Policy

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Guinea Worm Eradication in Nigeria, A Lesson To Learn From

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By Gordon Younkin

You may have seen in the news a little over a year ago that the WHO declared Nigeria free of guinea-worm disease. While this may be considered old news, it is still worth examining the campaign that successfully stopped its transmission.

Guinea-worm disease, also known as dracunculiasis, infects people via contaminated waterways, especially in slow-moving streams or stagnant pools. After entering the human body, it stays matures in its host without causing any symptoms for about a year before painfully emerging from the skin of the infected individual. It then releases thousands of larvae, and its life-cycle repeats. There is no vaccine or treatment for the disease—it is most effectively stopped through preventative measures such as water purification and behavioral change.

In 1988, the Nigeria Guinea Worm Eradication Programme was launched in response to a World Health Assembly resolution calling for the global eradication of the disease. At the time, there were around 650,000 reported cases of guinea-worm disease in Nigeria alone. Over the course of the 25-year campaign, thousands of volunteers traveled door-to-door in communities across the county to search for and contain the disease.

What I think is most notable is the use of polio vaccinators to help in the surveillance efforts. The campaign was able to use existing health workers already familiar with the communities and culture to more quickly and efficiently eradicate guinea-worm disease. It is this kind of cooperation between different public health efforts that is crucial to the continuing improvement of health worldwide. Dr. Margaret Chan, Director-General of the World Health Organization (WHO), commended the collaborative guinea-worm disease eradication effort: “This is the kind of joined-up effort that makes the most effective use of our human and financial resources, and has a dramatic and measurable impact.”

The last case of guinea-worm disease in Nigeria was reported in 2008, and the country was declared Guinea Worm free in late 2013. While the polio vaccination campaign is still in progress due to a number of cultural and infrastructural barriers, Nigerian President Goodluck Jonathan is committed to stopping the transmission of wild poliovirus by the end of 2015.

If you are interested in more information about guinea-worm disease eradication efforts in Nigeria, some useful references are:

http://www.who.int/features/2014/nigeria-stops-guinea-worm/en/

http://www.punchng.com/news/who-certifies-nigeria-guinea-worm-free/

Vaccines, Herd Immunity, and Disease Re-Emergence – What’s the Deal?

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By Michael Zingman

We hear about immunizations in the news. We are encouraged to get vaccinated. We hear friends and family talking about how they just “never got vaccinated” for something.

We then hear about outbreaks and re-emergence of vaccine-preventable diseases. So what is causing this re-emergence exactly?

Vaccines are one of the most crucial global health resources and are significant tools that can be utilized to protect large populations in both developed and developing nations from disease. Many diseases are vaccine-preventable, meaning if hypothetically everyone were to be vaccinated, the disease would become eradicated.

One of such eradicable diseases is measles. Measles was once “eliminated” from the United States; however, recently, there has been extensive media coverage over a measles outbreak within the country. Measles was eliminated but not eradicated because of a slight minority of people who went unvaccinated, and this number has increased and allowed the disease to return. These cases were found to be from parents who chose not to vaccinate their children, which ultimately harmed others.

Other parts of the world have also seen a re-emergence of vaccine-preventable diseases. One interesting case is that of Syria and the re-emergence of polio this past October. Polio had come extremely close to eradication in that area of the world; unfortunately, it has re-appeared. This was due to two key factors: 1) because of the ongoing civil war, the normal childhood vaccination routines have been altered or disrupted, and 2) polio has spread from Pakistan (which is one of the three remaining countries in which polio is still active), particularly through children, including those in refugee camps and those displaced in Syria. Polio has even spread to Iraq from Syria, and there is growing fear over proliferation of the crippling disease.

So why can just a handful of unvaccinated people lead to a wide-spread re-emergence of these preventable diseases? The key is herd immunity.

Herd immunity is defined by the Centers for Disease Control as when “a sufficient proportion of a population is immune to an infectious disease to make its spread from person to person unlikely; even individuals not vaccinated are offered some protection because the disease has little opportunity to spread within the community.” This concept of herd immunity is why widespread vaccination is necessary for prevention of these diseases. In an ideal world, everyone would be vaccinated for all of the vaccine-preventable diseases. However, that is not a practical situation (at least not at the current time). Herd immunity can be very effective in protecting large populations from these diseases, but often can be difficult to achieve as some diseases require greater than 90% of the population to be vaccinated. This threshold is frequently not met and populations are left vulnerable.

With a growth of anti-vaccination movements in the United States and around the world, some parents have stopped vaccinating their children. This has led to a decrease in herd immunity for these vaccine-preventable diseases, permitting their re-emergence. These movements have surfaced due to a growing fear that vaccines can have adverse effects on children. This fear has been augmented by conflicting information regarding vaccinations, as well as personal accounts of negative vaccine effects, including those by physicians. Misinformation has even led a significant portion of the U.S. population to believe that autism can be caused by vaccines. This belief became prominent in the 1990s and was one of the reasons cited for the growth of this anti-vaccination movement.

