Measles, influenza and open source software

Most people in the developed world think of measles as a pesky but fairly benign childhood disease. For the current generation, who has had the benefit of immunization with measles vaccine, it is also a historical curiosity. Not so for the developing world, where measles has been a major killer of children and infants. Africa has become the poster child for failed public health programs so it is nice to be able to say that when it comes to measles prevention, Africa is a special success story:

Africa, which has long had the most measles deaths, has seen the biggest drop, 91 percent. In many villages, measles shots, polio vaccines, deworming pills and insecticide-treated mosquito nets for malaria prevention are all being given out together.

Measles mortality has fallen less steeply in India and Pakistan, but campaigns are now starting there. (Washington Post)

This hasn't been over the long term, either. It has happened since 2001. Measles is very contagious, more contagious than influenza, which is saying something. Pneumonia and diarrheal dehydration will kill on average 10% of its young victims in the developing world. Some of those that survive suffer blindness or deafness. In 1990 the global death toll was over a million children and by 2000 it was still three-quaters of a million. That was cut by two thirds (to a quarter of a million) in the first year of the Measles Initiative, a partnership of private groups (American Red Cross), intergovernmental organizations (WHO, UNICEF) and the US CDC. So far it has cost $470 million, about two days worth of the War in Iraq. You do the arithmetic.

Measles vaccine is injected, so it's not as easy as an oral vaccine. But the Initiative has boosted vaccination rates in African children from 56% to 73%, an increase by almost a third (US pre-schoolers are 96% covered). As a greater proportion of the population becomes immune, it is harder for the disease to spread (the probability of a contact being between an infected and a susceptible decreases), so while the coverage isn't complete, this is a huge increase and the results show it.

Since we talk here a bit about Open Access publishing (and its cousin Open Source software development) the WaPo article linked above has another intriguing bit of information about this initiative:

The initiative is the first mass health project in the developing world to use hand-held computers in coverage surveys conducted to measure the success of interventions. Normally, that work is done with pen, paper and clipboard, and tabulating data takes weeks or months.

In October 2005, surveyors in tsunami-struck Aceh province of Indonesia figured out immediately after a vaccination campaign that as many as 70 percent of children had been missed in some districts. Vaccinators, who had not yet dispersed, were sent back to vaccinate in those areas.

More recently, surveyors in Africa have been using pocket computers loaded with an open-source program, EpiSurveyor, developed by a Washington-based nonprofit, DataDyne, to track coverage after supplemental measles vaccination campaigns.

I don't know this software or how specific it is for the measles program, but the fact it is an open source project means it could be adapted for other purposes -- like managing the consequences of an influenza pandemic. A facile programmer, maybe a high school student, might port an appropriately adapted version over to an iPhone or laptops to be used on a community or neighborhood level for keeping track of vaccination, cases, antiviral dispensing or who knows what else. Open Source (meaning the source code of the program is available and can be adapted or used without permission) enables the power of the hive mind to be entrained for the benefit of the community.

The use of hand held devices isn't going to save us if there is a pandemic. It is just another tool for filling the sandbags. But we'll need every tool there is when the time comes and I'll be glad if some enterprising young techie thinks this is a neat project.

Better than robots that kill people.