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Feb 21, 2014

WHO DG Speech for Polio Event in India

WHO Director-General celebrates polio-free India

Dr Margaret Chan
Director-General of the World Health Organization

Address at the “India celebrates triumph over polio” event
New Delhi, India 
11 February 2014

His Excellency, the President of India, the honourable Prime Minister of India, honourable Minister of Health and Family Welfare, the President of Rotary International, distinguished guests, ladies and gentlemen,

I am most pleased to join others in celebrating India’s triumph over polio. Everyone loves a success story, especially one of this magnitude. India has now gone three consecutive years without a single case of polio.

Confidence in this achievement is supported by a world-class surveillance system and a level of vigilance and preparedness ready to manage any imported case as a public health emergency.

In fact, the surveillance system in India not only meets all international standards for high-quality performance. It surpasses them.

After three years, we can say with certainty that the soil of this vast and densely populated country is now free of a virus that killed and crippled children for centuries.

Many critics believed that this day would never come, that the polio virus was too firmly entrenched in India, that India would never be polio free. In their view, India had limited means and unlimited challenges.

They could point to the country’s huge population, high birth rate, dense pockets of poverty, poor sanitation, widespread diarrhoea, difficult terrain, and resistance to vaccination among some groups.

These were real and daunting challenges, but the doubters missed one decisive factor: the power of India’s determination to achieve the impossible, to go from the world’s heaviest burden of polio cases to zero.

Viewed against the challenges, India’s achievement is an epic success story, a proof that any country that really wants to can defeat polio.

Government ownership of the eradication initiative, at union, state, and district levels, was decisive, as were the billions of dollars poured into the effort by the government.

India worked together seamlessly with its international partners, including Rotary International, the US Centers for Disease Control and Prevention, UNICEF, and WHO, with support from the Bill and Melinda Gates Foundation.

A can-do attitude was another reason for success, as witnessed by the unwavering dedication of millions of front-line workers. Vaccinators and religious leaders: I thank you for your service to your own people.

Let me illustrate the magnitude of this achievement with just a few statistics. In the 1970s, India was home to as many as 200 000 polio cases each year. Each nation-wide polio campaign involved the vaccination of nearly 170 million children by an army of 2.3 million vaccinators.

The reporting of suspected polio cases relied on a network of more than 39 000 health facilities from the public, private, and non-traditional sectors.

The need to reach every child meant that every nook and cranny of this vast country was criss-crossed by tireless polio workers. It also meant reaching every child in marginalized and migrant populations.

India, arguably facing the toughest challenges of any polio-endemic country, met each problem with creativity and innovation. In so doing, this country pioneered key operational and technical strategies as lessons for other countries.

India quickly took advantage of new technologies and served as a proving ground for their effectiveness. When better systems to support high-quality performance were needed, India built them. With support from the WHO country office, India built its world-class surveillance system. An efficient and reliable network of laboratories was established to support poliovirus testing and the rapid confirmation of cases.

Millions and millions of vaccinators were supervised and motivated. India also made very good use of another unique asset: its Bollywood film-stars and celebrities.

As the number of cases dwindled and the polio map began to shrink, independent monitoring of progress was introduced to provide a framework for accountability. Meticulous micro-plans were prepared to guide each and every vaccination team, on each and every day of an immunization campaign, ensuring logistical support down to the last detail.

Surveillance and monitoring generated high-quality data. Constant research produced the evidence for the fine-tuning of strategies, another strength of India’s polio programme.

Research improved understanding of the dynamics of transmission in different populations and environments, the effectiveness of different vaccines, and the reasons why some children were being missed. When research determined that vaccine efficacy was compromised in children with severe diarrhoea, social mobilization, led by UNICEF and supported by other partners, was used to educate households on diarrhoea prevention.

Pressure on the poliovirus increased each time a problem was uncovered and solved. In the end, it was the best of human creativity, ingenuity, determination, and perseverance that pushed the poliovirus out of India.

Ladies and gentlemen,

India has shown the world that there is no such thing as impossible. This is likely the greatest lesson, and the greatest inspiration for the rest of the world.

India’s leadership in polio eradication is widely appreciated and warmly welcomed, especially among the 194 Member States of WHO. The country has shared its experiences, best practices, lessons learned, and expert staff with the remaining endemic countries.

