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We Are About to Save Two Million Children. Here’s How

Ed note. This op-ed by GAVI CEO Seth Berkeley originally appears in Project Syndicate and is reprinted here with permission.

GENEVA – Ask most people to name the two biggest causes of death among children, and they will most likely say malaria and HIV. In fact, it is pneumonia and diarrhea – the “forgotten killers” – that are responsible for the highest death toll, claiming more than two million of the most vulnerable lives every year.

Together, these two diseases account for 29% of all deaths of children under five years old. That is more than double the total for HIV and malaria combined, and nearly as many as all other infectious diseases, injuries, and other post-neonatal conditions put together.

Yet as shocking as these statistics are, what is perhaps even more surprising is just how preventable pneumonia and diarrhea are – so much so that it would be quite feasible to introduce measures that by 2025 would reduce their death toll to almost zero. That is precisely what we are now aiming to do.

An ambitious new plan, called the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea, launched this month by the World Health Organization and UNICEF, aims to step up existing interventions and pool global efforts, with the goal of reducing the number of deaths from pneumonia to less than three children per 1,000, and of diarrhea-related deaths to below one in 1,000. This would effectively end the preventable deaths of more than two million children every year.

For any other infectious disease or global health threat, achieving this kind of reduction in incidence rate and mortality would be nothing short of miraculous. Yet, for pneumonia and diarrhea, we have every reason to believe that we can succeed, because we already know what works.

For example, infants who are not exclusively breastfed for the first six months have a ten-fold increase in the risk of death from diarrhea, and are 15 times more likely to die from pneumonia. Similarly, basic sanitation, such as improved hand washing and access to clean water, and better nutrition can also produce significant risk reduction, much of which can be achieved through simple education programs.

Immunization is also highly effective. Vaccinating children against rotavirus, for example, can protect them from a pathogen that is responsible for 37% of all diarrhea deaths in children under five, thus saving 450,000 lives every year. Similarly, vaccines exist to protect against pneumococcal disease, which accounts for a half-million pneumonia-related deaths annually.

When combined, these interventions significantly reduce both pneumonia and diarrhea; the problem is that, too often, they do not reach the children most at risk, such as those living in extreme poverty or hard-to-reach communities in the world’s poorest countries. That is why we now need the Integrated Global Action Plan.

The two diseases share so many common causes and risk factors, prevention strategies and interventions, and delivery platforms for care in clinics, communities, and schools that it makes sense to bring them together. But, if those hard-to-reach children are to benefit, our efforts must be scaled up significantly.

Until recently, this simply would not have been possible, at least not on the immunization front. The vaccines protecting against rotavirus and pneumococcal disease are both barely more than a decade old. In the past, such new vaccines would take, on average, 15 years to reach developing countries – and then at prices that would place them beyond the reach of those most in need.

This is one of the reasons why my organization, the GAVI Alliance, was created: to help accelerate the introduction of new vaccines and make them more affordable and accessible in developing countries. Through our unique public-private business model, we have worked with our partners to help increase supplies of these vaccines while simultaneously bringing down their price. Indeed, since 2006, the price of rotavirus vaccine has fallen by 67%, to just $2.50 per dose, while the price of a dose of pneumococcal conjugate vaccine has plummeted by 90%, to $3.50.

Such price reductions have and will continue to play a crucial role in saving the lives of millions of children and achieving the Millennium Development Goal of reducing child mortality by two-thirds. To date, GAVI has helped countries immunize more than 13 million children against pneumococcal disease and five million children against rotavirus, with plans to strengthen its efforts in countries where immunization coverage is below 70%.

None of this means that we will not still face significant obstacles. But the one thing that we know about immunization is that we can reach everyone. We did it with smallpox, which has now been eradicated, and we are doing it with polio (with less than 100 cases worldwide this year). The challenge now is to do the same with all of our life-saving vaccines – particularly those that target the biggest killers of children.

–Seth Berkley is CEO of the GAVI Alliance.

