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:
The 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.
It is a day that gives us each the space to better understand the magnitude of the TB threat, mourn the loss of the more than 1 million people worldwide who die of TB each year, recognize the tragic consequences for their loved ones and for economic stability in impoverished nations, and express gratitude for those who conduct TB research, finance and deploy on-the-ground interventions, and advocate for the resources needed to conquer this vicious killer.
TB is the second most common cause of death from infectious disease, after HIV/AIDS. In 2012, approximately 8.6 million developed TB and 1.3 million died from the disease, with the death rate particularly high among HIV-positive patients.
There is good news on the TB front: infection rates have been falling for a decade and the mortality rate has dropped 45% since 1990. These results are in line with the millennial development goals, which set TB control metrics for 2015. Unfortunately, progress against other targets is lagging, including a slower than hoped for reduction in the prevalence of active TB and highly disappointing results in the diagnosis and treatment of multi-drug resistant TB (MDR-TB).
In the US, it’s far too easy — and a dangerous mistake — to dismiss the significance of tuberculosis. It is true that gone are the days when TB was prevalent in the US, the days when Americans were quarantined to reduce the infection rate and sent to sanitariums for treatment that sometimes worked…and too often didn’t. But with global travel, TB is entering our country, and with drug-resistant forms of the infection spreading, American lives are at risk. There have even been cases reported of totally-drug resistant TB, which means that resistance has been detected in every known treatment. The implications of an outbreak of totally drug resistant TB in the US are as ominous as they are in developing countries, particularly for those with compromised immune systems.
So what’s next? Our role as a global leader and our identity as a compassionate people underscore the importance of robust American support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as robust appropriations for USAID and other on-the-ground efforts to combat TB. For sake of Americans and the global community, the National Institutes of Health and the Centers of Disease Control and Prevention must be resourced sufficiently to develop new TB treatments, identify new prevention strategies, and assist in global TB control.
And it is important to acknowledge philanthropic and private sector efforts to combat TB, including the work of RESULTS, the Gates Foundation, and companies such as Johnson and Johnson.
When 1.3 million people die each year from an infectious disease that poses a renewed threat to the United States, waging war against that disease is not an option, it is an imperative.
The Albert and Mary Lasker Foundation has announced the winners of its 2013 Awards:
- Richard H. Scheller (Genentech) and Thomas C. Südhof (Stanford University School of Medicine) will receive the Albert Lasker Basic Medical Research Award for discoveries concerning rapid release of neurotransmitters, a process key to the way our brain cells communicate.
- Graeme M. Clark (emeritus at University of Melbourne, Australia), Ingeborg Hochmair (MED-El, Innsbruck, Australia) and Blake S. Wilson (Duke University) will receive the Lasker~DeBakey Clinical Medical Research Award for the development of the modern cochlear implant — a device that allows the profoundly deaf to hear.
- Bill Gates and Melinda Gates will receive the Lasker~Bloomberg Public Service Award for inspiring philanthropy addressing the most pressing global health concerns. Continue reading →
On June 17, Research!America hosted a Capitol Hill briefing on neglected tropical diseases in partnership with Drugs for Neglected Diseases initiative (DNDi), Global Health Technologies Coalition (GHTC), The American Society for Tropical Medicine and Hygiene, and Doctors Without Borders/Médecins Sans Frontières (MSF).
Research!America also led a series of Hill meetings last week with influential congressional offices to discuss some of the successes of USAID’s NTD program and to highlight the need for continued investments. USAID’s NTD program – which was authorized by Congress in 2006 – has helped to deliver more than 580 million treatments to approximately 260 million people through mass drug administration campaigns. We were joined by Georgetown University, Baylor College of Medicine, the Global Network for NTDs, IMA World Health and the Latin America Society for Chagas (LASOCHA). The group – which represented a broad range of partners from organizations that implement USAID NTD programs to patient advocates to leading NTD expert, Dr. Peter Hotez – discussed the importance of the USAID NTD program to their work and updated staffers on emerging issues in NTD prevention and treatment. Continue reading →
On May 15, Research!America and our partners hosted “Neglected Tropical Disease Research in Louisiana: Saving Lives and Creating Jobs,” at the Tulane University School of Public Health and Tropical Medicine in New Orleans. (Read a recap of the event here.)
