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An Unprecedented Response to the Ebola Crisis

The Ebola crisis has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established

The Ebola crisis has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established. / Morgana Wingard

Today the world is facing the largest and most-protracted Ebola epidemic in history. Yesterday, at the Centers for Disease Control and Prevention, President Obama declared the Ebola epidemic in West Africa a top national security priority and announced a clear, comprehensive, and global strategy to stop the outbreak.

“Faced with this outbreak, the world is looking to us, the United States, and it’s a responsibility that we embrace. We’re prepared to take leadership on this to provide the kinds of capabilities that only America has, and to mobilize the world in ways that only America can do.  That’s what we’re doing as we speak.”

The United States has been combating the Ebola epidemic since the first cases were reported in March, and we have expanded our efforts and increased personnel in the region as the crisis has unfolded. More than 120 specialists from across the U.S. Government are on the ground in West Africa to prevent, detect, and stop the spread of this disease. USAID deployed a Disaster Assistance Response Team—or DART—to the region to oversee and coordinate the U.S. response, providing logistics, planning, program, and operational support to the affected countries; drawing forth critical assets and resources from several U.S. departments and agencies.

This crisis continues to escalate exponentially and requires an intensified speed and scale of response to address a rising rate of infection. It has quickly overwhelmed West Africa’s health system: new Ebola victims fill medical facilities faster than new ones can be established. Heroic doctors, nurses, and health workers are stretched to their personal and professional limits.

Against this landscape of overwhelming despair, there is hope. As the President declared in Atlanta:

“The world knows how to fight this disease. It’s not a mystery. We know the science.  We know how to prevent it from spreading. We know how to care for those who contract it.  We know that if we take the proper steps, we can save lives. But we have to act fast.“

That’s why yesterday afternoon President Obama announced a significant expansion of our response.

In an Ebola crisis, chlorine is used to disinfect areas that people infected with the virus may have come in contact with.

In an Ebola outbreak, chlorine is used to disinfect areas that people infected with the virus may have come in contact with. / Morgana Wingard

Through a whole-of-government approach, we’re mounting an aggressive U.S. effort to fight this epidemic and have devised a clear strategy with four key pillars to stop this epic crisis:

  • Controlling the epidemic;
  • Mitigating second-order impacts, including blunting the economic, social, and political tolls;
  • Coordinating the U.S. and broader global response; and
  • Fortifying global health security infrastructure in the region and beyond.

Our goal is to enable the most effective international response possible, using our government-wide capabilities to fight the epidemic on a regional basis. Our current efforts have focused on controlling the spread of the disease—bringing in labs for specimen testing; supporting the construction and management of Ebola treatment units; airlifting critical relief supplies; strengthening emergency response systems of the affected governments; supporting burial teams who are safely managing human remains to prevent transmission; and spearheading mass public awareness campaigns with communities to describe how to prevent, detect, and treat Ebola.

To complement these efforts, the President also announced the launch of the USAID-led Community Care Campaign, which will aim to provide every family and every community the critical information and basic items that can help protect them from this deadly virus.  Information will stress the importance of sick families members seeking help at a clinic or Ebola treatment unit and how to exercise basic infection control that can be life-saving, such as washing hands or not washing their dead relatives. Items like soap and chlorine can reduce transmission. Women are especially important to reach given their traditional role in washing the bodies of dead relatives — a prime transmission route of the virus. To reach people with low literacy, the campaign will train health volunteers and community leaders on how best to verbally provide messages to their neighbors.

Partnering with the affected countries, the U.N. Children’s Fund (UNICEF), the Paul G. Allen Family Foundation, and organizations on the ground, USAID will initially target 400,000 of the highest risk households in Liberia with this vital training and important tools.

The campaign is also rooted in a sobering reality. Half of all people who get sick don’t seek treatment at hospitals or Ebola treatment units. Many are frightened by rumors and deterred from traveling to hospitals where their friends and neighbors are taken and never return. A complex array of traditional beliefs and practices mean many of those who should seek help choose to stay in their homes – often putting those family members who care for them at risk.

The Ebola crisis is wreaking havoc on West Africa’s health care system. USAID is focused on supporting the construction and management of Ebola treatment units; airlifting critical relief and medical supplies; training health care workers; strengthening emergency response systems of the affected governments; and supporting public messaging with communities on how to prevent, detect and treat Ebola.

The Ebola epidemic is wreaking havoc on West Africa’s health care system. USAID is focused on supporting the construction and management of Ebola treatment units; airlifting critical relief and medical supplies; training health care workers; strengthening emergency response systems of the affected governments; and supporting public messaging with communities on how to prevent, detect and treat Ebola. / Morgana Wingard

This week, working alongside the Paul G. Allen Family Foundation, we will airlift 50,000 USAID-funded home health care kits to be delivered to some of the most isolated and vulnerable communities in Liberia. We will simultaneously work with every part of society to educate people on how to prevent and detect Ebola through mass public awareness campaigns supported by radio, text, television and community announcements. As we scale up our response, the only way the virus will be controlled is if we make concerted efforts to reach every community, and every home in the affected areas.

We know tough months lie ahead. It will require a coordinated effort by the entire global community to help stem this terrible public health crisis. But every outbreak of Ebola in the last 40 years has been stopped, and this one will be, as well.

ABOUT THE AUTHOR

Nancy Lindborg is the USAID Assistant Administrator for the Bureau for Democracy, Conflict and Humanitarian Assistance

5 Things You Didn’t Know About Female Condoms

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Langton Ziromba promotes female condoms in the casual and friendly space of his barbershop. / UNFPA

Since the first female condom hit global markets in 1992, the female condom has become more effective, more comfortable, and more accessible. Today, a variety of female condom products are sold worldwide, including the FC2, the Cupid, and the Women’s Condom. With more options for keeping yourself and your partner protected from HIV and STIs, there’s a lot to celebrate this Global Female Condom Day.

FC2 Female Condom Packaging

New packaging released for FC2. / The Female Health Company.

While the female condom has come a long way in user acceptability, user rates are still below targets needed to achieve an AIDS-free generation and prevent HIV and STI transmission among people of all genders. As awareness about the multipurpose protection benefits of the female condom grows, global demand is increasing.

In honor of Global Female Condom Day, read and share these five facts about female condoms, and help ensure that we continue celebrating successes in advancing sexual and reproductive health for all.

