{"id":657,"date":"2021-04-14T13:55:36","date_gmt":"2021-04-14T13:55:36","guid":{"rendered":"https:\/\/healthcareworld.com\/festival\/?p=657"},"modified":"2021-04-14T13:55:36","modified_gmt":"2021-04-14T13:55:36","slug":"taming-the-lions-stare","status":"publish","type":"post","link":"https:\/\/healthcareworld.com\/festival\/taming-the-lions-stare\/","title":{"rendered":"Taming the Lion\u2019s Stare\u00a0"},"content":{"rendered":"

Bruce Benton,\u00a0Manager\u00a0of the World Bank\u00a0Riverblindness\u00a0programmes, on how\u00a0their\u00a0success can impact Covid rollout in\u00a0Africa\u00a0<\/strong><\/p>\n

With the emergence of Covid-19 there is more awareness of how not just novel but\u00a0<\/span>also\u00a0<\/span>neglected diseases can affect a global population. \u00a0With questions around how Africa will deal with the current pandemic and manage the vaccine rollout, the success of the river blindness programme<\/span>s<\/span>\u00a0in West Africa is a salutary example\u00a0<\/span>of<\/span>\u00a0cooperation and dedication to\u00a0<\/span>controlling and eventually eliminating a devastating, widespread infectious\u00a0disease\u00a0<\/span>.\u00a0<\/span>\u00a0<\/span><\/p>\n

The\u00a0<\/span>OCP (<\/span>Onchocerciasis Control Programme)\u00a0<\/span>in West Africa<\/span>\u00a0and the follow-on APOC (African Programme for Onchocerciasis<\/span>\u00a0Control) covering the rest<\/span>\u00a0of the continent were partnerships co<\/span>–<\/span>sponsored by<\/span>\u00a0<\/span>the<\/span>\u00a0World Health Organization, the World Ban<\/span>k<\/span>, the United Nations Development Programme and the UN Food and Agriculture Organization.\u00a0<\/span>These control efforts were<\/span>\u00a0led by World Bank\u00a0<\/span>official<\/span>\u00a0Bruce Benton, an economist with an interest in public health<\/span>\u00a0who had been shocked\u00a0<\/span>by<\/span>\u00a0the\u00a0<\/span>widespread\u00a0<\/span>devastation of<\/span>\u00a0local communities and\u00a0<\/span>personal<\/span>\u00a0suffering\u00a0<\/span>wreaked by<\/span>\u00a0<\/span>the disease.\u00a0<\/span>\u00a0<\/span><\/p>\n

Onchocerciasis<\/span>\u00a0is caused by<\/span>\u00a0a parasite (<\/span>Onchocerca<\/span><\/i>\u00a0<\/span><\/i>volvulus<\/span><\/i>)<\/span>\u00a0<\/span>transmitted by a\u00a0<\/span>blackfly<\/span>\u00a0(<\/span>Simulium<\/span><\/i>\u00a0<\/span><\/i>damnosum<\/span><\/i>)<\/span>\u00a0that lays eggs<\/span>\u00a0in and around rapidly flowing rivers and streams throughout sub-Saharan Africa, six countries<\/span>\u00a0in Central and South America,<\/span>\u00a0<\/span>and Yemen<\/span>.<\/span>\u00a0<\/span>Once\u00a0<\/span>reaching adulthood<\/span>\u00a0in the body<\/span>, the 2 \u00bd foot long parasite spawns millions of<\/span>\u00a0microscopic parasitic worms<\/span>\u00a0that<\/span>\u00a0cause\u00a0<\/span>unbearable itching<\/span>,<\/span>\u00a0skin<\/span>\u00a0disfigurement<\/span>\u00a0and<\/span>\u00a0eventually irreversible<\/span>\u00a0blindness<\/span>.\u00a0<\/span>On average, victims of the disease become blind at 30 years of age.<\/span>\u00a0<\/span>Onchocerciasis is k<\/span>nown\u00a0<\/span>locally\u00a0<\/span>as the Lion\u2019s\u00a0<\/span>Stare<\/span>,<\/span>\u00a0<\/span>due to the fixed, lifeless\u00a0<\/span>gaze of\u00a0<\/span>those blinded by the disease<\/span>. I<\/span>t<\/span>\u00a0<\/span>affect<\/span>s<\/span>\u00a0<\/span>huge swathes of\u00a0<\/span>rural\u00a0<\/span>population<\/span>s<\/span>\u00a0numbering more than 10<\/span>m<\/span>\u00a0across the African continent<\/span>\u00a0<\/span>that are often\u00a0<\/span>unable to work<\/span>\u00a0due to disability<\/span>\u00a0and are trapped in absolute\u00a0<\/span>poverty<\/span>.<\/span>\u00a0<\/span><\/p>\n

