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Vaccine Coverage in MalawiIn 2010, the World Health Organization (WHO) approved the first solar direct-drive (SDD) refrigerators. It transformed how vaccines are stored in rural, remote areas worldwide. The Gates Foundation assisted in funding and supporting the spread of this innovation in Malawi; with the help of other organizations like UNICEF and Gavi, the Vaccine Alliance, WHO installed this in all 29 district-level vaccine storage facilities.

SDD Refrigerators

SDD refrigerators are solar-powered devices used to store vaccines at the proper temperature. Before the introduction of SDD refrigerators, earlier models were less reliable and more costly. Ice-lined refrigerators, which had been used for more than 20 years, were considered the most economical option.

Alongside absorption refrigerators and water-pack freezers, people found these units less efficient than solar-powered alternatives. They operated using gas, kerosene or batteries, which required frequent replacement and incurred high operational costs.

SDD Fridges in Malawi

Remote areas such as Malawi have been the top priority for the Gates Foundation due to their previous reliance on gas-powered refrigerators. Around 40% of community health clinics in Malawi are not on the electrical grid, making costly and outdated refrigerators their only option.

However, in 2015, Malawi received its first grant to implement only a few SDD fridges. After about three years of reliability, Gavi and UNICEF helped fund the installation of about 600 more in 2018. Since then, Malawi has replaced all gas and battery-powered fridges with solar-reliant fridges.

SDDs proved to be successful and sustainable. It is cutting carbon dioxide emissions significantly and giving cold chain managers the ability to track the maintenance of each refrigerator to confirm it is at the proper temperature. The equipment is also long-lasting and reliable, creating a concrete solution for Malawi.

Vaccine Coverage in Malawi

In addition to improving storage, Gavi and UNICEF are trying to bridge the gap between urban and rural access to vaccines. These organizations have specifically targeted communities with high rates of zero-dose children and developing equity-focused programming in collaboration with local governments.

The Expanded Programme on Immunization (EPI) from UNICEF shows that “across all antigens, Malawi is missing approximately 10% of children, with a significant portion of these zero-dose children in urban areas.” Providing adequate staff to recognize these patterns and advise immunization can catch these concerns promptly.

Impacts

According to Gavi, vaccine coverage in Malawi has shown impressive progress compared to a decade ago. This advancement has been supported by substantial funding and the availability of trained professionals in both rural and urban clinics, enabling effective vaccine storage and distribution.

Inclement weather is another factor in vaccine storage strategies. Malawi is particularly prone to extreme weather events such as cyclones and floods. When Tropical Storm Ana struck in 2021, significant damage was caused to the hydroelectric system, resulting in widespread power outages across the electrical grid. In previously vulnerable rural areas, health workers successfully kept vaccine doses cold using SDD refrigerators. At the same time, they had to move facilities relying on electricity-powered to avoid spoilage.

As a result, cold chain managers began re-evaluating the effectiveness of electric refrigerators compared to solar-powered ones. They transferred all vaccine doses from urban centers to more remote storage facilities. Solar refrigerators became the standard due to their strength and durability. 

Conclusion

The benefits of SDD fridges are vast, including bettering the environment and lowering long-term medical equipment costs. Cold chain management has taken a step in the right direction, with the Gates Foundation and more creating the possibility for success in countries like Malawi.

– Rachael Wexler

Rachael is based in Chicago, IL, USA and focuses on Technology and Global Health for The Borgen Project.

Photo: Unsplash

HIV/AIDS in ItalyHIV/AIDS infection and treatment are consistent concerns that health organizations in Italy are levying. Since high infection numbers in the early 21st century, rates of diagnoses have decreased from 3,858 in 2013 to 1,888 in 2022 according to WHO. Still, the health risk of the disease remains prevalent. Poverty can be an obstacle for seeking diagnosis and treatment for HIV/AIDS in Italy. Universal health services provide a great resource for those experiencing poverty. Currently, hospitals and health organizations in Italy are developing programs to make this impact more wide-spread.

