Remembering the NTDs on “Public Health Thank You Day”

By Peter Hotez, M.D., Ph.D. Dr. Hotez is the President of the Sabin Vaccine Institute, Director of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, and founding Dean of the National School of Tropical Medicine at Baylor College of Medicine. He is also Baker Institute Fellow in Disease and Poverty at Rice University, and University Professor at Baylor University, all located in the state of Texas.

In honor of Public Health Thank You Day, Dr. Hotez sits down to talk about his work on neglected tropical diseases and their importance in global public health initiatives:

hotezThe neglected tropical diseases – the “NTDs” – are a group of tropical infections that disproportionately plague the world’s poorest people in Africa, Asia, and the Americas. I used to refer to the NTDs as “the most important diseases you have never heard” until Ebola virus infection became a household name.

But Ebola virus infection is not even close to being the world’s most common NTD. Today, every single person living in extreme poverty suffers from at least one NTD. Many, like Ebola, are killer diseases such as African sleeping sickness and kala-azar. Indeed these NTDs killed hundreds of thousands of people in sub-Saharan Africa during the last half of the 20th century, most of them like today’s Ebola victims who live amidst conflict or in post-conflict countries and regions.

Still other NTDs are chronic and debilitating conditions such as hookworm, schistosomiasis, elephantiasis, river blindness and trachoma that thwart economic development because of their ability to damage agricultural workers and growing children, or adversely affect pregnancies and women’s health.

In the years following the launch of the 2000 Millennium Development Goals, the global public health community began waking up to the importance of NTDs and opportunities to control or eliminate them. A major approach has been to simultaneously target intestinal worms, schistosomiasis, elephantiasis, river blindness, and trachoma, with partial or complete so-called “rapid impact packages” of medicines administered once or twice yearly. The World Health Organization sometimes refers to this approach as preventive chemotherapy. Preventive chemotherapy is highly cost-effective in part because the major pharmaceutical companies are generously donating essential NTD medicines for these diseases and because they have a great safety profile and can be administered by community health workers or even school teachers. The United States Agency for International Development (USAID) recently announced that more than one billion people have received these medicines through their support, while the British Department for International Development (DFID) has also provided large scale funding as well as the private END (Ending Neglected Disease) Fund. Our Global Network for NTDs is simultaneously providing strategically placed advocacy to promote NTD awareness and support for other European nations, and some of the BRICS countries.

In parallel, there is an urgent need to conduct research and development (R&D) for new NTD drugs, diagnostics and vaccines. We have seen the horrible consequences of not investing in these products for West Africa. As a result we face serious delays in getting new Ebola virus drugs and vaccines to the people who desperately need them. But Ebola is not alone: Our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, based at the National School of Tropical Medicine of Baylor College of Medicine has a portfolio of new vaccines to combat several other NTDs including hookworm infection, schistosomiasis, Chagas disease, leishmaniasis, and West Nile virus infection.   We have been successful at early stage development for these new vaccines, but like the Ebola virus vaccine problem we need to refine and improve the roadmap and business model for rapidly accelerating their final product and development and licensure.   We have started to work with the US State Department to see whether we might enlist key research enterprises of foreign governments to partner with us in order to advance such vaccines – a concept I refer to as “vaccine diplomacy”.

We have a long way to go. Preventive chemotherapy is still reaching less than 50 percent of vulnerable populations who deserve access to essential NTD medicines, while R&D for new NTD vaccines and drugs is mostly at a nascent stage. In West Africa this fall of 2014 we have seen the dramatic consequences of doing nothing for NTD threats such as Ebola. It is an especially tragic situation that we do not have anti-Ebola virus vaccines stockpiled and ready to roll out even though the technology has been available for at least a decade in some instances. My hope is that the humanitarian crisis created by possibly not having an Ebola vaccine in time for this 2014-15 epidemic might reignite the global public health and scientific community to rethink the strategic and economic importance of new NTD products.

On November 24, Research!America and public health organizations and advocates will celebrate Public Health Thank You Day, a chance to recognize public health professionals who work round-the-clock to protect the health of all Americans. To learn more, visit www.publichealththankyouday.org.

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