Running from 1974 to 2015,\u00a0<\/span>OCP<\/span>\u00a0and APOC<\/span>\u00a0pulled together 27 donors,<\/span>\u00a0dozens of<\/span>\u00a0NGOs,<\/span>\u00a031 African<\/span>\u00a0governments and\u00a0<\/span>more than 100,000 local communities\u00a0<\/span>into a<\/span>\u00a0diverse<\/span>\u00a0partnership that led the\u00a0<\/span>control\u00a0<\/span>effort<\/span>.\u00a0<\/span>The success of the West Africa<\/span>n programme<\/span>\u00a0has enabled<\/span>\u00a0populations to resettle and cultivate some of the best land near rivers that had<\/span>\u00a0previously been<\/span>\u00a0abandoned due to the severity of the disease.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

Ambitious beginnings<\/span><\/b>\u00a0<\/span><\/p>\n

Covering 3<\/span>5<\/span>m people in 11 countries, the<\/span>\u00a0OCP relied principally on<\/span>\u00a0vector control, i.e.<\/span>\u00a0aerial spraying with insecticides<\/span>,<\/span>\u00a0to prevent the blackfly from reproducing and transmitting the parasite<\/span>. \u00a0<\/span>\u201cIt was\u00a0<\/span>a\u00a0<\/span>very successful\u00a0<\/span>control\u00a0<\/span>strategy\u00a0<\/span>that effectively halted<\/span>\u00a0transmission of the disease<\/span>\u00a0throughout the West African region<\/span>,\u201d says Bruce<\/span>,<\/span>\u00a0whose book\u00a0<\/span>Riverblindness<\/span><\/i>\u00a0in Africa, Taming the Lion\u2019s Stare<\/span><\/i>\u00a0is now published by Johns Hopkins University Press.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201cThere was no drug at the time<\/span>.<\/span>\u00a0<\/span>S<\/span>o<\/span>\u00a0the only way we could control the disease was to prevent the fly<\/span>\u00a0from\u00a0<\/span>transmitting it.\u00a0<\/span>Vector control\u00a0<\/span>worked effectively for\u00a0<\/span>more than<\/span>\u00a0<\/span>25 years and<\/span>\u00a0<\/span>largely eliminated onchocerciasis<\/span>\u00a0throughout\u00a0<\/span>most<\/span>\u00a0<\/span>of West Africa.\u201d<\/span>\u00a0<\/span><\/p>\n

During the 1980s<\/span>\u00a0<\/span>the wonder\u00a0<\/span>drug<\/span>, ivermectin,<\/span>\u00a0was<\/span>\u00a0<\/span>found to be effective against<\/span>\u00a0onchocerciasis<\/span>\u00a0<\/span>by scientists at the American pharmaceutical giant, Merck<\/span>.\u00a0<\/span>In collaboration with the Kitasato Institute<\/span>\u00a0in Japan, ivermectin was discovered from a compound\u00a0<\/span>found\u00a0<\/span>in a soil sample<\/span>\u00a0<\/span>on a golf course in<\/span>\u00a0<\/span>Kito<\/span>,<\/span>\u00a0Japan<\/span>.<\/span>\u00a0Through clinical trials it was learned that ivermectin<\/span>, given once per year<\/span>,<\/span>\u00a0killed off 95<\/span>\u00a0per cent<\/span>\u00a0of the microscopic worms<\/span>\u00a0(microfilariae)<\/span>\u00a0<\/span>in the human body with virtually no side effects<\/span>. However, it did not kill the adult worm, which\u00a0<\/span>continued to live in the body for up to 15 years. Hence, ivermectin needed to be<\/span>\u00a0given at least once a year for the 15<\/span>–<\/span>year lifespan of the adult worm.<\/span>\u00a0<\/span>By killing the\u00a0<\/span>microfilariae<\/span>,<\/span>\u00a0<\/span>ivermectin<\/span>\u00a0<\/span>stops the itching,<\/span>\u00a0prevents\u00a0<\/span>blindness and\u00a0<\/span>halts\u00a0<\/span>transmission<\/span>\u00a0over time<\/span>. Because onchocerciasis<\/span>\u00a0is concentrated<\/span>\u00a0in the poorest populations in remote rural areas<\/span>\u00a0in some of the poorest countries in the world, Merck decided in 1987 to<\/span>\u00a0donate ivermectin<\/span>,<\/span>\u00a0under the brand name Mectizan,<\/span>\u00a0for\u00a0<\/span>\u201c<\/span>as long as needed to as many who need it.<\/span>\u201d\u00a0<\/span>It was the first major drug donation for a disease in the developing world and set a precedent<\/span>\u00a0that has since led to<\/span>\u00a0follow-on<\/span>\u00a0drug donations<\/span>\u00a0from other<\/span>\u00a0pharmaceutical companies<\/span>\u00a0for\u00a0all of\u00a0the major neglected tropical diseases<\/span>.<\/span>\u00a0<\/span><\/p>\n

