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Global Health

BRINGING VACCINE EXPERTISE TO THE CENTER FOR GLOBAL HEALTH: BIOLOGICAL AND SOCIAL CONSIDERATIONS…...1

BECOME A KEY COLLABORATOR IN GLOBAL HEALTH…………....………....2

GLOBAL HEALTH LECTURE SERIES—FALL 2011 SCHEDULE…...…...........…...5

Issue 20 | Nov | 2011

ENCOURAGING ACTIVISM IN GLOBAL HEALTH THROUGH KNOWLEDGE, INNOVATION AND ENGAGEMENT

Vaccine availability in the developing world and among transitional economies is a primary concern for global public health. This is especially true for the pediatric population, because many underdeveloped countries have a very high proportion of individuals that are 15 years old and younger. For countries in Latin America, Africa, and Asia, the top four causes of death in children under five are pneumonia, diarrhea, malaria, and measles. Diphtheria, pertussis, tetanus, and H. influenza type b infections remain serious causes of mortality as well. Safe and effective vaccines exist for many diseases that claim hundreds of thousands of lives every year in the developing world. Moreover, the cost of treating fatal diseases such as those just mentioned is far higher than preventing them; prevention through vaccination is financially optimal. As such, there is a great need for systematic distribution of

these life-saving immunizations around the world. The significance of vaccination in the global health agenda is one reason that the Center for Global Health at the Colorado School of Public Health is pleased to introduce one of its newest members, Edwin Asturias, MD. Dr. Asturias is joining the Center with an extensive background in infectious disease surveillance and pediatric vaccinology. Born in Guatemala, Dr. Asturias graduated as a doctor from San Carlos University in 1989. He was board certified in pediatrics at the University of Colorado in 1995, and went on to obtain a pediatric infectious disease specialty at Johns Hopkins University. He sits on the World Health Organization Committee for Vaccine Safety, and is a Senior Investigator for the Center for Global Health.

For the last twelve years, Dr. Asturias has conducted pediatric research at the Johns Hopkins Bloomberg School of Public Health. His research examined the relationship between nutrition and infectious diseases among children in Latin America, the results of which sparked his interest in vaccines and immunization.

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Bringing Vaccine Expertise to the Center for Global Health: Biological and Social Considerations

Dr. Edwin Asturias, Senior Investigator, Center for Global Health, Colorado

School of Public Health

link

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A Global Mission

The health challenges of today present complex cultural, economic, political, and geographic issues. To tackle these challenges the global community requires scientific innovations and collaborations from among clinical, research, and educational professionals.

At the Center for Global Health, we stand at the center of this network – activating people and programs willing to improve the health and well-being of millions around the world. Our work includes implementation of clinical training programs, infrastructure development for the prevention and treatment of communicable diseases, and corporate consultation in global health education.

Become a Center for Global Health Affiliate

Affiliates of the Center for Global Health are committed people, organizations and institutions who sustain the ongoing operation of the Center, and participate in and contribute to the development of new and ongoing global health initiatives.

The Center for Global Health welcomes the opportunity for faculty, organizations and institutions to become affiliated with the Center. Becoming an affiliate is simple; just click on the below link and register as an affiliate of the Center for Global Health. You will be asked a few questions about your interest and skills in global health, and any areas of activity or expertise in specific countries.

You will receive confirmation of your Center for Global Health status within six weeks of completing your application. Should you have any questions about becoming an affiliate, please e-mail Michelle Shiver, program manager at michelle.shiver@ucdenver.edu.

Affiliated Faculty

This is an opportunity for faculty at the University of Colorado, and Colorado School of Public Health (this includes faculty at Colorado and University of Northern Colorado) to become affiliated with the Center for Global Health. Affiliated faculty are encouraged to collaborate with other Center for Global Health faculty on research, education, and international intervention projects. Collaborative grants and contracts that have been developed with substantial input from Center for Global Health faculty should be submitted through the Center for Global Health but when appropriate may be processed through the PI's primary department and school.

