Can We Nudge the Budget? Our Experience at the END7 Student Advocacy Day

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By Anjali Bhatla, Cyrus Ghaznavi and Sri Gopakumar
Rice University Undergraduates 

On a bright spring morning in Washington, D.C., we stood outside the U.S. Capitol in the middle of a whirlwind, 32-hour trip from Houston, Texas.  As we stood in the clearance line to enter the Capitol Visitors Center, we reviewed our materials to prepare for a day of meetings with congressional offices to advocate for a global health issue that each of us has become very passionate about. When we were invited by the Global Network to attend the first-ever END7 Student Advocacy Day on April 22, we realized that this would be a rare opportunity for us to get involved with the political process surrounding the federal budget  and lend our voice in support of neglected tropical disease (NTD) treatment.

This semester, we founded a campus chapter of the END7 campaign at Rice University after we were all separately introduced to the issue of NTDs by Dr. Peter Hotez, President of the Sabin Vaccine Institute, the founding dean of the Baylor College of Medicine National School of Tropical Medicine in Houston and a Baker Institute Fellow in Disease and Poverty at Rice University. Whether it was through working for Dr. Hotez or taking his seminar class, the three of us have been deeply moved by what he has taught us about NTDs – an important but neglected global health issue.

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NTDs have been shown to perpetuate the cycle of poverty by impairing physical and cognitive development, decreasing economic productivity, negatively affecting maternal and child health, and socially stigmatizing those that are afflicted. END7 at Rice is taking a three-pronged approach to addressing the need for greater investment in NTD prevention and treatment through committees focused on marketing, fundraising and advocacy. To increase awareness of NTDs in our community, we plan to implement creative events, programming and social media campaigns across campus.  And, through our END7 chapter, we hope to facilitate an exchange of ideas on how to address health disparities in the developing world.

We are particularly concerned about the funding gap for NTD treatment programs. The United States Agency for International Development (USAID) Neglected Tropical Disease program has been essential in providing NTD treatments around the world – more than 1.2 billion to date – but proposed cuts to the program’s funding in the fiscal year (FY) 2016 budget could stifle and potentially reverse the progress already made by the program to the NTD elimination effort. Having just started Rice’s END7 chapter, we decided that going to DC would teach us valuable lessons we could bring back to Houston and provide us with a greater context for our chapter’s goals.

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On the morning of the event, we gathered in a wood-paneled conference room in the Capitol Visitors Center and received a briefing on the global effort against NTDs from leaders of the Global Network, USAID, RTI International and WASH Advocates. Then we split into small groups for our afternoon meetings in congressional offices with each person taking on a particular role. One student would provide some background for their involvement in the END7 campaign: “I’ve been able to travel to countries including Haiti and India, where NTDs are endemic, and have seen firsthand the socioeconomic impacts these diseases have.” Another would carefully lay out the key statistics: “1 in 6 people are infected with an NTD!…more than one billion people in all!…every $1 of taxpayer funding leverages $26 worth of donated drugs, an incredible return on investment!” A third student would paint a holistic picture of the budgetary issue at hand and hammer in the final message: “Funding the USAID NTD Program is critical to solving this global health problem. Maintaining our momentum is essential and we don’t want to lose the good work we’ve done.” Then we answered questions about NTDs and USAID’s work to educate our leaders and their staff about this key global health issue. We concluded our meetings by inviting members of Congress to join either the Senate Caucus on Malaria and Neglected Tropical Diseases or the Congressional Caucus on Malaria and NTDs (one U.S. Representative joined that same day!) and delivering student signatures on END7’s petition to increase NTD funding to $125 million in FY 2016. (We had collected nearly 200 signatures on our campus alone!)

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At the end of the day, our time on the Hill brought the conversation surrounding NTDs alive for us in a new way. We learned so much during our time in Washington that we didn’t mind missing a few classes (even though finals were just around the corner!). Advocating alongside leaders of the Global Network for Neglected Tropical Diseases and fellow student supporters of the END7 campaign in meetings in congressional offices opened our eyes to the importance of public policy in the fight against NTDs. As aspiring physicians, we hope to become civically minded professionals who can communicate information effectively to our lawmakers. By engaging in the political process during the END7 Student Advocacy Day, we learned the importance of the student voice in advocating for NTD treatment. We genuinely hope that our message was well-received: the USAID NTD program budget is a best buy in global health and increased funding is needed to allow the progress of USAID’s NTD program to continue. We are excited to see that the 24 Hill meetings students participated in on April 22 have already made an impact, with the addition of a new representative to the Congressional Caucus on Malaria and NTDs and positive signs of increased support from key leaders. As students around the country mobilize around this cause, we hope the U.S. government takes a leading role in prioritizing NTD funding in the FY2016 budget and contributes crucial resources toward the NTD fight. We hope to return to D.C. next year to continue engaging in the political process as citizens, students and future medical professionals dedicated to seeing the end of NTDs.

You can support END7’s advocacy to protect and increase the USAID NTD budget by sending a message to your Senator. Learn more in our infographic and this Buzzfeed post created by student supporters and be sure to check out the END7 Student Advisory Board’s op-ed in the Hill!

