The Hindu, April 2014
This op-ed from a leading Indian newspaper highlights India's breakthrough...
According to UNICEF, diarrhea is a leading cause of death in children under the age of five. It causes more deaths than AIDS, malaria, and measles combined. Diseases caused by diarrhea are most often spread through person-to-person contact or fecal-oral transmission, which can be combated by washing hands thoroughly with soap and water. According to a study reported by the CDC, this simple act can reduce nearly 50% of diarrheal diseases by removing bacteria, parasites, and viruses from the hands. Seems like a simple, inexpensive solution right? But what does this look like on the ground?
As a Community Health Educator living in a rural village in northern Peru with the Peace Corps, I saw first-hand the barriers to this simple solution. Although, unlike many places around the world, this community was blessed with sufficient clean water, access to small “tiendas” or shops that sold soap, and rudimentary education on how and why to wash hands, diarrhea was still one of the leading health issues. Why?
While lack of comprehensive education was certainly a contributing factor, the largest obstacle turned out to be converting conditioned behaviors to new, healthier habits. Thankfully, after two years immersed, I was able to find ways to creatively and consistently engage community members, and here are a few things I found particularly helpful.
1. Start education young, especially in schools
Younger students are naturally more receptive to change, and are typically eager and willing to participate in educational activities. I worked with professors at the local elementary school to integrate hygiene and handwashing education into daily lesson plans via songs, pictures, art, dancing, photographs, and stories. Partnering up with the local health post, we were also able to celebrate Global Handwashing Day (October 15) with demonstrations, games, and giveaways.
Leading a handwashing demonstration at the elementary school on Global Handwashing Day.
Showing how our hands can look clean but still carry harmful bacteria during an afterschool club meeting at the elementary school.
2. Incorporate handwashing into any and all activities
During house visits, I always feigned dirty hands and asked to wash them, checking to see if mothers had water and soap on hand while giving a complimentary demonstration. When invited over for lunch (which happened more times than I can count), I always offered to help cook and used it as opportunity to remind mothers to wash hands before cooking and always insisted the whole family wash their hands with me before sitting down to eat. As part of an income-generating project, I also hosted baking classes, and used it as another way to promote the benefits of handwashing.
Washing our hands before sitting down to lunch.
Handwashing demonstration with a group of mothers before we begin a class on healthy eating and nutrition.
3. Celebrate the small wins
Changing habits is hard and each time one of my students or mothers remembered to wash their hands without a reminder, displayed proper hand-washing techniques, or offered me soap and water when I entered their home, I made sure to respond with a positive attitude and lots of encouragement. It can be easy to get discouraged, but every individual you reach is worth commemorating as you are inspiring generations of healthier kids to come. Celebrate it!
Posing with a mother who just won the hat she’s wearing by properly demonstrating handwashing techniques learned from one of my classes!
For great tips, activities, games, and information on handwashing, please see:
-- Brit Schneider lived in northern Peru as a member of the Peace Corps from September 2010 until November of 2012. She is currently pursuing a career in health and environmental education with underserved Latino populations.Read more
From Mukuyu Basic Middle School in Mazabuka, Zambia, to Boston University in Massachusetts, United States, all teachers want to see their students thrive -- and use their knowledge to make the world a better place.
Every year, at this time, I get very emotional. As a teacher nothing gives me more joy than seeing my students walk up to that podium and get their hard earned diplomas. The energy in their stride tells the world that they are ready to climb any dreadful mountain of challenge, failure, and frustration. The raw optimism of the speeches, original or recycled, and a healthy dose of “go change the world” get me really pumped up about doing just that. Yet, I also worry at this time every year. Are we really doing our bit to enable students to change the world?
We give our students plenty of debt, but do we give our students the tools to break the barriers of status quo? While I am certain that the students today are certainly willing to tackle “impossible” problems, I am concerned that they don’t know about the problems that have made life impossible for hundreds of millions. Solving these problems will affect not just those in New York but also New Guinea.
Biomedical engineers are a strange and an eclectic bunch. Some get motivated by the fundamental questions, some are interested in creating the next best technology for the biggest health challenges, and some want to see their technologies translated into the field, today. There is no shortage of health problems in the world, and some have every single criterion to get the heart of a good old nerdy biomedical engineer pumping. Pneumonia is at the top of that list. There are challenges in finding new and more precise biomarkers, questions about making better diagnostics and above all opportunities to save countless lives in a very, very short time. But somehow we are not telling our students the pneumonia story. We are not encouraging them to create solutions, at the fundamental or applied level, about the leading killers of children around the world. I am not arguing that everyone should be looking at solutions to solve the pneumonia challenge, but what I am arguing is that we are not doing a good enough job in motivating our students about a problem that is within our reach, that has all the essential ingredients of a complex yet solvable problem.