1. Best Multi-purpose Protection: According to research, the FC2 can be 97 percent effective in reducing risk of sexual transmission of HIV. The female condom is also approximately 80 percent effective in preventing  pregnancy. As a multi-pronged protection method, the female condom can transform women’s sexual and reproductive health lives and provide them with a means of taking control over their health, especially in circumstances where their choices are limited.

2. Global Appeal: The United States Government through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the largest procurers of female condoms worldwide. In 2003, PEPFAR supplied roughly 1.1 million female condoms worldwide. By 2009, global shipments had increased to almost 15 million per year. In 2012, a record 32 million female condoms were distributed in total by the international donor community. Today, the female condom is available in over 100 countries.

3. Becoming More Popular: In the past, many have been reluctant to use the FC2, or other female condom styles, claiming they feel unnatural. Subsequent designs made of latex can offer a natural feel for male partners.

4. Easy To Use: Female condoms can be inserted up to 8 hours prior to sex, giving people even more control over their bodies. For detailed instructions on proper usage, see here.

5. They Keep Getting Better!: In 2013, the Gates Foundation launched a $1 million award to create the next generation of more user-friendly condoms. Among the 11 proposed designs, is a new female condom infused with air that would be faster and easier to insert. Other innovations include the 100 percent silicone Origami female that is made of a single accordion-like piece that can be washed and reused. Several of these promising designs are set to reach the market in 2015.

ABOUT THE AUTHOR

Clancy Broxton is the Senior Social Marketing & Commodities Advisor for USAID’s Office of HIV/AIDS and Rahel Beigel is a Global Health Fellows Program intern working with Clancy on condoms.

An Opportunity of 300,000 Lifetimes

“Healing is a matter of time, but it is sometimes also a matter of opportunity.” The Greek physician Hippocrates wrote this in about 400 BC. Of course, when Hippocrates practiced medicine, opportunities to heal were scarce as he and his peers understood relatively little about anatomy and physiology, much less biomolecular science. In Hippocrates’ era, some percentage of young children were expected to succumb to illness. Over the last 2,000 years, however, developments in medical science have allowed for the previously unthinkable. The collective brilliance and hard work of scientists and healers have ensured that many of the maladies that afflicted Hippocrates’ patients took a one-way trip to the history books.  Children, for the most part, can be expected to reach adulthood.

Alas, some exceptions stubbornly remain.

There is no clearer example than pediatric HIV. A single generation has seen the rise of a devastating epidemic and, though there have been breakthroughs in the fight against the virus, 3.2 million children currently live with the virus and an estimated 700 children are infected daily. The recent, sudden viral rebound in the “Mississippi baby,” the first child believed to be functionally cured, was the latest punch to the gut in the long, drawn out brawl to protect children from the virus. In low-resourced regions, children living with HIV are often among the last to be tested and treated. Initiating children on treatment early, which allowed the Mississippi baby to remain virally suppressed for years, is exceptionally rare.

A baby receives life-saving drugs. / Anna Zeminski, AFP / Getty Images

A baby receives life-saving drugs. / Anna Zeminski, AFP / Getty Images

Now for some good news. Earlier this month, as part of the U.S.-Africa Leaders Summit, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR),in partnership with the Children’s Investment Fund Foundation (CIFF), launched Accelerating Children’s HIV/AIDS Treatment (ACT). ACT is an ambitious $200 million initiative to double the total number of children receiving life-saving antiretroviral therapy (ART) across 10 priority African countries over the next two years. This investment will enable 300,000 more children living with HIV to receive life-saving ART.

At the onset of the HIV epidemic in the early 1980′s, an HIV diagnosis was equivalent to a death sentence. Failing to treat a child remains just that, as half die by 2 years of age. Up to three people die of AIDS every minute and an estimated 190,000 children died of AIDS in 2013 alone.

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An HIV-positive mother holds her child after visiting an HIV clinic. For children who are born HIV-positive, life-saving antiretroviral therapy is critical to protecting their health. / AFP

Hippocrates was right: Healing is indeed both a matter of time and opportunity. Time does not heal HIV, however, and deaths continue to mount, a disproportionate number of them among children.

So, now is the time to act. Thanks to PEPFAR and CIFF, we have an unprecedented opportunity to do just that.

ABOUT THE AUTHOR

Dr. Benjamin Ryan Phelps is a Medical Officer who focuses on Preventing Mother-to-Child Transmission of HIV (PMTCT) and Pediatric AIDS. Follow him at @BRPhelpsMD.
Joella Adams is a Global Health Fellows Program intern working with PMTCT programs.

On the Frontlines of the Ebola Response: an Inside Look at a Program to Help the Grieving

The West African Ebola outbreak is the worst outbreak in history, affecting four countries. The U.N. World Health Organization declared it an international health emergency

The West African Ebola outbreak is the worst outbreak in history, affecting four countries. The U.N. World Health Organization declared it an international health emergency / Christina Goldsmith, CDC

In Liberia, a country gripped by Ebola, the outbreak has not only taken its toll on health care workers but also on the professionals who comfort the grieving.

“The outbreak of Ebola was very shocking and overwhelming to our country,” said Jestina Hoff, a counselor with the Liberian Red Cross. “It brought a lot fear.”

As a counselor with the Liberian Red cross, Jestina Hoff must find ways to comfort Ebola victims or their families without getting close to them

As a counselor with the Liberian Red cross, Jestina Hoff must find ways to comfort Ebola victims or their families without getting close to them. / Carol Han, USAID/OFDA

The outbreak has also hampered Hoff’s ability to do her job. “As a counselor, I talk to parents who lost a child or to someone who has gotten sick with the virus,” said Hoff. “They are feeling so discouraged, and I have to help them accept the situation and comfort them, but without touching them.”

Francesca Crabu, a clinical psychologist with the International Committee of the Red Cross, explained that having close contact with those who are grieving is key to providing psychosocial support. But in Liberia and other parts of Western Africa, preventative measures require people to stay at arm’s length from each other.

“Here in Liberia, it is very painful that you cannot shake hands. If somebody is dying I cannot hug you,” said Crabu.

To make matters worse, once Ebola claims a life, the body is taken immediately, before families have time to mourn their loss, according to Eliza Yee-lai Cheung, a clinical psychologist with the Hong Kong Red Cross.

