GLOBAL: WHO move boosts fight against fatal diarrhoea

DAKAR, 9 June 2009 (IRIN) - The World Health Organization has paved the way for children in Africa and Asia to be vaccinated against a diarrhoea-causing virus that kills some 500,000 children annually worldwide - 85 percent of them in African and Asian developing countries.

WHO has recommended that the vaccine for rotavirus - the leading cause of severe and often fatal diarrhoea and dehydration in under-five children - be included in national immunization programmes worldwide.

As of 2007 the organization had said more research was needed on the vaccine’s efficacy in developing countries with high child mortality; new data from clinical trials has led WHO to recommend global use of the vaccine, according to a 5 June communiqué.

The decision means poor countries in Asia and Africa can now apply for funding to include rotavirus vaccines in their national immunization programmes.

“This [vaccine] will significantly reduce mortality and morbidity of rotavirus disease,” Samba Ousmane Sow, associate professor of medicine at University of Maryland and coordinator of the Centre for Vaccine Development in Mali, told IRIN.

“For rotavirus, as with many infectious diseases, mortality is often a question of geography,” he said. “For the many people in rural Africa who cannot easily access medical care, the best and most practical solution [against this lethal illness] is to bring the vaccine to them.”

A child with rotavirus disease - which causes fever, vomiting and diarrhoea - can rapidly become dehydrated. Death from rotavirus is most common where there is no quick access to medical care, so vaccination is the most effective way to prevent severe cases and deaths, experts say.

Transmitted primarily by the faecal-oral route, the virus affects the vast majority of children globally before age three, according to WHO. The virus attacks the villi - tiny projections on the wall of the small intestine. Destruction of the affected cells reduces digestion and absorption of nutrients, resulting in diarrhoea with a loss of fluids.

The virus is resilient and traditional hygiene measures that might prevent other sanitation-related illnesses are not sufficient to limit its impact, according to PATH, an international health non-profit and one of the organizations conducting vaccine trials with WHO and the Global Alliance for Vaccines and Immunization (GAVI).

http://www.path.org/  

 http://www.gavialliance.org/  

But given that there are many causes of diarrhoeal disease, the rotavirus vaccine must be part of a comprehensive control strategy, including improving water quality, hygiene and sanitation and providing oral rehydration solution and zinc supplements, WHO says in its communiqué.

 ”This [oral] vaccine, coupled with improvement of sanitation and hygiene, can shrink the gamut of diarrheoal diseases within a population,” George Armah, professor and rotavirus expert at Ghana’s Noguchi Memorial Insitute for Medical Research, told IRIN in the Senegalese capital Dakar, where he was attending a meeting of the West Africa rotavirus advisory group. “But we know that hygiene alone does not eliminate the rotavirus, hence the urgent need for this vaccine.”

 Armah noted that now governments will have to prepare an investment plan for including rotavirus vaccine in their immunization programmes. The GAVI Alliance uses a co-financing approach, in which countries procure some vaccines with non-GAVI funds; the intention is for countries to gradually increase their share of vaccines’ cost, making immunization programmes sustainable.

http://www.gavialliance.org/vision/policies/new_vaccines/cofinancing/index.php

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Mosquito net mural in Bungoma, Kenya

Stef Schiffer commented on my previous post about what Concern Worldwide was doing for World Malaria Day, arguing that bed nets was just a Western feel-good initiative. The comment included this site, with a well-done video.  Thanks to Stef for telling me about it. The people on the video, many of them first- and second-generation Africans, make a good point, that the causes of mosquitos becoming malaria carriers in the first place are not cured by bed nets. That is certainly worth emphasizing, as is the role insecticides play in causing illnesses, directly and indirectly, to residents of poor countries.

But I generally reject false either-or debates. It’s not a question of bed nets OR reducing chemicals and insecticides in African and other nations. If one way to reduce the chances that a child - or adult - in a malarial-prone country will contract malaria is by having him or her sleep under a bed net, then why the hell not use that as one tactic? There are other approaches, beyond looking at chemicals and using nets, such as speeding up research of an anti-malarial vaccine.

In Uganda

Would the folks on that video condemning bed nets also agree that birth control is irrelevant to preventing unwanted pregnancies and transmission of certain diseases because the underlying cause is having sex in the first place? That seems to me the possible extension of their argument. I say come at a problem, especially one that takes so many lives, from as many directions as possible. Here’s a good Web site, from the Kaiser Family Foundation, to learn more about malaria.

The secret weapon in fight against global killer

April 25 is World Malaria Day

Malaria kills up to 1 million people each year—mostly children under five, more than 90 percent of them from sub-Saharan Africa. Half the world’s population—3.3 billion people in 109 countries—are at risk, and almost 250 million contract the disease each year.

