Thursday, September 30, 2010

Clinical trial capacity remains challenge for TB vaccine development

Tallinn, Estonia: While progress is being made in the development of new vaccines against tuberculosis (TB), sufficient clinical trial capacity remains a major challenge, researchers reaffirmed at the Second Global Forum on TB Vaccines in Tallinn, Estonia (21-24 September 2010). Read more



Scientists from around the world presented the latest developments in their research on new TB vaccines. Eight vaccine candidates were presented, which are now all tested on humans in various stages of clinical trials, many in Africa. Currently the most advanced vaccine candidate is the MVA85A vaccine developed by Oxford University.

While the current TB vaccine candidates have shown promising early-stage results on safety and immunogenicity in studies conducted at well-established world class TB vaccine research sites, further tests are required and additional clinical trial sites will be needed to meet the demand. The already long and complicated process of testing vaccines is made more challenging by a general lack of capacity for clinical trials worldwide, the researchers acknowledged.

"It is important to involve local communities from the very beginning," stressed Dr Tom Evans, MD, Chief Scientific Officer at Aeras Global TB Vaccine Foundation in a presentation.

Evans mentioned the need to address language issues, local (traditional) medical practices, local perceptions about giving blood and participating in clinical trials as necessary steps needed to avoid possible pitfalls. But even logistical problems such as power grid problems and limited access to electronic data, or unexpected situations such as worldwide travel problems and instability of governments can influence the course of clinical trials.

According to Robert Nakibumba, Community Representative to the New Vaccines Working Group at Stop TB Partnership, creating 'minds for a new TB vaccine' on community level is a challenge as well. "Many people think: there is a TB vaccine already, why you come up with a new vaccine?" he said in a later session at the meeting. "We have to tactfully explain to the community the limitations of BCG, they must know the existing tool is not effective."

BCG (Bacille Calmette Guérin) is the only currently available vaccine against TB. It is widely used around the globe and protective against severe forms of TB in children. But it is not effective enough against pulmonary TB in adolescents and adults, the most common and most infective form of TB worldwide.

Nakibumba also underlined the importance of involving local communities. "They are not only patients or participants in clinical trials. They are going to get the vaccine, they are serious stakeholders."

The Second Global Forum on TB Vaccines in Tallinn, Estonia, last week brought together around 200 scientists, clinicians, manufacturers, NGOs and governmental institutions from around the world. They reviewed the progress made in vaccine development in the past decade and look forward to the challenges and opportunities ahead.


Babs Verblackt - CNS
(The author is a freelance journalist, a Fellow of CNS Writers' Bureau and Associate Communications at TuBerculosis Vaccine InitiativeTBVI


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Wednesday, September 29, 2010

"Kothis" reducing risk to HIV and sexual violence among their community

Clinic manned by MSM doctors
providing medical aid to
Kothis in Lucknow
Having faced ages of neglect, denial and invisibility, "Kothis" (feminised males) are now being mobilized by groups like 'Bharosa' in Lucknow, Uttar Pradesh (India) to be empowered and demonstrate leadership in reaching out within their community for increasing access to essential services including HIV prevention, care, treatment and support services. They are routinely encouraged to practice safer sexual practices and protect themselves from any kind of abuse or exploitation. Read more



Kothis or feminised males are unique and don't necessarily identify with gender identities of a man, woman, or other identities now increasingly getting accepted like those of gays or men-who-have-sex-with-men (MSM).

Kothis are neither gays nor eunuchs due to which they are outcasts in these groups and several rungs lower in social status. Thus sans any rights within the said group, they are often severely exploited and abused.

The gays often consider them uncouth and crass while the Hijra community usually refuses to accept them as they are not anatomically qualified to join their brood. The general population where sexual or gender identity other than the man or woman is often not accepted, is most unlikely to accept Kothis exist in the society.

Predictably the Kothis remained a dirty secret in the society, abused and neglected that all know about but refuse to acknowledge.

Twenty seven year old Rama (name changed upon request), a kothi, is a social mobiliser functioning to educate his reclusive community of Kothis (feminised males) on how to survive in a hostile societal background. He works in posh neighbourhoods of Lucknow which doubles-up as pick-up points for men interested in having sex with men. Kothis are on list of preferences as this community as a discipline indulges in sex purely for pleasure and not money. So it's fun for free!

Bharosa Lucknow team that
 function as advocacy officers
 who address human rights
 violations against the Kothi
Rama's job in such a scenario is to ensure that no one is abused, attacked or forced into the act against their wishes, and he works tirelessly to make sure that protection against HIV and other sexually transmitted diseases (STDs) are duly taken.

Why is he different? Well what Rama does is important, as he is a positive example of a leader and motivator for a community that is crawling back from the brink of extinction. A kothi himself he helps organize and protect his community so that they can safeguard against harassment and sexual abuse they have faced for years together.