Eliza Yee-lai Cheung (right) a clinical psychologist with the International Federation of the Red Cross, listens as counselors in Monrovia share stories about helping families cope with Ebola

Eliza Yee-lai Cheung (right) a clinical psychologist with the International Federation of the Red Cross, listens as counselors in Monrovia share stories about helping families cope with Ebola. / Carol Han, USAID/OFDA

“They cannot hold a memorial service or burial according to their culture,” said Cheung. “That’s why it’s very hard for them.”

To give psychosocial counselors the tools to help grieving communities, the USAID Ebola Disaster Assistance Response Team (DART) is partnering with IFRC in Monrovia, Liberia’s capital city. Among other things, the DART and the International Federation of Red Cross and Red Crescent Societies are working to raise public awareness of Ebola’s mode of transmission, teach disease prevention practices to communities, and train health workers and volunteers.

Training materials passed out to counselors will help them train others in the community

Training materials passed out to counselors will help them train others in the community / Dagny Olivares, CDC

In a classroom, 19 people—counselors with the Liberian Red Cross, staff with NGOs and social workers with the Liberian Ministry of Health & Social Welfare—are learning from Crabu and Cheung how to organize culturally appropriate activities to help families cope with their loss. They are also taught ways to keep themselves safe from the virus and how to provide support to each other. This group will then go on to train others in affected communities with the hopes that such efforts will help the country come to grips with Ebola.

“It’s overwhelming,” said Hoff. “But we have a goal. I have a goal. We have to serve our country. We need somebody to take a step to help others move forward. It’s scary, but there’s hope.”

How Gender Analyses Shaped the Future of Microbicides

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available / Lisa Marie Albert

Engaging women in conversations about microbicides will help facilitate an effective introduction of this HIV prevention tool when it becomes available. / Lisa Marie Albert

Women account for more than half of all people living with HIV worldwide. In sub-Saharan Africa, young women are twice as likely to have HIV as young men. It is clear that women are disproportionately affected by the virus. Women’s vulnerability to HIV stems not only from a higher biological risk than men, but also from violations of women’s human rights, gender inequalities and marginalization.

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection../ Lisa Marie Albert

USAID, through PEPFAR, is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. / Lisa Marie Albert

USAID, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is committed to expanding the array of woman-controlled HIV prevention methods so that women and girls can better protect themselves from infection. In 2010, the CAPRISA 004 trial, funded in part by PEPFAR through USAID, provided the first proof of concept that a vaginal microbicide made of tenofovir gel could protect women against HIV infection when used appropriately. Microbicides are substances applied vaginally or rectally to protect users against HIV infection. This scientific breakthrough presented the global health community with a potential new, female-initiated tool in the fight against HIV.

With these encouraging findings and continued clinical trials to test microbicides, we now need to look ahead toward their meaningful introduction and use. Through this process, we will recognize potential barriers to successful roll out, and identify ways to mitigate those barriers. Are women interested in using microbicides, and if so, how easy will it be for women to access them? To what extent do women want to communicate with their male partners about microbicides? How accepting are men to women’s choices about HIV prevention? To what degree are policies supportive of women’s microbicide use?

One of our implementing partners, FHI 360, foresaw these concerns and acted. Under the USAID-supported Preventive Technologies Agreement, FHI 360, with support from Sonke Gender Justice in South Africa,  conducted gender analyses in South Africa and Kenya, two countries where microbicide development work makes its future introduction likely. Gender analyses are systematic processes used to identify and understand gender differences. They examine how gender norms and inequalities affect relationships and power dynamics between men and women, as well as women’s access to resources, their rights, their opportunities, and their health practices and outcomes. In South Africa and Kenya, FHI 360 implemented this analysis to understand gender-related barriers to women’s microbicide use, identify solutions, and prepare for a gender transformative introduction

Of FHI 360’s findings, there are three key takeaways we would like to highlight:

1.  Promoting microbicides to all women, not just most at risk populations, will be important to avoid stigmatizing the product. People in both countries cautioned against promoting this HIV prevention method as a niche product for specific populations, fearing that targeted promotion of microbicides might stigmatize the method and lead to microbicide rejection by the populations who could benefit from it the most.

2.  Balancing women’s autonomy and male partner engagement in microbicide introduction is crucial. Women have the right to choose whether they inform their partners of their microbicide use, and health providers need to support women in making the decision that is appropriate for them. At the same time, educating men about microbicides may help increase acceptability and adherence and foster couples’ communication about sex and HIV protection. Microbicide introduction programs must take care to position women as the gatekeepers to their male partner’s involvement.

3.  Sex sells. Many believed that microbicide promotion should focus on sexual benefit and pleasure in order to increase its appeal. By highlighting these positive aspects of the gel, which were identified throughout earlier microbicide trials, people may be more likely to adopt this HIV prevention method.

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection / Lisa Marie Albert

In Sub-Saharan Africa, women’s access to sexual and reproductive health services is key to protecting their health and preventing HIV infection. / Lisa Marie Albert

FHI 360’s gender analyses filled critical gaps in understanding that will enable public health practitioners to introduce this HIV-prevention method most successfully. As USAID and PEPFAR move closer to creating an AIDS-free generation, we recognize that gender analyses are a vital practice in order to better understand the communities with which we engage, strengthen the impact of our programs, and empower women and girls to protect their health and achieve their fullest potential.

ABOUT THE AUTHOR

Celia Karp is a public affairs intern in the Global Health Fellows Program II working in USAID’s Office of HIV/AIDS. Follow her @celkarp

Five Takeaways from AIDS 2014

Ten thousand miles away from Washington, D.C., global health colleagues from nearly 200 countries gathered at this year’s International AIDS Society Conference, AIDS 2014, in Melbourne, Australia. This conference, dedicated to ending HIV and AIDS worldwide, allowed researchers, activists and advocates to share their latest scientific findings and deliver thought provoking presentations on challenges the AIDS community faces. With a renewed commitment to ending the AIDS epidemic, AIDS 2014 provided its attendees and the greater AIDS community with an opportunity to learn from one another and strengthen our AIDS response efforts worldwide.