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Top of the Morning: USA Sending Troops to Jordan; Nigerian Tycoon Plans Major Oil Refinery Project

Top stories from DAWNS Digest

US Sending Troops to Jordan

It was little noticed in the American media today because of other major events, but with an eye on Syria, the US is deploying a contingent of troops to Jordan. “In a critical indication of growing U.S. military involvement in the civil war in Syria… Defense Secretary Chuck Hagel is ordering the deployment of up to 200 troops to Jordan, according to two Defense Department officials. The deployment…‘creates an additional capability’ beyond what has been there, one official said. The group will give the United States the ability to ‘potentially form a joint task force for military operations, if ordered,’ he said.” (CNN http://bit.ly/10i6u0Q)

Nigerian Tycoon Plans Major Oil Refinery Project

Nigeria is a huge oil producer, but it still needs to import 75% of its fuel…unless this refinery is built. “Africa’s wealthiest man, Aliko Dangote, says he aims to invest up to $8 bn in a major new oil refinery that would almost double Nigeria’s oil output. Nigeria is Africa’s biggest oil producer but lacks refining capacity and has to import most of its fuel. Mr Dangote, 56, told Reuters news agency that those who should have invested in refineries were benefiting from Nigeria’s lack of capacity. Building a major refinery would help all of sub-Saharan Africa, he said.” (BBC http://bbc.in/11ewJlu)

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Indian Children Discovered to Have Natural AIDS Resistance. Now What?

NEW DELHI – On May 31, 1987, as panic about AIDS spread, a reporter for the New York Times spent a month investigating the transmission of the global epidemic. “In the kingdom of AIDS,” he wrote, “a penis itself, often likened to a sword in folk tales, again becomes a deadly weapon…As for our friends the gays, they are not so very gay anymore.”

Since the 1980s, much has changed: AIDS is no longer considered a “gay” disease, anti-retrovirals have extended the lifespan of those infected, and the general illogic that accompanied the initial terror of the epidemic has, if not disappeared, at least in many places morphed to include basic facts of the disease. What hasn’t changed is that until now, there hasn’t been a cure. But this spring, researchers at the Pediatric HIV Clinic in Mumbai published a paper in the Indian Journal of Medical Research reporting the first known cases of children in India naturally resistant to AIDS.

For the last ten years, scientists world-wide have been studying “long-term nonprogressors” (LTNPs), people who are HIV-positive but who naturally resist developing symptoms for 6 to 10 years after contracting HIV. A smaller sample of people, known as “elite controllers,” have been known to stay healthy without any treatment for as long as 25 years after infection. While elite controllers are rare – there are only 25 known cases in the world – LTNPs are actually more prevalent than you might think, constituting somewhere between 5 and 15 percent of HIV-positive individuals, says Ira Shah, one of the doctors who wrote the Pediatric HIV paper.

The report studied children from western India, ranging in age from 9 to 13, who had been diagnosed with the virus, and who, without any treatment, maintained healthy CD4 counts, the white blood cells that fight infection. Their bodies naturally produce a type of broadly neutralizing antibodies (BNABs) that are able to keep up with the rapid mutation of HIV within the body. If scientists could artificially replicate these antibodies, an HIV vaccine might suddenly be in sight.

This isn’t necessarily news in the scientific community: More than a dozen types of BNABs have been discovered through various research centers over the last several years. But identifying Indian children who have antibodies is particularly crucial because the most common strain of HIV in Asia is different than that in the West, and identifying local elite controllers here is therefore of particular import.

