Press Release: New Vaccine is Effective against Ebola in Large Trial in Guinea

Press Release:
Results on a new vaccine to protect against Ebola indicate a high level of efficacy in a trial of more than 4,000 persons in close contact with the deadly virus in Guinea, one of the three West African countries stricken by Ebola.

The Lancet, the prestigious British medical journal, published the results of the trials on-line on July 31. The trial results indicate that the new vaccine called VSV-ZEBOV is 100 percent efficacious in about 10 days after being administered to a person without the infection.

“Having seen the devastating effects of Ebola on communities and even whole countries with my own eyes, I am very encouraged by today's news,” says Børge Brende, Minister of Foreign Affairs in Norway.

“This new vaccine, if the results hold up, may be the silver bullet against Ebola, helping to bring the current outbreak to zero and to control future outbreaks of this kind. I would like to thank all partners who have contributed to achieve this sensational result, due to an extra-ordinary and rapid collaborative effort.”

Because of the urgency of the Ebola crisis, clinical development of this vaccine proceeded from initial testing in humans to demonstration of vaccine efficacy and safety in a large Phase III study in Guinea in less than 12 months, a record time.

“Normally, it takes about a decade or more for a vaccine to come to this point,” says Professor Peter Smith, D.Sc., an epidemiologist and specialist in vaccine trials, from the London School of Hygiene & Tropical Medicine and a key advisor.

Because of the Ebola crisis, a massive team was assembled which included scientists, physicians, epidemiologists and experts from the World Health Organization (WHO), Norway, Canada, Guinea, Doctors without Borders, Universities of Florida, Maryland and Bern and the London School of Hygiene & Tropical Medicine.

“We knew it was a race against time and that the trial had to be implemented under the most challenging circumstances,” says John-Arne Røttingen, M.D., PhD., head of infectious disease control at the Norwegian Institute of Public Health and chair of the trial’s steering group.

Funding came from the Wellcome Trust, Norway, Canada, WHO, Doctors without Borders. MSD (known as Merck in the US and Canada), one of the world’s leading vaccines and pharmaceutical companies, based in Kenilworth, NJ., provided the vaccine. Scientists from the company, along with those from NewLink Genetics Corporation, an early developer of the vaccine, also gave detailed technical support to field trial staff on the vaccine and its administration.

“Health workers have been fighting an unfair battle against the Ebola and for the first time there is a prospect of a tool that could protect lives and break chains of transmission,” says Bertrand Draguez, M.D, medical director of Doctors without Borders, the first international organization to treat and follow up Ebola patients in Guinea.

“New technologies are critically needed to diagnose, treat and prevent Ebola and other emerging diseases”.

"We view this promising vaccine candidate as a global resource in the fight against Ebola,” says Gregory Taylor, M.D., Canada’s Chief Public Health Officer. “It is very encouraging to see the vaccine, which is the product of many years of research and innovation at the Public Health Agency of Canada’s National Microbiology Laboratory, receive positive results in this clinical trial. Having a regulated, safe and effective vaccine that has undergone clinical trials will be an important tool in further containing the current outbreak and providing protection against possible future outbreaks.”

The vaccine

The Public Health Agency of Canada and NewLink Genetics Corporation did the initial research on the vaccine. MSD licensed the vaccine in November 2014 and assumed responsibility for efforts to research, develop, manufacture and distribute the vaccine, which was tested in the trial.

The vaccine combines a gene encoding a key protein of the Zaire strain of the Ebola virus, which ravaged West Africa, and another unrelated virus –VSV. Combination of these components results in a weakened vaccine virus that cannot cause disease, but that does stimulate the body to generate an immune response. In this way, the vaccine triggers the production of antibodies to fight off the disease and is made safe.

“The VSV-ZEBOV vaccine works in a similar way to live-attenuated vaccines against other viral infections,” says Mark Feinberg, M.D, Ph.D., of MSD Vaccines. “The ability of this vaccine to elicit prompt immune responses against the Ebola virus following administration of a single dose represents an important attribute.”

After VSV-ZEBOV is further studied and licensed by regulatory authorities, MSD plans to produce enough doses to control future outbreaks. “It will be stockpiled for other Ebola emergencies,” says Dr. Feinberg. At this point, the vaccine will not be used like common vaccines such as those for polio and measles, which are routinely administered.

“Ebola is not a common infectious disease, and outbreaks arise in sporadic and unpredictable ways,” says Dr. Feinberg. “So the vaccine will likely be used in at-risk communities where and when it is required. However, it will also hopefully provide an important additional approach to help protect health workers who care for Ebola-infected patients.”

“We are doing additional research on the vaccine to provide a comprehensive set of data to inform licensure decisions by regulatory agencies and to facilitate the development and implementation of policy decisions by key international and national authorities,” says Dr. Feinberg.

A drawback to the current formulation of the vaccine is that it must be kept very cold in a tropical country with sparse electricity. Future work will be needed to develop a more thermostable formulation.

The outbreak in Liberia, Serra Leone and Guinea was caused by the Ebola strain called Zaire. Other Ebola virus strains that have been seen in previous outbreaks, such as Sudan, may require the development of new related vaccines. But the development of such new vaccines has been hugely helped by this study.

The trial
“This trial dared to use a highly innovative and pragmatic design, which allowed the team in Guinea to assess this vaccine in the middle of an epidemic,” says Professor Jeremy Farrar, M.D., Ph.D., director of the Wellcome Trust and one of the world's leading experts on infectious disease. “It is a remarkable result which shows the power of equitable international partnerships and flexibility.”

