Polio vaccine switchover: An untold success story in global health

Syed Latif, a polio vaccinator and activist, hands out polio information at the Mansehra Polio Resource Center in Mansehra, Khyber Pakhtunkhwa Province of Pakistan. Photo: Mansehra Polion Research Center.

This was originally published on Global Health TV on November 28, 2017.

In April 2016, something extraordinary happened in global health. Thousands of community health workers in more than 120 countries — from African villages to the Himalayas to the Pacific Islands — all mobilized and synchronized their efforts to switch from one oral polio vaccine to another. Any slip-ups could have resulted in creating more “vaccine-derived” poliovirus cases at a moment when we are down to our last few cases of polio.

The fact that many children receiving such oral vaccines were living in areas of high conflict and low development (which means low levels of health infrastructure) made the accomplishment all the more remarkable.

The feat was accomplished in a single day (each country was told to pick one day within a two-week period in April 2016 to make the change).

The story of this amazing synchronized switch constitutes an untold global health success story and can be told with the backdrop of the current number of wild poliovirus type 1 cases down to only 15 — 10 in Afghanistan and 5 in Pakistan. The polio eradication community had hoped that we would be down to zero by 2017. Now they are hoping it will happen in 2018.

Health workers, facilities under attack in 23 nations; UN accused of inaction

This hospital was damaged by clashes during a 79-day curfew from late 2015 to early 2016 in the city of Cizre in southeastern Turkey. Photo: Physicians for Human Rights.

This was originally published on Global Health TV on May 23, 2017.

In 2012, two Pakistani health workers were out vaccinating children against polio when they were both shot by extremists. One of them died. The other, shot in the leg, had 11 metal rods inserted into his leg and was hospitalized for three months.

In November, I met this remarkable man named Latif (his surname is withheld to protect his security). He is now fully recovered and back to work on the polio vaccination campaign. He told me he never considered giving up. Pakistan reported only two cases of wild poliovirus in 2017 as of May 17 and Latif is determined to see the polio campaign through to the end.

The attack on Latif is only one example of a tragic phenomenon that is not getting better – violence against heath workers and health facilities. In 2016, the extent and intensity of such violence “remained alarmingly high,” according to a new report released by the Safeguarding Health in Conflict Coalition.” The report also found that accountability for committing these attacks remains inadequate or non-existent.

The violence isn’t always perpetrated by terrorists. Sometimes it is committed by the police or the country’s military — institutions that should be ensuring tranquility.

Polio's days are numbered as teams close in on last few cases in 3 countries

This was originally published on Global Health TV on November 23, 2016.

PARIS, France — In 2012, Latif and his colleague were vaccinating children against polio in Pakistan when they were shot by extremists. Latif was shot in the leg. He had 11 metal rods inserted into his leg and was hospitalized for three months. His colleague died. Today, fully recovered and undeterred, Latif (his surname is withheld to protect his security) continues his anti-polio crusade in northwestern Pakistan.

Jim Costello, 73, contracted polio at the age of 15. It paralyzed his upper body: He has triple curvature of the spine, wears a spinal brace and has no use of his arms. His lungs are 75% paralyzed and he uses a medical ventilator for about 18 hours daily. He lives at home in Dublin, Ireland with his wife Delia, “my beloved partner of over 30 years,” on the weekends. During the week, he is in the hospital where he still uses an iron lung. Despite these limitations, he has led a productive life in the retail clothing business and in support of polio survivors. Since 1993, he has served as chairperson and board member of Post-Polio Support Group Ireland

Latif and Costello were two of five people honored as “polio heroes” at a World Polio Day event Oct. 24 at the Pasteur Institute here sponsored by Sanofi Pasteur and Rotary International, two organizations deeply invested in the fight against the disease. Meet Latif in this video and Khuram (an employee of Sanofi Pasteur) in this video (videos from Sanofi Pasteur/AKS Films).

We have never been this close to wiping out polio

This was originally published on the Huffington Post on November 23, 2016.

PARIS, France — Could the Global Polio Day we observed last week be the last such day with actual polio cases?

Participants at a World Polio Day event sponsored by Sanofi Pasteur and Rotary International at the Pasteur Institute here last week, all of them deeply invested in the fight against polio, heard experts say it may well be so, and that the disease could be eliminated in 2016 or 2017.

It is clear that the world is tantalizingly close to eliminating polio. As of last week, there were only 27 remaining cases of wild poliovirus — 15 in Pakistan, 8 in Afghanistan and 4 in Nigeria.  We are on the brink of eliminating the second human disease in history (smallpox, in 1980, was the first).

It is true that all three countries have security challenges. But in Pakistan, the country with the largest number of remaining cases, the security situation has improved markedly since 2014.

“There were close to half a million kids not reachable due to insecurity in 2014,” said Dr. Mufti Zubair Wadood, technical officer for the Global Polio Eradication Initiative at the World Health Organization (WHO) and former head of the WHO polio program in Pakistan. “Since then, the situation has been improving and right now there are almost no areas of the country that are not accessible. That has resulted in a significant drop in the number of cases. Pakistan deserves a huge pat on the back at a time when things were dire.”

