December 3, 2014 |

An immunization delivers a brighter future

How PATH battles the deadly Japanese encephalitis virus, community by community.
A group of women with children.
A group of women wait outside a clinic so their children can receive immunizations protecting them from Japanese encephalitis and other diseases. Photo: PATH/Sanjay Kumar Chauhan.

Friday, November 14Kaushalya Devi was first in line at the Kurkuri Village health clinic in Bihar, holding her 3-year-old granddaughter, Meni.

A young girl sitting on her grandmother's lap receives an oral vaccination.
The Japanese encephalitis vaccine has the potential to safeguard billions of people. Photo: PATH/Sanjay Kumar Chauhan.

When asked why she was there, Kaushalya said she was afraid of Japanese encephalitis (JE) and wanted Meni to get vaccinated.

Sitting next to her on the ground outside the clinic, several dozen other women and children waited their turn.

The fields of moist rice paddies in Bihar provide jobs and income for the state’s residents. They also breed the mosquitoes that carry the deadly JE virus that kills and disables their children.

“When the mosquito bites, the virus enters the bloodstream and can travel to the brain, causing the tissue to swell,” said Dr. Pritu Dhalaria, PATH’s senior team leader for JE in India. “Children who fall ill typically experience a severe fever and headache, which can lead to convulsions, coma, and death.”

Roughly one-third of people with symptoms die, and another third suffer permanent disabilities, such as paralysis or deafness. There is no cure for the disease, so treatment focuses on providing oxygen and keeping the person in a dark, quiet setting that does not further stimulate the brain. Because treatment options are limited, preventing exposure to JE is all the more important.

Boy receives vaccination in arm from woman.
A boy in India is immunized against Japanese encephalitis during a 2006 campaign. Photo: PATH/Julie Jacobson.

A 2005 outbreak killed 1,500 children in just four months in the north Indian state of Uttar Pradesh, and killed many others in Bihar and Nepal. In response, the Indian government asked PATH and other experts to find a vaccine that could be produced inexpensively and in large quantities.

“China had been using a Chinese-produced vaccine since 1998,” Dhalaria said. “PATH and others convinced the government of India that this could be the solution here.”

Bringing the vaccine to India and beyond

In advance of India licensing the vaccine in 2006, PATH collaborated with vaccine manufacturer Chengdu Institute of Biological Products Co., Ltd. (CDIBP); the World Health Organization (WHO); and ministries of health on clinical trials to prove the vaccine was safe and effective for widespread immunization campaigns.

Dhalaria recalled the multiple ways that PATH shepherded the vaccine through the process:

“We worked with CDIBP to negotiate a favorable price for public use. We helped them build a new manufacturing facility to ensure a high-quality, stable supply. And we provided technical and financial support so they would meet the international manufacturing standards required by WHO for ‘prequalification.'”

This final step, achieved in October 2013, allowed United Nations procurement agencies to purchase the vaccine while serving as an endorsement of quality for countries interested in adopting it. It was a milestone marking the first time a Chinese manufacturer received WHO prequalification, signaling China’s entry as a global vaccine supplier.

Protecting the children

Meanwhile, between 2006 and 2012, PATH helped the Indian government implement a system to immunize more than 100 million children across the country, and we worked with the government to integrate the JE vaccine into the routine immunization schedule.

During this time frame, JE immunization coverage increased from 25 to 68 percent, and the JE “positivity rate” in Bihar, where Meni lives, dropped from 19 cases in 2006 to 2 cases in 2014.

“PATH’s role in India’s program was supposed to end in 2012, but the government of India did not allow us to go,” said Dhalaria.

PATH then supported the government to open 104 24-hour encephalitis treatment centers, establish an ambulance system to transport patients, and train 20,000 health personnel. Ideally, centers were no further than six miles apart, so transport would take less than 30 minutes.

The vaccine’s journey—from China to Meni

The vaccine that Meni received this morning was part of a logistics operation that transported the vaccine from Chengdu to Kurkuri, more than 1,100 miles away.

A group of PATH visitors talk to a man man holding an insulated carrier used to transport vaccines.
PATH Journey visitors study a vaccine for Japanese encephalitis that arrived in a temperature-controlled carrier. Photo: PATH/Sanjay Kumar Chauhan.

PATH technologies played a critical role in this supply chain—from the vaccine vial monitor that indicated the potency of the vaccine once it reached the clinic, to protection of the necessary “cold chain” with refrigeration and temperature-monitoring technologies that support the safe transport of vaccines (for example, simple modifications to make vaccine carriers less likely to expose contents to freezing).

In Bihar, we met people who contribute to the process all along the line—from chronicling the arrival, storage, and subsequent distribution of the vaccines at the central health clinic; to packing the vaccine carrier for transport to satellite clinics; to teaching waiting families about the disease and the vaccine; and finally delivering the shot into the tiniest of arms.

As is the case everywhere in the world, the little ones on the receiving end despised it. The parents did their best to soothe, knowing that the temporary pain would safeguard their children for a brighter future.

The overall impact has been felt well beyond India

By 2013, the vaccine had been supplied to 11 countries outside China, reaching more than 200 million people.

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  • Lynn Heinisch is the director of Public Health Communications at PATH.