Skip Navigation
Johns Hopkins Bloomberg School of Public Health
Bookmark and Share
   

IVAC Blog

 
Keyword: pneumonia

By Huma Khawar, freelance journalist and consultant for Vaccine Implementation Technical Advisory Consortium (VITAC).

This article was originally published on the VaccinesWork blog and is cross-posted here with permission.

Girl with vaccine card

A little girl with her vaccination card. Photo: Gavi/Doune Porter

Doctors from across Pakistan gathered in Islamabad last Thursday to fight a disease that’s threatening children across the country. This time it wasn’t polio they were working against, but pneumonia, which kills as many as 71,000 children every year in Pakistan.

The event, held to mark World Pneumonia Day, aimed to empower key influencers to better advocate to stop pneumonia and discuss challenges to its prevention. It took place at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), which itself sees many cases of the disease with a daily turnover of over 500 children in its outpatient department from in and around Islamabad.

WPD Seminar Event

The entrance to the seminar. Photo: Huma Khawar.

The pneumococcal vaccine was rolled out in Pakistan in 2012 as part of the routine immunization schedule, when it had already helped children in many other countries avoid pneumonia. It is also proving effective in Pakistan, as Dr. Asad Ali, from Aga Khan University Karachi, demonstrated by sharing preliminary findings from the vaccine impact assessment in Sindh. He explained that even one dose of pneumococcal vaccine is highly effective against the main germs that cause pneumonia (pneumococcus and Hib).

However, pneumonia is still one of the major killers of children under five years old in Pakistan.  A major reason is limited routine immunization coverage – a little more than 50% of children are covered by a basic set of vaccines nationally, and the numbers of children immunized has even been declining in Balochistan. As a result, pneumococcal vaccine faces challenges reaching children across the whole country through this system, and so its population-level effects cannot yet be expected to be significant.

Doctors estimated that this underperformance is fuelled by caregivers’ lack of awareness. Too few parents know that the vaccine is necessary for child health, free-of-cost and available at immunization centers nationally. Yet improving vaccine coverage is crucial, as once infected, access to treatment options for infants remain limited especially in Pakistan’s rural, impoverished regions. Dr. Syed Saqlain Ahmad Gillani, National Immunization Program Manager, concluded the session by voicing support for a public-private health sector partnership to increase routine immunization coverage in the country.

Presentation at Pakistan Event

One presentation from the day. Photo: Huma Khawar.

Facing such a challenge, medical professionals are not the only ones who need to advocate for vaccination against pneumonia. Following the conclusion of the main session, an advocacy session tailored for teachers and headmistresses of public schools was initiated during which they were informed of the need to prevent pneumonia through other proven, low-cost techniques such as immunization, sound hygienic practices and balanced diets for infants and exclusive breast feeding for six months, ensuring good nutrition.

The teachers also shared various risk factors which make children more prone to pneumonia. Poor parental healthcare seeking was one: when children with severe pneumonia often undergo of trial and error at the field levels, before they actually reach the health facility for the right treatment in time.

Exposure to indoor smoke, which in rural Pakistan is an issue for more than 60% of families, is also damaging beyond imagination. There, an average household size is seven, which makes overcrowding (i.e the number of people sharing same room where children sleep) is another important factor contributing to pneumonia.

The teachers agreed that, more than ever before, we know how to protect and prevent children from catching pneumonia, and how to treat those suffering with this illness. They returned home to spread the message. 

By Rachel Bierbrier, a Policy, Advocay and Communications intern working with IVAC. 

International Vaccine Access Center (IVAC) is proud to celebrate the seventh annual World Pneumonia Day on November 12th, 2015.

Despite being preventable and treatable, pneumonia remains the leading killer of children under five years old; responsible for 16% of global under five mortality in 2015. More than half of these deaths occur in only six countries where gaps in access to life saving interventions exist.

