This is the second in a series of profiles to help IVAC partners and friends get to know our team. This one features Chizoba Wonodi, an epidemiologist who leads IVAC’s Nigeria work. We caught up with Chizoba just before she made a big move back to Nigeria with her family. After living in Baltimore for 10 years, Chizoba will now represent IVAC in country, and she will dig deeper into efforts to work with the Nigerian government and other stakeholders to improve routine immunization and increase accountability.
Tell me a bit about your background and when you joined IVAC.
Before coming to Baltimore, I worked as a physician in Nigeria, concentrating mostly on adolescent sexual and reproductive health and HIV/AIDs prevention. I came to Johns Hopkins for my masters in public health and, after that, I went on to the DrPH (Doctor of Public Health) program, completing both programs as a Gates Institute Scholar. In 2006, in my third year of the doctorate program, a colleague introduced me to the PneumoADIP project that would later morph into IVAC. I thought the whole concept of accelerating access to vaccines was novel and cool and I wanted to be part of it. So I sought and got work as student research assistant with PneumoADIP.
When I graduated from my doctoral program in 2009, I joined the Hopkins faculty knowing I wanted to focus my work on Nigeria. My desire has always been to take what I learned at Hopkins and apply it to my home country. At IVAC, I have been able to do just that. My work is to support the Nigerian government in developing effective policies and programs to deliver life-saving vaccines to children. We work alongside many organizations, including the WHO and UNICEF, in helping the government build stronger immunization systems. We do this through policy and operations research, translating evidence to policy, and brokering or advocating for relevant interventions. Instituting accountability within the health system is also a big part of my work in Nigeria.
Chizoba Wonodi with her niece. (Photo credit: Tyrone Shoots)
What inspires you to work in global health?
I think the potential to make a difference on a large scale drew me to global health. I came to this realization after medical school, when it was time to choose a clinical specialty. I considered pediatrics because I love children, but I didn’t have the affinity for one-on-one interventions when thousands were dying of preventable causes. I wanted to change things at a broader level. With public health, you can see how the policies and programs you implement affect large populations.
What does it mean for you to be doing work to help Nigeria?
It is a privilege because not everybody has the opportunity to come to Johns Hopkins, a world-class institution, and receive training from the best in the field and work beside them. It is wonderful to be able to take what I learned here back to Nigeria and try to make a difference there. However, it isn’t just about taking knowledge back, but also learning from the dynamic changes that have occurred in Nigeria.
Can you explain the kind of dynamic changes Nigeria has gone through?
There is more human capacity than before. In the last decade, a crop of globally educated public health revolutionaries – if I may call them that – have returned home with cutting-edge knowledge, skills, and attitudes. They’ve melded the global perspective with their local knowledge and sensibilities and have become a force for change. They resist doing business as usual and push for decisions to be evidence-based. They are forging partnerships in unusual places, demanding accountability, and focusing on results not just inputs.
Chizoba Wonodi at the National Vaccine Summit in Abuja, Nigeria, April 2012. (Photo courtesy of Tyrone Gibson)
In the vaccine world to be exact, there has been a growing awareness of and greater access to new vaccines. For instance, Haemophilus influenzae type B (Hib) vaccine was introduced last year, hopefully next year, pneumococcal conjugate vaccine (PCV) will follow. Although it took more than 15 years for these new vaccines to become available in the country, the momentum is shifting rapidly as more stakeholders acknowledge the importance of immunization. In April 2012, we saw a massive outpouring of support and promises at the National Vaccine Summit. Many hands are now on deck to help prop up the routine immunization system, and we are seeing positive results. Top among the donors is GAVI, who provides the single largest investment in routine immunization in Nigeria. As more partners come on board, the program space gets crowded and the pace quickens. It is all very exciting. However, one has to be nimble and responsive, to be relevant.
What has been your most rewarding or memorable experience at IVAC?
