Infectious Diseases

Climate Change, Infectious Diseases, Poverty, Research, Disease Outbreak

Climate Change and Health, Part 3: Infectious Disease

~Written by Joann Varickanickal (Contact:

This is my final post of a three part series on climate change and health. The first post looked at how climate change will influence the onset and severity of droughts in some areas. The second post examined how some regions are predicted to see an increase in droughts, which would decrease food supply; thus, increasing nutrient deficiencies in those areas. This post will briefly discuss the influence of climate change on waterborne diseases.

Change in climate, including the increases in temperature and changes in rainfall patterns may lead to an increase in waterborne diseases, where insect vectors contaminate the water (Shuman, 2010). Often, higher temperatures are needed for some insects to complete their life cycle. This is the case for mosquitoes, as they live in warm, aquatic habitats (Shuman, 2010). With an increase in temperature and more flooding, there will be an increase in mosquitoes (Shuman, 2010). Thus, there may be an increase in the transfer of dengue and malaria (Ramasamy & Surendran, 2011). These warm, aquatic habitats will also be ideal for snails, which transfer schistomiasis (Ramasamy & Surendran, 2011). Furthermore, with a rise in sea levels, there is likely to be an increase in saline levels (Ramasamy & Surendran, 2011). Certain types of mosquitoes and snails have a high tolerance for salt water and are thus able to breed in water with high salt concentrations (Ramasamy & Surendran, 2011).

Taken from: Watts N, Adger W N, Agnolucci P, Blackstock J, Byass, P, Cai W, Costello A (2015). Health and climate change: policy responses to protect public health. The Lancet, 6736(15)

The relationship between climate change and health is complex because there are many different contributing factors and there is limited scientific evidence for many regions, several of which are under-resourced (New York Times, 2015). Furthermore, areas of high-resource have not been impacted in the same way, due to advantages as simple as air conditioning (New York Times, 2015). Thus, more scientific evidence is needed, to determine more ways in which climate change could possibly influence the health of a population. More recognition also needs to be given to this issue so that contingency plans can be made for possible outbreaks of diseases that were discussed in this blog post.


Shuman, E. K. (2010). Global Climate Change and Infectious Diseases. The New England Journal of Medicine , 362 (12), 1061-1063.

Ramasamy, R., & Surendran, S. (2011). Possible impact of rising sea levels on vector-borne infectious diseases. BMC Infectious Diseases , 11 (18).

Tavernise, S. (2015, July 13). Unraveling the Relationship Between Climate Change and Health. Retrieved September 10, 2015, from

Global Health Conferences, Infectious Diseases

The World Hepatitis Summit 2015

~Written by Caity Jackson (Contact:

The World Hepatitis Alliance team members. Photo Credit: Caity Jackson

Today, viral hepatitis kills more people than HIV/AIDS, tuberculosis, or malaria and has become the 7th major cause of death globally. Despite this, hepatitis has not received the same global attention as the other illnesses it shares the Top 10 global killer list with. The President of the World Hepatitis Alliance Charles Gore noted in his plenary speech ‘‘we felt honestly, neglected.” Neglected they are not today.

Walking into the Scottish Exhibition and Conference Center (SECC), one could feel the energy and urgency in the crowd. The first ever World Hepatitis Summit brought together a group of patients, NGOs, academics, and government officials that have long awaited their time in the spotlight. The Summit’s three-day meeting came in response to last year’s World Health Assembly Resolution calling for concerted action to reverse the ever-rising death toll from viral hepatitis. It serves as the beginning of a series of summits focusing on information sharing and “how we can scale up and not waste the precious resources we know are limited” said Gore. Those at the summit are passionately working towards increasing awareness about viral hepatitis, focusing on the draft WHO Global Health Sector Strategy on Viral Hepatitis which aims to reduce new cases of chronic hepatitis B and C by 90%, reduce hepatitis B and C deaths by 65%, and treat 80% of eligible persons with chronic hepatitis B and C infections by 2030.

Because viral hepatitis has been neglected for so long (viral hepatitis was not included in the Millennium Development Goals) much needs to be done rapidly to make up for lost time. In that context, the Summit, intended as an annual event, will focus on the public health approach to viral hepatitis and become the central forum for countries to share their experience and best practices in order to drive rapid advances in national responses. The inaugural World Hepatitis Summit made history; an effort everyone hopes will lead to reducing the burden on those afflicted by viral hepatitis.

