July 1, 2024 | 9:30 AM
Bradley C Bowe / AP Photo
FILE: A herd of Holstein cows on dairy farm in Pennsylvania.
Aaron Simpson is a fourth generation dairy farmer at Lone Oak Farm in Westmoreland County. Alongside his family, he runs the farm with its 80 cattle and the store where they sell their fresh dairy products.
In recent years, theyve been concerned about the pinch from inflation and wholesale milk prices that havent tracked with rising retail prices. Around them, small family farms continue to close or sell to larger operations. The number of dairy farms in Pennsylvania fell by 8% from 2017 to 2022, according tothe most recent census from the U.S. Department of Agriculture.
Its against this backdrop that the H5N1 bird flu has latched onto the dairy industry in the United States. While the virus affects birds, its known to jump to other mammals. In March, scientists found it in cattle in the U.S. Since then,its spread to 60 herdsand infectedthree dairy workerswho had mild symptoms.
The virus has not been detected in Pennsylvania. Buta new study from the University of Pittsburghshows that the virus remains stable and infectious on the surfaces of commercial dairy equipment and in unpasteurized milk for at least an hour.
Dairy workers are most at risk because theyre right at the forefront of where these cows are, said Valerie Le Sage, research assistant professor of microbiology and molecular genetics at the University of Pittsburgh and lead author of the study.
However, the overall risk for the general public, including dairy workers, remainsvery low, according to the U.S. Centers for Disease Control and Prevention. Dairy farmers, veterinarians, state and federal agencies have been working to get ahead of the virus to stop the spread and put detailed plans in place in case the virus crosses into Pennsylvania.
For now, Simpson isnt concerned about the bird flu. This is not something thats really been on the radar, Simpson said. I know about it. On the periphery, people are concerned with it. But the regulations for dairy production are so stringent, theres really nothing to be concerned about.
Farmers must follow strict sanitation procedures on a daily basis, according to Ernest Hovingh, director of the Animal Diagnostic Laboratory at Penn State University. Thepasteurization process kills most viruses, including the bird flu, in the milk, according to the U.S Food and Drug Administration.
These procedures ramp up when theres a sick cow in the herd. Cows must be milked even when theyre ill but theyre milked last, and the entire line is sanitized and workers dispose of the sick cows milk.
Early warning signs of a sick cow include not eating or producing less milk than usual. If theres bird flu on a farm, it usually spreads quickly, according to Hovingh. Its not usually a case of a single sick cow. If I see all of a sudden that I have eight cows that are dropping the amount of feed that theyre eating and are dropping in milk production, thats a pretty big signal, Hovingh said. Hey, I better call my veterinarian. And then the veterinarian would decide if they need to call the state vets office.
So far, the bird flu in the U.S has been spread from herd to herd. It seems that the biggest risk factor is moving a cow from a herd that is infected to a herd that is not infected, Hovingh said. So one of the really, really big control points that we keep emphasizing to farmers is you really dont want to be moving any cows into your herd from Michigan or from Texas or any areas that are currently affected.
TheUSDA requires testinglactating cows for the virus before they can move across state lines. Any cow that enters Pennsylvania has to produce a negative test.
If a cow on a farm in Pennsylvania tests positive, theres a plan in place. The state would put the herd under a quarantine. The animals cant move to another farm while the cows are sick, milk from healthy cows must be pasteurized and the farm has to have an official biosecurity plan in place so that youre not, having visitors come onto the farms and then go back to their own farm without washing their boots and changing their clothes and things like that, Hovingh said.
In light of the recent research, Le Sage suggests dairy workers use masks, face shields and gloves around milking equipment. And the Pennsylvania Department of Agriculture is offeringfree personal protective equipmentfor farm workers.
If farmers suspect they have a case of the bird flu in their herd, they can get free testing fromthe lab at Penn State. And starting on July 1,the USDA will offer financial assistanceto dairy producers if cattle test positive for the virus to help cover some of the cost of the lost milk.
