After 40 years, a rotavirus vaccine for newborns is in sight

The clinic is buzzing with mothers, babies and small children. The babies are weighed, measured, and given vitamins and vaccinations. Outside the gates, the village has gathered, with vendors selling snacks and colorful plastic toys. We are here for Immunization Day. We are also here helping Indonesia make history.

Working together with the teams from Gadjah Mada University and Bio Farma — the Indonesian state vaccine manufacturer — as part of the RV3 Rotavirus Vaccine Program, we are studying an innovative rotavirus vaccine that could save thousands of children’s lives and prevent sickness for hundreds of thousands more each year. A vaccine four decades in the making.

It is a rotavirus vaccine for newborns, and this village is a part of the vaccine trial.

Rotavirus is the most common cause of severe diarrhea. Every year, the disease claims the lives of nearly half a million children globally, and hospitalizes millions more. In Indonesia, rotavirus remains a leading cause of death in children under age 5, and a significant cause of childhood hospitalization. According to recent surveillance efforts, 60 percent of diarrhea-related hospitalizations in children across six Indonesian provinces were for rotavirus.

Improvements in drinking water, sanitation and hand-washing are critical for disease control, but they cannot stop the spread of rotavirus. Rotavirus vaccines are the best tools we have today to protect children from this severe, deadly diarrhea. In fact, the World Health Organization (WHO) recommended all countries include rotavirus vaccines in their national immunization programs.

Before rotavirus vaccines were available, almost every child in the world, no matter where they lived or how wealthy their parents were, would have contracted rotavirus at some point before their third birthday. Now this is changing, thanks to recent immunization efforts.

Today, there are two rotavirus vaccines on the market, providing good protection against rotavirus. The first dose of these vaccines is typically administered between 6-8 weeks of life. RV3, the new vaccine being tested by our team, is derived from a strain of the virus found in newborn babies that did not cause illness. This vaccine may provide protection against rotavirus even earlier in life. In fact, we are examining whether it is possible to administer the first dose of this new vaccine in the first days of life.

Not only does a rotavirus vaccine for newborns have the potential to begin protecting children from birth, the timing of the first dose may also help to reach more Indonesian babies. The reason is this: some mothers live far from health centers, and may not come in contact with health workers — except to give birth. Administering the first vaccine dose shortly after birth, when a woman and her baby may already be in a health care setting, could help reach those infants whose mothers do not have easy access to health centers.

There is a strong desire to implement rotavirus vaccines in Indonesia and other middle-income countries, which are not eligible for vaccine financing support from organizations like the GAVI Alliance, but so far the costs have been prohibitive — something reflected in the relative slowness in rotavirus vaccine uptake in these countries. The goal of the RV3 Rotavirus Vaccine Program is to develop a safe, effective, affordable vaccine aimed at preventing rotavirus diarrhea from birth.

While the hope is to develop and introduce RV3 for infants within the Indonesian National Immunization Program and then to make it available for global procurement, we are still a few years away from seeing this vaccine on the market. Right now, clinical trials are examining its safety and efficacy — bringing together many partners across the world, including, in Indonesia, two regional hospitals, 23 primary healthcare clinics and more than 35 doctors and 300 midwives.

Preventing rotavirus saves lives. The mothers at the clinic know this, and they are proud of the part they are playing in the vaccine trial, just as they are relieved that their babies could be protected from rotavirus diarrhea.

As my colleagues and I walk back to the car at the end of the day, the mothers press small gifts of food into our hands. All I can think of is the gift they are giving infants across the world: a chance at a healthy life, from the very earliest opportunity.

By  Julie Bines, Melbourne pediatric gastroenterologist heading the Rotavirus Vaccine Program for RV3 at the Murdoch Children’s Research Institute (MCRI), The University of Melbourne and Royal Children’s Hospital. MCRI and Gadjah Mada University in Yogyakarta are collaborating with Bio Farma to develop the RV3 rotavirus vaccine.

Broadband Blueprint Could Give China an Edge

China will pour billions into a country-wide fiber-optic network. What is the US doing?

