New tools to help strengthen local advocacy skills

This post’s author, Rachel Wilson, is senior director of Advocacy and Policy at PATH.

Group seated outdoors, listening to two men standing and speaking. Photo: PATH/Eric Becker

Local leaders in Kenya gather for a community meeting. Photo: PATH/Eric Becker.

At PATH, we focus a lot of attention on global health technologies, tools, and delivery innovation. Over the years, that’s been our strength. Our work has accelerated progress in improving the lives of hundreds of millions of women and children around the world. It’s work I have been proud to advocate for over the last eight years.

Portrait of Rachel Wilson.

Rachel Wilson. Photo: PATH.

Many will argue—myself included—that all too often there’s been a top-down approach to addressing public health at the global level: donor country “w” funds “x” project in country “y” that is “accomplished” by “z” international nonprofit organization.

Where does the local community fit into this equation?

More and more attention is being placed on this important question. And rightfully so. It isn’t that previous efforts have completely left the local community out—local support and involvement have always been essential components to in-country public health work. Where more attention—innovation even—is needed is on building the capacity for local advocates to advance policy change in their own communities and for countries to more efficiently bring lifesaving innovation to their neighbors and citizens.

Group of people sitting, raising their hands, and listening to a woman gesturing and speaking. Photo: PATH/Eric Becker.

Local Kenyan woman leads a group discussion. Photo: PATH/Eric Becker.

There are a growing number of successful efforts to build advocacy capacity at the local level that have contributed to current health gains. PATH is working to create sustainable advocacy impact in the communities we and our partners are serving now and in the future. This work helps ensure that our innovation in products, tools, and health system delivery have the greatest impact.

Graphic of PATH's 10-stage advocacy framework.

PATH’s 10-stage advocacy framework offers guidance for achieving advocacy success at the local level. Click the image to see a full-size PDF (562 KB).

Through years of development of testing of advocacy approaches in the field, PATH has developed an accessible ten-part advocacy impact framework (562 KB) that provides a deliberate method for achieving advocacy success at the local level. Our approach to advocacy is practical, outcome-oriented, and designed to build the skills and knowledge needed to foster positive policy change. Local advocates can independently apply these skills toward their local needs and goals. Local agenda setting is our top priority, and it is working.

We have been fortunate enough to work with partners in more than 50 countries, primarily within Africa and Asia, to strengthen their ability to influence policy changes that support local health objectives. I knew we were starting to reach our goals when our partner at African Family Health in Kenya told us: “I have used the methodology to assist three national civil society organizations to clarify their advocacy goals and objectives and to craft advocacy messages to articulate concerns about service delivery around the free maternity care policy in Kenya. The communiqué has now been delivered to the president in person by key religious leaders.”

Group sitting outdoors and listening to a man gesturing with one hand. Photo: PATH/Eric Becker.

A group meets in Kenya to discuss family health. Photo: PATH/Eric Becker.

Each of our partnerships is tailored to the specific needs of the clients we serve, with a specific focus on local ownership, cross-sector learning and networking, and close collaboration among advocates and technical health experts and practitioners.

Learn more about our advocacy tools and capacity support. No matter what the health issue, we aim to help new and experienced advocates maximize their advocacy impact to extend the scale and sustainability of effective solutions. We’re ready for whatever is next—let us know how we can help!

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Zambia: eliminating malaria step by step in the hot zones

Four children smiling up at the camera.

The Zambian government has set a goal of near-zero deaths and five malaria-free districts by 2016, and PATH is playing a lead role in supporting the country’s efforts. Photo: PATH/Dana Terry.

Editor’s note: This is the third in a three-part series of blog posts by PATH’s president and CEO Steve Davis about his experiences visiting PATH programs in three African countries this summer. The first post, from South Africa, is about community caregivers, and the second post is about cervical cancer screening in Uganda.

Blue lake with peninsula.

Lake Kariba, Zambia. Photo: PATH/Lynn Heinisch.

Lake Kariba in southern Zambia is absolutely stunning. The world’s largest artificial reservoir is rich with fish, birds, crocodiles, hippos, and islands—and the lake’s shoreline town of Siavonga boasts a thriving tourism business. This beautiful area is also a breeding ground for the mosquitoes that carry malaria and is on the front lines of the Zambian government’s efforts to combat the disease.

When I met with Zambian Minister of Health Dr. Joseph Kasonde, he emphasized that the goal is not a “malaria-free Zambia” but malaria-free Zambians—stopping transmission of the disease by targeting the malaria parasite reservoir in humans. PATH is tackling malaria on many fronts, including improved drugs, diagnostics, vaccines, and systems. Key to this work is building evidence to support broad-scale use of these new innovations.

Portrait of Steve Davis.

Steve Davis is president and CEO of PATH. Photo: Auston James.

At Lake Kariba, I met more than 50 community health workers, participants in a PATH-led training session, who are helping to reduce malaria in the country’s Southern Province. These men and women hike—sometimes as far as 12 miles—into hilly regions that are often inaccessible by vehicles to test and treat people and ensure they have preventative measures like insecticide-treated bednets. Such remote areas often are the “hot spots,” the breeding grounds that contribute to the spread of malaria.