We need to be careful, Hovingh said. But at this point, the risk to milkers in Pennsylvania dairy herds appears to be extremely low because the virus does not appear to be here at all.
Colorados outbreak of bird flu among dairy cattle is now the worst in the country, with more cases in the past month than any other state, according to the latest state and federal data.
As of Monday evening, Colorado had identified 26 herds with cases of avian influenza. Of those, 22 were identified within the past month and the herds are still in quarantine. Four other cases were identified earlier and quarantines have since been lifted.
All affected herds are in the northeastern part of the state.
The rapid and still largely mysterious spread in Colorado hardly a leading dairy state contributes to growing concerns that U.S. health authorities are not doing enough to contain the virus. While the threat currently to humans is generally very low, infectious disease experts worry that the longer the virus spreads unchecked through animals, the greater the chances become that it will mutate to become more dangerous to people.
Dr. Maggie Baldwin, the state veterinarian, said Colorado agriculture and health officials are working closely with dairies to identify cases of the virus and to try to prevent its spread.
This is just a virus that likes to hang around, she said. Its really hard to mitigate once its in a sustained population. I think if we all implement really strong biosecurity we absolutely can prevent the spread, but its in a really close geographic region.
Colorados recent cases far exceed those in any other state Iowa and Idaho are the only other states to record double-digit case totals in the past month, with 12 and 10, respectively.
Colorados case total since bird flu was first identified in dairy cattle this spring places the state second nationally, behind only Idaho and one ahead of Michigan. But Colorado ranks far lower in dairy production than those states the state was 13th in the country for milk production in 2023, according to federal data.
There are slightly more than 100 dairy herds in Colorado, meaning the bird flu outbreak has now hit one-quarter of all herds in the state. On a per-cow basis, Colorados outbreak is roughly three times worse than Idahos, which has approximately 667,000 dairy cattle compared with 201,000 in Colorado.
Baldwin suggested that Colorados efforts at disease detection may be reflected in the states high numbers. She said the state has put in a lot of work getting information to dairy producers, as well as industry associations and veterinarians.
Were trying to really encourage early diagnostics, early reporting and really good symptom monitoring, she said, and I think the relationships that weve established in the state have allowed for producers to feel like they can come to us when they have a problem.
Baldwin said most cattle that are infected with bird flu are recovering from the disease though she doesnt have exact numbers, she has not heard reports of unusual mortality rates. But farmers are suffering from lost production during infection periods, and she said some cattle may not return to full milk production.
The more that were seeing our producers be affected by this, I think the more seriously theyre taking it and saying, We really want to do what we can to stop this and to be good neighbors, Baldwin said.
Bird flu, as the name suggests, is not something that usually infects cattle, and the initial spillover infections were believed to have been caused by wild birds hanging around dairy farms in the Texas panhandle.
Its subsequent spread to dozens of herds in at least 12 states was initially blamed on the movement of cows from farm to farm. Federal agriculture officials clamped down on this movement by requiring animals moving across state lines to be tested.
But, as the outbreak has persisted, a more complicated picture of spread has emerged.
Baldwin said some of the affected cattle in Colorado are in what are known as closed herds meaning there is no movement of cattle in and out, making it impossible for the virus to have spread to that herd through the introduction of an infected cow. U.S. agriculture officials found something similar with several herds in Michigan.
Focus has now turned to the potential for what is called fomite transmission, in which the virus hitches a ride on an inanimate object. In this case, workers or veterinarians moving between herds could inadvertently be carrying the virus on their clothing or on equipment as they travel from farm to farm.
Baldwin said the state is working with dairy operators on detailed biosecurity plans for their dairies. This includes lots of personal protective equipment not just masks, goggles and face shields for workers, but also booties and coveralls that can be thrown away before leaving a farm. It also includes plans for cleaning vehicle tires or other pieces of equipment leaving the dairy.