China appears about to give the United States -- if not the rest of the western world -- another thing to worry about.

On Aug. 17, the state-owned news agency Xinhua announced an extensive "Broadband China" strategy to expand broadband coverage to at least half of the country by 2015 and to almost all the rest by 2020, reaching speeds of 20 megabytes per second (mbps) in urban areas and 4 mbps in rural areas. The plan is designed to foster business development and provide an important aid to households.

China's fastest broadband speeds are designed to reach 100 mbps, according to the Xinhua release, in marked contrast to China today, in which average broadband speeds reach 1.8 mbps, far below international standards. The country has the fastest-growing number of Internet users on the planet, now numbering 591 million according to official figures and expected to hit 718 million by the end of the year.

Broadband in the US today reaches an average of 7.4 mbps, according to a survey by Forbes Magazine. That puts the US behind nine other countries, including, for instance, the Czech Republic, the Netherlands, Latvia and Hong Kong. South Korea boasts the fastest broadband in the world today, at 14.2 mbps.

In the US, average prices, run through commercial communications companies like ATT, cost US$25-40 per month. It is unclear what China will charge.To a Hong Kong resident visiting the US, service is frustratingly uneven, with dead spots and regular delays in transmission.

The decision to provide public broadband to the entire country is yet another indication of China's willingness to use its considerable public funds to pay for dramatic modernization of its infrastructure, in contrast especially to the US, where a hostile Congress in thrall to extreme conservatives has demonstrated the intent to cut investment to the bone, raising concerns that the US will fall out of competition with its biggest rivals -- and of course the biggest of those is China.

A 2013 survey by Ernst & Young of global business found that the US ranks a lowly 17th in quality of infrastructure, just ahead of Turkey, Switzerland, Singapore, Finland and Hong Kong rank at the top.

For all the money China has spent -- RMB4 trillion in its 2008-2009 stimulus package to combat the effects of the global financial crisis, it still ranks only 23rd, just ahead of Italy and India. It still has a lot of catching up to do.

"Concerned about maintaining its economic growth, China is pouring money into an already unprecedented infrastructure building spree? constructing high-speed rail and urban mass transit systems throughout the country," the Ernst & Young report said. "The high-speed rail program, which faced serious safety and corruption issues in 2012, appears to be getting back on track. These investments have supported dramatic economic expansion, but are adding to the country's large debt burdens and creating long-term liabilities for operating subsidies and ongoing maintenance."

China has built a vast system of high speed rail while the US has dithered. "Due to fiscal constraints at the federal level and fractured jurisdiction over rail and other key infrastructure assets, the United States lacks a national infrastructure investment plan," the Ernst & Young report says. "State, regional, and local agencies are filling the void, addressing mounting issues to stretch underfunded budgets for fix-it-first initiatives and find ways to build big-ticket projects like new roads, light-rail lines, transport terminals, and levees. Increasingly, public leaders at all levels are embracing PPPs while advocating various tax and user fee hikes."

This doesn't seem to bother the Chinese. In its Aug. 17 release, the government outlined targets and timetables for broadband development in order to boost information consumption and facilitate economic restructuring. China's state-owned telecoms companies are expected to spend US$11.2 billion in 2014 on 4G telephony as well.

To give an idea of the magnitude of the project, fewer than 14 percent of the population has access to broadband today, meaning thousands of miles of fiber-optic cable must be laid to service the country.

"The development of information technology and infrastructure not only improves broadband speed, but also means more economic opportunities," said Yu Xiaohui, senior engineer with the Ministry of Industry and Information Technology (MIIT), who led the drafting of the strategy.

Internet-based consumption should grow by at least 30 percent annually to 2.4 trillion yuan (US392 million), according to the guidelines, increasing the value of industries supported by information consumption by 1.2 trillion yuan by the end of 2015.

Small and medium-sized enterprises (SMEs) will benefit from the strategy, according to Xinhua, due to increased online business as the government will support third-party e-commerce platforms to facilitate SMEs in online sales, purchasing and other operations, said MIIT Minister Miao Wei.

