Scandinavian Biopharma, May 2013
Results from a clinical Phase I study of a novel vaccine against diarrhea...
Everywhere we went in Zambia, there were reminders of water. There were the fantastic and inspiring people we met working on WASH programs, of course, whose magnitude and potential—and impact already—is certainly worth notice. But there were other, subtler things all around us.
First thing, upon arrival and desperate to refresh after 24 hours of travel, I used bottled water to brush my teeth in the hotel bathroom, as would be my practice each morning and night thereafter. I was mostly certain I’d be fine otherwise, but still a bit nervous about my sensitive system.
Day one of the work week, at the Chikumbuso Project, Lisa and I channeled playground days, dropping our notebooks to spin on a roundabout with a secret: it conspicuously pumped water from a bore well deep below into a nearby reservoir. The children “keep on playing the whole day and don’t know they are working,” remarked Mary, a special skills trainer at Chikumbuso. Up above our heads, a superhero reminded kids to wash their hands with clean water and soap.
Without fail, when our car pulled up at a streetside clinic parking lot or along a side road in a local village, advertisements painted on the sides of shops or corrugated fences advocated “Chlorin” for water safety.
The week progressed with gracious hosts from several NGOs presenting their success stories. Alfred and Isaac from Africare escorted us to schools in Mazabuka District, where students proudly performed poetry and mock lessons about hygiene, handwashing, and preservation of precious water resources. Lusaka Water and Sewerage showed us what was up with WSUP (formally Water and Sanitation for the Urban Poor), who drilled bore wells and established water kiosks in Chazanga on the outskirts of Lusaka. Makeshift, shanty towns like this one crop up quickly and grow even faster, with extremely limited resources strained by overpopulation and minimal infrastructure.
And after the work was done, Victoria Falls. Hundreds of millions of liters spectacularly spilling over every minute. The thundering mist gently raining down over our awestruck expressions. Zambia’s defining geographical feature is a magnificent wall of water.
Our sightseeing well underway, a fellow guest at our inn recalled a visit to a local village, where girls were noticeably absent from classrooms, relegated instead to household chores, including the time-consuming but critical daily trip to collect safe water for her family. And indeed, along a dusty road coming home from a safari day-trip, we watched boys kick around a soccer ball while girls carried jugs toward distant wells.
A different picture will stay with me too. One morning, we noticed a little girl and her brother stopped on the sidewalk near the PATH office in Lusaka. Smartly dressed in matching uniforms, they walked together toward school. He stopped to gently weave flowers into her hair. A few inches taller, he had a perfect perspective, and she patiently waited for him to finish. Simple support and trust.
Water issues will always be tough, but partnerships can be just as simple, and simply rewarding. By learning about each other’s efforts, and the ideas we have to make things even a little bit better, we too can walk together toward progress.
Photo credits: 1 -4, PATH/Gareth Bentley; 5, Deborah Phillips; 6, Lisa AndersonRead more
Many of you already know about our team’s recent trip to Zambia to document diarrheal disease control efforts, but you might not know that we also spent a few extra days to fall off of the social media grid and drink in the beauty of the quintessentially African countryside, occasionally giving into the urge to break into a chorus of “Circle of Life.”
While rolling through expansive amber savannahs and kicking up dust during our safari drive, I marveled not only at the stunning beauty of the world we often take for granted, but also the intricate balance that underpins it all. For instance, I learned that birds simultaneously offer protection and get nourishment as they peck at insects on the backs of larger animals. Even plants have their own defense mechanisms: an acacia tree that’s lost too many leaves will release a chemical that creates a bitter taste, warding off hungry wildlife.
I am in awe of this balance because it seems so precarious. If one element goes awry, everything else suffers. Is that really so different with peoples and nations?
Globalization has made our world small. When we asked our colleagues in Lusaka about what we should eat while in Zambia, they mentioned not only traditional Nshima (a dish made from boiled maize and corn), but also their favorite Thai restaurant or the new jazz club downtown. In our hotel, we ate fish and chips in an Irish-themed pub, washed it down with Mosi (Zambia’s national beer), and listened to the Beatles. American clothing brands commonly appeared alongside brightly patterned chitenges. And always the omnipresent Cola-cola logo welcomed us even to the furthest reaches of our journey.
We can no longer pretend that oceans separate our fates. Lila Watson, an Australian aboriginal, poignantly encapsulates this idea: "If you’re coming to help me, you’re wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.”
Like the delicate balance that sustains the natural world, our fates are also tied together in many practical ways. Nations’ economies are interlinked; diseases know no borders; civil unrest in one country often spills into other regions. Our world needs balance, and prioritizing the health of a nation’s children is one of the surest ways that it can grow strong.
