cues to action: oral typhoid vaccine

this is a serious upgrade from five years ago when i last took the oral typhoid vaccine.

my 7-day, 4-pill course of medicine came equipped with a check-off timeline printed on a bathroom mirror sticker and a livestrong/wriststrongesque reminder bracelet.

color me impressed, as well as 25% of the way to being re-vaccinated.

(on another vaccine note — $300 for one of two courses for japenese encephalitis?!?)

Typhoid vaccine

yay me!

yay me!


more on polio vaccination efforts.

i have been trying to keep up with polio vaccination efforts here. but it seemed like this deserved a new post, as it deals not just with commentary on the recent killings but also some actions that USG could take, via charles kenny.

there is information here, followed by an interesting conversation in the comments section, and here.

It is a vital moment for the world community to do everything it can to encourage vaccination, especially against polio… The tragic violence against vaccination workers in Pakistan who were doing vital work… were linked to allegations that the CIA had used a vaccine campaign as part of intelligence gathering operations in the country…

A declaration by the US that public health interventions will not be used to gather intelligence could play a vital role in tipping the balance towards successful polio eradication –and enhance US national security

this petition will close on 8 Feb, so if you are interested, get on it! then you can go see zero dark thirty… or vice versa. either way, it seems like we should be talking about this right along side the torture debate.

thank you. water, sanitation, infrastructure, cholera.

someone said something helpful here. about cholera. but not about a new vaccine, a new super-antibiotic, or engineering a new vector that can be lulled to sleep by harp music, along with plans for a helicopter drop of harps or new ways to subsidize harps.

whenever epidemics of cholera occur, the global public health community is energized. experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted… [but]

the best intervention for long-term cholera control and, for that matter, for the control of the great majority of diarrheal diseases is the strategy that eliminated epidemic cholera from the united states and northern europe long before either marketed antibiotics or effective vaccines existed. the development and maintenance of water and sewage treatment systems assured safe drinking water and safe disposal of sewage for all, keeping contaminated sewage out of water, foods, and the environment. the strategy not only eliminated cholera but also dramatically reduced mortality related to diarrheal diseases of all causes.

among others, culter’s articles on mortality determinants are worth reading.

if it doesn’t kill them, it makes them stronger (III) / why would you do things that way? (II)

well, this is bad and annoying.

bad: malaria resistance to ACTs is being increasingly reported in Thailand.

annoying: the article’s narrator & interviewee go on to say that immediate steps need to be taken.

then, instead of listing some possible steps, they highlight that maybe a malaria vaccine is on the horizon.

1. what should we do now? use rapid-diagnostic testing? encourage proper use (dose-completion) of ACTs? encourage prevention with bednets?

2. what do we think is that actual probability of having a viable malaria vaccine in three years? if so, how likely is its protective immunity likely to last for an inoculated person?

3. why are we so, so, so jazzed about a malaria vaccine when malaria elimination & eradication in the past has been very much about environmental management? is sanitation not sexy enough? do we not think that governments in malarious countries can and should be providing drainage, sewage, and other services that reduce malaria breeding habitats?

from The Making of a Tropical Disease (Packard)

In the end, the book males a simple point. Malaria policy needs to be informed by history. The history of malaria tells us that malaria cannot be understood or eliminated independently of changes in the societal forces that drive it. This is not to argue that past and current malaria control efforts have had no effect on reducing the burden of malaria. Nor do I believe that malaria cannot be controlled before social and economic impediments to health are completely removed. Rather I argue that the array of biological weapons mobilized in the war against malaria needs to be joined with efforts to understand and improve the social and economic conditions that drive the epidemiology of the disease (xviii).

from The Fever (Shah)

The uncomfortable truth is that ending malaria over the long-term will require difficult social and economic adjustments in African communities, just as it has elsewhere. Infrastructure will have to improve. Settlement patterns and housing styles will have to change. Education and healthcare systems will have to be built. Antimalaria activists know this. But it is not possible for them alone to transform Africa’s economies and cultures. The best they can do is offer partial, short-term solutions. That is, in the meantime, they can blanket the continent with treated nets and better drugs… After all, the perfect need not be the enemy of the good. The question is how the short-term solutions impact the long-term ones. Usually, something good today doesn’t reduce the probability of something better tomorrow. But in malaria, it can (237).

The conflict over short-term solutions and long-term sustainability has yet to be adequately resolved. The US antimalarial program, government malariologist Thomas Ritchie says, ‘is pouring obscene amounts of money’ into quick fixes against African malaria, but is spending little on supporting local antimalaria leadership or building antimalarial infrastructure. Plenty of African clinicians, scientists, and community leaders are dedicated to taming malaria, Ritchie says, but when the world’s richest country decides to help, ‘they give these people nothing, not a cent!’ (238).

