HPV Vaccination in the Japanese MSM Community: A Call to Action

~Written by David Boedeker (Contact: dhboedeker@gmail.com; Twitter: @dhboedeker)

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Source: cancerfrontline.org

HPV vaccination has faced pushback from communities since its introduction in 2006. Perhaps the most shocking story comes from Japan. In 2010, the Japanese government began to give girls ages 12 to 16 the vaccine for free. The government recommended girls receive the vaccine[1], and vaccination rates climbed. However, all of that changed in 2013 when an anti-HPV vaccination movement successfully advocated that the government withdraw its recommendation. The aftermath has been dramatic: vaccination rates dropped from roughly 70% to 1%, leaving millions of adolescents unprotected from HPV-related cancers. Interestingly, this decision coincided with the United States moving to ramp up vaccination efforts. Moreover, the scientific data that prompted the Japanese government to withdraw its recommendation is based in theories that are not biologically possible, as one critic noted[2].

In response, many researchers and physicians are advocating for increased vaccination campaigns in Japan. Historically, these initiatives have focused on females since it has been established that HPV vaccination is important to prevent cervical cancer and other HPV-related cancers. However, it is increasingly recognized that HPV vaccination for males is also critical, especially to prevent throat cancers, which are expected to surpass cervical cancers as the most common HPV-related cancer by 2020.

HPV infection is not only related to throat and cervical cancers; it also increases the risk of developing mouth, tongue, and anal cancers. These are all cancers men can develop, and these are all cancers that Japanese men are currently at risk of developing because they are not vaccinated. Physicians, researchers, and government officials in Japan must expand vaccination efforts to include males, particularly the men who have sex with men (MSM).

MSMs are especially susceptible to anal cancer, a rare cancer, but one that disproportionately affects the LGBTQ+ community. Gay men are 20 times more likely to develop anal cancer compared to the general population, and HIV positive gay and bisexual men are 40 times more likely than the general population to develop this cancer[3].

Why must the Japanese government in particular take action? In Japan, same-sex behavior is stigmatized, which makes the LGBTQ+ community a hard-to-reach population [4] that may face challenges [5] when seeking healthcare services. These challenges may negatively impact the likelihood that they will receive the HPV vaccine. Also, the oncogenic (cancer-causing) HPV infection rate in the Japanese MSM community is 75.9%. Among MSMs who are HIV positive, the oncogenic HPV infection rate is 66% [6]. Most of these infections would have been preventable with administration of the HPV vaccine.

So, what can these government officials do? A driving force behind HPV vaccination is provider recommendation. Many patients state the reason they ultimately received the HPV vaccine is because their provider recommended it to them[7]. Some Japanese OB/GYNs are currently advocating that the government reinstate its HPV vaccination recommendation. A reinstatement might encourage more Japanese physicians to recommend the HPV vaccine, increasing the country’s vaccination rate and protecting its currently vulnerable population. However, it is important for these providers to advocate that the government not only recommend the vaccine to females, but to males as well. Moreover, this policy may benefit the MSM community by improving healthcare access and decreasing oncogenic HPV infection rates.

References:

[1] Hanley SJB, Yoshioka E, Ito Y, Kishi R. HPV vaccination crisis in Japan. The Lancet. 2015 June 27; 385(9987): 2571. DOI: http://dx.doi.org/10.1016/S0140-6736(15)61152-7

[2] The Public Hearing on Adverse Events following HPV vaccine in Japan [Internet]. Japan: Ministry of Health, Labour and Welfare; 2014 Feb [cited 2016 Sep 10]. Available from: http://www.mhlw.go.jp/stf/shingi/0000048229.html

[3] Margolies L, Goeren B. Anal cancer, HIV, and gay/bisexual men [Internet]. New York: Gay Men's Health Crisis; 2009 Sep [cited 2016 Sep 10]. Available from: http://www.gmhc.org/files/editor/file/ti_0909.pdf

[4] Nomura Y, Poudel KC, Jimba M. Hard-to-reach populations in Japan. Southeast Asian J Trop Med Public Health. 2007 Mar;38(2):325-7.