Affiliated Collaborating Organizations and Institutions

This is an opportunity for organizations and institutions to collaborate with the Center for Global Health. Examples of collaborating organizations and institutions include schools, departments, or programs of other universities, professional associations or organizations, foundations, and non-profit corporations. When collaboration involves a commitment of resources from the Center for Global Health and/or the collaborating organization and institution that is not related to external grant funding, a formal Memorandum of Understanding with the Center for Global Health should be developed and appropriately signed.

Affiliated Adjunct Faculty

This is an opportunity for collaborating faculty from other institutions to become affiliated with the Center for Global Health. Eligible faculty are those collaborating with a Center for Global Health sponsored project.

To learn more about becoming an affiliate or to apply to become an affiliate with the Center for Global Health, go to our website and click on “Your Participation, Join the Center” at: http://globalhealth.ucdenver.edu.

Become a Key Collaborator in Global Health

Affiliated Faculty, Affiliated Organization/Institution or Affiliated Adjunct Faculty: How can you join the Center for Global Health in their global mission to improve the health and well-being of millions around the world?

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“We started to unravel some of the epidemiology of H. influenza type b, and S. pneumoniae in Guatemala. We were interested in how to prevent those infections that caused serious meningitis and pneumonia in young children, and we possessed a vaccine at the time that had been introduced in the United States and Europe; so we started to push the project through to get that vaccine into Latin American countries. It’s a pretty successful technology” stated Dr. Asturias. “Later I worked on trying to find a better strategy to use the polio vaccine for the last part of the eradication effort, and a patch vaccine for the prevention of E-coli, a bacteria that causes traveler’s diarrhea. It’s not only important for travelers, after the rotavirus, it is the second most important cause of child death from diarrhea and dehydration.”

Since their inception, vaccines have astonished both the medical community and the general public, due to their relatively instantaneous and pervasive effect as a preventive public health intervention. “Vaccines are probably one of the most, not only strategic, but also effective, and I would say, equitable technologies we have in public health”, Dr. Asturias explains. Speaking to how this has shaped his expertise, he continues by explaining, “When vaccines are introduced to a country, they get to almost every child, and that’s a great thing…for me the technology of vaccines has always been very attractive as it provides the power of prevention.” Most of the developing world is very receptive to vaccination, in part because it is easier for mothers and health policy decision makers in those countries to see the efficacy of the immunization. They live with the threat of preventable diseases like measles, polio, and rotavirus, and they can see that vaccinated children are not dying from the same diseases that kill unvaccinated children.

“I think the Latin American population is quite supportive of vaccination. They have seen the illnesses that we talk about, and that vaccines have been able to prevent them more recently than in North America and Europe [where diseases have been significantly reduced for a long time].” He continues, “We have seen that when a vaccine becomes effective and wipes out the disease from a population, you are only left with the adverse event that a vaccine may cause [such as fever or local irritation]. In the United States and Europe, people have become less amenable to giving vaccines to their children as they fear the rumors of the side effects of immunizations, because they don’t see the devastating outcomes of the disease that the vaccine is preventing. We’ve seen that when a disease comes back, people become more amenable to vaccination.” The sociocultural perception of vaccine safety partly determines the success of a vaccination program. The concept of herd immunity, or a critical mass of vaccinated individuals that protect unvaccinated individuals, depends on just that, a critical mass. The magnitude of biological power contained in a vaccine has not always been cast in a positive light. For example, the alleged connection between autism and MMR (Measles-Mumps-Rubella) vaccines has been refuted by medical experts from a number of institutions, such as the World Health Organization, National Institutes of Health, and Center for Disease Control and Prevention, among others. Yet a few poorly conducted studies propagated by ill informed media conduits have had a tremendous impact on the public perception of vaccines. Media scares, sensationalized stories, and rumors threaten herd immunity by reducing the critical mass of vaccinated individuals. (Continued from page 1)

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“Vaccines are probably one of the most, not only strategic, but also effective, and I would say,

equitable technologies we have in public health.”

Edwin Asturias, M.D.

