This year, World Water Day coincides with the International Year of Sanitation, challenging us to spur action on a crisis affecting more than one out of three people on the planet.

Every 20 seconds, a child dies as a result of the abysmal sanitation conditions endured by some 2.6 billion people globally. That adds up to an unconscionable 1.5 million young lives cut short by a cause we know well how to prevent.

Poor sanitation combines with a lack of safe drinking water and inadequate hygiene to contribute to the terrible global death toll. Those who survive face diminished chances of living a healthy and productive existence. Children, especially girls, are forced to stay out of school, while hygiene-related diseases keep adults from engaging in productive work.

Leaders who adopted the Millennium Development Goals in 2000 envisioned halving the proportion of people living without access to basic sanitation by the year 2015 – but we are nowhere near on pace to achieve that goal. Experts predict that by 2015, 2.1 billion people will still lack basic sanitation. At the present rate, sub-Saharan Africa will not reach the target until 2076.

While there have been advances, progress is hampered by population growth, widespread poverty, insufficient investments to address the problem and the biggest culprit: a lack of political will.

With the right resolve, there are many steps that members of the international community can take. The Commission Sustainable Development in 2005 outlined a series of measures aimed at securing meaningful progress, holding Governments of affected countries primarily responsible. It also called for international support through a conducive policy environment, financial resources and the transfer of technology to countries in need.

If we take up the challenge, the positive impact will reverberate far beyond better access to clean water. Every dollar invested in water and sanitation yields an estimated seven dollars worth of productive activity. And that comes on top of the immeasurable gains in cutting poverty, improving health and raising living standards.

World Water Day offers a chance to spotlight these issues, but this year let us go beyond raising awareness – let us press for action to make a measurable difference in people’s lives.

Tuesday’s New York Times prominently featured an article describing the debate in the public health community about what are appropriate goals for the fight against malaria. Goals for fighting malaria vary between improving access to control and prevention measures and full eradication of the disease. Full eradication of the disease would mean that no person has the disease, but also that it exists nowhere, except as the New York Times notes, in a laboratory. This was last accomplished with smallpox when the last naturally occurring case of smallpox was recorded in 1977 in Somalia. Smallpox was certified eradicated in 1980.

The most recent round of discussions were sparked late last year when Bill and Melinda Gates called for a push towards eradication at a conference they held in Seattle. Despite the excitement created for such an initiative, the announcement enlivened debate among the scientific community about whether eradication is a realistic goal to set for the community and the potential disappointment of setting the goal and not reaching it. Smallpox had a unique set of credentials that made it a candidate for eradication, including that it could only be carried by humans rather than be primarily carried by mosquitoes in the case of malaria.

The past several years have seen a rapid increase in funding for fighting malaria. Spending from the United States, the Global Fund and World Bank on malaria from 2001 to 2003 was only $348 million. From 2004 to 2006, this number rose to just over $1 billion. The current version of the PEPFAR bill just recently agreed to in the House called for $5 billion in spending on malaria over the next 5 years from the United States alone. This would fund the United States’ proportionate share of the global estimates to achieve universal access to control and prevention for those living in endemic countries. Senators Clinton, McCain, and Obama have all committed to significantly ramp up the United States’ spending on malaria if elected president.

Though the debate about eradication versus control is one that is largely restricted to academic settings and concerns about setting realistic expectations, it is one that is likely to increasingly play out in the public discourse as the United States moves to spend more on fighting this disease.

As a visitor to Tanzania, I’m taking malaria medication, and I bet President and Mrs. Bush are, too.

If you live here, you can’t take the medicine forever, so you get sick, and your children are at risk. But as an American and a ONE member, I’m loving that we help Tanzanians do something about it. Malaria is basically gone from Zanzibar, an island of 1 million people where it used to be everywhere, and starting to come down on the mainland.

That will happen much faster with President Bush’s announcement today that the U.S. and the Global Fund will distribute 5.2 million vouchers for low-cost nets. I understood the need when I met Godlove Kiwanga yesterday just after he left church. I asked about malaria – he had it three weeks ago, high fever, serious pain, and lost income for three days. “People with money, they stay home for one week, two weeks. I had to work.” His daughter, Carry, is 3, and she was sick in December for over a week and had to have an IV at the hospital. Carry sleeps under a mosquito net, but not the good kind. You can get long-last nights near his house in the capital, but they cost about $9 each, a lot in a poor country. “We have net original and net fakes. Fakes are cheap, 2000 shillings (about $1.80). It’s a big difference,” he said. His next child will probably get an upgrade.

Yesterday, the House passed the FY08 omnibus bill that included significant increases in funding for extreme poverty and global disease programs.

If passed by the Senate later today, FYO8 spending would include over 7 billion on global health programs, which will literally make the difference between life and death for millions of people.

