News

Katherine E. “Kemy” Monahan, a career foreign service officer steeped in development issues and an economist and lawyer by training, was appointed as deputy executive director of the Global Health Initiative (GHI) in July. She had been the Brussels-based Counselor for International Development and the US Agency for International Development (USAID) Representative to the European Union. She took up her new post in late September and just three weeks into her job traveled to Kenya. On Tuesday, after seeing a Centers for Disease Control and Prevention (CDC) research site in the Kibera slum, she talked to GHTC’s Breakthroughs blog on site about her impressions of the US global health work in Kenya, the importance of research, and the critical need now to make the case to Congress for investing in global health. Katherine E. “Kemy” Monahan, a career foreign service officer Photo: Evelyn Hockstein/PATH Q: What was most memorable about your visit to Kibera? A: There is such a contrast. You see this very poor slum that is far from an ideal environment and then you see very healthy mothers and children inside their homes. That’s a real tribute to the work that CDC and Carolina for Kibera are doing here. When people do get sick, they can go to a clinic here, thanks to these organizations. I met a grandmother who was part of a CDC study. The CDC worker found out that the child had a very high fever, and the grandmother didn’t know about it. They took him to the clinic, gave him medicine, and the grandmother said he was better immediately. She was very happy. Q: What is the benefit of the CDC research in Kibera? A: The grandmother said it well. We asked her what the project was about. She said that the CDC was trying to find more out about the diseases that are most dangerous, that they would tell the Ministry of Health their results, and that would be used to help the neighborhood and the whole country. She was exactly right. CDC really has educated people well about the study. Q: Where does research fit into the priorities of the Global Health Initiative (GHI)? A: GHI is very focused on efficiencies, on all the agencies working well together, and working with other stakeholders such as the host government, other donors, and NGOs. If I think of the one thing that has been most important in cost savings and advancements in global health, it would be research and development (R&D). Research and development can create whole new paradigms. It can cut costs dramatically with one new vaccine, or one new drug, or one new test. R&D is expensive on the front end but very cost effective once you start implementing it. It’s so important that we remember this is a long-term investment. There are examples all over PEPFAR (the President’s Emergency Plan for AIDS Relief), with the pneumococcal vaccine, and the many new innovations now being tested, such as microbicides research. Q: Like many programs in the US federal budget, global health funds are under threat. A House bill would cut $700 million from the administration’s request. How do you make the case for global health in these times? A: There are so many reasons why GHI is good for Americans. It’s not just a moral imperative. It’s not just a reflection of American values—although it is both of those. It’s also about national security, making sure we know how to fight epidemics, helping keep other countries strong. It’s really value for our money. It’s a small percentage of the budget that really is making a difference. Q: If $700 million is cut, what is lost? A: We would not be able to do so many of the things that Americans support. We may not be able to do all the work in preventing malaria, for instance, or we may have to cut back on pre-natal care that is so vital for the health of pregnant women. The choices would be very hard. The United States takes its commitments very seriously. The world respects us for meeting our commitments. America’s word is a bond, something to be proud of. We don’t want to lose that pride when it comes to meeting our commitments in global health, especially when they are so meaningful to people around the world.