"The blueprint will change people's consumption habits and stimulate innovation in information products and services, thus facilitating China's economic restructuring," Yu said.  Asia Sentinel

Malaysia's Need for a New National Narrative

The post-Merdeka paradigms are near collapse

The ritualistic month-long celebrations of Merdeka (independence) activities in Malaysia have largely lost their meaning. Discussion about the roles that different groups played in the road to independence has largely been rewritten to support the current rulers of today.

The celebration of 31st August, the day Malaya gained independence from the British as the major national day, to take place tomorrow, seems to exclude the aspirations of Sabahans and Sarawakians, where on 16th September 1963 they joined Malaya and Singapore in the union called Malaysia. Groups like the Communist Party of Malaya, which fought and lost many lives against both the British and Japanese, are almost totally excluded from the narrative.

This is all occurring in an environment desperately in need of a narrative of inclusiveness.

The current Merdeka celebration suppresses the generation of new ideas and a national creativity that could spring up from an environment of inclusiveness. The celebrations have severed any empathetic connections between Malaysia's various elements within the rich and diverse history of the country, replacing it with a single narrative one would find on a cellulose film like "Tanda Putera," which purportedly describes the events of 1969 which led to the country’s worst race riots and which even before its release has kicked off a major controversy over Chinese-Malay relations.

A whole generation now exists who behave according to the beliefs and values incorporated within this narrow narrative. This denies the cascade of alternative realities and their accompanying narratives which stifles national creativity and evolution that Malaysia needs to face the challenges before it. The celebrations fail to incorporate any evolving aspirations that would promote and enhance the semblance of national unity.

Ironically under the Mahathir years, a strong national narrative existed which at the time appeared to be shared by middle-class society. Malaysia in the 1980s and early 1990s had a deep sense of national pride where any senses of inferiority were thrown out of the window with the catch cry of Malaysia Boleh (Malaysia can). Many people at the time believed it was the best country to live in. Almost 25 years on these feelings have been replaced with a sense of despair over law and order, corruption, religious intolerance and self-indulgence.

The fact that Malaysia has many domestic issues to solve and that its place in the world is slipping away, according to many international rankings, is largely out of the national discussion and public agenda. Rather it appears division is in everybody's best interests, from school administrations right up to the highest echelons of government.

Malaysia has lost that true spiritual unity between people that was the catalyst that brought independence in the first place, first with the British during the 1950s and then between the parties that made up the Malaysian union in 1963.

What is missing today are aspirations about the purpose and dreams the country was founded upon during the struggle for independence, and subsequent search for its identity as a nation. Malaysia as a nation is yet to realize that diversity has a spiritual unity about it. Suppress it and the national narrative becomes one without optimism for a just and equitable society.

The current national narrative is one captive under the old traditional caste system with little relevance to the needs of contemporary society. Consequently the Malaysian mind is a prisoner of this paradigm, unlikely to break free to enable an enlightened society.

The rulers have felt insecure with their own values, preferring to adopt a neocolonial development paradigm of unquestioned growth and development and profiteering. Development has been a game for the elite, without any questioning of this occidental paradigm. Greed and intolerance have developed into two of the most important post-Merdeka qualities.

This has been at a great cost to the development of any sense of shared spiritualism about the country. Malaysia is in need of the qualities of compassion, tolerance, mercy and forgiveness as the assumptions behind any national development agenda. This is where the universal values of Islam are important and where the true sense of an Islamic state really exists. Islam must be viewed as a way to enhance the quality of society rather than a tool to control society.

The banning of books, the demolition of buildings and the suppression of many practices is causing the cream of society to flee. Repression through brute force has cost the country dearly. Crony capitalism and corruption are keeping Malaysia in the relative dark ages. A static view of the economic pie lowers any national sense of vision. This parochial thinking is preventing any vision of a progressive and prosperous country in the coming decades, which may actually force Malaysia to become a slave to the new emerging world order.

Malaysia must find its own dream rather than adopting those of other nations. The aspirations of multi-media super corridors, Cyberjaya and biotechnology clusters are the stuff of other peoples' dreams, preventing the creation of something that could be uniquely Malaysian.