“Malaria is a killer disease,” said Marie Antoinette Musanabera, a trainer from the Ministry of Health who attended the workshop. “For us to bring services closer to the community—to bring services to their doorstep—that is how you break the chain of malaria.”

Health worker drawing a drop of blood from a man's finger.

During the training, community health workers practiced using rapid diagnostic tests for malaria, which require taking a drop of blood from the patient’s finger and give results within 15 minutes. Photo: PATH/Lynn Heinisch.

Community health workers are the heroes of global health, and they have been instrumental in making Zambia a malaria success story. Health facilities reported a 66 percent decline in the number of malaria deaths from 2000 to 2009; the drop was especially steep after distribution of 3.6 million long-lasting insecticidal bednets between 2006 and 2008. During this period, parasite prevalence declined 53 percent nationwide. In recognition of the country’s achievements, in 2013 the United Nations awarded Zambia the African Leaders Malaria Alliance Award.

The Zambian government has set a goal of near-zero deaths and five malaria-free districts by 2016, and PATH is playing a lead role in supporting the country’s efforts. Our approach builds on successful methods (such as using bednets, insecticide spraying, strengthening surveillance and data reporting, and testing and treating). We also pilot new tools and strategies, such as proactively providing drugs that halt malaria transmission by killing the parasite even if someone is not showing symptoms and which temporarily prevent people from being reinfected. The lessons learned from PATH’s Malaria Control and Elimination Partnership in Africa (MACEPA) program in Zambia and three other countries (Ethiopia, Kenya, and Senegal) will inform subsequent adaption and adoption of these methods across Africa.

Group of children and adults holding packaged insecticidal bednets over their heads.

Future malaria-prevention efforts build on the experience learned in previous projects, including bednet distribution and other strategies. Photo: PATH/Paul Libiszowski.

The Siavonga residents shared with me the impact they’ve seen from the collaboration to reduce malaria in Southern Province.

“During the times of peak months (rainy season), we used to have a lot of people in the hospital,” said Florence Namwanza, a mother of six, who described her bouts with the disease and its symptoms of sweating, vomiting, fever, and backache. “Now, there are not so many.”

The district representative emphasized the large-scale implications of this effort. “Once malaria is controlled, the outlook of people’s lives will be better,” said Dr. Phallon Mwaba. “They will be more productive in fishing and farming. It may look today like we are just trying to control malaria but, ultimately, it will affect the economic status of the people.”

Steve Davis conversing with a gesturing man.

During breaks in the training, I spoke to many of the community health workers about the challenges of combating malaria in rural Zambia. Seeing their conviction was inspiring. Photo: PATH/Lynn Heinisch.

Malaria is estimated to cost Africans $12 billion a year, including the cost of health care, days off school and work, decreased productivity, and loss of investment and tourism. The disease kills an estimated 630,000 people a year, most of them African children.

The good news is that increased prevention and control measures have led to a reduction in malaria mortality rates by 42% globally since 2000. During this period, PATH has made tremendous strides in research and development for new tools and in partnering with governments to scale up malaria prevention and control. Across PATH, more than $79 million is committed to malaria activities this year alone, and our portfolio of malaria programs and projects includes more than 125 staff members.

Globally, there is growing interest in finding new tools and approaches to reduce the burden of malaria and to accelerate progress towards the goal of eradication. Because of its remarkable progress, Southern Province offers a good test case for elimination. Once methods are proven successful there, they can be scaled up to the rest of the country. If successful in its quest, Zambia would be the first country in sub-Saharan Africa to achieve this transformation.

Some of the men and women I met at Lake Kariba have been doing this work for decades—and their hard work and commitment is paying off. Seeing their dedication and that of the government representatives renewed my conviction that, together, we can turn the tide.

One of the trainers summed it up like this: “The major reason we are here is to actively detect malaria parasites in people and treat them, to ensure that we have cleared them, in the hope and belief that one day we will be free of malaria.”

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Projecting health: the power of locally made videos to change behavior

The Projecting Health project empowers communities to use inexpensive video gear to create and screen locally made health education videos. Video: PATH.

Suman Patel is beaming. You can see her pride in the pleasure in her smile and her eagerness to talk about her latest efforts as a community health work in rural India. She’s succeeding at one of the biggest challenges in community health—getting people to change their habits in favor of healthier behaviors.

Her secret? Amateur actors, simple video production equipment, a low-cost portable projector, and a white sheet. She’s a part of PATH’s Projecting Health project, empowering local communities with the skills and digital tools to create health education videos customized for local contexts, customs, and dialects. In the process, she’s part of an innovative shift—made possible by recent advances in digital technology—that empowers neighbors and peers to be onscreen messengers encouraging behavior change in their communities.

Man directs two women having a conversation as a woman films them with a smartphone on a tripod.

The Projecting Health project empowers communities to make locally appropriate, technically accurate health education videos. Photo: PATH/Branded Filmz.

The power of peer persuasion

Until about a year ago, Suman tried to influence pregnant women in her mothers’ groups through talks and games. Her visual tools were limited to posters and flip charts. While she had some success, she knew her toolkit was often not compelling enough to convince all of the women to change key behaviors.