Here are my five key take aways from the conference:

Signs highlighting the 2014 International AIDS Society Conference on Princes Bridge in Melbourne, Australia. /  International AIDS Society/Steve Forrest

Signs highlighting the 2014 International AIDS Society Conference on Princes Bridge in Melbourne, Australia. / International AIDS Society/Steve Forrest

1.    UNAIDS announced its goal to end AIDS in cities by 2030. In order to achieve this monumental objective and create an AIDS-free generation, HIV and AIDS programs worldwide will need to coordinate their efforts to reduce new infections, stigma and discrimination effectively. Two of the objectives UNAIDS outlined in this goal include having 90 percent of people with HIV diagnosed and 90 percent of diagnosed people on treatment. Although it is an ambitious goal, it is achievable through hard work and collaboration among international researchers, AIDS experts and those working on the ground to fight this disease.

 International AIDS researcher Salim Abdool Karim of South Africa gives his speech 'State of the Art Epidemiology and Access'. / International AIDS Society/Steve Forrest

International AIDS researcher Salim Abdool Karim of South Africa gives his speech ‘State of the Art Epidemiology and Access’ / International AIDS Society/Steve Forrest

2.    The AIDS epidemic can be contained. In the Monday plenary session Salim Abdool Karim, Director of Centre for the AIDS Programme of Research in South Africa, which conducted the CAPRISA 004 trial — which provided the first proof of concept that a vaginal microbicide made of tenofovir gel could help protect women against HIV infection when used appropriately — provided an excellent overview of the history and epidemiology of the HIV and AIDS epidemic (23:50). (The CAPRISA trial was funded in part by PEPFAR through USAID). For many of us who have been invested in the fight against HIV and AIDS since the 1980s, Abdool Karim’s presentation helped refocus our attention on the disease origins and understand how the global AIDS response has developed. One of the most interesting aspects of his presentation was modeling that showed how the AIDS pandemic could be contained. With this encouraging information and a thorough discussion of ongoing challenges in this endeavor, we were able to collectively envision the future of AIDS and the end of the epidemic.

Members of the Australian Sex Workers Association participate in The Official AIDS Mobilisation March to Federation Square. /  International AIDS Society/Steve Forrest

Members of the Australian Sex Workers Association participate in The Official AIDS Mobilisation March to Federation Square. / International AIDS Society/Steve Forrest

3.    Preventing key populations from becoming infected is critical. Much of the conference’s focus was on the prevention needs of key populations (men who have sex with men, sex workers, injecting drug users and transgender people), and on the use of treatment as prevention. But in his plenary talk on Tuesday (1:03:00) Mark Dybul, Director of the Global Fund, gave a very powerful presentation arguing that behavior cannot be overlooked. As Dybul explained, the future of the global response to AIDS will need to maintain a strong emphasis on behavior change practices in order to dramatically reduce the epidemic.

Former US president Bill Clinton meets with public and delegates at the aids 2014 conference in Melbourne after his speech about the future for the treatment and prevention of HIV and AIDS. / International AIDS Society/James Braund

Former US president Bill Clinton meets with public and delegates at the aids 2014 conference in Melbourne after his speech about the future for the treatment and prevention of HIV and AIDS. / International AIDS Society/James Braund

4.    “Treatment as Prevention” must be carefully defined. With concerns expressed about the stigmatization of this approach to the AIDS epidemic, Virginia Bond, social anthropologist at the London School of Hygiene and Tropical Medicine, highlighted the importance of rethinking how we communicate about the prevention aspects of treatment. We must be clear that the burden of preventing more infections is not solely placed on infected persons taking antiretrovirals.

People living with HIV or AIDS, including young children, join prominent AIDS researchers on the stage at AIDS 2014. /  International AIDS Society/Steve Forrest

People living with HIV or AIDS, including young children, join prominent AIDS researchers on the stage at AIDS 2014. / International AIDS Society/Steve Forrest

5.    The needs and complexities of pediatric HIV and AIDS must be prioritized. One of the most engaging sessions of the conference was the presentation on adolescents with HIV. This session highlighted the intersection of working with vulnerable children, pediatric AIDS and the challenges of being an adolescent that has been HIV-positive since birth. Three young people from Thailand, India and Rwanda shared stories of their diverse battles with HIV and the struggles they dealt with throughout their youth. All three lost their parents at an early age. All three are on antiretroviral therapy. For me, the key point of the session was the vital role played by community organizations, social protection and other services for vulnerable children. None of these three young people would have survived to tell their stories without this protection, further reminding us that the success of “Treatment as Prevention” may well rest on the shoulders of community organizations.

The AIDS conference this year was a bittersweet affair. The tragic loss of some of our most distinguished colleagues and advocates cast a long shadow over the event. It is a loss we will feel for many years to come. However, with our relentless dedication to creating an AIDS-free generation and a clear direction moving us forward to meet the needs of those affected by the virus, the HIV and AIDS community is focused like never before.

 

ABOUT THE AUTHOR

David Stanton is the Director of USAID’s Office of HIV/AIDS in the Bureau for Global Health.

Can Private Financing Answer Uganda’s Health Care Woes?

Early this year, the U.S. and Swedish ambassadors went on a joint site visit to Rhona Medical Center, a medium-sized health clinic in Kampala. Site visits by the U.S. ambassador are not uncommon in Uganda where the health sector makes up the lion’s share of the aid budget. But this joint visit was unusual because it was to a private health facility that a year ago had received a loan co-guaranteed by USAID and the Swedish International Development Agency (SIDA).

Uganda’s adoption of the Anti-Homosexuality Act in February this year and the Ugandan president’s dismissal of the value of the U.S. Government’s development assistance to the country has prompted a review of our 50-year-long efforts in Uganda. In his February 24 speech, after signing the anti-homosexuality bill into law, Uganda’s President Yoweri Museveni stressed, “Uganda is a rich country that does not need aid, because aid is in itself a problem…”

Indeed, Uganda has made much smaller gains in key health indicators than its neighbors despite receiving larger aid inflows per capita, amounting to three quarters of all public health spending. I have spent some of my last three years at post pondering how we might be effective in improving the health of Ugandans when, despite the critical support provided by USAID and our implementing partners, the government fails to adequately enforce accountability and performance in the public health system. Uganda has had nominally free health care since 2001, yet a recent World Bank survey found that 51 percent of public sector health workers were absent from their posts and drug stock-outs also remain a problem.

