Drug Development Global Program

In-depth: Why isn’t oral rehydration solution defeating diarrheal disease?

A hand spoons ORS into the mouth of an infant held by her mother.

Administered spoonful by spoonful, oral rehydration solution is an effective treatment for childhood diarrhea. Photo: PATH/Heng Chivoan.

Oral rehydration solution (ORS), a simple mixture of salt, water, and sugar, was first introduced in the 1970s to reverse dehydration caused by severe diarrhea. Due to its simplicity, low cost, and high effectiveness, it was heralded as one of the most important medical achievements of the last century. Since its introduction, it is estimated to have saved a whopping 50 million lives from diarrhea.

A persistent threat

While the world has witnessed a dramatic decline in preventable child deaths over the past two decades, more than half a million children each year still lose their lives to diarrhea, and it remains the second leading killer disease of children worldwide. For children who survive, a bout of diarrhea can have persistent effects. The World Health Organization (WHO) estimates that 50 percent of malnutrition is associated with repeated diarrhea. In addition, when a child is malnourished or regularly ill during the first few years of life, there are associated negative effects on future cognitive development, education, and productivity.

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International Women’s Day: empowering women to transform lives as social entrepreneurs

Women and girls candid photos side-by side in Maharashtra, India. Photo: PATH.

Women and girls in Maharashtra, India. Photos: PATH.

Lorelei Goodyear is a senior program officer at PATH and a committed advocate for women’s health. Her work on PATH’s Healthy Households Initiative empowers women through entrepreneurship that enables their communities to live healthier lives. Lorelei, and the women reached through this project, truly know how to #MakeItHappen. This post was originally featured on the DefeatDD blog

My whole career has focused on increasing options for women and girls so that they can achieve their full potential. I have focused primarily on reproductive health because deciding if and when to become a mother is such a pivotal point in a woman’s life. Eight years ago, I became a mother and took on a new role leading PATH’s research and evaluation on safe water technologies. I quickly learned that diarrhea caused by unsafe water is a leading killer of children and safe water plays a crucial role in maternal and child health.

There are many effective water treatment methods, but getting people to use them is a big challenge. After experimenting with a variety of market models, we had the best results (highest rates of adoption) by training local entrepreneurs to sell water filters in their communities and providing consumer loans that made filters affordable through small payments over time. In nine months, we tripled the use of water filters in a community in Cambodia. We tested the same approach with latrines, and Cambodian customers were four times more likely to buy them when offered a loan.

For our Healthy Household Initiative (HHI), we built on this success and added clean cookstoves and solarlights (to reduce indoor air pollution that contributes to respiratory illnesses). By selling a product bundle, homes would become healthier and social entrepreneurs would have an incentive (profits) to sustain and scale up without relying on donor support.

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A fresh perspective: introducing David Shoultz

David Shoultz recently joined PATH as the program leader for drug development. Before PATH, he served as the Director of Grantee and Partner Engagement at the Bill & Melinda Gates Foundation, where he worked to deepen engagement between partner organizations. We spoke to him recently to find out what first drew him to global health, what inspires and motivates him, what opportunities and challenges he sees, and what he envisions for PATH’s Drug Development program.

David Shoultz plays with a child from the Garifuna community on a small island near Roatan, Honduras.

Enjoying the chance to play with some kids from a Garifuna community on a small island near Roatan, Honduras, 2013. Photo: David Shoultz.

Who inspires you?

I draw a lot of inspiration from Marc LaForce’s work to develop MenAfriVac®, a new vaccine for meningitis. Marc started by putting a lot of trust in end users and potential customers—ministries of health and community clinics—by asking what they needed most from a new vaccine. Overwhelmingly, he heard that it had to work against meningitis A (the most common type of meningitis in the region), it had to be safe and effective, and most importantly, it had to be inexpensive.

Keeping these requirements at the forefront, Marc and his team were able to develop a vaccine in record time and at one-tenth the cost of a typical vaccine. With more than 217 million people vaccinated so far and plans to include MenAfriVac® in routine childhood immunization programs, it has the potential to wipe out a disease that has been a scourge in the region. I truly admire Marc’s vision, persistence, and leadership on this project.

What first drew you to global health?

David Shoultz stands on the Great Wall of China, with the length of the wall extended behind him.

On a remote section of the Great Wall of China in the Beijing Region, 2009. Photo: David Shoultz.