Tiny video projector is adjusted by a woman's hand.

The increasing availability of inexpensive video technology makes the Projecting Health project possible even in rural communities. Photo: PATH/Branded Filmz.

Now she and other community health workers collaborate with village women to identify pressing health topics and train them to produce, act in, and edit videos that address local barriers to change. Enlisting local women to star in the videos is a key element, says Suman, because “people trust them.”

Fortunately, “there is no shortage of people who want to act in the videos,” says Kiersten Israel-Ballard, director of the Projecting Health project, who adds, “I’ve never worked on a project that was quite so community-driven.”

The women watch the videos in mothers’ groups and at village health and nutrition days. Seeing the topic played out on the screen (typically a sheet draped on a wall) by people they identify with leads to a more enriching discussion and sharing of experiences. If the women don’t understand something, they replay the video and discuss it until they do.

Women sit in a circle and discuss a video that is projecting onto a sheet hung on the wall behind them. Photo: PATH/Branded Filmz.

Women watch the Projecting Health videos in facilitated groups and discuss what they are learning. Photo: PATH/Branded Filmz.

Revolutionizing behavior change

Based on the project’s success in India, PATH and our partners plan to expand the Projecting Health model to countries in Africa and to other health topics, such as immunization, family planning, and adolescent health for girls. Says Dr. Ballard, “We feel it’s a method that can completely revolutionize behavior change across health topics.”

She and her team are particularly enthusiastic about how quickly the project is reaching a wider audience. So far, 35 videos have been made on such topics as breastfeeding, immunization, and preparing for childbirth. They’ve been screened locally more than 4,200 times and been played well over 40,000 times on YouTube.

Two men in colorful robes tiptoe across a carpet behind a smoking pot to speak to a man sitting on the ground.

Many of the videos are funny and engaging while delivering serious messages. Photo: PATH.

That the videos are accessed that often on YouTube is fantastic, but even more exciting is that women have taken the next step on their own. “We knew we wanted to take this mobile,” says Dr. Ballard, “but unbeknownst to us, the community had already figured out how to download the videos onto their cell phones. Women are showing the videos to their husbands and mothers-in-law and friends. The potential reach is huge.”

Early findings from a project evaluation make clear that all that viewing is having an impact on maternal and newborn care practices. Women who took part in Projecting Health showed significant improvements in their knowledge and behaviors around such critical activities as preparing for childbirth, breastfeeding, and preventing umbilical cord infections.

Suman can testify to the results: “When I used to visit a village and share health information, they would listen, but not put it into practice. Now when they see the films they understand. Now everyone practices what they see in the videos.”

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Help us envision how innovation will change the world

African woman and man talk to each other in a lab.

Will the most important lifesaving innovations in the next 15 years be cultured in a lab, forged of steel, built of silicon chips, coded from zeros and ones, or planted in the ground? Tell us your thoughts! Photo: Kate Holt/AusAID.

Lifesaving innovations are redefining the boundaries of global health and creating new opportunities for people to live healthy, productive lives.

And as the United Nations defines the 2030 Sustainable Development Goals’ health targets, PATH would like your help in identifying leading innovations by taking this survey and sharing it with your colleagues and networks.

Please click here to take our survey.In 2015 we will issue a major Innovation Countdown 2030 report, supported by the government of Norway, describing technologies and other interventions that offer strong potential to accelerate progress and “bend the curve” of present health improvement trends. Please help us identify those innovations!

Two men look at a cell phone while standing in an outdoor booth displaying various devices.

Maker Faire Africa highlights ingenuity from across the continent. Which innovations will accelerate health and development the most by 2030? Photo: Flickr/Maker Faire Africa.

Many of the game-changing innovations driving our progress today were already in the pipeline when the Millennium Development Goals were launched in 2000.

What if we had known then what impact those big ideas would have? How many more lives could we save over the next 15 years if we could identify and accelerate new innovations with transformative potential?

By engaging entrepreneurs, investors, innovators, and experts across sectors and around the world, PATH’s Innovation Countdown 2030 initiative aims to accelerate high-potential innovations, catalyzing investment and increasing awareness of and support for transformative ideas to improve health and save lives.

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Dance with us on Global Female Condom Day, September 16

People dancing in orange wigs in a conference exhibit hall.

The Dance4Demand kickoff event at the 2014 Global AIDS Conference in Melbourne, Australia, was a raucous good time! Photo: UAFC/Beatrijs Janssen.

The 2014 Global Female Condom Day Dance4Demand is being organized by PATH, the National Female Condom Coalition (NFCC), the Universal Access to Female Condoms (UAFC) Joint Programme, the Center for Health and Gender Equity (CHANGE), and the Association for Reproductive and Family Health (ARFH). This post’s author, Kimberly Whipkey, works on this initiative for PATH.

What do dancing and female condoms have in common?

Give up?

Kim Whipkey, wearing an orange jacket, speaks into a microphone.

PATH’s Kim Whipkey speaks at the Dance4Demand kickoff event. Photo: CHANGE/Devan Shea.