No human cases of bird flu arising from exposure to infected cattle have been identified in Colorado. But state and local health officials have monitored hundreds of dairy workers after possible exposure to the virus.
Following federal guidance, the state is only testing people who have flu-like symptoms. Scott Bookman, the Colorado Department of Public Health and Environments senior director for public health readiness and response, said the state has tested fewer than a dozen people. All those tests have come back negative.
Given that only three people nationally have tested positive for a case of bird flu believed to have come from exposure to infected dairy cattle one in Texas and two in Michigan, all of whom had minor symptoms Bookman defended the states testing approach.
There just isnt any reason on any evidence at this point to be doing any broader type of asymptomatic testing, he said.
Elizabeth Carlton, an epidemiologist at the Colorado School of Public Health, agreed that the risk to the general public right now is low. Systems designed to detect upticks in flu infections through hospital data and wastewater testing have not sounded any alarms. Pasteurized milk what is sold in grocery stores is safe to drink, though raw milk may not be.
Where we need to ramp up the level of concern in the population is when we see those dairy farm workers get infected and spread it to their families, she said.
Still, she said, now is the time for public health agencies to make sure their testing and disease-monitoring systems are running smoothly, so that they can detect if the current bird flu outbreaks in livestock evolve into a threat to humans.
As a general person right now, I dont think the level of concern should be that high, she said. But for public health, for people working in the field of infectious disease, this is exactly what we need to be working on right now.
Based on facts, either observed and verified directly by the reporter, or reported and verified from knowledgeable sources.
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According to the CDC, H5N1 bird flu has caused recent outbreaks in poultry and dairy cows, with a total of four human cases reported among U.S. dairy and poultry workers. In at least two cases, the only reported symptom was red eyes.
As of July 1, poultry and dairy cow outbreaks have been reported in 48 and 12 states, respectively, with 136 dairy herds affected. While the current public health risk is low, the ongoing multistate outbreak in dairy cattle raises concern.
Healio spoke with Scott A. Edmonds, OD, FAAO, who specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia, about the current situation and how optometrists can provide assistance in disease detection and reporting.
Healio: What should ODs know about bird flu?
Edmonds: Its an infection that normally just affects wild birds, and its been in the U.S. since the turn of the 21st century. In recent years, it has crossed over to first affect poultry and now cattle. In March 2024, the first human case of crossover infection was reported in the U.S., and this was from an infected dairy cow in Texas.
In the more recent cases in Michigan, the presenting symptom was conjunctivitis. In one case, they swabbed the nose and the eye tissue; the nose came back negative, and only the eye tissue demonstrated that the patient had bird flu. This was also unusual.
In the past month, the FDA approved testing at local public health labs. Prior to that, swabs had to be sent to the CDC in Atlanta, but now eye doctors can get results locally. Optometrists are critical for early detection and diagnosis, because, as seen in the case in Michigan, only the eye swab was identified as positive for bird flu. Optometrists are on the frontlines to identify patients at risk, intervene and get patients treated. Fast action on the front end may help prevent a pandemic.
Although bird flu in humans is pretty rare worldwide to date there have been only 900 cases but of those, more than 50% were fatal, so it is a dangerous virus if it becomes established.
Healio: What should patients know?
Edmonds: Patients in any state in the U.S. should avoid contact with sick or dead wild birds, and either ignore them or, if multiple birds are affected, contact authorities to see whether the birds should be tested.
Patients who work in the dairy or poultry industry particularly in states where human crossover of bird flu has been reported should be aware that if they develop red eyes, they should come in immediately and be tested. They should also consider wearing protective eye wear when handling the animals or when exposed to feces or other contaminated material.
Patients also should avoid drinking raw milk, as the virus has reportedly been detected in milk that has not been pasteurized or homogenized.
Healio: Who else may be at higher risk?
Edmonds: I think hikers or campers who may come into contact with dead birds are at risk, as are people who live on farmland or who are accustomed to drinking raw milk.