Says Rama, "the hardest part was that everyone wanted to interact with us but away from public eyes. For me coming from a Hindu middle class family with three brothers and a father who is a serving forest officer maintaining such a life of secrecy was traumatic. More so when, I was different from them as a feminized male. Being a  Kothi I was forced to drop out of high school and for many years I suffered with acute depression because of my sexual preference and feminine traits. Then I heard of a network of Kothis and men-who-have-sex-with-men (MSMs) and joined them. There I learnt to accept who I am and be myself, now I help others like me do the same."

The aim of many like Rama is to work on the concept of societal inclusion. They are now being trained to function as social mobilisers and 'peer group educators' (counsellors) etc sensitizing and spreading awareness on how the Kothis can unite to fight abuse and injustice against them. They also educate the general population about their community and have gained support from the society for their efforts to fight against the threat of AIDS and other evils like sexual abuse against minors.

Once ostracized and detested they have now made a place for themselves in the society and are back and with a vengeance fighting to save their identity!

BUT WHAT CAUSED THE TURN AROUND?

According to the Kothi veterans in the community, efforts put in for organising and uniting the Kothi community brought the much needed change in mindset and attitude. For which few resourceful members of the community got together and started 'Bharosa', an organisation that focused on welfare of Kothis and MSM community.

Arif Jafar, is a noted sexual rights activist who has been dedicatedly working for protecting human rights of sexually marginalized communities for over a decade, knew it would not be easy at first. Arif took the initiative for developing this concept of 'Bharosa' in 1996, and he is also involved with a globally-acclaimed group working with MSMs – Naz Foundation International (NFI).

Says Jafar, "Those kothis who had a good network within the community and a clean past record were identified and recruited as outreach workers. They underwent training and were put in place to monitor various cruising areas. Special care was taken to restrict the community from entertaining men seeking sex with children."

To ensure they would be taken seriously an innovative idea was worked upon by members of 'Bharosa' who liaison with police to develop a dress code to be worn by Kothi outreach workers. This way they could be identified as social workers in their areas and allowed to hold meetings and distribute condoms sans harassment by the police or local goons.

But why did he choose to recruit Kothis for the job?

"99 PERCENT KOTHIS HAD GIVEN UP HOPE OF EVER BEING TREATED WITH DIGNITY"

To which Jafar responds, "To develop their self esteem as when I did a survey to find out more about the Kothi community to organise them, I was shocked to see that 99 percent I interviewed had given up hope of ever being treated with dignity. What shocked me more was that each one wanted to commit suicide to escape the emotional and physical torment owing to their feminized looks and habits. In addition to that the Kothis felt that they were cursed by God and meant to die a horrifying death by knowingly contracting diseases like AIDS. So most were consciously not using any protection to get infected and die. This mindset was the result of years of conditioning by a society that refused to accept them. It was not only inhuman but a very sad way of living and had to be changed."

Adds Imran Khan, Programme Manager, Bharosa, and a MSM who oversees working of Kothi staff through the organisation, "Bharosa was set up in 2006 to work on guidelines of the National AIDS Control Organization (NACO) to create HIV awareness and motivate prevention. But we were already working on welfare of the community since 1997, hence it was decided to take up the issue to organize and improve the life of Kothis and MSMs. We had gained trust and credibility within MSM community but it was still a challenge where Kothis were concerned."

"There was a huge group of Kothis who were very reclusive due to the stigma attached to their sexual behaviour of having multiple partners which went up to 9-10 men a night. The disease was spreading in their community like wildfire owing to the unsafe sexual practices. Furthermore it was common for Kothis to suffer violations of human rights like unlawful arrest and detention in police stations overnight where they were often allegedly raped by the police thana staff all night. Forced unsafe sex was common even with Kothi children by men who believed sex with a child could cure AIDS. And there was nothing they could do to stop it as the police was often among one of the perpetrators. For solving these problems we decided to have an advocacy officer who should take every human right violation case against a kothi or MSM to court" said Imran.

And it worked as most Kothis had been molested and robbed by police, local political party netas, goons and anyone who wanted an unusual sexual experience complete with violence and abuse thrown in. The Kothis were given a hearing in court, more so after the landmark judgement regarding section 377 of Indian Penal Code (IPC) came into being on 1st of July 2009. A major battle won, the next move was to protect the community by changing their risky sexual behaviour.

Recalls Aamir (name changed upon request), a Kothi outreach worker who functions in one of the most notorious areas of Lucknow - the Daliganj station - alleged to be frequented by mafia lords, petty criminals and even paedophiles, "Now no one is allowed to get away  if they break rules and resort to violence sexually or otherwise against Kothis. We intervene immediately if such an instance is reported or if anyone refuses to use a condom. As a Kothi I grew up facing abuse both in the society and my family and could turn to no one for help but today I am here to help my community so they don't face what I had to.  I dropped out of school and gave up a job as a librarian owing to my feminized look and behaviour as it attracted a lot of ridicule from my colleagues and even unwelcome advances from the male staff. But that was then, today we have learnt to fight back and demand our rights. Talks are initiated with those guilty of abuse and they are made to see the folly of their ways and most understand it."

