What does it take to eradicate a deadly disease?

A woman holds an infant while a nurse administers an oral vaccine.

Africa is on the cusp of being polio-free after news that Nigeria—a country that has persistently battled the poliovirus—has gone one year without recording a single case of polio. Photo: PATH/Wendy Stone.

On an October night in 1977, Ali Maow Maalin didn’t feel well. He soon developed a fever that wouldn’t go away and a few days later his skin broke out in a rash. Concerned, Ali went to the hospital only to be sent home, misdiagnosed with a case of chickenpox.

At the time, Ali didn’t know that he was the last person on Earth to catch naturally occurring smallpox. He survived, but here’s the truly good news: after he was properly diagnosed, a search revealed no smallpox cases in Somalia on the local and city levels. A subsequent regional and country-level search confirmed that the virus stopped at Ali. In 1980, after the World Health Organization certified that smallpox had been eradicated, routine vaccination was discontinued around the world.

Smallpox showed us we could win the fight against a global disease.

It’s only a matter of time before a “last person on Earth” story can be told about polio.

A river runs through a village.

The poliovirus lurks in sewage and can be passed onto populations for years. Photo: PATH/Robyn Wilmouth.

Environmental surveillance: a game of hide and seek

Over the last two decades, the number of polio cases has fallen by 99 percent worldwide, thanks to global immunization campaigns. Africa is on the cusp of being polio-free after news that Nigeria—a country that has persistently battled the poliovirus—has gone one year without recording a single case of polio.

And yet, despite worldwide vaccination efforts, there are still pockets of the disease. The virus is incredibly contagious, it’s not always easy to spot, and small outbreaks can quickly spread across geographies with no consideration for borders. A dangerous proposition when international conflicts interfere with routine vaccination.

Monitoring the presence of polio is still measured by cases of paralysis (acute flaccid paralysis). But many cases are “silent,” meaning people carry the virus asymptomatically without exhibiting clinical signs of polio. Because the virus is shed through feces, the infection can pass onto populations for years, potentially sparking a resurgence.

“Because resurgence is a risk,” says David Boyle, senior research scientist in PATH’s Diagnostics Program, “we’re always asking: ‘Is the virus no longer there or are we just not seeing it?’”

Instead of waiting for cases to appear, there is an alternative approach—an early warning signal that tells us if the virus is present in the environment. And in the environment, that means looking for poliovirus in sewage.

Two men scoop water out of a river with a bag.

Surveillance and testing are important tools used to identify where diseases like polio might make a resurgence. Photo: University of Washington/Scott Meschke.

It’s a dirty business but someone had to make it more manageable

For years, environmental surveillance teams have used an aggressive strategy to identify the poliovirus before it has a chance to sicken a population. They do this by hand collecting samples of waste water that likely include sewage, which are then shipped to labs that can search for the virus.

Transporting waste water is difficult and limits how much material is used for sampling. An alternative approach is to use a tool called a “bag-mediated filtration system,” developed by Scott Meschke, a professor of environmental and occupational health sciences in the University of Washington (UW) School of Public Health, and his laboratory staff. It works by capturing polio and other viruses onto a filter, which is then shipped for testing. This allows the sampling of larger volumes, yet greatly reduces the size and weight of material shipped to the labs.

A prototype of the “bag-mediated filtration system.”

This prototype of the “bag-mediated filtration system” works by capturing polio and other viruses onto a filter, which is then shipped to a lab for testing. Photo: PATH/Robyn Wilmouth.

PATH and the UW School of Public Health have developed an all-in-one sampling kit and a processing tool to streamline testing. This team is working with polio laboratories in Kenya and Pakistan to validate the performance of the new sewage-sampling kit.

A second tool, a rapid and instrument-free polio diagnostic, can help surveillance officers test people who have symptoms that indicate potential poliovirus infection. It doesn’t require expensive equipment and has the potential to complement existing, more complex tests that are used only at regional laboratories. It may also be used as backup in areas where political unrest makes it difficult to ship samples to the regional laboratories for testing.

A man in a lab coat holds a test tube.

A fast, inexpensive polio diagnostic test can help surveillance officers test people who have symptoms of poliovirus infection. Photo: University of Washington/Scott Meschke.

The PATH and UW team recently met with global surveillance experts in South Africa and presented the project data and hands-on training of both tools. Their feedback, as well as comments from the field, are helping to refine the design and operation of these tools to optimize their performance.

“Good surveillance is crucial to monitor this approach and push the eradication strategy forward.” adds David Boyle, “It’s also important for us to know when immunization is working.”

The only way to fight polio is with immunization and vigilance

If we’re ever to tell that story about the last person on Earth who contracted polio, we need a multifaceted approach. Along with immunization, we need to continue global surveillance long after it looks as if the battle has been won. Effective tools will help confirm that the poliovirus has been eradicated at the global scale. Then, and only then, will polio be history.

More information

PATH blog post: Jonas Salk through the eyes of his assistant
• Our polio surveillance and diagnostic tools project
Press release about new polio surveillance tools

Friday Think: are condoms that detect STIs and change color a good idea?

