Diarrhea is the third biggest killer of children under five years of age in Zambia (40 per day; 15,000 each year), and rotavirus, the most common cause of severe and fatal diarrhea in young children, is responsible for nearly one-third of those deaths. As in many countries in sub-Saharan Africa, the region with the highest rates of rotavirus mortality worldwide, rotavirus contributes heavily to the tremendous drain on the health and economic resources in Zambia:

Vaccines are the best way to protect children in Zambia and the rest of the world from severe rotavirus diarrhea and the deadly dehydrating diarrhea that it causes.

Rotavirus vaccines play an essential and life-saving role in comprehensive diarrhea control strategies and are already saving lives and improving health in the countries where they are in use. A coordinated approach that combines rotavirus vaccines with other prevention and treatment methods, including oral rehydration therapy, zinc, breastfeeding, improvements in water, sanitation and hygiene as well as proper nutrition, will achieve the greatest impact on diarrheal disease morbidity and mortality.

Last week, an innovative, multisectoral partnership between the Zambian Ministry of Health (MoH), the Centre for Infectious Disease Research in Zambia (CIDRZ), and Absolute Return for Kids (ARK) launched the Programme for Awareness and Elimination of Diarrhea (PAED) to strengthen Zambia’s capacity to provide comprehensive diarrheal disease prevention and treatment strategies, including the introduction of rotavirus vaccines in the capital, Lusaka, to reduce the huge number of child deaths from diarrhea.

PAED’s coordinated approach to addressing the substantial burden of diarrheal disease in Zambia includes:

PAED hopes that the introduction of rotavirus vaccines in Lusaka and the scale-up of health worker training and community-level education will provide the MoH with the implementation and public health experience necessary to expand its program and vaccinate all Zambian children. Zambia is a GAVI-eligible country, and the MoH aims to work with GAVI to support its nationwide introduction and sustained use of rotavirus vaccines.

In addition to the contributions of CIDRZ and ARK to PAED, the Bill & Melinda Gates Foundation will support PAED’s monitoring and evaluation efforts, and GlaxoSmithKline has donated vaccines for PAED’s Lusaka rotavirus vaccination program in 2012.

RotaFlash is an e-news alert that provides breaking scientific news and updates on progress made by PATH and partners (GAVI, WHO, UNICEF, US CDC, manufacturers, universities, countries) toward increasing global access to vaccines against rotavirus, the leading cause of severe and fatal diarrhea in young children worldwide. RotaFlash is produced by PATH and funded by the GAVI Alliance and is one of the main advocacy and communication vehicles used to support accelerated introduction and access to rotavirus vaccines where children need them most urgently. If you’d like to learn more about rotavirus or receive PATH’s periodic RotaFlash newsletter, email rotavirusvaccine@path.org.

Rachel’s quilt patch

This year, I commemorated World AIDS Day at ONE and (RED)’s event in Washington, DC, where I listened to sitting and past presidents, members of Congress, corporate leaders, health workers from other countries, activists and even a few rockstars. At a time when every government cent is under scrutiny, I was reminded of just how far we have come in the fight against AIDS and many other diseases that disproportionately affect the developing world. I left the event feeling energized by the significant progress we have made and the leadership that has been shown by the US in addressing so many global health problems.

It wasn’t until I returned to my office and saw an email from a dear friend, who had chosen to stop taking the medication that is no longer protecting him against an ever-growing list of AIDS-related complications, that I was brought crashing back to reality. This juxtaposition between a community’s accomplishment and personal tragedy gave me pause. To be sure, we are winning the war against AIDS; but we also have a long way to go before we can declare victory.

The United States deserves a lion’s share of the credit for its leadership in the AIDS fight. My country, as Bono — Irish rock legend and cofounder of ONE — so articulately explained in a recent New York Times op-ed, has led. Really led. In just the last year alone, the US government, in partnership with nongovernmental organizations like PATH, has helped support:

In the midst of the current economic crisis, when morale is low, it is natural to focus on what our government is not doing. However, when it comes to issues of HIV/AIDS, malaria, and other global health issues, our leaders have really demonstrated our nation’s potential to positively impact many of the world’s gravest health problems.