\u201c<\/span>Mectizan<\/span>\u00a0became available through Merck\u2019s donation program in<\/span>\u00a0the early 1990s<\/span>.\u00a0<\/span>Under OCP,\u00a0<\/span>it was used as a supplement to vector control<\/span>\u00a0and enabled th<\/span>at<\/span>\u00a0West African programme<\/span>\u00a0to be brought to a successful conclusion in 2002<\/span>,\u201d says Bruce.<\/span>\u00a0<\/span>\u201c<\/span>However, the drug<\/span>\u00a0became<\/span>\u00a0central to the control strategy<\/span>\u00a0for the follow-on programme, APOC<\/span>, covering the rest of Africa<\/span>. Many of the countries covered by APOC<\/span>\u00a0were heavily forested<\/span>\u00a0<\/span>which prevented\u00a0<\/span>insecticide spraying via helicopters. The availability of Mectizan<\/span>\u00a0permitted\u00a0<\/span>oncho control to be widened to cover 20 additional countries<\/span>\u00a0in East, Central, and Southern Africa<\/span>.<\/span>\u00a0<\/span>And,\u00a0<\/span>i<\/span>n 2009\u00a0<\/span>it was<\/span>\u00a0discovered<\/span>\u00a0under APOC<\/span>\u00a0that where the drug had been used for 15-17 years<\/span>,<\/span>\u00a0the disease had completely disappeared<\/span>. Consequently,<\/span>\u00a0the objective under APOC shifted from control to elimination of the disease throughout Africa via sustained\u00a0Mectizan\u00a0treatment<\/span>.<\/span>\u201d<\/span>\u00a0\u00a0<\/span>\u00a0<\/span><\/p>\n

Learning the lessons<\/span><\/b>\u00a0<\/span><\/p>\n

Under the OCP there were more than 1000 people working on the programme, many working as flycatchers on\u00a0<\/span>river<\/span>\u00a0banks<\/span>\u00a0to<\/span>\u00a0catch and dissect flies<\/span>\u00a0<\/span>to\u00a0<\/span>determine whether the<\/span>y<\/span>\u00a0<\/span>were infect<\/span>ive with the parasite<\/span>. \u00a0<\/span>\u201c<\/span>OCP<\/span>\u00a0was\u00a0<\/span>high tech and expensive<\/span>\u00a0because<\/span>\u00a0we used\u00a0<\/span>a fleet of\u00a0<\/span>helicopters to spray<\/span>\u00a0<\/span>up to 50,000 km<\/span>\u00a0of rivers<\/span>\u00a0a week<\/span>,\u00a0<\/span>more than<\/span>\u00a0twice the lengths of the\u00a0<\/span>Mississippi, the Missouri, the Ohio<\/span>, and the Columbia<\/span>\u00a0Rivers\u00a0<\/span>combined<\/span>. Although the overall cost was high, it averaged out to\u00a0<\/span>less than<\/span>\u00a0<\/span>$1<\/span>\u00a0per person protected per year<\/span>,<\/span>\u201d\u00a0<\/span>Bruce<\/span>\u00a0says. \u00a0<\/span>\u00a0<\/span><\/p>\n