Seeing the impact of the policies we’ve helped influence result in access to new vaccines for children has been most rewarding. I remember when I came to the PneumoADIP and we were working on the introduction of PCV into developing countries. At that time PCV was considered too expensive for poor countries, but by getting countries to recognize the burden of pneumococcal disease, by convincing vaccine manufactures that there was a market beyond Europe and America, and by mobilizing the right financing, we (and others) helped accelerate PCV introduction into Africa and Asia.
Six years later, it is gratifying to see PCV introduction has outpaced earlier projections. This means many more children (in the millions) are being vaccinated and protected than we ever thought possible. There aren’t many opportunities where you get to contribute to change as big as that.
At the National Vaccine Summit in Nigeria (left to right): Dr. Ado Mohammad, Executive Director of the National Primary Health Care Development Agency; Dr. David Okello, former WHO Representative for Nigeria; and Dr. Chizoba Wonodi, Epidemiologist and Nigeria Projects Lead at IVAC. (Photo courtesy of Tyrone Gibson)
Wow, that sounds wonderful but also very demanding. What do you do in your free time to relax?
I like to cook. I watch the Food Network to learn new recipes. I love Asian food so I started learning to cook Chinese and now Korean food.
Speaking of cooking and eating, if you could have dinner with anyone – alive or dead – who would you pick and why?
I would choose Nelson Mandela. I don’t think there is anyone in the world as loved and as esteemed. I would like to feel the essence of the man and understand what makes him stand out so much. It would be a wonderful opportunity to learn from someone who has so much compassion, knowledge, and wisdom.
So through our conversation so far, it is obvious you are very proud to be Nigerian. What about Nigeria do you like best?
I love the people. We are proud and very happy people. In fact, there was a study that found Nigerians are the happiest people on earth. You wouldn’t think that given all our challenges and issues; but that is just who we are. We are very welcoming and very hospitable. And I love that when you meet a Nigerian, they proudly proclaim they are Nigerian.
What is your wish for Nigeria?
My immediate wish is that the 2015 elections will come and go flawlessly without any major upheavals. I also hope that the bloodshed in the north will stop so people can get back to living their lives. And I wish that Nigerian leaders would recognize and build our biggest resource – our human resources. Part of that includes making sure girls are educated. Once girls are educated, half the job is done in terms of alleviating poverty, adopting healthy behaviors, and nurturing the next generation.
Lastly, if you could visit anywhere in the world, where would that be and why?
Bhutan. I had a colleague that worked at the Hib Initiative who visited Bhutan. It is very difficult to go there, and you need to have a special reason to visit. My colleague went as a part of a vaccine delegation and she said the country is just pristine, the air is clean and clear, and you can hear birds chirping everywhere. I would love to see that country which has been unspoiled by modern life.
This is the first in a series of profiles to help IVAC partners and friends get to know our team. We thought we’d start with Lois Privor-Dumm, a long-time IVAC team member and Director of our Alliances and Information team. We caught up with Lois in between her busy travel schedule to chat about her background, her work at IVAC and what she likes to do in her spare time.
Tell us a bit about your background, what inspired you to work in global health, and how you ended up at IVAC.
I didn’t set out to work in global health, but I’ve always wanted to work internationally. I spent most of my career in the private sector and was fortunate enough to have the opportunity to launch Prevnar®, the first pneumococcal conjugate vaccine (PCV), in the U.S. and then help other countries around the world introduce the vaccine. I had worked with other vaccines and pharmaceuticals, but this experience, coming in direct contact with families impacted by pneumococcal disease, particularly meningitis, made a major impression. I saw the value that the vaccine had for countries that had introduced, but also recognized the severe disparities that existed in vaccine access around the world. I decided I could play a role in helping reduce those disparities. Although I was able to influence some change while working in pharma, I thought I could make a bigger impact by bringing my understanding of the industry and my marketing and operations experience to public health. I was fortunate to be working with experts on PCV, including Orin Levine, Mathu Santosham and Kate O’Brien, who recognized how my perspective – despite my non-traditional background for a public health career – could be beneficial. We shared the vision that new vaccine introductions did not need to see delays of 20 years or more between licensure and introduction in low-income countries, and helping devise and implement a plan to achieve this goal was very intriguing to me.