But, I believe the most important ways in which we are tied together are also the most intangible. Zambia Ministry of Health official Vichael Silavwe’s direct experience with a mother’s grief changed the course of his life. In a rural health clinic, I met Teresa, whose son, Vusi, had just received the rotavirus vaccine, and we chatted and laughed about her son’s antics: how he is an angel during the day but “sings his songs” all night (read: makes far too much noise!). No doubt this would bring a knowing smile to mothers all over the world.
Both practicality and empathy are on our side when we remember to look beyond artificially constructed borders to help repair and restore balance for a healthy global community. Working together for the world’s children is a great place to start.Read more
On January 12, 2010, life was forever changed in Haiti. It wasn’t only the earthquake damage – the deaths, the destroyed buildings – it was the disaster that ultimately introduced cholera into Haiti. On October 17, 2010, the first cholera death in Haiti’s history was recorded. The impact was felt beyond Haiti’s borders; the lack of water and sanitation and the quick transmission of the cholera bacteria meant that Haiti’s neighbors in the Dominican Republic felt the effects too. Since, more than 500,000 Haitians have been sickened by cholera; death tolls climb into the thousands, heightened during the rainy season. Tens of thousands of Dominicans have fallen ill.
Amid the death and sickness, the governments of Haiti and the Dominican Republic have come together to combat the world’s worst cholera epidemic. Just a day before the two-year anniversary of the earthquake, January 11, 2012, the Governments of Haiti and the Dominican Republic announced a call to action for major investment in water, sanitation and hygiene, with particular focus in Haiti. The government leaders, along with PAHO, CDC, UNICEF, and other partners, are calling for the elimination of cholera and the promotion of sustainable development in both countries. The Coalition acknowledges that “improving water and basic sanitation would significantly reduce the prevalence of many water borne illnesses,” cholera included.
And I couldn’t agree more. The solutions to cholera – and other diarrheal diseases – aren’t glamorous. They are things that I take for granted; clean water and a flush toilet. Yet in Haiti, these simple solutions are virtually nonexistent. Clean, safe water, improved toilets and latrines, and good handwashing practices in Haiti and the Dominican Republic could save thousands of lives. The Coalition that formed in January officially launched the “Declaration to Eliminate Cholera in the Island of Hispaniola” in June.
The commitments and the pledges are promising, but I believe the people of Haiti and the Dominican Republic deserve more. Government, donor, and NGO support must translate into action; realistic plans for infrastructure improvements must be developed and funded in the long term. Access to safe water and improved sanitation facilities must be unequivocally available. In the short term, we have to ensure that simple, cost-effective diarrheal disease prevention is available: safe-water solution to enable families to treat their water at home, and soap to ensure handwashing at appropriate times.
Before that fateful day in October 2010, no Dominican or Haitian ever suffered or died from cholera on Hispaniola. And the fact is that we have the tools to return Hispaniola to a cholera-free place. I think the Coalition and its new Declaration are a beginning. I believe the progress is good and the vibe is positive. However, the positive vibe must translate into accountability and action. The Coalition governments and partners are responsible to the people of Haiti and the Dominican Republic, and I would like them held accountable. We have solutions for the short term and a plan for the long term – it is time to make good on the promise and return Hispaniola to a cholera-free island. The clock is ticking for a Cholera-free Hispaniola by 2022.
Photo credit: PATHRead more
Precious sleep. From birth, it is essential to our health and well-being. And no one knows this more than a new mother: the sleep her infant needs, and the glorious—albeit inadequate—hours she can snatch in the seemingly endless cycle of waking, resting, changing, feeding, and soothing.
Precious, yet precarious. So little can make so big a difference in the restful and restorative sleep a baby needs. From colic, teething, the slightest change in a routine, or a tiny tummy’s ache, a new mother knows the perils that threaten a sound afternoon nap or a solid night’s sleep all too well. But she also quickly learns her best defenses. Lullabies, teething rings… and vaccines?
Rotavirus vaccine is the latest child health hero, and it can go a long way toward restful nights, by ensuring stomach and intestinal health as well as reducing a mother’s anxiety. Rotavirus is the leading cause of severe childhood diarrhea, and it does not know geographical or socio-economic boundaries. It is virulent and resilient—nearly all unvaccinated children worldwide will have at least one rotavirus infection by age 3. But when vaccination is routine—with new vaccines introduced as recently as 2006—rotavirus infections plummet dramatically, and clinicians and researchers also note a marked reduction of infant diarrhea from any cause.