They both involve getting your groove on! And more importantly, they’re both the theme of this year’s Global Female Condom Day (GFCD) Dance4Demand campaign, led by PATH and our partner organizations.

The female condom is the only available woman-initiated method that is designed to protect from both unintended pregnancy and sexually transmitted infections, including HIV. But female condoms are not widely accessible, especially in places with high rates of HIV and unmet need for contraception. Global Female Condom Day, celebrated annually on September 16, is an opportunity to increase awareness, access, and use of female condoms through unified global action.

This year female condom fans around the world will rise and “dance for demand” to show that women and men want access to this powerful tool for protection. Participants will organize dance events in their communities, videotape and photograph their moves, and share their experience and female condom advocacy messages through social media using the hashtags #Dance4Demand, #GFCD2014, and #femalecondoms.

To kick off the GFCD Dance4Demand, we got the party started in July at the International AIDS Conference in Melbourne, Australia. Dozens of people moved and grooved to show their passion for this protection option. One participant remarked, “I danced today to demand the female condom so women can control their sexual health…and have access to the female condom worldwide.”

Conference attendees from around the globe show off their moves during the Dance4Demand kickoff event at the International Aids Conference 2014 in Melbourne, Australia. Video: UAFC/Suzy WongChung.​

We want you to participate! Join this campaign and Dance4Demand because:

  • Dancing is fun and easy. Dance4Demand can be used to recruit friends, colleagues, and allies to become new supporters of female condoms.
  • Dancing is newsworthy. Dance4Demand events appeal to journalists and attract media coverage that will help get the female condom message out more broadly.
  • Dancing is a powerful advocacy strategy. Dance4Demand will show policymakers, donors, and health providers that there is a strong demand for female condoms—a key strategy in realizing increased commitment to female condom programming.

It’s easy to get involved! Visit the Global Female Condom Day website to sign up and access all the information, resources, and tools you need to organize your Dance4Demand activities. If you have questions about the GFCD Dance4Demand, please email

We look forward to dancing with you on September 16!

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A “toolkit of innovation” to tackle cervical cancer in Uganda

Exterior of a clinic in Uganda with many people sitting and waiting on the grounds and path.

Early in the morning the grounds of the Mulago National Hospital, where the Uganda Cancer Institute is located, were already crowded. Photo: PATH/Lynn Heinisch.

Editor’s note: This is the second in a three-part series of blog posts by PATH’s president and CEO Steve Davis about his experiences visiting PATH programs in three African countries this July. The first post, from South Africa, is here. Steve will deliver a keynote speech at this week’s 29th International Papillomavirus Conference & Clinical Workshop in Seattle.

The July morning I visited the Uganda Cancer Institute at the Mulago National Hospital in Kampala, several dozen people filled the courtyard by 9:00 a.m. Inside, I found many more waiting to see a doctor.

Steve Davis and two Ugandan doctors talk in a hallway.

Our hosts describe the critical need for high-quality cancer screening and care in Uganda. Photo: PATH/Will Boase.

The institute’s director, Dr. Jackson Orem, told me that the number of cancer patients at the institute has more than doubled in the last three years. This rise reflects the growing impact of noncommunicable diseases (NCDs) like cancer, which are disproportionately affecting poorer countries. By 2030, NCDs are projected to be the most common cause of death in Africa.

Sitting in the waiting room, Imelda Muggnyi clung tightly to her paperwork as a nurse briefed her and other patients on the symptoms and treatment for cervical cancer. Muggnyi, 42, had traveled eight miles on a motorcycle taxi, having been referred from another health facility after an initial screening last month.

“I want to confirm if I have it. I am feeling well and I want to know more so that, if I have a problem, I can start to be treated,” she said. “I want to know more about this cancer.”

Nurse with flip chart speaks to african women sitting in a hallway.

A nurse discusses cervical cancer with patients and family members at the Uganda Cancer Institute. Photo: PATH/Will Boase.

Cervical cancer is caused by human papillomavirus (HPV), a common sexually-transmitted infection that usually resolves on its own but can become cancerous if it persists without treatment. While wealthy countries successfully screen women with Pap tests and treat precancerous lesions before they develop into cancer, most developing countries lack the laboratories, trained technicians, and financial resources to effectively screen. As a result, 85 percent of women dying from cervical cancer live in poorer countries.

“Before the advent of the HPV vaccine, a lot of women were exposed to infection. Next year, Uganda will begin to vaccinate girls nationwide to give them protection from this leading cancer,” said Dr. Denise Njama-Meya, senior program officer for PATH’s Cervical Cancer Prevention Project in Uganda. “Here in Uganda, we have one of the highest incidences of cervical cancer. It accounts for up to 40 percent of all cancer cases.”

Tackling cervical cancer from every angle

PATH began working on cervical cancer in 1991, and our program in Uganda is a prime example of our comprehensive approach to solving health problems in the world’s most challenging settings. We tackle the issue from every angle—prevention, detection, and treatment—using a “toolkit of innovation.”  This work involves teams from across PATH and partners from both government and the private sector.