Better Together: Integrating Immunization and Deworming during World Immunization Week

 

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Beginning tomorrow, global health partners around the world will be celebrating World Immunization Week. While the week’s events primarily focus on achieving equitable access to immunization, the Global Network for Neglected Tropical Diseases is particularly excited about the opportunities World Immunization Week presents for integrating deworming and immunization campaigns.

In Honduras, for example, the Ministry of Health has used World Immunization Week as a platform to deworm hundreds of thousands of children throughout the country.

Read our Honduras case study here: HONDURAS: LEADING THE WAY IN THE AMERICAS THROUGH INTEGRATED EFFORTS TO TREAT NEGLECTED TROPICAL DISEASES (NTDS)

Integrating deworming with immunization campaigns under the umbrella of World Immunization Week is an extremely cost-effective way to prevent many diseases at the same time. By providing deworming medicine alongside immunizations, Honduras is maximizing the impact of its health interventions.

Honduras has also integrated water, sanitation and hygiene (WASH) practices, as well as vitamin A supplementation into World Immunization Week. Since poor WASH contributes to increased intestinal worm infections, and intestinal worms can worsen and intensify malnutrition, integrating these three health interventions is essential for maximizing the health of children.

Honduras’ unique and successfully-integrated approach to fighting intestinal worms should be celebrated and replicated. To learn more about the country’s efforts, read our case study here.

Tackling NTDs to Help End the Cycle of Poverty and Disability

 

Hadiya Hussien's eyes are examined by a community worker credit: CBM

Hadiya Hussien’s eyes are examined by a community worker. credit: CBM UK

By CBM UK

This blog post is part of Global Network’s #G7forHealth series, which highlights the current and potential impact of G7 countries on those suffering from neglected tropical diseases. 

Hadiya is 9 years old. When CBM community workers met her in her village in Amhara, Ethiopia, her eyes had been itching and watering for three days. “It keeps her from being able to see others. She can’t see them clearly because of the tears,” explained her father Ali. But it wasn’t the first time Hadiya has experienced trachoma and she’s not alone in her village. 6 out of every 10 children in this region of Ethiopia suffer from an active trachoma infection.

Hadiya’s infection was treated with Zithromax, and her family now knows how face washing can help prevent the disease. CBM’s partner, Organisation for Rehabilitation and Development in Amhara (ORDA), has been working with the community to ensure that the village well is protected with the source capped and a retrieval unit fitted so that the water used for drinking and washing stays clean.

These interventions will make a huge difference to Hadiya. Not only will she be free from the itching and pain of the trachoma infection, but she is no longer at risk of losing her sight to the disease. And in a poor community like Hadiya’s the consequences of sight loss can be utterly devastating. Her chances of completing her education would be much reduced – only 1 in 10 children with disabilities in the global south goes to school. She would be at 2-3 times greater risk of violence or abuse. Her access to healthcare and opportunities to earn a livelihood would be far more limited. Like millions of people with disabilities worldwide, she could very easily find herself trapped in a cycle of poverty and disability.

Neglected tropical diseases (NTDs) such as trachoma are caused by poverty, flourishing under conditions characterised by poor housing and sanitation, unsafe water and limited access to basic health care. But by causing disability, they also lead to increased poverty for individuals and communities. This is why we believe investment in the fight against NTDs should be a priority for the world’s leading economies and why CBM UK — alongside 100+ international institutions and experts working on NTDs — is one of the signatories of an open letter to G7 leaders, asking them to sustain their current support for NTD control and elimination as well as to address current gaps.

Tackling disability is vital to ending extreme poverty, and eliminating NTDs like trachoma is a key way to prevent disability – 2.2 million people are visually impaired due to trachoma, and of them 1.2 million are irreversibly blind.

CBM has been working to prevent and treat blinding NTDs such as river blindness (onchocerciasis) and trachoma for over 20 years. CBM UK is currently involved in the Queen Elizabeth Diamond Jubilee Trust’s programme to tackle blinding trachoma in 10 out of 18 Commonwealth countries where trachoma is confirmed or estimated to be endemic.

Within the Trust’s programme, CBM UK is an implementing partner in Kenya, Uganda and Malawi, aiming to eliminate trachoma as a public health problem in each of these countries. This is done by implementing the ‘SAFE’ Strategy which consists of Surgery, Antibiotics, Facial Cleanliness and Environmental Improvements. The programme has recently completed its first year. During this time, CBM has held a number of community outreach camps to conduct trachoma surgery, which is used to treat the more advanced, blinding stage of the disease. The surgery element of the SAFE Strategy is used to address the backlog of trachoma cases, whilst the other elements are aimed at prevention and stopping (re)infection.

Funding programmes like the Trust’s initiative make a crucial contribution to the World Health Organisation’s (WHO) Alliance for the Global Elimination of trachoma by 2020 (GET 2020). The UK and the other G7 members must now ensure that this moment is sustained to permanently eliminate trachoma and other NTDs.

CBM is in international Christian disability and development organisation improving the quality of life of millions of people living with or at risk of disability in some of the world’s poorest communities. CBM UK programmes include a range of NTD programmes and other disability related programmes in Health, Livelihoods and Inclusive Education.