[5] Hidaka Y, Operario D, Tsuji H, et al. Prevalence of Sexual Victimization and Correlates of Forced Sex in Japanese Men Who Have Sex with Men. Stephenson R, ed. PLoS ONE. 2014;9(5):e95675. doi:10.1371/journal.pone.0095675.

[6] Nagata N, Watanabe K, Nishijima T, Tadokoro K, Watanabe K, Shimbo T, Niikura R, Sekine K, Akiyama J, Teruya K, Gatanaga H, Kikuchi Y, Uemura N, Oka S. Prevalence of Anal Human Papillomavirus Infection and Risk Factors among HIV-positive Patients in Tokyo, Japan. PLoS One. 2015;10(9):e0137434. doi: 10.1371/journal.pone.0137434. PMID: 26368294, PMCID: PMC4569050

[7] Hanley SJ, Yoshioka E, Ito Y, Konno R, Hayashi Y, et al. Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls. Vaccine. 2012 Aug 24;30(39):5740-7. PubMed PMID: 22796375.

Refugee Health in Europe: Who is Responsible?

~Written by Victoria Stanford (Contact: vstanford@hotmail.co.uk)

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Tents below a motorway pass, Piraeus Port, Greece. Photo credit: Victoria Stanford

The number of refugees arriving in Europe continues to rise, despite the EU-Turkey deal struck in March 2016 aimed at halting the numbers of new arrivals. This deal represented one of the first consensual decisions made by the 28 member states of how to respond to the unprecedented refugee crisis in Europe seen over recent years. However, across Europe there remains an overwhelming lack of political effectiveness, or indeed will, to co-ordinate the care of those arriving on the continent. Supranational institutions, European governance bodies, NGOs and humanitarian partners have scrambled in varying degrees of commitment to offer their services to refugees and the impression for many is that they are not achieving enough, quickly enough. But how have the various actors responded to the health needs of the refugees, and who is held accountable for this most basic human necessity?

Arrival versus Settlement

There is a significant difference between the immediate and long-term healthcare needs seen among refugee populations. This protracted crisis must be able to respond to both the immediate and often-life saving measures needed on Greek islands where refugees are still arriving by boat, and the long-term needs of refugees who have settled in host countries, in many cases for months or even years. Understanding this transition between the emergency and post-emergency phase, is essential for planning an effective healthcare response. The needs of those new arrivals mostly consists of sanitation, nutrition, shelter and basic safety provision, whilst those further along the asylum process must be integrated into long-term health systems that provide them with more complex and comprehensive services such as chronic disease management.

 As it stands, the initial needs of refugees arriving to European shores are often provided by humanitarian agencies who are equipped to launch an emergency response, and gradually they hand over this responsibility to the local health care structures. An excellent example of this was seen in Bulgaria when Doctors without Borders provided medical care to over 1500 refugees, allowing the national authorities who have now taken over healthcare service provision in this area, to build capacity and prepare (1). In many places this handover scenario has not been achieved so clearly and in fact often it is best for organisations and local partners to share the healthcare responsibilities. For example in Piraeus port in Athens (now dissolved), NGOs such as Praxis and the Red Cross were stationed within the camp itself and acted as primary care providers to the population on the ground, referring patients who required more specialised care on to state-run and funded hospitals or clinics in Athens. A similar system is currently established between the residents of the Jungle camp in Calais and the PASS clinic (Permanence d'Accès aux Soins de Santé)-provided by the government for refugees and others without social security insurance in France. However the extent to which this collaborative effort is effective depends much on the nature of the healthcare needs required; patients with mental health issues requiring long-term psychological treatment or those with post-surgery rehabilitation needs are often prematurely discharged or simply not offered longstanding care. Logistical difficulties are also often neglected as many appointments and consultations are arranged in neighbouring cities and patients are required to arrange their own transport which for many is an impossibility.  Achieving adequate provision and access in healthcare for refugees is complex and is largely dependent on context, their status in the asylum process and capacities of local health organisations.