Prevention: PATH projects were among the first to assess how to most effectively protect adolescent girls in the developing world with the HPV vaccine, so that they would receive the same protection as their peers living in industrialized nations. We have been helping the Ugandan Ministry of Health with its HPV vaccination program since 2007, an effort in which Ugandan First Lady Janet Museveni has been very involved. The week before my visit, the cabinet approved a nationwide HPV immunization program that will begin in 2015, a point the Minister of Health emphasized when I met with him. “The government is committed to the introduction of this vaccine. We are very happy that you are doing this work and we give you total support,” said Minister Ruhakana Rugunda.

Detection: Through our partnership with the Uganda Cancer Institute, health workers across the country have been trained on a simple and effective screening method that doesn’t require specialized personnel, infrastructure, or equipment. The “visual inspection with acetic acid” (VIA) method provides immediate results so women can be treated as soon as possible—sometimes during the same visit—by freezing the affected cells, a procedure known as cryotherapy.

Three lab machines set on a blank white backdrop.

QIAGEN began development of the careHPV Test in 2004 with support from PATH. Photo: QIAGEN.

We’ve also partnered with QIAGEN, a private diagnostics company, to bring to market an even more accurate but still affordable test for low-resource settings. With the careHPV DNA test, women can provide their own samples, which will increase the number of people being tested while reducing the burden on busy health workers. Uganda hosted the first studies of careHPV in Africa, and the product is expected to play a key role in reducing cervical cancer worldwide.

Treatment:  We are working with a medical device company, CryoPen, Inc., to assess the field effectiveness of their new product, which is designed to mitigate the limitations of traditional cryotherapy equipment. The CryoPen device is small and portable and does not require an external supply of freezing gas. We are providing CryoPen units to different types of Ugandan health facilities and collecting data on how reliable the devices are and how easy they are for health workers to use.

All of these examples illustrate how critical PATH’s partnerships are to our work. On a personal note, I was doubly excited to visit the Uganda Cancer Institute, which has a close collaboration with the Fred Hutchinson Cancer Research Center. Like PATH, “the Hutch” is headquartered in Seattle. I was board chair at the Hutch when we approved funding for the Uganda Cancer Institute/Hutchinson Center Cancer Alliance, which now benefits millions of people.

Steve Davis and a Ugandan doctor look at equipment above a surgical bed in an operating room.

Staff at the Uganda Cancer Institute were very generous in taking time from their busy schedules to show the PATH delegation their facility. Photo: PATH/Will Boase.

Changing the story

Given the breadth of our portfolio, PATH is uniquely positioned to work across this “care continuum” from strengthening tools and systems for prevention and screening of cervical cancer to treatment of precancer for women in developing countries. In our 12 years of working in Uganda on a wide variety of health issues, we’ve formed a close partnership with the government, with whom we’ve established a strong track record of introducing new and improved health technologies to serve Ugandans.

Forty years ago in the United States, cervical cancer was the leading cause of cancer deaths for women. Due to improved screening and treatment, the number of cases and the number of deaths from cervical cancer have decreased significantly.

PATH and our partners are aiming to write a similar story in Uganda, across Africa, and worldwide.

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Accelerating MDG progress in Africa: 6 important global health commitments

Young African woman in a classroom turns and smiles at the camera.

Since the launch of the Millennium Development Goals in 2000, we’ve seen remarkable global progress. But work remains to be done. Photo: PATH/Gabe Bienczycki.

This post’s author, Heather Ignatius, is a senior advocacy and policy officer at PATH.

Portrait of Heather Ignatius.

Heather Ignatius is a senior advocacy and policy officer. Photo: courtesy of H. Ignatius.

This week we move into the final 500 days of the Millennium Development Goals (MDGs), which were established in 2000 with a 15-year timeframe.

Since the launch of the MDGs, we’ve seen remarkable global progress toward reduced child mortality, better maternal health, and control of HIV/AIDS, malaria and other diseases. The number of deaths of under-five children has been halved. There has been a 40% reduction in the number of women dying due to complications in child birth. And, there are significantly fewer deaths from AIDS, tuberculosis, and malaria.

But there is still considerable work to be done. Too many mothers and children continue to die, and the majority of these deaths are preventable. In this final 500 day push, we must accelerate progress towards ending preventable maternal, child, and newborn death in the world’s most vulnerable areas.

Graphic of the MDGs

The MDGs are eight international development goals established in 2000.

World leaders must prioritize health issues within their countries to achieve MDG success. Earlier this month, over 40 African heads of state joined President Obama at the US-Africa Leaders Summit to explore new cooperation and partnerships for progress in Africa, including health.

US-Africa Leaders Summit Provides Six Key Commitments

Trade and private sector investments as drivers for economic growth emerged as the primary focus of the Summit, a theme we first saw when President Obama traveled to Africa last summer. While trade and investment are important tools for development, and US policies and partnerships in this area have been notably lacking, market-based solutions do not always reach Africa’s most vulnerable people, particularly for health.