For the full press release please visit the WHO Media centre

For another perspective, please visit the BioMed Central Blog

Children, Government Policy, Health Systems, Infectious Diseases, Vaccination, Poverty

Life after Polio: Towards Improving the Situation of Polio Survivors

~Written by Hussain Zandam (Contact:, twitter: @zandamatique)

A woman paralyzed by polio, Rotary International (2010)

A woman paralyzed by polio, Rotary International (2010)

here is a surge of excitement among international development communities and global health partners as the World Health Organization announced that the battle against polio is gradually coming to an end (WHO, 2013). The Global Polio Eradication Initiative (GPEI) has set out a new strategy (Eradication and Endgame Strategic Plan), which hopefully will be the final onslaught that will result in a global certificate eradication of the disease by 2018 (GPEI, 2013). The eradication will be a significant victory for the global population, as future generations will also be saved from polio's devastating toll of death, morbidity, and disability.

Map of the world comparing countries with polio cases in 1988 and 2014. Centers for Disease Control and Prevention, CDC (2014).

Map of the world comparing countries with polio cases in 1988 and 2014. Centers for Disease Control and Prevention, CDC (2014).

While a vast amount of resources has been disbursed to prevent polio since 1952, inadequate attention has been devoted to understanding the devastations left behind in the lives and households of polio survivors. The damage is more severe in those permanently disabled by the disease and those recently identified with post-polio syndrome (PPS). Post-polio syndrome is characterized by a renewal or new experience of polio symptoms including disability and functional deterioration after years of recovery and functional stability. PPS usually occurs 30-40 years after original infection and affects about 40% of polio survivors including those who developed permanent disability and those who recover from initial affectation with no or few symptoms (Lin and Lim, 2005). 

Although the situation of polio survivors in high-income countries is relatively well documented, there is a dearth of information in low and middle-income countries. This has profound political, economic and social implications for local, national and international policy-making. While the number of individuals disabled by polio will begin to disappear in the next few decades in the developed world, those in the developing world will continue to be a major concern for at least another generation (Gonzalez et al., 2010). And as the population of younger polio survivors reaches middle and old age, a new wave of individuals with PPS will begin to make additional demands on developing countries’ health systems.

Generally, individuals disabled through polio confront not only a range of physical disabilities but also significant social, financial and human rights barriers hindering integration and participation in families and communities. These barriers in turn, lead to chronic ill-health, social marginalization, limited access to education and employment, and high rates of poverty (Groce et al, 2011). Women are impacted disproportionately, as are individuals from poorer households, minority communities and from rural and urban slum areas (WHO/World Bank, 2011). 

To design effective programs and policies that improve life course outcomes for polio survivors, more research is essential. To begin, more accurate estimates of regional prevalence of polio survivors and the degree of residual disability sustained will be useful for efficient planning and appropriate resource allocation. In particular, addressing the stigma and prejudice encountered by persons disabled by polio must be part of long-term strategies to address the needs of people living with PPS and must be linked to broader efforts to confront disability and stigma faced by all people with disabilities. Ratification by countries of the Convention on the Rights of Persons with Disabilities (CRPD) and progressive national legislation are not enough - inclusion of polio survivors in community awareness campaigns and increased support by DPOs is also needed. And given the disproportionate impact of polio on women, DPOs must pay particular attention to gender sensitive research.



Global Polio Eradication Initiative, 2013. Polio Eradication and Endgame Strategic Plan: 2013e2018.

Groce, N., Kett, M., Lang, R., Trani, J.F., 2011. Disability and poverty: the need for a more nuanced understanding of implications for development policy and practice. Third World Quarterly 32 (8), 1493e1513.

Gonzalez, H., Olsson, T., Borg, K., 2010. Management of postpolio syndrome. The Lancet Neurology 9 (6), 634e642.

Lin, K.H., Lim, Y.W., 2005. Post-poliomyelitis syndrome: case report and review of the literature. Annals-academy of MEDICINE SINGAPORE 34 (7), 447

WHO, 2013. Poliomyelitis. Fact Sheet No. 114. WHO, Geneva. mediacentre/factsheets/fs114/en/index.html (accessed 11.08.15.).