Research!America produced two short videos in conjunction with the event. The first video is a broad discussion on NTDs and their effect on the Southern U.S. Chagas alone affects 300,000 Americans and has an economic impact of $1 billion, between health care costs and lost productivity.
To demonstrate what it’s like to live with Chagas, the second video is the personal story of Maira Gutierrez. She was originally diagnosed with Chagas while giving blood, but her primary care doctor was unaware how to treat it. Gutierrez believes more research and more awareness is needed to combat Chagas and other neglected tropical diseases.
An endeavor twelve years in the making, University of California, Berkeley researchers are celebrating a breakthrough in synthetic biology and malaria treatment. A research team led by chemical engineer Jay Keasling began with a straightforward—though not easy—goal of genetically reprogramming a simple single celled organism, yeast, so that it would produce a chemical compound normally only found in the sweet wormwood plant. This compound is the starting material for one of the most effective anti-malaria medications available on the market. Yet, because the compound was derived from a plant that grows in select areas around the world, the availability and price were inconsistent. Continue reading →
END7 recently released the above video aimed at raising the profile of neglected tropical diseases. END7 is a Global Network campaign which raises money to increase access to NTD treatments and strives to end seven of the most common NTDs by 2020. NTDs affect millions each year, so it is extremely important to increase awareness of these diseases among the public and major political and philanthropic leaders.
In addition to the seven NTDs targeted by the campaign, it is critical that momentum continue to build around research and control efforts for other NTDs such as Chagas, dengue and leishmaniasis. Nature recently published results from a leishmaniasis study in Nepal, which indicated that leishmaniasis drugs are not effective in one-fifth of patients. Although the study doesn’t cite a particular reason for the drug failures, many suspect that the disease is becoming resistant to the most commonly used medication. With treatment failure rates up to an alarming 70% in areas of India and Brazil, drug resistant leishmaniasis is an increasing global concern. In addition, NTDs are on the rise here at home. Texas news outlets reported that 60-80% of animals in southern parts of the state are infected with Chagas, and experts warn that the overall risk of infection has increased. Florida officials have also confirmed that dengue has officially re-established itself in the state.
Despite these challenges, progress is being made in the fight against NTDs. Inviragen, a vaccine research organization based in Colorado, recently began Phase II clinical trials for its dengue vaccine candidate. The vaccine was well tolerated in the first phase of clinical trials and experts hope that Phase II will prove its efficacy and safety in young children.
On March 24, World Tuberculosis Day, the Lancet published a series of papers on the need to combat drug-resistant tuberculosis. Cases of drug-resistant TB are on the rise, posing a growing threat to the health of populations in all parts of the world.
The series consists of six papers written by international experts in the tuberculosis field, including Professor Alimuddin Zumla, Director of the Centre for Infectious Diseases at the University College London Medical School and Dr. Marco Schito at the National Institute of Allergy and Infectious Diseases. Some papers focus on TB diagnostics, highlighting advances such as the Xpert MTB/RIF test as well as the dire need for new affordable and effective diagnostics that can detect drug-resistant strains of the disease. One paper focuses on the more technical aspects of the disease and identifies the need for additional funding to research biomarkers for drug-resistant TB. Yet another paper discusses the importance of integrated health service and control efforts, as countries are facing a high burden of TB as well as non-communicable diseases such as diabetes and cancer. Finally, the last two papers discuss the importance of community engagement in research and the need for visionary political leadership to advance global efforts to control TB.
Taken together, this series not only warns of the danger of the TB, but of the danger of inaction. If we are to make progress in the global fight against TB, we must take some of the recommendations for research and control efforts laid out in these papers. It will take concerted action from political leaders, health policy makers, funders and researchers to stem the growing threat of drug resistant TB.