Foreign aid must continue be a strong component of US cooperation with Africa in order to make changes that save lives and achieve the MDGs. At the Summit, over $37 billion dollars in commitments were announced by the US government and multi-sector investors to further development in Africa. They included key global health commitments that will advance efforts to end preventable maternal, child, and newborn deaths:

  1. The United States commitment to save 8 million children and 350,000 mothers by 2020. “Accelerate Action in Africa”, launched by the Obama Administration, will build on the vision outlined in USAID’s Acting on the Call report and create a policy and financing framework to meet its ambitious targets for lives saved.
  2. A recommitment to the Global Alliance for Vaccines and Immunization (GAVI) and broader immunization coverage. Since 2000, GAVI has supported the immunization of 390 million children worldwide. Immunization is the most cost-effective health intervention, saving an estimated two to three million lives every year.
  3. Scale-up of malaria interventions. Renewed support for the US President’s Malaria Initiative. With assistance from the US, scale-up of malaria interventions over the past decade has saved 3.3 million lives, 90 percent of which were under-five children in sub-Saharan Africa.
  4. A $200 million commitment to antiretroviral therapy (ART) for African children. The U.S. President’s Emergency Plan for AIDS Relief, with the Children’s Investment Fund Foundation, will double the number of children receiving ART across ten priority African countries over the next two years.
  5. Regulatory harmonization for lifesaving medicines. The US government committed $1.5 million to support a new initiative in East Africa to harmonize regulatory processes for medicines. This is an important step in ensuring access to lifesaving and innovative treatments.
  6. Recognition of good governance and an engaged citizenry as priorities in African countries. Building capacity for stronger in-country advocates will help citizens hold their governments accountable for health commitments to accelerate progress toward the MDGs. Later this month, PATH will roll out Advocacy Impact for Health. The new initiative will give citizens and community groups the tools necessary to become successful advocates for policy change.

These important commitments will save lives and improve health in the areas where such efforts are needed most. The progress towards MDGs, and the ongoing global commitment to health equity and poverty eradication, are cause for cautious optimism. We must continue to accelerate efforts if we are to achieve a world where all people truly have an opportunity to live healthy lives with dignity.

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Immunize mosquitoes? A radical approach to stopping the spread of malaria

Close up of a mosquito biting into skin against a green background.

Could a human vaccine to protect malaria-transmitting mosquitoes break the cycle of disease transmission? Photo: Penn State/James Gathany.

This post’s author, Ashley J. Birkett, leads PATH’s Malaria Vaccine Initiative.

Portrait of smiling man.

Ashley Birkett left the private sector for the PATH Malaria Vaccine Initiative. Photo: Genelle Quarles/Burness Communications.

On August 20 the world marks World Mosquito Day—so called to commemorate the 1897 discovery by British doctor Sir Ronald Ross that malaria in people is transmitted to and from mosquitoes. Dr. Ross went on to win the Nobel Prize for his discovery, and since then, mosquitoes have been enemy number one when it comes to defeating a disease that takes a life every single minute—most of them young children in sub-Saharan Africa.

On this historic day, let’s focus on approaching malaria in a surprising new way: with a vaccine to protect those malaria-transmitting mosquitoes. That’s right—a vaccine to stop humans from giving malaria to mosquitoes.

If we can do this, we might finally stop malaria once and for all.

So, why protect mosquitoes from humans? First, you have to understand the vicious cycle of malaria, which works like this: a mosquito bites a girl and transmits the malaria parasite, perhaps causing her to get very sick. But it doesn’t stop there. A week later, a noninfected mosquito feeds on the same child, yet this time, it is the girl who passes the parasite to the mosquito. Soon, that mosquito—now carrying malaria parasites and buzzing around the same area, as mosquitoes typically do—bites the girl’s father, passing the parasite to him. Even if he shows no symptoms of malaria and doesn’t get sick, he can still pass parasites on to another mosquito that…well, you get the picture.

That’s where a vaccine comes in.

Zambian mother holding her infant.

Malaria is one of the most severe public health problems worldwide. It is a leading cause of death and disease in many developing countries, where young children and pregnant women are the most affected. Photo: PATH/David Jacobs.

A vaccine—we call it a transmission-blocking vaccine (TBV)—could break this never-ending and often deadly cycle. This type of vaccine actually prevents the mosquito that bites the malaria-infected person from getting infected, thus stopping the parasite’s life cycle in its tracks. If the mosquito doesn’t get infected, it can’t give malaria to another person.

Of course, vaccinating humans to protect mosquitoes from malaria might sound a little crazy. From polio to smallpox, we think of vaccines as preventing people from getting a disease. This type of vaccine wouldn’t protect someone bitten by an infected mosquito from getting malaria or lessen its symptoms.

But what it would do is help protect that person’s family and community. And if almost everyone in a community received such a vaccine, over time, the entire community would benefit by having fewer and fewer infected mosquitoes flying around and, therefore, fewer cases of malaria. Ultimately, this would create “community immunity” and eliminate malaria altogether from these areas. This long-term approach for the greater good—rather than immediate, personal protection—seems a bit novel, but the outcome would benefit us all: eradication of malaria.

Graphic of vaccines and the malaria lifecycle.

Three stages in the malaria lifecycle where vaccines could have an impact. Click to see larger graphic. Credit: PATH.