An assortment of colorful condoms.

Photo: Creative Commons/Anina Mumm.

It takes more than a really cool idea to get an innovative solution to market.

Case in point: would you use a condom that changes color when it identifies a sexually transmitted infection? On paper, it may be a great idea, and we certainly applaud the concept and encourage young innovators (a team of UK teens won a TeenTech Award with this concept, and an invitation to Buckingham Palace).

So why does Martha Kempner make the argument that the S.T.EYE condom may not be a concept worth exploring?

Here’s an excerpt from her RH Reality Check article “No, Teens Did Not Create a Working Condom That Changes Colors if You Have an STI, and Maybe They Shouldn’t.

This condom-and-STI-test-wrapped-in-one is not coming soon to a pharmacy near you. It’s an interesting idea, but that’s all it is: just an idea. It’s a thought with theory behind it on how it might work. It has not gotten past the concept stage. There is no operational prototype.

And this raises the whole question: What makes a truly innovative solution worth taking to the next step in development? The article with a very long title continues. . .

. . . in order for their idea to work, the teens would have to figure out a way to attach the antibodies [of STIs] to latex. It’s unclear whether this is feasible, but certainly no one has done it yet. William Smith, executive director of the National Coalition of STD Directors (NCSD), told RH Reality Check, “While I can applaud these smart young people’s ingenuity in approaching a serious sexual health issue, this is but a concept and one where I think the science would be elusive in making it happen.”

It’s also unclear how expensive such a device would be. Ward Cates, a researcher who has been studying condoms for years, applauded the idea as a way to promote testing among young people, but told CNN: “It would be quite sophisticated and my guess is quite costly.” He added that testing for more than one STI at a time might be cost-prohibitive. One of the benefits of condoms as a method of STI protection and pregnancy prevention has always been that they’re very inexpensive, and thus, widely available.

Even [if] this condom were to be possible and affordable, I have some other practical concerns about the concept. It’s meant to detect STIs in both the male wearer and his partner, but that can’t happen until it comes in contact with blood, semen, or vaginal or cervical secretions. In most cases, this would mean the condom wouldn’t change colors until well into the sexual act—likely too late to provide added protection for that encounter.

Read Martha Kempner’s article in its entirety on RH Reality Check.

During the week we scour the news for the hottest stories on innovation. Our feature, The Friday Think, highlights one we’ve found particularly fascinating.

Delivering “paper doll petitions” to save lives

Images of US senators cut out and pasted onto paper doll chains.

These “paper doll petitions” were presented to policymakers on Capitol Hill by global health advocates and their children in support of the Reach Every Mother and Child Act. Photo: PATH/Allie Mooney.

Earlier this week, I took my daughters—Cleo, who is 4 years old, and Lily, who is 18 months—to Capitol Hill to meet with US senators. Although they enjoyed running up and down the sidewalk and long hallways (my girls, not the senators), we weren’t there just for fun.

We were part of a group of mothers and children who stormed the Hill to deliver “paper doll petitions” encouraging US policymakers to support an important new piece of legislation aimed at saving the lives of women and children around the world.

Heather Ignatius and her children walking to Capitol Hill.

Heather Ignatius and her daughters, along with other moms and children, stormed Capitol Hill to advocate for the Reach Every Mother and Child Act. Photo: PATH/Allie Mooney.

Continue reading »

Breastfeeding: giving a boost to babies’ best food

Women hold their infants at a clinic.

Women hold their babies at a clinic as they learn about community-based infant feeding activities. Photos: PATH/Evelyn Hockstein.

“I learned not to feed the babies [solids] straight after giving birth to them.”

Even though she’d had four previous children, it was the first time this new mother had received postnatal support, and she was pleased to share what she had learned from the community health workers. “They teach us about expressing milk, breastfeeding, and the danger signs of the baby, and that you must exclusively breastfeed until 6 months.” Continue reading »

A first: European regulators give thumbs up to malaria candidate vaccine

Group of women holding infants.

If licensed, the RTS,S malaria vaccine candidate, when used with other malaria prevention tools such as bednets, could help prevent millions of cases of malaria each year. Photo: PATH/Doune Porter.

A partnership with pharmaceutical company GlaxoSmithKline (GSK), PATH’s Malaria Vaccine Initiative, and research centers across Africa has achieved a significant scientific milestone in the quest to develop a malaria vaccine. GSK’s RTS,S (Mosquirix™) has received a positive scientific opinion from European regulators, bringing it one critical step closer to possible implementation.

RTS,S is the first vaccine against the malaria parasite that has reached this far. This positive opinion is an important step in the process of developing a vaccine for use alongside existing malaria prevention tools, such as bednets, drugs, and indoor residual spraying. The opinion underscores that it is technically possible to develop malaria vaccines, although a number of steps remain before one might be available for use. It also validates the continued investment in next-generation vaccines. Continue reading »

Friday Think: why infrastructure investments matter

Man surrounded by paper records with a computer on a desk.

