We just profiled a new effort to fight intestinal worms. It’s backed by Johnson and Johnson, who will fund mebendazole treatment for helminths. This support is a logical fit for Johnson and Johnson, who are known for their health care products and toiletries, especially for children, around the world. It’s natural for them to support deworming[i], and other efforts to improve child health.

It’s also part of the long history of public-private partnerships in the battle against NTDs. The effort to combat NTDs has consistently featured innovated methods of public-private partnership. In a time when innovation is the world on everyone’s lips in global health, NTD partnerships can be a model.

One of the oldest partnerships is the Global Partnership to Eliminate River Blindness, supported from the private sector by Merck, which has been donating ivermectin since 1987 to fight river blindness in 30 countries globally. At this point, Merck has donated more than 2.5 billion tablets of Mectizan, their ivermectin formulation. River Blindness is the world’s second largest cause of preventable blindness, and the Global Partnership has now eliminated River Blindness – and documented it – in several locations.

Another flagship partnership was the International Trachoma Initiative[ii], which was established in 1998 by the Edna McConnell Clark Foundation and Pfizer. Pfizer supports community training and education programs, and it provides donations of Zithromax, a powerful antibiotic which kills Chlamydia trachomatis, the bacteria which causes the disease. Zithromax is a key component in the SAFE strategy (surgery for advanced disease, antibiotics for infection, facial cleanliness to reduce transmission, and environmental improvement.)

GlaxoSmithKline donates albendazole to support elimination of lymphatic filariasis[iii].  That’s a big deal – they have donated over 1.4 billion treatments and their goal is to donate as much albenzadole as needed to treat everyone at risk from the disease.

But it’s not the only impressive effort from GSK. They have also a neglected tropical disease propriety knowledge pool to stimulate research into medicines for 16 NTDs. It’s a complicated idea, so I will quote from their website here:

Our pool is focused on the 16 NTDs defined by the US Food and Drug Administration (FDA) as this provided a credible third-party list, which includes most of those diseases we believe to be a priority…To initiate the pool we published details of over 800 GSK patents and patent applications for small molecule pharmaceuticals which we have identified as being potentially useful for the treatment of the 16 NTDs…

Then they took the whole knowledge pool idea farther:

Since then we have had discussions with three groups of stakeholders. In discussions with the scientific and research community who could potentially benefit from the pool, we learnt that they appreciated us making the patent information public. However, what would really help them was access to our know-how and experience. They want to ask us what we have tried already and what the results were, about what worked and what did not, and about how we overcame particular challenges. We have therefore committed to making this knowledge and experience, as it relates to the 16 NTDs, available to the pool. As the pool goes far beyond patents we now refer to it as a ‘proprietary knowledge pool’.

Neglected Tropical Diseases were shut out from support by traditional donors for a long time, which forced advocates to look in other directions for funding. As funding for global health funding shrinks and the challenges we face grow, NTD partnerships can be a model for the whole field.

————————————————————————————————————————————————–

[ii] Trachoma really gives me the creeps. Every time I think about eyelids turning inwards it makes me break out in goosebumps.

[iii] Aka elephantiasis, it’s the waterborne one where you’re infected by tiny threadlike worms. Moderately less cringe-inducing than trachoma, at least if you’re me.

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.

STH is endemic to some of the poorest tropical and sub-tropical regions of the world–where sanitation and clean water are scarce. Up to 800 million children are affected by this disease, increasing their vulnerability to malnutrition and other serious infections. STH is preventable and treatable through a comprehensive approach of deworming medication and access to clean water, sanitation, and hygiene education.

“This donation paves the way for CWW to reach more children, who desperately need life-saving drugs and their basic needs met,” said Mark Rosenberg, director of The Task Force for Global Health.” Johnson & Johnson is providing a model for how business, governments, and in-country health providers can unite to address our most serious health issues and improve quality of life for millions of children globally.”

To date, Children Without Worms (CWW), a partnership between The Task Force for Global Health and Johnson & Johnson has worked to treat more than 20 million children per year with mebendazole, and to address the root causes of STH in eight countries: Bangladesh, Cambodia, Cameroon, Cape Verde, Lao PDR, Nicaragua, Uganda and Zambia. In 2001, the World Health Assembly set as a goal to treat at least 75 percent of all school age children at risk of STH by 2010. This partnership and the Company’s contributions of mebendazole are credited as primary drivers leading Cambodia, Cape Verde, Loa PDR, Nicaragua, and Uganda to reach key WHO indicators years ahead of the target date. 