“Our hope is that this vaccine will now help bring this epidemic to an end and be available for the inevitable future Ebola epidemics. This partnership also shows that such critical work is possible in the midst of a terrible epidemic. It should change how the world responds to such emerging infectious disease threats.”

The vaccine had been tested on animals successfully, but not initially on humans. Thus, it was unknown if the vaccine would be well tolerated and stimulate a positive immune response in humans and thereby protect individuals from infection.

“In early human trials, the vaccine had only transitory side effects –such as fever and joint pain— in a few of the individuals who received the vaccine,” says Professor Smith. “These side effects were generally mild and of a limited duration and are consistent with those seen with a number of other live viral vaccines.”

In a recent review of the available safety data, the WHO’s Global Advisory Committee on Vaccine Safety concluded that the VSV-ZEBOV vaccine has an acceptable safety profile. In addition to the study in Guinea, the vaccine is being studied in large clinical trials conducted by the U.S. National Institutes of Health and their partners in Liberia, and by the U.S. Center of Disease Control and Prevention and their partners in Sierra Leone. 

In September 2014, world-leading experts assembled at the WHO in Geneva, Switzerland. At that meeting, it was decided to prioritize clinical testing of two vaccine candidates. In early October, Norway decided to support vaccine trials in Guinea. On the margins of a high-level vaccine meeting at WHO on October 23rd, a working group for vaccine trials in Guinea was established and a November 5th meeting of this group decided to move forward with the trial based on financial commitments from Norway.

The design of the trial was unique in a number of ways. Firstly, the experts used a ring vaccination strategy, developed to control smallpox from the mid-1960s to its eradication in 1980. It isolated smallpox patients by vaccinating family members and other close contacts, creating a ring barrier around the disease.

Using the ring approach, when the Ebola epidemic in Guinea had dispersed into smaller local outbreaks, the vaccinators and the trial team were able to move with it. It allowed the trial to continue and at the same time contribute to the control the Ebola outbreak seamlessly.

The volunteers who received the vaccine came from areas in Guinea that had Ebola outbreaks. These volunteers were directly in contact with those who had contracted the virus or were contacts-of-contacts, such as neighbors, classmates or extended family.  In some cases, the clusters were whole villages. In others, the clusters were smaller sections of towns and cities.

Secondly, the experts abandoned the placebo régime used in many clinical trials, because of ethical concerns. The volunteers were still randomized into two groups. The intervention group received the vaccine immediately. The control group received the vaccine three weeks later. This replaced the classical placebo régime, but the trial is still a randomized controlled trial.

The results found that within 10 days the vaccine protected against the Ebola virus for both groups.
“The global health community may now have a very important new tool to beat Ebola”, says Dr. Røttingen. “This trial has showed us how to isolate this virus with a vaccine and protect entire villages. We are doing that through a public health intervention like the ring vaccination strategy.”

“More importantly, it showed us the power of a well-organized international partnership working hand-in-hand to overcome a public health emergency in record time.”

“We have new confidence from the lessons we have learned with the development of the Ebola vaccine and the trial that so far indicates remarkable efficacy. Inevitably, further analyses and a longer follow up are needed but this is a wonderful result.”

“These encouraging results from the Ebola vaccine trials show how WHO, working with partners and the international community, was able to advance rapidly on Ebola research and development,” says Margaret Chan, M.D., Director-General of WHO.

“By compressing into months a process that usually takes years, we have developed potential new tools in our continuing battle against Ebola. The governments and all those involved in the vaccine trials deserve our thanks and backing.”

Want to be a freelance journalist in Africa?

By Esther Nakkazi

A young man came to see me at my small office recently, fresh from University, with a qualification in Mass Communication.

He did not come from a rich background and so had to pay his way through University. While at University, his talent for radio was recognised by a producer from the national broadcaster who then offered him the opportunity to host a children’s programme.

This however, did not bring in much financially, so he doubled it with another part time job doing handiwork around a home. His goal is to become a freelance journalist in Africa.

Various challenges have threatened this goal including his realisation that he has not identified many African journalists who have succeeded as freelancers. He noticed that many of his workmates at the national broadcaster had held the same post for numerous years and had little enthusiasm or passion for their work.

It is not that I have made it yet, but freelancing has made me a wiser journalist and I have some tips to share.  

The term freelance journalist is used differently in Africa. In Uganda, it basically means that you work for one media house but without the liberty of reporting for another media outlet. You are also kept on a small retainer and do not qualify for any company benefits. Whereas a full time or staff reporter will have a regular salary and company benefits.

Elsewhere, the term is used for a person who is self-employed and is not necessarily committed to a particular employer long term. It remains unfamiliar to many here.

I do not know how many times I have been ‘bumped’ from a function even when I am on the official media ‘list’ because I have described myself as a freelancer. It gets really nasty with event entry with security personnel who believe they can override the media lists, which indicate my title as a freelance journalist. Sometimes I appeal to the organisers, sometimes, I just walk away.

On occasion, the organisers will give security a nod, assuming that you are still working for a media house they remember you at, it’s no good explaining that you moved on, its better left that way.

So my advice to the young man was that before you jump into freelancing its important to first work for a local media house to establish a name in the industry. Five years would be good.

Freelancing can be a very lonely affair. One is typically on their own for just about everything ranging from no big desks in air conditioned newsrooms or colleagues to shout a question at through to the need to cater to ones own health insurance and lunch.

When I decided to do it, I moved into a small office, now over two years back. For two months I had worked from home. I was eating all the time or watching television. It did not work.