Some additional highlights from the bill below:

• Basic education: The federal government will provide $694 million for grants to organizations that support basic education programs around the world. An
  estimated 72 million children worldwide lack access to basic education.
• Access to safe drinking water: With $298 million allocated for safe water programs, this legislation will enable high-priority countries to provide
  safe drinking water, build water systems and implement hygiene programs.
• Child and maternal health: The funding would provide $450 million dedicated to improving child and maternal health. Everyday, 27,000 children die from preventable, treatable diseases such as diarrhea, pneumonia and measles. Additional funding for child and maternal health programs will provide effective, affordable preventative measures such as immunizations, antibiotics, clean drinking water and vitamin supplements.

-Virginia Simmons

This week in Seattle, an extraordinary group of people – scientists, policymakers, and advocates – came together for three days to discuss what can be done to stop malaria. Melinda and I issued a challenge to those attending the meeting. We asked them to begin charting a course to eradicate malaria – not just to control or reduce it, but to work toward a time when no one on earth is infected with malaria, and no mosquitoes carry the disease.

Today, malaria kills more than one million people every year, most of them children in Africa. That’s the equivalent of losing every student in the New York City public school system in one year.

We know that eradicating malaria is an audacious goal. But advances in science and medicine, new political commitments, and the dedication of people like you have given the world an historic opportunity to conquer malaria. It won’t be easy and it won’t happen quickly, but I’m optimistic that we can make this disease history.

At the forum in Seattle, Melinda and I called on the U.S. presidential candidates to commit to expand the President’s Malaria Initiative, a great program started by President Bush. I hope you will join us in asking all of the candidates to make this pledge and keep the fight against malaria on the national agenda.

I am confident that together, we can produce the energy, compassion, and commitment needed to win the fight against malaria.

Save the Children launched a new global initiative, chaired by former U.S. Senate Majority Leader Bill Frist, to save the lives of millions of children who die each year from treatable or preventable causes in developing countries.  

 The new initiative- Survive to 5- addresses the almost 10 million children who die every year before their fifth birthday, the subject of MDG 4 on child mortality. Most of these deaths are preventable with a package of low-cost health interventions such as immunizations, insecticide-treated bednets, oral rehydration therapy, and by making health care available to the poorest and most vulnerable mothers and children.  

In addition to raising funds, the initiative seeks to public support for the importance of child survival and other global poverty issues. Senator Frist is also a co-chair of the ONE Vote 08 initiative. 

Masaiti District, Zambia, July 2007 -- The vaccination assessment team from the capital city of Lusaka listens intently as a village official describes local participation in the recent measles vaccination campaign. He believes that all eligible children in the village were taken to the vaccination posts, but urges the team to verify this for themselves.

In a nation where many households have no phone and no address, collecting health data is a daunting task.

It means getting out into some of the most remote districts, like the Masaiti District, and going from house to house, asking "Did your children get vaccinated? May I see the vaccination card?" This kind of fieldwork can generate hundreds of pages of paperwork: multiple sheets of information for each household multiplied by the hundreds or even thousands of households that are visited.

But through a year-old pilot program, Zambia is replacing paper-based health surveys with those used on PDAs (personal digital assistants). This means no data entry, no cumbersome clipboards, and most importantly no waiting weeks or months for data entry clerks to enter stacks of paper into a computer for analysis.

This week researchers are meeting in Seattle to discuss the 33 vaccine trials happening right now on every continent. The recent revelation that for every one person treated, six new people get infected has redirected crucial attention to the race for an HIV vaccine.

From an editorial in the Seattle Times:

“Treating those infected with HIV or who have full-blown AIDS is critical. But no one should forget that there is no way out of the AIDS epidemic without a vaccine.

Seattle has become a gateway for such efforts. The Bill & Melinda Gates Foundation last year put $287 million behind the collaborative efforts of 165 scientists from 19 countries. Long-term grants and improved funding from nonprofit organizations and the federal government have attracted more scientists, including younger ones, to the vaccine search.”

“Investing in sanitation is about giving people health, dignity and development,” said the Dutch crown prince Willem-Alexander today in a speech at the UN-Water Seminar in Stockholm, Sweden.

“It leads to lower child mortality, better maternal health, fewer deaths from waterborne diseases, fewer girls dropping out of school and more women playing an active role in their communities. I repeat today what I have been saying for the past several months: every dollar spent on sanitation is a dollar spent on at least five other Millennium Development Goals,” the Prince of Orange said.

The High Court of Chennai (the Indian city known as Madras) dismissed a challenge brought by Swiss drug-maker Novartis Monday. NGO’s that advocate poor countries’ access to affordable drugs applauded the ruling.

Novartis attempted to change Section 3d of the Indian Patent Act of 2005, which permits the manufacture of low-cost life-saving generic drugs for the world's poor, by only allowing drug patents of new medicines if they are significantly more effective. The case highlights the conflict between public health interests and intellectual property rights.

When Novartis filed for a patent on its leukemia drug Glivec, India’s patent office ruled the drug was simply a new form of an existing treatment that was developed before 1995. It was India's first-ever drug patent rejection. Novartis was selling Glivec in India at a cost of 26,000 dollars a year per patient, while generic versions of the drug in India cost about 2,100 dollars per patient per year.