So, I first joined Hopkins in 2005 as Director of Communications and Strategy on the Hib Initiative and soon after took on the role of Director of Access and Implementation, and later Communications, for the PneumoADIP. Our approach of addressing the needs of all stakeholders – countries, donors and suppliers – proved to be an effective way to achieve our vision, and we’ve been fortunate that we’ve been able to continue our mission through what is now IVAC. I consider myself very lucky to work with such a diverse, creative and talented team. I think it is the team and the way we work that has enabled us to work on some really tough challenges that have a big impact and achieve success.
I’m also a strong believer that there are always solutions and, at Hopkins, I value the opportunity to help facilitate those solutions, bringing both a manufacturer perspective and that of someone working with global health colleagues and country leaders. There’s been significant progress in vaccine access in the past decade or so, and I hope our work will continue to accelerate greater access and equity for vaccines and other interventions that make such a difference in peoples’ lives and contribute to healthier and more productive societies.
What projects do you work on at IVAC?
Lois Privor-Dumm and a group of children at the 1st National Vaccine Summit in Abuja, Nigeria in April 2012.
I lead the Alliances and Information team at IVAC, which includes projects covering advocacy and communications – both globally and in-country – as well as policy research and supply and access issues. I spend a great deal of time on our country-focused work, namely India, where we have been working to synthesize the evidence base and advocate for interventions for pneumonia and diarrhea at both the national and state level, and Nigeria, where we have helped analyze barriers and solutions to improve routine immunization and continue to provide technical support and encourage government accountability. I’m also excited that we’ve recently added country work with Pakistan.
Our work is varied, and there is never a dull moment. Our efforts have helped others become advocates and add their voice to important issues in child health. For instance, we’ve run advocacy workshops and collaborated with a network of trained experts to address child pneumonia and diarrhea in their countries. We support the efforts of experts including the ROTA Council, a dedicated council of scientific experts working to accelerate the introduction of rotavirus vaccines, and the Global Coalition Against Child Pneumonia. With the help of key partners, we established World Pneumonia Day to call for action on protection, prevention and treatment of the leading global killer of children. Our team also coordinates closely with IVAC’s Epidemiology and Economics & Finance teams to help communicate the results of their work and highlight the work of other researchers that relates to vaccines and child health.
Last but not least, I spend much of my time on our supply and access work, which is also very important. One of our more recent projects centers around primary container decision making and building awareness of how these seemingly straightforward decisions have significant impact on not only cold-chain space and procurement cost, but also wastage and other costs, vaccine coverage, and safety. We’ve developed a framework and have been working with various experts to help advocate for a more robust approach to considering all the implications of these decisions.
I’d be remiss not to mention, that none of this, of course, could be done without the great team of hard working and very capable individuals and students on the A&I team.
What have been some of your most rewarding or memorable experiences at IVAC?
One of my most memorable experiences was my first week at Johns Hopkins. I was working with the Hib Initiative and went to the Gambia and Bangladesh to film the BBC World Kill or Cure: Hib documentary, which highlighted the impact of the disease and efforts needed to bring a vaccine to developing countries. I remember meeting people at the labs and families that had been affected by meningitis and seeing how dedicated they were to finding the solution. I have great memories from that trip, for example touring the lab at MRC and then having tea with a family in the Gambia with little kids around very curious about all of our cameras. Bangladesh was no different, although it was tough seeing a child and her mother who did not know whether her daughter would survive the night or succumb to a severe case of pneumonia.
