Ms.Yang Hee Kim (center) with local collaborators in Odisha, India.

IVI and its collaborators in Odisha, India conducted a mass vaccination campaign with an oral cholera vaccine (OCV). Over 31,000 people received the vaccine through the campaign, which was conducted using Odisha’s public health infrastructure. The results of the campaign were published this February in PLOS NTD. We talked to Yang Hee Kim, IVI Associate Research Scientist, who worked on this project, to learn more about her experiences in Odisha

Before we begin, could you please tell us a bit about yourself, your work at IVI, and how you became involved in the Odisha project?

Yes, I have a Bachelor’s degree in Nursing Science and a Master’s degree in Public Health from Yonsei University (Seoul, South Korea). I am in the Vaccine Development and Delivery Unit at IVI, where I have worked for the past three and a half years. I became involved in the Odisha project two months right after joining IVI. They needed someone with a public health background and with prior experience working with patients, and I had both. Even though I had never been to India before, I was very excited to participate in this project.

What was the project about?

The project was about delivering an oral cholera vaccine (OCV) in a public health setting. More often than not, vaccine studies are conducted in research settings, but this time it was different because we wanted to see if the OCV could be given in a “real life” situation. We call this a public health setting, because the vaccine is given under real-life conditions using the community’s own resources, like its own community health workers and its own government structure. Over 31,000 people from a rural, resource-limited community were vaccinated.

Why conduct the study in Odisha?

And where exactly is Odisha? We worked in Odisha because communities there were identified at a high risk of cholera during the rainy season. In fact, it was during a meeting among Indian policymakers in 2009 that several stakeholders recommended introducing the OCV there. Odisha is in the northeastern part of India, on the coast and adjacent to the Bay of Bengal. To get there from South Korea, I had to fly from Seoul to Singapore and then to Delhi or Kolkata, as there are no direct flights. Once at Odisha airport, I took a 1.5 - 3 hour bus ride to the city of Puri, where we conducted the work.

Can you tell us more about the team that you worked with in Odisha?

The IVI project team was a very diverse group of people; I believe we were five Koreans, three Nepalese, one Bangladeshi, and one Indian. Not all of us were there at the same time; we took turns over a two-year period. We also worked with a lot of local people. Some of them were very young and enthusiastic people in their twenties who worked for the Regional Medical Research Center in Bhuvaneswar, Odisha. They were our main connection with Odisha’s community health workers. Overall it was a very good team!

You seem very happy when you talk about your team. What made your team so good to work with?

We were all very enthusiastic about conducting our work. Field work can be very hard so enthusiasm is key. I remember temperatures were very high during the vaccination days, sometimes as high as 43 degrees, and we did not have an air conditioner in our office! It was very humid and there was a lot to do. In some villages, a lot of people were queuing to receive the vaccine. Sometimes we could not even stop for lunch because there were so many people queuing, and we did not want to make them wait in the hot and humid weather. But there were fun times too. At the end of the vaccination, our team celebrated with local food and drinks.

What was your favorite food whilst working in Odisha?

There were so many! My favorite dish was Vindi Massala.

What was the most difficult challenge you encountered in Odisha?

Well, the initial challenge was that before Odisha I had no experience working in developing countries. I had to adjust very quickly! A second challenge was the language barrier. I had to work with interpreters as local people speak Oriya and not English. Perhaps a third challenge was that our team didn’t know what to expect before my trip there. We were initially concerned that, being Korean, I may look too different and that this would discourage local people from trusting us or from participating in the mass vaccination. But when I worked in the villages, the local people were very friendly, and they approached us and talked to us. I didn’t understand what they were saying but they were friendly and smiling. Some of them even asked to take photos of us with their cell phones!

Is there anything you would like to convey to our donors or to our audiences?

First, I would like to thank all of the donors (Bill & Melinda Gates Foundation, Governments of South Korea, Kuwait and Sweden, and the Korea Racing Authority) for their support. Even though it is not a typical clinical trial that we usually have conducted, I think it is important to realize that this type of study is very important because we identify operational challenges associated with the introduction of a ‘new’ vaccine in the community. Based on our experience, we recommended the use of a controlled temperature chain during vaccine delivery, which has become an important agenda for delivery of the cholera vaccine in other settings around the world. Another recommendation is a simpler presentation of the vaccine to make it easier to administer. This was our first experience on the use of this vaccine using the public health infrastructure. I would like to request donors to continue supporting this type of project.

What is next? What happens to the Odisha project now?

Well, after the vaccination, we got funding from the Thrasher Foundation to conduct a vaccine effectiveness study, which is nearly in its final stage. Also, after successful completion of this campaign, the Odisha government is planning to use this vaccine in other more remote areas targeting the tribal communities that are at risk of cholera.