The ‘Unofficial’ Refugee

Much complexity has been added to this crisis by the lack of clarity in defining those who are arriving in Europe- undocumented migrants, labour migrants, refugees and asylum seekers are terms often confused and used interchangeably and this has an impact on how these people can interact with official services. As refugees and others spread across Europe, the way in which they settle varies dramatically-there are families living in air-conditioned containers in official UN-led refugee camps, whilst others squat in abandoned buildings in the suburbs of Athens. This undoubtedly leads to much heterogeneity in terms of both their access to and quality of healthcare. Much of the healthcare that refugees living in official camps receive is provided by large, international NGOs such as Doctors without Borders (MSF) or the Red Cross. These organisations provide high-standard medical and nursing care, including psychological support in many cases, and also organise public health services such as child immunisations. As priority for official camp accommodation is usually given to families with children or vulnerable people with either chronic diseases or disabilities, providing comprehensive healthcare services to these populations is even more imperative. What this means however, is that resources are stretched thin and those refugees who are either in transit or living in unofficial areas often receive a lower quality or even a complete lack of healthcare.

The legal status of a refugee can also be a barrier to seeking healthcare, particularly in the few chaotic months after arrival in Europe. Many do not fully understand their legal rights or how to access healthcare in host countries; this is particularly problematic for those who are not settled immediately into official camps, instead attempting to cross international borders or avoid registration for fear of the barriers this may pose to freedom of movement (2). This means many do not receive their healthcare entitlements and depend on the ad-hoc and inconsistent presence of healthcare-providing groups often from outside any official aid delivery process.

The ‘unofficial’ refugee population is in fact where the grassroots organisations have trumped more established humanitarian groups. Countless groups have been set up in recent years by concerned citizens across Europe and have provided the in-the-field manpower that many official partners have failed to do. Groups such as Drop in the Ocean, Care 4 Calais, Help Refugees and many others have integrated into the ‘official’ aid delivery system and have in many cases outpaced those organisations who are often restricted by mandates or internal bureaucracy.  These groups offer assistance that is not always recorded on health surveillance statistics or official reports but in fact they are in many cases acting as primary carers. As healthcare itself is not the only way of keeping refugees healthy, these groups who attend to other needs such as shelter and food provision, hygiene, childcare and education may actually be having a significant impact on the refugee population’s health (3).

What about the Supranationals?

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Red Cross Measles Vaccination Campaign, Scaramangas Camp, Athens. Photo credit: Victoria Stanford

Under the 1951 Refugee Convention, refugees should enjoy access to health services equivalent to the host population, and institutions such as the World Health Organisation (WHO) and the Office of the United Nations High Commissioner for Refugees (UNHCR) are tasked with upholding these rights under the UN Charter (4). It is increasingly clear that Europe is struggling to deal with the crisis and the UN has put pressure on European governance bodies to establish a comprehensive, mutually-agreed response plan to address the health needs of the refugee populations. This has achieved some success particularly in communicable disease control with large-scale vaccination programmes used in camps and non-camp settings alike (5) (see photo).

 However, the long-term nature of this crisis will require more of a focus on capacity-building of existing healthcare structures in host countries. For this reason, the WHO has performed a number of Assessment missions in countries receiving the most footfall of refugee movement including Cyprus, Greece, Italy and others, providing countries with context-specific information and guidance on responding to the health needs of refugees either temporarily or permanently settling in these countries (6). These analyses of the current preparedness of national health structures have helped to pinpoint where increased funding or skills are needed to boost local response; the European Commission have subsequently invested over 5 million euros on projects with the aim of “supporting member states under particular migratory pressure in their response to health-related challenges” (7). Crucially, these projects integrate NGOs with national structures, bridging the gap between short and long-term response, and focus on fostering comprehensive access to all aspects of the health system, not only emergency care. One of these projects also places a particular focus on the health needs of pregnant women, unaccompanied minors and young children, highlighting a concern for the most vulnerable populations in this crisis (7). However, whilst these projects are theoretical problem-solvers, there is a gap between plan and action. Many projects will take years to see results and whilst they do, countries such as Greece are reliant on existing health care systems, which have been struggling for years to cope with both the steady influx of refugees over many years and domestic austerity policies (8).

