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This blog was originally posted on March 6, 2018 in Pajhwok Afghan News.

By Lois Privor-Dumm and Dr. Ghulam Dastagir Nazary

Afghanistan is a country under siege, but one threat doesn’t make the news. The toll is felt among the most vulnerable in an already fragile country. Every year, nearly 5,000 children under five die of rotavirus, a fast-moving and severe form of diarrhea. Afghanistan’s rotavirus death rate is among the highest of any country in Asia.  

Fortunately, Afghanistan is among the frontrunners in Asia to introduce rotavirus vaccine for children to prevent this life-threatening disease. The vaccine, which will be available for free in health facilities throughout the country, is the 10th vaccine to be introduced in the national immunization schedule.

Click here to read more.

Afghanistan Immunization Poster UNICEF

Image courtesy of UNICEF

Cervical Cancer Campaign in Vietnam

Photo above: School girls at an HPV vaccination campaign event in Vietnam.
© 2007 Amynah Janmohamed, Courtesy of Photoshare

Despite effective vaccines, screening, and treatment, cervical cancer still kills hundreds of thousands of women, most outside rich countries. Experts call for scaling up proven solutions to prevent this.

Cervical health scares have reached mainstream awareness in pop culture, between Abbie in the film 20th Century Women, Hannah on HBO’s Girls, and Sharon on Channel 4’s Catastrophe.  

While a terrifying specter to these LA, New York, and London women, cervical cancer isn’t among the top 5 cancer killers in highly developed regions. Eight of every 10 cervical cancers occur in low- and middle-income countries. While this cancer is preventable, over 230,000 women globally die every year–most in low-resource countries, like those in Sub-Saharan Africa.

As the world observes World Cancer Day this year, we issue a challenge to all to remain focused on the continuing challenges preventing us from reaching more girls and women with effective primary and secondary cervical cancer prevention services in low- and middle-income countries. It’s time to take action, to take the tools we have and start building evidence-based programs, with communities, for the future.

cervical cancer

Photo: In Mozambique, nurse Celeste Machava and Cristina José discuss cervical cancer symptoms, screening and treatment during a medical consultation (Photo: Fernando Fidélis /Jhpiego).

Primary Prevention with HPV Vaccines

More than 3 out of 4 women globally will contract HPV, the primary cause of cervical cancer, within their lifetime. Three currently available HPV vaccines have close to 100% efficacy1 at preventing persistent infection and pre-cancerous disease caused by the two HPV types that cause 70% of the world’s cervical cancer, all with minimal and mild adverse reactions. The newest vaccine directly protects against 5 additional HPV types, which together account for another 20% of the world’s cervical cancer.

Vaccines are hailed as the best buy in public health: Compared to the considerable cost of treatment and lost productivity from cervical cancer, vaccinating girls against cervical cancer is usually a cost-effective investment2 for countries, particularly in a low-resource setting.


Photo: Education and counseling is a key component in cervical cancer screening. A health care provider in Abidjan, Cote d’Ivoire is using a job aid to explain the screening results.  (Photo courtesy of Ricky Lu)

What’s next in the vaccine landscape?

1. Taking steps to reduce vaccine price and ensure reliable supply. Currently licensed HPV vaccines are expensive compared to older, routine immunizations. A global HPV vaccine supply shortage over the past few years has also affected access for girls in the highest-burden, most price-sensitive countries.

But new vaccines must show equivalence against already-approved vaccines. To do this, companies need lab tests that allow direct comparison of molecular and immunology markers—tests that don’t yet exist. Looking to the future, the U.S. National Cancer Institute has launched a new initiative3 to develop and evaluate this type of lab test, opening the way for the development of new, potentially lower-cost HPV vaccines.

2. Reducing the number of doses. The World Health Organization (WHO) recommends two doses of HPV vaccine for girls aged 9-14, at least 6 months apart. Young people who are 15 years old and older, as well as people with a compromised immune system should get a third dose. Scientists are studying whether or not a single dose, or at least a much lengthier between-dose interval, might be as good as two doses. If the results are promising, this study could remove the logistical challenge of tracking down each girl to administer an additional dose for full coverage and reduce costs.


Informational poster

Photo: Poster announcing a screening campaign in San Juan De Lurigancho, in Peru. (Photo courtesy of Ricky Lu) 

Secondary Prevention: finding and treating pre-cancers

Tools for early detection and treatment of the precursors to cervical cancer build upon a solid basis of proven interventions. Yet to effectively prevent cervical cancer in low-resource settings, there are remaining challenges:

3. Scaling up the use of vinegar to identify abnormal cells. Cytology screening, wherein lab workers inspect cells from the cervix under the microscope for abnormalities, is relatively costly and requires access to a functioning and staffed laboratory system. Visual Inspection using Acetic Acid (VIA) technique, which has been used for over a decade, is a safe, effective alternative for onsite screening where there is no lab equipment or personnel. Most well trained health workers can perform this task—task shifting is an important cost savings technique. However, VIA requires robust quality assurance and a large pool of trained providers if it is to be delivered to women at scale. 


