Armed with creative ideas and a modest Canadian grant, a committed, courageous group of vaccine advocates will venture into one of Pakistan's most difficult regions to fight deadly diseases and ignorance of vaccines and their benefits.
"The Awakening project" will establish village health committees, school drama clubs and radio programs among other novel means to promote child vaccination in Pakistan's mountainous Swat district, once one of the most dangerous parts of a highly conflicted part of the world -- an area where one child in 10 dies before age five due largely to vaccine-preventable diseases like polio, measles or hepatitis.
"The infamous Swat district was controlled by the Taliban until 2009 and health workers seldom dare to visit," says Erfaan Hussein Babak, director of The Awakening project. "The population has suffered greatly over the years and the child mortality rate from preventable diseases is distressingly high."
The project is one of five awarded US$10,000 to educate developing country populations in need about disease prevention through vaccines and immunization. The five were chosen through a peer reviewed competition from among 60 applications to the Southern Vaccine Advocacy Challenge (SVAC), created and supported by the Ethical, Social and Cultural Programme of the Canadian-based Sandra Rotman Centre.
Remarkably, it is the first time the challenge approach -- involving the invitation of innovative ideas from a community of stakeholders to address a problem -- has been used as a tactic to promote developing world vaccine education and use. The grant announcements coincide with the start of the World Health Organization's World Immunization Week 2012 (April 21-28).
The five projects funded -- in Pakistan, Uganda, Egypt, El Salvador and South Africa -- were the most innovative and practical among some 60 submitted for consideration from 25 low and middle income countries.
The rough geography of Pakistan's Swat area adds challenge to an unpredictable political and social situation, says Mr. Babak, increasing the isolation of many communities.
Project participants will visit schools and facilitate drama clubs for children to inform them about vaccines, broadcast health workers on daily radio programs discussing vaccines and immunizations, and organize 240 awareness sessions in the district.
The project will also target ill-founded beliefs.
"Some local religious leaders speak against immunization programs, making it almost impossible for some members of the population to have access to vaccines or even information about immunization," says Mr. Babak.
"We will talk to people on the basis of passages in the Holy Quran, in which it is clearly stated that He has provided the medicines for every illness. We can quote verses related to health issues, as well as the rights of children and parents. Many religious leaders in the district are supportive and through them we hope to reach others" says Mr. Babak.
Says Peter A. Singer, MD, Director of the Sandra Rotman Centre at the University Health Network and University of Toronto: "The Awakening project in Pakistan reminds me of the first bird of spring. It offers the hope of renewal in a region where normal life has long been absent."
Dr. Singer notes immunization levels have steadily increased globally over the last 30 years with 80% of the world population being vaccinated by 2006, preventing an estimated 2.5 million child deaths annually. And each year, 1.7 million children die from a vaccine-preventable disease -- one life every 20 seconds. Vaccine-preventable diseases remain prevalent in the developing world and cause or contribute to 20 to 35% of all deaths of children under five, and stunt the mental and physical development of countless more.
Says Dr. Singer: "The paradox is that, for the first time in history, we have or will soon have vaccines to control many deadly diseases and improve the quality of life of every child on the planet. But the supply of vaccines is not enough. Success at preventing disease with vaccines in developing countries also depends on building demand. And for that we need "voices from the global South" to mobilize creative energies and new voices at grass-root levels. These initial SVAC projects represent an important and innovative step in that direction, filling a significant gap."
Dr. Singer co-chaired the public and political support working group of the Decade of Vaccines Collaboration with Dr. Nicole Bates, Senior Program Officer, Global Policy & Advocacy at the Bill & Melinda Gates Foundation. "Our vision for the Decade of Vaccines is to extend the full benefit of immunization to all people," says Dr. Bates. "Innovative approaches to generating public awareness and demand are a critical component to realizing this vision."
Science Café educates Ugandan women in local languages
In Uganda, where a large part of the population is illiterate, a project undertaken by the charity organization Science Café Uganda welcomes participants to community meetings at which scientists explain in the nation's local languages (of which there are 56) how the Human Papilloma Virus (HPV) vaccine prevents deadly cervical cancer.
