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CSU 17/2009: DOES DEWORMING WORK?/VACCINE INVESTMENTS

Thursday, 9th of April 2009

CHILD SURVIVAL UPDATE 17/2009: DOES DEWORMING WORK?/VACCINE INVESTMENTS
 
 QUERY TO READERS
 
 Do any readers have published or unpublished accounts of the use of cell
 phones for public health in developing countries?
 
 1) DOES DEWORMING WORK?
 
 Now that most African countries have incorporated use of broad spectrum
 antihelminthics, such as albendazole or mebendazole, into semiannual
 campaigns, it is not too late to look at the scientific basis for
 deworming. In the following article, available on the Internet at
 http://www.biomedcentral.com/1471-2334/9/20 Kirwan and colleagues do a
 careful assessment of the impact of deworming on Ascaris lumbricoides in
 one site in Nigeria. Summary below; full text on the Internet.
 
 Good reading.
 
 BD
 
 Summary:
 
 Patterns of soil-transmitted helminth infection and impact of four-monthly
 albendazole treatments in preschool children from semi-urban communities in
 Nigeria: a double-blind placebo-controlled randomised trial
 
 Patrick Kirwan* 1 , Samuel O Asaolu* 2 , Síle F Molloy* 1 , Titilayo C
 Abiona* 3 , Andrew L Jackson* 1 and Celia V Holland* 1
 1Department of Zoology, University of Dublin, Trinity College, Dublin 2,
 Ireland
 2Department of Zoology, Obafemi Awolowo University, Ile-Ife, Nigeria
 3HIV/AIDS Research and Policy Institute, Chicago State University,
 Chicago, IL, USA
 author email corresponding author email* Contributed equally
 BMC Infectious Diseases 2009, 9:20doi:10.1186/1471-2334-9-20
 © 2009 Kirwan et al; licensee BioMed Central Ltd.
 
 Abstract
 Background
 Children aged between one and five years are particularly vulnerable to
 disease caused by soil-transmitted helminths (STH). Periodic deworming has
 been shown to improve growth, micronutrient status (iron and vitamin A),
 and motor and language development in preschool children and justifies the
 inclusion of this age group in deworming programmes. Our objectives were to
 describe the prevalence and intensity of STH infection and to investigate
 the effectiveness of repeated four-monthly albendazole treatments on STH
 infection in children aged one to four years.
 Methods
 The study was carried out in four semi-urban villages situated near
 Ile-Ife, Osun State, Nigeria. The study was a double-blind
 placebo-controlled randomised trial. Children aged one to four years were
 randomly assigned to receive either albendazole or placebo every four
 months for 12 months with a follow-up at 14 months.
 Results
 The results presented here revealed that 50% of the preschool children in
 these semi-urban communities were infected by one or more helminths, the
 most prevalent STH being Ascaris lumbricoides (47.6%). Our study
 demonstrated that repeated four-monthly anthelminthic treatments with
 albendazole were successful in reducing prevalence and intensity of A.
 lumbricoides infections. At the end of the follow-up period, 12% and 43% of
 the children were infected with A. lumbricoides and mean epg was 117 (S.E.
 50) and 1740 (S.E. 291) in the treatment and placebo groups respectively
 compared to 45% and 45% of the children being infected with Ascaris and
 mean epg being 1095 (S.E. 237) and 1126 (S.E. 182) in the treatment and
 placebo group respectively at baseline.
 Conclusion
 Results from this study show that the moderate prevalence and low intensity
 of STH infection in these preschool children necessitates systematic
 treatment of the children in child health programmes.
 Trial Registration
 Current controlled trials ISRCTN44215995.
 2) VACCINE INVESTMENTS
 From The Lancet Infectious Diseases
 
 214 www.thelancet.com/infection Vol 9 April 2009
 Vaccine investments raise millions to save children’s lives
 
 In March, HSBC, a leading UK bank, offered innovative vaccine-themed
 investments to individuals and institutional investors in the UK, to
 provide additional funding to the Global Alliance for Vaccines
 andImmunization (GAVI) for its childhood immunisation programme.
 