John Donnelly, a writer working with the GHTC, will be blogging this week from our trip to visit global health research projects in Kenya. This is his first post from the field. Inside a large room at the US Embassy in Nairobi, Robert F. Breiman, MD, the country director for the Centers for Disease Control and Prevention (CDC) in Kenya, explained a portion of the US-funded research in Nairobi’s largest slum, Kibera. He referenced the recent hit movie, Contagion, in which an infectious disease speeds around the world, spread by air travelers and killing people within days of contact. “It’s not that Contagion couldn’t happen like in the movie,” Breiman said. “But what we are doing in Africa is changing the whole game in detecting infectious diseases.” During the beginning of the Global Health Technologies Coalition’s 10-day trip to Kenya to look at US-funded global health research and development (R&D), Breiman took us to Kibera to illustrate the use of technologies to control the spread of infectious disease and also to act as a warning system for the emergence of possible epidemics. As we walked in CDC-issued gumboots over ground inside the slum that was literally human refuse, garbage, plastic bags and mud, Breiman said the US government started efforts to hold clinical trials and track infectious disease in Kibera in 2004. Before, it had only worked in rural areas in Kenya. He said the shift into Kibera came because of the rapid urbanization of the country and the knowledge that a new disease such as SARS “would spread in a far different way in a rural area than it would in a tinderbox like this.” CDC officials held many meetings with residents about the project. “At first, we didn’t have their trust,” Breiman said. “Some people thought we would just be here for a few studies and then go.” Photo: Evelyn Hockstein/PATH He said that the purpose of CDC’s studies in the area was clear: Collecting data to impact policy. He also told them that CDC was committed to starting a program and staying. The program gave study participants the benefit of free health care, which later led to the building a health clinic in the slum. Of the many projects in two of Kibera’s 12 villages, Soweto and Gatwikera, one was a door-to-door HIV testing campaign, using rapid HIV tests; 80 percent—an astounding number—accepted the tests. A second larger project has been an ongoing disease surveillance of 28,500 residents. CDC community health workers visit each resident’s household every two weeks, using hand-held PDAs to record detailed information on family members’ health. They collect data on fevers, diarrhea, tuberculosis, pneumonia, and jaundice. Any sick member of the family is referred to the health clinic. “In the big cholera outbreak in 2010 in Nairobi, we detected it immediately because of our surveillance,” Breiman said. “Our team immediately jumped on it and started a safe water campaign.” The CDC team also has detected a daunting number of typhoid cases, which was virtually wiped out in the United States in the late 19th century. “By the age of 10, one out of every five children has had typhoid in their blood in Kenya,” he said. “It’s extraordinary, almost unimaginable.” Using population modeling, CDC estimated that 30,000 to 40,000 people contract typhoid every year in Kenya’s slums. It presented the data to the government of Kenya. “This kind of early detection of dangerous pathogens is important before they wreck havoc in these communities and around the world,” he said. Residents who have participated in the studies told us that they had their doubts at first, but now trust the CDC research. Photo: Evelyn Hockstein/PATH “For me, I was distrustful at first,” said Margaret Opondo, 42, a widow with three children. “There are people who try to take advantage of those of us in the slums. They do tests or take photos and they benefit. But I do trust them now. I believe their work is very important.” Last week, she said her son had a major nose bleed, and the clinic referred her to a hospital for treatment. He recovered, and Opondo didn’t pay anything. CDC covered the cost. “I was very happy about that,” she said. Another resident, Agribina Asingwa, 47, said when CDC workers came to her door for HIV testing, everyone agreed to be tested – all 11. “If they hadn’t come and done that, it would have taken us a longer period to get tested. CDC made it easy for us. “And,” she said, “I was really excited afterward. None of us tested positive.” Next: A trip to the western Kenya city of Kisumu.

Alex Dehgan, science and technology advisor to the admistrator of USAID, talks global health R&D with GHTC Dr. Alex Dehgan is the science and technology adviser to the administrator of the US Agency for International Development (USAID), where he helps employ science, technology, and creativity to help solve traditional and persistent development challenges. Previously, he worked in the Department of State on science diplomacy issues with the Muslim world, including Iraq, Afghanistan, and Pakistan. He talked with GHTC’s Breakthroughs blog on a number of issues, including a NASA-USAID innovation for remote areas and the promise of several products in the pipeline that could save many lives. Q: During USAID’s 50th year, there’s a lot of talk about helping women in the developing world. How are you doing this with scientific research? A: Microbicide research is a good example. It would empower women to protect themselves against HIV. In areas where there are economic disparities, where the relationship involves older men and younger and poorer women, and