The Ministry of Health and other national organizations are working towards spreading awareness, providing testing and developing medication. They hope to eliminate the possibility of HIV infection altogether. Many institutions have created goals which aim to reduce the number of new diagnoses and provide equitable treatment and counseling to all residents of Italy, regardless of their financial situation.

Injective PrEP Could Prevent HIV/AIDS in Italy

In December 2024, The National Institute for Infectious Diseases (IRCCS) and the Regional Hospital of Lombardy (ASST) collaborated on a solution-oriented program. Authorities in health spoke about emerging technologies at the national health conference, “Long-Acting Retrovirals–looking to the future.” The goal is to investigate and approve PrEP (pre-exposure prophylaxis) as a preventative measure against HIV/AIDS in Italy. Currently, the only available form of PrEP is the once-daily pill.

PrEP is a medication that reduces the risk of contracting HIV when individuals who are at-risk for infection take it. In the United States, the FDA has approved both the oral and long-acting injective forms of PrEP. 

The Italian initiative will provide controlled access to the injective method for 800 individuals and monitor their response. These health servicers wish to provide an alternative to at-risk people who have difficulty accessing or using the oral method. Injective PrEP allows for longer periods between intake compared to the daily oral method. 

“Three Times Zero” 

To commemorate International Day Against AIDS in Italy (December 1, 2024), IRCCS held a health conference. Many Italian changemakers attended including the Minister of Health, Orazio Schillaci, and the Director General of Health of the Lazio Region, Andrea Urbani. 

IRCCS aims to promote the goal of “three times zero against HIV: zero risk of transmission, zero diagnoses and deaths, zero stigma and discrimination.” Powerful entities such as the Italian Red Cross signed the protocol. It sets the precedent for advances in prevention and treatment. It also addresses the marginalization that those with HIV in Italy experience. 

Likewise, this protocol acknowledges the groups of Italian residents facing a disproportionate risk of contracting HIV. This includes men who have sex with men, foreign-born migrants and injective drug users. 

The DiMePReJ (Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area) found that individuals living in marginalized conditions have higher rates of infection. Risk factors include “financial difficulties and lack of secure housing.”

UNAIDS argues that the fight against HIV/AIDS cannot succeed without upholding the human rights of those suffering from the disease.  

Free Testing for HIV/AIDS in Italy

Accessible testing and education are vital to the reduction of HIV infections, especially among marginalized communities. Many free and readily accessible testing methods are available in major cities of Italy. “Let’s do it quick” (facciamolo rapido) launched in 2017 to provide an alternative to the typical blood test for HIV and HCV. This innovative test offers results by testing the saliva, removing the risk of blood contamination among health workers. 

This program supplements “room 13” (stanza 13) at IRCCS in Rome. The institute offers blood tests for HIV and Syphilis at no cost with same-day results. It also provides free counseling for those seeking preventive measures or treatment information. Search engines are readily available online for residents to locate their closest testing and counseling facility.

Vaccine Development

New developments are on the horizon. The Higher Institute of Health (ISS) in Italy partnered with the European HIV Alliance in 2016 to support its development of an HIV vaccine. The EU’s Horizon 2020 Research and Innovation program provided funding for their work. The alliance hoped to develop two new prophylactic vaccine candidates for clinical development using a multidisciplinary vaccine platform (MVP) and further identify scientific basis for continued research. 

Although the alliance has concluded, clinical trials for their vaccine, “EHVA P01” continued. Trials concluded at the end of 2024 with pending results. Scientists aimed to test the efficacy of a vaccine for HIV-uninfected adults. A preventative vaccine for HIV in Italy could reduce infection rates by large margins.

Global Collaboration Against HIV/AIDS

Still, many trials for preventative and therapeutic HIV vaccines are ongoing. Italy is one actor in an international mission to reduce–and eventually eliminate–the risk of infection for HIV. Health authorities are employing both preventative and therapeutic measures to address at-risk and infected individuals. Programs like “Three Times Zero” are reducing the stigma surrounding the disease and those who carry it. National hospitals, like IRCCS, have the potential to close the infection gap between income and population groups by continuing to provide free and accessible health services. Scientific collaboration in Italy has led to emerging treatments that indicate an HIV-free future.