Many groups are dispossessed and have no part in the national narrative. Rather capitalistic greed entrenched within so-called development projects continue to bypass the poor and needy. Malaysia is not only divided by race but by socioeconomic class, taking the country further away from any notion of a single Bangsa Malaysia (Malaysian nation).

History has been written by those who have dominated society. Malaysians have been blinded by the political paradigm created by those who rule, preventing people from seeing new possibilities. This history doesn't match contemporary aspirations.

The evils of this progress will be felt by future generations who will have to pay dearly when picking up the pieces of a destitute and stripped environment that others before them have ravaged.

As UMNO, the ruling party, goes back into the shell of Ketuanan Melayu (Malay superiority), the language of intolerance and inequality will continue and maintain a divided country. This ignores the needs of a rapidly changing society, which will almost certainly bring further friction where the illusion of harmony may come to an abrupt end.

The current divisions within UMNO are serving the interests of a select few who can dictate the agenda. This will prevent UMNO learning how to reengage its traditional constituency and reform itself in the spirit of Merdeka.

At the same time, the popular vote in the last election strongly indicates that the majority of people are looking for some form of genuine change within society. But the election was really just a hope or even fantasy that any outcome would actually bring change of any significant nature. Real change could not occur as all the parties involved within the political process are institutionalized. Any real change requires a complete rebirth of ideas and new processes to accompany them. This requires a totally frank national dialogue in the spirit of accepting diversity in the spirit of those people who worked together to achieve Merdeka more than 50 years ago.

One may have to question the results of the political system as being an occidental outcome where a Malaysian solution is required. The Westminster system supports an adversarial system of government and opposition. Maybe the Malaysian political process should be much more consultative, like it once was. National unity coalitions may serve better than the current adversarial system of government and opposition. It's time to explore these possibilities for the sake of Malaysia's future.

Policy must be looked at through apolitical eyes, consensus and bi-partisanship. This is more the Malaysian way, where this new sense of national unity would also help develop this elusive or even mythical 'Malay unity' that many are seeking. Malaysia is not yet a large enough country where it can afford to divide its administrative talent between government and opposition. All hands are needed on the deck of government for Malaysia to prosper.

The underlying message of GE-13 in terms of both the popular vote and seat results could be interpreted as a general wish for all to work together regardless of race, color or creed. This is where the new Malaysia could be born, where justice and equity could be achieved. Malaysians must move onto new truths and reconciliations in the belief of one nation Malaysia. Otherwise Malaysia will continue to be divided with increasing frictions.

This new rebirth requires a scrapping of the current race-based political system, something often talked about. Race-based idealism must be replaced with policy-based idealism, where governments work upon a platform based on consensus. Ritual must be replaced with principled pragmatism with ample social discussion on how Malaysia should be shaped for the future. That is a fragile goal indeed.

(Murray hunter is an Australian academic and development specialist working in a Malaysian university)

The Consequences of the Syrian Conflict in Asia-Pacific-How the US reacts won't be much different from how it would react should war break out in the South China Sea

The Consequences of the Syrian Conflict in Asia-Pacific-How the US reacts won't be much different from how it would react should war break out in the South China Sea

The Syrian civil war might be out of mind and out of sight for the leaders of Asian-Pacific states. However, make no mistake, this conflict and its outcome will have a direct impact on those living here.

There is no doubt that any US intervention in Syria would delay Washington's pivot to Asia-Pacific, to the satisfaction of China but to the concern of America's regional allies. With China's increasing assertiveness, especially in the South China Sea, there are those who believe that any US intervention in Syria is an unnecessary distraction and would allow the Chinese to expand their reach in the region.

Those critics in favor of non-intervention, believing the US should wash its hands of the Middle East once and for all, and focus instead its attention on Asia-Pacific would do well to look at the big picture. Syria is Asia-Pacific.

One can extrapolate Washington's actions and reactions to imagine a possible US intervention, particularly in response to the South China Sea maritime and territorial disputes. Just as in Syria, should war break out, the US would inevitably find itself drawn in. Although the particularities may be different, the politics in Washington remain the same.