While outreach workers like those quoted above, are the face of the work being done upfront, the responsibility of behind the scene back up to build rapport, network and gain confidence and trust of the community members rests with peer educators who prefer to keep their identity concealed.

A thirty year old kothi and a peer group educator who works as a security guard at a security firm in Lucknow has been very focused in intervening on behalf of the community when they face harassment and also in educating them about dangers of risky sexual behavior.

ASK HIM WHY HE DOES IT?

And pat comes the reply, "Initially as cruiser in Gomti Nagar and Chinhut (residential areas in Lucknow and pick up points) I came to 'Bharosa' for group meetings and began volunteering here that's when I learnt how our community was dying out so I decided to do my bit to help make things better."

And he did as today he is an asset to the community who nominated him as a peer educator for his efforts to prevent abuse of underage feminized males at the local gyms in the city.

"I resisted all attempts of forceful exploitation and became role model for the young kothis boys who face the same thing today. I feel it's my duty to stop such abuse as being members of the society we have a right to be and get justice for those wronged" he further said.

This is something that is badly needed in their community for which many like him are now working tirelessly. Their focus is not only Kothis in Lucknow but also the common public and they are making a valuable contribution to society to help sensitize and save innocent lives by creating awareness about HIV prevention and AIDS treatment, care and support services.

This is undoubtedly an effort that needs all the support that it can get.

Anjali Singh - CNS
(The author is a UNICEF consultant and a senior journalist. She is also the Director of Saaksham Foundation) 



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Monday, September 27, 2010

No more Kandhamals!

Photo credit:
Deepak Srinivasan, 
Maraa
In August 2008, one of the worst communal genocide attempts on the Christian community occurred in Orissa's Kandhamal district, among India's poorest places. Over 100 people including women, differently-abled, children, Adivasis and Dalits were killed. 3 women were gang raped and many were injured. 295 churches were destroyed. Educational and medical institutions were not spared. 15,000 fearful and threatened survivors who cannot return to their villages unless they convert to Hinduism are still living in tents. Read more


The high displacement in the last two years, hellish life in refugee camps and the breakdown of many families due to poverty have affected the aggrieved, psychologically. Minor and adolescent girls are being trafficked for 'security' and livelihood. Widespread ostracisation of Christians in Kandhamal affected adult employment and children's education. The meagre government compensation was insufficient for the immediate medical needs of many.

While Sangh Parivar followers attacked Adivasis and Dalits, the administration stood either as a silent spectator or indirectly supported the violence. The state's deliberately negligent behaviour is common where the population primarily comprises marginalized communities like Scheduled Castes and Scheduled Tribes (SC/ST as per official jargon). From 3300 victims' complaints filed in the local police stations, only 831 were registered as FIR's most of which are pending inquiry. The minimal investigations and bias have acquitted the criminals 'arrogating' them before the minorities.

The attacks on Christians spread to over 10 states in India, hurting the fundamentals of democracy and spiritual harmony. Karnataka recorded the maximum anti-Christian attacks in India in 2009 and is keeping pace this year.


The National Solidarity Forum, a coalition of over 55 organisations nationwide held solidarity events across India. Strongly condemning attacks on religious minorities, it requested all democratic forces to unitedly fight the rising communal fascism. Appealing to all peace loving people in the country to support the cause for justice in Kandhamal, it demanded:

* Prosecution of - police personnel who failed to register FIR's and encouraged the communal violence in Kandhamal
- those responsible for forcing conversions to Hinduism
- relevant administrative officials for dereliction of duty

* Transfer of investigation to CBI/SIT

* Compensation for - houses destroyed in mass arson
- victims of gender violence,
- loss of livelihood for two years
- all widows/next of kin of those who died in the riots

* Resettlement in home villages with full land rights and security

* Employment of men and women victims

* Counseling for traumatised children, women and men

* Rehabilitation of children, especially girls whose education is interrupted

* Reissue of property documents and educational certificates destroyed

* Implementation of a witness protection scheme and provision of necessary assistance to survivors to ensure their court testimony

* Repeal the Orissa Freedom of Religion Act, 1967, which fuels prejudicial attitudes towards religious minorities

* Establishment of a State Commission for Minorities, like its national counterpart

Photo credit:
Deepak Srinivasan, 
Maraa
Peoples’ Solidarity Concerns (PSC), Student Christian Movement, India (SCM-I), St. Joseph's College of Arts and Science, Visthar and The Other Media-Communications (TOMC) were among those who organized a protest outside Town Hall, Bangalore, on 25th August, 2010. These groups also facilitated a talk by Dr. Ram Puniyani on "Color of Terror: Saffron, Green or Black" on 10th September 2010 in Bangalore. Dr. Puniyani, Prof. Ninan Koshy and Mr. Jagadish Chandra of PSC subsequently responded to questions.

A set of poignant sketches by two artists whom the violence directly impacted is here.