men refuse to use condoms, a microbicide might be the only way for a woman to protect herself. Another example is research and development with mobile phones. It helps women capitalize on the benefits of microfinance. It allows children to have access to educational materials. It allows for easy cash dispersal. And in health care situations in remote locations, NASA and USAID have an incubator program called LAUNCH. One of the innovations is essentially a lab-in-a-box, a handheld device that takes a drop of blood and analyzes it for quick diagnosis of a variety of diseases. This could have exceptional uses, including for regular checkups for women who are pregnant. Q: You’ve just had a large gathering in Washington, DC, of researchers at the Saving Lives at Birth event, part of USAID’s Grand Challenges initiative. Why was this important to you? A: We focused on three constraints: How to improve the capacity of caregiver, how to deliver new tools, and how to ensure demand generation by women. What we need to do now is provide women in remote settings with new tools. For instance, we’ve now have these simulation models that allow health care workers to simulate doing a C-section surgery. That kind of innovation is very important. Q: So what innovation jumped out at you at this gathering? A: One that caught my attention was a nominee from Australia on stopping post-partum bleeding, which is a major cause of death after childbirth. Now, there’s a drug that stops the bleeding, but you need cold chain – refrigeration – which can be difficult in remote areas. What the inventor did was turn the drug into an aerosol, which doesn’t need refrigeration. It’s a great example of how we use innovation to create easier ways to get the products people need out in the communities. Q: What about challenges in research? What happens after you get unexpected results from a trial? A: Microbicides is a good example. It’s one of the challenges that exist and it involves a great deal of trial and error research. It requires incremental knowledge, and it requires building upon the failures of other people, so that we can get to a product that works. We all tend to celebrate breakthroughs, but we don’t often look at how many combinations we had to try in order to get to the point itself. You have to try a variety of combinations. We are frequently expecting results very quickly and come up with answers on timelines, but it doesn’t always work out that way. That said, we need to recognize that failure is actually an opportunity to learn and move forward; we need to not be afraid to take risks.

This is an exciting week for the GHTC. Not only are we launching our “Breakthroughs” blog, but we’re also taking off on an amazing trip to Kenya to discover how global health research is changing people’s lives on the ground. We can’t wait to share live updates on our blog from the trip, and give you a sense for the incredible progress taking place in Kenya. We’re very fortunate to be meeting with several GHTC members conducting ground-breaking work in Kenya. In Nairobi, we have plans to meet with local researchers from the Drugs for Neglected Diseases initiative (DNDi), the International AIDS Vaccine Initiative (IAVI), and the International Partnership for Microbicides (IPM). DNDi is leading an incredible effort to create new treatments for visceral leishmaniasis, or VL, a painful and deadly disease that affects half a million people worldwide each year. IPM and IAVI are leading work to develop new HIV prevention methods in the form a vaccine (IAVI), as well as gels, rings and other products women can use to protect themselves against HIV (IPM). Also while we’re in Nairobi, the GHTC is meeting with several dedicated American officials working on global health research in Kenya. These committed US citizens work with agencies such as the State Department, the US Embassy, and the Centers for Disease Control and Prevention (CDC). They’ll share with us why the US Government thinks research for new global health tools is so critical to American interests at home and abroad. After Nairobi, we’ll visit Kisumu in Western Kenya. Kisumu is home to some of the most exciting health research going on in Kenya, including an incredible partnership several US agencies have with the Kenya Medical Research Institute (KEMRI). The CDC has been working with KEMRI for 30 years, and we’ll be visiting some exciting research projects the CDC/KEMRI partnership is working on with GHTC members. For example, there’s some remarkable vaccine research going on in and around Kisumu—GHTC member Aeras is conducting research for a new tuberculosis (TB) vaccine among infants in the region. And we’ll get the chance to hear about a ground-breaking study, called HPTN 052, on using antiretroviral drugs for HIV prevention in couples. The Department of Defense (DoD) also has a long history of medical research in Kisumu that we’ll get the hear more about during our visit. Finally, we’ll be visiting a great program in western Kenya run by our secretariat PATH. The program, called APHIA II, provides comprehensive health care and prevention services for diseases such as HIV and AIDS, TB, and links these services to others that improve maternal and child health. APHIA shows the impact of lifesaving tools - such as drugs, vaccines, bed nets, and other treatments – that only exist as a result of the research investments that helped to develop them. We hope you’re as excited about the GHTC’s trip as we are. We’re thrilled to share these stories with you, and hope you follow us throughout the week.