The politics of intervention
There is an unquestionable moral imperative for the US and its allies to intervene in Syria and remove President Assad from power. The use of chemical weapons against its people constitutes a heinous act that cannot be tolerated under any circumstance, and under most circumstances, if not for the obstruction of Russia and China in the UN Security Council, legal authority would have already been given for the US and its allies to intervene.

Given this, it is not legal justification that has preoccupied President Obama. With or without the permission of the UN, the US would act. To do nothing, to turn a blind eye to the crimes currently being perpetuated is equally criminal. The US may not receive legal authority by the UN to intervene; however, it has a moral responsibility to do so. There is an international coalition ready and willing, and there is a demand by the Syrian people. All that is now required is for someone to lead.

The question thus far has been the extent of US military action. How far would President Obama be willing to go in assisting the Syrian opposition? Airstrikes, drone strikes, and missile strikes may weaken government forces, but it is not enough to win the war. Planes and ships, after all, cannot hold ground; and surely this long war has weakened the strength of the Syrian opposition's ground forces.

The thought of sending US troops into the fray is undoubtedly one that has crossed the mind of President Obama. However, the sight of any American flag-draped coffin would be sure to cost a congressman or woman, or senator, his or her seat come next election. As such, congressional support and approval would be hard to find, to say nothing of the President's reservations. Still lingering in the mind of every elected official in Washington is Iraq and Afghanistan, and the financial and human cost it left.

Yet, as long as Assad remains in power, the US will be unable to focus on its commitments elsewhere. There is a very real concern that Syria's weapons stockpile would find itself in the wrong hands, such as Al Qaeda and Hezbollah. Moreover, there remain suspicions in Washington on just who comprises the Syrian opposition, and whether these forces, should they assume power, would not then turn their attention against the US.

Airstrikes alone will not defeat Assad; however, they could level the playing field and allow the Syrian opposition the chance they need to defeat Assad's forces. Conversely, there is no guarantee that the Syrian opposition, should they succeed, would not sell whatever chemical weapons or weapons of mass destruction to America's enemies. It is a question of control, and without direct control -- undoubtedly an option of last resort -- Syria will continue to plague the US long after the war is over.

Short of Assad stepping down, there does not appear to be a diplomatic solution at this time. Instead, what can be hoped is that a decisive and overwhelming military strike against the Syrian government by the US and its allies would encourage Russia to negotiate a deal to restore order in the country. Russia would surely be agreeable to any new government it can do business with rather than a government it can't.

US intervention in the South China Sea
Thus, to what extent does Syria represent Asia-Pacific? In many respects, a South China Sea conflict would pose a similar set of problems for the US as Syria. It is unlikely that the president at the time would find much support among the public to intervene in a foreign conflict far away from its shores.

Nevertheless, regardless of the American public's reluctant appetite for war and their leaders' hesitance to send troops abroad, the US will and must intervene, if only to preserve its regional interests. The question, again, is how much and how far would the US be willing to go? Whereas the Syrian civil war is restricted to within its borders, any war in the South China Sea would span across Southeast Asia and perhaps all of Asia-Pacific. The human toll could prove prohibitive.

Asian-Pacific leaders, keeping this fact in mind, would do well to curry favor with the US, to reinforce their importance to American foreign policy. It is merely a matter of quid pro quo. Just as some Southeast Asian countries are concerned with China's increasing assertiveness, so too is the US.

Yet, why should the US take these countries' concerns into consideration if they are unwilling to assist the US abroad? It would only be too easy for the US to do what it wants and how it wants without input from regional countries, unless Washington has reason not to.

Rather than urging the US to withdraw from the Syrian conflict, Asian-Pacific states should instead be ready to assist any US/NATO operation against the Assad regime, for if the Syrian people are of no importance to the US, then of what importance are the people of Asia-Pacific?

(Khanh Vu Duc is a lawyer and part-time professor at the University of Ottawa's Civil Law Section; and researches on Vietnamese politics, international relations and international law. He is a frequent contributor to Asia Sentinel.)