Pushpa Achanta
(The author is a freelance writer, a Fellow of Citizen News Service (CNS) Writers' Bureau, and a community volunteer based in Bangalore, India)

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Sunday, September 26, 2010

Not Screening For Diabetes During Pregnancy Is Dangerous And Costly

The theme for the World Diabetes Day 2009-2013 campaigns is: "Diabetes Education and Prevention"; with a view to "Understand Diabetes and Take Control". Diabetes, mainly type-2 diabetes is very common in India and there are 50.8 million people living with diabetes currently in the country. The International Diabetes Federation (IDF) estimates this number to rise to 70 million by the year 2025. So there is an urgent need for a national diabetes control programme. Read more


Women are as equally affected by diabetes as men. When compared with men, women have a 50 percent greater risk of diabetic coma, a condition brought on by poorly controlled diabetes and lack of insulin. Diabetes also poses special challenges during pregnancy. Diabetes during pregnancy (gestational and type-1 diabetes) results in an increased risk for problems such as high birth weight, birth defects, and other complications for the mother. It also puts the woman and her child to an increased risk for developing type-2 diabetes later.

"Women who have uncontrolled or undiagnosed diabetes in pregnancy can have several complications like: infertility, recurrent spontaneous abortions, higher risk of congenital malformations in the developing foetus, cardiac malformations, gastro-intestinal malformations etc. Moreover, they have a higher chance of having a macrosomic baby who can have several complications in the early neonatal period like hypoglycemia, hypocalcemia. A large baby can also create problems during childbirth and lead to increased incidence of operative delivery" said Dr Amita Pandey, a leading gynaecologist and Assistant Professor, Department of Obstetrics and Gynaecology, CSM Medical University (CSMMU, erstwhile King George's Medical College - KGMC).

Yet, diabetes as a maternal health issue is largely unaddressed in developing countries like India. Gender inequality places a higher burden of social and economic consequences of diabetes on women, while at the same time imposing greater barriers to access to care. Diagnosis of gestational diabetes identifies women as well as their children at very high risk of future diabetes. So identifying and providing care for diabetes during pregnancy are crucial.

Dr Pandey rues that "doctors working in the smaller cities and in the peripheral health centres, are not programmed to diagnose and manage diabetes in pregnancy. Most of the times it goes unnoticed, and only when complications, like congenital malformation or abortion, occur and the patient consults a specialist, is it diagnosed. So although the health system is equipped to screen for the disorder and diagnose it early (there are simple screening tests, like the 50g, one hour blood sugar screening test, available to diagnose GDM in all government hospitals), the doctors don't lay enough emphasis on this and often overlook the problem. In fact, it may appear to be shocking, but in the state of Uttar Pradesh at least, very often the doctors do not even get the haemoglobin of the woman estimated during the entire pregnancy. So how can one expect them to think about blood sugar screening to diagnose gestational diabetes? One may justify it by calling it a result of system failure or adverse effect of over-population, but we do fail on this aspect as far as public health services are concerned."

A study carried out in 2004, by Diabetes Care and Research Institute, Chennai, and the Tamil Nadu Health Department, in and around the rural/urban areas of the city found a 13.8% prevalence of gestational diabetes. This prompted the Tamil Nadu state government to make diabetes screening compulsory for all pregnant women, since 2007. This needs to be emulated on a national level.

Dr Pandey agrees that "diabetes is perhaps a complication of the super-mechanised lives we lead these days. We Indians have very poor dietary habits--a high intake of simple carbohydrates and fats with very little physical exercise. This results in fulminant diabetes in those (like Indians), who are genetically predisposed for the same. Moreover, Indian women are more negligent in controlling blood sugar levels and often end up with grave consequences and complications of diabetes. They are also not able to spend sufficient money on getting a proper treatment for themselves as the husband and the sons get a higher priority as far as health and treatment expenditures are concerned."

So while on the one hand, we have an overburdened health system which is ill equipped to conduct basic health checkups, on the other hand we have educated but ignorant expectant mothers, who have been traditionally tutored to neglect their own health. Little do they realize that undetected/untreated gestational diabetes involves a higher risk of maternal and prenatal morbidity and poor pregnancy outcomes.

Hence it is important that women shed their apathetic attitude and pay proper attention to eating a healthy diet and to go for regular walks and other forms of exercise. Merely doing household chores is not enough exercise. Exercise lowers glucose levels, helps weight loss, maintains a healthy heart and helps relieve stress. They also need to demand to have their blood sugar tested in both the first and second trimester, if pregnant. It is to their advantage to discover gestational diabetes early, if it exists.

Also, there is an urgent need for government action, to not only focus on women with diabetes, but have compulsory screening for gestational diabetes in all public/private hospitals. It should also be mandatory for all government/non government enterprises and educational institutions to have annual health tests for diabetes and other non-communicable diseases for their staff.

In the words of Dr Anil Kapur, President of the World Diabetes Foundation (WDF), "focussing on gestational diabetes is a low cost preventive way to improve maternal and child health, and a small investment in providing screening for mothers at risk for gestational diabetes is likely to have an impact on the beneficiaries as well as on health care systems and budgets."


Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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Thursday, September 23, 2010

Let Us Live In Honesty And Harmony

We Indians have a tendency to delve in the past and then either gloat over it or cry over it. We love to waste time and energy, reminiscing about the yesteryears, with scant thoughts of improving our present and future. We do not let 'Bygones be Bygones', but rather cling to them in a sadistic sort of way. It rarely occurs to us to learn lessons from the past mistakes in order to improve upon our present.  What’s the point in revelling about India being the land of ‘milk and honey’ in the eras gone by, when the present chaos (compounded by hunger and violence) promises to get worse with every passing day? Read more

It would, perhaps, be more worthwhile to analyze critically and ponder over the mistakes (and not repeat them) which have led to a gradual decline in public/private morality and brought us to abysmal depths of depravity—the ongoing controversies surrounding the (non)preparation of Commonwealth Games, and the Ayodhya tangle  being just two of the myriad examples of our moral turpitude.

The sheer gravity of the ongoing Babri Masjid-Ramjanmbhoomi seems to be defying all solutions. As I write this piece, rumours are rife in the city of Lucknow, and elsewhere too, about what may (or may not) happen in the next couple of days. With bated breath, all are waiting for the D Day – the day of judgement (not by God but by the Allahabad High Court). One community is pitched against another; rhetoric is whipping up emotions; and a palpable scare pervades the very air we breathe. A distraught mother of my colleague wants to stockpile groceries lest there be a curfew; parents are wary of sending their wards to schools even at the cost of missing an exam; many shopkeepers feel it is safer to close shop on the day of the verdict; people are trying to refrain from travel and stay within the confines of their home-sweet-home; while others are anxiously waiting and watching, twiddling or biting their thumbs.

And all this frenzy is in the name of Ram/Allah or Khuda/Ishwar.

How does it matter whether the disputed site was the birth place of Lord Ram or housed a mosque?

Probably it was both- in that chronological order. Or, maybe it was not. Even if it were a place of worship of one of the two communities, it needs to be respected by the other. Enough rabble has been roused by Muslims and Hindus, or rather by their political/religious leaders, on this issue. It is time now for the Phoenix to rise from the ashes of what must once have been a prosperous place. Some of our so called leaders have been crying hoarse that they will not tolerate an insult to their God and build a temple/mosque there (irrespective of the court order).

Surely there are better and more constructive ways of showing reverence to our religion. Let us (including our religious leaders) follow the real principles of Lord Ram and/or the true tenets of Prophet Muhammad, rather than squabble over the proprietorship of a piece of land. Let us try to bring back Ram Rajya (a synonym for ideal governance) in our country by becoming morally upright and law abiding citizens who prefer love to hatred. Let us not brush aside our misdemeanours- whether it be passing the buck in the murky dealings of the organizing committee of Commonwealth Games, or in casting aspersions on each other in the Mandir – Masjid (each is a six letter word beginning with an M) fight. It would be in the fitness of things, and for the benefit of all, if we take the responsibility of undoing the harm already perpetrated by us.

As right minded and responsible citizens, let us demand (and work for) the construction of a hospital, at the disputed site in Ajodhya—a hospital which will be free from corrupt practices and provide holistic care to the common patient with love and compassion. I think we can call it the 'Allaram Hospital' or the 'Ramallah Hospital' or, for that matter, give it any other name. As the Bard said--"What's in a name".

This is the only healing touch which will soothe the frayed nerves of the gods and human beings. It is also one of the ways in which we can truly worship our religion—whatsoever it might be.
Let us be truly religious by living honestly and peacefully.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org) 




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Wednesday, September 22, 2010

TB doesn't get the prioritization it needs

Tallinn, Estonia: Tuberculosis (TB) is considered a major public health issue by decision makers, yet commonly doesn't get the place of importance it needs as a health care priority. These are the preliminary results of a study presented at the Second Global Forum on TB Vaccines in Tallinn, Estonia, on Wednesday, 22 September 2010. Read more



The market research study provides an overview of national-level decision makers’ views on the introduction of new vaccines against TB. Undertaken in eight countries with high TB burdens, researchers conducted 86 one-on-one interviews (45-60 minutes) with senior Ministry of Health (MoH) civil servants responsible for vaccine introduction, MoH technical experts involved in delivering vaccines through the Expanded Programme on Immunization, senior Ministry of Finance (MoF) civil servants responsible for health budgets, senior public health clinicians, (children’s) health related NGOs, parliamentarians, and senior journalists. The study was conducted in China, India, South-Africa, Brazil, Russia, Mozambique, Cambodia and Romania.

The interviewees were presented with three hypothetical scenarios for new TB vaccines and asked questions about, among others, the likely demand and likelihood of rapid implementation. Overall, there was enthusiasm for (the use of) a new TB vaccine. "We still need to further analyze and break down the results, but generally they are encouraging," said Lew Barker, Senior Medical Advisor with the Aeras Global TB Vaccine Foundation. "What is striking is that the answers varied both within and between countries, ranging from positive to negative, and often with a wait and see attitude."