But though rotavirus diarrhea crosses all boundaries, equity is not universal when it comes to rotavirus vaccination. The sad irony is that access to vaccines is lowest in settings where disease burden is highest. If we work together to get them in practice at every clinic worldwide, rotavirus vaccines stand to make a lasting impact far beyond a restful nap – and far beyond the health benefit to the children vaccinated.
When a baby is fully vaccinated, the protective effects are immediate, yet the health, educational, social, and economic impacts are long term. A mother misses fewer work days due to a child’s illness. Household and government expenditures for health care costs are significantly lower. When child health is protected, families are more stable, leading to the growth of communities and nations. A nation is strong when it has the resources to ensure that its children don’t die from a preventable illness. In rich countries, episodes of diarrhea that may interrupt a child’s restful sleep are inconvenient. In low resource settings, they can be deadly.
The good news is that the global health community has woken up to acknowledge the threat of rotavirus and the promise of rotavirus vaccines. Ultimately, mothers and their infants will be able to access rotavirus vaccines freely through public sector health systems. First, with support from international donors and coalitions, and eventually with national governments bearing the cost of supply and delivery. Countries in sub-Saharan Africa are beginning to add rotavirus vaccines to routine immunization programs, and emerging-country manufacturers are working on new vaccines that will increase market competition and drive down price. When rotavirus vaccines are included in an integrated approach to diarrhea control that includes both prevention and treatment interventions, children have their greatest chance ever at a healthy start – including precious, uninterrupted rest to nourish the growth of strong bodies. That ought to make mothers worldwide sleep a little easier, too.
-- Deobrah Phillips, Communications Officer, and Hope Randall, Communications Associate for defeatDD at PATH
For more information:
-- Rota-what? Learn more about rotavirus.
-- Zambia is preparing for a national rotavirus vaccine rollout, and the defeatDD team got a first hand glimpse of the preparation.Read more
Children in Zambia are dying from three major killers: malaria, pneumonia, and diarrhea. Until recently, diarrhea was the only disease target without a comprehensive intervention and prevention mechanism in place, a tragic fact recognized by the Zambian National Ministry of Health (MOH), donors, NGOs, social entrepreneurs, and community advocates and champions alike. At this critical time, cross-sector opportunities among multiple stakeholders have prepared the stage for addressing the leading cause of childhood diarrhea with a national rotavirus intervention in Zambia.
Following World Health Organization guidelines advising rota control is needed in Zambia, the MOH decided to introduce a rotavirus vaccine. After community perception tests and pilot testing in Lusaka Province, a national rollout will take place in all districts next year. Such an endeavor called for capacity-building at the facility and community level alike. Rota vaccine cold storage facilities and cold chain capacity are in rapid scale up mode at the MOH headquarters in Lusaka in preparation for the national roll out. Clinician training and community health worker recruitment and education on the new rota vaccine are being conducted, in urban, peri-urban, and rural clinics and communities.
The Zambian MOH describes a three-pronged approach to diarrhea disease intervention: promotion, prevention, and control. Community health workers (CHWs) promote education and disease prevention messaging in the communities they serve, and educate on water safety (such as boiling or chlorinating water, covering boreholes, etc), household sanitation, the importance of giving vitamin A supplementation, exclusive breastfeeding up to 6 months of age, and when to seek treatment. Control is now championed by rotavirus vaccination. Delivery points for information and education regarding water, sanitation, and hygiene and the upcoming availability of rotavirus vaccine include heath care facilities, community health volunteers, local NGOs, churches, and schools.
Awareness and buy-in of the vaccine at the community level is extremely important in order for the intervention to be successful. In community perception testing groups, stakeholders discovered that the word "virus" in "rotavirus vaccine" as planned to be listed on immunization cards triggered negative responses; community members related the word to "virus" as in HIV. Additionally, community members like that is it an oral dose, and tastes sweet, as opposed to polio vaccine, which is bitter in taste. A sweet, oral, "rota vaccine" is not only acceptable, but parents are excited to soon have a vaccine that prevents diarrhea. Members of a community gathering outside Mukuyu Health Clinic, receiving education from their CHW, expressed excitement and eagerness to learn of the vaccine, and said with pride the roll-out should start in their province.
Mr. Vichael Silavwe, Chief Integrated Management of Childhood Illness Officer of the MOH’s Child Health Unit is passionate about diarrhea control and worked first hand treating sick babies suffering from preventable diseases. "It is we [adults] who are responsible to care for the health and safety of the child. It is we who are responsible for them, to protect them from getting sick." Rotavirus vaccination, in conjunction with ongoing water and sanitation education, will help parents throughout Zambia echo Mr. Salavwe’s heartfelt call to protect children from preventable disease.
-- Lisa Anderson is a Program Assistant for Vaccine Development at PATHRead more