My office these days is simple, it is just my desk, and two chairs; one for me and the other for a visitor. It is roofed with old iron sheets. So when it gets hot, you could fry an egg in there without fire. When it rains, you hear every drop hitting the roof, you barely hear the other person on the line when you get a phone call. But it works for me.

I sub-let the office from a non-governmental organisation. It is relatively cheap, close to my home, so I do not have to sit stuck for endless hours in a traffic jam. It also has a big compound and a huge tree to shelter when the office gets too hot.

Freelancing to me is better than remaining in a media house for decades watching generations come and go. During this time, you have little to show for progress within the media house.

Freelancing requires wit, hard work, thoroughness, flexibility and a tough skin. You never stop looking for work. The art of juggling work becomes the norm. I work as a fixer, translator, edit publications, do social media, training and mentoring.

Pitching for work is also a difficult task. I have sent pitches to foreign media houses looking for content, only to get the response that its ‘too local.’ Sometimes I give up. Sometimes I persist. Other times its impossible to go beyond the first bi-line in the publication of your dreams.

Freelancing frees up a lot of your time. You do not have to sit in long, boring conferences to satisfy the boss. You decide what you want to write free of the need to meet a pre-set number of stories you have to deliver every month. You sort of stick to what you really need and it allows you to explore different issues in-depth.

My advice to the young man was do your time, earn the bi-line until such a time that you can become free range.

( I also posted this here https://www.the-newshub.com/media/want-to-be-a-freelance-journalist-in-africa)
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The Noisy Ride to Kumasi

By Esther Nakkazi 

I landed in Accra at 11.40 am en route from Nairobi. It was hot. Very hot. Instead of travelling for 40 minutes in a small plane.  I opted for the 6-hour comfortable V.I.P bus ride to Kumasi, Ghana’s second-biggest town after its capital Accra.

The bus was red. A Daewoo type, decorated with a Ghanaian flag with a huge TV screen at the front. This chain of buses is owned by one Ghanaian international footballer, I was told, as if to explain the luxuriant comfort.  

My seat number was two, on the aisle, directly behind the driver, which enabled me to watch the road way ahead of the journey.

I was headed for a two-day journalists and scientists meeting (15th -16th July) as one of the trainers at the Kwame Nkrumah University of Science and Technology (KNUST).

My VIP ticket 

It was indeed a smooth and comfortable bus ride except about 20 minutes into the journey after clearing through the city traffic, the noise started and continued for the six hours up to Kumasi!

First, it was the preacher. Armed with a bible we started off with a prayer for journey mercies, not bad, not bad at all!

He then started real preaching, given that I do not understand any of the languages spoken in Ghana, I was only an observer, occasionally glancing behind at the other passengers. 

Everyone was quiet as if we were in church. The loud preacher went on and on, occasionally ‘ the congregation would shout Amen or clap like real church time.

Then I recalled, on my first trip to Ghana in 2012, I had this big dream of writing a book titled ‘happiness’. Maybe sometime it will come to pass. 

I was randomly asking Ghanaians- what was the happiest day of their life.  Most of my answers were 'finding Christ, turning to Jesus or the day they were born again'.

That was it. I was later to find out that it was not just in words but in practice too. I left my luggage with no attendant at the busy bus terminal building on the insistence of the bus driver and 20 minutes later, Voilà! The bag was there and intact. That does not happen in many African countries!

In the V.I.P bus, two hours into the journey the preacher alighted. In came the herbalist. First, he gave a brief of what he was selling, what it heals, that was about twenty ailments and then there was a testimony from a woman in the back seat of the bus.

I was told by my neighbor, a young girl, that the woman said she had used the herbs and they worked fine. So this girl bought six packets of whatever... When I inquired why so many, as if they were tablets recommended by a doctor and she had to complete a dose, she said the woman’s testimony was very convincing.

Then there was what seemed to be a commercial break, a bit of silence, then the conductor switched on the TV. Unfortunately, because of the proximity of my seat to the TV, the blaring noise was just in my ears as though I had tuned maximum volume with headphones on.

The loud adverts were played first. It was ‘a camp of only Jesus production’. Initially, I pretended to fall asleep but the loud movie noise could not let me. So I settled into watching it. 

I got bored but there were no alternatives. Except for the men who were selling dead wild animals ( I presumed ) on the roadside and I thought of Ebola, which scared me to death.

Three hours into the journey we stopped and a young lady selling bread entered. Passengers were waving at her to sell to them loaves as if her basket was a supermarket. In minutes it was all gone. She looked very pleased with her day's sales and tipped the driver when it was time to alight and off she hopped off.  

By the time we arrived in Kumasi, I heard listened to the preacher, herbs vendor, and the real loud movie and music from the radio- like disco time. What a  noisy ride!

Randomised trials in child health

By Esther Nakkazi

The latest research on child health in developing countries with evidence derived from all the randomized trials published over the last year 2014-15 are in a booklet available at www.ichrc.org.

This year there were 245 publications from randomised or controlled trials, more than in any previous year. These came from all regions of the world, mostly from developing country researchers. The summarise are aimed at making this information widely available to paediatricians, child health nurses, midwives, researchers, students and administrators in places where up-to-date health information is hard to find.

"We hope it will be helpful in reviewing treatment guidelines and clinical and public health approaches, and in teaching about paediatrics and evidence-based medicine," said Prof Trevor Duke, from the Centre for International Child Health, University of Melbourne and MCRI Intensive Care Unit, Royal Children’s Hospital Melbourne, Victoria, Australia. 