WHO/World Bank, 2011. World Report on Disability. WHO, Geneva. http://www. (accessed 12.08.15.).

Infectious Diseases, Vaccination

Polio Eradication: How Close are We?

~Written by Theresa Majeski (Contact:, twitter: @theresamajeski)

Polio may become the second viral human disease (following smallpox) ever eradicated from this planet. Like smallpox, polio can be prevented with vaccination and, perhaps most importantly, polio relies solely on person-to-person transmission for survival. This means that polio does not require any vectors like mosquitos or snails for its life cycle, so humans are the only ones infected by poliovirus. Polio is usually spread through a fecal-oral route, meaning that the virus is in the stool of an infected person and could come in contact with the mouth of an uninfected person through contaminated foods, hands, utensils, etc. If we can interrupt transmission through vaccination, poliovirus will be unable to find someone unimmunized to infect and will be eradicated.

Polio has a long history within the human population. Only sixty years ago, polio was a feared disease in the United States. Summer time brought with it polio season and public facilities such as swimming pools were shut down. This reaction was not unwarranted. In 1952 almost 600,000 children were infected with the virus. More than 3,000 died and thousands were paralyzed. Iron lungs were used to keep children alive as the paralysis left them unable to breathe on their own.

Photo of children in iron lungs. Photo courtesy of the National Museum of Health and Medicine. 

Photo of children in iron lungs. Photo courtesy of the National Museum of Health and Medicine. 

President Franklin D. Roosevelt contracted polio as an adult, years before taking office. He made fighting polio a national priority and established the March of Dimes to encourage everyday citizens to fund polio research. Jonas Salk created the first polio vaccine, approved in 1955; Alfred Sabin created a second polio vaccine, approved in 1963. Through the use of these two vaccines, the United States was able to eradicate polio by 1979.

Despite this, it wasn’t until the 1970’s that polio was recognized as a serious problem in developing countries. Once polio was identified as being prevalent in developing countries, routine immunization campaigns were implemented worldwide which helped bring polio under control in many countries. In 1988, when the Global Polio Eradication Initiative began, more than 1000 children worldwide were paralyzed by polio every day. Since then, the global incidence of polio has decreased by 99 percent.

Countries that have achieved elimination have not done so without challenges. The two polio vaccines have benefits and drawbacks. The Salk vaccine, also called the inactivated polio vaccine (IPV), contains chemically inactivated polio virus. It stimulates a strong systemic immune response but because it is an injection, it does not cause a strong mucosal immunity. Without a strong mucosal immune response poliovirus can replicate in the intestines of immunized people without causing symptoms and can then be contagious. On the other hand, the Sabin vaccine, also called the oral polio vaccine (OPV), is a live-attenuated vaccine. This means that the vaccine contains live, weakened poliovirus. The Sabin vaccine is given orally so it stimulates mucosal immunity and systemic immunity. However, because it is a live vaccine, it can revert to a virulent form and cause vaccine-derived polio infection. The Sabin vaccine is easier to administer because it doesn’t require syringes, and it provides longer immunity than the Salk vaccine, however, it requires strict transport conditions because it is live. The World Health Organization is advocating for countries to move towards the IPV and phase out use of the OPV, to help prevent vaccine-derived polio cases. The Global Alliance for Vaccines (GAVI) recently announced that they will be helping Pakistan introduce the IPV as part of the Polio Eradication and Endgame Strategic Plan 2013-2018.

Currently, polio is endemic in only three countries: Nigeria, Pakistan and Afghanistan. In order for a country to be declared free of polio, three years must pass without a case of endemic (wild type) polio. Nigeria achieved one year without an endemic polio case on 24 July 2015. This means that only two more years remain before the African continent may be declared polio-free. India was removed from the list of polio-endemic countries in 2012, and in 2014 India achieved polio-free status. India, long considered the country facing the greatest challenges to eradication, demonstrates that global eradication is possible. However, some countries that had achieved elimination are experiencing outbreaks of polio, partly due to political instability, which has impacted vaccination rates. For example, Syria was polio free from 1999 to October 2013 when imported cases of polio closely related to strains circulating in Pakistan were confirmed in Deir ex-Zor and Aleppo. This demonstrates the importance of maintaining a high vaccination rate in every country until the disease is eradicated. 

