Global Health Ideas

Finding global health solutions through innovation and technology

Archive for the ‘Vaccine’ Category

Speeding Vaccine Adoption – Mapping Relationships

Here’s an interesting idea from McKinsey – analysing decision maker networks to speed vaccine adoption.

Nearly 11 million children die every year due to a lack of vaccinations. McKinsey research suggests that network analysis, which companies use to improve business outcomes by analyzing information flows and personal relationships, could speed their adoption. Specifically, these techniques can shed light on the complicated processes and interactions that underpin (and often slow down) the introduction of vaccines.

The process of introducing vaccines varies from country to country and involves the influence of many stakeholders—ministries of health and finance, international agencies such as the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), nongovernmental organizations (NGOs), community leaders, experts on disease, and funders, to name just some of the players. Defining roles, decision rights, and data requirements for this constellation of participants is difficult. The resulting confusion slows decision making and compounds chronic problems, such as poor infrastructure and limited public-health budgets. Delays, sometimes as long as 15 to 20 years, between the introduction of a vaccine in developed countries and its adoption in developing ones are the result.

Surveys were done on vaccine introductions in Egypt, Mauritania, Mexico, and Zambia. Only Mexico consulted international disease experts, which helped speed adoption of the vaccine. We found as well that in all four countries surveyed, finance representatives either had no role in the process of deciding whether and when to introduce vaccines or were peripheral to it—and usually brought in near its end.


Written by farzaneh

September 25, 2008 at 3:58 am

Mosquirix – Promising New Vaccine for Global Health?

More than 12 years (let that time horizon sink in) after the first indications of success,  there will be a large scale trial for a new malaria vaccine. The potential global health implications of this are obvious, read the full news article, it has some good tidbits in it:

“With the exception of Mosquirix, there’s no possibility of one coming on the market within five or six years…It took eight more years of development and testing before scientists were ready to conduct a large-scale trial of the vaccine. London-based Glaxo and its partners will begin a $100 million study of Mosquirix later this year, vaccinating 16,000 children in seven African countries. If the results are positive, the drug could be on the market as soon as 2011, making it the first vaccine against the deadly disease. “

Full article at Bloomberg (here).  Hat tip to  Families USA.

Written by Aman

July 16, 2008 at 9:20 pm

Global Health Council 5: We ♥ Margaret Chan

Friday ended with an impressive lineup of global health leaders discussing the disconnect between horizontal and vertical funding in the plenary session titled Meeting Along the Diagonal: Where the First and Last Mile Connect.  A webcast of this session, and 2-3 others from the Global Health Council Conference, will be available on starting Tues-3-Jun-2008.  It’s nearly 2 hours long, but brings together ideas from the Gates Foundation, WHO, the Global Health Council, and USAID.  As much as it was about these organizations and the types of organizations (foundation, multilateral, advocacy, bilateral), it was about the individuals who spoke their minds:

  • Jaime Sepulveda, Director, Integrated Health Solutions Development, Bill & Melinda Gates Foundation
  • Margaret Chan, Director-General, World Health Organization
  • Nils Daulaire, President and CEO, Global Health Council
  • Henrietta H. Fore, Administrator, U.S. Agency for International Development, Director, U.S. United States Foreign Assistance
Victor Kamanga of the Malawi Network of People Living With HIV/AIDS was supposed to speak at this panel representing the community perspective, but was denied a visa by the United States.  Nils was brave enough to say that it may have been due to Kamanga being HIV-positive.
The session was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and her performance – one that was witty, but neither overbearing or spectatorish – made more sense after I learned about her NewsHour and NPR roots.
Administrator Fore spoke of USAID’s accomplishments and left immediately for the White House.  The session was awash in metaphors related to the theme: diagonal (Sepulveda), fractal (Daulaire), circular (Gordon Perkin, in the audience).  Dentzer synthesized the overall position of each of the speakers in a few words (in order that they spoke):
  • Fore: “horizontal aspects to vertical programs”
  • Sepulveda: “integration”
  • Chan: “connect”
  • Nils: “fractal”
The collective message for me from the session was this: health systems are complex, we need to look at integrated solutions, and it will take time.
Sepulveda’s framework for looking at health systems requirements was his effort to “make that black box {of health systems] transparent”.  His four requirements of health systems are:
  1. Stewardship
  2. Financing
  3. Delivery (personal and non-personal services)
  4. Resource Generation (people, information, vaccines, technology)
He referred in his comments to 2 articles:
  1. Walsh J A & Warren K S. Selective primary health care: an interim strategy for disease control in developing countries. N. Engl. J. Med. 301.967-74, 1979.
  2. An “forgotten” article that Sepulveda wrote in the 1980s in the Bulletin of the WHO on the topic of “diagonalism”, but perhaps not in those words.  (I wasn’t able to find it, but if you know of the article, please post a link as a comment.)
Both Sepulveda and Daulaire had some interesting things to say, but I want to focus on Margaret Chan.  About 2/3 of the way through the sesssion, I was so taken by Margaret Chan’s honesty and perspective that I wrote “I ♥ Margaret Chan” in my notebook.  I passed my notebook to an NIGH colleague sitting next to me, who then showed me his notebook which had “I [heart] Margaret Chan” written atop his penultimate page of notes.  He didn’t want to draw a heart, he later told me, because he was afraid somebody might see it.  If that wasn’t weird enough, I told the story to another NIGH colleague, who responded that she too had written “I ♥ Margaret Chan” in her notebook.
Some Margaret Chan highlights (keep in mind her emphases in her tenure at the WHO have been Africa, primary healthcare, and women)
  • Dentzer told her she was “the James Brown of global health”, a reference to her work ethic
  • “What works for Hong Kong doesn’t work for Zambia.”  This sounds obvious, but there was quite a lot of talk at this conference about exporting successful models from one country to another.  I’m not saying you can’t learn from successes, but there is at least some better work we need to do in adapting those models to different situations.
  • “Primary healthcare faded from the vocabulary of global health.”  She cited Periago’s “crushed” comment from earlier in the day.  In fact, she brought in a lot of examples of what other people were saying throughout the day, so it’s clear that she was listening.
  • One of the other examples she brought up was a Johns Hopkins professor who in a morning comment advocated for “health impact assessments” like “environmental impact assessments” prior to doing something new.  (Sorry, don’t know the name of the JHU professor.)
  • “Famous soft drink”.  She didn’t name it because she didn’t want to advertise for it, but asked “why can’t we get to the same areas of the world?” (a reference to technologies like vaccines and medicines).  If we can’t do that, “we fail our people”.
  • “It’s easy to blame people when you fail.”
  • In referring to her 30+ years of experience: “I look young, but I’m not”.
  • “Primary healthcare was alive” in places like Brazil, India, and Argentina, even though it wasn’t in the “official vocabulary”.
  • “I’m not going to repeat the WHO definition of health.  To me health is a social objective.”
  • In indicating that we need to train more mid-level professionals: “For the clinicians in the audience, don’t worry, there’s plenty of work.”
  • “We have not listened enough.”  “We underestimate the ingenuity of the community.” “If you say ‘talk is one thing, walk is another’, I rest my case.”
  • “We are insular. We only look at the health sector.”  We need to look at safe water and sanitation, education, etc.
  • “Ministry of Health [alone] cannot handle the complexity of the situation.”
  • “Let’s be realistic. Even NGOs are making profits.”
  • “Why is it that working with industry is seen as dirty?” “Industry is part of the solution.”  We need to work with food and pharmaceutical industries.
  • Peer review is “another elephant in the room”- Chan identified most of the elephants.  It is a process by which “your friends condone your work”.

And my favorite, because it directly addresses the work I do and that we need to advocate for in the development of new technologies and services:

  • “I didn’t realize that the color of bednets makes a difference.”
  • “It wasn’t until we brought in the anthropologists that we found out that the color red represented death.”
  • They changed the color to yellow and people started to use them.
I encourage you to watch the session if you can spare the time.  Posted from the Wi-Fi bus between DC and New York.

WHO Launches Tracking System for H5N1 Viruses

(Summary of ProMedMail Report of 24 January 2008)

Responding to concerns raised by Indonesia and other developing countries, the WHO has instituted an electronic tracking system to track H5N1 isolates submitted, and what is done with them. Vietnam and Indonesia have provided the most isolates, but are concerned that private companies that are developing vaccines from these isolates will market vaccines that are too expensive for developing countries to purchase in the event of an outbreak. In 2007, as a result of these concerns, Indonesia withheld samples for 5 months.

A country-by-country list of submissions has been created, and the tracking system permits anyone to search for particular isolates by date of submission, source country, host species, and several other variables. The system provides a page of detailed information for each isolate, including a list of all the laboratories to which the virus has been distributed, including pharmaceutical companies.

Read the rest of this entry »

Written by farzaneh

January 25, 2008 at 2:48 am

Benefit for Measles Initiative – Boston

Joint Benefit Concert for the Measles Initiative
BU Law Auditorium
Friday, 13 April 2007, 7:30 pm

Tickets $8 at the door, or email:
Sponsored by Harvard, Tufts, BU, & MIT Red Cross Societies

For as little as US $1, one child can be vaccinated against measles. Although measles has been virtually eliminated in the West through effective vaccination, it still kills nearly 454,000 people globally per year. 90% of these deaths are children under five. Measles is one of the leading causes of death among children in most developing countries despite the availability of a safe, effective and relatively inexpensive vaccine for more than 40 years.  Sub-Saharan Africa has the highest burden of measles, and since 2001, efforts by the Measles Initiative have reduced estimated measles cases and deaths by 60%. The effort is now being expanded to Asia.