When the interviewees were initially asked about their country's major public healthcare priorities, none mentioned TB. Rather issues such as primary healthcare, mother and childcare, chronic diseases and HIV/AIDS topped the lists. "But if they were then asked about TB, the respondents immediately acknowledged it is a big problem that doesn't get the attention it deserves," Barker explained. "So TB is not at the top of their mind but it definitely is there on a lower level. It is a neglected disease - we already know that - that is one of the challenges the fight against TB has to face."

The results further showed a widespread dissatisfaction with the only currently available vaccine, Bacille Calmette Guérin (BCG). The vaccine is protective against severe forms of TB in children, but not effective enough against lung TB in adolescents and adults, the most common and most infective form of TB worldwide.

The market research study titled 'Barriers and Drivers for Introduction of New TB Vaccines' was done as part of a broader initiative of the Stop TB Partnership's Task Force on Economics and Product Profiles for New TB Vaccines. It will be published online later this year.

At the international conference in Tallinn, around 200 scientists, clinicians, manufacturers, NGOs and governmental institutions from around the world this week (September 21-24) review the progress made in vaccine development in the past decade and look forward to the challenges and opportunities ahead.

Babs Verblackt-CNS
(The author is a freelance journalist, a Fellow of CNS Writers' Bureau and Associate Communications at TuBerculosis Vaccine InitiativeTBVI


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Tuesday, September 21, 2010

New effective TB vaccine would be 'game changer'

Tallinn, Estonia: Despite progress made in recent years, tuberculosis (TB) remains a challenge for the world, participants heard at the special opening session of the Second Global Forum on TB Vaccines in Tallinn, Estonia. New vaccines could make a significant difference. Read more



Christopher Dye of the World Health Organization in Geneva pointed out that treatment success and case detection has shown tremendous improvement in the past decades. "The TB incidence rate is going down, but the problem is that it is going down slowly," Dye explained. "The dominant reason for the lack of success is persistent transmission," he said, referring to the difficulties of diagnosing patients promptly within weak health systems.

Dye underlined that various new tools are needed in the fight against TB. But if there would be a new vaccine it would "really change the game", he emphasized. "It would have a big impact and shift the emphasis from cure to prevention," Dye said, stating that he sees reasons to be hopeful a vaccine can be found.

Also Peter Small, Senior Program Officer for TB at the Bill & Melinda Gates Foundation, called an effective new vaccine a 'game changer' that would 'revolutionize the fight against TB'. "An effective TB vaccine would fundamentally transform the strategy for global TB control and permanently change the trajectory of the epidemic," Small said, emphasizing increased funding and commitment will be critical to continue progress in TB vaccine research and development. "Government and philanthropy must do their part, but so must leading biotech and pharmaceutical companies around the globe."

"Vaccines are the best buy in public health - we believe strongly in the power of vaccines to improve health and save lives," he said. "Childhood vaccines are modern miracles - for just a few dollars per child they prevent death and disease for a lifetime. They are also a smart, long-term investment - immunizations give kids a shot at a healthy, productive life and healthy children lead to healthier families and more self sufficient communities and countries."

Scientists, clinicians, manufacturers, NGOs and governmental institutions from around the world this week will review the progress made in vaccine development in the past decade and look forward to the challenges and opportunities ahead. Tallinn has been selected as the venue for the meeting as TB is a significant health problem in Estonia, yet the country has been successful in the fight against the airborne infectious disease.

"We have seen good results but we need to go further," Hanno Pevkur, Estonian minister of Social Affairs, said at the opening session. "Multidrug resistance is our biggest problem, but also TB/HIV co-infection as well as TB and alcohol abuse. We have to look at the future and have special programs."

"We have different problems," Piret Viiklepp, head of the Estonian Tuberculosis Registry and special guest at the conference, agrees. "And if we want to reduce TB we have to work with all problems."

According to her political commitment has made a difference in the country. "All treatment is free of charge, but only under DOTS (directly observed treatment, short-course). You can't just be treated by your doctor or go to the pharmacy and ask for TB drugs. You have to go through DOTS programs. That way we also hope to prevent multidrug-resistant (MDR) TB from spreading."

The Second Global Forum on TB Vaccines, with around 200 participants one of the largest TB vaccine gatherings for a decade, will continue until September 24.


Babs Verblackt-CNS
(The author is a freelance journalist, a Fellow of CNS Writers' Bureau and Associate Communications at TuBerculosis Vaccine Initiative – TBVI) 


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Justice Jha Commission Case: Jabalpur HC seeks full assistance of Chief Secretary

A Special Bench of Justice Shri K K Lahoti and Justice Shri Ajit Singh issued directions to the Chief Secretary of the Government of Madhya Pradesh (GoMP) to personally ensure full assistance to the Court on all issues pertaining to the Justice Jha Commission of Inquiry which has been investigating into the massive corruption of a few hundred crore rupees in the rehabilitation of the Sardar Sarovar Project affected oustees. Read more


Alternatively, the Chief Secretary was directed to appoint a competent officer not below the rank of a Secretary who should be duly instructed to assist the Court in sorting out all the problems with regard to the Commission’s functioning and also be in a position to make a statement on behalf of GoMP and also be being present before this Court.