Says Christine Munduru, a public health worker and volunteer leader of the project, entitled "Taking Science to Rural Ugandan Communities": "The incidence of cervical cancer is growing in women of reproductive age. More than 7 million Ugandan women of reproductive age are at risk of developing the disease; every year about 3,600 women are diagnosed and almost 2,500 die from it," says Ms. Munduru.
"There are lots of myths about the HPV vaccine among those aware of it; most people don't know it exists. People don't have information and that poses serious danger to women's health."
"People want to know," she adds. "Everywhere where we go, people are so interested in having these discussions."
The convenient timing, non-academic location and relaxed informality of the Science Café-organized meetings with high calibre scientists helps empower Ugandan women, she says.
"The rural poor in general but, due to their socio-economic position, women and girls in particular aren't reached by information via the popular media."
"Men are the decision-makers in Uganda and many are uninformed on women's health issues. We have therefore worked hard to include men in these discussions, both separately from the women and together."
Contests and coloring books help promote pneumonia vaccines in Egypt
In Egypt, a group of young doctors along with 400 volunteers nationwide aim to educate 5,000 parents at hospitals and nurseries about preventing child pneumonia by using a simple competition involving child coloring books as the prize.
"We wanted to spread health information in an innovative way, especially around pneumonia, which contributes to about 15% of the total number of deaths of Egypt's children under five years old -- 42,000 children on average every year," says Dr. Mohamed Zaazoue, project director of the "Protect Your Children" project.
"We came up with the idea not to call this a health awareness campaign but a competition in which the prize is a coloring book for the parent's child."
"We offer parents a brief presentation about the disease and its prevention, a very simple multiple choice quiz, with the prize of crayons and coloring books about pneumonia for their children. The truth is, everybody wins," says Dr. Zaazoue.
Dr Zaazoue adds "Thanks to a donation from US drug giant Pfizer, the project is also able to offer, through university hospitals' pediatric out-patient clinics, 14,000 free doses of pneumococcal conjugate vaccine to high-risk children."
El Salvador: Building grass-roots pressure to promote HPV vaccination
In El Salvador, a group working to prevent cervical cancer, a major health issue for Salvadorian women, is targeting female parliamentarians with the program "With Love We Learn," mobilizing civil society to educate and lobby so that, by July, the national government will commit to including the HPV vaccine in the National Plan of Immunization.
Says Dr. Lisseth Ruiz de Campos of Asaprecan (El Salvador Cancer Prevention Association): "Our health system is unprepared to address cervical cancer. Cancer is treated in general hospitals and only 20% of the population of El Salvador has access to radiotherapy."
"The vaccination of 80% of 13 years old girls would reduce the rate of cervical cancer by 70%,' according to Dr. Ruiz de Campos. "But if the population doesn't know what causes the cancer and how to prevent cancer, there is no social pressure to deploy the resources needed."
Fighting the problems of HIV ignorance, stigma in South Africa
South Africa's "Future Fighters" project of the Desmond Tutu HIV Foundation involves about 30 youths, mostly girls 15 to 18 years old, in a peer-to-peer education model in areas where roughly one quarter of the population is HIV positive, including roughly one in 10 teenagers.
Through poems and skits performed at 10 schools, the project aims to change perceptions of HIV, educating students on relevant vaccines and offering role models for fighting stigma -- a huge challenge in the community. Many young HIV victims fail to seek out appropriate medicines and treatment out of fear of social stigmatization.
The Future Fighters will not only present information through drama, dance and poetry but encourage and mentor students at the schools to create their own groups of HIV education ambassadors.
"Youth are either forgotten about or taught about vaccines using pamphlets and boring Power Point presentations. What they respond to are fun, engaging activities like skits, poems and song," says Lavinia Brown of the Desmond Tutu HIV Foundation.
"All of these projects and organizations are finding new ways to spread basic messages about health and vaccination and immunization that will have a profound impact on their societies, either by reducing child mortality or improving their quality of life. And they do it in an amazingly effective way, by building the desire and demand for vaccines on the part of the people who need them most," says Dr. Singer.
About the Sandra Rotman Centre
The Sandra Rotman Centre, based at University Health Network and University of Toronto develops innovative global health solutions and helps bring them to scale where they are most urgently needed. www.srcglobal.org