Reflections On A Year Fighting Worms
2011 has been a banner year for those of us in the global health community who are working to tackle Neglected Tropical Diseases (NTDs), especially for those of us who focus on the dreaded intestinal worms that affect more than one billion people around the world. And of those one billion, it is children who bear the brunt of the burden. Worms affect children because they are just being children – playing in the soil, exploring their surroundings, being carefree and innocent – totally unaware of the danger lurking in the very soil that is our lifeline. Thus STH, soil transmitted helminthes, infect children through casual interactions and ultimately become a constant irritant in their systems, sucking up the valuable scarce nutrients needed for their cognitive and physical development, leaving them lethargic at school or even too sick to attend.
Two significant events have occurred that will forever change the lives of children who have the misfortune of being infected by STH. The first is the realization from the global health community that something needed to be done for this significant public health problem. In 2001, the World Health Assembly collectively developed resolution WHA 54.19 that stipulated 75 percent of infected or at-risk children (approximately 600 million school-aged children) should be treated with anthelminthics (deworming drugs) to reduce the burden of morbidity from intestinal worm infections.
The second milestone came almost ten years later. In late 2010, many in the global health community realized that we were falling far short of reaching the WHA 54.19 resolution target. In response to the numbers, Glaxo Smith Kline (GSK) and Johnson & Johnson stepped up with expanded commitments of deworming medicines with a combined total of 600 million treatments. In the worst case scenario, if all the infected children needed two treatments a year because of the extremely high burden of STH, the commitment would reach about 300 million children. However, if we only have to treat children once a year, when the conditions improve and the intensity and prevalence of infection is reduced, the medicines can treat up to 600 million children. Thus meeting and, perhaps even exceeding, the WHA resolution target.
Unlike other health interventions, deworming children is relatively simple and does not require direct involvement by health care professionals. In many countries, deworming is conducted in schools with the responsibilities relegated to school teachers. In fact, that is the basis for a deworming program,Children Without Worms, borne out of the original donation of Vermoxäfrom Johnson & Johnson back in 2006. The program was built on the framework passionately advocated by Professor Don Bundy of the World Bank and others who realized early on that school systems provide a logical and effective venue for reaching children with this simple, yet impactful, health intervention.
In addition, schools are the ideal forum to disseminate education on good hygiene practices that can be readily conveyed back to the children’s families and communities. Professor Michael Kremer and his colleagues recently conducted impact studies in Kenya demonstrating that not only do children benefit from school-based deworming, but that the nearby communities also enjoyed benefits from those health interventions. Children being agents of change in hygiene and sanitation is an evidence-based approach embraced and touted by UNICEF for their successes in Indonesia, Malawi and Nigeria.
This is not to minimize the efforts required to institutionalize school-based deworming around the world. It was only after the medicines became available this past year that the global health community took a pragmatic look at what it takes to deliver the medicine to 600 million children around the world. It soon became evident that the quantity of medicines donated has outpaced the capacity of the global communities to absorb the donation and administer to the children in their schools.
To that end, the newfound interest in deworming catalyzed by the commitments from GSK and Johnson & Johnson has not escaped the proponents of children’s health and education at the World Bank and among other global health and education stakeholders, including the World Health Organization and the Global Partnership for Education. Hosts of activities are abuzz to make sure we can develop the programs that will make effective use of the valuable resources that have been committed. Much coordination is necessary to ensure that all the actors are aligning their strategies, moving forward in a coordinated fashion and not wasting valuable scarce resources. As this memorable year winds down, we look forward to jump starting an equally productive 2012 where it will be time to roll up our sleeves and ride the momentum to realize the vision of a worm-free world.
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By: William Lin, Director, Corporate Contributions, Johnson & Johnson