The President’s Emergency Plan for AIDS Relief, or PEPFAR, which was started under President George W. Bush, has been pivotal in turning the tide against this disease. Furthermore, in an historic announcement last week, President Obama pledged to help 6 million people get treatment by 2013, 2 million more than the original goal. To have our 43rd and 44th presidents so invested in this vital issue makes me proud to be an American. It shows me that, when they want to, our two political parties can achieve some pretty remarkable feats in global health. It is our job as taxpayers to remind them of this, especially now as they consider cutting foreign assistance, a move that would only worsen morale at home, not to mention adversely impact the lives of millions around the world.

I refuse to believe that the era of bipartisanship is dead. In fact, bipartisanship was on full display at the ONE and (RED)’s event. Representative Barbara Lee, D-Calif., one of Congress’ most devoted champions on the HIV/AIDS issue, was joined on stage by freshman Senator Marco Rubio, R-Fla., and — wait for it — they both agreed with each other! In one of my favorite quotes of the morning, Senator Rubio remarked that, as a country, we “are not just blessed so we can have; we’re blessed so we can give.” I couldn’t agree more.

It is through events like this and other World AIDS Day events that we are able to tangibly see the impact of foreign assistance and the leadership role the US has played in getting that assistance to those who need it. If the American public and policymakers better understood what the US has accomplished with their investments, I truly believe they would be reinvigorated and feel a sense of responsibility to care for the world’s poor. We are a nation of generous people, and this generosity, by and large, transcends our differences in culture, race, religion, and politics. To quote the timeless adage, which was echoed throughout the day, “To whom much is given, much is required.”

It is time, as our President so eloquently stated, to “put humanity before politics…and to fight for all the people who didn’t live to see [our success].” I promise to continue fighting for my friend and for all of the men, women, and children who were taken far too early from this world by this and other diseases. I hope you will join me.

Add your voice to the (2015)QUILT. By creating a personalized, digital panel and using it as your social media avatar you can show your support for a HIV-free generation and future US investments in global health.

I had to return to Burkina Faso, one of the hottest countries in Africa, during one of the hottest months of the year. A surveillance team from the World Health Organization (WHO) was sending me weekly updates from the West African country. Still, I had to see for myself whether our ten-year effort to rid Africa of one of its most devastating diseases was succeeding.

When I was last in Burkina Faso, in December, excitement filled the air. Millions of young people were on the move—traveling for miles by foot, bicycle, and donkey to village health centers where they waited patiently to be vaccinated against the most virulent form of meningitis in Africa.
There had been no doubt that they would come. The brand-new vaccine was a gift of hope.

Meningitis A has terrorized African families for centuries. If its victims don’t receive timely medical attention, which is all-too common in remote communities in sub-Saharan Africa, the fatality rate can approach 80 percent. Death can come within a day. Even if a child survives the disease, chances are high he or she will be left with serious neurological side effects—brain damage, deafness, or epilepsy.

Meningitis arrives with the hot winds of the dry season, in January, and vanishes with the start of the rains, typically in May. During the 2008 “epidemic season,” Burkina Faso had more than 25,000 suspected meningitis A cases. The country’s massive immunization campaign in December was timed to head off another season like this. In just 12 days, 11 million people between the ages of 1 and 29 were vaccinated, close to 100 percent of the target population.

Each week after the immunization campaign, the WHO surveillance team collected data on any suspected meningitis cases in the country. Each week, no cases were found. Nevertheless, I was anxious when I returned to the country in March, during the height of the epidemic season.

The hospital wards were empty. I was elated.

By the end of May, only one person in the country had contracted meningitis A, and she hadn’t been vaccinated. There were three more cases in unvaccinated individuals from neighboring Togo who had crossed into Burkina Faso.