– Sarah Lang

Sarah is based in Pittsburgh, PA, USA and focuses on Technology and Politics for The Borgen Project.

Photo: Pexels

Malaria in the PhilippinesThe Philippines is familiar with the problem of malaria. In 1970, the country’s malaria morbidity rate per 100,000 people was nearly 80%. The mosquitoes that transmit the parasitic disease extend all across the nation. With the devastation that the Philippines faced, its government became very committed to limiting and reducing the damage caused by the disease.

Success in Malaria Reduction

One of the many ways the Philippines fought malaria was through an increase in surveillance systems, working toward finding specific malaria outbreaks to target with boosted treatments. The government’s actions were extremely successful. In 2005, the Philippines achieved a reduction rate of 92% in cases and a decrease in the malaria mortality rate by 98%. Additionally, around 60.9% of the country’s provinces were officially declared malaria-free in 2018.

Leveraging Digital Technology

By employing new digital technology, specifically its Online Malaria Information System, the Philippines is able to catalog, process and distribute information on malaria outbreaks. This allows for speedy treatment and prediction of future outbreaks by monitoring reports made by locals. This system is available to everyone on Android, so it is very accessible to the Filipino people.

Current Challenges and Advanced Strategies

Due to significant humanitarian aid and government infrastructure expansion, the Philippines experienced a general decline in malaria cases. However, in 2023, the country saw a sharp increase in cases, about 6,248, nearly doubling from the previous year, which was 3,245. Many health professionals attribute this rise to the relaxation of restrictions in the post-COVID-19 world. Nonetheless, new health centers are now focused on eliminating and preventing the spread of malaria.

Filipino health centers collect data on patients and the environment to monitor potential malaria outbreaks. Quick identification leads to quick treatment and with sufficient treatment, the Philippines aims to be entirely malaria-free by 2030. The approach is more complex than merely distributing surveys or looking for common symptoms.

The health centers are exploring advanced diagnostic and geographical mapping tools, improved surveillance technology and the identification of less common and often overlooked symptoms of malaria. With better diagnostic tools, medical professionals can assess patients more quickly and determine which strain of malaria is affecting them, enabling faster and more effective treatment.

The geographical mapping tools allow people to monitor the spread of outbreaks, see where the infected mosquitoes are moving and act proactively against the disease. As the World Health Organization (WHO) advises, surveillance is one of the best ways to prevent and combat malaria, so the Philippines is looking to improve its preexisting system to fight this current wave of malaria.

Conclusion

Malaria is one of the most notorious and dangerous diseases and humanity has been fighting it for decades. The Philippines, in particular, has a long and difficult history with malaria but has developed effective systems to combat it. The Filipinos’ active efforts to reduce malaria in their country offer hope for a malaria-free world, evidenced by the 72 provinces that are now officially malaria-free.

Another promising development in the fight against recent malaria outbreaks is the emergence of new vaccines that provide immunity against various strains of the life-threatening disease. With a vaccine in the works and new health centers being established, the Philippines is optimistic about seeing a reduction in malaria cases soon.

– Paige Tamasi

Paige is based in Los Gatos, CA, USA and focuses on Global Health and Politics for The Borgen Project.

Photo: Unsplash

Impact of COVID-19 on Poverty in MalaysiaMalaysia saw its first confirmed case of COVID-19 on January 24, 2020. The Malaysian government implemented the Movement Control Order (MCO or PKP) around two months later in response. This mandate restricted travel, work, assembly and established quarantine measures jeopardizing the financial integrity of Malaysian households. Here is some information about the impact of COVID-19 on poverty in Malaysia as well as the country as a whole.

The World on Pause

For fully vaccinated individuals, the MCO ended in November 2021. However, under the mandate, conditional and variable ordinances ultimately played a part in the impact of COVID-19 on poverty in Malaysia.