Current polio distribution around the world. Graphic courtesy of Global Polio Eradication Initiative. 

Current polio distribution around the world. Graphic courtesy of Global Polio Eradication Initiative. 

Achieving eradication through eliminating polio in the last few countries will not be easy. The areas with endemic polio transmission face several challenges including conflict and political instability, hard-to-reach populations, and poor infrastructure. Furthermore, community workers trying to administer polio vaccine are being attacked by groups who oppose polio vaccination. The CIA providing vaccinations as a cover for searching for Osama bin Laden certainly eroded trust between health workers administering vaccines and community members, making poliovirus vaccination campaigns that much harder. However, focusing on strengthening all routine immunization delivery, helping locals take ownership of polio eradication in their communities, working directly with community members and leaders, and building trust by keeping a lower profile on international deadlines may help overcome the remaining challenges.

Humanity is on the cusp of another great infectious disease achievement, eradicating polio by 2018. Polio eradication is achievable; however continued focus and resources are required to interrupt transmission in the hardest to reach places. Eradicating polio will save many lives and prevent countless children from paralysis; a goal that can be achieved in our lifetime.

Disease Outbreak, Economic Burden, Government Policy, Healthcare Workforce, Health Systems, Infectious Diseases

Lessons, Impact, and the 'Fearonomics' of the Ebola Outbreak in Nigeria

~Written by Sulzhan Bali, PhD (Contact:

Also published on the DGHI Diaries From the Field Blog

Passport Sticker with Ebola Symptoms and National Helpline. Photo Credit: Sulzhan Bali, PhD

24th of July.

The day Macchu Picchu was discovered in 1911.

The day Apollo XI returned to the Earth after the first successful mission of taking humans to the moon in 1969. 

Yet, in Nigeria, that day in 2014 will always be marked as the day Patrick Sawyer—the index patient of Ebola—died and set an outbreak in motion in one of the most populated cities in Africa. Patrick Sawyer was a Liberian-American citizen and a diplomat who violated his Ebola quarantine to travel to Nigeria for an ECOWAS convention. His collapse at the airport, coupled with an ongoing strike by Nigerian doctors in public hospitals, landed him at a private hospital in Obalende, where he infected eight other people. 

Patrick Sawyer’s death marked the beginning of an Ebola epidemic in Lagos, a city of 21 million. Lagos is a major economic hub in Africa and one of its biggest cities. An uncontrolled Ebola epidemic would have a far-reaching economic impact beyond the borders of the city, its country, and even its continent.

A recent study has shown that Ebola virus remains active in a dead body for more than a week. Add to this that the body is most infectious in the hours before death, and it is a "virus bomb" waiting to happen if handled incorrectly. West Africa, especially Nigeria, has a strong funeral culture. This Ebola-infected Liberian diplomat’s body was transported and incinerated in accordance with the WHO and CDC protocol. This feat was achieved despite immense political and diplomatic pressure to return the body for funeral rites. It represents one of the many cases of collaboration and "clinical system governance" that are at the heart of the successful containment of Ebola in Nigeria. It is one of the many stories that I'm hoping to highlight in my research on the role of the private sector in Nigeria’s successful Ebola containment.

One of Many Ebola Information Posters Around Lagos. Photo Credit: Sulzhan Bali, PhD

As part of my research, I am looking at 10 different economic sectors to understand how the Ebola outbreak impacted the private sector and how the private sector dealt with the challenges that the Ebola outbreak posed. My hope is that this research will lead to lessons for the private sector on how, in times of an epidemic, they can help the government to mitigate the disease’s economic impact. I also hope that the resulting report will help governments engage with the private sector more effectively in times of emergencies.

With many outbreaks, especially of highly fatal diseases such as Ebola, fear is the biggest demon. This fear has led to the crippling of economies of Ebola-affected countries. This fear has cost Sierra Leone, Guinea, and Liberia 12 % of their GDP in foregone income and unraveled the years of progress made by these countries. However, this fear is not just a phenomenon limited to West Africa. I had a very personal encounter with this fear recently, when I was quarantined for a few hours in the United States (despite Nigeria being declared Ebola free since October 2014). 