MenAfriVac™ is the first vaccine designed specifically for Africa. It was developed by the Meningitis Vaccine Project—a partnership between PATH and the WHO—through an innovative vaccine development model that spanned four continents. The vaccine took a relatively short ten years to develop and cost less than one-tenth the US$500 million usually required to develop and bring a new vaccine to market. If it’s introduced throughout the 25 countries in sub-Saharan Africa affected by meningitis A, it could prevent more than 1 million cases over the next decade and free up more than US$350 million that would otherwise be spent on medical costs.

In Burkina Faso, it was clear what the future could hold—the end of meningitis A epidemics in Africa. It’s only the beginning of the end, and more political will and funding will be needed. But as the temperature climbed well over 100°F that March day, I couldn’t have been happier.

Photo courtesy of PATH

-Dr. Marc LaForce is the director of the Meningitis Vaccine Project.

Growing up in a Ghanaian coastal village, the dry and dusty trade winds that blew in from the Sahara were associated with Advent, Christmas and happiness.

But as I moved inland with my work, they also became linked with meningococcal meningitis A (men A), Ghana’s most common form of meningitis, which brought major epidemics every eight to 12 years.

Men A strikes children and young adults suddenly, causing severe headaches, fever and a stiff neck. Patients can die within 48 hours.

I still remember the hospital wards where I used to work. Meningitis patients were usually on the floor because their seizures made them fall off the bed. As a medical student, I often had to bend the rigid patients into a fetal position so that I could extract the cloudy fluid from their spinal cord and confirm the suspected diagnosis. Year after year, we gave intravenous antibiotics every four hours and prayed the patient would survive without major complications.

In 1989, I became the district medical officer responsible for preventive health of a city of one million people. On one memorable occasion, with an epidemic threatening, a terrified crowd of people nearly broke down the vaccine cold store door in an attempt to get the vaccine. The fear on their faces was palpable.

Then, in 1997, the biggest-ever Men A epidemic struck, not just in the four northern regions as usual, but throughout the country, hitting about 20,000 people.

And just a few years later, in 2001 a close relative of mine, a healthy 20 year old, began complaining of a headache. He later collapsed and was given intravenous antibiotics. Within 48 hours, he was dead.

His death devastated my family, with rumors amok about the role of evil spirits. A decade later, my extended African family is still coming to terms with the loss.

I’m proud to say the GAVI Alliance has just committed another US$100 million to support the roll-out of a new conjugate vaccine, MenAfriVac, to rid the region of these men A epidemics. If our pledging conference is successful on June 13, GAVI will be able to roll this vaccine out to all African countries at risk.

This Christmas, I am taking my children back to Ghana. The new men A conjugate vaccine gives us the opportunity to celebrate without fear of this ancient scourge. It provides us hope for the future.

- Mercy Ahun, managing director of GAVI’s Program Delivery Team

Crossposted on Bill & Melinda Gates Foundation’s Foundation Notes blog

The world has been watching a drama unfold in Libya as NATO struggles to create a functional multilateral partnership capable of delivering on the mission of protecting civilians. Clearly, mobilizing a complex, multicountry, multi-organizational alliance is hard work fraught with complications and unforeseen stumbling blocks.

While multilateral efforts cannot stop every political upheaval or the devastation of natural disasters, they can prevent the unnecessary deaths of millions of people. One of the best examples is the GAVI Alliance. As a person who works to bring lifesaving vaccines to vulnerable children around the world, I see how this committed multilateral partnership is quietly, yet profoundly protecting the world’s poorest children from the most deadly childhood diseases.

The GAVI Alliance is a partnership of UN agencies, donor and developing-country governments, vaccine manufacturers, and civil society organizations that is accelerating the introduction and use of critical, lifesaving vaccines in poor countries. One clear example of how this multilateralism succeeds is GAVI’s ability to drive down the price of new vaccines to an affordable level.