Working in multiple phases, the MCO developed into the Conditional Movement Control Order (CMCO/PKPB), Recovery Movement Control Order (RMCO/PKPP) and the National Recovery Plan (NRP/PPN). These restrictions prevented movement between states, travel to and from Malaysia and mass gatherings in addition to the closure of schools, government and private premises except those considered essential. Those who violated the MCO were at risk of receiving fines or facing jail time.

Hurting Those Already Struggling the Most

Three-quarters of the Malaysian population live in urban areas, with the majority of individuals falling into the 15-64 age group. A four-part research study that UNICEF and UNFPA conducted titled “Families on the Edge” found that a typical Malaysian household has an average of 5.5 members.

The head of these households are mostly married Malay males around 46 years old with low educational attainment. These workers face a high risk of unemployment, pay cuts or other stresses to household income as they were in jeopardy before the pandemic.

Reports have indicated that a 5% increase in employment occurred between March 2020 and June 2021. Despite the rise, a third of those employed before the crisis experienced work disruptions and 27% faced income reduction.

The World Bank found that around 65% of jobs in Malaysia cannot occur remotely even after modifying them so that they were in an online format. This is because approximately 51% of jobs require close physical proximity. With the MCO restrictions, these jobs were most vulnerable with one-fourth of heads of households experiencing unemployment during this time.

The Impact of COVID-19 on Food and Education

The impact of COVID-19 on poverty in Malaysia consequently affected access to food and quality of education. With little to no income, households spent around 84% less on education and 4% less on food between December 2019 and June 2020. While expenditure on food reduced, approximately 30% reduced food intake itself to cope with financial difficulties.

While employees adjusted to remote working, children needed to transition to online learning. Two-fifths of children do not have access to the required equipment (such as a computer) or internet connection to resume their education.

Closures have also prevented children from impoverished families from accessing meals provided at school-distributed supplemental food programs. This food insecurity pushed households to adopt cheaper and less healthy diets, further threatening the country’s child malnutrition crisis.

A Citizen’s Surrender

Some low-income residents resorted to waving white flags from their flats during the government-mandated lockdown to express the financial stress they were experiencing. This Bendera Putih, or “White Flag” movement emerged to help families ask for assistance. The white cloth outside their homes would encourage others to donate food.

In response, three computer science students from Multimedia University Cyberjaya urgently developed and released the “Sambal SOS” app within the same month the White Flag Movement gained traction. More than 7,000 users registered on the site just two days after its launch.

Here, users could digitally and anonymously report that they needed help. They then could connect with other users ready and able to provide aid.

An Economic Recovery Plan

Prime minister Tan Sri Muhyiddin Yassin announced the Pelan Jana Semula Ekonomi Negara (PENJANA), also known as the Economic Recovery Plan, in June of 2020. This stimulus package totaled RM35 billion (more than $7 billion) allocated to 40 initiatives organized into “three key thrusts:”

  • Empower People
  • Propel Businesses
  • Stimulate the Economy

Some initiatives to empower people included a wage subsidy program, social protection for the gig economy workforce and the internet for education and productivity. PENJANA funded entrepreneurship financing to propel businesses while supporting small enterprises through e-commerce and tourism financing. Initiatives to stimulate the economy included a campaign to buy Malaysian products and financial relief for those working in the agriculture/food sector.

Although poverty rates are still higher than before the COVID-19 pandemic, poverty levels have decreased by 16% between May 2020 and March 2021. Government assistance increased overall average household income since 2019, including disabled-headed households.

Households rely on savings, government and Zakat assistance for financial support as the labor market recovers. While PENJANA has proven to help boost the economy temporarily, many families still do not receive registered business-related aid and do not have social protection or insurance. The impact of COVID-19 on poverty in Malaysia emphasized that social protection assistance still needs to improve its scope of coverage to help the urban poor rebuild post-crisis.