Prof Duke says they hope  that such information will be helpful in reviewing treatment policies, clinical practice and public health strategies. The booklet is compiled annually, using the PubMed search engine. The search strategy is reproducible by anyone with access to the Internet, through http://www.ncbi.nlm.nih.gov/sites/entrez

The method of the Randomized Trial is the Gold Standard for determining attributable benefit or harm from clinical and public health interventions. So Randomized controlled trials (RCTs) when done properly eliminate bias and confounding. 

However their results should not be accepted uncritically and they should be evaluated for quality and validity. Before the result of an RCT can be generalized to another setting there must be consideration of the wider applicability, feasibility and potential for sustainability.

Here are some of the summaries on child health in Africa found in the 2014-15 booklet;

In a high-mortality setting in Kenya where co-morbidities are common, among children with non-severe pneumonia, oral amoxicillin was non-inferior to intravenous benzylpenicillin, and failure rates at day 14 were 13.5 and 16.8% respectively. In Brazil oral amocycillin given 2 times per day was as effective as 3 times per day in treating non-severe pneumonia with treatment failure rates of 23% and 22% respectively.

Children in African hospitals with severe anaemia were more likely to die in the first 24 hours (case fatality rate 13%) than those with mild or moderate anaemia (7-8%). Children with severe anaemia who were not transfused at 2.5 hours had a much higher risk of dying than those who received blood early.

In rural children in India, Pakistan and Zambia, an early developmental intervention taught to parents over 3 years improved cognitive abilities regardless of the type of development risk the child faced.

Using a test of “intestinal permeability”, the lactulose: mannitol urinary excretion test, among children at risk of environmental enteropathy, zinc or albendazole reduced the apparent progression of intestinal permeability.

Among African children with prolonged convulsions use of intra-rectal diazepam was more effective in controlling seizures than sublingual lorazepam.

In adolescents and adults in sub-Saharan Africa with HIV and first-line treatment failure, use of a nucleoside reverse-transcriptase inhibitor was more effective as a ritonivir-boosted protease inhibitor (lopinavir-ritonavir), and as effective as combined NRTI and lopinavir-ritonavir, in achieving good HIV control (no stage 4 events, CD4>250, viral load<10,000 copies /ml at 96 weeks of observation).

In HIV exposed, uninfected infants in Kenya and South Africa, not breast-feeding was associated with a significantly increased risk of serious infectious events in the first 3 months of life.

In Zimbabwe, Nigeria, Malawi and South Africa, trials of the implementation of “Option B+”, which provides all HIV-infected pregnant and breast-feeding women with lifelong combination ART, have been planned and are underway.

In Cameroon, mobile-phone text messaging and phone call reminders increased attendance for HIV exposed or infected children.

A controlled trial of wearing shoes failed to reduce hookworm, because those in the control arm also acquired shoes! Wearing shoes in either arm was associated with a lower risk of hookworm infection.

Among children in Tanzania infected with Trichuris trichura, the use of albendazole and oxantel pamoate, or albendazole and ivermectin, were more effective than the albendazole and mebendazole, or mebendazole alone.

In Ghana, providing rapid diagnostic tests for malaria along with realistic training markedly increased the prescription of rational therapy, and in Camaroon use of RDTs reduced the costs of health care in a study which helped define the best type of health worker training.

A meta-analysis of trials of intermittent preventative therapy for malaria on the effect on anaemia showed a modest protective effect only.

Among children in Malawi treated for malaria with chloroquine-azithromycin, the incidence of subsequent respiratory and gastrointestinal infections was lower than those treated with chloroquine alone.

Among Ugandan children the use of dihydroartemisinin-piperaquine compared with artemether-lumefantrine reduced the risk of recurrent malaria and hospitalisations over the 84 days of follow-up.

Among children with sickle-cell disease, malaria parasite clearance was slower than for children without SCD when treated with artemisinin-based therapies.

In a large cluster RCT of community-based treatment of moderate malnutrition in Burkina Faso, the giving of locally produced ready-to-use supplemental feeds resulted in better weight gain than merely counselling parents about appropriate foods.

In Kenya, Mozambique and Tanzania, mothers receiving intermittent preventative therapy for malaria with mefloquine had significantly lower rates of malarial parasitaemia, placental malaria and non-obstetric hospital admissions than mothers receiving placebo, but those who received mefloquine had higher rates of perinatal mother-to-child transmission of HIV. This was an exploratory finding with potential confounding, but requires further investigation.

In Malawi, a large trial of maternal nutrient supplementation with lipid-based nutrient supplementation failed to show improved birth size or child growth in the first 18 months of life. However in another large trial in Ghana, birth weight was greater (+85g) and risk of low birth weight less with lipid-based nutrient supplementation.

In a large trial in rural Tanzania, home-based counselling of newborn care practices by volunteers improved several practices, including clean cord care and exclusive breast-feeding.

In 6 countries in South America, Asia and Africa, a trial of antenatal steroids fopr pregnant women at risk of preterm birth did not reduce mortality in those who delivered preterm, but increased neonatal and maternal sepsis and increased overall neonatal mortality.

In Democratic Republic of Congo, Kenya and Nigeria, the community based treatment of low risk but possible bacterial infection in newborns with simplified antibiotic regimens which included oral amoxicillin instead of injectable penicillin were no different in effect on newborn sepsis. Similarly for infants up to 3 months of age with fast breathing only, oral amoxicillin was as effective as injectable penicillin and gentamicin. Both trials were done in populations at very low risk of serious bacterial infection.

In a large trial in 55 villages in Burkina Faso, the implementation of an agriculture, nutrition and health behaviour program run by Helen Keller International reduced wasting, diarrhoea and anaemia.