An obvious answer to me was to invest in the emerging private sector, rather than continuing to unsustainably prop-up the public system. While USAID continues to support the public sector to ensure that the poorest Ugandans continue to access vital health care services, we can also ensure that people have additional health service options outside of the public sector, even when those options require payment. By distributing our aid across the public and private sectors, we hoped to continue to reach the poorest Ugandans while also helping increase the quality of health services through private sector development.

A nurse works in southwest Uganda's Kabwohe Clinical Research Center, a facility that received a $35,000 loan guaranteed through USAID's Development Credit Authority, and was able to hire more staff and provide life saving AIDS treatment to 4600 patients as a result. / USAID, Morgana Wingard

A nurse works in southwest Uganda’s Kabwohe Clinical Research Center, a facility that received a $35,000 loan guaranteed through USAID’s Development Credit Authority, and was able to hire more staff and provide life saving AIDS treatment to 4600 patients as a result. / USAID, Morgana Wingard

Over the last three years, with invaluable support from USAID’s Development Credit Authority, USAID/Uganda has built a portfolio of risk-sharing guarantees with local banks to open $10 million in private lending for Uganda’s health sector, at a cost of only $315,000 to USAID. The financing was made available for everything in the health sector from small drug shops to hospitals in Kampala, with an emphasis on facilities that serve rural areas – a segment that banks previously considered too high-risk to qualify for commercial loans.

Thanks to the risk-mitigating guarantees, private clinics can now access commercial loans to purchase medical equipment and expand their facilities to serve more clients. The results so far are impressive – Centenary Bank has utilized 50 percent of a five-year guarantee in a little over a year, reflecting the pent-up demand for credit. One of its loans – of around $25,000 – went to Rhona Medical Center and was used to purchase a dental x-ray, a scanning machine, a clinical chemistry machine, a hematology analyzer and six desktop computers.

Accompanying the U.S. and Swedish ambassadors on this site visit, Rhona’s director, Dr. Edward Bemera, shared with us that the clinic was able to get much better terms on its loan thanks to the USAID guarantee facility.

Along with the new medical equipment, he used his loan to hire additional nurses and to make renovations to the facility. As a result, the Medical Center’s revenues more than doubled, and the number of clients receiving better services quadrupled.

Dr. Bemera explains Amb. DeLisi, Amb. Andersson and the rest of the team about how he used the loan to scale up activities at his clinic.

Dr. Bemera explains to Amb. DeLisi, Amb. Andersson and the rest of the team about how he used the USAID-backed loan to scale up activities at his clinic. / USAID, Roberta Rossi

The contribution of the private health sector will grow significantly in years to come as banks realize that this segment is credit-worthy. This is evidenced by the fact that there have been no defaults to date under the guarantee. Increased competition will gradually reduce prices for patients, making private health care more affordable and of better quality.

USAID/Uganda has embraced the value of this private partnerships approach in other areas of our work. For example, since girls’ secondary enrollment is a strong predictor of improved maternal and child health outcomes, we are about to launch a new loan guarantee for girls’ school fee loans, that will be managed as part of our Orphans and Vulnerable Children program.

For me, to be given the opportunity to champion innovative approaches to development, and to see those translated into tangible results is a dream come true.

 

ABOUT THE AUTHOR

Daryl Martyris is a Health Development Officer in USAID Uganda’s Office of Health, HIV/AIDS and Education.

If You ‘Let Girls Learn,’ You Save Lives Too

letgirlslearn_rev2

Oppression and prejudice toil in a cage of ignorance and cruelty.  Before the U.S. Civil Rights movement altered the course of history, Jim Crow laws and terror imposed segregation and licensed discrimination, casting a pall of shame over America.

Today, the inhumane degradation and culturally sanctioned abuse of girls in many parts of the world is a shockingly similar shame. Denied the most basic universal human rights, girls have limited access to health care, nutrition, education and job skills training, as well as productive resources, such as water, land and credit.

The kidnapping of 300 Nigerian girls by the extremist group Boko Haram focused global attention, issuing a clarion call that girls’ education and health are civil rights worth fighting for, leading to benefits, not only for girls, but for entire communities and nations. In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children. A child born to a literate mother is 50 percent more likely to survive past the age of 5.

  • In low income countries, mothers who have completed primary school are more likely to seek appropriate health care for their children.
  • A child born to a literate mother is 50 percent more likely to survive past the age of 5.
  • Women with some formal education are more likely to seek medical care and ensure their children are immunized.
  • Women with some formal education are more likely to be better informed about their children’s nutritional requirements, and practice better sanitation.
  • An educated girl is three times less likely to contract HIV.

Segenet Wendawork was 5 years old when her mother died. After her father moved away, she bounced around, living with her grandmother for a while, then an aunt who kept her home from school to help with chores.  Thanks to a USAID scholarship program, Segenet was able to return to school in Ethiopia and complete her education. “Before the scholarship, I was unable to dream about the future,” she said.

Sixty-two million girls are not in school, and are also unable to dream about their future. And millions more are fighting to stay in school. The U.S. Government invests $1 billion each year through USAID in low-income countries to ensure equitable treatment of boys and girls, to create safe school environments, and to engage communities in support for girls’ education.

According to the Working Group on Girls (WGG), a coalition of over 80 national and international non-governmental organizations, schoolgirls of all ages report sexual harassment and assault, ranging from gender discrimination to rape, exploitation and physical and psychological intimidation in school.

Last week, a new effort was launched by the U.S. Government, and led by USAID, to provide the public with meaningful ways to help all girls get a quality education. Let Girls Learn aims to elevate a conversation about the need to support all girls in their pursuit of a quality education. In support of the effort, USAID also announced over $230 million for new programs to support education around the world.

Thomas Staal, a senior leader with USAID, said education is essential to fight poverty and all its corollaries: hunger, disease, resource degradation, exploitation and despair. “Women are the caretakers and economic catalysts in our communities. No country can afford to ignore their potential.”

Since education level has the greatest effect on the age at which a woman has her first birth, and adolescent mothers are more likely to die in childbirth, education both empowers young people directly and affects family planning choices and labor force participation.