The bottom line is that funded and elected institutions such as the UN are mandated to protect the rights of refugees and these include access to healthcare. This situation sees the heavily bureaucratised system overloaded and rendered flimsy by the sheer volume of refugees depending on it, not only in Europe. This has meant that other humanitarian partners and grassroots movements have stepped in and provided invaluable assistance on the ground. The provision of healthcare to refugees in Europe largely depends on capacity and it is clear that there must be far-reaching plans made to build on both national and international health system structures. Whether these plans will materialise into effective action that both prevents ill health and treats disease remains to be seen as the crisis, without long-term solutions, inevitably continues. 

References:

(1)   MSF (2016) Bulgaria: providing healthcare to Syrian refugees [Online] Available at: http://www.msf.org.uk/article/bulgaria-providing-healthcare-syrian-refugees [Accessed August 2016)

(2)   Global Health Watch (2015) Migrants and asylum seekers; the healthcare sector, London, Page 63.

(3)   Kuepper, M (2016) Does Germany need to rethink its policies on refugees? Researchgate.net [Online] Available at: https://www.researchgate.net/blog/post/does-germany-need-to-rethink-its-policies-on-healthcare-for-refugees [Accessed August 2016]

(4)   UNHCR; Health (2016) [Online] Available at: http://www.unhcr.org/uk/health.html [Accessed August 2016]

(5)   UN News Centre (2015) UN seeks common European strategy on healthcare for refugee and migrant influx [Online] Available at: http://www.un.org/apps/news/story.asp?NewsID=52630#.V7DT6_krK01 [Accessed August 2016]

(6)   WHO (2015) Stepping up action on migrant and refugee health [Online] Available at: http://www.euro.who.int/en/countries/greece/news/news/2015/06/stepping-up-action-on-migrant-and-refugee-health [Accessed August 2016]

(7)   European Commission Health Programme (2015) Health projects to support member states, Geneva.

(8)   Chrisafis, A (2015) Greek debt crisis: of all the damage, healthcare has been hit the worst, The Guardian, 9 July 2015 [Online] Available at: https://www.theguardian.com/world/2015/jul/09/greek-debt-crisis-damage-healthcare-hospital-austerity [Accessed August 2016]

Lessons Learned from Ebola

~Written by Kelly Ann Hanzlik (Contact: kelly_hanzlik@hotmail.com)

According to the World Health Organization, 28,616 people contracted Ebola and 11,310 lives were lost during the Ebola epidemic. After so many lives lost and the hopeful, but understandably tentative countdown of Ebola free days continues once again in West Africa, it is imperative that we take a moment to consider what we learned from the devastating and tragic epidemic.

I spoke with Dr. Ali S. Khan, former senior administrator for the Centers for Disease Control and Prevention, former Assistant Surgeon General, and current Dean of the University Of Nebraska College Of Public Health. He noted initially, that there is always the risk of importation of cases; that is how it started he reminds us. He elaborated further that the epidemic “changed the response from the WHO and caused a change in political focus by the nations involved that will affect future outbreaks and ensure native capabilities, as well as link them to the global response.” He also noted that new medical counter measures, such as vaccines and related therapeutics, were also the result of the Ebola impact. When asked about what we learned, he did not hesitate. “The first thing was a new vaccine that permits a novel prevention strategy using ring vaccination to prevent spread and new cases. The second is the new monoclonals and antivirals for treatment.” He also noted the better understanding of the viral progression and clinical diseases that will influence options for acute treatment and follow up of convalescents.

Ebola has provided us with a virtual plethora of opportunities to learn about the disease, its treatment and control, as well as the control of other infectious illnesses through our attempts to prevent its spread as well as through our failures, and successes. We gained valuable treatment modalities and tactics that will likely be used in future outbreaks of Ebola, as well as many other infectious diseases.

Ebola taught us other things too. It has been some time since global health has taken center stage. Ebola changed that. During the epidemic, one could not watch the news or go through a day without hearing an update on the latest development in the Ebola crisis. Although other infectious diseases like Plague, Polio, AIDS, SARS, H1N1, Cholera, and now Zika have captured the world’s attention, few diseases have made such an intense impact, nor caused the uproar and fervor that Ebola elicited. Ebola reminded us that global health is public health and affects us all, and as such, deserves to be a priority for national and international focus and funding for everything from vaccine development and research, to capacity for response locally, nationally, and internationally. Global health has teetered on the edge of public awareness, and remained a quiet player in the competition of priorities in national budgets. Today, it is abundantly clear how vital this sector is to each nation’s, as well as the world’s health, safety, success and even its survival.