By bundling the demand for vaccines in the developing world and pooling significant donor resources, vaccine manufacturers have an incentive to invest in building necessary manufacturing capacity and offering prices that are many times less than those in the developed world. The GAVI Alliance’s procurement strength has also provided a market for vaccine manufacturers in developing countries, including India and China, who will be instrumental in providing even lower cost vaccines in the future.

Prior to the formation of the GAVI Alliance in 2000, 12 to 15 years would pass between the introduction of new vaccines and their routine use in the developing world. This time lag meant nearly 30 million infants were not receiving vaccines that parents in richer countries take for granted. This lengthy gap persisted despite the fact that the poorest children are in most desperate need of these vaccines.

The impact of this multilateral mobilization on reducing the time lag is huge. Take, for instance, the recently rolled out pneumococcal vaccine. Pneumococcal disease is the leading cause of pneumonia, which takes the lives of 1.5 million children each year. It can also lead to meningitis, sepsis (blood poisoning) and otitis media (infection of the middle ear), which can cause permanent deafness.

In Kenya, where 35,000 children die from pneumonia annually, thousands of women waited in line with their children for the vaccine. Thanks to the work of GAVI, children in Kenya received the newest generation of pneumococcal vaccines before the vaccine had been introduced in the United States. In line the first day the vaccine was introduced was Tabitha Muikali, who lost her first son to pneumonia. Now she was now able to give her youngest son, one-year-old John Dolo, a lifetime of protection.

Over the past ten years, GAVI has saved the lives of an estimated 5 million children like John Dolo. This is truly multilateralism at its best.

-John Wecker, director of Vaccine Access and Delivery, PATH

Photo courtesy of GAVI/11/Riccardo Gangale.

Amadou Francois Dipama is a town crier. Every day between the hours of 3 and 6 p.m., he steadily traverses the streets of Saaba, Burkina Faso by bike or foot, doing the local version of the evening news.

For a small fee, Amadou, 54, will raise his bullhorn to his weathered lips, flip the switch, and, after a punishing blast of feedback, declaim items of interest to the people of Saaba. He might announce a show, a dance or a community meeting. Lately, he’s been talking about meningitis A.

All of the young people need to come get the vaccine, Amadou says.

To get the word out about Burkina Faso’s campaign to vaccinate everyone between the ages of 1 and 29 with MenAfriVac™, public health officials have used modern techniques, such as television and radio announcements. Posters advertising the campaign are taped to health center walls and vehicles. Ball caps with the campaign’s logo are on the heads of some health workers; others have gone house-to-house to make sure their neighbors know the vaccine is here. And Amadou and his colleagues have been out with the bullhorns.

Whatever they’ve been using in Saaba, it seems to be working. On our way to an early morning visit to the region’s health center, we pass several lines of people. In their hands are bright white “cartes de vaccination,” records updated each time they receive a dose.

In the area where Amadou brings the news each night, nurse Boubacar Sawadogo, 41, reports that more than three-quarters of the people ages 1 to 29 came to get their vaccination during the first three days of the campaign. That’s much better, he says, than the rates for vaccination against some other diseases.

“For this vaccine, no one has said no,” Boubacar says. “People are all for it. They know it is a serious disease.”

-by Kathleen Donnelly, PATH senior publications associate

Our friends at PATH are on an amazing mission to bring a new meningitis vaccine to Burkina Faso, Mali and Niger. Follow their stories on the ONE Blog as the journey unfolds.

Alidou Ouedraogo can’t remember when meningitis stole his hearing. He frowns slightly as he watches his teacher’s fingers spell out the question in sign language. He gently touches his head, to indicate he’s thinking. Then he signs, “When I was very small.”

It’s been at least 16 years since Alidou recovered from meningitis, but not without experiencing one of its most common side effects: hearing loss.

Age 19 now, he began school at the Integrated Education and Training Center of Deaf and Hearers in his hometown of Ouagadougou, Burkina Faso when he was three.