Children contract measles in overcrowded living conditions (especially refugee camps), at very young ages when their immune systems are not strong, and if they are malnourished. In the West, measles often presents as a mild rash, but in developing conditions, fatal complications can include pneumonia, diarrhea, or brain damage from measles encephalitis.

The Measles Initiative is led by the American Red Cross, with operational support to measles burdened countries. The Initiative follows the WHO/UNICEF strategy, which includes routine vaccination, vaccination campaigns, surveillance of the disease and treatment of sick children with vitamin A in all countries. The inclusion of vaccination campaigns was adopted as a result of the highly successful Rotary effort to eradicate polio, and has a profound impact on reducing measles cases and deaths as it allows health care workers to immunize children who do not have access to routine health services.

Impressively, the campaign has a very clear structure:

  1. PLANNING – Coordination among the core partners, in-country partners, and Red Cross national societies to determine target populations, resource needs, and logistics
  2. THE COLD CHAIN (supply) – The process of getting the vaccine and all needed supplies from a warehouse in the country to the hundreds of vaccination posts
  3. SOCIAL MOBILIZATION (create the demand) – The Red Cross role of spreading the word about the importance of immunization to each family with a child in the targeted age group
  4. FOLLOW-UP – Processing the results of the campaign to determine the successes based on coverage, weak points, and future plans

For more information: Measles Initiative

Written by farzaneh

April 13, 2007 at 8:36 am

Globorix – new low-cost meningococcal vaccine

The new combination vaccine candidate Globorix(TM) promises to help control pediatric meningitis in the “meningitis belt” of Africa. Meningitis control has historically depended on expensive last-minute outbreak immunizations, and in 2000, WHO and public health experts called for a sustainable strategy where meningitis vaccine could be administered in general immunization campaigns. Until today no combined conjugate meningococcal vaccine has been available to protect infants in Africa against the disease.

Globorix (TM) is a conjugate vaccine developed by Glaxo-Smith Kline that provides immunity against diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Neisseria meningitides serogroups A and C. In clinical trials including countries in Africa and Asia, the conjugate meningococcal vaccine has demonstrated a good safety profile and immunogenicity against meningococcal meningitis caused by Neisseria meningitidis serogroups A and C in addition to five other major childhood diseases.

The current meningitis control strategy relies on reactive mass immunization campaigns using polysaccharide vaccines. While these campaigns are estimated to have saved 70% of lives in epidemics, this older type of vaccine has significant drawbacks. Polysaccharide vaccines do not offer protection to infants and in older children and adults they only protect for 3-5 years, leaving them vulnerable to future epidemics. Polysaccharide vaccines also do not address endemic meningitis

Read the full press release here

BBC News Report

Written by farzaneh

April 7, 2007 at 4:36 am

Indonesia, Avian Influenza & Global Inequities in Technology Access

Two weeks ago Indonesia announced that it would no longer provide samples of the H5N1 (Avian Influenza) virus to the World Health Organization (WHO). The decision by Indonesian Health Minister Siti Fadilah Supari was based on reasoning that commercial entities would use information derived from freely donated Indonesian samples to develop vaccines that would not be accessible to most Indonesians.

Indonesia is faced with with various challenges (world’s 4th most populous nation, 6000 inhabited islands) to dealing with a human epidemic, should one occur. And should one occur, Indonesia is a likely to be hit hard – currently 38% of mortalities worldwide (63 out of 167) have been identified in Indonesia (source: Wikipedia).

Instead of providing the viral samples with the WHO, Indonesia’s plan was to share exclusively with Baxter HealthCare (USA) in exchange for technology to develop the vaccine domestically. This arrangement has met with considerable sympathy (The Lancet), but the WHO was of course very interested in continuing to receive samples.

More recently, Indonesia has agreed to “resume sending avian flu virus samples to the [WHO] as soon as it is guaranteed access to affordable vaccines against the disease” (source: Indonesia Offering Samples of Bird Flu, NY Times).

One Indonesian reporter’s view is in agreement with Indonesia’s position, but in more direct language (source: RI must stay angry, but temper its anger with wisdom, The Jakarta Post):

Treating poor countries as Petri dishes for the robust growth of diseases so pharmaceutical companies can produce vaccines, and perhaps life-saving drugs, only for countries able to afford them is obliviously discriminative.

There is a local saying cacing pun marah ketika diinjak, literally translated as even a worm gets upset when stepped upon. This must seriously be pondered upon by those with greater power to review their initial righteous intentions of creating a better world.

Indonesia has made a bold, but necessary, move on behalf of itself and other developing countries. Upcoming developments will tell how much of an impact such an action can have.

Written by Jaspal

February 20, 2007 at 7:05 am