Using research with LTNPS,the International AIDS Vaccine Initiative (IAVI) has since 2001 been testing vaccine combinations around the world. The vaccine, developed by U.S. bio-tech firm Therion Biolgics in India, takes genetic material from six HIV genes and uses a “viral vector,” or a version of a benign pox virus, that has been genetically manipulated to serve as a transport mechanism. Because only pieces of the virus are used, there’s no way that the vaccine could actually cause infection, but the introduction of the virus is hoped to stimulate the production of specific cells known as cytotoxic T lymphocytes – what the children in the Shah’s study had naturally. Two different versions of these vaccines are currently being tested in Africa, and the Bangkok Vaccine Evaluation Group has a third initial trial in Bangkok with 2,545 intravenous drug users, the results of which have been so promising the trial’s continued to subsequent phases.

But as hopeful as these developments are, testing HIV vaccines raises difficult questions. In India and throughout the developing world, drug trials and medical research are still in a Wild West phase. These trials are being conducted in areas with high incident rates and vulnerable populations. In the coldest possible terms, these experiments depend on healthy people getting exposed to the disease in order to determine the vaccine’s efficacy. The issue of informed consent, considered a basic standard in human-tested research, takes on tricky nuances when working with these marginalized populations, who frequently lack even a basic understanding of the disease. Put simply, there’s a reason the vaccines tests aren’t being conducted in New York. It’s unclear what the vaccine researchers’ obligations are in providing care for people who contract HIV while participating in the trials, or whether these well-funded trials should also include education and prevention components – which, in some ways, would defeat the researchers’ purpose.

Recently a trial was run on HIV-positive people in Mumbai to test a bovine immunodeficiency virus vaccine without getting the patients’ consent, a story which only broke when one of the patients died. While it’s exciting that research in India is progressing, as projects launch into testing phases these issues will need to be addressed. IAVI India Country Director Rajat Goyal is aware of these concerns, explaining that IAVI’s work is not “just about having good labs and good research, but about good participation. We need media coverage, civil society, and political buy-in.” Last year, IAVI opened a $12 million dollar laboratory with federal support to continue their HIV vaccine research, and as they roll out projects, they have a unique opportunity to set standards for this sort of testing.

Unlike the recent case of a child in Mississippi, splashed across U.S. headlines as the first “cured” case of AIDS, IAVI isn’t working with rare, one in a million cases. The goal for HIV vaccines is surprisingly banal – even a 50 percent rate of prevention would be heralded as a success and likely rolled out into the population at large. But in public health, like with the HPV vaccine, even small developments can dramatically reduce the burden of disease. In 2012, 34 million people were HIV-positive, and more then 2.5 million people contracted the disease. If even 50 percent of those could have been prevented, that’s something to – cautiously – celebrate.

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Bahrain’s Formula One Grand Prix Crackdown

For the third time in three years, Bahraini citizens are protesting the Formula One Grand Prix. And it looks like for the second time in two years, the Fédération Internationale de l’Automobile will ignore massive human and civil rights repression and let the race go as planned.

Bahrain’s citizens have been abandoned by the world. Pro-democracy protests started in February 14, 2011, with activists calling for a constitutional monarchy and greater economic freedom. Three days later, protesters were violently evicted from Manama’s Pearl Roundabout, and it only got worse. A state of emergency was enacted and King Hamad bin Isa Al Khalifa let the Gulf Cooperation Council’s Peninsula Shield Force enter the country to essentially enact martial law. This is on top of the use of torture on activists, show trials of medical professionals, and the recruitment of mercenaries.

And as it did this, other nations did nothing. The civil war in Libya attracted the most attention in the region, followed by Syria. Even the United States and other Western nations turned their backs. The United States maintains an interest in Bahrain – its Fifth Fleet is housed there. With the international community’s focus elsewhere, the monarchy spent millions on foreign public relations firms to mask any internal trouble.

The Formula One Grand Prix is a major money maker for both Bahrain and the sport, but the protests are causing problems. The FIA canceled the race in 2011, but let it happen in 2012, despite renewed protests and dissent from teams themselves. And with the race set to happen this weekend, Bahrain’s rulers aren’t taking any chances of losing their image. Human Rights Watch reported that police are arresting activists to prevent any major rallies during the race weekend.