The problem on our end starts with awareness. I have asked over 500 students, what is the number 1 killer of children in the world? They start with HIV, malaria, malnutrition –no one has ever gotten this question right. Once I show them the data, they are amazed, appalled, and at the same time intrigued about why we still have this problem, and why kids from Congo to Pakistan to Papua New Guinea die of such a preventable disease.
Second, students follow the paths of their teachers and mentors in choosing projects and research topics, but there is very little research activity among my colleagues in addressing this global challenge. Part of it lies in few funding opportunities and part is rooted in the same lack of awareness. There are research grants out there, somewhere, but the researchers are unaware of them, or the grants come with bureaucratic hoops that many do not consider worth their time to apply.
Finally, the very few students, who by sheer determination, work on this problem and come up with a new tool or solution find new and often fatal problems in raising capital in countries with no insurance and little venture capital activity. Lack of mentorship does not make this problem particularly easy either.
The deadly cocktail of these problems in our teaching, research, and mentorship means that our students may never tackle the problem that is begging for their attention. Our best resource—the minds and passion of our most gifted students—is not being applied to diagnose, manage, and stop a preventable disease before it takes the lives of another million children this year.
Despite all of this, I am optimistic because the conversation has started in the corridors, classrooms, and labs. More importantly, it has started on the Twitters, Facebooks, and Tumblrs of the world. We just need to sustain it. This is the season to celebrate both the past and the future. The students have earned their diplomas and are ready to bend the arc of the future towards a healthier world. We, as teachers and mentors, will find them to be fully capable of doing their part, if we are ready to do ours.Read more
There are a number of seemingly insurmountable development challenges, but child survival — particularly combating diarrheal diseases — is not one of them.
The Global Enteric Multicenter Study (GEMS), published in The Lancet last week, provides health and policy experts with evidence to pinpoint areas where research for new vaccine candidates is urgently needed to combat diarrheal diseases — the second leading cause of death among children globally. It also reveals other important opportunities for intervention.
GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, filled critical gaps in knowledge that were not captured in previous studies by using consistent methodologies across seven of the highest-burden countries and enrolling more than 20,000 children over the course of three years.
The study tested for almost 40 pathogens and confirmed that just four are responsible for the majority of moderate-to-severe diarrhea cases: rotavirus, Cryptosporidium, Shigella and ST-ETEC, a type of E. coli.
We can make cross cutting inroads in reducing the transmission of these pathogens by expanding access to treated water supplies and improving sanitation. Complications and mortality among children who develop diarrheal disease can be reduced by providing oral rehydration and zinc therapy. However, we can also decrease the susceptibility of young children to these infections by providing vaccines that make them immune to these specific pathogens. Indeed, vaccines are among the most cost-effective specific tools that we have to prevent clinical illness as well as to interrupt the spread of infectious diseases.
Fortunately, we already have two licensed vaccines that protect against rotavirus, the leading pathogen identified by GEMS, and a third seems to be well on its way toward approval. The GAVI Alliance’s efforts to rollout these vaccines in high burden countries will have a dramatic effect on improving child health. We commend the commitments of manufacturers to improve access to these vaccines by making them available to infants in the world’s poorest countries at lowered prices in conjunction with GAVI. Further refinements to these vaccines, such as making them heat stable, will help achieve an even greater impact.
In addition to rotavirus, it is critical to rally support for the development of vaccine candidates for the other three leading causes identified by GEMS.
Shigella and ST-ETEC were previously estimated to account for nearly one billion cases of diarrhea annually; as a result, approximately 300,000 children die each year before they reach their fifth birthday. GEMS confirmed these two pathogens as leading causes and added a renewed sense of urgency to the need to accelerate the development of vaccine candidates. These bacteria have been on the radar of some scientists and vaccine developers and have been priorities of the World Health Organization. Nevertheless, additional support is needed to bring these products to market faster and save more lives.
Cryptosporidium, the second most common cause of diarrhea among young children across all study sites, was not considered to be a major cause of diarrheal disease prior to GEMS. Unfortunately, little research is underway for a vaccine and only one drug is approved for treatment, but it is limited to use in children who are HIV negative and above one year of age. It is imperative that we expedite the research needed to develop a viable vaccine candidate.