– Aishah French
Photo: Flickr

COVID-19's impact on North KoreaOn May 12, 2022, the president of North Korea, Kim Jong-Un, made a public appearance. For the first time, he was wearing a mask. The world took even greater surprise when he declared that North Korea was under its first lockdown. This calls into question: what is COVID-19’s impact on North Korea?

Isolated From the Rest of the Globe

Prior to this announcement, North Korean officials claimed that not a single case of Coronavirus had entered their country. The nation, isolated from the rest of the globe, has previously endured life-threatening conditions. Recently, after a severe flood, North Korea has faced its most intense food shortage in the past decade. What’s more, its already limited healthcare system has deteriorated and left millions of people without adequate care.

Many question the accuracy of disease data. As a closed-off country, journalists find it very difficult to paint the full picture of North Korea. For instance, researchers were unaware of the 1990s North Korean famine until its aftermath, when survivors told their famine stories.

Draconian Lockdowns

Professor Park Won-gon, from the Department of North Korean Studies at Ewha Woman University predicted that North Korea could “institute draconian measures to those of its biggest ally, China,” according to VOA News. This meant strict lockdowns confining people to their homes, workplaces and dorms. Unlike China, though, North Korea doesn’t have the basic food supplies that China has to enforce such extreme restrictions. Consequently, thousands of people in North Korea are starving to death under this new lockdown protocol. Citizens could not access new harvests or markets which further strangled the economy.

The lockdown also stymied other solutions proposed by organizations. Particularly, the lack of mobility severed communication with international agencies. COVID-19’s impact on North Korea has, thus, proved massive. Medical resources and help have been inaccessible due to such stringent lockdowns.

Herbal Medicine: Fix or Fallacy?

Without vaccines, North Korea has resorted to herbal solutions. KCNA recently reported that “Thousands of tonnes of salt were urgently transported to Pyongyang city.” North Korea will use salt to produce an antiseptic remedy — in place of vaccines. Shanghai also transported millions of traditional medicines like herbal remedies and flu capsules to address COVID-19 in North Korea.

Unfortunately, these have no scientific grounding. Citizens have been drinking teas, salt water and even taking antibiotics. However, due to mass famines, many North Koreans have weak immune systems.

It’s unclear if this has worked. The treatments are approved by the DPRK, which develops methods for “scientifically controlling the spread of the…virus.”

Before these herbal treatments, North Korea reached around 400,000 cases daily. Recently, it reported “about 17,000 to 30,000 new fever cases.” Many experts believe North Korea is manipulating health data to shield itself against geopolitical consequences. Yet if it isn’t manipulating data, these herbal remedies may help mitigate COVID-19’s impact on North Korea.

Necessary Compromises

So far, North Korea has rejected most international help. Aid agencies have opened their doors to provide the nation with the necessary medical resources. Kim Jong-Un twice denied vaccines from Covax, according to The Washington Post. South Korea and the U.S., too, have asserted that they are open to providing aid. Nonetheless, North Korean elites continue to prioritize geopolitical leverage over the health of their constituents. It remains unclear whether North Korea will accept aid and scientifically proven disease resources from other countries.

Looking Forward: The Broader Picture

North Korea’s sudden outbreak demonstrates that the COVID-19 pandemic is not nearing an end. While the U.S. and other major nations are equipped with a “vaccine arsenal,” other countries are not as fortunate.

As of May 18, 2022, one report found that fewer than 13% of people in low-income countries are vaccinated. With such low rates, COVID-19’s impact on North Korea and developing countries is disproportionately larger than developed nations.

These concerns are urgent. Officials in Geneva told reporters that “uncontrolled transmission of the virus” in developing countries could give rise to new COVID-19 variants, The New York Times reports. North Korea, for example, could be a new variant’s breeding base.

Although North Korea hasn’t accepted aid from many countries, it seems to be getting health resources from China as of May 30, 2022. However, if the outbreak becomes too severe, North Korea will always have the open arms of the U.S. and U.N. to provide assistance.

