On diarrhea and importance of changing perceptions in global health

Two-year-old Abdul receives a rotavirus vaccine from Mohamed Tarawally, a community health officer based in Sierra Leone. Photo by: Doune Porter / GAVI / CC BY-NC-ND

Governments and decision-makers will have to change their perception — and understanding — of diarrhea if they want to address (and even end) one of the leading causes of death among children all over the world, according to Rotavirus Organization of Technical Allies chair Mathuram Santosham.

“Diarrhea is such a common disease that people often think it is not important and can easily be cured,” he told Devex. Diarrhea kills more than half a million children globally every year — second only to pneumonia — or about 9 percent of all deaths among children under 5, according to data from UNICEF.

A major barrier to controlling the condition is the lack of understanding among policymakers about the causes of diarrhea. Almost 40 percent of the child deaths per year caused by diarrhea — or about 200,000 lives — come from rotavirus. Despite this, only about 80 countries have programs to fight rotavirus, leaving almost 100 million children without access to care.

“Diarrhea can be cured if children seek care early on and if you give them the right treatment,” he explained. “The sad part is many children don’t have easy access to care and don’t get to physicians until it is too late.”

While deaths from diarrhea are “totally preventable,” Santosham explained that total eradication of the disease will only be possible if development stakeholders adopt a comprehensive and unified strategy. He said everyone from the highest levels of power to the program level needs to be on the same page.

“It is unconscionable that in 2016, half a million children each year are dying of very preventable causes,” he said.

Preventive vaccination

One of the simplest interventions countries could take would be to introduce vaccination. Pharmaceutical giants GlaxoSmithKline PLC and Merck & Co. both make vaccines.

This is evident in the Asia-Pacific region, where 63,000 children die every year from diarrhea linked to rotavirus. Yet many countries in the region have been less inclined to introduce rotavirus vaccines in their national healthcare system, Tony Nelson, ROTA council member for Hong Kong, told Devex.

Policymakers in Asia “are uncertain of the price [of vaccines],” he said. “They know that the price can be quite high and they’re not sure how to negotiate that price, so it’s often easier for the governments to not even enter into that discussion.”

Still, Nelson said interest in rotavirus vaccines and addressing diarrhea is picking up pace, albeit slowly. India, for instance, successfully launched and introduced a locally produced vaccine into their national health program in March. Vietnam, which also has one of the highest hospitalization rates for rotavirus-caused diarrhea according to the World Health Organization, is currently developing its own vaccine.

“The governments in Asia are sort of less excited to push to get the vaccines at a cheaper price,” Nelson said. “Maybe that’s the perception that diarrhea is not a big problem.”

Competing priorities

Yet even if rotavirus vaccines are universally adopted, it won’t end all diarrheal disease. That disconnect poses a challenge in explaining to and convincing policymakers and parents to treat rotavirus.

“[The vaccine] prevents a major cause of diarrhea but not all diarrhea,” said Santosham. “When you give it to a child [and] you say to the mother, this is a vaccine to prevent diarrhea. What if the child gets another form of diarrhea? In her mind she thinks, I got the diarrhea vaccine but my baby is still getting sick. [It is] prevalent even among professionals … that even though rotavirus is a leading cause of diarrhea, the vaccine doesn’t prevent all causes.”

Another issue is the competing priorities within the global health sector and the need to scale up treatment while introducing vaccines. A white paper by ROTA Council, for instance, found that many countries should increase focus on WHO-recommended solutions such as oral rehydration therapy — or a simple mixture of sugar, salt and safe drinking water — and treatment with intravenous fluids. Simultaneously they should increase investment in vaccines because it “prevent[s] the disease in the first place.”

Groups advocating for different causes may also grab attention away from diarrhea, given governments’ and the international community’s limited resources.

“[The] concept of competing priorities is always a discussion point. I think often doctors and other health experts are incorrectly competing amongst themselves trying to argue that my disease is more relevant from your disease,” Nelson said. “I think this is a real challenge.”

Santosham concluded: “I think if people take the attitude that they have to choose one intervention versus the other, that compromises our ability to totally control diarrhea.”

For more Devex coverage on global health, visit Focus On: Global Health 

About the author

  • Lean Alfred Santos

    Lean Alfred Santos is a former Devex development reporter focusing on the development community in Asia-Pacific, including major players such as the Asian Development Bank and the Asian Infrastructure Investment Bank. He previously covered Philippine and international business and economic news, sports and politics.