Bringing Vaccine Expertise to the Center for Global Health: Biological and Social Considerations

Dr. Edwin Asturias

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There are many reasons that vaccines have come under scrutiny throughout the recent past. Some people reject vaccination due to religious conflict, others assert that governmental immunization requisites infringe on personal rights, while others still fear that vaccines are biologically ineffective or unsafe. Perhaps the greatest potential for backsliding is the belief that vaccine-preventable diseases will not return to pose serious health risks. While some portions of the industrialized world have begun to reject immunization through the anti-vaccine movement, low and middle income countries could greatly reduce morbidity and mortality rates among children, and keep adult individuals in the work force by using existing vaccines that are simply unavailable to them. The decisions regarding vaccines that are made here in the United States have a direct impact on the production of these much-needed vaccines for use in the developing world. In Latin America, Africa, and Asia, vaccination is not only a valuable approach to precluding infection, reducing morbidity and mortality, but also important for limiting treatment expenses, and potentiating future economic growth through healthier populations. The economic implications of successful vaccination programs are immense. Dr. Asturias offers, “There has been a substantial increase in costs [to vaccinate a child], yet at the same time I think people have become more aware, especially public health decision makers, that there’s an opportunity here, where you might have to spend a lot for the vaccine, but the cost of the disease is much higher. It depends on where you want to have that money spent.” Dr. Asturias elaborates how policies created in the United States have determined which vaccines become available for greater distribution, “There are examples of vaccines

that could have been quite beneficial for helping developing countries, but actually were taken out of the market in the United States for one reason or another, and then they didn’t become available to save lives in other places. There are pros and cons; I think one could say the way that the American population looks at a vaccine [and sees] that it has some risks for developing countries, but on the other hand ensuring vaccine safety is going help most of the world to elevate their standard.” Elevating standards is at the core of Dr. Asturias’ work. As he explains, “I will continue my work on vaccine safety at the international level with the World Health Organization as well as doing projects in Latin America to strengthen their vaccine safety systems. Through the Center for Global Health, we are working on the more permanent areas for research in maternal and child health, and right now both research sites are concentrated in Guatemala, and potentially Colombia and Mexico.” He continues, “The idea is for the University of Colorado, Colorado School of Public Health, and the Children’s Hospital Colorado to have a more systematic presence in international research, where we can basically try to answer global health questions and partner with solutions. If we are able to study what we have here in terms of technology and translational research, we can develop some other international locations for ongoing research, education for faculty and students, as well as some direct service. We are firm believers that we need to combine these three things in order to really provide for the people.” This multifaceted and tactical aspect of global health defines the expertise that Dr. Asturias’ is bringing to the Center for Global Health. Successful vaccine campaigns depend on both biomedical efficacy and safety, as well as cultural sensitivity and well-intentioned, well-informed media exposure. Look for more stories on Dr. Asturias’ work and the development of the site in Guatemala in future issues of the Global Health Link. To learn more about his work with vaccines; please contact Dr. Asturias at Edwin.asturias@childrenscolorado.org.

Bringing Vaccine Expertise to the Center for Global Health: Biological and Social Considerations

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University of Colorado Denver Center for Global Health

Mail Stop A090, 13199 E Montview Blvd, Suite 310

Aurora, CO 80045 http://globalhealth.ucdenver.edu/

Global Nutrition: Basic Human Research to Inform Health Policy

Nancy Krebs, M.D., M.S., Professor of Pediatrics & Head, Section of Nutrition, Uni-

versity of Colorado

November 30, 2011 12 noon/Children’s Hospital Colorado,

Mt. Oxford Auditorium, Aurora, CO

Global Health Lecture Series

Only two lectures left in our Fall 2011 schedule and you don’t want to miss

them!

Maternal to Child Transmission of

HIV by Breastfeeding in Africa

Edward Janoff, M.D., Tim Gill Professor of Medicine & Microbiology and Director,

Mucosal and Vaccine Research Center, Uni-versity of Colorado

December 14, 2011 12 noon/Education Building One,

Room 1400 Anschutz Medical Campus

Aurora, CO