Although World Pneumonia Day began seven years ago, IVAC’s commitment to reducing the burden of pneumonia originated much earlier with PneumoADIP; an innovative project that aimed to improve child survival and health by accelerating the evaluation of and access to new, life-saving pneumococcal vaccines for the world's children. Although this project is now complete, it was critical in sparking both the birth of IVAC as an organization and its ongoing commitment to increasing access to pneumonia prevention interventions, with a specific focus on vaccination.

IVAC is thrilled to announce the release of its annual Pneumonia and Diarrhea Progress Report. This year’s theme is Sustainable Progress in the Post-2015 Era. Using the most recent available data, the report documents the progress of the 15 countries with the greatest burden of pneumonia and diarrhea, in implementing high-impact interventions outlined in the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) relative to GAPPD coverage targets. For the first time, the report includes in depth analysis of the challenges associated with the sustainability of pneumonia and diarrhea interventions in Gavi graduating countries as well as country specific analysis of the challenges and successes in three focus countries - India, Indonesia and Nigeria. The report and other great resources can be found at www.worldpneumoniaday.org.

Other events hosted by IVAC for World Pneumonia Day 2015 are taking place at the Johns Hopkins Bloomberg School of Public Health. An information table with World Pneumonia Day facts and goodies is set up from 12:00pm-1:00pm in front of the school’s Wall of Wonder – to share information with the future leaders of global health. In the evening, the Child Health Society is hosting a talk by IVAC’s own Dr. Laura Hammit. Dr. Hammit’s talk takes place from 5pm - 7pm in the Hampton House Auditorium.

Pneumonia Fighters

In Abuja Nigeria, IVAC has joined forces with the government of Nigeria and the Pediatric Association of Nigeria to host a high-level symposium on pneumonia. During the symposium senate leaders, Senator Olanrewaju Tejuosho and Senator Mao Ohuabunwa, will unveil two creative projects on pneumonia – a World Pneumonia Day Calendar, created from paintings done by teenagers in Abuja, and a Pneumonia Social Media Video Challenge. Using the precision of science and the drama of arts, IVAC is helping to propel the message to #BeatPneumonia.

Student artists whose works were used in the calendar. (Nigeria)

Student artists whose work were featured in the calendar. (Nigeria)

Today, IVAC continues to be active in many pneumonia-related initiatives. In addition to the PERCH project, the PCV Technical Coordination Project and many other innovative projects ongoing at our center, IVAC recently received generous support from the Bill and Melinda Gates Foundation to assume the role as a coordinator for the Global Coalition Against Childhood Pneumonia and Diarrhea. Under this grant, IVAC will work to increase collaboration and communication between members of the Coalition. These activities won’t stop on World Pneumonia Day, they are year round and include the creation and implementation of innovative advocacy tools and efforts.

Pneumonia remains the leading killer of children under the age of five despite being both preventable and treatable. Decreasing the global burden of pneumonia cannot and will not occur without continued advocacy, innovation and collaboration. As a global community, we must continue to work together beyond World Pneumonia Day to ensure that all children have access to sustainable, life saving pneumonia interventions. We have the tools to fight pneumonia; we now need to ensure that these tools are being distributed equitably around the globe.

By Dr. Anne von Gottberg, Respiratory and Meningeal Pathogens Research Unit, National Institute for Communicable Diseases

This article was originally published on www.vaccineswork.org and is cross-posted here with permission.

If you had looked at South Africa’s invasive pneumococcal disease (IPD) surveillance data before 2002, you would have never guessed that one day that data would land on the pages of the New England Journal of Medicine

Even I thought such a feat was impossible. Surveillance for IPD was passive and patchy – certainly not the kind of data you could use to examine trends or measure impact.  In 2002, experts in pneumonia and respiratory disease suggested that we completely revamp the system: start measuring antimicrobial resistance and serotypes, obtain clinical data from cases to explore risk factors for resistance.  Although this was long before the pneumococcal conjugate vaccine (PCV) was introduced, we knew any investments we made in the surveillance system now would pay huge dividends later, and possibly allow us to measure the impact of PCV introduction.