 “Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

“Education is essential to fight poverty and all its corollaries.” In this photo, school children in Haiti. / Devon McLorg, USAID

Conversely, a healthy start in life and good nutrition are essential for children to thrive, develop and spend more time in school. Last month, USAID launched a new global nutrition strategy  aimed at reducing the number of chronically malnourished or stunted children by at least 2 million over the next five years. Every year, under-nutrition contributes to 3.1 million child deaths—45 percent of the worldwide total.

In the strategy, USAID is prioritizing the prevention of malnutrition given the irreversible consequences of chronic under-nutrition early in life. Under-nutrition inhibits the body’s immune system from fighting disease and impedes cognitive, social-emotional and motor development.

In addition to focusing on good nutrition in the first 1,000 days for mother and child, USAID is also saving newborns from severe infections, protecting young children from the risks of diarrhea, pneumonia and malaria, and helping women space the births of their children to protect their health and that of their children.

This week, USAID, the governments of Ethiopia and India, in collaboration with UNICEF, the Bill & Melinda Gates Foundation, and others will hold a high level forum to take stock of recent efforts aimed at reducing child and maternal deaths and plot a new course that will ensure progress continues.

USAID will refocus the majority of our maternal and child health resources toward specific, life-saving tools in 24 countries where the need is greatest and empower our partner countries to lead with robust action plans and evidence-based report cards to save an unprecedented number of lives by 2020.

USAID Assistant Administrator Ariel Pablos-Mendez said by coupling family planning investments with policies supporting child survival, girls’ education and job creation – especially those targeting women – countries can be positioned to realize substantial economic growth that lifts everyone out of poverty.

Doing so will allow girls and boys to follow their wildest hopes and dreams and live productive lives.

ABOUT THE AUTHOR

Chris Thomas is a communications advisor in the Bureau for Global Health. Read more from the author in the latest FrontLines, which features articles about the Agency’s work in maternal and child health: In Health Research Fueled by USAID Is Fielding Innovative Solutions, he writes about innovative, cost-effective and life-saving health care solutions whose research and development were aided by USAID; and in Your Voice: Frontline Health Workers are the Unsung Heroes of Global Health Progress, he describes just how essential community health workers are to rural and other underserved communities in developing nations.

Global Leadership, Collaboration Aligned in the Fight Against Tuberculosis

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035.

Tuberculosis preys on the urban poor. ​​In the photo, the family of Rehmat Shek deals with the disease in Rafik Nagar slum in India. Global leaders in the fight against TB hope to end the epidemic by 2035. David Rochkind / WHO

With approval of the post-2015 global tuberculosis strategy by the World Health Assembly, the global community stands united as we work toward ambitious new targets for 2025 and 2035 to end the global TB epidemic. As we look to the future, it is important to evaluate the current global response to the epidemic so we may develop an effective and coordinated approach going forward. Major investments in TB by high-burden countries, the U.S. Government, the Global Fund (GF), the World Health Organization (WHO) and others have led to impressive progress and shown the potential for future impact. Promising new tools are now finally available, with others in the pipeline, and governments, donors and partners are allied around a new strategy with refocused resources.

Where are we succeeding?

TB kills three people a minute, is a security threat to the world, and puts health care personnel and poor and marginalized populations at risk around the globe. Yet, TB treatment is one of the best buys in global health – the disease is almost always curable (unless resistant to major drugs) with inexpensive medications and low-cost delivery approaches, and has been considered in various assessments as one of the most cost-effective public health interventions. New and cheaper models to diagnose and treat multidrug-resistant TB are being scaled up in many high-burden countries and the cost of second line drug treatment regimens to cure TB have decreased by 32 percent, thanks to efforts by the Global Drug Facility (GDF).

In the space of 17 years since the implementation of a new standard approach to control TB, 56 million people across the globe have been successfully diagnosed, treated and cared for, and WHO estimates that 22 million lives have been saved by using comprehensive and proven approaches to TB care[U1] , compared to what would have occurred if previous standards continued. These milestones reflect the ongoing commitment of governments and the global community to transform the fight against TB and work toward elimination of this major public health problem and global threat. Since 1990, TB deaths have declined by 45 percent and TB prevalence has declined by 37 percent globally. The world is now on track to meet the MDG target of 50 percent reduction in mortality by 2015.

Key ingredients to success and readiness to face challenges:

1.  Proven strategies, collaboration and leadership. Coordination and harmonization of efforts were the key to high effectiveness and success. The national programs take the lead in establishing policies aligned with international best practice and ensuring their implementation within primary care services. A clearly budgeted national strategic plan is fundamental to optimizing the use of resources and identifying gaps. Technical partners and financiers support the plan in a uniform manner. Supporting this model, the U.S. Government is the largest bilateral donor for TB and USAID serves as the lead agency for international TB control. Without this current systematic response, we will miss out on opportunities with endemic country partners and governments. Most importantly, progress in saving lives will be slowed.

 2.  Boots on the ground.  The U.S. bilateral program works directly with local governments and ministries of health to develop country-owned approaches and build national capacity so countries can successfully implement their TB care and treatment programs. This close collaboration with ministries of health has resulted in faster detection and treatment of TB; scaled-up prevention and treatment of multi-drug resistant TB (MDR-TB); expanded coverage for interventions for TB/HIV; and improvements in the health system. This approach also improves the strategic use of GF and domestic resources as well as the quality of TB programs.

3.  Resource Allocation and Realignment. The Global Fund and the United States both recently realigned their resources to further strengthen the next phase of TB response and focus where the need is greatest to sustain value and resolve outstanding challenges. Among the concerns faced by countries are ability to match external financing, coverage of services, and the MDR-TB and TB/HIV burdens. Since 2009, the U.S. Government has allocated almost $3.3 billion towards implementation of TB programs in high-burden countries with over $600 million in FY13 (see table below). The U.S. bilateral program, led by USAID, is focused on countries with the greatest TB burden and need. The current 27 USAID-supported countries carry almost 70 percent of the world’s annual TB cases, not including China. Through its new funding model, the GF has also redefined support for TB.  Twenty-four of the eligible countries account for 79 percent of the world’s annual TB cases (not including China) and have been allocated almost 60 percent of the total of TB funds. The GF has increased TB resources from 16 percent to 18 percent of all funds for 2014-2017.

