At the Heart of Science: How a Small Chewable Tablet Is Helping Tackle a Disease That Impacts Nearly 1 Billion Children Globally
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leven-year-old Sheti dreams of someday traveling the world as a flight attendant.
"I want to learn many languages," she says, standing in the playground of her elementary school as classmates race by her in a game of tag, kicking up dust in their wake. "I think first I will learn Portuguese. I want to travel everywhere."
Sheti is dreaming big, far beyond her remote home in the Amazon region of Peru. Here on the outskirts of Pucallpa, down dirt roads lined with banana trees and clapboard homes, Sheti rides a three-wheeled motokar (a hybrid motorcycle and car) 15 minutes to and from school every day. When she gets home, she helps her mother take care of her five younger brothers. Her father, like many men in this community, works for a timber company cutting down trees deep in the Amazon and is often away for months at a time.
So her siblings take care of each other, especially when one of them gets sick. Which is often.
Almost every year, and sometimes several times a year, Sheti has to miss school because of a debilitating stomachache caused by intestinal worms. Also called soil-transmitted helminths (STH), these intestinal parasites are transmitted through contaminated soil, food or water in areas with poor sanitation, and affect 1.5 billion people worldwide—including nearly 840 million children.
"I get so tired," she says of the times she gets sick with STH. "My stomach hurts so bad and I just want to throw up all the time."
But there's hope now for Sheti and other kids like her. As part of an ongoing national deworming campaign in Peru that began in 2007, Johnson & Johnson has been working with nonprofit INMED Partnerships for Children to provide kids and their families with a medication that could help create change when it comes to STH in regions like the Peruvian Amazon—change that helps give children back the freedom to play, learn, grow—and dream big, just like Sheti.
A Medical Innovation to Help Keep Vulnerable Children Healthy
Pucallpa, a city in eastern Peru located on the banks of the Ucayali River in the hot and humid Amazon rainforest, lacks paved streets or sewers in many areas. This creates the perfect conditions for parasitic diseases like STH—which proliferates in warm, moist climates where hygiene is poor—to thrive.
Kids are especially at risk of contracting STH because they spend time playing in the dirt and water, and don't always wash their hands. And the effects can be grim: In addition to stomach pain, STH infections can impair physical and cognitive development in children. In some very serious cases, intestinal worms can lead to internal blockages and even death.
Since 2006, Johnson & Johnson has been donating mebendazole, a medication made by the Janssen Pharmaceutical Companies of Johnson & Johnson, to treat children in STH-endemic countries. To date, the program has donated more than 1.6 billion doses of mebendazole, enough to treat approximately 880 million children globally.
The donation program is run through the World Health Organization (WHO), which works with local governments and nongovernmental organizations (NGOs) to distribute the medication. Deworming campaigns occur once or twice a year, depending on infection prevalence. The medicine is most often administered by community health workers—trained by local and international NGOs, like INMED—who are on the ground implementing the campaign, which also includes education on proper handwashing and hygiene.
Until recently, mebendazole had been administered as a solid pill, which younger children can sometimes have difficulty swallowing. But in 2019 the WHO prequalified a new pediatric formulation of mebendazole, developed by Janssen, that can either be chewed or mixed with a small amount of water to form a soft mass—similar to the consistency of apple sauce—that's easier for children as young as 1 to swallow.
Last year, Johnson & Johnson extended its commitment, pledging to donate up to 200 million doses of mebendazole annually through 2025. This equates to an additional one billion doses of the new chewable tablets that will be delivered to such STH-endemic countries as Peru and communities like Pucallpa.ShareDid you like reading this story? Click the heart to show your love.
Last year, Johnson & Johnson extended its commitment, pledging to donate up to 200 million doses of mebendazole annually through 2025. This equates to an additional one billion doses of the new chewable tablets that will be delivered to such STH-endemic countries as Peru and communities like Pucallpa. This year, despite the COVID-19 pandemic, the company is on track to deliver on its commitment to donate 200 million doses to countries in sub-Saharan Africa, southeast Asia and Latin America.
And reaching children in need like Sheti and her siblings is arguably more important than ever right now.
"The COVID-19 pandemic has taken a devastating toll on lives and livelihoods, as well as on the ability of the most vulnerable to access the care they need," says , Vice Chairman of the Executive Committee and Chief Scientific Officer, Johnson & Johnson. "This is why, during these unprecedented times, Johnson & Johnson is especially committed to supporting global public health programs like this one, which is helping to ensure children are treated for intestinal worms so they can thrive."
"One More Thing on a Long List of Worries": Why Easy Access to Treatment is Essential
Professor Abner Isac Silva Acosta, Sheti's teacher at La Institución Educativa San Francisco, understands the urgent need for intervention. He used to teach in one of Peru's more remote schools in the village of San Francisco, a three-hour boat ride upriver into the Amazon from Pucallpa. There, he was stunned to see how many of his students had their attendance and educational performance impacted by STH infections.
"You can see their stomachs sticking out, and you find them sleeping on their desks. When it is recess time, they won't play with other kids," he says. "It's normal to see them sick."