Noluthando Duma works in the lab

An example of disease surveillance activities. Here, Noluthando Duma works in the lab. Photo: NICD.

Revamping a national surveillance system was not an easy task.  Our institute managed the process - from employing surveillance staff throughout the country to collecting data - and we had many, many challenges.  This project seemed so unusual, so impossible, that it was difficult to convince anyone to join us.  We would interview surveillance officers at remote regional sites who wondered how they could report to a central office in Johannesburg, given that they had never even been there; they couldn’t imagine how such a big, unwieldy national program could ever work. We would answer their questions with what I hoped sounded like confidence, but the truth was that we were figuring out the answers as we went along.

Despite these human resource challenges, we charged ahead, but it was a slow-and-steady race.  At our national surveillance officer and principle investigator meetings, we had to bring together key stakeholders to discuss the surveillance network.  We had to get buy-in on the methods, the case definitions, the flow of data, and sharing of information, and then we had to hire staff to operationalize our ambitious plans. Many new hires had never been on an airplane before, and some had never seen the ocean – the surveillance network really made South Africa smaller, bringing people together in the “new South Africa” in ways that I could not have predicted. So we anxiously booked window seats, made time for quick excursions to the beach, and hoped for the best. And although we had our fair share of hiccups along the way, our small team continued to grow, the years passed, and we kept on finding ways to silence the naysayers!

Meanwhile, things did not stay still around us.  The South African government suddenly found the political will to tackle the HIV/AIDS epidemic, and with a tremendous effort, the government and civil society rapidly improved care of HIV-infected pregnant women, HIV-infected children, and adults in general.  With these sudden improvements in healthcare, IPD also changed, making it more difficult to attribute any declines to the vaccine, even with the new surveillance system.  But through a series of discussions with local and international colleagues and friends, countless conference calls, and careful review of the data, it finally became possible to tell the story that was in the data, collected for so many years by our dedicated surveillance teams.

southafricasurveillance

Colleague Kedibone Ndlangisa conducting lab work. Photo: NICD

Last week, as experts and decision makers gathered in Kenya to discuss the results of various PCV impact studies from across Africa – all showing significant reductions in pneumococcal disease after the introduction of the vaccine – I was reminded of how far we had come on our journey and the many lessons learned on our path. 

By maintaining our slow-and-steady approach remembering to “ask a friend” when we were stumped, and above all continuing to plow on in the face of challenges, we were able to turn data that at first glance may have looked like a mess into a meaningful and robust assessment of the impact of PCV. 

This study is part of the the Vaccine Implementation Technical Assistance Consortium (VITAC) - a collaboration of PATHCDC, and IVAC - supports the achievement of the mission to save lives, prevent disease, and promote health through timely and equitable access to new and underused vaccines. VITAC is focused on accelerating the introduction and sustained use of vaccines by creating the evidence base, advocating for evidence-driven decision making, and establishing a platform for countries to assess the resources needed for sustained and optimal use of vaccines.

This post originally appeared on the VaccinesWork blog and is cross-posted here with permission.

By Huma Khawar

In 2012, Pakistan was the first South Asian country to introduce the pneumococcal vaccine with Gavi support. Provided free of charge to children under the age of five, the vaccine protects against a major cause of pneumonia, a disease that is a major killer of children worldwide. But in order for any vaccine programme to be successful, information and support are essential. And where do many people get their information? The media.

Pakistan Media Session

The question and answer session in action. Photo: Huma Khawar

Dr Taimoor Shah, Deputy Director Khyber Pakhtunkhaw province’s Expanded Programme on Immunization (EPI), knows this well. On World Pneumonia Day last November, he took the opportunity to gather a room full of journalists of all backgrounds at the Press Club in Peshawar, to talk specifically about the pneumococcal vaccine and to answer their questions. 