Healio: Anything else our readers should know?
Edmonds: All optometrists should be prepared to take conjunctival swabs and send them to a public health lab to test for H5N1. This is especially critical for ODs in Michigan and Texas, where we know of human cases, but also in states where H5N1 was reported in dairy cows Idaho, South Dakota, Colorado, New Mexico, Texas, Kansas, Michigan, Ohio, Minnesota, Wyoming, Iowa and North Carolina. If youre an OD who practices in one of those states, you should be ready to do swabs and know where to send them for testing.
Its a good idea for all ODs to be ready, though, because I cant imagine this will be limited to just those states.
Scott A. Edmonds, OD, FAAO, specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia. He can be reached at scott@edmondsgroup.com; linkedin.com/in/scott-edmonds-3427a2a; or @scottedmondsOD.
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The U.S. government will pay the vaccine maker Moderna $176 million to accelerate development of a pandemic influenza vaccine that could be used to treat bird flu in people, as concern grows about cases in dairy cows across the country, federal officials announced Tuesday.
Moderna already has a bird flu vaccine in very early-stage testing that uses the same mRNA technology that allowed rapid development and rollout of vaccines to protect against COVID-19. The new funds from the U.S. Department of Health and Human Services include continued development of the vaccine, including a late-stage trial next year if those early study results are positive.
But the project can be quicky redirected to target another form of influenza if a different threat than the H5N1 form of bird flu emerges, HHS officials stressed.
The award was made through the Biomedical Advanced Research and Development Authority, or BARDA, a program that focuses on medical treatments for potential pandemics.
The H5N1 virus was detected earlier this year in dairy cows and has spread to more than 135 herds in 12 states and infected three people to date, all with mild cases. Federal health officials stress that the risk to the wider population remains low.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institutes Science and Educational Media Group. The AP is solely responsible for all content.
By Stephanie Nolen
Stephanie Nolen interviewed more than 30 scientists, health officials and other key players in the development of the malaria vaccines to report this article.
Nurses in countries from Sierra Leone to Cameroon are packing a new vaccine into the coolers they tote to villages for immunization clinics: a shot to protect against malaria, one of the deadliest diseases for children.
Babies and toddlers in eight countries in the region recently started to get the vaccine as part of their routine childhood shots. Seven other African countries are eagerly awaiting its arrival.
This is a milestone in global health.
But its also a cautionary tale about a system that is ill equipped to deliver critical tools to the people who need them most.
It took decades and at least a billion dollars to reach this point. Even now, only a fraction of the children whose lives are at risk will get the vaccine this year, or next year, or the year after.
Its been clear for some time what went wrong, but almost none of those issues have been fixed. That means that the next desperately needed vaccine stands every chance of running into those same problems.
Take, for example, a new vaccine for tuberculosis that started clinical trials a few months ago. If it works as well as hoped, it could save at least a million lives a year. Well know by 2028 if it stops tuberculosis infections. But if it follows the same trajectory, it will be at least 2038 before its shipped to clinics.
Dr. Joe Cohen, co-inventor of the first malaria vaccine
The U.S. Army started work on a malaria vaccine back in the 1980s, hoping to protect soldiers deployed to the tropics. It teamed up with the drug company GlaxoSmithKline, and together they produced promising prototypes. But the military lost interest after a few years, and that left GSK with a problem.
The people who desperately needed a malaria vaccine were in villages in sub-Saharan Africa. They would not be able to pay for a product that would cost millions of dollars to develop.
GSK needed an altruistically minded partner. It found one in the nonprofit global health agency PATH, and by the late 1990s they had a vaccine to test. The Bill & Melinda Gates Foundation put up more than $200 million to test it.
The clinical trials were complex, because this was a whole new type of vaccine the first ever against a parasite delivered to children in places with limited health systems. The process took more than a decade.
Finally, in 2014, results showed this vaccine cut severe malaria cases by about a third.