Can polio and Guinea worm both be eliminated in 2016?

Nuru Ziblim, a Guinea worm health volunteer in Ghana, educates children on how to use pipe filters to avoid the parasite when they go to the fields with their families. Credit: The Carter Center

This was originally published on Global Health TV on January 14, 2016.

Only once in history has a human disease has been eliminated from the face of the earth. That was smallpox, eradicated in 1980.

There is a reasonable chance that in 2016 two diseases could be eliminated  — polio and guinea worm.

We won’t eradicate either disease this year. Eradication requires that several years pass with no new cases being detected. But it does look like 2016 is the year we could eliminate both diseases.

To be sure, we have been close before with polio, and then lost ground. The World Health Organization (WHO) says that “failure to stop polio in these last remaining areas could result in as many as 200,000 new cases every year, within 10 years, all over the world.” So there is little room for error.

Family planning in India and Pakistan: Picking up the pace of change

Birula, living in Bihar, India, was all smiles about her sterilization. 
Photo: David J. Olson

This blog was originally published by Global Health TV on Jan. 27, 2015.

WALLAH, Pakistan and ARA, India -- Last month, I met Sumeera, 26, in a Dhanak clinic (“dhanak” means rainbow in Urdu) in the village of Wallah, in the rural Punjab of Pakistan. She and her husband have four children ages 7, 5, 3 and 1, and have agreed that four is enough. She had come for a pregnancy test and to secure a contraceptive method to keep her family from getting bigger. Her pregnancy test was negative, and she went away happily, with an intrauterine device inserted by her Dhanak midwife and clinic owner Kaneez Fatima. “Before we found Dhanak, my husband and I knew about family planning but did not have access to it,” Sumeera told me. “Dhanak made a big change in my life.”

One thousand four hundred kilometers to the southeast and a week later, I met Birula, 25, in a Surya clinic (“surya” is the Hindi word for sun) in Ara, a rural town about two hours outside of Patna, India, the capital of Bihar state. She has three children ages 7, 6 and 1½. The previous week she had been sterilized at this clinic; she was back to have her stitches removed. Her relief was palpable – she couldn’t stop smiling.

Sumeera and Birula come from different cultures in different countries but the problems they face are remarkably similar – too many children and too little ability to control the size of their. In India, women cannot always determine the size of their families because of a strong preference for the male child and male dominance in decision-making. In Pakistan, religion also plays an influential role. Both countries are confronting the problem, albeit in different ways and with varying degrees of success.

The top 10 in contraceptive social marketing

Two salesmen from DKT India make a pitch for contraceptives to the owner of a pharmacy in the Mumbai slums. In 2013, DKT India was the ninth biggest contraceptive social marketing program in the world. 
Photo: David J. Olson

This was originally published on the Knowledge4Health Blog on Dec. 23, 2014.

Social marketing organizations around the world delivered more impact than ever before in 2013 —70 million couple years of protection (CYPs), an increase of 6.8% from the 65.5 million CYPs produced in 2012, according to the 2013 Contraceptive Social Marketing Statistics just published by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article for more details).

The report provides details on 93 contraceptive social marketing programs in 66 countries, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries.

The social marketing program producing the most CYPs in 2013 was DKT Indonesia, delivering 6.7 million CYPs, consisting of contraceptives sold through social marketing channels such as pharmacies, convenience stores and medical wholesalers. The second biggest program was the Government of India, with 5.8 million CYPs (although over 40% of these CYPs were for products given out for free, which was not the case with other programs in the Top 10). Here is the Top 10 list in contraceptive social marketing in 2013:

1. DKT Indonesia, 6.7 million CYPs

2. Government of India, 5.8 million CYPs

3. Social Marketing Company (SMC), Bangladesh, 4.44 million CYPs

4. Greenstar Social Marketing, Pakistan, 4.42

5. PSI India, 3.8 million CYPs

6. Society for Family Health, Nigeria, 3.4 million CYPs

7. Population Health Services India, 3.3 million CYPs

8. DKT Ethiopia, 3.1 million CYPs

9. DKT India, 2.89 million CYPs

10. Profamilia, Colombia, 2.87 million CYPs

Social marketing poised to make major contribution to 2020 family planning goal

A Pakistani couple receives family planning counseling at a health center that is part of DKT Pakistan's Dhanak social franchising network.

This blog was originally published at Devex.com on Nov. 3, 2014.

Social marketing organizations are providing more contraception than ever before, but its leaders are determined to up their game even more and become major contributors to the international family planning goal of 120 million new women and girls in the next six years that was set by Family Planning 2020 (FP2020).

In 2013, social marketing organizations around the world delivered 70 million couple years of protection (CYPs), an increase of 7% from 2012, according to the 2013 Contraceptive Social Marketing Statistics published recently by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article). The report provides details on the 93 contraceptive social marketing programs that produced more than 10,000 CYPs in 66 countries.

2013 FP2020 report is released

This week, FP2020 released its annual progress report, announcing that 8.4 million additional women and girls used modern contraception in 2013 as compared to 2012. The report notes that this accomplishment did not meet the goal of 9.4 million additional users in the first year but “is still a significant milestone.”