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.
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 hosted a forum, “Neglected Tropical Disease Research in Louisiana: Saving Lives and Creating Jobs.” The forum, featuring leading NTD experts from the region, was held at Tulane University School of Public Health and Tropical Medicine in New Orleans.
Pierre Buekens, MD, PhD, dean of the Tulane University School of Public Health and Tropical Medicine, made opening remarks. He set the scene for the day, reminding us that there is a false divide between global and domestic health. Dr. Buekens pointed out that borders don’t matter when we share climates and that NTDs can affect people in all corners of world, including New Orleans. He argued that the US is not doing enough to address the threat of NTDs and said that it is “really time to wake up, we really can’t tell other countries what to do if we don’t address it at home.”
The first panel focused on NTDs and NTD research in the U.S. and Louisiana in particular. The panel was moderated by Dean Buekens and featured the following panelists: Patricia Dorn, PhD, Professor of Biological Sciences at Loyola University New Orleans; John B. Malone, DVM, PhD, Professor of Pathobiological Sciences at Louisiana State University; Raoult C. Ratard, MD, State Epidemiologist at the Louisiana Department of Health and Hospitals and Dawn Wesson, MS, PhD, Associate Professor of Tropical Medicine at Tulane University. Continue reading →
Research!America and Global Health Experts Focus on the Economic and Health Burden of Neglected Tropical Diseases in the U.S.
Leading researchers discuss emerging health threats at panel discussion
During a panel discussion today at Tulane University’s School of Public Health and Tropical Medicine, hosted by Research!America, several researchers and leading public health experts said the nation must increase public awareness and research to address the emergence of neglected tropical diseases (NTDs) in the U.S.
NTDs, commonly associated with the developing world, have recently been identified in many parts of the country including Louisiana. Factors such as increased globalization, trade, migration, urban sprawl or climate change have been cited as potential underlying causes for the emergence of NTDs in the U.S. Chagas disease, which can cause heart failure, affects more than 300,000 people across the nation and costs the U.S. an estimated $1 billion in health care and lost productivity each year. Researchers at Loyola University New Orleans identified the first locally acquired case of Chagas disease in Louisiana. Continue reading →
Based on their name, you might think that neglected “tropical” diseases (NTDs) aren’t something American physicians would encounter often. While that may have been true in the past, there is a growing threat of tropical illnesses spreading through the U.S. Many factors may contribute to the rise in incidence, but the bottom line is a very real health threat that the American medical community may not be prepared to face.
Take the story of Maira Gutierrez, for example. A resident of the U.S. for over 30 years, she found out she was infected with Chagas, a neglected tropical disease, after she donated blood. For years, no medical professional could provide more than cursory information about her disease, nor prescribe a treatment. Just like her diagnosis, she felt “neglected” by the medical community. Gutierrez and other patients will be featured in a video as part of our upcoming Neglected Tropical Diseases Forum at Tulane University in Louisiana on May 15. Continue reading →
April 20-26 is World Immunization Week. Sponsored by the World Health Organization, World Immunization Week is intended to raise awareness and support for one of the world’s most powerful tools for health – vaccines.
Immunization is an extremely successful and cost-effective health intervention, preventing an estimated 2 million to 3 million deaths each year. In addition to saving lives, vaccines save money by avoiding the health care costs and lost productivity that accompany illness. Thanks to the global immunization campaign led by WHO, smallpox was completely eradicated in 1980 – the first disease so classified. Polio, another vaccine-preventable disease, is close to being eradicated. In fact, during an “Ask Me Anything” session on Reddit, Jos Vandelaer, MD, MPH, director of UNICEF’s Global Immunization Program, said that polio could be eradicated by 2014.
Despite these successes, significant challenges remain. More than 22 million children are still incompletely vaccinated at 12 months of age, in part due to logistical difficulties with storing, maintaining the safe temperature of, and transporting vaccines in low-resource settings. Moving forward, it is critical that governments worldwide adopt strategies to ensure the safety and efficacy of vaccines and support research to improve the global vaccine supply chain. Additionally, vaccines simply do not exist for many diseases, including a majority of neglected tropical diseases (NTDs) which affect more than 1.6 billion people worldwide. More research investment is necessary to develop the next generation of vaccines and technology that could have the power to prevent NTDs and other global diseases.
– Morgan McCloskey, global health intern
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.
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.
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.
On February 5, the Task Force for Global Health, a non-profit based in Decatur, Georgia announced that it received a $28.8 million, five-year grant from the Gates Foundation for neglected tropical disease research. This funding will support the new Neglected Tropical Diseases Support Center and will allow the center to work with the NTD community to address challenges in implementing NTD control programs. The Center will focus primarily on operational research and will work to develop new solutions to increase the efficiency and cost-effectiveness of NTD interventions. The grant will also support the development of a “Coalition for Operational Research for NTDs,” which will allow for more collaboration between international NTD researchers. Awarded just over a year after the London Declaration on NTDs, this grant is an important step forward in the fight against NTDs as it “will support the research needed to eliminate and control these dreaded diseases.”
-Morgan McCloskey, global health intern
In November 2012, the Hudson Institute and the Global Network for Neglected Tropical Diseases released a Social and Economic Impact Review on Neglected Tropical Diseases. The report, which was the culmination of a comprehensive research and policy analysis study, outlined the economic and social impact of seven of the most common NTDs including lymphatic filariasis, onchocerciasis, trachoma, schistosomiasis, hookworm, ascariasis and trichuriasis. These diseases impose a huge economic burden by causing roughly 46-57 million years of healthy life lost due to premature death or years lived with a disability. The report also quantified the economic burden in terms of lost productivity caused by NTDs and highlighted the success of current treatment efforts. For example, trachoma, the world’s leading cause of preventable blindness, causes up to $5.3 billion in lost economic productivity each year while treatment efforts for lymphatic filariasis have saved over $24 billion in lost economic productivity.
The report argues that one of the most promising ways to treat many of these NTDs is mass drug administration (MDA), which involves treating entire populations with drugs for the seven most common NTDs. These MDA programs are also successful examples of critical public private partnerships. The combination of federal government investments in basic R&D and private sector investment in later stage R&D has produced crucial drugs that private sector companies are now donating in order to support mass drug administration programs. These public private sector collaborations, combined with investments in research and development for new tools to control NTDs, remain one of the core recommendations from the report. Research!America will continue to advocate for federal government support for R&D for NTDs and will be working with the private sector to limit the economic devastation and healthy life years lost to these diseases.
-Chris Bennet, Senior Manager of Global Health R&D Advocacy