Another big moment was the first World Pneumonia Day in 2009 and seeing that kick off not only in the U.S. but probably more importantly around the world. That sense of pride continues when I see how many other people have taken up the cause. As we move into World Pneumonia Day’s fifth year, I am increasingly impressed by the level and volume of activities that take place – creating a global community of sorts. The fact that people are talking about antibiotic access, bringing new vaccines into countries, improving breastfeeding rates – it is very gratifying.
What is the most interesting place you’ve traveled to? Anyone who has seen your passport will know this will be a tough question to answer.
Yes, it is. Everywhere I’ve gone has been interesting. Large countries hold a lot of interest for me simply because of the level of contrast you see within the same country. I’m always struck by the disparities within the countries, but at the same time, the level of hope and generosity of those that don’t have much. I am fascinated by the diverse modes of transportation like the trucks that are brightly painted with “honk please” signs in India and Bangladesh, navigating the same roads as people walking with bundles of firewood on their heads or families piled three or four onto a small motorbike seat. In Nigeria I’ve been captivated by the people and the diversity of just about every aspect from dress to food, language and density of the population. And in some countries you’ve got such a long history that can’t help but impact you – Angkor Watt in Cambodia, Petra in Jordan, and slave quarters in Africa – it reminds me of how far the countries have come, yet how much more is still to be achieved.
Since you spend a lot of time in India and Nigeria, what similarities and differences do you see between the two?
Lois Privor-Dumm and fellow participants at a national course on pneumonia and diarrhea prevention in Delhi in December 2012.
That’s a great question. I’d love to hear the perspective from those who live in one of the two countries. From my perspective though, they are similar in that they both have some wonderful, high caliber people. Both have large bureaucracies and complex environments, and I’m always impressed by
individuals who’ve been great champions of children who’ve successfully been able to navigate the environment and overcome some real barriers to getting things done. The real heroes are the ones who’ve been able to not just talk about change, but have been able to see things through, and there have been examples in both places. Another similarity is that health is very much a state subject, and implementation and sustainable change is highly dependent on the individual states. As different as priorities and ways of life are between these countries, the same can be said of individual states, and it is important to understand the priorities and players in each.
Both countries obviously have had to tackle an ongoing challenge of polio, and the related challenges and opportunities of an enormous vaccine effort. India has now gotten ahead of the curve with no cases of wild-type polio for the past two years. Nigeria still faces many challenges with polio, but has moved ahead to strengthen routine immunization and add new vaccines.
One major difference may be in the way vaccines are portrayed in the press in each country. Although the dialogue is changing and more and more positive stories emerge surrounding vaccines, media in both countries still often like to report on sensationalist stories that do not hold scientific muster, and controversy reigns. Politicians and bureaucrats often do not recognize how political capital can be built by improving routine immunization. In Nigeria, although there are anti-vaccine sentiments, particularly surrounding polio in certain areas, health is an important issue, and leaders will take advantage of reporting on the steps they’ve taken to combat disease.
On a related note, what progress have you seen in vaccine access in India and Nigeria recently, and what do you expect to see in the next few years?
I think there is much more recognition in both countries that the systems must be strengthened, infrastructure for delivering polio immunization can be leveraged, and that a focus on bringing up routine immunization coverage will benefit new vaccines and vice versa. There has been a greater level of engagement at the state level, and I expect that this will become increasingly important moving forward. As states are implementers and must ultimately ensure that there is both adequate demand and supply, their engagement in the planning and decision-making process is key. Another area that should see improvement over the next few years is surveillance, not only to be able to measure the impact of the vaccines but also to be able to monitor any adverse events that may happen and to quickly determine if they are related to the vaccine. This has especially been a challenge in India, where activists and media have questioned whether adverse events are due to vaccine and have treated government assurances with suspicion. Good surveillance with baseline measures of child health statistics prior to introduction will make it easier to assess claims and address concerns that may be unfounded, as well as provide a basis for measuring the trends and impact that are so important to communicate to sustain public and policy maker support for vaccines.
On a personal note, when not traveling internationally, you split your time between Baltimore and West Chester. What do you like about each?