The school, which is known by its French acronym, CEFISE, is directed by Théresè P. Kafando, who helped her late husband build the school from 19 students in 1988 to about 3,500 today.

From the start, CEFISE has accepted an exuberant mix of deaf and hearing children on the theory that they help each other learn. Today, about 450 of her students are deaf, Madame Kafondo says. At least 80 percent of those students, she estimates, are deaf because of meningitis.

In a bright yellow dress and chartreuse sling-backs, Madame Kafondo hurries across the school’s dirt courtyard, dispensing correction or affection to students, depending on need.

On the third day of a countrywide vaccination campaign, the five-year-olds are lined up and ready to receive MenAfriVac™, a new vaccine that holds promise to eliminate the strain of meningitis that causes epidemics in African countries like Burkina Faso.

Madame Théresè Kafondo, director of the school

If a similar vaccine had been available close to 20 years ago, would Alidou’s world be different now? It’s a question he sees no sense in pondering, choosing instead to look ahead. He is interested in electricity and how it works. He would like to go to the university. He doesn’t know which career he’ll choose.

“Right now I can’t tell you,” he signs. “There are many, many things I can do.”

-Kathleen Donnelly, senior publications associate, PATH

Photos courtesy of PATH/Gabe Bienczycki

In Emmanual Ouisnoma’s village — Korsimoro, Burkina Faso — people know that epidemic meningitis is a disease that kills. And that’s not all, says Ouisnoma, a long-time health center volunteer who spoke with me yesterday about the effect of meningitis in his village. They know that a vaccine that can protect against meningitis for 10 years or more is “something really special.”

I’m here in Burkina Faso because of the extraordinary aspects of that vaccine, MenAfriVac™,
developed through the Meningitis Vaccine Project (MVP). Along with other representatives of PATH, which is a partnering with the World Health Organization in MVP, I’m here to document the launch of a vaccine that could mean the end of epidemic meningitis in villages like Ouisnoma’s.

My colleagues and I have been here for only about 48 hours, but we’ve already seen the enthusiasm the vaccine attracts.

This morning, we joined about 2,000 others in Ouagadougou’s Place de la Nation for a celebration of the first countrywide vaccination campaign using the new vaccine, MenAfriVac™. The central square was dressed for a party, and the invited guests — a mix of global health superstars and hundreds of Burkinabe schoolchildren — were in a festive mood.

After Burkina Faso’s president addressed the crowd, a ripple ran through the kids in one especially excited sector. A group of young children began making its way toward dozens of health workers in white coats sitting at tables laden with coolers holding vaccine. Seconds later, there was a crush of press photographers as the first few children got their shots.

Pitroipa Boukaré, a 3-year-old pixie with an expression befitting the seriousness of the occasion, received one of the first doses while sitting in a health worker’s lap. You can see her being vaccinated in the video that accompanies this post. The sting was a shock, and she cried. But she was soon comforted and gently placed on the ground to make way for the next child.

Her mother was nearby, but Pitroipa stood her ground, eyes wide as she watched, along with the world, the beginning of the end of epidemic meningitis.

-Kathleen Donnelly, senior publications associate, PATH

Vaccine arrival in Burkina Faso in preparation for MenAfriVac launch. Photo credit: WHO

On Monday morning, I’ll wake up in Ouagadougou, Burkina Faso and join the crowds of people moving toward the Place de la Nation in the center of town. As the sun rises high and hot in the West African sky, we’ll stand together in the rose-colored dust of the plaza and watch musicians and dancers perform. A few dignitaries, including the nation’s president and the head of the World Health Organization, will speak. Then, the children and young adults of Ouagadougou will form a line, bare their shoulders and receive a dose of a vaccine with the potential to end epidemic meningitis in Africa.

The first mass vaccination campaigns with MenAfriVac™ will have begun. By early next year, some 20 million people throughout Burkina Faso, Mali and Niger will have received the vaccine, and will be protected from a disease that has killed or disabled hundreds of thousands in their homelands.