Developing and delivering vaccines for these top diarrheal disease pathogens will require stakeholders at all levels to advocate for the resources needed to create inexpensive, simple tools that can be implemented in low resource settings across sub-Saharan Africa and South Asia where the need is greatest. Advocates will also need to push for policy changes in these regions to expedite regulatory approvals and rollout of new vaccines.
As health and policy experts debate the prioritization of investments for global health, they must remember that vaccines are one of the most powerful and cost-effective tools available to improve child health and advance our broader development goals. Now that we are able to better quantify and measure the burden of diarrheal disease, we can assess the impact of evidence-based decisions aimed at improving child health.
It’s time to replace rhetoric with action for every parent or caregiver who wants nothing more than to look their child in the eye and know with certitude that they can provide for their health needs. We owe it to the world’s children to provide them with access to every effective tool to survive the gauntlet of potentially lethal infections they confront during early childhood while living in the world’s least developed countries.
For more information:
-- INFOGRAPHIC: The GEMS data visualized
-- NEWS: Results of Phase III rotavirus vaccine candidate show promise
-- PHOTOS: Vaccines are foundational to child healthRead more
Health leaders from around the world have gathered at the 66th World Health Assembly this week to decide on priorities for the year ahead. In her opening remarks, Dr. Margaret Chan, Director General of the World Health Organization, expressed excitement about the new Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD):
A new integrated global action plan for the prevention and control of pneumonia and diarrhoea was released by WHO and UNICEF last month. The plan focuses on the use of 15 highly effective interventions. Each one can save lives. When the 15 are put to work together, this is powerhouse that can revolutionize child survival.
The newest vaccines and best antibiotics are included, but so are some time-tested basics, like breastfeeding, good nutrition in the first 1000 days, soap, water disinfection, sanitation, and the trio of vitamin A, oral rehydration salts, and zinc.
Equally impressive are the ingenious delivery solutions, worked out by front-line workers, for reaching the poor and hungry children who are most at risk.
I find this integrated delivery approach an exciting way to move forward. The tremendous success in controlling the neglected tropical diseases clearly tells us that integrated strategies can stretch the impact of health investments. They can stretch the value of development dollars.
For more information:
-- More expert/leader voices of support for the GAPPD
-- Toolkit: Resources to advocate for GAPPD implementation at the national levelRead more
Sometimes history is made at the ballot box, sometimes on a battlefield. Today it was made in a hotel ballroom. That is where I was able to witness an historic breakthrough as the Indian Government and Bharat Biotech announced positive results from a Phase III clinical trial of a rotavirus vaccine developed and manufactured in India.
I was one of many at the International Symposium on Rotavirus Vaccines for India—The Evidence and the Promise to learn that ROTAVAC® is safe and protects children against rotavirus infections, the most severe and lethal cause of childhood diarrhoea.
Of course, the ballroom wasn’t really where history was made – just where we heard about it. It really happened in hospitals, scientific laboratories, vaccine production lines, and health clinics.
The idea for an Indian-based rotavirus vaccine arose in the mid-1980s, when two different groups of scientists working in India discovered unusual strains of rotavirus that infected newborns in hospital nurseries but didn’t make them sick. Dr. M.K. Bhan, who later became the Secretary of India’s Department of Biotechnology (DBT), was among the scientists at the All India Institute of Medical Sciences who discovered one of these strains, called 116E, during routine diagnostics of newborns in New Delhi.
Dr. Bhan went on to lead a global team contributing to the development of a vaccine using the 116E strain that included scientists and health experts across several Government of India agencies, the Society for Applied Studies in India, Bharat Biotech International, Ltd., Stanford University School of Medicine, the US National Institutes of Health, the US Centers for Disease Control and Prevention, and PATH. Dr. Bhan, along with his colleague, Dr. T. S. Rao, was tireless in fostering the social innovation partnership and ensuring the highest standards for the vaccine that is now called ROTAVAC®.
Along the way, PATH was pleased and privileged to be one of the partners contributing to this public health effort, and we are now tremendously excited by these scientific results. This vaccine, if licensed, has the potential to save the lives of thousands of children each year in India.
We congratulate Dr. Bhan and all his colleagues in the Government of India, Bharat Biotech, and the diligent group of researchers who were the principal investigators for this pivotal clinical trial, as well as all of the dedicated and visionary individuals and institutions who helped make history today.Read more