In a large meta-analysis of 30 trials, praziquantel was the most effective drug for treating urinary schistosomiasis, however the proportion of patients cured varied from 22-83%, and trials of combination therapy with other agents is indicated. There is still no appropriate formulation of praziquantel for young children.

In a trial of shortened tuberculosis drug regimens, use of a 4-month regimen that included moxifloxacin was significantly less effective than the standard regimen 2RHZE/4RH. At this stage shortening TB treatment to less than 6 months is not of proven efficacy.

In South Africa, influenza vaccine given to pregnant HIV-positive and HIV-negative women provided partial protection (around 50% efficacy) for them, and protection for the infants the infants were HIV-unexposed. There was no protection of giving maternal influenza vaccine to infants who were HIV-infected or exposed.

In 11 African sites 3 doses of the RTS,S/AS01 malaria vaccine given to infants provided 40-50% protection against clinical malaria, 34% protection against severe malaria and 19% protection against all-cause hospitalisation.

There were several large trials of neonatal vitamin A supplementation reported on in 2014-15, finding minimal or no effect on mortality (NeoVitA trials). In one trial in India of over 40,000 newborns randomised to vitamin A 50,000 U or placebo, vitamin A showed a modest and non-significant lower mortality (-3 per 1000, 95% CI -6% to 0.1) in the first 6 months of life. In similar trials in Ghana and Tanzania involving 22,000 and 32,000 newborn infants respectively, the mortality risk was also not significantly different in the vitamin supplemented group. Bulging fontanelle was reported as an adverse effect in <1% of newborns given vitamin A. Trials from Guinea Bissau also confirmed no beneficial effect of neonatal vitamin A supplementation.
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Fun Mobile App to Dispel Sexual and Reproductive Health Myths

By Esther Nakkazi

A mobile application to dispel sexual and reproductive health myths won the ‘#HackForYouth’ Hackathon organized by Reach A Hand and the United Nations Population Fund (UNFPA) in Uganda.

The 3G Tree@viQ is an incentive-based mobile application, which will provide young people with information about Sexual and Reproductive Health and Rights (SRHR).

It is simple, basic, interactive and fun said Natalie Cojohari, who works with UNFPA in Moldova and was the head of the winning team, 'Put It on', at the three day Hackathon (22-23 July) held at the Sheraton in Kampala. Teams ARSHiCA and Olympians for Tulumbe also faired equally well and others included Funky Omega, Hactivate Youth, Lighting Youth and Hack 10.

Natalia and some members of the winning team at Sheraton

The hackathon followed principles of “user-centered design”, actively engaging young people in the development of solutions that are based on their real needs and experiences. It was graced by the Mr. Ahmad Alhendawi, the UN Secretary General’s Envoy on youth and Chris Baryomunsi, the Uganda State Minister of Health. It attracted young people from 13 countries.

Although the winning team developed the app for especially the youth in eastern Europe, it can also be adapted elsewhere. The region is burdened by increasing rates of HIV and STIs with no sex education in school and what is available is not accurate but also has the advantage of high mobile phone penetration.

Ms. Cojohari explained that there are many sexual and reproductive health myths in eastern Europe like; you cannot get pregnant if you have sex for the first time, it is safer to use two condoms, if you wash your genitals with Coca-Cola after sex you will not get pregnant.

So the app will basically be a quiz based on myths and if the player wins they will be incentivized with free data, airtime or meal. Ms. Cojohari said it will increase the users' self-esteem and improve their knowledge on sexual and reproductive health.

At the pitching session, teams came up with innovative solutions which were interactive, informative and educative to youthful users in their privacy, customised with appropriate content for particular regions that offer unconventional solutions to promote young people’s knowledge on SHR.

The apps ranged from those that could aggregate data; offer vouchers to young pregnant girls to get SHR services; send youth friendly messages; chat in privacy with a certified e-volunteer about SHR and an app that gives access to information to empower against sexual harassment.

The judges said the 3G Tree@viQ was well packaged, the quiz gives the youth a challenge and since at that age, everyone wants to beat the system, it will keep them engaged and rewarded at the same time improving their knowledge on sexual and reproductive health and rights in their privacy.

Moving forward, UNFPA will help the youngsters deal with intellectual rights issues and get the app registered. Momentarily, they only have bragging rights.

At a time when young people are always looking for data and they want to seek for sexual and reproductive health information in comfort and privacy, a mobile health solution is one way to do it. It was a fruitful event and to me, all the teams were winners at least in the area of rapid innovations.

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First Testing For Malaria Reduces Over Diagnosis and Prescription

Press Release;

Using malaria rapid diagnostic tests (RDT) in registered drug shops in a highly endemic region in Uganda substantially reduced over diagnosis of malaria, improving the use of valuable malaria drugs, according to a new study published in PLOS ONE.

Most of the 15,000 patients that visited drug shops with a fever chose to buy an RDT when offered one by the trained vendors taking part in the study. Once they performed the test, results showed that less than 60% of the patients had, in fact, malaria. The vendors usually complied with the test results, reducing over prescription of malaria drugs by 73%.

The researchers from the Artemisinin-based Combination Therapy (ACT) Consortium (http://www.actconsortium.org) at the Ministry of Health in Uganda and the London School of Hygiene & Tropical Medicine in the UK carried out the study because up to 80% of malaria cases in Uganda are treated in the private sector. 

Students in Tororo after getting a bed nets from Malaria Consortium Uganda

The private sector is a common source of treatment in many other malaria-endemic areas, especially where there is poor access to public health facilities. Patients buy antimalarial drugs in shops to medicate themselves, although malaria is not always the cause of their fever, and thus inappropriate treatment is very common.

