What if her swaddling covered her mouth while she slept? How could we tell if her skin tinged the slightest bit, threatening jaundice? And how could I politely convince neighbors and friends to slather themselves in antibacterial gel?
I had an online community of mothers and easy access to pediatricians to help me keep my girl safe and healthy. In places where new parenthood is fraught with far greater threats, the recent Every Newborn Action Plan aims to bring the same security. Issued by a partnership that includes UNICEF and the World Health Organization, and boosted by supportive evidence published in The Lancet, the action plan calls for a renewed commitment to dramatically improve the health and survival of newborn babies and their mothers. Coupled with the global commitment to safeguard the fragile health of all children under five years old through the 2012 Promise Renewed pledge, this new plan completes a circle of protection for the most vulnerable among us.
While plans like these center on inspiring action among policymakers and donors, they are supplemented by tools that communities and families can implement today to increase children’s chances at a healthy start. Chief among these early interventions is breastfeeding, which gets to work straightaway to help develop infants’ immune systems, improving responses to vaccines and preventing infections including pneumonia and diarrhea.
Another powerful tool at a mother’s disposal is her voice. One of the most striking statements in The Lancet’s summary of its Every Newborn article series notes that the most affected communities can often be “the most vocal agents for change.” Not all mothers have a platform like this very blog to share news, encourage healthy behaviors, and call for national commitments to their families’ health. But a key component of the Every Newborn plan aims to empower and engage parents. I am proud to lend my voice to raise awareness about the urgent needs for health equity and the opportunity for all mothers and fathers to rely on a safe start for their children. And I hope to raise a daughter who one day adds her voice to this global community as well.Read more
Heather Ignatius, Senior Policy and Advocacy Officer for PATH, is the proud mom of 3 year old Cleo and 7 month old Lily.
Every night when I put my three-year-old daughter to sleep I ask her, “what are you thankful for?” I’m trying to teach her the concept of gratitude and it’s nice to have the last thoughts before going to bed each evening be about the people, privileges or experiences that we are grateful for. I try and mix it up each night to capture how truly blessed we are to have so much.
When I ask Cleo this question, her response is always an immediate, “You first, mama,” and it gives me pause for a moment while I try to come up with something new to say. Because, you see, if I answered that question honestly, the answer would be the same. Every. Single. Night. I’m thankful that my girls are alive, happy and healthy.
In my job at PATH, I’m an advocate for global child and maternal health, so I’m constantly reminded about what I have that other mothers around the world do not. I won’t have to carry my feverish child in my arms for miles to the nearest clinic in hopes of getting treatment in time. My kids have had their rotavirus and pneumococcal vaccines, making it unlikely that they will perish from two of the leading killers of kids. My decision to breastfeed had more to do with IQ points and bonding – not survival. My girls will more than likely make it to see their fifth birthdays.
Mothers in other countries are not so lucky. Each year we lose 6 million kids to diseases like diarrheal disease and pneumonia and 800 moms a day die giving birth. Tragically, these deaths are completely preventable.
But there is reason for optimism. Over the last 20 years, the number of child deaths has been halved and maternal deaths have reduced by one third as programs to save moms and babies have expanded. These programs teach families the importance of healthy behaviors like breastfeeding and handwashing; they provide essential services such as having trained healthcare workers present at births; and they scale up low cost health products such as medicines for life threatening childhood diseases and vaccines to prevent them.
In 2012 governments around the world came together to acknowledge that we had reached a turning point in maternal and child survival. The United States, Ethiopia and India issued a call to action to put an end to preventable child and maternal deaths within a generation. It was a pivotal moment—the first time governments set a radically ambitious goal for child and maternal health and pledged action to meet it.
Reaching this goal is possible if we scale up the interventions we know work. And we can reach it even faster with new innovations – products like a low cost breathing device for newborn asphyxia or new screening devices to test for common ailments and risks during pregnancy.
As the second anniversary of this call to action approaches, commitment abounds. More than 175 countries around the world have signed onto the pledge to end preventable child and maternal deaths. Yet we are at a critical moment where ambition must turn into action in short order. Now is the time for governments to put forward the strategies and resources to achieve the goal.
This month two social media campaigns are being launched to call attention to child and maternal health: Mom and Baby and 5th Birthday and Beyond. Share your photos and help show the world how precious these lives are. But more importantly, call upon your government to follow through on the commitment it has made to end preventable child and maternal deaths.
Ps. If you want to know what Cleo is thankful for, most nights she says ”candy!”
-- Heather Ignatius is a Senior Policy and Advocacy Officer for PATH and proud mom of 3 year old Cleo and 7 month old Lily.Read more
Mothers wait to vaccinate their babies at the Kpele-Eleme Health Centre in Togo.
My cousin Mada, who lives in Atakpamé, Togo (about 160 km from the capital Lomé), tragically lost her son Dissirama to severe diarrhea. After the baby fell ill, my cousin took him to a traditional healer who prepared a potion and told my cousin to pour it on her ancestors’ graves and ask for their blessing to spare her son’s life. The traditional healer did not advise my cousin to give her son oral rehydration salts (ORS) or to take him to the hospital to receive intravenous fluids, which are necessary to treat severe dehydration from diarrhea. Because Dissirama did not receive ORS or intravenous fluids, he passed away.
Consultation of traditional healers is deeply rooted in Togo’s culture, especially in rural areas. While traditional healers may play important roles in Togolese society, children suffering from severe diarrhea need to be treated with ORS or intravenous fluids. Sadly, parents and caregivers in rural areas often lack access to information about the importance of taking children to health centers for medical treatment. In addition, health centers are often located far away from rural communities and may be out of reach of parents and caregivers.