It has been a humbling experience so far, as I try to understand how this fear and the hysteria around Ebola can lead to significant behavioral changes—some of them necessary but some extreme. Everyone I speak to has a story to share. Some people tell of how they bought more than two bus tickets to prevent sitting next to other people. Others tell of hospitals resembling "ghost buildings" as people avoided hospitals and doctors like the plague. Many tell of the "Ebola elbow-shake" that replaced the usual handshake or hug. The reality is that although the Ebola outbreak infected 21 people in Nigeria, it actually affected the lives of 21 million people in Lagos alone, in one way or another. I have come to realize that there is a thin line between precaution and hysteria. Maintaining the equilibrium between the two is the key to controlling the disease and mitigating its economic impact.

As I wrap up my interviews, a few questions resonate with me time and time again from these sessions.

“Are we prepared for the next time?” 

“Ebola is back in Liberia. What can we do to prevent Ebola from coming back to Nigeria?” 

 For the doctors who died in Nigeria’s fight against Ebola:

“Can we truly say our country is a safer place after their sacrifice?” 

And for myself:

“How will your report help Nigeria?”

These are the questions that keep me going. Although my report may not be able to answer all of the aforementioned questions, I do hope it will at least get policy makers, students, and advocacy groups talking about how countries can be better prepared for the next big outbreak and how public-private collaboration can lead a country out of an epidemic and on a path of recovery.

To end on a positive note, 24th July, 2015 also marked one year since the last polio case in Nigeria—an achievement that clearly shows what collaboration in global health can achieve.

(To learn more about my research or to contribute/collaborate in my study, please contact me.)

Community Engagement, Global Health Conferences, Healthcare Workforce, Infectious Diseases, Vaccination

World Hepatitis Day 2015 - Focusing on Prevention

~Written by Theresa Majesty (Contact:; 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

Figure 1: A poster from World Hepatitis Alliance. 

If you’d like to get involved in raising awareness about hepatitis, please visit 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.

Built Environment, Economic Development, Water and Sanitation, Infectious Diseases

Implementing Sustainable Wastewater Treatment Methods to Reduce the Risk of Waterborne Diseases

~Written by Joann Varickanickal (Contact:; Twitter: @joann_s_v)

Bello Wastewater Treatment Plant, Medellin, Colombia (Photo Credit:

The discharge of household and industrial waste can lead to the spread of waterborne diseases if left untreated because of cross contamination with drinking water or other forms of direct contact (Daley et al., 2015). This issue of wastewater sanitation has become prevalent in several low-resource countries, as the treatment of wastewater can often be expensive, and the policies needed to implement low-cost methods do not exist. 

One example of this is in Kenya, where sustainable water management practices have yet to be implemented. Furthermore, rapid urbanization and population growth have contributed to this problem (Mburu et al., 2013). Overall, due to the low operational capacities, only 5 percent of the country’s sewage is properly treated (Mburu et al., 2013). Thus, untreated or partially treated domestic wastewater is discharged into local freshwater rivers and lakes, leading to severe contamination. This not only results in the prevalence of diseases such as cholera, but it can also lead to high economic costs due to a decrease in work productivity as well as strains on the healthcare system (Mburu et al., 2013).  

Colombia has also faced issues due to ineffective wastewater treatment. While this country has not had issues of water quantity, the issue of water quality remains a problem. In some areas, nutrients, suspended solids and organic matter can be effectively removed using existing methods; however, in some areas, treatment can be difficult due to geographic location and/or cost (García, Paredes, & Cubillos, 2013). Nevertheless, many of the current systems are unable to successfully remove pathogens, which can eventually lead to waterborne diseases (García et al., 2013). 

When examining wastewater treatment in any region, in this case low-resource countries such as Kenya and Colombia, sustainable methods must be implemented. Constructed wetlands (CWs) are a possible method that can be used to improve wastewater sanitation. Characterized according to the water flow direction in the system, CWs have been implemented in various regions over the years to treat polluted water (García et al., 2013). These planted and unplanted systems have proven to remove heavy metals, nutrients and pathogens. For example, horizontal subsurface flow constructed wetlands (HSSF-CWs) have been successfully implemented for over four decades in developed countries with temperate-climates. The use of CWs has proven to be inexpensive, as it has minimal energy requirements and low maintenance needs (García et al., 2013). Thus, implementing these systems could greatly benefit many regions, and especially those that are currently facing health risks associated with wastewater treatment. 