Prof. Anthony Mbonye from the Ugandan Ministry of Health and lead author of the study, said: “Our findings show that it is feasible to collaborate with the private health sector and introduce malaria RDTs in drug shops. The next step is to refine the strategy and understand the cost implications of scaling it up in Uganda. Our long term aim is to provide evidence to help the World Health Organization develop guidance to improve malaria treatment in the private sector.”

Dr Sian Clarke from the London School of Hygiene & Tropical Medicine, also a principal investigator in the research, said: “This study shows that RDTs can improve the use of ACTs – the most effective treatment for malaria – in drug shops, but it’s not without its challenges. These tests alone will not improve the treatment of other diseases. We now need to continue working with the Ministry of Health to investigate how to improve our approach and expand it to other common illnesses.”

At present, drug shop vendors usually treat patients based on their signs and symptoms without testing their blood for the presence of malaria parasites, as recommended by the World Health Organization. This can result in patients with a fever being over diagnosed with malaria and purchasing an ACT which they don’t need.

Microscopy is a method that requires laboratory equipment and qualified staff, while RDTs are alternative, simple tools that require minimal training to diagnose malaria. These rapid tests can help health workers and vendors in remote locations to prescribe the correct treatment for malaria.

An investigation conducted alongside the trial, published in Critical Public Health, found that despite their popularity, malaria tests were not a simple fix in the private sector. Patients welcomed the RDTs as well as government involvement in improving drug shops, and vendors “felt big” and more akin to qualified health workers in the public sector for being allowed to test blood. But researchers warn that this could give a false impression of vendors’ other skills and services, and regulation by authorities is needed.

The team have recently received a new grant to investigate the feasibility of training and equipping registered drug shops to manage three key childhood diseases: malaria, pneumonia and diarrhoea.

The ACT Consortium is funded by a grant from the Bill & Melinda Gates Foundation to London School of Hygiene & Tropical Medicine.

Distributed by APO (African Press Organization) on behalf of ACT Consortium.

'Viral' Health Awareness videos in Luganda a must watch!

By Esther Nakkazi

I am part of the Health Information for All (HIFA) dgroup, which has some
real good information on health. Today, Medical Aid Films posted cool
videos that promote good health I think all Ugandans should watch.

Increasingly, it could be that short videos watched on mobile phones
will be used to improve health awareness and literacy among the public
in Africa. For instance in Burkina Faso, a project Funded by a
Grand Challenges Exploration grant from the Bill & Melinda Gates
Foundation, promotes maternal and child health
using short entertaining films that can be watched on mobile phones.

The project taps into this trend by creating ‘viral videos’ in local
languages that promote positive maternal and child health behaviours.
Each of the films delivers a specific message, such as the benefits
of hand washing, and the promotion of treatment-seeking for
diseases such as malaria, pneumonia and diarrhoea.

In Uganda, there are eight new films in Luganda for use by
community health workers that can be used to build awareness
around nutrition,warning signs in pregnancy, newborn care
and other essential topics in maternal and child health.

Medical Aid Films worked in partnership with the Royal College of
Paediatrics and Child Health, who run health worker training and
community education projects in Uganda to produce the films.

The films are now available to watch and download for free from
the website just follow the links below. If you have any feedback
about these films ­ please email helen@meddicalaidfilms.org.

Emere yo obulamu: Abakyala abali embuto kyebetaga occult
(Food for Life: What Pregnant Women Need to Eat)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125022187

Emere yo obulamu: Okuyonsa
(Food for Life: Breastfeeding)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125021454

Emere yo obulamu: Kiki na di lwo liisa omwanawo
(Food for Life: What and When to Feed Your Child)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125021453

Obuboneero bwo obubenje nga omukyala alilubuuto
(Warning Signs in Pregnancy)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125021452

Engeri yokulabirira ebujje; (How to care for a newborn)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125021451

Okumanya Obuboneero bwa kafuuba; ekidukano Nâ Omusujja
(Is your child sick? Identifying signs of pneumonia, malaria and diarrhoea)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125021450

Manya omubiri gwo: Engeri yo kwetegekera olubuto
(How to plan a pregnancy)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=125021345

Okulabirira Nakawere Okwenjawuulo
(Focused Antenatal Care)
http://medicalaidfilms.org/our-films/films-in-luganda/?v=124984993

So it could be that more people in Africa could actually consume health information
on short videos watched on mobile phones, we are counting of course on mobile penetration
and cheap data to make this happen. 

Uganda Finally has a Science Ministry

By Esther Nakkazi

Uganda has finally established a ministry to spearhead and harmonise the development of science, technology and innovation (STI) in the country. But it is not independent. The new ministry is now called the Ministry of Education, Science, Technology and Sports.

On March 1st 2015 during a cabinet reshuffle by the President Yoweri Kaguta Museveni. announced that the Science and Technology docket will be placed under the Ministry of Education and Sports, but some stakeholders criticised the decision, charging that it is misplaced, because this ministry is already too big and handles too many issues.

Before the announcement, Uganda remained the only country in East Africa without an independent, dedicated science ministry.

George William Byarugaba-Bazirake the dean, faculty of science at Kyambogo University, said scientists have had so many consultative meetings the Government and recommended that the Science ministry should be placed alone or under the Ministry of Information Communication and Technology (ICT).

Byarugaba-Bazirake said that the Science ministry will be swallowed up in the gigantic Education and Sports ministry and issues of science, technology and innovations would not be articulated properly and besides it might not be allocated enough resources.

