by: Helen Coster

I’m in Washington, D.C. as part of a fellowship with the International Reporting Project. Next Saturday I head to Bolivia, where I’ll be reporting and writing on public health and a number of different topics.

One advantage of spending time in D.C.—in addition to meeting other IRP fellows and running past the White House— is the opportunity to meet with the world-class scientists and policy makers who work here. Yesterday I met with Dr. Peter Hotez, the president of the Sabin Vaccine Institute, a non-profit organization that’s affiliated with George Washington University. The Sabin Institute—named after Dr. Albert Sabin, who developed the polio vaccine— develops vaccines for Neglected Tropical Diseases (NTDs), a group of 13 diseases that affect poor people in the developing world. NTDs include diseases like guinea worm, Chagas disease, kala azar and lymphatic filariasis. Together they impact 1.4 billion people, most of whom live on under $1.25 a day.

Public health experts refer to HIV/AIDS, malaria and tuberculosis as “the big three,” because they impact a disproportionate amount of the world’s population and have powerful backers like the Gates Foundation and groups like ONE and Malaria No More. The NTDs aren’t as well known, and because drug companies lack the commercial incentive to tackle them, scientists like Hotez need to be creative about funding R&D and treatment.

Through the Sabin Institute Hotez cofounded an advocacy program, called the Global Network for Neglected Tropical Diseases, through which he hopes to raise awareness, political will, and funding to control or eliminate the seven most common NTDs. The group’s backers include the Gates Foundation and Legatum, a UAE investment group.

Hotez and his colleague, Karen Palacio, are also developing a “trust fund” for NTDs in Latin America. They’re partnering with the Inter-American Development Bank and the Pan American Health Organization to raise money for health projects that will piggyback on existing development work. If the IDB is working on a water sanitation project in Mexico, for example, the NTD partnership would promote proper hand washing and latrine use as a way of avoiding intestinal worm infection. They’re still looking for donors, so if you’ve got funding to spare, give them a call.

Other organizations like DnDi (which I wrote about here) and the Institute for One World Health do product development for NTD-fighting drugs. Sabin does development for vaccines. Hotez and his team of 35 researchers are currently working on vaccines for hookworm infection and schistosomiasis, a chronic disease caused by parasitic worms.

The Sabin team works in the labs at GWU, where they splice the genes from the parasites and add them to yeast. The genes secrete recombinant protein, which the researchers purify and pass off to two partners in Brazil—FIOCRUZ and Instituto Butantan— which manufacture the vaccines. They also conduct clinical trials in the Minas Gerais state of Brazil, where 68% of people have hookworm and 45% have schistosomiasis. The parties file the drugs with the FDA in the US and the Brazilian equivalent, ANVISA.

Within the next five years, Hotez hopes to prove that the vaccines work. If they’re approved, companies can manufacture them for under $1 a dose. The governments of affected countries would purchase and administer them.

 No one will get rich from the vaccines. But for diseases that occur exclusively in the developing world, the for-profit business model doesn’t work.

1. We announced the beginning of the Global Maternal Health Conference 2010 spearheaded by a partnership between The Maternal Health Task Force (MHTF) and the Public Health Foundation of India
2. We highlighted an upcoming Neglected Diseases Workshop in Boston
3. Alanna Shaikh gave us a lesson on the importance of sound governance structures for successful NTD programs
4. A new editorial in PLoS NTDs called for emerging market economies to join the US, UK, and Japan as partners in neglected tropical disease (NTD) control efforts
5. VOA News featured Dr. Peter Hotez on a segment about the US Global Health Initiative
6. Our Campus Challenge winner and former intern Manuel Claros shared his recent humanitarian missionto Honduras with us

For those of you in the United States, have a great Labor Day weekend!

Because of my own experience growing up in a rural Colombian community with the constant threat of contracting a parasitic infection, I knew that as an adult, I would do as much as I could to help improve the lives of children growing up in communities similar to mine. I recently joined a one-week public health humanitarian mission with Global Brigades, a nonprofit global health organization, where we worked to better the living conditions of a rural community in Honduras named Joyas del Carballo.