Yes, both places are great. West Chester is where I’ve lived for a long time, and where I spend a part of the week with my husband and dog. It is a historic city with brick sidewalks, and a small town where I’ve gotten to know a lot of people over the years. I consider it home, although I am originally from upstate NY. Baltimore is a great city. I love where I live in Fells Point, right by the water. I’ve got great colleagues and friends in the city, and the ability to walk to work is a huge bonus!
Do you have any interesting hobbies?
I like doing things outside, including spending time gardening, hiking and exploring different places old and new. But, there is no place I’d rather be than under the water diving (although on safari is a close second). I’ve been diving since 1992 and try to go every year. One of my favorite places is the South Pacific where you have just an amazing range of color and variety of marine life – sharks and eels and all sorts of different things. I think I like it because I’m an explorer at heart, and you never know what you’re going to find down there, and it’s a way to really relax.
What is the most recent book you’ve read?
I just read Cutting for Stone about a doctor from Ethiopia and am now reading Behind the Beautiful Forevers – Life, Death and Hope in a Mumbai Undercity. I like reading about places I’ve been or would like to go. I also have been reading some of the excerpts from an international thriller novel a friend of mine is working on publishing – can’t wait to see that in print.
Ok, just one last question. If you could have dinner with anyone, alive or dead, who would you pick and why?
That is a really tough question. Can I just throw a party?! I’d love to meet famous women who have made a difference – like Aung San Suu Kyi or, closer to home, Hillary Clinton. They are role models for how you can help change the world. And then there are people who I’m just starting to hear about who are doing some cool things with social innovation – not as well known of course, but just as inspirational. Coming from a business background, I’m interested in hearing about new ways to solve the world’s problems.
By Kelly Healy
When I first traveled to India as part of my master of public health program,
Participants at Hib Symposium in Odisha, India in July.
I left feeling inspired to do something to help India’s children and families. Less than a year later, now at The Johns Hopkins University as a new research associate for IVAC, I had the opportunity to return to India as part of a team working to accelerate vaccine introduction to reduce child deaths from pneumonia and diarrhea. While there, I was able to see in real terms the impact efforts by IVAC and its partners have had.
I traveled to Bhubaneswar, a “small” city, if only by Indian standards, with a population of less than 900,000, that is the capital of Odisha. There, on July 9th, technical experts, government officials and other key stakeholders gathered for a one-day Hib Symposium, hosted by the policy unit of the National Institute of Immunology along with the Asian Institute of Public Health and designed to share data and experiences related to Hib disease and available interventions, including vaccines. While lesser known than pneumococcus, Hib or Haemophilus influenzae type b is a leading cause of pneumonia, the top killer of children in India and worldwide. It is also the leading cause of meningitis, which can result in death or serious neurological sequelae.
In 2010, nearly 400,000 deaths of Indian children under five were caused by pneumonia. While Hib vaccines have been proven to reduce cases of pneumonia and have been available for more than a decade, uptake has been slow in India especially in the public sector. However, that seems to be changing now, as more Indian states have expressed interest in adding Hib vaccines to their immunization programs, which would make them available at government clinics that reach the lower income populations who are at greater risk of dying from diseases like pneumonia and meningitis.
Media coverage of Hib Symposium.
Two states, Tamil Nadu and Kerala, have already introduced Hib vaccines (in the form of the pentavalent vaccine, which also protects against diphtheria, pertussis, tetanus and hepatitis B), and six more are slated to do so by the end of 2012. At the symposium, Ministry of Health and Family Welfare officials shared that eight more states have expressed interest. Judging from press coverage of the event, other states may not be far behind. All of this is great news for champions who have been advocating for Hib vaccines for several years, and a sign that Hib vaccine support may have reached a tipping point in India. The current momentum is driven by Indian technical experts and advocates like those who gathered in Bhubaneswar and other stakeholders at the center who recognize the important contribution of the vaccine. Our team at IVAC and its partner Global Health Strategies, Emerging Economies, are proud to offer technical assistance and opportunities to provide insight from other countries’ experiences and enable forums like the Hib Symposium.