This was a successful result, but not as much protection as scientists had hoped to see. Still, GSK and PATH planned a production facility to make millions of doses. Gavi, the organization that procures vaccines for low- and middle-income countries, with funds from donors, would buy them.
Then the Gates Foundation pulled its support.
There was a shake-up in the malaria division, and the leadership reoriented toward a new goal: eliminating the disease.
The new malaria team said the vaccine didnt work well enough to justify pouring millions more dollars into it. It would be better, they said, to wait for a more effective shot in the future, and in the meantime to fund other strategies, such as genetically modifying mosquitoes.
Dr. Robert Newman, former director, Global Malaria Program, W.H.O.
The decision was driven by researchers who were looking at data. They didnt factor in that the idea of a vaccine, even one with limited efficacy, would be so important to African parents and African governments, which would come to see this as a classic example of a paternalistic donor ignoring their priorities. More than 300,000 children died of malaria that year.
The foundations announcement shoved the vaccine into limbo in ways the foundation today says it did not anticipate.
Dr. Chris Elias, president of global development at the Bill & Melinda Gates Foundation
Why Is Vaccine Maker Emergent BioSolutions Stock Trading Higher On Tuesday? (UPDATED)
Editors Note: The story has been updated to replace the erroneous content published earlier.
Tuesday,Emergent BioSolutions Inc.(NYSE:EBS) received more than $250 million in contract modifications from the Administration for Strategic Preparedness and Response (ASPR) at the United States Department of Health and Human Services to deliver millions of doses offour medical countermeasures. These contract modifications will help ensure continued supply/stockpiling of critical medical countermeasures to address biological threats and emergencies against anthrax, smallpox, and botulism. The four awards include:
A contract modification valued at $30.0 million to supply Cyfendus (Anthrax Vaccine Adsorbed, Adjuvanted) this year.
Previously known as AV7909, Cyfendus is a two-dose anthrax vaccine for post-exposure prophylaxis use in individuals 18 and older. This new procurement funding is from Emergents existing 10-year contract with the Biomedical Advanced Research and Development Authority.
A contract modification valued at $99.9 million to supply ACAM2000 (Smallpox (Vaccinia) Vaccine, Live) this year. This is under Emergents existing 10-year contract with ASPR.
Two new contract options totaling $122.9 million have been awarded to supply the Strategic National Stockpile with VIGIV [Vaccinia Immune Globulin Intravenous (Human)] drug product and BAT [Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G) (Equine)] drug substance and delivery of drug production this year and into early 2025.
VIGIV is used for complications to smallpox vaccination, while BAT is indicated for symptomatic botulism following documented or suspected exposure to botulinum neurotoxin serotypes A, B, C, D, E, F, or G in adults and pediatric patients.
Both are under Emergents existing 10-year contracts with ASPR.
Read Next:
Price Action:EBS shares are up 13.6% at $8.02 at last check Tuesday.
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Advisers to the Centers for Disease Control and Prevention unanimously voted last week to replicate last years coronavirus vaccine guidance for the coming fall. That means everyone 6 months and older is recommended to receive a newly formulated coronavirus shot later this year.
I understand the rationale behind this decision. Guidance that applies to nearly everyone is simpler to understand and to implement. It also aligns the cadence of the vaccine with that of the seasonal flu. Americans are used to receiving a flu shot every fall; now, they can expect two seasonal shots a year.
But a population-wide recommendation is not nuanced, and there are downsides to choosing simplicity over specificity. There are two particular issues I want to highlight in this weeks newsletter, using new data presented at the CDCs meeting last week.
First, the elderly continue to bear the brunt of severe illness due to covid-19. Of the approximately 50,000 covid-associated deaths in 2023, more than 44,000 or about 88 percent occurred in people 65 and older.
Yet, the vaccination rate among older individuals remains disturbingly low. Even among the highest-risk group, individuals 75 and older, just 36 percent received the booster shot in the fall and winter.