UNCST building in Kampala ( By Esther Nakkazi)

However, Elizabeth Gabona, the director of higher, technical and vocational educational said that although such fears could be valid, they would be so only if they are not thought out through properly and if funds allocated to science are “borrowed” and used for different activities.

“Education and Sports is a big ministry, Science and Technology can be swallowed up and forgotten. These are real fears but they can be addressed if we make conscious transition plans to add value,” said Gabona.

The new ministry is now called the Ministry of Education, Science, Technology and Sports. Previously STI fell under the Ministry of Finance, Planning and Economic Development, which paid them little attention. Other responsibilities were with the Ministry of ICT and the Uganda National Council for Science and Technology.

For long scientists and researchers in Uganda reasoned and begged for a Science ministry. The Uganda parliament passed a bill in June 2013 to pave way for its creation.

But some stakeholders say Education and Sports is still the best parent for a ministry for Science and Technology.

Uganda National Council of Science and Technology (UNCST) assistant executive secretary Ismail Barugahara said the ministry should be the home of the Science and Technology portfolio, since it reaches the grassroots through established structures.

“I believe Education and Sports has structures all the way from top to bottom that can effectively support science, technology and innovation,” Barugahara explained, adding: “Through the Ministry of Education Sports, Science and Technology, every community can be reached”.

John Opuda-Asibo, the executive director, Uganda National Council for Higher Education, supports Barugahara’s view stating: “When you ask for something and you get it, let it work. Let us see how this will work. I am glad that it has been placed in the Education ministry”.

Central Bank Governor on why the Uganda shilling is at its lowest ever

Uganda currency -By Esther Nakkazi

Remarks by Prof. Emmanuel Tumusiime-Mutebile, Governor, Bank of Uganda,

To members of the Uganda Manufacturers’ Association At Lugogo Show ground
Thursday July 02, 2015

The Depreciation of the Exchange Rate and its Implications for Manufacturing Industry

Introduction

Good morning Ladies and Gentlemen. I would like to begin by thanking the Chairman of the Uganda Manufacturers’ Association for kindly inviting me to speak to you this morning.

Many people in the business community are concerned about the developments in the exchange rate. Over the course of the 2014/15 fiscal year, which ended on Tuesday, the Ugandan Shilling depreciated against the US dollar by 27 percent.

Uganda is, however, not alone in this respect. The Tanzanian Shilling fell by 20 percent, the South African Rand by 15 percent and the Kenyan Shilling by 13 percent in 2014/15. Even major international currencies fell heavily against the dollar in this period; the Euro and the Japanese Yen fell by 22 and 21 percent respectively. 

Many emerging and frontier markets have suffered similar problems to Uganda over the last 12 months because export commodity prices have fallen, demand in key export markets has weakened and it has become more difficult to mobilise capital on international markets.

For Ugandan importers and exporters, the most relevant measure of the exchange rate is the trade weighted exchange rate index, which is based on a basket of currencies from the countries with which Uganda conducts international trade. The trade weighted exchange rate index depreciated by 17.5 percent in 2014/15.

Why did the Shilling depreciate in 2014/15?

Uganda has a market determined exchange rate. As such the strength of the supply of, and demand for, foreign exchange are the main factors which determine the exchange rate. Developments in the balance of payments (BOP) determine the supply of, and demand for, foreign exchange. In the 2014/15 fiscal year, Uganda’s BOP deteriorated as a consequence of several factors.

First, Uganda’s current account deficit widened in 2014/15 by an estimated $700 million, to almost $2.9 billion. This was mainly because our exports of goods and services fell in the last fiscal year, as a result of lower global commodity prices, problems in regional markets such as that of South Sudan, and a drop in tourism arrivals. 

Despite the fall in the price of oil, which enabled Uganda to reduce its fuel import bill, imports of goods and services increased, partly because of higher Government spending on imports related to infrastructure projects but also because of stronger demand from the private sector for non-oil imports.

As a result of these adverse trends in our imports and exports, our trade deficit in goods and services was larger by $582 million in 2014/15. As a percentage of GDP, our trade deficit was estimated at 12.1 percent in 2014/15 compared to 10.2 percent in the previous fiscal year. This means that, for every 100 Shillings of goods and services produced in Uganda, we actually absorbed 112 Shillings in consumption and investment spending. In addition to the larger trade deficit, dividend payments by foreign owned companies were higher by almost $250 million, which reflects a recovery in corporate profits in 2014/15, and this also contributed to the widening of the current account deficit.

Our current account deficits have to be financed by surpluses on the financial account (this is what used to be referred to, in the terminology of the balance of payments, as the capital account). However, while the current account deficit widened in 2014/15, the surplus on the financial account failed to keep pace. 

This was mainly because of a fall of almost $240 million, or about 20 percent, in inflows of foreign direct investment (FDI), which is the single largest component of the financial account. The fall in FDI in the last fiscal year was mainly because of lower foreign investment in the oil industry, caused by the fall in the global price of oil and delays in reaching agreements between the oil industry and Government on issues related to the development of the sector in Uganda.

Because the financial account surplus was not large enough to fully finance the current account deficit, Uganda incurred an overall BOP deficit in 2014/15, and hence a fall in foreign exchange reserves, which is estimated at $535 million. We had expected to incur an overall BOP deficit in 2014/15, because of the large Government payments to the contractors for the Karuma and Isimba hydro power projects, but the deficit was much wider than we had originally forecast because the
external environment was much worse than had been anticipated, and this adversely affected export earnings for both goods and services.

What are the prospects for 2015/16?