The Global Bridge Group!

My objectives during this trip were to identify any deworming activities and the impact of NTD control within this area, and to provide at least one family with the basic tools they need to live healthier lives in order to avoid the threat of parasitic infections.

After a week of hard work, our brigade had built a latrine, a basin for clean water, a heat efficient stove, and poured concrete over dirt floors in Don Gregorio’s home. With these new additions, his grandchildren, Hector and Catherin, will grow up free of soil-transmitted parasites. They will be able to use a clean latrine, bathe on a daily basis, and wash their hands before eating. They will be able to thrive and excel in school and to come that much closer to escaping poverty.

Their lives have changed forever.

We also visited Jose Rivera Paz Rural School, a grade school comprising of students aged 6-13 years. There, we watched a play that the students had prepared for our group. The play was an opportunity for the students to demonstrate what they have learned from community health educators and other Brigade groups, such as the benefits of the medical and public health brigades in the community. The play also included a re-enactment of a deworming activity. I spoke with one of the school’s teachers, Dora, who was funnily enough standing by a large poster of “Dora the Explorer.” She thanked us for the work we were doing in her community and then introduced us to all of her students.

Student holding up a bottle of Albendazole, used to treat intestinal worm infections

Dora also has an instrumental role in protecting her students from NTDs. She ensures that her students are treated every six months with deworming medicines supplied by the groups sent by Global Brigades.  She documents the names of children who receive treatment along with the type of drug they are receiving, then reports the numbers to the local health center.

Most of the students at this school are a part of families that have gotten new floors, stoves, water basins, and latrines through the efforts of Global Brigades. These changes within their homes and regular deworming campaigns at the school will sustain a strong new generation, one free of parasites.

Hector, Catherin, and the students at Jose Rivera Paz Rural School are all living proof of sustainable public health interventions that have been carried out by Global Brigade groups.

I plan to return to Honduras on the next Brigade to visit Hector and Catherin at their new improved home to see the impact of our project.

Manuel Claros, winner of the individual Campus Challenge, is a graduate student at GW School of Public Health MPH Global Health policy.  He is a foreign medical graduate from Colombia  with 10 years of experience in HIV prevention and education. He enjoys photography, going to the movies, traveling and cooking.

P.S.  More pictures from Manuel’s trip to come!

www.youtube.com/watch?v=01EeAp4cYmE

Video courtesy of VOA News

U.S. Secretary of State Hillary Clinton recently announced a new $63 billion Global Health Initiative with an emphasis on maternal and child health, family planning and programs to fight infectious diseases such as malaria, tuberculosis and HIV/AIDS. President of the Sabin Vaccine Institute Dr. Peter Hotez reacts to announcement.

In an editorial in the August edition of PLoS Neglected Tropical Diseases, President of the Sabin Vaccine Institute Dr. Peter Hotez calls for emerging market economies to join the US, UK, and Japan as partners in neglected tropical disease (NTD) control efforts. Entitled “Neglected Tropical Disease Control in the ‘Post-American World,’” Dr. Hotez states that the US and UK have already started commitments of up to US$100 million annually for NTD control — with plans to possibly double this amount by 2011 — while Japan has provided additional funding for global parasite control. Still, successful control of NTDs requires new financial support to complement current control and elimination efforts by the US, UK, and Japan. Emerging market economies must now join in the control efforts and share this commitment.

NTDs disable and debilitate 1.4 billion people worldwide living on $1.25 a day who are often the poorest of the poor. These parasitic, viral, and bacterial infections are devastating. They disproportionately impact the emerging world and exacerbate poverty by impairing child development, maternal health, and productivity.

As little as US$.50 annually is needed to help eliminate this global health threat.  Even with a modest commitment, BRIC, Gulf Cooperation Council (GCC) and other emerging market nations can provide the funding necessary for mass drug administration (MDA) – which is the wide distribution of treatment throughout an affected community – to support the elimination of the seven most common NTDs. This commitment will also assist provide resources for development assistance to what Dr. Hotez refers to as “the other 50 truly devastated nations,” which are countries are underdeveloped.