Standardized information systems and strong infrastructures influence national economies, but governments must be willing to invest in them. Photo: PATH/Will Boase.

It’s not enough to make an app for a phone or develop a logistics management information system, you must also have the infrastructure—and the power—to support the technology. And without deliberate infrastructure investments, we risk getting stuck in the past.

To me, one of the defining characteristics of countries that are effectively using technology is the recognition by their respective government leadership that national-level infrastructure and standardized information systems matter if they want to grow their economies. It’s in this atmosphere that true creativity flourishes and local problems meet local solutions.

Kate Wilson

Kate Wilson, director of Digital Health Solutions at PATH. Photo: PATH.

In a recent article in the New York Times, reporter Norimitsu Onishi discusses the challenges faced in sub-Saharan Africa due to an aging infrastructure that is challenged daily to create a sufficient, reliable power supply.

Here’s an excerpt from the article “Weak Power Grids in Africa Stunt Economies and Fire Up Tempers.” Continue reading »

A day in the life of a global health advocate

Jenny Howell in front of the US Capitol Building in Washington, DC.

A passion for policy and global health led Jenny Howell to PATH, where she advocates for US Congressional support for maternal child health, immunization, and malaria control. Photo: PATH/Allie Mooney.

This is how Jenny Howell describes what it’s like to be a global health advocate on Capitol Hill:

So, you have a population, ridden with disease. You have a vaccine that can prevent that disease or an effective drug to treat it. How do you get the support of the influential people who can direct resources and shape policies to get these tools to the people who need them most? How do you get the support of policymakers?

Howell pauses to add this caveat:

You have 20 minutes to make them care.

Jenny Howell is the face of PATH’s US congressional advocacy on Capitol Hill in Washington, DC. She spends her days advocating for evidence-based policies to save the lives of women and children around the world and to stop diseases like malaria.

Supporting global health is an easier sell for some than others. Continue reading »

A very small hero and a lifesaving vaccine

Samba Sibiry and his mother.

Today, Samba Sibiry is growing up strong. In 2007, he became one of the first people to receive the MenAfriVac® vaccine. Photo: PATH.

Samba Sibiry: a hero for meningitis

In 2007, two-year-old Samba Sibiry became a hero. At the time, he had no way of knowing the significance of his role. But the part he played as a toddler was crucial in saving the lives of millions against a scourge that has plagued sub-Saharan Africa for more than 100 years.

One of the first of millions

Samba was one of the first children in the world to participate in a clinical trial of a vaccine against meningococcus type A, the strain most destructive to people living in Africa’s meningitis belt. It’s an insidious disease that can strike anyone, but primarily targets infants, adolescents, and young adults. The disease can damage their brains and spinal cords, causing deafness, mental retardation, seizures, or paralysis.

Thanks to MenAfriVac, millions of people, many of them children like Samba, will now be protected against meningitis. Watch Samba’s story. Video: PATH.

Continue reading »

Friday Think: a vaccine trial with a cosmic twist

The International Space Station.

A view of the International Space Station and Earth from the Space Shuttle Atlantis. Photo: NASA/Crew of STS-132.

Orbiting 249 miles above our terrestrial home is the International Space Station (ISS), the largest peace-time international project in human history. It’s also one of the sites of a year-long experiment involving twin astronauts, Mark and Scott Kelly.

The subject? Flu shots with a twist.

Earlier this year, both brothers received their flu vaccinations. But while Mark stayed home on terra firma, Scott Kelly took a ride up to the ISS for a year-long stint. Both brothers will continue to be studied by NASA researchers to track how extended stays in space affect human immune systems. They’ll receive a second flu shot in November, this time while Mark is on Earth and Scott is aboard the ISS.

Francesco Berlanda-Scorza, a senior technical officer in PATH’s Vaccine Development Program, is keenly aware of the challenges hard-to-reach locations can pose during vaccine trials, let alone one that is miles above the surface of Earth. He shares this perspective after reading a recent article in Time: Continue reading »

Meeting demand: access and equity in reproductive health

Jane Hutchings, Seema Kapoor, and Christopher Brady of PATH share how PATH’s work helps family planning resources reach the most vulnerable populations. Following is an excerpt from an article that originally appeared on the NextBillion health care blog.

Health worker showing an unwrapped male condom.

Around the world, there is increasing demand for family planning products and services. Here, health workers are demonstrating proper condom use. Photo: PATH/Felix Masi.

For decades, governments in low- and lower middle–income countries have been, often with significant development assistance, the primary provider of health care services, including family planning. What happens when public-sector and donor resources cannot meet demand?

Against a backdrop of 1.8 billion young people entering reproductive age—the largest cohort in the history of the world—many governments across the globe are committing to expanding access to contraceptives and family planning services. Yet, public health systems alone cannot keep pace with the growing demand. Beyond the public sector lies the private sector, which consists of nongovernmental organizations, a range of social marketing organizations providing subsidized products and services, and the largely untapped potential of the commercial sector. Using the total market—strategically working across all sectors—is one way to effectively deploy resources to meet family planning needs. . . . Continue reading »