Another effect from the Ebola crisis was the opportunity to educate people about public health and the transmission of infectious disease. Through education, public health officials were able to promote behaviors that ensured the safety and health of the public. It is stunning that in this day and age, we persist in so many behaviors that put us and those we interact with at risk. The discrepancy in what we say we will do, and what we are actually willing to commit to and take action on, looms large. Persisting low vaccination rates and the prevalence of infectious diseases such as sexually transmitted diseases, measles, pertussis and influenza show this. Ebola offers yet another opportunity to demonstrate the connection between our behaviors and our risks and disease.

Ebola also showed us that many nations continue to lack sufficient financing, infrastructure, facilities, support and medical staff to treat their own populations. Endemic conditions like malaria, and neglected tropical diseases like Guinea worm disease, Yaws, Leishmaniasis, Filariasis, and Helminths, as well as other conditions continue to affect millions globally.  Maternal and childhood morbidity and mortality rates remain deplorable as well. And millions of children around the world continue to suffer and die of malnutrition and disease before they reach the age of five. This is unacceptable, especially because proper treatment and cures for these conditions exist. Ebola also highlighted the need for treatments for chronic non-infectious conditions as well.

Moreover, Ebola clearly demonstrated the enormous need that remains for sufficiently trained medical professionals and healthcare staff to provide adequate care for many populations throughout the world. The loss of so many extraordinary and heroic staff that dedicated their lives to helping others in need under the most daunting and challenging of circumstances was devastating to those whom they served, and must not be in vain.

Additionally, Ebola provided us with yet another chance to relearn lessons about the role of safety in giving aid to others in need. We learned that we cannot just rush in with aid, but must recall the basics that every first responder and medical student must learn:  Ensure scene safety before giving care, and first do no harm. Ebola showed us the necessity to strategize and prepare to give care by utilizing personal protective equipment. It also reminded us very quickly that we could indeed do harm, and worsen the epidemic when we acted without first assessing the situation and ensuring proper protection and preparation.

So, it remains to be seen just how much we will learn from Ebola. Will we learn from our mistakes? Will we take the global view in the future, or the narrow one? Will we truly live by the motto of the Three Musketeers and be "one for all and all for one", or persist in "it's all about me"? Only time will tell. 

Is Measles Eradication Possible when the World is Still Trying to Eradicate Polio?

~Written by Theresa Majeski (Contact: theresa.majeski@gmail.com)

Also published on Global Contagions

Humanity has only truly conquered one human infectious disease, smallpox. Smallpox was successfully eradicated in 1977 after causing between 100 and 300 million deaths in the 20th century. Strides are being made to make polio the second eradicated infectious disease. Polio eradication efforts have been ongoing for almost 30 years, costing nearly 11 billion dollars. The World Health Organization (WHO) set a goal for polio eradication by 2000 but, 16 years later, that goal has yet to be achieved for reasons such as oral polio vaccine (OPV) effectiveness, armed conflict, and myths about vaccine dangers. The global public health community has been “burned” by the polio eradication campaign and may not have the money or energy for another global eradication campaign, especially since the polio campaign is still ongoing. Even if the global health community is burnt out on polio eradication efforts, is it time to turn our attention toward measles eradication?

Measles, along with smallpox and polio, is one of the very few diseases that meets the criteria necessary for eradication. Measles cases can be easily diagnosed due to the characteristic rash, the vaccine is incredibly effective, and there is no animal host where the virus can hide. Perhaps most importantly, measles transmission has been eliminated in large geographic areas, demonstrating that eradication may be feasible.

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Number of reported measles cases from April 2015 to September 2015 (6 months); Photo Credit: World Health Organization

Measles is a deadly disease. In 2013, measles killed an estimated 145,000 people, mostly children in Africa, while leaving countless others deaf, blind, or otherwise disabled. To prevent measles individuals need to receive two vaccinations, which are 99% effective at preventing measles. While the number of children receiving measles vaccinations has risen over the past decade, there are still a handful of countries where children aren’t receiving vaccines (Democratic Republic of Congo, Ethiopia, Nigeria, India, Pakistan). Even places like the United States and some countries in Europe, which have eliminated measles locally, are seeing outbreaks due to imported cases. Until measles is eradicated, imported cases will continue to pop-up in countries without local transmission.