\u201c<\/span>Vector control under OCP<\/span>\u00a0worked well, although the fly\u00a0<\/span>eventually\u00a0<\/span>became resistant to\u00a0<\/span>temephos<\/span>,<\/span>\u00a0<\/span>the cheapest and most benign insecticide\u00a0<\/span>availabl<\/span>e<\/span>\u00a0at the time<\/span>,\u00a0<\/span>caus<\/span>ing<\/span>\u00a0a crisis<\/span>\u00a0which nearly doomed the effort<\/span>. \u00a0But\u00a0<\/span>eventually\u00a0<\/span>we\u00a0<\/span>overcame resistance,\u00a0<\/span>for the\u00a0<\/span>first time ever<\/span>, b<\/span>y using operation<\/span>al<\/span>\u00a0research\u00a0<\/span>to\u00a0<\/span>discover<\/span>\u00a0<\/span>backup<\/span>\u00a0insecticides that were\u00a0<\/span>environmentally safe and use<\/span>d<\/span>\u00a0them in rotation<\/span>\u00a0to defeat<\/span>\u00a0<\/span>resistance<\/span>\u00a0–\u00a0<\/span>a huge achievement, really.<\/span>\u201d<\/span>\u00a0<\/span><\/p>\n

\u00a0Under\u00a0<\/span>t<\/span>he second programme<\/span>, APOC<\/span>\u00a0\u2013 which was launched at World Bank<\/span>\u00a0headquarters<\/span>\u00a0in 1995<\/span>\u00a0\u2013<\/span>\u00a0<\/span>the control strategy was based solely on drug distribution through local communities<\/span>. Once it was determined that\u00a0<\/span>Mectizan<\/span>\u00a0treatment could stop transmission, the o<\/span>bjective shifted from eliminating the disease as a public health problem to eliminat<\/span>ing the\u00a0<\/span>disease entirely<\/span>.<\/span>\u00a0<\/span>APOC<\/span>\u00a0<\/span>ended in 2015<\/span>, but elimination of the disease remains the objective<\/span>\u00a0under a<\/span>\u00a0third<\/span>\u00a0programme<\/span>,<\/span>\u00a0ESPEN<\/span>\u00a0(Expanded Special Program<\/span>me for the Elimination of Neglected Tropical Diseases)<\/span>.\u00a0<\/span>\u00a0<\/span><\/p>\n

Through operational research under APOC,\u00a0<\/span>a method was found to reach a high percentage of the infected population<\/span>\u00a0in remote areas<\/span>\u00a0<\/span>by delivering Mectizan through\u00a0<\/span>local<\/span>\u00a0communities.<\/span>\u00a0The method became known as Community<\/span>–<\/span>Directed<\/span>\u00a0<\/span>Treatment<\/span>,<\/span>\u00a0or ComDT.\u00a0<\/span>\u201c<\/span>Under ComDT<\/span>,<\/span>\u00a0the communities select<\/span>ed<\/span>\u00a0volunteer community distributors\u00a0<\/span>who took responsibility for ensuring that all those at-risk in the community\u00a0<\/span>would receive a dose of Mectizan at least once a year. That proved to be extremely effective\u00a0<\/span>in<\/span>\u00a0ensuring that a high enough percentage of the at-risk population received the drug\u00a0<\/span>to stop transmission over time and eventually eliminate the disease,\u201d\u00a0<\/span>says Bruce.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201c<\/span>Up\u00a0<\/span>to 35 NGOs worked to help train the community<\/span>–<\/span>directed distributor<\/span>s<\/span>\u00a0<\/span>on how to deliver the drug,\u00a0<\/span>recogni<\/span>s<\/span>e<\/span>\u00a0potential\u00a0<\/span>side effects<\/span>,<\/span>\u00a0and<\/span>\u00a0<\/span>keep records\u00a0<\/span>to<\/span>\u00a0ensure\u00a0<\/span>that the drug was<\/span>\u00a0safeguarded<\/span>\u00a0and<\/span>\u00a0readily<\/span>\u00a0available<\/span>\u00a0when needed<\/span>.\u201d<\/span>\u00a0<\/span><\/p>\n