A few times over the past year Acosta got sick himself with STH. "You can't avoid it," he says, before calling his students back from recess and beginning a lesson on personal pronouns. Before they take their desks, the kids rush over to pet a dog who gave birth to a litter of puppies the day before—a potential way to contract intestinal worms.
Babies are especially vulnerable to STH because they crawl around on the ground, points out Monica Patricia Ochavono, who has a 7-year-old daughter and a 5-year-old son who attend the school. She knows this firsthand: When her son was seven months old, he was hospitalized for intestinal worms. "He had blood in his stool, and he was vomiting," she recalls.
Her son's doctor explained that he would try to stop the parasites from spreading to the baby's brain. "For 15 days I sat crying in the hospital with him," Ochavono recalls. "I was so afraid. And now, I am afraid for mothers who aren't afraid of these worms."
Even though medication to fight STH is available through donation programs, Ochavono says that mothers in the community don't always access treatment because they either don't recognize the symptoms, or they don't realize the seriousness of the situation.
The Peruvian Amazon is a highly endemic area, and it's been terrific to see how this campaign has grown. In communities with 90% infection rates we've been able to reduce that to 50% or lower with this medication.ShareDid you like reading this story? Click the heart to show your love.
Indeed, for many families in the region who struggle with poverty, it's just one more thing on a long list of worries. "I think here people aren't always able to prioritize health," says Rebecca Sanchez, mom of a 1-year-old and an 8-year-old. "We have so many other concerns."
And most recently, those other concerns include the COVID-19 pandemic, which has posed additional extreme challenges to communities in the region. Peru has one of the highest reported death rates per capita from the pandemic, and it was the first country to record more than 100 deaths per 100,000 inhabitants.
The Ucayali region, where Pucallpa is located, has seen especially high numbers of cases. Because of this, education institutions have been closed since March. Children have been learning from home, but many are struggling, since the area doesn't have good internet connectivity and other educational resources are scarce. At-home learning has also impacted deworming efforts.
“Children typically receive deworming medications at school, and with most schools closed due to COVID-19, it has become difficult to administer treatment to those at risk of infection,” says Lynn Leonard, Global Program Leader for Johnson & Johnson's STH efforts. "During the pandemic, we’ve worked with partners to ensure our medicine is still readily available for use in any setting, to help minimize long-term disruption to deworming.”
Why Peru Is on the Path to Becoming the First Country to Eliminate STH in 70 Years
At Sheti's school, she and her classmates eagerly line up with other students to receive a dose of the chewable medication from an INMED volunteer doctor.
"It tastes like strawberry!" Sheti shouts, and runs off to play soccer on the dirt pitch beneath a mango tree.
Through the campaign, Dr. Fernando Perez, National Director of INMED Andes in Peru, estimates that they will be administering 10 million doses of mebendazole per year, with the goal of reaching 80% of preschool- and school-age children in the region.
In fact, the number of children who benefit from the medication could be even greater—potentially 2.5 million more Peruvian kids across the country, estimates Dr. Linda Pfeiffer, President and CEO of INMED Partnerships for Children. Thanks to the wide distribution of medication, Peru is poised to hopefully become the first country in 70 years to eliminate STH as a public health problem.
"The Peruvian Amazon is a highly endemic area, and it's been terrific to see how this campaign has grown," Pfeiffer says. "In communities with 90% infection rates we've been able to reduce that to 50% or lower with this medication."
Deworming treatment alone, however, cannot create lasting change without improvements in water, sanitation and hygiene. In Peru, 8 million people lack sanitation facilities and 3 million lack access to clean water.
At Sheti's school, kids are also being taught about the importance of properly washing hands with soap, washing fruits and vegetables, and only drinking clean water.
Pfeiffer adds that addressing STH is crucial beyond the obvious goal of ridding a community of the parasites themselves. Programs like this one, she says, act as an entry point for communities that need new ways to access education about healthcare, well-being and self-reliance.
"With these campaigns, communities see that you're providing them with something that has immediate results," she explains. "And that makes them open to other forms of education." Pfeiffer hopes that the mebendazole campaign will open the door to other activities that can benefit communities in the long run, including academic opportunities and other health interventions.
The long-run is paramount to Johnson & Johnson, too. In addition to its donation program, the company is currently innovating to develop a new tool that uses artificial intelligence to detect worm eggs in stool samples. The goal: More accurate identification of worm eggs could lead to a better evaluation of infection prevalence, as well as where drug interventions are needed.
Together, these programs and initiatives are all pointing toward a safer world for millions of children.
At La Institución Educativa San Francisco, a group of kids lines up for a dose of medication at the end of the school day. Their moms wait for them together, sitting on the stone bleachers across from the open-air gym.
"I'm so happy they are doing this today," Ochavono says, pointing to the desk where her daughter waits to get her dose from Dr. Perez. "It's one less thing for us to worry about."
Want to meet some of the students and teachers from this inspiring donation program? Check out this video: