The Indian government is undertaking two major campaigns in the span of one month to protest hundreds of millions of Indians against soil-transmitted helmins and lymphatic filariasis – or worms and elephantiasis, respectively.
The government-led campaigns are working with international organizations in an effort to reach the most people possible. The goal: that some 140 million people will be protected against parasitic worms and more than 400 million will take medicine that prevents elephantiasis.
Evidence-based case to deworm
On Feb. 10, India will celebrate National Deworming Day. Twelve states in the country will participate in the largest-ever deworming campaign. The government and its states are working with Evidence Action, a U.S.-based nongovernmental organization that promotes evidence-based solutions to global problems, to carry out the campaign. It is the culmination of years of work for Evidence Action to reach more children with an effort that has strong evidence of positive impact.
“We’ve been advocating for increasing coverage,” said Alix Zwane, executive director of Evidence Action, in an interview with Humanosphere. “This is doable and repeatable and sustainable and it is backed by evidence.”
The evidence comes from a randomized control trial conducted in Kenya in 1998. Researchers Michael Kremer and Edward Miguel found that providing children deworming tablets reduced missed school days by 25 percent. At a cost of 50 cents per student per year, it proved to be a cost-effective way to improve health and education for children. Such a cheap intervention stops dead the worms that have a significant impact on children.
“Soil-transmitted helminths interfere with nutrient uptake in children; can lead to anemia, malnourishment and impaired mental and physical development,” said Dr. David Addiss of Children Without Worms, in a news release.
Nearly 100 million children in India, Ethiopia, Kenya and the Gambia have received deworming treatment as the intervention has scaled up. The new campaign will more than double that total number, and given children a better chance to learn.
“We’re tremendously excited about that this could be game-changing in the next year or so in terms of the global burden of soil transmitted helmins,” said Zwane. “I think it is a bit moment for us, qualitatively. It is a big leap.”
An end to elephantiasis?
Close to half a billion Indians are at risk of contracting lymphatic filariasis. The campaign – launched in early January – seeks to provide preventive medication for free and an accompanying public service campaign to encourage people to take action.
“India has made great strides over the last decade to eliminate lymphatic filariasis in endemic states and we are now on the verge of reaching elimination targets nationally. However, the last mile of the journey is often the most difficult,” said C.K. Mishra, additional secretary and mission director of the National Health Mission at the Ministry of Health and Family Welfare. “We are employing a wide range of new communications tactics and partnerships that will help us encourage all people at risk from this disease to consume their free dose of medicine during our annual mass drug administrations.”
One partnership is with the Sabin Vaccine Institute. The group worked with the government, fellow partners and media groups to launch a PSA for the “Hathipaon Mukt Bharat” (Fliaria Free India) campaign. The hope is that destigmatizing elephantiasis will encourage people to take the steps necessary to prevent its spread and eventually reach the goal of zero infections.
“There is not enough awareness about this that people to feel like they need to take all of the drugs,” said Richard Hatzfeld, communications director for the Sabin Vaccine Institute, in an interview with Humanosphere. “We became involved when the Ministry of Health and Family Welfare said, ‘We are already planning to roll out this massive campaign and the issue is, we need help with the creative and communications materials.’ ”
Both Zwane and Hatzfeld raised the importance of clear information necessary to see the two campaigns succeed. The driving role for Sabin is to inform Indians about lymphatic filariasis and how it is treated. However, in both campaigns there is a concern about what Zwane called “adverse events” that coincide with the campaign. Much like how anecdotal stories impact vaccine uptake in the Untied States, fatalities or negative health problems that occur following a campaign to distribute drugs can lead to misconceptions about the cause of an “adverse event.”
“We worked a lot time setting up protocol on management of treatment and adverse events correlated with the treatment,” said Zwane.
If everything goes according to plan, millions of Indians will have two fewer infections to worry about. The not-so-neglected duo of soil transmitted helmins and lymphatic filariasis could be a part of the nation’s past.