Big Problems? Think Big Solutions

Children playing, running and laughing. This should not be too much to ask. But it may be a tall order if these children are harboring hundreds and sometimes thousands of intestinal worms.

I remember first encountering this issue during time spent in my ancestral village of Fanling in the then undeveloped New Territories of Hong Kong. Visiting from the city, my parents were always warning to be careful about what I touched and watched over me like a hawk to ensure I wash my hands thoroughly with soap and water before meals with my grandparents. I also remember that we carried our own bar of soap in a soap box. It was only years later that I learned that my parents were concerned about my contracting intestinal worms.

Fast forward to 2008, on a trip to the outskirts of Phnom Penh, bumping along on rutted and unpaved roads reminded me of those childhood trips to Fanling. This time, we were driving out to Poek Ho, a school in in Kandal Province. We were on the way to a "deworming day" with about 10,000 doses of deworming medications in the back of the van. Driving up the long dirt driveway to the school, there was a sea of children milling about the schoolyard awaiting our arrival. They knew why we were there and could not be more excited to see us.

As I got out of the van, I will never forget the face that caught my attention. She was a lovely little girl of about six or seven. I found out later that her name was Mealea. She was a beautiful girl in spite of the slightly sunken cheeks and ashen complexion. The dullness in her eyes and lethargy in her face is characteristic of the many children I have seen suffering from a parasitic worm infection. You see, worms sap the energy needed to do the things that children are supposed to do, like learn and play.

There are 600 million children like Mealea at risk of infection with soil transmitted helminthes (STH) or intestinal worms. STH is one of the Neglected Tropical Diseases (NTDs) that persist throughout the developing world because so many people lack access to safe water, proper sanitation, and adequate health care. Parasites live in the soil, and because so many children in the developing world have no soap or water to wash hands or shoes to wear as they play or do chores, parasites enter their bodies and literally steal their energy. Infection with STH is not only painful, it causes anemia, increases susceptibility to other serious infections and stunts their growth. The long-term impact on a person's ability to earn a living is subsequently compromised because children who are unable to go to school are not able to learn.

Big problems need big solutions, so earlier this year, a group of 13 pharmaceutical and health care companies, the United Kingdom government and the Bill & Melinda Gates Foundation gathered in London to sign the London Declaration on NTDs-an unprecedented agreement to commit resources to tackle ten of the world's most common tropical diseases and where possible, eliminate them completely. STH was one of those diseases.

What is so remarkable is that the diseases this group agreed to address have been "neglected" because although they infect up to almost 2 billion people worldwide and lead to other complications, they don't usually kill. Because of this, they have often been a low priority on the global health agenda and receive limited resources for research and development. However, recent donation commitments from pharmaceutical companies and key global health stakeholders have brought international recognition of the impact of these diseases, and changed the prospects for controlling these diseases.

Big problems need big solutions, on the heels of the annual meetings on tropical medicines in Atlanta, more than 500 global health stakeholders from 65 countries gathered at the World Bank in Washington, D.C., to put the commitments of the London Declaration into action. Dr. Jim Yong Kim, President of the World Bank opened the meeting along with other global health leaders and aptly directed the group to "...reach the point where we no longer look at these diseases as neglected".

In addition, private sector colleagues--GlaxoSmithKline, Johnson & Johnson, and Merck Serono--gathered a subset of partners committed to control of STH and schistosomiasis to discuss and map the logical approaches to school-based deworming to ensure that all donations are utilized effectively and efficiently to maximize the impact.

School-based deworming is the prime focus because it is one of the most efficient ways of making sure children get the protection they need. Working with non-governmental organizations and government ministers of health and education, Johnson & Johnson partner Children Without Worms (CWW) has been able to deliver more than 100 million doses of the deworming medicine, Vermox, in 2012. Along with delivering deworming medicines, CWW also works with government ministries to ensure that children learn good hygiene practices to make sure the infection doesn't come back. Simple behaviors like washing hands frequently, using proper sanitation and wearing shoes all make a tremendous difference. With more partners at the table, more schools and more children can be reached.

I would never have guessed that the three words, "wash your hands", that were indelibly etched into my brain in those weekend trips into the countryside in Hong Kong would be part of a global health discussion at the World Bank. These developments are great news for children like Mealea and all her friends at Poek Ho who receive hygiene education as part of their national school health curriculum. That means not only are these children getting treating periodically with Vermox from Johnson & Johnson, the parallel efforts in hygiene education and water and sanitation will improve their chances of being parasite free through these formative years--and with a little teamwork--healthy and productive for a lifetime.