- Reduce morbidity in school-age children infected or at risk of infection with soil-transmitted helminths (STH - intestinal worms including roundworm, whipworm and hookworm).
- Partner with global health stakeholders to implement programs that prevent the cycle of worm transmission through promotion of hygiene education and access to clean water and improved sanitation.
What are the health needs and challenges?
Many diseases disproportionately affect women and children in the developing world, and soil-transmitted helminthiasis (STH) is one of them.
Although the World Health Organization (WHO) estimates that STH infections cause as many as 135,000 deaths a year, the greatest public health significance is the chronic and disabling effects of these infections. Effects include abdominal pain and distension, intestinal obstruction, iron-deficiency anemia, increased susceptibility to other serious infections, stunted growth and impaired cognitive development in children. Ultimately, these conditions may have socio-economic consequences such as poor school performance in children, which in turn leads to decreased labor productivity when these children become adults.
More than 800 million school-age children are infected with intestinal worms. According to the WHO, in 2010, only about 30% are receiving treatment.
Description of partnership activities and how they address needs and challenges
Children Without Worms (CWW), a partnership between The Task Force for Global Health, Johnson & Johnson (J&J) and GSK, envisions a world with children free of intestinal parasites so they can grow, play, learn and enrich their communities. To achieve this vision, CWW distributes doses of the anthelmintic medicine mebendazole donated by Johnson & Johnson, and supports comprehensive hygiene education efforts to reach children who are most severely affected or at high risk of STH infection.
CWW advocates for a comprehensive strategy to break the cycle of reinfection with soil-transmitted helminths, referred to as the four-component strategy—Water, Sanitation, Hygiene Education and Deworming—the WASHED Framework.
- Water – access to clean water for hand washing and the cleaning of food minimizes reinfection
- Sanitation – latrines and other improved sanitation facilities keep infected human excretions from the areas where people live, work and play, further minimizing the risk of re-infection in treated individuals and preventing new infections.
- Hygiene education – promoting personal and environmental hygiene in communities reduces the risk of re-infection of treated individuals and prevents new infections.
- Deworming – treatment with broad spectrum antihelmintic drugs like VERMOX™ and albendazole kills intestinal worms in infected individuals, thereby reducing the morbidity caused by high worm burden. Reducing the number of individuals with high-intensity infections will reduce the spread of the infection.
With increased drug donations, there needs to be a systematic means to allocate the medicines, assist countries in developing the capacity to administer the treatment programs, and subsequently monitor the progress and health impact. Children Without Worms (CWW) serves as the secretariat to the program to ensure that the objectives of the program are being met. Project partners include the Ministries of Health and Ministries of Education of recipient countries. CWW also works with these governmental agencies to identify in-country, non-governmental organizations (NGOs) to institute hygiene education in regular curricula and to install and maintain water and sanitation facilities.
Working with multiple countries comes with challenges unique to individual countries and are addressed on a case-by-case basis. CWW is the secretariat to the STH Advisory Committee, which has representatives from academia, global health authorities (including the WHO), health economists, epidemiologists, country program managers and government ministries. Key issues are addressed and discussed at this level, and plans of action are developed. In executing solutions, country ministries and program managers are integrally involved because of the need to ensure country ownership.
The medicines to treat intestinal worms made available from both J&J and GSK are only one part of the solution. Inclusion of hygiene education and clean water and adequate sanitation are key to preventing transmission and re-infection of STH. If these issues are not addressed, treatment will need to be carried out in perpetuity. With the renewed commitments on NTDs as they relate to achieving the MDGs, there is a need to develop collaborations with those involved in WATSAN and infrastructure development.
The funding for NTDs, especially for the control of STH, is never guaranteed. It is critical to be vigilant in advocating for continued support of the program from year to year. It does not have the visibility of other major diseases like HIV/AIDS, TB and malaria. However, the morbidity due to high intensity of infection is no less debilitating; robbing chronic sufferers from a quality of life and subsequently, a productive livelihood. The DALYs lost, a measure of disease burden, from chronic infections is significant and relegates communities and populations to a vicious cycle of poverty.
Summary of impact and forward looking information
To date, Johnson & Johnson has donated more than 1 billion doses of mebendazole and plans to donate up to 200 million doses each year through 2020 as part of its commitment to London Declaration on Neglected Tropical Diseases (NTDs). Together with a major annual donation of albendazole by GSK, this donation program has had a major impact on providing treatment to over 75% of the 870 million at risk children targeted by the WHO.
In October 2016, the FDA approved ERMOXTM CHEWABLE (mebendazole chewable 500mg tablets) for the treatment of patients one year of age and older with gastrointestinal infections caused by Ascaris lumbricoides (roundworm) and Trichuris trichiura(whipworm). Following the approval, Johnson & Johnson intends to include the chewable tablet in its donation program.