While measles meets the criteria for eradication efforts, there are still challenges to achieving that goal. One major challenge is that measles is incredibly contagious; infectious droplets can linger in the air for up to two hours, infecting unsuspecting people. To interrupt measles transmission, over 95% of the population needs to be vaccinated, compared to only 80% for smallpox and polio. The measles vaccine is also harder to deliver than the OPV, which is administered via a few drops in a child’s mouth. The measles vaccine must be given via injection, thus trained staff is necessary, and the vaccine has to be reconstituted in the field (liquid added to the powder vaccine to make the complete vaccine). Once reconstituted, the vaccine is only viable for six hours, which isn’t much of an issue for large vaccination campaigns but becomes problematic when only one or two children need to be vaccinated.

As with many global public health campaigns, governments and non-governmental organizations donate money to help high-risk countries control the spread of measles. In 2009, the global recession hit and measles eradication efforts lost significant funding. Mass vaccination campaigns were canceled or reduced and routine vaccination programs suffered. Following the reduction in vaccinations the number of measles cases exploded in southern African countries, going from 170,000 in 2008 to 200,000 in 2011. Added to these challenges is the perception of measles in high-income countries. Even though measles is a deadly disease, many in high income countries view measles as a minor illness with  a rash and fever; certainly not something worth spending billions of dollars on over the course of many years.

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Source: Butler D (2015). Measles by the numbers: A race to eradication. Nature 518 (7538): 148-149. doi: 10.1038/518148a.

Measles eradication is feasible. Measles meets the criteria necessary for eradication; it is easily diagnosed, it has an effective vaccine, and humans are the only host. It has been successfully eliminated in large areas of the world (for example, all 35 countries of the Americas eliminated measles in 2002), demonstrating that it is possible to at least end local transmission. However, significant challenges do exist. While the global health world may be hesitant to embark on another “eradication” campaign after the continued struggle with eradicating polio, perhaps it’s best to start eradicating measles without labeling it an “eradication” campaign. Avoiding the “eradication” label may help prevent critics who are hesitant about taking on another potentially long and expensive eradication campaign, especially as the polio eradication campaign is still ongoing. Regardless of the use of the word “eradication” in the efforts to rid the world of measles, without measles in the world, lives will be saved. Let’s ensure measles is added to the very short list of human diseases we’ve eradicated.

Part I- To Get Inspired, Build Empathy into Your Project Plan

~Written by Lauren Spigel, Monitoring and Evaluation Coordinator (Contact: lauren.spigel@vaxtrac.com; Twitter: @vaxtrac)

Also published on VaxTrac blog

Build Empathy First
In our first blog post about human centered design, we talked about building empathy for design thinking. But what does “empathy” really mean, and how does it translate into research methodology?

To have empathy is to understand another’s perspective. If your goal is to build empathy with the community you’re designing for, it’s important to budget time, space and resources to talk to a variety of project stakeholders about the challenge you’d like to solve before the project starts. While it’s difficult to convince donors to spend money on an extended R&D phase, giving communities a voice at the onset of your project can save your organization time and money by allowing stakeholders to voice their opinions and be active participants in the design process.

The methods we use to build empathy are reminiscent of the research methods found in academic settings. Human centered design is especially akin to the philosophy of community based participatory research (CBPR), which also recognizes that when given a voice, communities are best equipped to identify sustainable solutions to challenges they face. Like CBPR and more traditional qualitative research methods, human centered design relies on interviews, focus groups, observations, surveys, card sorts, among other interactive methods, such as role plays, immersion and community mapping to elicit feedback from stakeholders.

Let’s dive into the case example of how we are building empathy with health workers in Nepal to improve our user interface and workflow.

The Problem
The clinics we work with in Nepal are fundamentally different than the clinics we work with in Benin. In Benin, the clinics are urban and busy. There are vaccination sessions almost every day. Caregivers bring their children to the clinics for vaccinations.