Funding Stream

2009 (USD M)

2010 (USD M)

2011 (USD M)

2012 (USD M)

2013 (USD M)

2014 (USD M)

USAID TB Bilateral[1]

176

249

238

256

232

244

PEPFAR TB/HIV[2]

150

137

152

132

132*

132*

USG Portion of GF TB Grants**[3]

129

172

145

166

242

213

Total TB funding for Country Implementation

455

558

535

554

606

589

*Assumed flat-line budget numbers based on the public FY12 figures.

**This represents 1/3 of the total TB allocations to countries in each year. It is the actually disbursement of TB funds for in this year. Note, the increase in 2013 is due to a large increase in distribution of funds for India.

 4.  Research and Innovation. After decades of using outdated tools that limited achievements, the TB community now has newer rapid molecular diagnostics, modernized approaches and new medicines already available for the treatment of MDR-TB. With the introduction of an innovative diagnostic test, Xpert, countries can implement faster and better detection of TB and drug resistant TB.  Further, the price buy-down of this new technology by the U.S. Government, the Bill & Melinda Gates Foundation and UNITAID has ensured rapid adoption and implementation of Xpert by over 100 low- and middle-income countries. In addition, new TB treatment regimens that use novel drugs and will bring renewed hope for TB patients are under study, including the expanded STREAM study (a 9 month MDR-TB regimen with a new drug) and the PaMZ study that is evaluating the efficacy, safety and tolerability of a treatment regimen for both drug susceptible and drug-resistant TB. Lastly, the work of the Global Drug Facility, supported by the U.S. Government, has ensured that quality, affordable second line drugs are available as countries scale-up MDR-TB treatment. USAID has collaborated with the Global Drug Facility and other partners to support over 40 manufacturers to improve the quality and availability of second-line drugs and make MDR-TB treatment more affordable.

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

A doctor visits a patient at the Group of TB Hospitals in Mumbai during the daily rounds. / David Rochkind, WHO

Future Strategic direction: 

The post-2015 Global TB Strategy approved at the World Health Assembly in May 2014 focuses on three pillars including: patient centered care and prevention; bold policies and supportive systems; and intensified research and innovation. The U.S. Government  is developing a new long-term strategy that will align with the recently approved WHO post-2015 strategy to Reach, Cure, and Prevent.  The U.S. Government commits to Reach every person with TB, Cure those in need of treatment and Prevent new infections and spread of the disease. To reach these goals, the different U.S. agencies involved in TB treatment and control will need to leverage their collective strengths and continue to collaborate through existing processes such as a common strategy and joint projects, defined roles, joint reporting and regular coordination.

Filling the Funding Gap – Despite recent wins and progress against TB, the current funding gap of $2 billion per year remains a fundamental challenge to face. The availability of this funding would result in major benefits for a huge number of people. As mentioned in the recent February Lancet commentary, domestic resources should continue to be mobilized for long-term and effective TB care and treatment. The international community must continue to bolster national efforts as well as support the development of global, common goods such as research, affordable and quality TB commodities, and support for innovations and new research. Global partners should help mobilize resources to fill gaps in TB care, including crowding in partner country financing and identifying new partners.

Building a multi-sectoral response – Tuberculosis provides a perfect example of how health security is intimately linked to social and economic development. Ending extreme poverty is critical to global progress on TB as are overarching efforts to achieve universal health coverage. A person’s health status is intimately entwined with underlying poverty, political and social stability, economic growth, food security, education and gender equality.  Development agencies such as USAID, along with U.N. agencies, NGOs and civil society, need to play their part in building cross-sectoral links. Together, we must work in harmony to reduce the social determinants of TB and to reach and serve the poorest and most vulnerable.

Research – The post-2015 goals will be difficult to achieve without a more robust research pipeline. This will require additional funding for research to ensure that the top priorities for innovation are a point-of-care diagnostic, better and shorter regimens and a new vaccine.  New tools for improving approaches at the country level will be necessary to optimize results.

The global fight against TB remains fragile, given resource constraints. Yet, promising new tools are now available, with others in the pipeline, and donors and partners are allied around a new strategy with refocused resources. We are now at a crossroads between ending the TB epidemic by 2035 and witnessing millions more TB deaths. But with continued consultation, coordination and leadership, we believe we will end the epidemic.

 


[1] USAID CBJ budget figures for each year

[2]  PEPFAR FY13 CBJ: http://www.pepfar.gov/documents/organization/222642.pdf

[3] GF website: http://portfolio.theglobalfund.org/en/Home/Index

[U1]Footnote that this is WHO data.

 

ABOUT THE AUTHOR

Dr. Ariel Pablos-Mendez is the Assistant Administrator for Global Health at USAID
Dr. Mario Raviglione is the Director of Global TB Programme for WHO
Dr. Dyah Erti Mustikawati is the NTP Manager at MOH/Indonesia
Mr. Lerole David Mametja is the Chief Director for TB Control and Management at MOH/South Africa

 

10 Reasons Vaccines are the Best Protector of Human Life

A young boy receives an oral polio vaccination at a USAID -funded medical clinic on July 13, 2010 in Petionville, Haiti.  In 2011 in Haiti, the U.S. Government  vaccinated nearly 157,000 children under the age of one for routine childhood diseases and provided more than 350,000 antenatal care visits and more than 131,000 post-partum/newborn care visits.  The United States is providing access to health services for 50 percent of the people of Haiti.  Kendra Helmer/USAID

A young boy receives an oral polio vaccination at a USAID-funded medical clinic on July 13, 2010 in Petionville, Haiti. In 2011 in Haiti, the U.S. Government vaccinated nearly 157,000 children under the age of 1 for routine childhood diseases. / Kendra Helmer, USAID

Immunization is one of the most powerful health interventions ever introduced. Every year, the World Health Organization estimates, vaccines save between 2 and 3 million children from killers such as polio, measles, pneumonia, and rotavirus diarrhea.

To mark World Immunization Week, USAID partner PATH is reporting on the lifesaving potential of vaccines against four illnesses that kill more than 2 million young children a year: malaria, pneumonia, rotavirus, and Japanese encephalitis. Here, Dr. John Boslego, director of PATH’s Vaccine Development Program, lists the top 10 ways vaccines make a difference for children and for global health. This post originally appeared on PATH.

No. 10: Vaccines lower the risk of getting other diseases.

Contracting some diseases can make getting other ones easier. For example, being sick with influenza can make you more vulnerable to pneumonia caused by other organisms. The best way to avoid coinfections is to prevent the initial infection through vaccination.