\u201cW<\/span>hat<\/span>\u00a0was so amazing about OCP and APOC<\/span>\u00a0was that they were led by a<\/span>\u00a0wide-ranging<\/span>\u00a0partnership comprised of<\/span>\u00a0<\/span>mo<\/span>r<\/span>e than<\/span>\u00a0100\u00a0<\/span>diverse<\/span>\u00a0partners\u00a0<\/span>who\u00a0<\/span>all pulled in the same direction<\/span>.\u00a0<\/span>This was possible because the programme<\/span>\u00a0objective<\/span>\u00a0and the\u00a0<\/span>strategy<\/span>\u00a0to achieve that objective were kept simple and consistent over time<\/span>.<\/span>\u00a0Hence, all\u00a0<\/span>the partners<\/span>\u00a0ha<\/span>d<\/span>\u00a0the same understanding<\/span>\u00a0<\/span>of the end goal\u00a0<\/span>and what was needed to get there.\u00a0<\/span>Also, t<\/span>he<\/span>\u00a0various<\/span>\u00a0partner\u00a0<\/span>groups<\/span>\u00a0\u2013 donors, African governments,<\/span>\u00a0sponsoring agencies, NGOs, and research entities \u2013<\/span>\u00a0<\/span>had different<\/span>, but complementary<\/span>\u00a0skill set<\/span>s<\/span>,<\/span>\u00a0which\u00a0<\/span>led to\u00a0<\/span>synergistic results\u00a0<\/span>through a division of labo<\/span>u<\/span>r.\u00a0<\/span>\u00a0<\/span><\/p>\n

\u201c<\/span>In managing\u00a0<\/span>the partnership, we went out of our way to recogni<\/span>s<\/span>e each partner as responsible for the success of the effort.\u00a0<\/span>Spreading credit around liberally was important in ensuring that each partner\u00a0<\/span>would stick with\u00a0<\/span>the programme<\/span>\u00a0over the long haul<\/span>.\u00a0<\/span>I<\/span>t\u00a0<\/span>also\u00a0<\/span>helped<\/span>\u00a0the partners<\/span>\u00a0\u2013 be they governments, foundations, or NGOs \u2013<\/span>\u00a0retain support domestically\u00a0<\/span>as\u00a0<\/span>the word<\/span>\u00a0got out<\/span>\u00a0that they were responsible for the success<\/span>.<\/span>\u00a0<\/span>And the continuation<\/span>\u00a0of support<\/span>\u00a0was<\/span>\u00a0remarkable. \u00a0<\/span>The original nine\u00a0<\/span>donors<\/span>\u00a0that launched OCP in<\/span>\u00a0<\/span>from<\/span>\u00a01974\u00a0<\/span>were still<\/span>\u00a0supporting the\u00a0<\/span>effort<\/span>\u00a0<\/span>35 years later.<\/span>\u00a0<\/span><\/p>\n

\u201c<\/span>There are a lot of lessons to be learnt from how the partnership\u00a0<\/span>was<\/span>\u00a0put together<\/span>,<\/span>\u00a0held together<\/span>,<\/span>\u00a0and sustained over\u00a0<\/span>decades<\/span>.<\/span>\u00a0<\/span>\u00a0It was particularly strong on cooperation<\/span>,<\/span>\u00a0<\/span>operational<\/span>\u00a0research, and<\/span>\u00a0fund mobili<\/span>s<\/span>ation<\/span>\u00a0over many years<\/span>,<\/span>\u00a0which enabled the programmes to weather<\/span>\u00a0<\/span>crises and take advantage of new technologies and<\/span>\u00a0other<\/span>\u00a0new opportunities. \u00a0We learned it had to be a regional approach, rather than country<\/span>–<\/span>by<\/span>–<\/span>country<\/span>\u00a0effort<\/span>\u00a0due in part<\/span>\u00a0to the<\/span>\u00a0up to 500 km<\/span>\u00a0flight range of the blackfly<\/span>.<\/span>\u00a0<\/span>I<\/span>f the disease was\u00a0<\/span>eliminated in one\u00a0<\/span>country<\/span>\u00a0it would\u00a0<\/span>return quickly\u00a0<\/span>via re-invading infective blackflies from a neighbo<\/span>u<\/span>ring country.\u00a0<\/span>The regional nature of the programmes also had the advantage of producing high-value\u00a0<\/span>regional public goods<\/span>\u00a0benefiting<\/span>\u00a0all\u00a0<\/span>participating\u00a0<\/span>countries, such as Africa-wide operational research<\/span>, the application of new technologies, and\u00a0<\/span>the\u00a0<\/span>development<\/span>\u00a0of\u00a0<\/span>common<\/span>\u00a0concepts and methodologies.\u201d\u00a0<\/span>\u00a0<\/span><\/p>\n