The defeat of polio in India paves the way for certification of the entire South-East Asia region as polio-free, possibly at the end of March. When this happens, nearly 80% of the world’s population will be living in countries that are certified polio-free.

The polio-free status of every country remains under threat as long as poliovirus is still circulating anywhere in the world. We still have some way to go. But India provides the decisive proof that eradication is feasible, technically and operationally.

India is fully aware of the need to safeguard its magnificent achievement. Immunization against polio remains high, and emergency preparedness and response plans are in place to respond urgently to any importations.

India will continue its role as a global leader as the Polio Endgame is implemented, including through the introduction of inactivated polio vaccine and the stepwise phasing out of oral polio vaccine.

Right now, the country is using the legacy of its polio success to intensify routine immunization, with a special emphasis on reaching underserved and marginalized populations. The elimination of measles will likely be the next permanent improvement for the health of India’s people.

The 13 January news that India had now gone 3 years without a polio case made headlines around the world. This is a monumental achievement that fully deserves today’s celebration.

Thank you.

Feb 18, 2014

Commentary: Science for the poor _ making Vaccines to combat poverty

Peter Hotez, M.D, Ph.D.
The Huffington Post | 11 February 2014
Is it possible to vaccinate against poverty?
According to the World Bank, an estimated 2.4 billion people live on less than $2 per day, while 1.2 billion live on less than $1.25 per day — a group often referred to as “the bottom billion”. We now know that almost all of the bottom billion and many of those living on less than $2 per day remain trapped in poverty because they are chronically debilitated by a group of afflictions known as the neglected tropical diseases, or ‘NTDs’.
NTDs are long-lasting parasitic and related infections such as ascariasis, trichuriasis, hookworm, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, Chagas disease, and leishmaniasis. The major point is that these NTDs can actually cause poverty either because they make people too sick to go to work and limit agricultural productivity, or because they strike children at vulnerable times, thereby stunting their physical and intellectual development.    NTDs also disproportionately affect pregnant women, making them ill and causing them to produce low birth weight or premature infants.
Beyond their staggering public health impact, the economic losses from NTDs are also impressive: our studies with collaborators at Johns Hopkins University show that Chagas disease results in more than $7 billion lost annually, mostly in the Western Hemisphere. There are similar data available for many other NTDs.
Remember, the NTDs are not rare conditions — virtually every single person living in extreme poverty is infected with at least one of these conditions.
Science can offer a lot to prevent these infections, thereby making poor people well enough to   go back to work, children healthy and intellectually vibrant, and improving pregnancy outcomes. One approach now underway is annual mass treatment with a package of essential medicines that targets several NTDs at once, and costs only 50 cents per person. Although not a true vaccine, the World Health Organization uses the term “preventive chemotherapy” to describe this approach because when used over a period of time, together with other supportive measures, it is actually leading to the elimination of lymphatic filariasis and trachoma, and in some cases even river blindness in dozens of impoverished countries. In collaboration with several international organizations we organized a Global Network for NTDs that is raising awareness about the opportunity for these low-cost preventive chemotherapy approaches.
For other NTDs, however, we need new technologies. In 2011 the Sabin Vaccine Institute allied with Texas Children’s Hospital and Baylor College of Medicine to expand its development portfolio of new and novel vaccines to combat NTDs. The result is the expansion of a unique non-profit product development partnership that is located in Houston’s Texas Medical Center — a medical city of 100,000 people — to transition discoveries from the bench to the clinic and produce the next generation ‘antipoverty vaccines’, i.e. vaccines that would not only improve health but simultaneously also lift people out of poverty. For example, hookworm infection affects more than 400 million people in Africa, Asia, and the Americas, where it is a leading cause of anemia and childhood malnutrition, and has been shown to reduce future wage earnings. Our product development partnership, through activities led by Dr. Maria Elena Bottazzi, has developed, transitioned, and produced a prototype hookworm vaccine undergoing clinical trials in Brazil, and will soon undergo additional testing in Gabon through a so-called HOOKVAC consortium of European and African partners. We are also working to evaluate and modify the vaccine so it targets additional parasitic infections such as ascariasis and trichuriasis.
Finally, a new schistosomiasis vaccine is under development and will soon begin clinical trials.
Nor is poverty exclusive to developing countries or failed nations. Today, almost two million families in the United States live on less than $2 per day and poverty is rampant in southern states such as Texas and others along the Gulf Coast. We found that NTDs are also widespread among these impoverished Americans. For example 300,000 people in the United States suffer from Chagas disease, a cause of heart disease transmitted by kissing bugs — our group, which includes a consortium of Mexican institutions, is now working to develop one of the first Chagas disease vaccines for clinical trials.
Dr. Albert Sabin, whose name and legacy our Institute honors once said, “A scientist who is a human being cannot rest while knowledge which might reduce suffering rests on the shelf.” Our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development is one of six major international product development partnerships currently pioneering vaccine development in the non-profit sector. Together we are making the vaccines for diseases that affect millions if not billions but only those living in extreme poverty.
Almost thirty years ago I graduated from New York’s Rockefeller University, whose motto is Scientia pro bono humani generis – science for the benefit of humanity. Developing a new generation of antipoverty vaccines is a true expression of that concept.
Peter Hotez, M.D., Ph.D. is president of the Sabin Vaccine Institute and the founding dean of the National School of Tropical Medicine at Baylor College of Medicine, where he is also Professor of Pediatrics and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics. Prof. Hotez is also the Fellow on Disease and Poverty at the James A. Baker Institute for Public Policy at Rice University. He is the author of Forgotten People, Forgotten Diseases (ASM Press).