The conflict plays out in heated debates at international malaria meetings. At one, an official from the Nigerian MoH became engrossed in a long argument with a representative from Sanofi-Aventis, which was at the time the sole purveyor of WHO-recommended ACT drugs. Finally she turned to me. ‘Write it in your paper,’ she commanded. ‘We need to build African capacity to make treated nets and ACTs. That is the only way we can solve malaria. They don’t want to do technology transfer,’ she said, motioning to the drug company rep. ‘They just want us to buy, buy, buy’ (238).

Although it publicly recognizes the need to build infrastructure in endemic countries, RBM has also stated that tackling the disease cannot be the responsibility of local governments. ‘If malaria control is left to governments to plan and execute,’ RBM wrote, ‘malaria will not be controlled.’ This is, of course, exactly backward. It is the only way malaria will be controlled. Malaria-endemic societies have proven this over and over again, from when the Italians distributed quinine to their populace – and built the schools and clinics and roads they needed in order to do it – to when Malawi banned the sale of chloroquine and rid the country of chloroquine-resistant parasites… ‘You can do a lot of good with bed nets, with spraying,’ says malariologist Tom McCutchan, ‘but in the end, you have got to give power to the people who are at risk’ (239).

you’re not helping: seriously, CIA, we have enough problems convincing people to get vaccines, polio and otherwise

“At the behest of CIA officials, Afridi reportedly launched a fake polio vaccination campaign in Abbottabad last year, using it as a front to gather DNA samples from people thought to be relatives of the elusive Osama Bin Laden. This elaborate scheme would later contribute to the frenetic manhunt for and subsequent assassination of the Al Qaeda leader.

“(Before this) happened, one could brush aside negative perceptions about the polio vaccine, terming them baseless and ‘agenda-driven’, but not this time,” Fazal Shah, a development sector professional based in the northern district of Mardan, told IPS.

Religious leaders and tribal elders who had hitherto been highly successful in generating public support for the polio vaccine – by breaking myths about the vaccine being life-threatening, made of haram (forbidden) ingredients or causing infertility among both male and female recipients – found their efforts seriously hampered by Afridi’s hoax vaccination drive.”

Rest of article. (h/t KFF)

Update 6 March 2012 (h/t KFF)

“The CIA’s use of the cover of humanitarian activity for this purpose casts doubt on the intentions and integrity of all humanitarian actors in Pakistan, thereby undermining the international humanitarian community’s efforts to eradicate polio, provide critical health services, and extend life-saving assistance during times of crisis like the floods seen in Pakistan over the last two years,” the InterAction coalition wrote to the CIA director, David Petraeus.

Update 18 Oct 2012 (h/t Humanosphere)

“News reports out of Pakistan on the polio efforts there vary wildly, saying two very different things. Some say the efforts to vaccinate against polio are moving forward despite opposition from the Islamists, and from locals still mistrustful of health workers thanks to an ill-conceived fake vaccine ploy by the CIA… This report seems to indicate things are actually getting worse.”

Update 24 December 2012

“Yesterday, a male polio worker was fatally shot, and today four women were killed within about 20 minutes of each other in three apparently coordinated attacks in poor Karachi neighborhoods, including Gadap, where the July shootings occurred. Another woman was killed in Peshawar. Taliban insurgents have repeatedly threatened campaign workers, but so far no one has claimed responsibility for the current or previous attacks.”

Nice editorial 3 Jan 2012

“Pakistan now has a three-fold responsibility: addressing systemic polio eradication impediments, getting vaccination back on track with appropriate security cover for more 90,000 vaccinators, and reaching out to the masses with the right information to ally mistrust. At a minimum this would demand the will to prioritize action, the intent and ability of political factions to work collaboratively, and the ongoing injection of resources. With parliamentary elections forthcoming, all these will be in short supply.”

Further comment on recent polio worker killings via the lancet 4 Jan and 4 Jan.

Nice post from Amanda Glassman and Charles Kenny (19 Dec 2012).

This situation unfortunately follows allegations that US security agencies used a Hepatitis B vaccination campaign as a vehicle for intelligence gathering (see here).  And it is clear that such allegations have had a chilling effect on vaccination programs—for example in Nigeria (see here)–even when completely baseless.

Given that, it is in our own interest to make crystal clear that the US supports global public health programs to improve global health alone and that US-backed public health interventions will not be used to gather intelligence. While far from a panacea, it might help persuade a few more parents to get their kids vaccinated, or a few more local leaders to back down from a boycott.  In the battle against global communicable diseases like polio and measles, every little bit helps.

Wired update 11 January 2013 (h/t humanosphere)

Worldwide, the polio campaign depends on the efforts of volunteer and low-paid vaccinators who work solo or in small teams, and there are signs that the Taliban intimidation has kept those teams at home. In Pakistan, both The News and The Frontier Post are reporting that “lady health workers” are staying home out of fear or as a result of family pressure… The crisis in Pakistan is not just about the changeable fortunes of the polio campaign, which has waxed and waned in public opinion since its launch in 1988. It is specifically in response to the admitted-to ruse by the CIA