– Ashwin Telang
Photo: Flickr

Vaccines in SyriaDuring the Eid holidays, the number of border crossings in and out of Syria drastically increased. As a result of such rising travel, the subsequent transmission of COVID-19 and reported cases additionally increased. With the remnants of the aforementioned influx continuing into late August and September 2021, vaccines in Syria are desperately needed, due to Syria being home to one of the fastest increasing rates of infection in the world. Thus, the early September shipment of over 358,000 vaccinations from WHO Turkey came as a welcome respite.

A Broken Healthcare System

As Syria nears the peak of its second infection curve, outside reporters and internal government agents look back at the path that brought Syria to its position of viral precarity. Syria entered the pandemic in a state of civil war that suffered the healthcare system as the most severe casualty. Since the inception of the Syrian civil war, there have been nearly 600 documented attacks on medical facilities. Of these, Physicians for Human Rights attributes over 90% to the state government. As a result of such unabashed violence, nearly 70% of healthcare workers fled the country. The shortage of workers placed yet another strain on an already damaged healthcare infrastructure. Such was the initial state of Syrian healthcare at the genesis of COVID-19.

A Worsening Crisis

Syria, the home to the largest population of Internationally Displaced Persons (IDPs) in the world, found itself massively unprepared for the ills of COVID-19. In the Northwest, nearly 4 million IDPs were equipped with a total of 212 ICU beds designated for pandemic patients. Such a dearth of medical supplies represented the norm across nearly all of Syria.

According to the WHO, COVID-19 transmission in IDP camps increased 200% since August 2021, with over 1,000 new daily cases. Dramatically ill-equipped to address the initial wave of COVID-19, this infrastructure proved similarly ill-equipped for the dissemination of vaccines.

Early estimates of the Syrian government’s capacity to vaccinate its population suggest that as of October 2021, only 2.6% have received both doses. At such a pace, the medical system would require a further 490 days simply to achieve a 10% vaccinated threshold. These predictions arrive in tandem with Syria’s highest infection rate to date, with a daily average of 347 reported on October 20.

New Vaccines, New Hope

Amidst all of this difficulty, NGOs and global organizations such as WHO and the U.N. have sought to aid nations struggling to vaccinate their citizens. One example is the shipment of over 358,000 vaccinations from WHO Turkey, a much-welcomed respite in Syria. In early September 2021, WHO reported the delivery of these vaccines to Northwest Syria by way of the Adana airport. These doses represent more than double the number of previously administered vaccines before their arrival. This arrival resulted from a collaboration between WHO Turkey, UNICEF and the Syrian Immunization Groups.  Their massively helpful collaboration presents just one example of the necessity of international aid in vaccinating the global population, and subsequently, beating this pandemic.

– Jonah Stern
Photo: Flickr

COVID-19 Vaccine
The World Health Organization (WHO) is making plans for how a life-saving COVID-19 vaccine could be distributed around the globe.

COVID-19 Vaccine Distribution

There are concerns about countries “hoarding” stores of vaccines for their own citizens. The countries that have the most money on hand will have the ability to buy a larger portion of available vaccines for citizens. While global leaders have come together to pledge $2 billion towards the creation of a vaccine, there is currently no formal worldwide plan to successfully manage the future COVID-19 vaccine and its distribution.

The public-private partnership that lead to this $2 billion pledge, Gavi, focuses on increasing childhood vaccinations in underdeveloped countries. It has support from WHO, UNICEF and the Bill and Melinda Gates Foundation. Bill Gates himself has promised $1.6 million towards Gavi, along with $100 million to help countries that will need aid to purchase COVID-19 vaccines.

U.S. Involvement and WHO

The U.S. government has decided to stay out of the recent Gavi-organized funding pledge. The country has also pulled monetary support from WHO. In the past, the U.S. has been a large supporter of the creation of the HPV and pneumococcal vaccines, which has left many experts confused by the recent moves of the U.S. to disassociate itself from the larger global race towards a COVID-19 vaccine.

Beyond hoarding concerns, there are always issues surrounding legal and sharing agreements between countries, quality control, civil uprising and unrest and natural disasters when it comes to vaccine distribution.