I wrote a series of columns last year about the dismal rates of coronavirus vaccination in nursing homes. My primary concern with a universal recommendation is that it does not focus on people who need the vaccine the most. Put simply, vaccinating a healthy adolescent is not as urgent as vaccinating an elderly nursing home resident.
Older individuals, particularly those residing in congregate living facilities, must hear this message over and over: It is essential for them to receive the updated booster this fall.
Second, the messaging around vaccines needs to account for both their benefits and limitations. I continue to receive countless messages from readers asking why they cant get frequent vaccines to prevent infection. People going on cruises or family vacations want to be sure they wont get covid, so why shouldnt they get top-ups whenever they want?
I have long advised against this, and will continue to do so. Thats because its still possible to be infected despite being recently vaccinated.
As I wrote about before, the coronavirus vaccines effectiveness has changed over time. Earlier in the pandemic, it greatly reduced the chance of infection. But as the virus evolved, and as people gained immunity through infection, the added benefit of the vaccine at thwarting infection decreased.
The CDCs most recent analyses show that in people 50 and older, the vaccine only reduced symptomatic infections by 44 percent. This was specifically for the seven days to two months after a shot was administered, which is when it is most effective. By four to six months after vaccination, it fell to 30 percent.
These numbers are not meant to dissuade people from getting the booster. The primary reason for the shot is to reduce severe illness, which again matters most for older adults.
Moreover, a 44 percent reduction in symptomatic illness is still significant. Even if someone doesnt become severely ill with covid, its not pleasant to have flu-like symptoms, and there is always the chance of developing long covid after infection. Reducing that possibility, even for a short period, is a worthy goal. This is why Ill be getting my coronavirus shot this fall.
Its also reasonable for people to try to time their booster so that they have maximal protection for when they are most likely to be exposed to the virus. Getting the timing right isnt easy, though. There are multiple factors involved and not a small amount of guesswork as to when covid will spike.
In past years, covid levels rose as the weather got cooler. Infection risks were high around the winter holidays, as people gathered indoors during times of higher virus activity.
Some people might choose to wait until a bit closer to the holidays before getting their fall boosters. This is especially advisable if they recently received a spring vaccine or have just recovered from covid infection. Others who have a higher-risk event coming up might choose to get their booster sooner, knowing that effectiveness will wane a bit before the holidays.
None of these choices are wrong, but they are nuanced and wont be answered by broad federal guidance. Nor should they. We have long been in the stage of covid-19 when decisions should be personalized for individual circumstances. Blanket recommendations from the CDC need to be tailored with an emphasis on ensuring that the most vulnerable have access to the tools they need to best protect themselves.
The U.S. government is giving drugmaker Moderna $176 million to develop an mRNA vaccine against the bird flu amid the ongoing outbreak in dairy cows across the country.
The vaccine is in the early stages of development and would not be available until at least next year, Dawn OConnell,assistant secretary for preparedness and response at the Department of Health and Human Services, said during a call with reporters Tuesday.
The timeline may change, but we anticipate starting phase three trials in 2025, OConnell said. While the vaccine would target H5N1, the mRNA technology would allow manufacturers to pivot quickly if another new flu strain emerges.
Since the outbreak was first detected in March, three people all dairy workers have tested positive for the virus. All had relatively mild cases and have since recovered.
There is no evidence yet that this strain of the bird flu spreads easily from person to person. But the concern is that the longer the virus circulates among mammals, it could mutate into a form that does.
The risk in the general population right now remains low, and CDCs assessment of that has not changed, Dr. Nirav Shah, the principal deputy director at the Center for Disease Control and Prevention, said on the call.
So far, 137 herds have been affected in a dozen states: Colorado, Idaho, Iowa, Kansas, Michigan, Minnesota, New Mexico, North Carolina, Ohio, South Dakota, Texas and Wyoming.
Herds in Colorado, Idaho, Michigan and Texas have been hit hardest, with more than 20 cases each.