My mother, Janice Shoultz, was an early influence. She recently retired, but for many years, she was a professor of community health nursing at the University of Hawaii. She focused on issues affecting rural communities, including domestic violence and nutrition. Watching her career develop, I saw the passion and the reward, and I got to know more about the critical work she did. She spent a month working in rural health care in China in the early 1980s, and it was a mind-expanding experience to begin to understand what rural health care is and how it compares between China and the United States. Her stories and pictures from that trip helped to fuel my early interest in global health.

Later, I was drawn into global health by Dr. King Holmes at the University of Washington. In the 1990s, global health was considered a niche field, primarily known as tropical medicine and hygiene. King drew me to global health as we know it today, teaching me the critical value of understanding the knowledge, attitudes, beliefs, and practices of the people that we intend for our global health interventions to benefit. I was—and am to this day—inspired by his ingenuity, generosity, and work ethic.

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Top moments in 2014

As 2014 comes to a close, we spent some time reflecting on the moments that helped set this year apart. Take a trip down memory lane as we count off our most memorable highlights.

1. Innovation. Transformation. Inspiration.

We kicked off 2014 with an in-depth examination of ways the public and private sectors can work together to save lives. Three guest contributors penned posts for our blog addressing topics such as factors for success in public-private partnerships, the arc of product development and the potential for global innovation hubs, designing for the poorest of the poor, and more.

2. Perspectives on defeating malaria

Infographic showing, "I raise my hand to #DefeatMalaria," written on an open palm.

An infographic from the campaign illustrating one of the ways to participate. Photo: PATH.

To commemorate World Malaria Day in April, we joined with a group of organizations to launch the #DefeatMalaria campaign on social media. Campaign participants were asked to contribute photos and tweets using the #DefeatMalaria hashtag with messages of support and statements about their work.

In addition, we hosted a month-long blog series featuring a range of perspectives in the fight to end malaria. The blogs included personal experiences, exciting scientific advances, and reports from the field from individuals including Karen Goraleski of the American Society of Tropical Medicine and Hygiene, James Whiting of Malaria No More UK, and many others.

3. Changing the reality of diarrheal disease

Snackable promoting the campaign to #DefeatDD.

A still from our recently released video highlighting an integrated approach to defeat diarrheal disease. Photo: PATH.

In collaboration with our colleagues at DefeatDD, in June, we introduced a new video, “Defeat diarrheal disease? Together, we’ve got it covered.” The video highlights the simple solutions we can stitch together now—such as exclusive breastfeeding, good nutrition, handwashing, safe drinking water, vaccines, and effective treatments—to bring an end to preventable childhood deaths from diarrhea. Eugenio de Hostos, our head of research and preclinical development, also offered his thoughts on what it will take to defeat diarrhea.

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Drug development news digest—October/November 2014

Two pre-exposure prophylaxis (PrEP) trials demonstrating unexpectedly early success, a Muppet that talks about poop, new lessons in drug resistance gleaned from a soldier dead for 99 years, and more… Dive into this unusual collection of recent media highlights to get caught up on your global health news!

At the recent HIV Research for Prevention (HIVR4P) conference in Cape Town, South Africa, a major focus was placed on the need to develop a range of prevention options and put more prevention tools into clinical practice, as well as close gaps in care, to curb the epidemic. DispatchLive

Six-year-old Raya isn’t shy about poop. As the newest addition to Sesame Workshop (the global health arm of the Sesame Street series), Raya’s job is to break the taboo around open defecation and educate kids about using toilets and proper hygiene to protect against sanitation-related diseases. NPR: Goats and Soda

Faced with drug shortages, the Indian government has joined with pharmaceutical companies, the World Health Organization, and others to provide medicine to 150,000 HIV/AIDS patients at risk of missing dosages. Reuters

As coordinator of the President’s Malaria Initiative, Rear Adm. R. Timothy Ziemer has been credited with helping to reduce the burden of malaria worldwide and fostering closer collaboration between malaria organizations. He discusses lessons learned from experience (including a childhood bout with malaria), his approach to zeroing in on malaria, and his motivation to serve. The New York Times

Exciting (and unexpectedly early) results from two PrEP trials in Europe demonstrate that oral Truvada used as PrEP significantly reduces HIV infection among men who have sex with men, adding to the growing body of evidence showing the effectiveness of this prevention tool. All men in PROUD (United Kingdom) and IPERGAY (France and Canada) trials will now be offered PrEP to protect themselves from the virus. The IPERGAY is also significant because it tested an “on-demand” PrEP regimen, which can be seen as an effective and versatile alternative to daily dosing. AIDSmap

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#IWashMyHands. Spread the word!