A recent example of how the world dealt with vaccine distribution during a pandemic is the 2009-2010 H1N1 swine flu pandemic. With the money they had, wealthier countries purchased most of the vaccine available through early orders, leaving developing countries to scramble for leftover vaccine stores. Eyjafjallajökul’s eruption in Iceland in April of 2010 also created vaccine shipping delays. Many countries, such as the U.S., Australia and Canada would not let vaccine manufacturers ship vaccines outside of their countries without fulfilling their people’s needs first.

Going Forward

To create a successful global vaccination program requires the cooperation from all countries involved, not just a few. Many may die without the equitable sharing of vaccines as this pandemic will flourish in underdeveloped nations. It may be seen by the rest of the global community as selfish to not try and help other countries in their fight against the virus.

Even after a vaccine is created, different strains of COVID-19 could easily return to Australian, Canadian or American shores, wreaking havoc all over again. While there are efforts being made to prevent distribution issues with the future vaccine, without the help of the United States,—one of the wealthiest countries on Earth—it may be long before a COVID-19 vaccine is fairly distributed.

Tara Suter
Photo: Flickr

Dengue FeverAccording to the World Health Organization, dengue fever is one of the ten major global health threats of 2019. The mosquito-borne illness results in flu-like symptoms that can kill up to 20 percent of those infected. Approximately 390 million cases of dengue fever are reported each year across 100 different countries, although, many cases go unreported. Cases of dengue fever have also increased 30 times in the last 50 years, meaning that today, 40 percent of the world’s population is at risk of contracting the disease.

Why the Increase?

While dengue fever used to be concentrated in countries with extreme tropical climates, such as India and Bangladesh, the disease is now prevalent in countries that have more temperate climates, such as Nepal. With higher than average temperatures, rainy seasons are lasting longer which creates the perfect environment for the Aedes mosquito, the carrier of the disease. Unfortunately, the geographic regions that the Aedes mosquito inhabits coincide with low and middle-income countries. Many of these countries do not have sufficient health care systems to cope with this major health issue. Therefore, the effects of dengue are even more severe.

Protection from Mosquitoes

The World Health Organization is leading efforts to reverse the increasing threat of dengue fever. One common tactic used is immunization. The first immunization for dengue fever was approved in 20 countries in 2015. However, follow-up data from 2017 showed that the vaccine was actually harmful to those who had never contracted the disease, putting people at a higher risk of more severe cases of dengue. Now, the vaccination is recommended as a measure for those who have already been affected.

In addition to immunization, people can inhibit the Aedes mosquito’s survival and procreation by properly disposing of human waste, and not leaving out any stagnate, uncovered containers of water, as mosquitoes thrive and lay eggs in both environments. It is also advised to use spray insecticide to repel bugs and invest in screened windows and sleeping nets for protection in homes.

Combatting the Threat

The World Health Organization is partnering with local organizations and governments in affected countries to ensure that the number of deaths caused by dengue fever will decrease by 50 percent in 2020. In order to reach this goal, however, additional funding and research are needed so that the scope of dengue fever is properly understood. Health care providers also need the training and resources to properly address the issue and detect the disease in its early stages as well. If dengue fever is diagnosed before the symptoms become too severe, mortality rates of the disease become much more optimistic.

 

Madeline Lyons
Photo: Flickr

UNDP Supports Universal Immunization Program in IndiaWith high risks of communicable diseases like bacterial diarrhea, malaria, hepatitis A and E and typhoid, there’s a rising necessity for a proper immunization program in India. The United Nations Development Programme (UNDP) has partnered with the Indian government and Ministry of Health and Family Welfare to design and put into effect an Electronic Vaccine Intelligence Network (eVIN). This project, known as Improving Efficiency of Vaccination Systems in Multiple States, has already run since 2014 and is to run until 2021 to strengthen the evidence base for policy-making related to vaccine delivery, procurement and planning, and ensure equity in availability.