Currently, according to the WHO, 205m people are at risk of contracting<\/span>\u00a0onchocerciasis<\/span>, with 20.9m infected<\/span>\u00a0\u2013 99<\/span>\u00a0per cent\u00a0<\/span>of whom are<\/span>\u00a0<\/span>in sub-Saharan Africa. \u00a0To date 1.1m people suffer from blindness<\/span>\u00a0due to onchocerciasis<\/span>.\u00a0<\/span>\u00a0<\/span>A<\/span>nd\u00a0<\/span>NGOs<\/span>\u00a0such as\u00a0<\/span>Sightsavers<\/span>\u00a0<\/span>International\u00a0<\/span>undertake important work in helping<\/span>\u00a0to train community distributors to<\/span>\u00a0distribute\u00a0<\/span>Mectizan<\/span>, providing\u00a0<\/span>more than 513m treatments\u00a0<\/span>to<\/span>\u00a0alleviate suffering and<\/span>\u00a0<\/span>prevent\u00a0blindness<\/span>.<\/span>\u00a0<\/span><\/p>\n

\u201cThe success of the OCP<\/span>\u00a0and APOC<\/span>\u00a0programme<\/span>s along with<\/span>\u00a0<\/span>the continuing efforts of NGOs to combat<\/span>\u00a0onchocerciasis<\/span>\u00a0ha<\/span>ve<\/span>\u00a0alleviated tremendous<\/span>\u00a0<\/span>suffering<\/span>\u00a0over the past 40+ years<\/span>\u00a0and ha<\/span>ve<\/span>\u00a0<\/span>promoted<\/span>\u00a0economic<\/span>\u00a0development in sub-Saharan Africa by increasing human productivity and opening up arable land to resettlement<\/span>\u00a0and cultivation<\/span>,\u201d says Bruce. \u00a0\u201cI am extremely proud of the<\/span>\u00a0results we achieved\u00a0<\/span>to create a situation where<\/span>\u00a0many of<\/span>\u00a0the poorest of the poor<\/span>\u00a0are now<\/span>\u00a0free of suffering<\/span>\u00a0and have<\/span>\u00a0regained<\/span>\u00a0the ability to lead productive\u00a0<\/span>lives<\/span>.\u201d<\/span><\/p>\n

Riverblindness in Africa, Taming the Lion\u2019s Stare<\/span><\/i>\u00a0is now published by Johns Hopkins University Press.\u00a0<\/span>\u00a0<\/span><\/p>\n

www.sightsavers.org<\/span><\/a>\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Bruce Benton,\u00a0Manager\u00a0of the World Bank\u00a0Riverblindness\u00a0programmes, on how\u00a0their\u00a0success can impact Covid rollout in\u00a0Africa\u00a0 With the emergence of Covid-19 there is more awareness of how not just novel but\u00a0also\u00a0neglected diseases can affect a global population. \u00a0With questions around how Africa will deal with the current pandemic and manage the vaccine rollout, the success of the river blindness […]<\/p>\n","protected":false},"author":1,"featured_media":658,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[10],"tags":[],"table_tags":[],"class_list":["post-657","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/posts\/657","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/comments?post=657"}],"version-history":[{"count":1,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/posts\/657\/revisions"}],"predecessor-version":[{"id":659,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/posts\/657\/revisions\/659"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/media\/658"}],"wp:attachment":[{"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/media?parent=657"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/categories?post=657"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/tags?post=657"},{"taxonomy":"table_tags","embeddable":true,"href":"https:\/\/healthcareworld.com\/festival\/wp-json\/wp\/v2\/table_tags?post=657"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}