Modernas vaccine would be separate from the 4.8 million doses of bird flu vaccines already stockpiled by the government. OConnell said she expects those shots, which use traditional vaccine technology, to be available starting in the middle of July. The Food and Drug Administration would have to authorize either of the vaccines before theyre used in the general public.
Shah noted that its too soon to recommend the shots for any group, even dairy workers.
Since the outbreak began in March, more than 780 people exposed to sick cows have been monitored, and 53 were tested for H5N1.
Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, said the efforts to shore up multiple types of bird flu vaccine are important, but added that the governments response so far hasnt been fast enough or aggressive enough.
Although the virus does not currently pose a direct pandemic threat to humans, its concerning, Rivers said. We have not seen influenza in agricultural animals like this before, and so I think that alone should really push us to be more forward-leaning.
Rivers called for health officials to be transparent, for example, about when they would move forward with rolling out bird flu vaccines to the general public.
Also on Tuesday, health officials reiterated that the commercial milk supply is safe. Last week, the FDA and Department of Agriculture released a study showing that the most common milk pasteurization method heating it to 161F for 15 seconds neutralized H5N1 virus particles that had been added to milk samples.
In each of the nine repeated experiments, the virus was completely inactivated, said Don Prater, acting director of the Center for Food Safety and Applied Nutritionat the FDA.
Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."
The fact that the Democratic Republic of the Congo (DRC) last carried out a census about 30 years ago hasnt exactly made the countrys efforts to reach every child with essential vaccines easy, points out Dr Pierre Akilimali, a researcher at the Kinshasa School of Public Health. The definitive denominator the number of children the programme ought to be immunising has been lacking for a couple of generations now.
Fortunately, in the meantime, technology has become capable of leapfrogging logistical hurdles. Dr Akilimali works as a research coordinator on a Ministry of Health-led project called Mapping for Health (M4H), which uses granular geospatial data from high resolution satellite images, along with data collected on the ground with a smartphone app, to help health workers create detailed, thorough vaccination plans.
Broadly, the intention is to zero in on zero-dose children; specifically, the project supports a Ministry of Health aim to boost vaccine coverage by 15% per targeted province initially by 2020, then by end of 2024, translating to 220,000 additional children protected.
In 2020 and 2021, Mapping for Health, with Gavi funding, targeted five priority provinces: Kinshasa, Kasa, Kasa-Oriental, Haut Katanga and Lomami. In those provinces, during that time-frame, the health system recorded a significant increase in vaccine coverage.
Weve refined our approach to locating and reaching zero-dose children in our community, said Yves Mukendi, a community health worker (CHW) in Haut-Lomami, one of nine provinces in DRC where M4H has now been put into play. Prior to the Mapping for Health project, immunisation campaigns were scheduled using antiquated and insufficient data. Since it was difficult to pinpoint every childs specific location, some children particularly those who lived in isolated areas were frequently overlooked.
This indicates that more kids are going to receive vaccinations, and the general health of our community will significantly improve, Mukendi added.
The mapping process layers existing info such as satellite images with the knowledge that local health teams carry in their files, their phones and their heads.
In whats typically a ten-day process, according to a November 2023 research report published by Kinshasa School of Public Health and HealthEnabled, and funded by Gavi, two mappers work with health zone representatives to figure out the basic contours of the area: settlements, boundaries, and health facilities. The mappers train health workers to take their smartphones back to the communities they serve, and fill in the blanks with GPS coordinates.
Next, a mini-census survey is conducted in random sample areas of the province, and then integrated with the mapping data to build a spatial model that can produce good population estimates. Specifically, Dr Akilimali said, the population estimates cover areas of 100x100 metres, offering demographic estimates for age and gender.
M4H is not just a tool; it's a paradigm shift in how we approach health care planning, Dr Akilimali emphasised. There are cases, he said, in which M4H has helped to detect and record entire villages that were missing from the standard, outdated maps.