Dr. Hotez emphasizes that in the “Post-American World” the geopolitical and economic transformation of emerging nations could have a wide-ranging impact on the control of NTDs. He concludes that “BRIC countries, Nigeria, Indonesia and other emerging market economies, as well as the wealth GCC nations in the Middle East must agree to take on this challenge.”

To read the full article, please visit the PLoS website.

Franciscka Lucien is a research intern at the Global Network.  She is currently an MA/MPH candidate at The George Washington University.

Last week I mentioned briefly that poverty is a major factor in the spread of NTDs. It’s not the only non-medical factor that contributes to the damage done by NTDs. One thing that’s rarely mentioned in relation to NTDS – but matters a lot – is governance. Rule of law, effective government, and transparency are important to the fight against NTDs. You don’t get those from a mass drug administration, unfortunately.

Effective government starts with health system strength – having enough trained personnel, sufficient infrastructure, good data, and enough money to provide health care and support health. But the effective government needed to support health programs goes beyond the health sector. You need to be able to collect taxes or manage donor money to fund all services, including health. And you need a Ministry of Finance capable of moving the money in ways that work.

Corruption is another major issue. How much money is lost to the health sector – or the government at large – because of corruption? Government support to social services and health is lost when money goes to blinged-out private jets or overseas bank accounts. Corruption within the health sector is a problem, too. A 1997 health services survey in Uganda found that “If system leakage could be halted or slowed, indications are that health care effectiveness and efficiency could increase by 30-50%.” As one author points out, that’s a bigger impact than vaccines, which are pretty much the gold standard for high-impact health interventions.

Then there’s rule of law. Connecting rule of law to neglected tropical diseases sounds vaguely like a mad lib gone horribly wrong, but it’s actually surprisingly direct. On physical protection level, you can’t do a mass drug administration if it’s not safe for your health workers to travel into rural areas. Example: visceral leishmaniasis is endemic in Somalia. Somalia is also where the last smallpox case happened. Do you think we could eradicate smallpox now?

Rule of law also matters in ways that don’t relate to physical safety. Manufacturing or procuring NTD drugs requires a sophisticated business environment. That means the ability to draft and respect a contract, provide a line of credit if needed, and transmit non-cash payments from one party to another. You need to pay able to pay your health workers, and have them trust that you will continue to pay them. If there is a problem with a contract or payment, you need people to be able to resolve it within the justice system, not with violence. (Somalia again: I heard of a situation where two local NGOs got into a shoot-out because one group had received funding to commemorate International AIDS day and the other felt it had been unfairly awarded.)

None of these governance issues are easily resolved, but they can’t be ignored either. All the drugs and the funding in the world won’t help if you can’t get the drugs where they need to go, or don’t have the people you need to distribute them.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not neccesarily the views and opinions of the Global Network.

MeND2010 is a workshop convened in the spirit of both optimism and urgency: to showcase the array of resources (funding, organizational and scientific) available for Neglected Diseases research and to develop new resources for the ND research community to ratchet up the pace and scope of discovery. All sectors will participate: academic scientists; clinicians and other front-line health workers; funders and funding experts; scientists and managers of biopharmaceutical companies, large and small; not-for-profit product development partnerships; students and other trainees who will become the next generation of leading researchers, developers and advocates.

The workshop will focus on defined problems and develop key resources for the biomedical research community committed to developing health technologies that can help to break the cycle of poverty for the billions living, for now, at the margins of global society.

Please visit the MeND2010 website to register, or click here to be directed to the registration page. A webcast is available for those who can not make it out to Boston; more information can be found on the registration page. Registration closes Wednesday, September 8, 2010.