The result was a discussion that sounded more like a medical classroom than a group of reporters. How many vaccines are included in a child’s immunisation programme? What are the diseases that can be prevented through immunisation? How expensive is the pneumonia injection? It was difficult to decide whether to feel surprise at the lack of awareness among the media about vaccine preventable diseases or to be happy at the eagerness and genuine interest expressed in the reasons for Pakistan’s high rates of child mortality.  

The session was both informal and interactive. Journalists from different organisations suggested ways to educate people on vaccination and eradication of fatal diseases through media messages. They concluded that it was the common duty of parents, government health institutions, media and civil society to take steps for overcoming health issues through vaccination and timely treatment. 

One journalist confessed that although he knew all about how and when to give the different vaccinations, he didn’t know the importance of each. ”It will be easier, he said, to convince mothers on the importance of getting their babies immunised.”  

The session also gave the health journalists an opportunity to express their own opinions and share insights. They talked openly about how, over the years, with so much money and emphasis directed towards polio eradication, routine immunisation had taken a backseat.    

By the end of the session, some 30 plus media personnel had learned much more about vaccines and routine immunisation. One digital reporter admitted that this type of question and answer sessions was essential as a vast majority of journalists have limited knowledge of vaccines and their potential. 

“A lot of mothers get their information from newspapers. Media should be up to date. If their knowledge is suspect, they will pass on wrong information to parents. This can be very dangerous,” he said.

And in a country where each year one in twelve children born die before reaching the age of five, many of them due to vaccine-preventable diseases, spreading this newfound knowledge can only be a good thing. 

media event in Pakistan card

Photo: Humar Khawar

Huma Khawar is a freelance journalist and IVAC communications consultant who works in Pakistan.

GUEST BLOGGER

Huma Khawar

Huma Khawar is a freelance journalist and IVAC communications consultant who works in Pakistan.

This post originally appeared on the VaccinesWork blog and is cross-posted here with permission.

Vaccine implementation requires policy and community-level approaches to ensure on the one hand that vaccines are available and on the other hand that parents bring their children to be immunized. Two events held in Pakistan this year on World Pneumonia Day illustrate the importance of these approaches.

On the eve of World Pneumonia Day, as a joint initiative of the communications team at the Federal Expanded Program on Immunization (EPI), which includes Pakistan’s EPI and partners from Gavi, UNICEF, and Japan’s International Cooperation Agency, a meeting with members of Provincial Assembly of Sindh was held to discuss immunization, not just for pneumonia but the entire routine immunization program and polio, which is of course a top priority for the country.

WPD-logo-2014

More than 70 members of the Sindh Assembly attended. Deputy Speaker Syeda Shehla Raza opened the meeting, followed by remarks by Ms. Ayesha Raza Farooq,  Coordinator Prime Minister’s Polio Cell, who spoke about the role of the Federal government in routine immunization and the Prime Minister’s commitment to the cause. Ms. Shahnaz Wazir Ali, Provincial Coordinator for public and primary health care programme, spoke about the current status of polio and routine immunization in Sindh, where vaccine coverage levels are very low. Members expressed their concern about the overall 29% coverage of routine immunization in the province and recommended legislation on compulsory immunization to improve the current state of the coverage. The meeting concluded with a declaration presented by Syeda Shehla Raza on behalf of all members in support of Immunization and Polio Eradication Program.

The next day, in Islamabad, the capital city of Pakistan, civil society organizations working with Expanded Programme on Immunization and Civil Society Human and institutional Development Program held an awareness raising event in a minority slum community. More than 120 children and their mothers participated. The event included a puppet show that gave the children information about immunization, followed by a quiz with prizes awarded. The children also enjoyed face painting and games while an EPI vaccinator administered PCV 10 to children who had previously been missed in the community.

Many other organizations across Pakistan took advantage of the day to draw attention to pneumonia, which kills more than 100,000 children in Pakistan each year and sickens many more.

Pakistan

Above: the one day event for under privileged children in Islamabad, Pakistan. Messages on pneumonia and other preventable diseases were given by doctors to children and their mothers. A quiz competition on vaccine preventable diseases and a puppet show was also part of the event. 

Photo: Huma Khawar