By harnessing the power of geo-spatial data, we can create targeted interventions that reach the most vulnerable populations, ensuring that no child is left behind, he said.
Getting granular about demographics also opened the door to targeted, progressive interventions. In some provinces, a gender-conscious approach was built into the planning process.
M4H prioritises gender equity in health care delivery, explained Emmanuel Rukengwa, a national coordinator with the larger GRID3 mapping project that encompasses Mapping for Health, explaining that the aim is to balance out social biases that may prevent girls from receiving immunisations at an equivalent rate to their male counterparts.
A set of gender toolkits for EPI workers and their partners were released as part of the project to help reduce barriers to vaccination linked to gender and social exclusion factors in the DRC. For example, said Rukengwa, male involvement is essential to improving maternal and child health outcomes. The toolkits provide methods for conducting gender-based analyses and for integrating gender dimension into vaccination intervention planning.
Mamie Kabeya, a district-level health worker in Kasa, said, Being made more aware, we made extra efforts to deal with problems blocking girls access to vaccination. This implies that, regardless of a childs gender, we collaborate with communities to make sure that boys and girls are brought to immunisation clinics and that everyone is aware of the significance of vaccinating every kid.
Just three years in, users and researchers alike point to tangible impact. M4H has changed our immunisation approach in Haut-Lomami, said Mukendi. We have been able to discover 20% of new villages that were not in old maps.
Mukendi is far from alone in his enthusiasm: 86% of Haut Lomami workers who spoke to the KSPH and HealthEnabled surveyors said the geo-referenced tool was easy or very easy to use. A similar number described themselves as satisfied or very satisfied with its use.
It allows us to identify each population, each village and the distance, and the target population of each village, and even the vaccine to use, said one anonymous respondent from Haut Lomami. If I go somewhere in a small village that is, I dont know, 65 kilometres away with its target, I can already plan the vaccine I need to take, the tools I need to use, the means I need to use and how long I need to take. Its our map, it allows us to do a lot of things, and it makes it easier for us to do a lot of things.
The impact of the change on immunisation rates was traced in the KSPH research report. Comparing immunisation patterns in 2020, 2021 and 2022 in Haut Lomami with control provinces revealed that the GRID3 intervention and use of geospatial data for immunization may have contributed to a sustained increase in immunization coverage, increase in identification and immunization of zero-dose children, and minimal dropout.
The researchers elaborate: Data on initial vaccination coverage from the 2020 ECV [Vaccine Coverage Survey], and from ECVs carried out in 2021 and 2022, for BCG and OPV [oral polio vaccine] 0 antigens in the three provinces of Kasa, Kasa-Central and Haut-Lomami, show identical trends for all antigens, with clear progress on one side and stagnation on the other.
Clear progress arguably sells it short. Haut Lomamis coverage rates with the first dose of pentavalent vaccine, for example, rose from 9.9% in 2020, to a staggering 93.6% by 2022.
Kasa-Central, a control province for the study, made strides too but these were decidedly more modest. With a coverage rate of 26.3% for the first dose of pentavalent vaccine in 2022, 59.3% of Kasai Centrals eligible children had received that jab by 2022. Meanwhile, Kasas coverage of the same vaccine rose just slightly, from 51% in 2020, to 58.3% in 2022.
Several health structures have not yet begun to use geo-referenced data in routine immunisation and microplanning, noted sources, since in several provinces where the intervention has been implemented, validation and correction of maps or data is still ongoing. Another round of data collection is ongoing since October 2023 with different partners and in more provinces.
As we look to the future, initiatives like M4H serve as a testament to the transformative potential of technology in health care delivery, and the vital role it plays in safeguarding the health and well-being of our communities, said Emmanuel Rukengwa.
As DRC continues to catch up its post-pandemic immunity losses as of 2022, the countrys coverage with the third dose of the basic diphtheria, tetanus and pertussis-containing vaccine (DTP3) had slipped to 65% from 73% in 2019 thats encouraging indeed.