The Court was a hearing a letter dated 20th August 2010 sent by the Secretary of the Commission seeking full co-operation from the GoMP and more staff for effective functioning. In its letter, the Commission had brought to the Court’s notice the ongoing gigantic task of examining 8,000 witnesses, sellers, purchasers etc. in the fake registrations cases and also technical investigation into the quality of civic amenities at 88 R&R Sites. The Commission has sought a further term-extension of at least one year to complete these and other enormous tasks of inquiring into various aspects of corruption as per the two orders of the High Court Orders dated 21-08-2008 and 12-11-2009.

It may be noted that the same Bench had earlier issued a Show Cause Notice to the state government in May 2010, warning it of strict action if compliance with all the earlier orders to provide funds and facilities to the Jha Commission is not ensured by 24th June. It required such strong orders for GoMP to designate the High Court’s Registrar as the Budget Controlling Officer and disburse the requisitioned funds.

Pleading for the petitioner, Narmada Bachao Andolan, Medha Patkar reminded the Hon'ble Court of the magnitude of corruption and the need for a full-fledged Special Investigation team of police, revenue and PWD officials, additional members and secretarial staff to carry on the Commission’s work unhindered.

The case has been listed for further consideration on the 1st October to decide on the issue of extension of the Commission’s term which is to expire by October 8th and also for hearing a series of applications filed by NBA, responding to the contentions of the GoMP and NVDA and also seeking directions to the Jha Commission to file an Interim Progress Report.

Taking serious cognizance of the fact that no lawyer representing the central monitoring agency, Narmada Control Authority was present in the Court today, the Court issued directions to the Registry to ensure adequate representation of NCA on the next date of hearing. The Court also directed all the parties to file their replies to NBA’s applications by the next date of hearing.

Significantly, the Court observed that the NVDA being a separate entity cannot file a reply on behalf of the Madhya Pradesh Government and a separate response from the GoMP is expected.

In another pending matter, wherein some displaced persons sought the intervention of the Hon’ble Court to direct the Jha Commission to permit disbursal the second instalment of the cash-based Special Rehabilitation Package, the Court disposed off the matter with a direction to Justice Jha Commission of Inquiry to fully investigate into their land registries, after giving NBA a due opportunity of being heard and then decide the matter in accordance with law.

The timing of the directions to the Chief Secretary comes at a crucial time when the on the one hand, Jha Commission is recording the evidences in hundreds of cases of fake land registries which is clearly bringing out the nexus between the officials and touts and on the other NVDA is making insidious attempts to exclude discussion on the entire issue of corruption itself from the agenda of the R&R Sub-Group of NCA.

The expose will have to continue and the Andolan will pursue the matter to prove how whole process of rehabilitation has derailed due to the corruption and irregularities, thereby justifying a speedy, effective and independent investigation by the Commission.

Kamla Yadav                     Devram Kanera           Bhagirath Kavche

Sunday, September 19, 2010

ICPS aims at building a protective environment for children

"Child protection is a way of ensuring that children, under-privileged children in particular, are brought under a safety net umbrella. It is a system under which the most unwanted child is ensured the warmth of security, and full enjoyment of the basic rights," said Ratna Saxena, Integrated Child Protection Scheme (ICPS) consultant, UNICEF. Read more


Ms Saxena, was addressing media persons at the bi-monthly media sensitization programme on children's issue at "Media for children" jointly hosted at UP Press Club by "Media Nest" and UNICEF.

Explaining Integrated Child Protection Scheme (ICPS) in detail she informed that it is a centrally sponsored scheme of the Government of India which aims at building a protective environment for children and guarantees against child abuse, exploitation, violence and deprivation of primary care. While the programme is running in 15 states, Uttar Pradesh (UP), where in live the largest number of the country's children is yet to sign the memorandum of understanding (MoU). ICPS which came into force in 2009 capsules a number of government schemes on child protection.

"From ensuring total and lasting child protection the government and civil society must join hands," said Ms Saxena, adding that of course things will start rolling once the first and most vital step of the state government signing the MoU is completed.

The second step will be to ensure that other mandatory structures like-setting up committees, database, building capacity of families, communities and NGOs who will help carry forward the scheme.

She emphasized that media role is very important in the successful implementation of ICPS.

She played video clips of the beautiful song where India's top singers lend their voice to focusing attention on child rights. The song which called for ensuring that the children get all the rights to live said that we must not forget that these children are the future of our country.