“A vaccine is probably many years away, if not still a dream,” says Michelle Kouletio, Health Advisor for Concern Worldwide, the international relief and development agency. “But we have the tools to effectively prevent and treat malaria.” she adds, and “a simple solution with dramatic results is the distribution of long-lasting and insecticide-treated mosquito nets and showing people how to use them.”

“Mobilizing communities to manage their own health care is the secret weapon of our Rwanda program,” says Kouletio. “Simply distributing nets is not enough. That’s only part of the solution—the second vital ingredient is education. Knowledge is power: community health volunteers show their neighbors how to safely hang the nets in the small, crowded homes where the most vulnerable children often live.”

In Rwanda, Concern began distributing subsidized nets to pregnant women in 2004. The program was so successful that the Rwandan government was able to secure Global Funds to procure millions of nets to distribute to all families with young children. Just months after the October 2006 net campaign, the number of cases of malaria was cut in half, reports Kouletio, who oversees the USAID funded Expanded Impact Child Survival program, a Concern led partnership with the International Rescue Committee and World Relief.  It covers six districts reaching 20 percent of all Rwandans.

“These nets only cost less than $8 apiece and, once distributed, the nets provide protection for several years—at a cost far less than the $20 cost of spraying of homes with insecticide, a procedure that has to be repeated several times a year and poses environmental health hazards,” Kouletio explains.

Concern trains and forges connections among community elders, healthcare professionals, government officials, and the families themselves. Specially trained and equipped Community Healthcare Workers (CHWs) are at the core of this community effort.

Concern trains the CHWs to instantly identify symptoms—fever, chills, convulsions—and to educate families about potentially harmful home remedies and traditional healing practices. “The CHWs,” says Kouletio, “provide treatment on the spot to children with symptoms of uncomplicated malaria.”
“They are well known and trusted members of the community,” she says, “with ready access to families’ homes. They are the “ordinary heroes” who are at the heart of this treatment of malaria. “Having health care workers based in the community is essential,” continues Kouletio—“they can intervene rapidly—and time is of the essence.”

“In its past two years alone, our program has treated more than 180,000 Rwandan children under five for malaria,” reports Kouletio. The success of this program has brought about significant changes in the country’s policy for treating malaria and has opened the door for community treatment of the other two leading child killers, pneumonia and diarrhea.

Concern works in 28 of the world’s poorest countries, including 17 sub-Saharan African nations, and reaches some 23 million people. The organization’s goal is the ultimate elimination of extreme poverty and the reduction of suffering. The organization’s programs focus on emergency relief and long-term development work in the areas of health, HIV and AIDS, livelihoods and education. Concern’s education programs are benefitting more than 465,000 people in 12 countries.

According to Population Action International: “The policy disqualifies foreign non-governmental organizations (NGOs) from receiving U.S. family planning funds if they provide legal abortion services in cases other than a threat to the life of the woman, rape, or incest; if they provide counseling and referral for abortion; or if they lobby to make abortion legal or more available in their own country.”

Photo Credit: Barbara Kinzie, Jhpiego

It also wasted precious U.S. aid money by impeding the improvement of women’s health care in desperately poor nations. Studies repeatedly have shown that one of the main engines of development is the improved status — physical and material — of women. To deny women a full range of medical information and treatment (and I’m not talking about abortion here) is to construct obstacles to economic progress for entire families in struggling parts of the world where women not only care for the children and the home, but often do the farming or other income-generating activities. It’s putting ideology above people and pragmatism.

The policy was first instituted in 1984 by President Reagan. It h been on a yo-yo ever since, with Democratic President Bill Clinton lifting it in 1993 and Republican President Bush reviving it in 2001. So Obama doesn’t need simply to claim his date on the calendar when he rescinded the policy. He needs to figure out how to prevent the policy from being reinstated.  

The obvious solution is a legislative one. That route was attempted in September 2007, when U.S. Sen. Barbara Boxer (D., Calif.) and U.S. Rep. Nita Lowey (D., N.Y.) introduced an amendment to a State Department funding bill that would have lifted those restrictions to U.S. aid as set out in Mexico City policy.  President Bush scuttled their effort by signing an executive order, which modified the rule, but still hamstrung women’s health groups.

There needs to be another legislative effort that rescinds the restrictions on U.S. aid for family planning and women’s health and funds an aggressive education campaign to promote abortion only in the cases of incest, rape and the life of the mother. Abortion should not be used as contraception in other cases. 

One of the other big problems with he global gag rule is that it showed U.S. ignorance about the status and rights of women in many developing countries. A nuanced, pragmantic policy that uses education to address the problem that comes with abusive practices against women will have a far more enduring impact on reducing the incidence of unnecessary abortions while providing women with a full range of health care.