Experimental vision cure proves successful, Thomas H. Maugh, Los Angeles Times
Global immunizations hit record but miss millions, David Morgan, Reuters
Mystery eye disease spreads across Northern Bahr el Ghazal, Ngor Arol Garang, Sudan Tribune
Lymphatic filariasis in India: Epidemiology and control measures, S Sabesan, P Vanamail, KHK Raju, P Jambulingam, Journal of Postgraduate Medicine

1. The Global Network got an awesome opportunity to showcase a 15 second spot on the CBS Superscreen in New York City! Check out the video and join Alyssa Milano and Text “LIFE” to 30644 to End The Neglect!
2. Our wonderful communications/grassroots intern Linda shared her experience in  Honduras as a student volunteer working on construction projects for impovrished communities.
3. We got a little clinical when discussing Lymphatic Filariasis in our second “Worm of the Week” installment.
4. We got excited about the 30th anniversary of smallpox eradication!
5. Alanna Shaikh talked sandflies and giant sores, with a great article on  leishmaniasis, a horrific neglected tropical disease threatening 350 million men, women and children in 88 countries!
6. The Bill & Melinda Gates Foundation also had some great articles about smallpox this week, so we were excited to reprint them here for your reading pleasure!

It was recently pointed out to me that I’ve never covered leishmaniasis in my posts. I’d hate to make an NTD extra-neglected, so I’ll look at it today. As a quick refresher, you may recall that I named it “giant sores and organ damage disease” in my very first post on this blog. It’s also known as kala-azar.

For a somewhat more formal description of leishmaniasis, we can turn to the World Health Organization (WHO). They’re just issued an information page on the disease. (Which, by the way, is good news. It will help raise the profile of this NTD and all the others as well.) The WHO would like you to know that:

Leishmaniasis is caused by protozoan parasites belonging to the genus Leishmania. The parasites are transmitted by the bite of a tiny – only 2–3 mm long – insect vector, the phlebotomine sandfly.

Photo Credit: CDC

I think they’re kind of burying the lede there. I don’t honestly care about the length of the sandfly that transmits the parasite that causes the huge sores. (Though, on a personal note, sandflies bit the heck out of me last summer and I spent many insomniac hours worrying about leishmaniasis. Working in global health is not always good for the psyche. And I googled; we do have leishmaniasis in Tajikistan, although not in terrible amounts. It’s genetically unique.) They also suggest you watch the trailer of a film on the disease.

If you scroll down the page a little more, here’s the numbers that made an impact on me:

Leishmaniasis threatens about 350 million men, women and children in 88 countries around the world. As many as 12 million people are believed to be currently infected, with about 1–2 million estimated new cases occurring every year.

88 countries (including Tajikistan) is an awful lot of territory. And the WHO page doesn’t get into leishmaniasis control at all. Once you tell me 12 million people have the disease, and 2 million more every year, I want to know how to stop the thing. The WHO does have a leishmaniasis control page, with their chosen five points for fighting the disease (my thoughts in parentheses):

• Facilitation of early diagnosis and prompt treatment (Helps both the people who get treated and keeps them from being a reservoir for the disease.)
• Support for control of sandfly populations through residual insecticide spraying of houses and use of insecticide-impregnated bednets (I wonder if they use the same insecticides used for mosquito spraying? I am going to assume yes, otherwise the bednets situation would be ridiculous.)
• Provision of health education and production of training materials; (What are people being educated on? I guess bednets and spraying and why sandflies are bad.)
• Detection and containment of epidemics in the early stages (Not quite sure how this is different from the first point. I guess it’s based on looking at data at the population level and requires support to government bodies on data collection, as opposed to training individual health care providers.)
• Early diagnosis and effective management of leishmaniasis/HIV co-infections. (That had never even occurred to me – leishmaniasis and HIV. Makes sense though.)

I think the WHO is missing one more tool to fighting leishmaniasis, and all NTDs: poverty reduction. The NTDs are still fundamentally diseases of the poor. Less poverty will mean fewer infections. It’s not exactly the WHO’s field, I admit, but it’s worth pointing out.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’ The views and opinions expressed by guest bloggers are not neccesarily the views and opinions of the Global Network.