This issue, like many others related to public health, is complex. Policy-makers, engineers, and health professionals are among the many groups that need to work together to ensure that such systems can be effectively implemented and monitored in order to reduce the health risks that are associated with contaminated water. 


1.      Daley, K., Castleden, H., Jamieson, R., Furgal, C., & Ell, L. (2015). Water systems, sanitation, and public health risks in remote communities: Inuit resident perspectives from the Canadian Arctic. Social Science & Medicine, 135, 124–132. doi:10.1016/j.socscimed.2015.04.017

2.      García, J. a., Paredes, D., & Cubillos, J. a. (2013). Effect of plants and the combination of wetland treatment type systems on pathogen removal in tropical climate conditions. Ecological Engineering, 58, 57–62. doi:10.1016/j.ecoleng.2013.06.010

3.      Mburu, N., Tebitendwa, M., S., Rousseau, P.L., D., Bruggen, J. J. A. Van, & Lens, N.L., P. (2013). Performance Evaluation of Horizontal Subsurface Flow-Constructed Wetlands for the Treatment of Domestic Wastewater in the Tropics. Journal of Environmental Engineering, 139(March), 1152–1161. doi:10.1061/(ASCE)EE.1943-7870

Government Policy, Health Systems, Infectious Diseases, International Aid

Program Science: Improving Public Health Interventions

~Written by Theresa Majeski (Contact:

Program science is a relatively new term being used to describe the application of scientific knowledge to improve the design, implementation, and evaluation of programs. Evidence-based interventions are becoming more mainstream in public health but there is still work to do to ensure that public health concepts work the way we hope they will. That’s where program science can help.

Program science extends beyond looking at the implementation of a program, which is the logistics of developing and implementing evidence-based interventions, and focuses on the bigger picture. Program science looks at entire programs, which may include more than one intervention, for a particular population in a specific context. For example, program science may look at efforts to decrease HIV rates in youth of color in a specific borough of NYC. There are probably many interventions working on this issue, targeting different populations of youth via different methods. Program science would look at how all of these interventions work together to achieve the overarching goal of decreasing HIV rates in youth of color in that specific borough of NYC.

Program science focuses on questions like, "Who should be targeted and for how long?," "What is the best combination of interventions to achieve our goal?." " How can we sustain the program?," and "What quality improvement processes exist?" Program science helps to bring together researchers, policy makers, program planners, frontline workers, and communities for an ongoing engagement to help the program succeed.

Source: Sevgi O. Aral, 2012. Program Science: A New Initiative; A New Approach to STD Prevention Programs. 2012 National STD Prevention Conference

Program science is popular in HIV/STI work right now because such work involves long-term complex population-level behavioral interventions. For HIV/STI work, program science can be especially useful in determining why some interventions aren’t as effective as they were in the past and why some disease incidence rates are leveling out (or increasing) instead of continuing to decrease.

The Centers for Disease Control and Prevention (CDC) focused on program science at their 2012 National STD Conference. In the US, HIV/STI program science can be used to strengthen public health initiatives in a time when public health funding is decreasing and funders want to see substantial impact. Program science can ensure that money is allocated to the most effective interventions that will have the greatest impact on the population.  HIV related program science can be useful on a global scale to ensure that we fully understand the epidemic, who is impacted, and to ensure that the “money follows the epidemic and the interventions follow the evidence”.  Because each HIV affected population of the world has different characteristics it is important to not just apply one intervention to everyone but to really understand how each population is affected and what interventions would work best for each population.  

Program science is a logical progression from a focus on developing evidence-based interventions and rolling them out to a target population, to a more comprehensive focus on how various interventions are impacting the target population. this progression into a "big picture" way of looking at things will hopefully create more effective and efficient programs that contain targeted interventions to increase health of the target population. As program science continues to gain traction in public health, I believe we will see a shift to "big picture" thinking for all sorts of public health activities currently operating without this broad focus.