3. Reducing test prices. HPV DNA tests are quite accurate at flagging persistent and chronic infection with cancer causing human papilloma virus. Also, while cytology and VIA require pelvic examinations, women can collect HPV DNA tests at home or at a health facility. Facilities can process many tests together to maximize cost effectiveness. However, the tests require an initial start-up investment as well as continuing financing to purchase test kits and supplies. 

4. Expanding options for freezing therapies. Cryotherapy currently uses compressed nitrous oxide or carbon dioxide to freeze abnormal cells off the cervix so normal ones can grow back. Providers who aren’t physicians can be trained to provide the therapy, but machines require reliable gas supply as well as equipment maintenance and transport. Clinical trials are underway to develop new and more practical delivery approaches. Two promising developments are the gasless Cryopen and the dry-ice based CryoPop4. Both destroy the pre-cancerous lesion by freezing the offensive tissue.  

5. Heating to destroy precancerous cells. Thermal Coagulation, in which heat at 100-120 degree Celsius is applied to the cervix to destroy precancer lesions, is being clinically and programmatically evaluated to determine its effectiveness and safety by the International Agency for Research in Cancer.

cryotherapy orientation

Photo: An orientation on cryotherapy through clinical simulation for nurses and clinical officers in Nairobi, Kenya (Photo courtesy of Ricky Lu)

What lies ahead?

We have powerful tools: safe, effective vaccines, and many tested strategies to prevent cervical cancer. We welcome your ideas about additional opportunities to leap across barriers we’ve noted, as well as many others, and address this pervasive threat to women the world over.

Mary Carol Jennings, MD, MPH, is a public health physician and a scientist at the International Vaccine Access Center, in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. She serves as the IVAC HPV Technical Lead, and her research and work focus on innovative ways to ensure equitable vaccine delivery. Reach her at

Ricky Lu, MD, MPH is a public health physician and directs the FP/RH and Cervical Cancer Prevention unit at Jhpiego, an affiliate of the Johns Hopkins University and an implementing agency operating in over 40 countries globally.  He leads the Jhpiego cervical cancer prevention effort partnering with MOHs to strengthen their prevention and control program. Reach him at


1Chow EP, Danielewski JA, Fehler G, Tabrizi SN, Law MG, Bradshaw CS, Garland SM, Chen MY, Fairley CK. Human papillomavirus in young women with chlamydia trachomatis infection 7 years after the australian human papillomavirus vaccination programme: A cross-sectional study. The Lancet Infectious Diseases 2015;15(11):1314-23.

2Brisson M, Jit M, Boily M, Laprise J, Martin D, Drolet M, Alary M, Benard E. Modelling estimates of the incremental effectiveness & cost-effectiveness of HPV vaccination: Executive summary. ; 2016. Available from:

3Cole M. New HPV Serology Laboratory Aims to Standardize Assays and Contribute to Vaccine Implementation and Access [Internet]National Cancer Institute: Frederick National Laboratory for Cancer Research; accessed Jan 21 2018, Available from:

4Varady, M. et al. (2015) CryoPop: Merging design with demand to build a low-cost cervical cancer prevention toolAnnals of Global Health , Volume 81 , Issue 1 , 201. Retrieved from:

This article was originally published on the Dengue Vaccine Initiative website and is cross-posted here with permission. IVAC is a member of the Dengue Vaccine Initiative (DVI). 

On December 9 2015, Mexico approved Sanofi Pasteur’s dengue vaccine marking the first time a dengue vaccine has been licensed for use in a country. Called Dengvaxia® and developed by the French pharmaceutical company, Sanofi Pasteur, the vaccine was approved for people aged 9 to 45 years in areas that are highly endemic, with a dengue seroprevalence of more than 60 percent.

The Dengue Vaccine Initiative (DVI) views Mexico’s licensure of Dengvaxia® as an important milestone in the fight against dengue. Recent studies have demonstrated that in children and adolescents aged 9 years and above, Dengvaxia® reduces dengue cases overall by approximately 65 percent; dengue cases requiring hospitalization by 81 percent; and severe dengue cases by 93 percent. The vaccine’s efficacy was most apparent in individuals with evidence of prior dengue virus exposure. In children below the age of 9 years and in those with no evidence of prior dengue, the vaccine’s efficacy was substantially lower. There was also an increased risk of cases requiring hospitalization during the third year after vaccine initiation in children under 9.

These results suggest that Dengvaxia® may have significant public health impact in reducing dengue disease burden for people 9 years of age and older, especially in areas with existing high infection rates of dengue. Questions remain regarding Dengvaxia®, including duration of protection, price, and impact on overall dengue virus transmission given that the youngest age groups will not be vaccinated. These and other issues will have to be closely followed in order to ascertain the ultimate impact of this vaccine.