NTD Article Round-Up

 

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Starting this month, the Global Network will be presenting a round-up of articles on neglected tropical diseases (NTDs). Check back every month for the latest. To suggest an article, you may post a comment below.

1. Unprogrammed Deworming in the Kibera Slum, Nairobi: Implications for Control of Soil-Transmitted Helminthiases

PLoS Neglected Tropical Diseases – Published to PubMed 3/12/15
Julie R. Harris, Caitlin M. Worrell, Stephanie M. Davis, Kennedy Odero, Ondari D. Mogeni, Michael S. Deming, Aden Mohammed, Joel M. Montgomery, Sammy M. Njenga, LeAnne M. Fox, David G. Addiss

“In countries with endemic soil-transmitted helminth infections, deworming medications are widely available from multiple sources, including over the counter. However, in many countries, national programs already provide deworming medications in mass drug administrations to primary school students, as part of World Health Organization recommendations. Evaluations of the effectiveness of such medications at reducing worm burden in children is based solely on the national program’s distribution schedules, primarily because little is known about how frequently deworming medications are obtained from other sources. We investigated sources of deworming medications received by children in a Kenyan slum, finding that more than half of school-aged and preschool-aged children received deworming medications outside of a national school-based deworming program. These drugs were received from multiple sources, including chemists, healthcare centers, and at schools, via the efforts of non-governmental organizations. These data strongly indicate a need to collect data on all sources of deworming medications when evaluating the effectiveness of national school-based deworming programs.”

2. Mass Drug Administration for Trachoma: How Long Is Not Long Enough?

PLoS Neglected Tropical Diseases – Published to PubMed 3/23/15
Violeta Jimenez, Huub C. Gelderblom, Rebecca Mann Flueckiger, Paul M. Emerson, Danny Haddad

“Trachoma, the world’s leading infectious cause of blindness, is scheduled for elimination by 2020. Reaching this elimination target depends on successful implementation of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). Annual mass antibiotic distributions are key to breaking the cycle of transmission in a community. However, it is not clear how many annual mass treatments need to be carried out in order to achieve elimination. Our study analyzes the effect of mass antibiotic distribution on different baseline prevalence levels of trachoma, in order to assess factors that affect the success of reaching elimination goals. We find that the prevailing belief, which suggests that 3 annual mass treatments can achieve local elimination of trachoma at prevalences between 10–30%, and 5 annual mass treatments for districts above this benchmark, is probably incorrect. In fact, much longer intervals may be required with “business as usual” programmatic strategies, which often include skipped years of treatment. Districts with high prevalence levels may require more intense treatment strategies to eliminate trachoma. Intensified recommendations must be implemented without delay in order to reach the 2020 elimination deadline.”

3. Neglected Tropical Disease Control and Elimination: Is Human Displacement an Achilles Heel?

PLoS Neglected Tropical Diseases – Published to PubMed 3/19/15
Kaylee Myhre Errecaborde, William Stauffer, Martin Cetron

“The United Nations High Commission for Refugees (UNHCR) has estimated that over 40 million people are currently displaced and have variable access to health care in the country in which they reside. Populations displaced by conflict are largely disenfranchised, and high prevalence of neglected tropical diseases (NTDs) has been documented. NTDs generally affect the least advantaged people in poor societies—populations with little voice or representation. These already susceptible people become even more vulnerable when forced from their communities as internally displaced persons (IDPs), refugees, or forced migrants. To further complicate matters, many of these people of concern are under 18 years old. Children experience the greatest risk and suffer the most consequences of NTDs. As marginalized populations flee from conflict or environmental catastrophe, they are often burdened with insidious NTDs ranging from asymptomatic to overt and debilitating disease. Many suffer from chronic consequences such as malnutrition, growth stunting and developmental delays, inhibiting chances for sustainable livelihoods and making it less likely that they will successfully overcome the adversity.”

4. Gut Instincts: Knowledge, Attitudes, and Practices regarding Soil-Transmitted Helminths in Rural China

PLoS Neglected Tropical Diseases – Published to PubMed 3/25/15
Louise Lu, Chengfang Liu, Linxiu Zhang, Alexis Medina, Scott Smith, Scott Rozelle

“Soil-transmitted helminths (STHs) are parasitic intestinal worms that infect more than two out of every five schoolchildren in rural China, an alarmingly high prevalence given the low cost and wide availability of safe and effective deworming treatment. Understanding of local knowledge, attitudes, and practices regarding STHs in rural China has until now, been sparse, although such information is critical for prevention and control initiatives. This study elucidates the structural and sociocultural factors that explain why deworming treatment is rarely sought for schoolchildren in poor villages of rural China with persistently high intestinal worm infection rates. In-depth, qualitative interviews were conducted in six rural villages in Guizhou Province; participants included schoolchildren, children’s parents and grandparents, and village doctors. We found evidence of three predominant reasons for high STH prevalence: lack of awareness and skepticism about STHs, local myths about STHs and deworming treatment, and poor quality of village health care. The findings have significant relevance for the development of an effective deworming program in China as well as improvement of the quality of health care at the village level.”