-Morgan McCloskey, global health intern
Nearly 11% of the world’s population does not have access to clean drinking water. This represents a tremendous burden on global health, as almost 2 million children die from water-borne illnesses each year. Improvements in sanitation and the availability of clean water are essential to improve health around the world.
America has been a leader in clean water legislation and water-borne disease research. The late Paul G. Rogers, Research!America’s former chair, was a key leader in the passage of environmental legislation, including the Safe Drinking Water Act, during his tenure in Congress. Today, American investment in research is providing new therapies and prevention strategies for water-borne illnesses like schistosomiasis and Guinea worm disease, both neglected tropical diseases. Learn more about neglected tropical diseases here.
Here are some interesting facts for World Water Day 2013:
- Did you know that agriculture accounts for roughly 80%of the world’s water consumption?
- For every $1 invested in water and sanitation, an average of $4 is returned in increased productivity. (Source: WHO, Geneva, 2012: page 4)
- Every year, around 60 million children in the developing world are born into households without access to sanitation. (UN Water)
- 443 million school days are lost each year due to water-related diseases.
Last week, the Wall Street Journal reported that a Nepalese man detained at the U.S.-Mexico border has extremely drug-resistant tuberculosis, XDR-TB. Tuberculosis, a potentially fatal disease that can be passed through the air, has historically been curable with appropriate treatment. However, new strains of TB that are resistant to available drugs have recently emerged and pose a significant public health threat. Some strains are resistant to only a few drugs (multi-drug resistant TB) while other strains, such as the one carried by the man in this story, are resistant to nearly all existing drugs. Because of this, XDR-TB is extremely difficult to treat and experts warn that new drugs will be necessary to treat growing numbers of patients with this disease.
In addition to the need for new drugs to combat XDR-TB, this case underscores the need for improved TB diagnostics. Because this man was tested in the U.S., his samples were sent to an advanced laboratory that had the equipment necessary to detect the drug-resistant strain. However, many developing countries where TB poses the largest burden do not have the technological or health infrastructure to accurately diagnose XDR-TB cases. Therefore, patients may not receive appropriate treatment, which is detrimental to their own health and means that they can continue to pass drug-resistant TB onto others. Research to develop simple, efficient and low-cost TB diagnostics is urgently needed.
Unfortunately, this story is not an isolated case. Prior to entering the U.S., the man had made his way through 13 countries and had likely come into close contact with hundreds of people, many of whom may have been infected. In this era of globalization, diseases will continue to cross international borders and it is imperative that public funding for new tools and for this type of research is sustained.
–Morgan McCloskey, global health intern
Did you know that neglected tropical diseases such as dengue, Chagas and hookworm affect over 1.4 billion people worldwide, including individuals here in the U.S.? To discuss the global burden of NTDs and how federal funding and policy decisions impact the research and development of tools to combat these diseases around the world, Research!America will be hosting a panel at the Consortium of Universities for Global Health (CUGH) conference*. The panel, “Are NTDs a Growing Threat? Research, Access and Next Steps,” will be held on Thursday, March 14 at 1:30 p.m. at the Marriott Wardman Park Hotel.
The conversation will be moderated by Karen Goraleski, Executive Director of the American Society of Tropical Medicine and Hygiene (ASTMH) and will feature the following panelists: Rachel Cohen, Regional Executive Director of the Drugs for Neglected Diseases initiative (DNDi); Brian D’Cruz, Emergency Physician with Doctors Without Borders/Médecins Sans Frontières North America; LeAnne Fox, Medical Officer and Team Lead on NTDs at the Centers for Disease Control and Prevention (CDC); Kristy Murray, Associate Professor of Pediatrics at the National School of Tropical Medicine, Baylor College of Medicine and Mark Rosenberg, President and CEO of the Task Force for Global Health.
*Please note that attendance at the CUGH conference requires registration fees. For more information, please visit the conference website here.