Each year on October 15, hundreds of millions of people around the world mark Global Handwashing Day to highlight one of the most important health practices around—handwashing with soap. Handwashing is cost-effective and simple, and it’s one of the easiest ways to protect against the most common illness among children worldwide—diarrheal disease.

Over a half million children under five die from this treatable and preventable cause each year, with many survivors continuing to suffer from chronic malnutrition and stunting far after the illness has passed. Children that are most vulnerable live in rural, impoverished areas with unsafe water and poor sanitation, where needed treatment can be too difficult to access or too costly to afford.

It doesn’t have to be this way. Working together with an integrated approach that includes vaccines, treatment with oral rehydration solution and zinc, drugs, safe water, nutrition, education, and better sanitation, we can save lives and create better health and opportunity for everyone. Help spread the word this Global Handwashing Day. Pass on one or more of the images below with important messages about handwashing and diarrheal disease prevention, and check out our list of resources.

Happy handwashing!

Handwashing with soap saves lives.

 

 

 

 

 

 

Global Handwashing Day 2014

Global Handwashing Day 2014

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Resources

Drug development news digest—September 2014

From “Science Kardashians” to a significant announcement from a public official in San Francisco—catch up on your science, R&D, and global health headlines with the collection of stories below.

Proving that not all news is bad news, here’s an uplifting map that shows the incredible progress made in just a few decades to increase rates of child survival around the world. Humanosphere

Science uses a new Kardashian Index (named for reality star Kim Kardashian) to identify the “science stars” of Twitter and stirs debate about whether scientists should spend less time tweeting and more time writing papers. Science

For decades, researchers have combed the corners of the earth searching for microorganisms that could be used to make the latest lifesaving antibiotics. A new study suggests they could have been looking much closer to home—at the bacteria that live inside our bodies. The New York Times

Women in high HIV incidence settings could benefit greatly from biomedical prevention tools, but a new publication raises questions about products that, while promising in the lab and in some trial settings, face real-life barriers to acceptability in the field. Science Speaks blog

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Making the case for research and innovation for health in the post-2015 development agenda

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda. This post was originally featured on the Global Health Technologies Coalition blog Breakthroughs.

The new paper make the case for the inclusion of research and innovation for health as a central component of the post-2015 agenda. Photo: PATH/Gabe Bienczycki.

The new paper make the case for the inclusion of research and innovation for health as a central component of the post-2015 agenda. Photo: PATH/Gabe Bienczycki.

A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV/AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda.

In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/AIDS, malaria, and other diseases).

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Drug development news digest—August 2014

“Positive deviants” in the fight against AIDS, vaccines for mosquitoes, and the man responsible for saving 50 million lives from dehydration due to deadly diarrhea—these are just a few of the stories featured in our round-up of news from August. Dive into the selection below to get caught up on some of the trending headlines in malaria, HIV/AIDS, diarrheal disease, and more.

It’s no secret that breastfeeding provides infants with the best start in life, but did you know it also provides important health and economic benefits for everyone else? In fact, it’s tied to every one of the Millennium Development Goals. The Guardian

The man behind oral rehydration therapy—heralded as “potentially the most important medical advance” of the twentieth century—describes how this radically simple solution came to be. BBC

Rwanda, Ethiopia, and Malawi—three surprising “positive deviants” in the global fight against AIDS. How are they doing it and what can we learn? The New York Times

An important milestone for malaria elimination—first malaria treatments containing semisynthetic artemisinin are now shipping to malaria-endemic countries. The Guardian

At the time of its introduction, oral rehydration solution was a breakthrough in saving lives from diarrhea, but superstition, distrust, and a significant “know-do” gap prevented it from reaching widespread adoption for years. The New York Times

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A decade of teamwork and collaboration

Ten years ago, we launched an ambitious plan to capitalize on a synthetic biology innovation to create a non-botanical source of artemisinin for antimalarial drugs. This summer, the first artemisinin-based combination therapies (ACTs) containing semisynthetic artemisinin (ssART) are hitting the market. Take a look back at a few moments from this journey that spanned multiple sectors, countries, cultures, and time zones!

At the OneWorld Health office in San Francisco, CA, during the early days of the projectquick team photo before getting back to work.

Team members pose for a photo gathered around a table. Champagne flutes in the foreground.

Photo: PATH Drug Solutions.

One of several trips to France—getting to know our colleagues and project partners over a meal and a stroll (2008).

08.2France Sept08 014

Photo: PATH Drug Solutions.

Colleagues on the Artemisinin Project stand in front of an architectural arch

Photo: PATH Drug Solutions.

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