However, many pieces of the puzzle still need to fall into place to gain widespread coverage of Hib vaccines among Indian children. In that light, state government representatives from Tamil Nadu and Kerala gave their peers at the symposium helpful insights from their rollouts, in particular highlighting the importance of pre-launch activities including evaluating the cold chain, training staff, establishing monitoring systems for adverse events and sensitizing policymakers and the media. They noted it was especially important to prepare stakeholders for the potential of adverse events following immunizations (AEFIs). One child died in Kerala after receiving the pentavalent vaccine, but thanks to sensitization efforts for government officials and a swift and clear response to the media, the state was able to quickly confirm the death was not caused by the vaccine and avoid derailment of the vaccine rollout. With careful preparation, Kerala and Tamil Nadu were able to carry out smooth launches and vaccinate more than 600,000 children in the two states combined through June.
I am excited to join the team here at IVAC at a time of such promise for India and look forward to seeing more progress in the coming months and years.
Kelly Healy, MPH, is a Research Associate at IVAC.
By Geoff Kahn
I must admit, I’m still fairly new to IVAC and to the kind of work we do here. A year and a half ago I worked in a lab, and the only contact I had with the outside world was when the FedEx delivery man would drop off a batch of new samples. Now I collaborate with doctors and other scientists halfway across the world. Specifically, I work in India, and I’ll tell you that at least as far as public health is concerned, 2012 is off to a good start:
On January 13 India celebrated one year without a new polio case; the introduction of the Hib-containing pentavalent vaccine that was launched in two states on December 14 and 17, 2011 continues unabated; and this month a hospital in Chennai will begin using a new, state-of-the-art real-time PCR machine to examine the causes of childhood meningitis with greater precision than ever before. While not as prevalent an illness as pneumonia or diarrhea, meningitis is nevertheless a fearsome disease due to its high mortality rate even in settings with advanced healthcare and its propensity for leaving up to a third of survivors with permanent disabilities, including deafness, mental retardation and seizure disorders. It is also linked inexorably with the more widespread pneumonia, as several bacteria species, notably Hib and pneumococcus, are leading causes of both diseases. The Institute of Child Health and Hospital for Children in Chennai, Tamil Nadu, is one of several sites in India where IVAC has been providing technical assistance to ICH to conduct surveillance of childhood meningitis. Their new PCR machine will enable scientists and doctors to test for over 10 different species of bacteria and viruses with greater sensitivity, leading to improved understanding of the causes, and therefore the means to combat, childhood meningitis in India.
But, to me, this machine is as much a symbol as it is a tool. It is a symbol of what is possible when local dedication, technical expertise, and international support come together. See the transformation that has been wrought:
Left: Not terrible, but also not much more than a box: cluttered space, no laminar air flow or UV lamps to keep things sterile. Right: That’s the new PCR machine in white, and yes, it is so fancy that it requires its own dedicated computer.
As impressive as it is, one is sobered by the realization that with success comes raised expectations. This hospital in India now possesses technology on par with any machine to be found at the CDC in Atlanta; it possesses scientists trained to use that technology, and it already possesses a commitment from the state government to take over funding the PCR work in 2013, once the support from IVAC ends. As advances like new machines, new vaccines, the fall of polio are made, the shortfalls - maternal and <5 mortality rates that are currently trending to fall short of MDG goals, malnutrition that runs rampant, gender equity that remains elusive - become less and less tenable. It is great that India is making the advances that it is, and it has been wonderful to work with the doctors and researchers in Chennai and elsewhere, but we (IVAC, the public health community, perhaps you, dear reader?) must always be wary of stopping too long to rest on our laurels. It has been my pleasure to share the accomplishment of our partners in Chennai, but now, if you will excuse me, it’s time to get back to work.
Geoff Kahn is a Research Associate at IVAC.