But the trouble won’t go away. The monarchy, backed by Saudi Arabia and other GCC states, is trying to foster the blame of protests on Iran, which is splintering the opposition – predominantly Shia – along sectarian lines. The monarchy wants the opposition to devolve into infighting, but right now both the GCC and Iran are raging a proxy war that will only continue to harm Bahrainis and spur more extreme action from protesters.

The international community can’t continue to ignore Bahrain. With the triumph against dictators in Egypt and Tunisia, it’s clear that oppressive regimes are fully delegitimized in the eyes of their people. Stopping the crackdown will improve long-term security in Bahrain, something the United States should realize is a worthy goal, not short-term peace via violence. Turning a blind eye to the repression in Bahrain will only invite more suffering and polarization in the country. Other nations don’t need to stage a military intervention, they don’t need to pay a fortune. They need to pay attention and pressure Bahrain’s monarchy to end the crackdown.

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Top of the Morning: Latest on the Iran/Pakistan Earthquake; Troubles in the Central African Republic

Top stories from DAWNS Digest

Massive Earthquake Strikes Iran/Pakistan Border

A 7.8 magnitude earthquake struck Iran’s southwestern border with Pakistan on Tuesday. Pakistan has reported that at least 34 people were killed on their side and 80 were injured, while reports from Iran are hazy and inconsistent. “A Pakistani policeman…said nearly three dozen homes and shops collapsed in one village in the Mashkel area, which was the hardest hit by the quake. …The Pakistani army ordered paramilitary troops to assist with rescue operations and provide medical treatment. Additional troops are being moved to the area, and army helicopters were mobilized to carry medical staff, tents, medicine and other relief items.” Iranian state media originally reported 40 deaths, but it soon backtracked and removed those figures from its website. “It also was the second deadly quake to hit Iran in less than a week after a magnitude 6.1 temblor struck near Bushehr, on Iran’s Persian Gulf coast, killing at least 37 people and raising calls for greater international safety inspectors at Iran’s lone nuclear reactor nearby.” (USA Today http://usat.ly/109qgeS)

CAR Troubles: Security Situation ‘Rapidly Deteriorating’ in Bangui

It’s going from bad to worse, and quite quickly. “The United Nations says it is alarmed by the ‘rapidly deteriorating’ security situation in the Central African Republic following last month’s coup d’etat. UN High Commissioner for Human Rights Navi Pillay says there has been a wide range of alleged rights violations including targeted killings, torture, rape, arbitrary arrests and recruitment of child soldiers. Pillay says 119 people have been killed since the fall of the government on March 24, with 20 of those deaths occurring since Saturday in the capital, Bangui.” (Voice of America http://bit.ly/14u3CiG)

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8 year old Martin Richard, peacemaker, killed in yesterday's attack

Boston Marathon Bombing Marks a Deadly Week So Far

The Boston Marathon bombing does not even rank as the deadliest terrorist attack in the world this week. To put this in perspective:

On Sunday, at least 29 people were killed in a pair of bombings in Somalia. The attack targeted the Supreme Court building in Mogadishu, killing a number of lawyers and other court officials. Another simultanous bombing stuck near the airport. Al Shebab claimed responsibility. This bombing shattered a period of relative calm and security in Mogadishu, which is just starting to recover from a long period of intense fighting with Al Shebab, which had been largely defeated.

Monday:  Boston Marathon Bombing: 3 killed, 140 injured.

TodayAt least 50 people were killed in dozens of coordinated attacks across Iraq, in advance of elections next week. “Officials said more than 30 bombings and a shooting hit 12 different areas of Iraq, leaving 50 people dead and making Monday the country’s deadliest day since March 19.”

In Pakistan, at least  9 people were killed and nearly 50 injured in a suicide bombing at a political rally. This was the fourth deadly attack on politicians and political rallies in Pakistan over the past three days. There will be elections next month.

…And it’s only Tuesday.

Let’s all try to live up to peacemaker Martin Richard’s hopes and expectations of us as a species.

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