We’ve made remarkable progress, but innovation is still needed

While we’ve made extraordinary progress over the last decade in reducing malaria deaths, the wily malaria parasite is rapidly becoming resistant to some of our best tools—drugs and insecticide sprays. Another tool to break the cycle of transmission could help tip the balance against malaria, and history tells us that a disease is unlikely to be eradicated without a vaccine.

To reach the end game, we need a suite of new tools that would work together—a suite that includes a vaccine.

There are a number of potential transmission-blocking vaccines in early development. The program that I direct, PATH’s Malaria Vaccine Initiative (MVI), is working with partners to research a number of vaccine approaches. In collaboration with Fraunhofer USA, we have advanced their transmission-blocking vaccine candidate through early-stage clinical trials, and the National Institutes of Health is also testing at least one vaccine approach in early-stage trials. The Malaria Vaccine Technology Roadmap, updated by the international community in 2013, has called for vaccines by the year 2030 that reduce transmission to help eradicate malaria.

Should a transmission-blocking vaccine become a reality, it would be another critical tool that paves the way for eliminating and eradicating malaria.

So on World Mosquito Day, I’m calling for a vaccine to protect mosquitoes. Because ultimately, a world of malaria-free mosquitoes means a world of malaria-free people.

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New, faster HPV test frees up resources for more cervical cancer screening

Eight-five percent of cervical cancer cases occur in the developing world. Increasing prevention, screening, and care is essential in countries like Nicaragua. Photo: PATH/Mike Wang.

This week Seattle is proud to host The 29th International Papillomavirus Conference & Clinical Workshop, and will be sharing two blog posts on our cervical cancer work. This post’s author, Dr. José Jerónimo, is PATH’s senior advisor for women’s cancers. 

Recently, we’ve seen tremendous progress in the availability of new, potentially game-changing technologies that promise to help us screen more women for cervical cancer, no matter where they live, and to effectively treat those with precancer.

Portrait of José Jerónimo.

Dr. José Jerónimo says self-screening for HPV can dramatically increase the ability of clinics and hospitals to treat more women with precancer. Photo: Courtesy J. Jerónimo.

In the past few years several new human papillomavirus (HPV) tests have become available, including the careHPV test developed by QIAGEN, an international medical device manufacturer, with support from PATH. We’ve completed trials of that field-friendly and inexpensive test, and it is now time to scale it up to reach all of the women who need it. We also have learned that teaching women to use careHPV to gather screening samples themselves frees up the time of busy health workers and can dramatically increase the ability of clinics and hospitals to treat more women with precancer, and thereby prevent cervical cancer.

HPV, the virus that causes cervical cancer (it also can cause penile, anal, and throat cancers) infects nearly every sexually active person, but most of us don’t experience advanced disease because our bodies are able to clear the infection. However, in some women the infection persists, and the disease advances over 10–20 years to a precancerous stage (when it is easy to treat), and years later to invasive cervical cancer. About 266,000 women die from cervical cancer every year, with 85 percent of mortality occurring in the developing world.

That is where PATH is focusing its efforts: low-resource settings in Africa, Asia, and my home region of Latin America.

Guatemala, Honduras, and Nicaragua have declared their interest in partnering with PATH in a project to deploy HPV testing, and related treatment options, through their public health systems. This is big! In the first project year, PATH will “seed” each country with 110,000 careHPV tests, and will work with the respective ministries of health to develop systems for effectively using the test in pilot settings. In subsequent years the countries will purchase careHPV themselves and expand availability. Through the course of the project, we estimate that more than half a million women who would not otherwise have been screened will benefit from the service.

Three lab machines set on a blank white backdrop.

QIAGEN began development of the careHPV test in 2004 with support from PATH. The careHPV test addresses health care challenges that many women face in developing countries, particularly women living in areas where medical care is infrequent and hard to access. Photo: QIAGEN.

Self-sampling—the key to universal screening?

In addition to increased sensitivity compared to the Pap test or visual inspection, a major benefit of careHPV screening is that it gives good results even with vaginal samples women collect themselves. We have found that when women “self-sample,” the test works nearly as well as when doctors or nurses gather cervical mucus samples during a pelvic examination. Pelvic exams are a rate limiter—the exam takes time, limiting the number of women who can be seen by each trained provider.

Self-sampling has the potential to dramatically increase the number of screenings clinics can organize, and allows them to focus pelvic exam resources on treating the women who test positive for HPV. This is what we mean when we talk about game-changers. Mexico and Argentina already are using self-sampling, and the three PATH project countries will do the same.

To make screening more affordable to countries over the long term, we also are working with the Pan American Health Organization (PAHO) and other partners to create a regional procurement system for screening and treatment products. PAHO member countries already save a lot of money by purchasing vaccines together in bulk orders, and we intend to garner similar savings for cervical cancer prevention equipment too.

New treatment devices overcome old obstacles

That said, screening without treatment is pointless, so we’re looking at both sides of the equation. For years PATH has been recommending cryotherapy (freezing) to treat precancerous tissue, but we also are aware of the challenges related to traditional “cryo” equipment—such as the recurring cost of gas. We are working with the Peruvian Cancer Institute and other partners to assess the performance of a new technology, CryoPen, that freezes tissue but without needing to regularly replace the gas. We’re also collaborating with a US manufacturer of an alternate treatment device that uses heat to destroy precancerous tissue (confusingly called “cold coagulation”), and which can treat up to 30 women with power from a single, portable, rechargeable battery. Working on multiple treatment options increases our chances of success and will give countries a choice.