 Heike Reichelt from the treasury of the World Bank (Washington DC, USA)
 confirms that “the investments, issued by the International Finance
 Facility for Immunisation (IFFIm) and rated triple-A, are expected to raise
 at least UK￡50 million.” This will be channelled directly and quickly to
 GAVI for dissemination of vaccines that provideprotection against
 diphtheria, tetanus, pertussis, Haemophilus influenzae typeb (Hib), and
 hepatitis B.
 
 The UK investments “will create an additional cash flow upfront so that in
 the short-term finance gaps in
 vaccination can be funded, backed by long-term multigovernment binding
 commitments from seven countries including the UK”, explained Philippe
 Beutels, professor of health economics at the Vaccine and Infectious
 Disease Institute (University of Antwerp, Belgium). This will add to the US
 $1 billion and $223 million raised through similar issuances in London
 (November 2006) and Japan (February 2008), all of which are now disbursed.
 
 A further $429 million was raised this February in Japan, but a proportion
 of those funds will be kept to pay back existing bondholders. Nevertheless,
 the total contribution to global vaccination is impressive: “since 2006,
 IFFIm has raised roughly $1・6 billion that is enabling GAVI to pretty much
 double its spending on vaccination programmes globally,” confirmed Dan
 Thomas from GAVI.
 Vaccination is one of the most cost-effective health interventions, and
 puts a relatively low burden on
 public-health-sector budgets. “Despite this, many countries have come to
 depend on donor resources to support their immunisation programmes,
 particularly when introducing important newer vaccines such as Hib,
 rotavirus vaccines, and hepatitis B”, said Ruth Levine of the Center for
 Global Development (Washington DC, USA). An ongoing and increasing stream
 of funding is vital for both routine childhood vaccination and immunisation
 campaigns and funding needs to be deployed carefully. “The extra money
 already raised through IFFIm has been channelled to various
 non-country-specific programmes such as the creation of a polio and yellow
 fever vaccine stockpile, measles mortality reduction, and maternal/neonatal
 tetanus elimination campaigns”, reported Thomas. Specific investment cases
 indicated that these were highly cost-effective programmes that would have
 a significant health impact. Some of the stockpile funds were reallocated
 to support funding gaps in the operational cost of campaigns within the
 polio eradication programme, Thomas told TLID.
 
 Beutels stresses that the impact of the recent funding boost has already
 been substantial. “Not only has it been possible to procure and deliver
 more vaccinations, but health systems have been strengthened and the safety
 of injections has been improved, both of which are of major importance to
 the safe and efficient delivery of current and future vaccines”, he said.
 
 Levine agrees, she regards GAVI as one of the pioneers in using vertical or
 intervention-specific funding
 to strengthen core health-system functions, based on proposals from
 recipient governments.
 
 Maya Vijayaraghavan, an economist in the Global Immunisation Division at
 the Centers for Disease Control
 and Prevention (Atlanta, GA, USA) views the current IFFIm investment
 opportunities as “test cases whose
 performance will determine donor support for similar bonds in the future”.
 
 There is insufficient information on their popularity and their impact on
 programme performance, she thinks,
 to determine whether they could become a staple of fundraising for
 vaccination programmes. Levine
 is also cautious about making predictions, but she is hopeful that
 institutional and individual investors
 will “continue to see the merits of combining financial returns with social
 value”. Vijayaraghavan concurs,
 “with likely declines in charitable giving during tough economic times,
 vaccine bonds do double duty,
 providing philanthropic funding and are a particularly attractive option
 for both retail and institutional investors”.
 The investment strategy is also likely to be popular with governments,
 since the majority of high-income
 countries are not on track to spend 0・7% of GDP on aid, points out
 Beutels.
 
 “It is important to remember that vaccine bonds and investments are
 complementary to other funding
 sources. Direct public development aid, advance market mechanisms to
 stimulate development of vaccines
 for poor-world problems, public–private partnerships, tiered pricing, and
 mutual responsibility provisions
 are all required to achieve financially sustainable programmes in the long
 run”, he concluded.
 Kathryn Senior
 
 For more on vaccine-themed investment strategy see
 http://www.gavialliance.org/vision/strategy/vaccine_investment/
 For more on HSBC vaccine themed investments see
 http://www.hsbc.co.uk/1/2/personal/investments/vaccine-investment
 For more on vaccine bonds see http://www.iff -
 immunisation.org/pdfs/pr_2_5_09.pdf
 For more on IFFIm see http://www.iff -immunisation.org/