Feb 16, 2014

New Oral Vaccines means No more needles

New oral vaccines are being developed to increase immunity against Tuberculosis (TB) and influenza, and prevent C. difficle, which will mean leaving needles behind, according to researchers from Royal Holloway, University of London. 

The new type of vaccinations were developed using probiotic spores by Professor Simon Cutting, lead researcher of the study, from the School of Biological Sciences at Royal Holloway.

The professor implemented trials to analyze the biology of the bacterium Bacillus subtilis, which caught the attention of microbiologists because it has the capability of making spores that live millions of years until they germinate in proper environmental conditions.

"The mechanisms by which this process occurs have fascinated microbiologists for decades making it one of the most intensively studied bacteria. Its simple life cycle and ease of use make it an ideal laboratory subject," said Cutting.Bacillus spores were found to be perfect for transporting antigens and boosting immune responses.

Cutting explained:

"Rather than requiring needle delivery, vaccines based on Bacillus spores can be delivered via a nasal spray, or as an oral liquid or capsule. Alternatively, they can be administered via a small soluble film placed under the tongue, in a similar way to modern breath fresheners. As spores are exceptionally stable, vaccines based on Bacillus do not require cold-chain storage alleviating a further issue with current vaccine approaches."

In addition to being less painful than vaccines given through jabs, oral vaccines also come with certain advantages, such as being safer to administer, particularly in nations where HIV is a major concern. Also, these types of vaccines will be more cost effective to make and easier to keep fresh, lowering the risk of adverse outcomes. 

Trials have been conducted, by Professor Cutting, to determine the effectiveness of Bacillus based vaccines for many different diseases, such as influenza, Tuberculosis, and tetanus. Now, he is is examining whether the vaccine can be used against Clostridium difficile, a disease extremely prevalent in the West.

C. difficile is a serious cause of diarrhea linked to antibiotics and can result in intense inflammation of the colon, or pseudomembranous colitis.

The professor said: "C. difficile, is a gastrointestinal infection that is commonly picked up following hospital stays and causes around 50,000 infections and 4,000 deaths per year in the UK, mostly in elderly patients. Currently, there is no vaccine against the disease, and although several approaches are currently undergoing clinical trials, none are expected to provide full protection, and new solutions are urgently needed."

Bacillus based vaccines offer distinct advantages as unlike other approaches, oral delivery can cause a more specific immune response in the gastrointestinal tract to fully eliminate C. difficile."

Cutting has been given private seed investment to continue his research and develop the new vaccine for Tuberculosis, C. difficile , and influenza.

Written by Christine Kearney

Copyright: Medical News Today
Not to be reproduced without the permission of Medical News Today.

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