Unfortunately there is little prospect for substantial improvement in the external economic environment in 2015/16. Global economic growth is forecast to remain weak and there is no immediate prospect of a recovery in demand from South Sudan, which is our largest export market. Nevertheless, I expect a modest improvement in the BOP in this fiscal year for two reasons.

First, the exchange rate depreciation which has taken place over the last l6 months, since February 2014, should have strengthened the competitiveness of our traded goods industries and boosted demand for our exports. For example, it will be cheaper for tourists to visit Uganda. This should help to bring about a small narrowing of the trade deficit in goods and services.

Secondly, we are forecasting a rebound in FDI, especially related to the oil industry, and financial inflows for the large energy projects of Karuma and Isimba, which will contribute to a larger financial account surplus. Consequently, I hope that we will be able to achieve an overall BOP surplus in 2015/16 and thus accumulate foreign exchange reserves. Our target is to increase foreign exchange reserves by just over $250 million in the current fiscal year.

How does the depreciation of the exchange rate affect manufacturing industry?

Manufacturing firms are among the largest users of foreign exchange in Uganda, especially because many material inputs are imported along with most capital equipment used by manufacturers. Depreciation will make these inputs more expensive. However, most manufactured goods are what economists call “traded goods’ which means that potentially they can be traded across international borders. 

Traded goods are either exported or are sold in the domestic market but face competition from imports. As such, the real exchange rate matters for the competitiveness of traded goods. A real depreciation of the Ugandan exchange rate makes Uganda’s traded goods cheaper relative to their foreign produced competitors and, therefore, should boost demand for the Ugandan goods, whether in the domestic market or in export markets. 

This is the case even for industries which have to import most of their inputs, because the depreciation affects both the value of their output and their material inputs, and the former should always exceed the latter. Although it may take time for production to expand in response to improved competitiveness, in the long term real depreciation should lead to faster growth of traded goods industries in Uganda, including manufacturing industries.

What are the policy implications?

Uganda adopted a flexible, market determined exchange rate in the early 1990s, because it offered two crucial advantages over a fixed, or pegged, exchange rate. First, exchange rate flexibility helps the economy to adjust to external shocks, for example by improving the competitiveness of traded goods industries when there is a negative shock. Second, it provides a mechanism for maintaining BOP sustainability, and thereby avoiding the risk of BOP crises of the type which afflicted Uganda in the 1980s. Exchange rate flexibility has contributed to the sustained growth of the Ugandan economy over more than 20 years.

In the face of the worsening external economic environment which has faced our economy, exchange rate depreciation is unavoidable. It is not sustainable for the Bank of Uganda to try and prop up the exchange rate, at levels which are not consistent with supply and demand in the foreign exchange market, by intervening and selling foreign currency. 

The BOU would simply deplete its foreign exchange reserves if it attempted to do this. Furthermore, as I have already mentioned, depreciation can help the Ugandan economy adjust to a more challenging external environment, by boosting the competitiveness of traded goods industries, including manufacturing industries, and by encouraging Ugandans to purchase domestically produced goods rather than imports.

Hollywood actress Awakens Science and Arts in Education debate

By Esther Nakkazi

Lupita Nyong’o, Kenya’s Oscar Award Winner for Best Supporting Actress, has spoken up for Arts courses, which have been labelled ‘useless’ in comparison to Sciences in education in some eastern Africa.

Ms. Nyong’o, last week urged guardians to be supportive of children with an affinity for Arts, while attributing her success in the film industry to a distinctive and motivational pattern that fanned her passion.

Speaking to students and artists during a session dubbed “Arts in Education” at the Kenyatta International Convention Centre, Nairobi; Lupita said she grew up in a community that fosters creative self expression and around guardians who “validated her dreams.”

Ms. Nyong’o's advice and job stand out among the many debates ongoing about Sciences being better than humanities in eastern Africa.

In Uganda, President Yoweri Museveni, a champion of sciences, has urged public Universities funded by the Government to take on more science courses and drop the arts and humanities, which he described as ‘useless’.

"He posed a question to university students studying conflict resolution: ‘What would happen to you when conflicts are resolved?"

Museveni has continuously expressed concern that these ‘useless’ courses are not marketable in the labor market, neither in Uganda nor internationally and are irrelevant to development. Except, Ms. Nyong’o has proven him wrong.

Professor Ratemo Michieka from the University of Nairobi said development lies in Science, Technology and Innovation and giving more prominence to Sciences than other disciplines may just be the answer to development.

"No country has developed without a critical mass of scientists," said Professor Nelson Sewankambo.

“In the 60’s it was statistics, then environment, gender. Now it is Science. It is not wrong for government to say that while its easier to produce humanities, we need more science and technology graduates. It is not that the other should be abolished,” said Professor John Opuda-Asibo, the Executive Director, National Council for Higher Education

He added that Uganda was only looking at what was neglected for a long time.

Professor William Kyamuhangire, Associate Professor and Manager of the food technology and business incubation centre at Makerere University has argued that Museveni’s intention is to harness the local scientific human resource to develop a hi-tech industry in Uganda that can use locally available raw materials to produce value added products for the local and export markets and at the same time, create jobs.

He noted that most African economies, in this 21st Century have advanced needs and their economies can only be driven by science and technology.

Countries like Uganda and Kenya that have recently discovered petroleum, need to have the technology to refine it into usable products, which calls for training in geology and mining, petroleum extraction, petroleum refining and their management.

Lupita frowned upon the fact that “arts education is often dismissed as non-essential.” She laid emphasis on reinforcing children’s abilities and talents as opposed to imposing careers on students.

Ms. Nyong’o elevates the Arts in education but the debate continues.