Two key aspects of the debate over vaccinations include a lack of information (or misinformation) and a mistrust of governments, health institutions and research agencies. These are major problems in the United States, but also in many countries throughout the developing world, including those countries in which GlobeMed partner organizations are located. A lack of research to disprove these supposed negative vaccine effects has made it hard for the public health community to convince people that no link exists. Furthermore, much of this research comes from pharmaceutical companies, leading to mistrust of this research due to potential biases. An overabundance of information also has prevented people from receiving direct information from health institutions regarding vaccine effectiveness and has caused them to educate themselves from other sources that are less reliable. On a similar note, there is a lack of public understanding about vaccinations that stems from a mistrust of health institutions. It can often be more difficult to vaccinate people in developing countries in which people view vaccinations as a corrupt government program. Some people even believe that required vaccinations for schools are done for the economic benefit of the government.

All of these issues discussed have increased fear of vaccines in many locations around the world, including in those places with GlobeMed partner organizations. Vaccine education needs to be expanded and effective national vaccination action plans need to be both developed and carried out to increase herd immunity. GlobeMed and its partner organizations, as well as similar global health organizations, need to empower communities around the world in order to enhance vaccination efforts. Education through vaccine information is necessary to present to the public why population immunization is essential and why a decrease in herd immunity can have tremendous negative effects.

A perspective from Paris

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In many ways, Paris is not so different from New York, Chicago, or any major city in the United States. There are all the modern amenities, locals are chic and cosmopolitan and pop culture in Europe has largely molded itself around American media. The one thing people tend to point out is that the French tend to take their time to enjoy the ordinary. The lifestyle is slower, whether it’s how long it takes a waiter to bring over a check or the way Parisians linger over three-hour dinners of bread, wine, cheese and espresso even on weekdays.

In time, I realized that this way of life reflects the lengthy scope of European history and, in turn, the principles around which many European societies are organized. Unlike the United States, many EU member states have over a thousand years of history, have waged countless wars with their neighbors, and have often redrawn messy national borders. With this sense of history comes a sage understanding of the life course, of personal success, and of mortality; not everyone is exceptional, and no one is exceptional when it comes to death at the end of one’s life.

There seems to be more of a collective sense of the past, a true focus on the present, and generally less anxiety about the immediate future. The socialist redistribution of wealth and development of the welfare state demonstrate the importance of enhancing the lives of all citizens in the present rather than focusing on future gains trickling down from a small elite. The French welfare state ensures that one has the tools to be a productive member of society, and, in the case of illness or unemployment, that he or she will be offered social assistance.

It would be essentializing to say that there is only to live, work and enjoy in France. But I think the U.S. as a state and as a culture has a lot to learn from France in terms of approaches to life, success, and an individual’s place in the society. It is a preoccupation with being the best and having it all that has characterized and shattered the American economy. So while we bemoan the demise of American exceptionalism, Americans need to understand the falsehood of individual exceptionalism and rethink the notion of what it means to live a happy life. The sooner we realize that the vast majority of us are ordinary, that it’s good to be ordinary, and that–even in a capitalist society–ordinary people deserve protection from market failure, the sooner we can start working towards reducing health and other inequalities in America. –TIFFANY WONG

Tiffany Wong is a former co-president of GlobeMed at Northwestern and is studying on the Northwestern International Program Development Public Health in Europe Program.

Meeting with Dr. Atsu

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“Ten years from now we will see this project grow out of the work of some students from the U.S. It will go beyond everyone’s dreams.” – Dr. Atsu, regional health director of Ho Municipality, in reference to the nutrition program at the H.O.P.E. Center

On Monday, the GROW Team and Margaret met with Dr. Atsu, the new regional health director of the Ho Municipality. During this meeting we discussed the role that Ghana Health Service (GHS) should play at the HOPE Center and the partnership between GHS and GlobeMed. Going into the meeting, we were all really unsure about how receptive Dr. Atsu would be to our ideas, but we were all really pleased with what he had to say. Dr. Atsu sees Ghana Health Service playing a major role in the H.O.P.E. Center and GlobeMed’s outreach programs. It was rewarding to see how well-received our work has been by GHS and the strides they are willing to make to expand this project to other communities. He stressed how important GlobeMed’s projects are, as they are one-of-a-kind projects, at least in the Volta region of Ghana. He sees the nutrition project as a model for similar projects throughout the Volta region, and thus wants to play a more active role in the research that the GROW Team and other GlobeMed students conduct. He wants all research conducted and all reports written to be validated and owned by Ghana Health Service so that our projects can be implemented in other communities.

Dr. Atsu also addressed the ideas of cultural competency and creating reports that accurately reflect the Ghanaian culture and mindset. As we all make progress on the reports of our various community surveys, it was important to keep these ideas in mind. What might seem significant and extraordinary in our eyes may be completely common place to the average Ghanaian. I was glad to be reminded of this idea that is constantly stressed in any discussion on global health projects. Even though I completely understand the idea of cultural competency and value its components, it is really easy and almost human nature to take a piece of data and place it in the context of one’s own culture. -REEMA GHATNEKAR