PNEUMOADIP January-February 2004

PNEUMOFOCUS

BULLETIN OF GAVI'S PNEUMOADIP AT JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
PNEUMO ADIP: PNEUMOCOCCAL VACCINES ACCELERATED DEVELOPMENT AND INTRODUCTION PLAN

Volume 1, No. 2 January/February, 2004

NOTE FROM THE EXECUTIVE DIRECTOR

This issue highlights preliminary efforts to establish surveillance networks for laboratory confirmed pneumococcal disease in Africa and Asia. Also, you’ll see from our efforts with colleagues at the CHANGE project in Washington, DC that important challenges are ahead in terms of communicating the importance of pneumococcal disease and the value of prevention to policy-makers in developing countries.

You’ll also see how we have solicited feedback from technical experts on key issues in the area of research and surveillance to help us refine our strategy for research and disease burden studies. By April 15th, we aim to open a Small Grants Program designed specifically to help scientists based in developing countries to conduct small studies consistent with the objectives of the PneumoADIP. An e-mail will be circulated to announce its launch, but you’ll want to check out our website www.preventpneumo.org for the most current information on funding opportunities and other news.

Orin Levine
Executive Director

NEW EFFORTS TO TRACK PNEUMOCOCCAL DISEASE WORLDWIDE:
AFRICAN AND ASIAN COUNTRIES IN UNIQUE COOPERATION

Mombasa, Kenya. In conjunction with PneumoADIP's objectives to promote research and gather information on pneumococcal disease PneumoADIP and the WHO recently co-sponsored an international meeting of investigators from pneumococcal surveillance networks in developing countries. Eighteen investigators representing 5 surveillance networks in South and Southeast Asia and East and West Africa attended the meeting along with representatives from the WHO and PneumoADIP and international experts on surveillance.

Meeting objectives included the standardization of definitions and procedures across surveillance networks, establishing patterns of collaboration between networks and PneumoADIP, and determining ways in which PneumoADIP can help surveillance networks become more effective. Topics discussed included core definitions for pneumococcal disease, methods for patient evaluation and diagnosis, and standardization of laboratory methods and reporting.

The meeting generated intensive, productive discussions among the participants. Investigators were very committed to improving the process of collecting quantitative information on pneumococcal disease. Most expressed a belief that the local burden of pneumonia and meningitis caused by pneumococcus is far greater than most countries currently appreciate.

This meeting laid the groundwork for better and intensified collaboration between the investigators of the participating regions. The interaction and contribution of these investigators will improve the quality of data that will come from the surveillance studies. PneumoADIP is working to establish a coordinated system for reporting data that will facilitate international comparisons of surveillance findings and assure that each network shares its findings with the others.

WORLD’S LEADING EXPERTS ON PNEUMOCOCCAL DISEASE MEET AT
JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

Baltimore, MD. GAVI's PneumoADIP held its first Scientific Advisory Board meeting in December 2003 with more than 30 of the world's leading experts in pneumococcal disease attending. The agenda covered a broad range of topics - from advice on PneumoADIP strategy to developing countries' current perceptions of pneumonia to pneumococcal disease's economic consequences. Disease burden was a major focus - challenges addressed included improving disease burden estimates and the identification of major knowledge gaps. Improving disease monitoring through the implementation and support of surveillance networks was also a critical focus because this will later play an important role in demonstrating the value of any vaccine that might be introduced.

Both the interactive format of the meeting and the presence of representatives from all sectors involved in pneumococcal disease research helped make this meeting a success. The primary goal of the meeting was to generate advice for the PneumoADIP but attendees commented that the open and constructive discussions were valuable beyond the limited focus of the PneumoADIP. Important insight and advice was generated on the challenges PneumoADIP faces in its efforts to accelerate introduction of pneumococcal vaccines in developing countries. These insights will be incorporated into the overall PneumoADIP strategy.

PNEUMONIA PREVENTION NOT AMONG HEALTHCARE PRIORITIES IN DEVELOPING COUNTRIES

In collaboration with colleagues at the CHANGE project, Hans Kvist, Director for Communications at the PneumoADIP, recently participated in a systematic assessment of key decision-makers' health priorities perceptions and attitudes at the national and global levels. Of particular interest was the priority assigned to prevention of pneumonia and pneumococcal disease in children. The perception and attitude survey was executed in four developing countries in Asia and Africa representing a variety of different economic and health situations.

Senior government officials, Secretaries of Health, heads of EPI programs and NGO's, representatives from UNICEF and WHO, and national experts in vaccine research and pediatrics were all included as interviewees. A standardized questionnaire was used for these in-depth interviews, but questions were modified to be relevant to the different target audiences interviewed. The interviews were recorded and guarantees were given that all participants would remain anonymous.

CHILD HEALTH, BUT NOT PNEUMONIA, AMONG THE LEADING HEALTHCARE PRIORITIES

The health of children was a high priority in all countries visited and all were focused on decreasing child mortality. However, none of the 40 interviewees spontaneously mentioned pneumonia as a priority for control and/or prevention. When interviewees were directly asked about respiratory disease they all admitted that pneumonia was a major problem among children in their countries. Although admitting that pneumonia was a common disease, interviewees also pointed out that little information was available on the causes of pneumonia episodes and that there are problems in knowing if the pneumonia was caused by a bacteria or a virus. They also indicated that information was needed on how effective a vaccine would be in preventing pneumococcal disease in their countries.

These findings indicate a need for increasing awareness of pneumonia as a major child health problem in developing countries and supporting efforts to collect more information where they are not available. Even more importantly, a major effort is needed to demonstrate to decision-makers that pneumonia is preventable and that there are solutions available to this major child health problem. The work summarized here was conducted by Edelman, Inc. and supported by the CHANGE Project at Academy for Educational Development with funding from USAID. The PneumoADIP provided technical support to this work.