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Child health trials will not prove a failure in the long term

This week, hopes were dashed about the possibility of using a new vaccine to protect children from tuberculosis (TB).

The medical community had been optimistic about the new vaccine, known as MVA85A. Trials among adults had gone well, where the vaccine had stimulated a good response in the immune system. However, when tested among nearly 2,800 babies in South Africa, the new vaccine did not have the same effect in small children.

Speaking to The Guardian, the professor responsible for the development of the vaccine admitted that it “induced modest immune responses against TB in the infants, but these were much lower than those previously seen in adults, and were insufficient to protect against the disease.” Despite this disappointing result, the medical team were upbeat about the future. They believe results from the trial will provide vital learning data and help them develop a successful vaccine in the future.

This belief reflects an important, but often little discussed fact – that most ‘success stories’ rely on a previous history of failures. It’s a basic principle in science that breakthroughs and successes often follow from analysing why previous attempts went wrong.

With this principle in mind, researchers at Mumbai’s City Initiative for Newborn Health have recently published their disappointing results from a three-year programme to improve maternal and infant health in the city’s slums. The project used a model which had been successful elsewhere in India (as well as Nepal and Bolivia) and reduced newborn mortality rates by 30-40%. This had been achieved by setting up regular women’s groups and having social workers discuss health issues.

However, whereas such groups had worked in rural areas, in the urban setting of Mumbai’s slums, the approach proved ineffective. Mothers in the crowded slum community of Mumbai (home to around 7.5 million people) were often reluctant to depend on neighbours or join groups from other slum blocks. And in the city, women were less reliant on basic health advice and more in need of physical improvements such as safe water, sanitation and better emergency care. 

In response to the findings, the Indian team therefore rebooted the programme to offer more concrete assistance, such as providing immunisation, feeding and family planning services through small health centres and helping families access the city’s convoluted health and social service systems. This collective organisation approach appears to be working much better in the slums. Reporting on this ‘learning-from-failure’ project, the New York Times’ global health reporter concludes that “making a difference in the world is hard, often messy work”, but charities and development organisations should be open about their failures (as well as their successes), since these can provide lessons which are just as valuable in the long term.

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