More proven interventions are available to prevent and treat diarrhea than any other major child killer Jones G Bryce J. et al., Lancet CS series 2003

The Effectiveness of ORS Oral rehydration treatment reverses dehydration in more than 90% of patients Since 1971, saved the lives of over 50 million children When ICDDR,B began experiments with oral rehydration in the 1960s, fatalities among diarrhea patients dropped from 50% to zero.

Zinc for the Treatment of Diarrhea: Research Findings 25% reduction in duration of acute diarrhea 29% reduction in duration of persistent diarrhea 40% reduction in treatment failure or death in persistent diarrhea WHO-issued recommendations about the use of zinc in treating diarrhea Zinc Investigators’ Collaborative Group. Am J Clin Nutr 2000

Breastfeeding Non-breastfed infants aged 0- 5 months have 7-fold increased risk of death from diarrhea 13% of the under-5 deaths could be prevented if infants were exclusively breastfed for 6 months. 6% of under-5 deaths could be prevented with adequate and safe complementary feeding. WHO, “Key strategies for promotion of breastfeeding” Photo: PATH

GSK Rotarix® - monovalent, human, live, attenuated, oral rotavirus vaccine Lyophilized vaccine reconstituted with CaCO 3 buffer human G1P8 strain; cross-protective of multiple strains high efficacy and safety 2-dose schedule, given with DPT1,2 WHO prequalification: Jan 2007 Merck RotaTeq® - pentavalent, human- bovine reassortant, live, attenuated, oral, rotavirus vaccine Liquid vaccine, 5 human-bovine reassortant strains: G serotypes - human G1, G2, G3 and G4; bovine G6; cross-protective of multiple strains high efficacy and safety 3-dose schedule, given with DPT1,2,3 WHO prequalification: Oct 2008 Rotavirus vaccines Photo: PATH June 2009: WHO recommends rotavirus vaccines be included in all country’s national immunization programs.

Diarrhea Still a Top Killer Source: Bryce J. et al., Lancet 2005

Incidence of Diarrheal Disease Remains High Incidences for Diarrheal Episodes per Child per Year from Three Reviews of Prospective Studies in Developing Areas, Gerald T. Keusch,et al, "Diarrheal Diseases." Disease Control Priorities in Developing Countries (2nd Edition),ed New York: Oxford University Press. DOI: / /Chpt-19.

Decline in ORS use Source: UNICEF. State of the World’s Children

Uptake of ORS: Ram et al, Bulletin of the WHO, March ‘08 In 23 countries - 14 in Africa - use of ORS has declined

Perceptions Research: Donors, Policymakers, Advocates & Academics Indicate Diarrheal Disease Ranks Low Among Global Health Priorities Perceptions Research: Respondents Say Diarrhea Currently Ranks Low Among Global Health Priorities Whenever policymakers talk about global health problems… they leave out the big three of the neglected problems – diarrheal disease, pneumonia, and malnutrition -Academic Policymakers think of specific diseases, and I don’t think diarrheal disease comes in the top ten -Advocate N = 33 PATH, FSG Social Impact Advisors. Diarrheal disease advocacy: Findings from a scan of the global funding and policy landscape.

Interviewees Offer Reasons Why Awareness of Diarrheal Disease May be Low Diarrheal disease does not have a well-known spokesperson from either the scientific or celebrity community “We are really lacking a champion for diarrheal disease. You need two people – a celebrity... and someone from the scientific community to bring credibility” “There is no high profile person – we need a Bono. But who wants to be associated with diarrhea? …You can’t make diarrhea sexy” “Diarrhea has dropped out of the public health agenda – it has become totally invisible. This is not only a problem with lay people, but public health specialists, too. People have forgotten about diarrheal disease” Lack of advocacy around diarrheal disease in the last decade PATH, FSG Social Impact Advisors. Diarrheal disease advocacy: Findings from a scan of the global funding and policy landscape.

Diarrheal Disease Has Failed to Capture the Attention of Donors & Policymakers © PATH

The Potential of Integration No single solution is adequate Successful at the policy level One intervention – like rotavirus vaccines – can mobilize adoption of others Allows flexibility to design a package appropriate for a country’s needs Programmatic level? Combining interventions may offer efficiencies/cost savings Opportunity to strengthen health systems

Rotavirus vaccines Zinc treatment New-ORS/ORT/ breastfeeding Sanitation/ hygiene Enhanced Diarrheal Disease Control From Individual Interventions… …To An Integrated Approach

Jim Grant’s Vision “The world community has now set itself the challenge to reach the goal of 80% ORT use by the end of I am convinced that the goal can be reached…” -”Celebrating 25 years of ORT” conference, 1994

When Asked What Motivates Donors and Policymakers, Interviewees Agreed On Actionable Solutions and Hard Data Key Factors Motivating Health Funders and Policymakers to Take on a Particular Issue or Disease Increasing Access to Data PATH, FSG Social Impact Advisors. Diarrheal disease advocacy: Findings from a scan of the global funding and policy landscape.

N = 30 Perceptions Research: Increasing access to proven interventions is believed to be the most effective way to accelerate progress toward MDG 4 Percent Respondents Selecting Each Intervention as Integral to an Integrated DD Approach Increasing Access to Interventions PATH, FSG Social Impact Advisors. Diarrheal disease advocacy: Findings from a scan of the global funding and policy landscape.

What Will It Take to Put Diarrheal Disease Back on the Public Health Stage?

Action Agenda: Pursue a research agenda around individual and integrated interventions for the prevention and treatment of diarrheal disease Communicate the evidence and data to policy- makers Support integration of packages of interventions to prevent and treat diarrheal disease Speak out to raise awareness of diarrheal disease