It feels like many different factors are coming together in the fight against cervical cancer, and this is nowhere more evident than in Latin America. PATH is proud to be in that fight.

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A new era for malaria treatment

Woman in stock room looks at paper with shelves of medicines.

A pharmacist checks a stock of malaria drugs at the Gwembe District Medical Office in Zambia. Photo: PATH/Laura Newman.

Malaria drugs made with semisynthetic artemisinin make their way to patients

Portrait of David Kaslow.

Post author Dr. David Kaslow leads our drug development efforts. Photo: Merck.

This month, after nearly ten years of effort, the first batch of malaria drugs manufactured with a new, semisynthetic form of the key ingredient, artemisinin, will start reaching African countries battling the disease. The lifesaving drugs, manufactured by our partner Sanofi, a French pharmaceutical company, are the first of their kind to use semisynthetic artemisinin (ssART) in place of the plant-derived form of artemisinin used in the past. The new shipment marks a milestone in global health, potentially improving access to treatment for the millions of people, mostly African children, sickened by malaria every year.

The story of ssART—and the bold partnership that brought it from concept to use—highlights the crucial role international markets play in shaping global health, and the power of collaborative innovation to improve the systems that bring lifesaving products to the people who need them.

Soothing a volatile market

Asian sweet wormwood plant with green, feathery leaves.

Artemisia annua, or Asian sweet wormwood. Photo: Flickr/Scamperdale.

In 2004, doctors worldwide were increasingly using a powerful group of drugs called artemisinin-based combination therapies (ACTs), to treat malaria infection. That was good news for children and families everywhere. But as more countries sought ACTs, the supply and price of artemisinin, which was derived only from a slow-growing plant called Artemisia annua, or Asian sweet wormwood, fluctuated wildly. Changes in demand and supply from year to year created a volatile up-and-down cycle of pricing and supply. In 2005, for example, the price of artemisinin was at a high of US$1,100 per kilogram. That price sparked more farmers to plant sweet wormwood, creating an oversupply in 2007 that caused the price to plummet to just $180 per kilogram. That cut the incentive to grow sweet wormwood again, which resulted in a 2009 shortage that drove prices back up over the next two years, to an average of $530 per kilogram in 2011. These fluctuations strained markets, and made it difficult for leaders, manufacturers, and others to stabilize and plan global supply, risking a global shortage.

In short, the lifesaving drugs that millions of children, families, and communities relied upon were tied to a supply structure struggling under the push and pull of a volatile market.

Worldwide, a market challenge had turned into a crucial global health imperative.

Graphic showing time to grow (10 months) versus synthesize (3 months) artemesinin.

Producing semisynthetic artemisinin takes just three months, helping ensure a more stable supply to meet demand for ACTs. Graphic: PATH.

A groundbreaking partnership

Solving the challenge took a groundbreaking partnership, led by PATH’s Drug Development program, that brought together experts in research, pharmaceutical product development, and public health. In 2004, the partnership set out to develop a new manufacturing process to produce high quality, year-round, and affordable artemisinin to supplement the plant-based supply. Over a decade of work, our combined innovation and vision brought a promising concept from small laboratory batches, to large-scale production, and on to global markets.

Technician in protective gear holding an ACT antimalarial tablet.

Sanofi’s gold-standard ACT made with semisynthetic artemisinin, pictured here at the manufacturing plant in Morocco, is making its way to customers. Photo: Sanofi.

Now, as the first shipment of ssART-based malaria drugs—1.7 million treatments of Sanofi’s gold-standard ACT, Artesunate Amodiaquine Winthrop®—make their way to customers for the first time, we’ve reached the goal we set out to achieve ten years ago. Semisynthetic artemisinin opens a new future for the global artemisinin market. In doing so, it offers new security for the millions of people who rely on ACTs in countries where malaria is a constant threat. By providing a year-round source, ssART helps to manage imbalances in supply and demand, maintain stable and affordable pricing, and keep the market on an even course—ultimately expanding access to ACTs.

The future

Of course, ssART is only one part of the solution. Eliminating and controlling malaria requires a highly integrated strategy, including new vaccines and diagnostics, expanded surveillance and control, strong partnerships with governments, and much more.

I think I can speak for all of our partners when I say that we won’t be satisfied until that very last patient is cured of malaria. Until then, however, the sustained production of ssART, and the careful integration of our product into global markets, has the potential to change the landscape of global health. For the first time in history, artemisinin shouldn’t be a limiting factor in our work to develop and deploy lifesaving treatments. Even more, ssART provides clear evidence that with expertise, hope, and tenacity, it is possible for public and private sector leaders to achieve a bold humanitarian goal.

Together, we’re paving the way for a robust, reliable supply of antimalarial drugs.  And by continuing to work together, we can create a market where supply chains, farmers, extractors, manufacturers, and funders all align to create a healthier future for women and children worldwide.

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