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 October 11th, World Sight Day, the World Health Organization will raise awareness about visual impairment around the world, as well as their Vision 2020 initiative aimed at eliminating avoidable blindness by 2020. WHO estimates that 285 million people worldwide are visually impaired and about 39 million of those individuals are permanently blind. However, up to 80% of these cases are due to preventable causes like cataracts, glaucoma, diabetes, trachoma and onchocerciasis. The last two causes on that list may not sound familiar – trachoma and onchocerciasis are two types of neglected tropical diseases (NTDs), diseases that have historically received little attention despite affecting 1.4 billion people throughout the world and right here in the U.S. On World Sight Day, we must not only raise awareness about these diseases, but of the need for additional funding and research to eliminate NTDs once and for all.
As the world’s leading cause of infectious blindness, trachoma results in an estimated $2.9 billion in lost productivity each year. Trachoma is a parasitic infection that mainly affects poor, rural communities in Africa and Asia. WHO has established key strategies for eliminating the disease, including surgery and antibiotic treatments for affected individuals and educational campaigns about the importance of facial cleanliness. International partnerships between the U.S. Agency for International Development, the International Trachoma Initiative and pharmaceutical companies have implemented these programs and helped to reduce trachoma cases from 149 million in 1997 to 60 million in 2008. Onchocerciasis, or river blindness, is the second leading cause of infectious blindness and can result in over $30 million in economic losses each year. Onchocerciasis is a parasitic infection transmitted through black sand flies and primarily affects river communities in sub-Saharan Africa. Through collaboration with global partners like WHO and USAID, the African Program for Onchocerciasis Control has focused on insecticide spraying and administering drugs in high risk communities since 1995. Overall, this strategy has reduced cases of river blindness by 73%, down to an estimated 37 million cases today.
This year on World Sight Day, we must celebrate the progress that has been made, while recognizing that there is clearly more work to be done. Current programs can be difficult to implement in rural areas and vaccines do not exist for either of these diseases. Additional investment in NTD research to develop new prevention and treatment methods will be an important component for Vision 2020’s efforts to eliminate preventable blindness around the world.
–Morgan McCloskey, global health intern
On Friday, September 7, at the National Institutes of Health campus, the Trans-NIH Global Health Working Group hosted a lecture titled, “Rapid, automated diagnostics for tuberculosis: a potential new benchmark.” Mark Perkins, MD, who has worked at the Global Tuberculosis Programme of the World Health Organization and is currently the chief scientific officer at the Foundation for New Innovative Diagnostics (FIND), discussed the development of a new testing method for tuberculosis.
Identified as the cause of death for 1.4 million individuals in 2010, including people in the United States, TB is a significant global health concern. However, it is consistently underdiagnosed due to inadequate and outdated testing methods. As Perkins explained, “The primary test for TB in 2004 was practically the same as the primary test for TB in 1882.”
These outdated methods could take weeks to deliver results and could not detect drug resistant strains of TB, leaving patients completely untreated or treated with the wrong drugs. With recent reports from WHO estimating that 9% of TB cases worldwide are extremely drug resistant, new methods to recognize these strains were desperately needed.
Funded in part by the National Institute for Allergy and Infectious Diseases, collaboration between FIND (a Geneva -based product development partnership involved in research for global health), California-based biotech Cepheid and the University for Medicine and Dentistry of New Jersey led to the development of a new diagnostic for tuberculosis in 2010. The test, called Xpert MTB/RIF, allows health care workers to diagnose TB and detect drug resistance in less than 2 hours. The speed and accuracy of this test allows individuals to receive appropriate treatment the very day they are diagnosed, which is critical in those parts of the world where many patients live far away from medical centers. The Xpert machine has already been implemented in several countries with remarkable success; in clinical trials, more than 95% of TB infections have been accurately identified.
In light of this success, several audience members raised questions regarding the broader applications of this diagnostic. Perkins noted that Xpert could be used as a basic model for new diagnostics to identify other strains of drug-resistant TB and possibly other diseases as well. Other audience members had questions about the feasibility of implementing this diagnostic in low-income settings. In response to an inquiry about the costliness of the test, Perkins noted that “because TB has such a high mortality rate, any successful diagnostic tool is cost effective.”
He pointed out that the U.S. government and other partners have agreed to help finance the manufacturing of this test, reducing the market price from $16.68 to $9.98 per test. Perkins emphasized that this kind of support for new diagnostics is crucial, particularly because TB tests are not the only outdated diagnostic. Although new diagnostic tools could dramatically improve treatment for several diseases, only a few private companies and PDPs are working to develop them. Continued U.S. government support for this project and R&D for new diagnostics is essential for future efforts to combat critical global health issues.