Mr Rajib Ghoshal, Child Protection Specialist, UNICEF, said that creating protection homes for children should be the last priority of the government. The emphasis should be to foster care for poor, unwanted children. He said in order that for society and community may take on this additional responsibility willingly both social as well as economic incentive must be made the pre-requisite.

He quoted the scheme is running well through Palanhaar of Rajasthan.

As per the 2001 census, the population of children (below 18 years) was 42.2 crores (422 million) out of which around 17 crores (170 million), i.e. 40% of the children, are vulnerable or experiencing difficult circumstances.

The protective environment also focuses on children deprived of primary caregivers, particularly in the context of a) children who are in formal care institutions; b) children deprived of their liberty; c) separated children; d) abandoned children; e) children living in the streets; and f) orphaned and vulnerable children (OVC).

Earlier Mr Augustine Veliath, Communication Specialist, UNICEF, in his opening remarks asked a very vital question. He said many a time children are left behind alone with no fault of theirs like children of locked-up parents, sex workers, orphans. "Where do we take children who have nobody?"

He said that while the Integrated Child Protection Scheme (ICPS) aims at the development of the child, it also ensures the total protection to a child left alone to face the world.

"For the success of the scheme that ensures every child its right through society and government it is important that media asks the right question on a ICPS," said Mr Augustine.

Kulsum Mustafa - CNS
(The author is a senior journalist and also serves as the Secretary-General of Media Nest)

UN High Level Summit On Non-Communicable Diseases (NCDs)

With just a year to go, the countdown to the UN Summit on Non Communicable Diseases (to be held in September, 2011 in Brussels) has already begun. The Non-Communicable Diseases (NCD) Alliance, (consisting of the International Diabetes Federation (IDF), World Heart Federation, Union for International Cancer Control, and the International Union for Tuberculosis and Lung Disease - The Union) is gearing up to play a prominent role in this movement to drive home strong outcomes. It is a unique alliance representing the four priority NCDs (cancer, diabetes, chronic respiratory and cardiovascular diseases) identified by WHO, and has more than 880 member organizations in over 170 countries and territories. Read more




The epidemic of NCDs, despite being a global emergency, has been largely ignored by the international community. NCDs account for 60% of all deaths globally, 80% of which are in low- and middle-income countries. The World Health Organization estimates that 8 million people die prematurely in these countries from NCDs every year.The World Economic Forum (WEF) has identified NCDs as the second most severe threat to the global economy in terms of livelihood and potential economic loss. NCDs are a major cause of poverty, a barrier to economic development, and a neglected global emergency. This has prompted UN member states to unanimously call for a Summit on NCDs  recognizing that there is an urgent global need to address this debilitating and costly epidemic .

The NCD Alliance has broad long term global objectives, which provide the context for the specific requirements from the UN Summit on NCDs in September 2011. This long term vision includes: NCD / disease national plans for all;  Improved lifestyles;  Strengthened health systems; Global access to affordable and good quality medicines and technologies; A tobacco free world; and  Human rights for people with NCDs.

Diabetes, one the four priority NCDs identified by WHO, remains a neglected global epidemic which is now imposing a heavy dual burden of infectious and non communicable diseases on under resourced health systems in low and middle income countries.

According to the IDF:
there are over 300 million people with diabetes worldwide, with  low- and middle-income countries accounting for 4 out of 5 cases of diabetes. Most deaths and complications related to diabetes in low and middle-income countries are in the economically productive age group (30 to 50 years). There are 50.8 million people with diabetes in India and 92.4 million in China. Africa will have the highest percentage increase in the number of people with diabetes over the next 20 years. 80% of people with diabetes in Africa remain undiagnosed.

IDF hopes to contribute to the UN Summit on NCDs by working with its network in 200+ member associations in 160+ countries, and partners to produce diabetes specific deliverables by:
1. Leading global advocacy for diabetes
2. Producing diabetes evidence and analysis
3. Promoting best practice and workable solutions
4. Mobilising our members at national and regional levels
5. Building strategic alliances for diabetes

IDF also envisages to link the UN Summit to two events happening right after it. IDF will use the November 2011 World Diabetes Day (WDD) campaign to further engage the general public on diabetes and continue the momentum, putting pressure on political leaders to deliver what has been promised.
Summit outcomes will also be discussed at the one day political event, the Global Diabetes Forum, planned for the World Diabetes Congress in Dubai, December 2011.

The NCD Alliance wants full implementation of the WHO Framework Convention on Tobacco Control (a major risk factor for all NCDs) and for the Summit to deliver action from global to local levels on NCD prevention. Allocating sufficient resources to NCD treatment, prevention, management, research and health systems is essential to implementing Summit recommendations.

The UN Summit on NCDs is a great opportunity to put diabetes and other NCDs on the global agenda and leverage commitments that will stem an epidemic which is destroying millions of lives. The global diabetes community needs to mount a visible and coherent campaign to ensure diabetes needs and priorities get into the global agenda of the UN Summit.

Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. 
Email: shobha@citizen-news.org, website: www.citizen-news.org) 


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