By contrast, the clinics we work with in Nepal are rural. The population is dispersed. As a result, vaccinations only happen a few days a month. There may be one or two sessions that take place at the main clinic, but there are usually also a number of outreach sessions, in which the health workers walk several hours to sub-health posts within their catchment areas. Since the population is small, only a few children come to each session.

Building Empathy through Brainstorming and Workflow Cards
There are a number of methods we could use to get into the mindset of the health worker. The key is to remember that health workers are the experts. They understand their job better than anyone else. Our job is to listen, build empathy for what they experience in their jobs and translate that into our software design.

We are starting with the goal of understanding health workers’ workflows in different situations. In other words, what do health workers do to prepare for a vaccination session? What happens during a session? What happens after?

Our DC-based team started by brainstorming objects, people and actions involved in a vaccination session. We scoured the internet for images to represent everything that we came up with. We put together sample workflow cards and brought it to our project partners in Nepal.

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Draft Workflow Cards (Source: vaxtrac.com)

Seeing the sample workflow cards inspired our in-country partners Amakomaya to continue the brainstorm. They looked at our cards and told us what images worked and which images did not convey the right meaning. They grabbed a marker and started brainstorming their own list. We sketched images together.

We designed an interactive activity with health workers to use the workflow cards to get a better understanding of the different workflows they use during vaccination sessions. We are currently working to add Amakomaya’s feedback into an updated version of the workflow cards, which we will test out with a group of health workers early this year.
Using cards with simple images on them is a great way to get health workers talking about how they do their work. Cards are tangible objects that health workers can put in their hands and arrange in different ways. It gives the group a visual to refer to when someone has a question. It allows our team and health workers to identify gaps in the work flow as well as pain points.

We hope that by understanding current workflows and processes, we can understand the challenges that health workers face in their daily jobs and iterate our software so that it improves their workflow.

Check out our next post in our series about human centered design next week, where we’ll give examples of how we’ve been prototyping a monitoring and evaluation dashboard with our team in Benin.
________________________________________

To learn more about incorporating design thinking into your projects, contact Lauren at lauren.spigel@vaxtrac.com or check out IDEO’s resources

World Hepatitis Day 2015 - Focusing on Prevention

~Written by Theresa Majesty (Contact: theresa.majeski@gmail.com; Twitter: @theresamajeski)

The World Health Organization (WHO) states that approximately 1.5 million people die each year from the various types of hepatitis caused by hepatitis viruses A, B, C, D, and E. It is estimated that half a billion people worldwide are infected with hepatitis B or C virus, the strains responsible for the majority of cases of liver cirrhosis and liver cancer.

In order to bring attention to the large global burden of disease caused by viral hepatitis, 2015’s World Hepatitis Day is July 28th. This date was chosen to honor the birthday of Nobel Laureate Professor Baruch Samuel Blumberg who discovered the hepatitis B virus and developed the first hepatitis B vaccine. This year the emphasis is on prevention, with the slogan “Prevent hepatitis. Act now.”

We can prevent hepatitis by providing safe food and water (hepatitis A and E), vaccines (hepatitis A, B, and E), screening blood donations and providing proper equipment to maintain infection control (hepatitis B and C). While hepatitis B and C can be treated, many people in low- and middle- income countries lack access to treatment due to a lack of screening and the high cost of treatment. Until screening and treatment options become more accessible and affordable, prevention messages are incredibly important.

To help people learn how to prevent hepatitis, the WHO World Hepatitis Day 2015 campaign focuses on four key prevention messages:

1. Prevent hepatitis - know the risks
2. Prevent hepatitis – demand safe injections
3. Prevent hepatitis – vaccinate children
4. Prevent hepatitis – get tested, seek treatment

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Figure 1: A poster from World Hepatitis Alliance. 

If you’d like to get involved in raising awareness about hepatitis, please visit worldhepatitisday.org. There you’ll find some ideas on how to get involved, information on what social media campaigns have been formed, and materials to share to help spread the word that hepatitis is preventable.