I am the chair of the Union of Nongovernmental Organizations (NGOs) in Togo (UONGTO), a national umbrella organization of NGOs that works to strengthen advocacy and communication capacities of Togolese NGOs. UONGTO is a member of the GAVI Civil Society Organisation (CSO) Constituency Steering Committee and the focal point for the GAVI-funded CSO Platform that promotes immunization in Togo. CSOs such as UONGTO are vital in the efforts to educate rural communities about proper medical treatment of diseases and to mobilize and motivate parents to get their children vaccinated to prevent disease. CSOs also work to encourage policymakers to financially support the introduction of new vaccines and to strengthen existing health systems.
In 2009, with funding from GAVI, UONGTO conducted a census of maternal and child health CSOs in Togo to increase CSO engagement in promoting routine immunization. This effort earned us a prize at the 2009 GAVI Alliance Partners' Forum. With this momentum, UONGTO raised funds to train CSOs in advocacy and community mobilization. In 2011, with the support of the World Health Organization, our CSO platform wrote to the Ministry of Health asking the Government to submit an application to GAVI for support to introduce pneumococcal and rotavirus vaccines.
Today, three years after our CSO platform wrote to the MoH, Togo finally celebrates the historic dual introduction of pneumococcal and rotavirus vaccines! These new vaccines prevent the most severe forms of pneumonia and diarrhea - killer diseases devastating our children. Pneumonia causes 16% of deaths of Togolese children under five and diarrhea causes another 10%. With the introduction of these lifesaving vaccines, Togo’s government and CSOs have an opportunity to work in partnership to help our communities by providing the knowledge and tools to prevent and treat these diseases. Going forward, CSOs in Togo will aim to increase outreach to rural communities with important health information, including news that these lifesaving vaccines are available free of charge. That is why today is a day of glory for Togo!
I thank my Government for taking this critical step, because the introduction of these vaccines will permit Togo to significantly reduce childhood diseases and deaths linked to pneumonia and diarrhea. I hope my Government will use today’s introductions as a catalyst to increase communication efforts in rural communities to help them understand that vaccination is the best way to prevent the most severe forms of these diseases. I also thank donors and the GAVI Alliance for their financial support, which enables Togo to continue our efforts to achieve the Millennium Development Goals.
Parents and caregivers, when children are suffering from severe illness, it is important to take them to health centers for treatment. This way, we can avoid we can avoid unnecessary deaths like that of my little cousin Dissirama. It is even better to prevent disease in the first place through vaccination, so please go to your nearest health center where these lifesaving vaccines are now available! Protect your children against deadly diseases like diarrhea and pneumonia! Vaccinate your children and save their lives!
Ewé : Misi abͻta na miabéviwo, élé djͻwoanu éyé élaԃéwo da tso dͻsi wuaméwo gbͻ
Kabyè: Biya hεtu kεnε pͻyͻ kãtu bilisuwεkudomiε sim sinisi dε
[To vaccinate your children is to save. Protect them against deadly diseases.]
Photo credit: TOMETY Mawli-DodiRead more
A few months ago, PATH's Drug Development blog provided an overview of the drug discovery and development process. What is very clear is that, while drug discovery is a very difficult and risky business, the potential benefit for millions of people worldwide makes it all worthwhile. Large pharmaceutical companies have significant resources to help absorb the failures that are inevitable in the drug discovery business. As nonprofit groups working to discover new drugs for diseases in developing countries, we need to do everything in our power to minimize the risk for failure and improve the likelihood for success. This requires partnering between groups that have complementary expertise and resources.
Moving beyond the lab bench
CWHM at Saint Louis University is a relatively new player in the rapidly expanding “academic drug discovery center” phenomenon. Formed in 2010, CWHM is made up of a group of drug discovery scientists with more than 200 years of collective experience in the pharmaceutical industry. This group is essentially a complete drug discovery project team embedded in an academic environment, with expertise in translation of basic science into new drug candidates for clinical trials.
This model of a drug discovery team in an academic environment takes advantage of CWHM’s expertise in drug discovery—that is, the teamwork and scientific proficiency needed to successfully identify a potential new drug. However, to be truly successful, CWHM needed collaborators that have expertise in 1) the broad spectrum of diseases that directly affect people in low-resource settings and 2) the design and execution of clinical trials. This is why partnering with PATH through its Drug Development program is critical to the successful identification of a new antidiarrheal drug. PATH has the expertise in both diarrheal diseases and implementation of clinical trials for potential new antidiarrheal drugs.
Targeting diarrheal disease
In 2010, CWHM initiated a project that sought to reposition high-quality inhibitors of neutral endopeptidase (NEP) that had previously failed to reduce blood pressure in clinical trials, yet were demonstrated to be safe for humans. We established preclinical models of diarrhea and began investigating NEP inhibitors for antidiarrheal effect in those models.
Early on, we partnered with PATH’s Drug Development program to advance this project. Our collaboration was instrumental in guiding our efforts at a very early stage, and helped to focus our efforts in a manner that kept the need for a clinically relevant agent at the forefront of our thoughts. After working together for a little over two years, we have now identified three high-quality clinical compounds that have demonstrated antidiarrheal effects in preclinical models.
What has contributed to our success is teamwork. We discuss results and strategy monthly with our drug development colleagues at PATH. This ensures that our efforts are aligned with the common goal: to identify an excellent treatment for acute secretory diarrhea that will be widely available and convenient for those who need it so that it becomes a drug that will be used to save lives.
The best way to prevent needless deaths from diarrhea in developing countries is through a team effort that combines the strengths of each partner. As we continue our partnership with PATH, we are eager to see what other successes we can achieve together.
Photo credit: Jonathan Torgovnik ©Read more