For decades, it seemed we’d never wake up to this day. The challenge, after all, was daunting: develop a vaccine specifically for the African “meningitis belt” — 25 countries regularly ravaged by a disease that kills one in 10 who contract it and leaves as many as a quarter of survivors with severe disabilities. Make it long-lasting and safe and effective for young children as well as adults. And do it all for less than 50 cents a dose.

As Dr. Marc LaForce, director of the Meningitis Vaccine Project, describes in this video, going from zero to vaccine launch in less than 10 years — and at less than one-tenth the development cost of a typical new vaccine — took the creative collaboration of partners almost fanatically dedicated to the project’s success. A partnership between PATH and the World Health Organization, the Meningitis Vaccine Project now provides a blueprint for how vaccines made specifically for poor countries might be developed in the future. I’m looking forward to telling you more of the story from Ouagadougou in the days to come.

=Kathleen Donnelly, senior publications associate, PATH

Renewed emphasis on science and technology:

In a breakfast with Dr. Alex Dehgan, science and technology adviser to USAID Administrator Rajiv Shah, I learned more about the agency’s efforts to restore science and innovative thinking as integral parts of its agenda.

He noted that historic leaps in development — reductions in child mortality and the Green Revolution, for example — have depended on critical innovations in development science, and so we should be working to develop new technologies that allow us to skip ahead and solve problems instead of just making incremental progress. He also stressed the need to elevate partnerships that capture local innovation and equip those in the developing world to solve their own problems.

More than just a phone:

At the mHealth (mobile health) Summit, I attended sessions with tech nerds, policy wonks, curious investors and government reps — all of whom have recognized the growing power of mobile technology to improve outcomes in global health programs.

I’ve seen some of these programs first-hand in places like Rwanda, where the TRACnet clinic’s nurses receive real-time data via text message from AIDS patients living in the most remote villages, and it was fascinating to see the breadth of new mHealth projects popping up around the world: treatment reminders across sub-Saharan Africa; hypertension and diabetes monitoring in rural parts of the US; election tracking in Afghanistan; smoking cessation programs globally; and the list goes on.

Some of these, of course, will never make it beyond the pilot phase, but it is amazing to think of a cell phone or a blackberry as a tool for real social and public health change — not just email and Sudoku.

A FORWARD-thinking approach for USAID:

Back at USAID, senior staff hosted a teleconference to outline its new FORWARD strategy, which aims to “change the way the agency does business — with new partnerships, an emphasis on innovation and a relentless focus on results.”

For an agency known for being rather entrenched and bureaucratic, it was a real breath of fresh air to hear frank discussions about topics including staff policy and training, local capacity building in development planning and the Development Innovation Ventures Fund — designed to attract transformative approaches and technologies that can be brought to scale and have an impact on development.

Innovation doesn’t have to be purely technical. Policy innovations are also shaking things up. Perhaps most exciting is USAID’s reform of their procurement process. They’ll be looking to increasingly utilize local systems and products in their development efforts, which should help to cultivate real ownership of projects by stakeholders in the field.

They’ll also reform their grant-writing procedures to emphasize cost-effectiveness and results (increased crop yields) rather than inputs (bags of seed purchased). Of course, these reforms make for great sound bites, and the administration’s real test will come as it seeks to implement them. But the rhetoric and processes already underway are very encouraging.

New partners + new vaccine = lives saved:

On Friday, we met with our partner PATH to learn about the upcoming launch of their new meningitis vaccine in three West African countries starting December 6th.

The vaccine and its distribution represent major innovation in product development partnership (with engagement from the US government, Indian pharmaceuticals, philanthropies and local stakeholders) and vaccine pricing (reduced all the way down to 40 cents per dose!), and aims to dramatically reduce the threat of meningitis for millions of people. Stay tuned to our blog for many more real-time updates on this exciting new venture.