Government Policy, Poverty, Economic Burden, Infectious Diseases, International Aid

Sustaining the Fight against Malaria

~ Written by Randall Kramer, PhD, M.E. (Professor of Environmental Economics and Global Health, Duke University) & Leonard Mboera, PhD, MSc (Chief Scientist, Tanzania National Institute for Medical Research)

*Also published on the Duke Global Health Institute Website 

On World Malaria Day, April 25, there’s much to celebrate and acknowledge when it comes to the fight against malaria. Over the past 15 years, we’ve seen a huge ramp-up of international funding, and the latest statistics show impressive progress—a 46% decrease in malaria infections among children in sub-Saharan Africa and an estimated 4.3 million deaths averted globally over time.

One of the most effective malaria control measures has been the free distribution of several hundred million insecticide-treated mosquito nets that protect people from mosquitoes while sleeping. In 2004, only 3% of at-risk people in sub-Saharan Africa had an insecticide-treated mosquito net available to them, compared to 49% in 2014 after an international campaign.

The U.S. government is among the major funders of malaria control, and it’s one of the few international assistance programs that has garnered bipartisan support through the Bush and Obama terms. But despite the upsurge in spending and the laudable success of these programs, malaria remains one of the leading causes of death in poorer and tropical parts of the world.

The need for continued support is critical; it’s estimated that eliminating malaria as a major global disease threat would require double the current $3 billion invested annually in malaria control. But in the face of so many other pressing needs, why should we continue to invest in malaria?

In the last year, nearly 200 million people suffered from malaria, and its death toll—more than 500,000—was 50 times greater than that of the widely publicized outbreak of Ebola in West Africa. And malaria takes a particularly devastating toll on the young. More than 80% of the deaths from malaria are in children under five, and those who manage to survive the illness often suffer lasting effects on development, school performance and lifetime earnings.

Because malaria is such a resilient killer, we can expect to see these malaria losses continue and potentially rise in the absence of continued financial support. In fact, with temperatures steadily increasing throughout the world as a result of global warming, malaria-transmitting mosquitoes have begun to take residence in new regions, raising the specter of malaria spreading far beyond its current boundaries.

In addition to the physical suffering malaria causes, the disease stunts national economic progress.

Studies by Columbia University economist Jeffrey Sachs suggest that, if not for malaria keeping children out of school and agricultural workers out of the fields, the rate of economic development in sub-Saharan Africa would have been much higher in the past few decades.

And lastly, we can’t underestimate the goodwill generated by our investments in mosquito nets and other malaria-defeating approaches in recipient countries. As one community member told our research team in rural Tanzania, “Mosquito nets have been a great help to us. The day when mosquito nets were distributed, people were very happy, because many people in our community could not afford to buy the mosquito nets.”

The malaria parasite, a resilient and opportunistic pest, has successfully co-inhabited with humans for thousands of years, and it continues to adapt and evolve, damaging populations and economies across the globe. We now have the knowledge, technology and health systems to significantly reduce its devastating human impacts. But putting these assets into action will require renewed political will and financial commitment from rich and poor countries around the globe—including the U.S.

Poverty, Government Policy, Health Systems, Disease Outbreak, Infectious Diseases, International Aid

Keeping the Spotlight on Neglected Tropical Diseases (NTDS)

-Written by Adenike Onagoruwa, PhD (Contact:

Neglected tropical diseases (NTDs) are a group of diseases with different causative pathogens that largely affect poor and marginalized populations in low-resource settings and have profound, intergenerational effects on human health and socioeconomic development. The WHO has prioritized 17 NTDs that are endemic in 149 countries, of which some such as dengue, Chagas disease, and leishmaniasis are epidemic-prone.

NTDs can impede physical and cognitive development, prevent children from pursuing education, frequently contribute to maternal and child morbidity and mortality, and are a cause of physical disabilities and stigma that can make it difficult to earn a livelihood. Largely eliminated in developed, high-resource countries and frequently neglected in favor of better-known global public-health issues, these preventable and relatively inexpensive to treat diseases put at peril the lives of more than a billion people worldwide, including half a billion children. Several reasons have been postulated to explain the neglect of these diseases; an underestimation of their contribution to mortality due to the asymptomatism and lengthy incubation period that is characteristic of many of the diseases, a greater focus on HIV, malaria and TB because of their higher mortality, and a lack of interest in developing (non-profitable) treatments by pharmaceutical companies.