Dengue, also known as “breakbone fever,” is caused by a virus transmitted by Aedes mosquitoes, the same mosquitoes that can transmit chikungunya and Zika virus. Dengue virus causes approximately 400 million infections globally each year. In the Americas alone, dengue’s economic burden has been estimated to cost $2.1 billion dollars a year.

DVI believes that this first vaccine licensure in a dengue-endemic country may pave the way for other countries considering new technologies to fight dengue, but stresses that the decision to introduce a dengue vaccine should follow scientific evidence. Following registration, ministries of health will still face important decisions about whether and how to introduce the vaccine into national programs. These decisions may vary according to the specific demographic characteristics, dengue epidemiology and the capacity of public health systems of each country. Therefore, DVI continues to strongly support increasing efforts to improve endemic countries’ access to the evidence needed to inform vaccine introduction decisions.

DVI also welcomes the decision by Mexico as an opportunity to increase our understanding of the questions raised above, as well as the effectiveness of the vaccine in field conditions. DVI recognizes the importance of effective integration of dengue prevention and control strategies, notably vaccination and vector-control approaches, to comprehensively reduce dengue. DVI also encourages the global health community to facilitate and support mechanisms for regional knowledge transfers and information sharing among endemic countries to collectively fight dengue and other vector-borne diseases that are also on the rise. We hope this development spurs other vaccine candidates currently in clinical development to continue to progress in the pipeline.

About the Dengue Vaccine Initiative
The Dengue Vaccine Initiative is an international consortium of the International Vaccine Institute, the World Health Organization Initiative for Vaccine Research, the International Vaccine Access Center at the Johns Hopkins University Bloomberg School of Public Health and the Sabin Vaccine Institute that specializes in research, health economics, policy and advocacy to equip countries with objective information and scientific evidence to fight dengue fever. The Initiative is supported by the Bill & Melinda Gates Foundation.

This article was originally published on Global Health Now and is cross-posted here with permission.

By: Dr. Mathuram Santosham

A healthy child in Uttar Pradesh, India, 2010 © Gates Foundation

World Immunization Week provides a moment to reflect on the tremendous progress in reducing one of the world’s leading killers of children—diarrhea.

While oral rehydration solution has significantly reduced diarrheal disease mortality since its adoption in 1978, diarrhea continues to be a major cause of childhood illness and death globally. Rotavirus, the most common cause of severe diarrhea, is responsible for approximately 40% of all diarrhea hospitalizations and hundreds of thousands of deaths in children under 5.

Rotavirus vaccines offer the best protection for children and are an essential part of comprehensive diarrhea control. While the WHO recommends that all countries introduce rotavirus vaccines, only 77 have done so, 34 of which are Gavi-eligible countries where many of the deaths occur. Unfortunately, some of the most vulnerable children and communities do not have access to the vaccine.

In particular, Asia has lagged in introducing rotavirus vaccines, even though it accounts for more than 40% of global rotavirus deaths. To date, no country in the region has introduced the vaccine into its national immunization program.

While dramatic reductions in deaths from childhood diarrheal disease have been achieved in Bangladesh, there are still more than 2.4 million rotavirus cases each year. It causes 2 out of every 3 diarrhea-related hospitalizations among children under 5. There are also serious economic consequences. One episode of rotavirus costs the average Bangladeshi family about USD $80 in direct hospital costs, a significant portion of average monthly income.

In neighboring India, where rotavirus is equally ubiquitous, the disease poses a significant financial burden to families and the country’s economy. Studies have shown that a hospitalization for rotavirus could potentially push a family into poverty or keep them there. Depending on the level of care, the total cost of a rotavirus hospitalization could range anywhere from nearly $32 to more than $135, equal to up to 2 months of income for an average Indian family. Rotavirus also burdens the healthcare system with the high cost of hospitalizations and outpatient visits. One study estimated that hospitalizations and outpatient visits cost India approximately $78 million and $86 million each year, respectively—each more than the estimated $72 million it would cost to fund a rotavirus immunization program.

For fast-growing countries like India and Bangladesh, tackling rotavirus—which cheats children and the nation of productivity, well-being and development—should be a priority. However, the available and effective rotavirus vaccines are not yet available in the national immunization programs of either country. 

Many of my scientific colleagues in Bangladesh are making a good case to their leaders for national introduction of rotavirus vaccines. And, I’m inspired by the strides being made in India. Last July, Prime Minister Narendra Modi announced that rotavirus will be included in the Universal Immunization Programme; and just last month, the first India-made rotavirus vaccine, ROTAVAC, was launched. Now is the time to get to the finish line—the cost of delaying access to rotavirus vaccines continues to mount. Together we can close this immunization gap and virtually eliminate rotavirus.

Dr. Mathuram Santosham is the Director of the Center for American Indian Health, Chair of the ROTA Council, and Senior Advisor at the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health. Dr. Santosham and his colleagues won an Honorable Mention in GHN's Untold Global Health Stories Contest for their submission of rotavirus in Bangladesh and India. GHN will feature one Honorable Mention story per month from now until the next contest in early 2016.

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.

Mar 2018