Here a Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. Patrick D Smith/USAID

A Nepalese boy demonstrates the water flow of a USAID-built electric tube well used for irrigation in the Terai region of Nepal. / Patrick D Smith, USAID

No. 9: They keep people healthier longer.

Some vaccines protect people for a limited time and require booster doses; others protect for a lifetime. Either way, vaccinated people are much safer from many serious diseases than people who haven’t been vaccinated, both in the short and long term.

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo (DRC) administers the oral polio vaccine March 23 in the Commune of Ndjili, Kinshasa. On that day, Minister of Health, Victor Makwenge Kaput officially launched a vaccination campaign against the wild polio virus in the capital city. USAID/A. Mukeba

As part of a USAID-supported polio initiative, a vaccinator in the Democratic Republic of Congo administers the oral polio vaccine in the Commune of Ndjili, Kinshasa. / USAID, A. Mukeba

No. 8: They are relatively easy to deliver.

Through national immunization programs and mass vaccination campaigns, vaccines can be delivered quickly to large numbers of people, providing widespread protection. Thanks to creative strategies, delivery in even the remotest parts of the world is becoming easier.

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo.  Pictured is a young child suffering from cholera and receiving food aid from the Agency.  /  Frederic Courbet

USAID and the Medical Relief International Charity (Merlin) support cholera treatment centers in Goma, Democratic Republic of Congo. Pictured is a young child suffering from cholera and receiving food aid from the Agency. / Frederic Courbet

No. 7: They prevent disease where medical care isn’t an option.

Too many children die because high-quality care is unavailable. When a child in poverty gets sick, medical care could be inadequate or several days’ travel away. Stopping disease before it starts could be that child’s only lifeline.

Solar lights funded by OTI in Cap Haitien and en route to Caracol, Haiti, on Oct. 19, 2012.. / Kendra Helmer/USAID

Solar lights funded by USAID help children read at night in Cap Haitien. Haiti, on Oct. 19, 2012. / Kendra Helmer, USAID

No. 6: They play well with other interventions.

Vaccines complement other global health tools. We’re seeing this with the integrated strategy to protect, prevent, and treat pneumonia and diarrhea through basic sanitation, safe drinking water, hand-washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, and vaccines. Leveraging these tools across diseases could save the lives of over 2 million children by 2015.

This photo took third place in the FrontLines photo contest. Maamohelang  Hlaha tenderly kisses her young son Rebone. An HIV-positive mother of four, Hlaha’s  village is inaccessible by vehicles and a three-hour hike from the nearest health clinic.  She receives HIV treatment through the Riders for Health program, which is funded  by USAID and run by the Elizabeth Glaser Pediatric AIDS Foundation. As part of the  program, pony riders and motorcycle riders transport blood tests, drugs and supplies to  Lesotho’s remote mountain health clinics. The system allows people to receive HIV test  results sooner, access life-saving drugs and ensure an uninterrupted supply of medication.  Rebone, whose name means “we have witnessed,” was born HIV-free in August 2008. / Reverie Zurba, USAID/South Africa

A mother of four who receives HIV treatment through a USAID-funded program tenderly kisses her young son in South Africa. Thanks to the treatment, her son was born HIV-free in August 2008. / Reverie Zurba, USAID

No. 5: They continue to evolve.

Tackling unmet health needs requires us to continue to pursue the next generation of better and more affordable vaccines. Candidates like RTS,S for malaria and ROTAVAC® for the leading cause of severe diarrhea—rotavirus—are two examples of innovative technologies on the horizon that give families and communities more cause for hope.

This photo was chosen as a finalist in the FrontLines photo contest. These schoolchildren in Aqaba, Jordan, are beneficiaries of the Jordan Schools Program and  Education Reform Support Program. Both of these projects are funded by USAID to  support the Jordanian Ministry of Education’s reform efforts in improving the quality of education in the country. March 2011. / Jill Meeks, Creative Associates International

These schoolchildren in Aqaba, Jordan, are beneficiaries the Jordan Schools Program and Education Reform Support Program. Both  are funded by USAID to support Jordan’s efforts to improve the quality of education in the country.  / Jill Meeks, Creative Associates International

No. 4:  They indirectly protect loved ones and communities.

For many diseases, immunizing a significant portion of a population can break the chain of transmission and actually protect unvaccinated people—a bonus effect called herd immunity. The trick is immunizing enough people to ensure that transmission can’t gather momentum.

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes ("blini") with cottage cheese and vegetable salads that their mothers prepared for them after a training. / USAID

A little girl in Tajikistan eats mashed potatoes with greens, which her mother prepared for her. Over 5,000 Tajik children under 5 years old tasted new foods such as pancakes (“blini”) with cottage cheese and vegetable salads that their mothers prepared for them after a USAID-supported nutrition training. / USAID

No 3: They are safe and effective.

Vaccines are among the safest products in medicine and undergo rigorous testing to ensure they work and are safe. Their benefits far outweigh their risks (which are minimal), especially when compared to the dire consequences of the diseases they prevent. Vaccines can take some pretty terrible diseases entirely or nearly out of the picture, too. That’s the case with smallpox and polio, and others will follow.

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Malak Shaher, USAID/YMEP

School girls in Sana’a gather for their lesson. Since many girls in Yemen do not attend primary school or graduate from it, recent USAID-backed measures have ensured all girls a right to attend school and increase literacy. / Clinton Doggett, USAID

No. 2:  They are a public health best buy.

Preventing disease is less expensive than treating severe illness, and vaccines are the most cost-effective prevention option out there. Less disease frees up health care resources and saves on medical expenditures. Healthier children also do better developmentally, especially in school, and give parents more time to be productive at home and at work.

This image captured top honors in the FrontLines photo contest. These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

These rural schoolchildren participate in the USAID-funded Southern Sudan Interactive Radio Instruction project, which uses radio to broadcast interactive student lessons. The lessons, based on Southern Sudan’s primary school syllabus, complement classroom instruction in literacy, English, mathematics, and life skills for grades one through four. July 2010. / Karl Grobl, Education Development Center Inc.

No. 1:  They save children’s lives.

Roughly 2 to 3 million per year, in fact. In short, vaccines enable more children to see their 5th birthdays, let alone adulthood. That’s reason enough to top my list.

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