As the world’s largest immunization program, eVIN technology has already shown results in enabling real time information on cold chain temperatures and vaccine stocks and flows in all 371 implementing districts in India. It has managed to achieve over a 98 percent reporting rate from vaccine storage areas, with over 2 million transactions logged each month, and developed the skills of over 17,000 government staff in store keeping, data operating or cold chain handling in over 550 batches of training programs.

The eVIN is setup on a mobile application that easily allows cold chain handlers to log stock positions at the end of each routine immunization day, which is then relayed immediately onto a web interface for assessment by health officials. In India, this can come to play an important role as geography and communications can pose an issue, like in the small hill-state of Manipur, where vaccine vials are carried over extensive distances to session sites by auxiliary nurses and midwives. Instances of stock-outs have decreased by more than six times here, and eVIN has enabled staff to learn how to use a smartphone and other technology, improving quality of work and management in the process.

This immunization program in India has also significantly empowered women health workers, giving them the opportunity to work with technology after attending regional and district eVIN training sessions. This allows them to manage stocks and temperatures themselves, bridges the digital divide in rural parts of India and ensures transparency alongside accuracy. Over 50 percent of cold chain handlers are women, and many are from older age groups.

EVin has taken India out of the unproductive days of delayed decision making, shortages and expirations, and has created an efficient health system that allows for valuable state-wide geographic, stock-out or excess stock and temperature overviews on each district’s centers. It also allows for large savings by reducing vaccine wastage and allowing for timely and quality injections, as in Rewa, where around $70,000 was saved after six months of eVIN activation.

Though led by the UNDP and Ministry of Health and Family Welfare in India, the Universal Immunization Program is largely supported by GAVI, a global vaccine alliance established in 2000. With support from GAVI and the Indian government, the Universal Immunization Program in India has immunized at least 65 percent of India‘s children and expects to immunize 27 million more each oncoming year.

Zar-Tashiya Khan

Photo: Flickr

Malaria Vaccine Trial
Malaria is one of the deadliest diseases afflicting developing countries across the world. In 2015 alone, it took the lives of 429,000 people, with a majority being African children. The most developed malaria vaccine trial is currently scheduled to be used in parts of Africa beginning next year, where the disease is still rampant.

Miguel Prudêncio and his team at iMM Lisboa, a biomedical research nonprofit institution, have been researching solutions to end malaria in the area. They decided to approach malaria as scientist Edward Jenner approached smallpox, by using a less harmful version of it as a shield against deadlier versions. In a similar fashion to how Jenner used cowpox to fight smallpox, Prudêncio and fellow researchers at iMM Lisboa wanted to conduct a malaria vaccine trial using a rodent version of the malaria-causing parasite. iMM Lisboa is going to carry out the trial with the help of the Radbound University Medical Center, based in the Netherlands, and PATH in Seattle.

The new malaria vaccine trial will take place at Radbounumc in the Netherlands. The first half of the trial will involve three groups of six volunteers, with each team enduring a different number of bites from mosquitos exposed to the parasite. Each volunteer will be thoroughly examined after the process because of the risk that comes from exposure. This examination will continue until the researchers can decide that it is safe to begin the second half of their malaria vaccine trial. The goal is that “the modified rodent parasite will help induce a protective response in healthy human volunteers.”

This will be the first time that humans will be purposely introduced to the rodent version of the parasite. The volunteers’ reaction to the first part of this malaria vaccine trial will be a deciding factor as to the effectiveness of this approach. With luck, the second phase will prove that smallpox is not the only disease that can be fought off by genetically modified versions of itself.

The success of this malaria vaccine trial could mean saving the lives of hundreds of thousands of people in the future. Ultimately, the goal is to see malaria eradicated just like smallpox, but in upcoming years it will be a breakthrough if a vaccine is developed with a protective efficacy of at least 75 percent against malaria. Prudêncio and his fellow researchers are hoping to achieve the elimination of malaria once their vaccine trial is complete.

Mackenzie Fielder

Photo: Flickr