Progress has been made in recent times in combating these diseases and several international measures have been taken. Resolution WHA66.12 adopted at the sixty-sixth World Health Assembly in May 2013 highlighted strategies necessary to accelerate the work to overcome the global impact of neglected tropical diseases. Previously in January 2012 at the “London Declaration”, representatives of governments, pharmaceutical companies and donor organizations convened to make commitments to control or eliminate at least 10 of these diseases by 2020. They proposed a public-private collaboration to ensure the supply of necessary drugs, improve drug access, advance R&D, provide endemic countries with funding and to continue identifying remaining gaps.

So far, the coalition has made progress with delivering on their promises:

Pharmaceutical Companies - In 2013, drug companies met 100% of drug requests, donating more than 1billion treatments. On the R&D front, clinical trials for some NTDs have been started. In addition, several drug companies have enabled access to their compound libraries.

Governments - Compared to 37 in 2011, 55 countries requested drug donations at the end of 2012. Also, over 70 countries have developed national NTD plans. Within a year of the Declaration, Oman went from endemic trachoma to elimination and by 2014, Colombia eliminated onchocerciasis.

Donors - NTDs have become more visible on the development and aid agenda, especially with the £245 million earmarked in 2012 by DFID for NTD programs. Other donors have since followed suit.

However, despite these strides, challenges remain as treatments are not reaching everyone in need. Although 700 million people received mass drug administration (MDA) for one or more NTDs in 2012, only 36% of people in need worldwide received all the drugs they needed. There’s also the anticipated challenge of environmental and climate change on NTDs; with dengue being identified as a disease of the future due to increased urbanization and changes in temperature, rainfall and humidity.

The spotlight needs to remain on NTDs and their contributions to ill-health and poverty for efforts to be sustained. 

To sustain these efforts, greater advocacy has to be made for integrating NTD control into other community and even national level programming, without losing them in the crowd. Some anthelminthic drugs for preventive chemotherapy are on the WHO Model List of Essential Medicines and their distribution has been effective and economical. However, to succeed at NTD elimination, we have to look beyond mass drug administration to the removal of the primary risk factors for NTDs (poverty and exposure) by ensuring access to clean water and basic sanitation, improving vector control, integrating NTDs into poverty reduction schemes and vice versa, and building stronger, equitable health systems in endemic areas. There needs to be a consensus as to how to ensure this. At present, it seems there is a gap between elimination objectives and how to incorporate them into other health and development initiatives such as water and sanitation, nutrition and education programs. It has long been established that helminth parasite infection contributes to anemia and malnutrition in children. The presence of other protozoan, bacterial and viral diseases also contribute to school absenteeism. Guinea worm disease (dracunculiasis) can be recurrent when there is no access to safe drinking water.

There is also a need to maintain a surveillance and information system for NTDs in light of increasing migration and displacements. Another way to ensure that the spotlight is kept on NTDs is research that provides evidence of interactions and co-infections with other diseases. For example, epidemiological studies from sub-Saharan Africa have shown that genital infection with Schistosoma haematobium may increase the risk for HIV infection in young women (Mbah et al, 2013). Understanding that neglected diseases can make the “big three” diseases (malaria, HIV and tuberculosis) more deadly and can undermine the gains that have been made in health, nutrition and education is important (Hotez et al, 2006).

Erroneous overstating of the progress made in controlling and eliminating NTDs can have a detrimental effect on funding and public perceptions of their importance. Thus, there is a need for increased synergy between stakeholders. Achievements in polio eradication do not equal achievements in human African trypanosomiasis eradication. While some NTDs can be managed with specific drugs, some such as dengue do not have a specific drug. Therefore, while keeping the spotlight on NTDs collectively, it is important to emphasize their diversity and to also keep in mind the subgroup of NTDs categorized as emerging or reemerging infectious diseases, which are deemed a serious threat and have not been adequately examined in terms of their unique risk characteristics (Mockey et al, 2014).

Lastly, it is important to keep the heat on NTDs in the UN’s post-2015 sustainable development agenda by advocating that proposed goals support efforts to monitor, control and eliminate NTDs. As highlighted by the Ebola crisis, strengthening health systems is paramount. Nevertheless, the future looks optimistic regarding NTDs. Encouraging is the inclusion of neglected and poverty-related diseases on the agenda of the 2015 G7 Summit, which will be held in Germany in June.


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