CONTACT: Kim Koporc, Director of Children Without Worms
kkoporc@taskforce.org

About Children Without Worms
Children Without Worms (CWW) supports global efforts to reduce the burden of soil-transmitted helminth (STH) infections in children most severely infected or at high-risk for infection and who have limited access to safe and effective treatment. The program achieves its goal by leveraging the donation of mebendazole from Johnson & Johnson and working with national programs to promote comprehensive and sustainable control of STH. For more information, please visit www.childrenwithoutworms.org.

Established by the United Nations Educational, Scientific Cultural Organization (UNESCO) in 1965, International Literacy Day serves as an important reminder that, one in five adults worldwide is not literate. That’s about 774 million people. Two-thirds of illiterate populations are women and 75 million children are not in school. These staggering numbers themselves indicate that illiteracy is still a major economic threat to developing countries. But in addition to threatening worker productivity, it also has a major impact on health. If people are not able to read and write, they will not be empowered to seek out the appropriate health interventions when they are sick. They will not be able to read the labels on their medicine bottle.

They will not get better.

Students in Paynesville Community School in Monrovia, Liberia. Photo Credit: Glenna Gordon, UNESCO

When someone is afflicted with an NTD for instance, being literate will not only enable them to seek appropriate medical care and understand treatment methods, but also to be educated on control and prevention. A health literate person can then educate family members and others in his/her own community.

It also makes sense that countries with low literacy rates have a high NTD burden. Children who are infected with a soil-transmitted helminth or schistosomiasis have lower school attendance and performance.

According to the United Nations Development Programme Report from 2009, the five countries with the lowest literacy rates are as follows:

1. Mali: 26.2%
2. Niger:  28.7%
3. Burkina Faso:  28.7%
4. Guinea:  29.5%
5. Chad:  31.8%

Africa carries 90% of the global NTD burden. Mali for example has the lowest literacy rate, and it is not surprising that lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis and trachoma are all endemic, with 12 million people at risk for contracting one or more of these diseases.

One great way to help educate communities is through access to health campaigns, one of which was recently carried out in India. This specific health campaign was focused around one NTD—lymphatic filariasis—and the campaign itself helped educate those in the community towards a greater understanding about direct ways to treat the disease, such as washing and cleaning procedures and directions on how to take medication. Published results of the campaign indicated that compliance among individuals who were exposed to the educational outreach went from 50% to 90%. It really works.

The health campaign study is just one example, but it’s an important indicator that health literacy programs can empower communities and strengthen existing health systems.

By: Christopher R. Albon

Vaccine diplomacy is the central argument in more than half a dozen articles in well-respected publications, including, including Science and Foreign Policy magazines. However, compared to other forms of diplomacy, there exists few clear examples of vaccine diplomacy. The classic – and well cited – example is the U.S. – U.S.S.R. Cold War cooperation on an oral polio vaccine. While a great success, this type of health cooperation between belligerents might well be better defined as an outlier than a trend. If the United States is going to use vaccine diplomacy as a regular tool of foreign policy as advocated by its most predominant proponent, the Sabin Vaccine Institute’s Dr. Peter J. Hotez, then it must actively explore new forms of it.

One potential new type of vaccine diplomacy is through military to military relations. Militaries have a historic interest in immunization-based health interventions. From the Peloponnesian War to Afghanistan, infectious diseases have influenced military behavior. Furthermore, militaries weakened by disease are less capable of fulfilling their charge of providing international and domestic security. For these reasons, militaries have a long-standing interest in improving the immunization coverage within their forces. The United States’ uniformed services maintain one of the most advanced and capable public health systems in history. This system has made significant contributions to global health, including a possible Ebola vaccine. Using the United States’ military health system to strengthen the health services of foreign militaries through immunization campaigns could be the path to building valuable long-term relationships.

In many countries, the military holds a central position in the government. By developing programs to strengthen the vaccination capacity of foreign military health systems, the United States could benefit in two ways. First, increased institutional interaction between the United States military and those of foreign governments would build strong relationships between the two countries. These relationships, despite their technocratic nature, can be invaluable during future crises, offering potential avenues for dialogue and cooperation. Second, this type of military to military vaccine diplomacy improves global stability. Militaries weakened by infectious disease are less capable guarantors of security. This can make states more vulnerable to local insurgencies and political instability. By strengthening their immunization capacity, the militaries become more resilient to epidemics and thus more capable providers of domestic and regional stability.

Christopher Albon is a Ph.D. candidate at UC Davis researching human security, health diplomacy, and public health consequences of armed conflict. He writes at ConflictHealth.com.

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!

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. NTDs disproportionately impact the emerging world and exacerbate poverty by impairing child development, maternal health, and productivity.

As little as US$0.50 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 provide resources for development assistance to what Dr. Hotez refers to as “the other 50 truly devastated nations.”

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 wealthy 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.