The future of the fight against hepatitis looks promising. WHO has been increasing its efforts to fight hepatitis by establishing the Global Hepatitis Programme in 2011, and in 2014 moved that program to the cluster of HIV/AIDS, Tuberculosis, Malaria, and Neglected Tropical Diseases to help facilitate work between HIV/AIDS and hepatitis programs (due to the high number of people around the world living with both HIV and viral hepatitis). Furthermore, WHO, in conjunction with the Scottish Government and the World Hepatitis Alliance, is organizing the first ever World Hepatitis Summit in Glasgow, Scotland over 2-4 September 2015. This invite-only summit will bring together policy makers, patients, and other key stakeholders to determine how best to make lasting progress to reduce the global burden of hepatitis.

There is still progress to be made by the global community in order to win the fight against hepatitis. Key efforts, such as establishing events to publicize the global burden of viral hepatitis and holding summits to bring together the stakeholders that can make a difference, are contributing to saving lives in the fight against viral hepatitis.

Review of Unite for Site Global Health and Innovation Conference 2015

~Written by Sarah Weber (Contact: sarahkweber@gmail.com)

I attended the Unite for Site Global Health and Innovation Conference last weekend which brought together over 2,000 global health and international development professionals, social entrepreneurs and students to exchange ideas and leading practices. One of the best parts of the conference was meeting committed global health professionals with the bonus of connecting with other TWiGH team members and viewers. The conference was held at Yale and participants had the opportunity to enjoy the quaint city of New Haven as well as the snow that fell throughout Saturday. The conference was similar to many other global health conferences I’ve attended but had a unique feel due to its social innovation edge and opportunity to hear from social entrepreneurs competing for the J.M.K. Innovation Prize. The innovation prize was established by the J.M. Kaplan Fund to provide grants to emerging social sector innovations.  

The conference had some very engaging and high profile speakers. I thoroughly enjoyed listening to the key-note address by the Honorable Minister of Health of Rwanda, Agnes Binagwaho, MD. She is an energetic women who isn’t afraid to speak her mind, even on controversial topics. She spoke about how Rwanda has greatly decreased its AIDS deaths, which is the fastest decrease ever in the world. She stressed how imperative it is that women have the choice for family planning since “There is no woman crazy enough to say, I want a baby every year”. She spoke about the need to meet people where they are and to move where you are needed most (rather than nice areas with beaches or better amenities). When asked what she would do if she were the Health Minister of the United States, she said she would put parents who refused to vaccinate their children on trial! Lastly, she urged us to work together and unite since “We live in one world, not three.”

Another engaging speaker was Cal Bruns, CEO/Chief Creative Incubationist at Matchboxology who presented on “What Condom Manufacturers Could Learn from Car Designers.” He spoke about a fact that car manufacturers learned long ago, that people are more motivated to purchase a product with a benefit that they want, rather than a product to prevent something they don’t want. He proposed that the condom companies should work on creating condoms with advanced technology such as stimulating beads on the inside of the condom to increase pleasure. Then men would be motivated to use condoms for the increased sensation which would as a by-product help reduce STIs and unwanted pregnancy. It was a different look on condom promotion than I’d heard before, but totally made sense.

The Social Impact Labs, which was the catalysis feature of the conference, brought together social entrepreneurs to pitch presentations about new innovations in front of a panel of judges and the audience in competition for the innovation prize. The innovation pitches ranged from nascent ideas, grassroots projects, to initiatives already underway being backed by large public health NGOs, universities and/or private companies. We heard about innovations ranging from a sex education program in Kenya teaching farmers to spread HIV prevention messages, a movement to create greenhouses in inner-city Baltimore to bring fresh produce to areas lacking produce options, to a project that creates wells to provide safe drinking water at a low cost to prevent arsenic poisoning in Bangladesh. The winning innovation was presented by Lucy Topaloff with a company called Miraclefeet which provides high quality, low cost braces for patients with Clubfoot in India. Miraclefeet won $10,000 which will be used to help provide braces to 40+ children. 

Overall it was a motivating and encouraging weekend. It’s always great to meet other public health professionals passionate about improving health and opportunities for disadvantaged populations globally. Listening to all the enthusiastic and motivated young people during the social innovation pitches drove home the idea that: great ideas + passion + commitment = opportunities. These individuals, in collaboration with their networks and connections, are turning ideas into solutions to help the less advantaged. That is inspiring!