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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

Topics covered at the conference include Ideas and Interventions to Improve Maternal Health, Underlying Factors in Maternal Mortality and Morbidity, Policy, Advocacy and Communications, and much more.

Check out the conference’s livestreaming schedule, and spread the word about the Conference by using their hashtag #GMHC2010 on Twitter.

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!

By: Dr. Tadataka Tachi Yamada

When I was growing up in Japan, my close friend Keichi Maruyama, who lived right next door to me, was crippled from polio.

Most people today are too young to remember, but it was a disease that struck fear into every family. We knew it could hit home at any time.

Dr. Tadataka Tachi Yamada watches as a boy receives a polio vaccination at Bhairon Mandir Temple. Tachi was there to understand the importance of transit and migratory populations in contributing to polio transmission. New Delhi, India. April 5, 2009. Photo courtesy of the Bill & Melinda Gates Foundation / Prashant Panjiar.

Polio is no longer a threat in most of the world, thanks to a polio vaccine and an enormous global commitment. We are now locked in a mortal battle to completely eradicate the disease and have reduced the fight to just four countries – Nigeria, India, Afghanistan, and Pakistan.

This week I attended a symposium to commemorate the 30th anniversary of smallpox eradication. Thanks to the development and delivery of a vaccine, we achieved one of the greatest global health victories of all time. Vaccines are the most important and cost-effective intervention available to prevent illnesses and death.

I believe the fundamental lessons from smallpox can be applied to many diseases, especially the fight against polio. We need political will, sufficient human and financial resources, and ongoing scientific innovation

Of course there will be challenges along the way. I think the biggest lesson from the smallpox success is that we must approach each new challenge with the spirit of continuous learning and be flexible enough to adjust along the way. We must do the same until the world is polio-free, so that our children’s children will never have to say: “You came this close and gave up.”

Dr. Tachi Yamada, president of the foundation’s Global Health Program, leads the foundation’s efforts to help develop and deliver low-cost, life-saving health tools for the developing world. He oversees Global Health’s grantmaking, which focuses on four major activities: discovery, development, delivery, and advocacy.

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.

By: Walt Orenstein

I will never forget March 16, 1975.  It had been almost four months since I began working in India’s largest state, Uttar Pradesh (UP), to try to eradicate smallpox. 

On that morning, I was contacted about a new case of smallpox.  I reached the patient about 1 ½ hours after she died from an unusual complication, late hemorrhagic smallpox.  Her name was Shanti, a 7 month old child, the daughter of Pyari Lal. She was probably infected by her sibling.  Her death was totally preventable, but fortunately she turned out to be the last case of smallpox in UP.

We finally broke the human chains of transmission of that terrible virus.  That experience in India taught me how serious vaccine preventable diseases could be and how powerful vaccines are in preventing these types of tragedies.

Walter A. Orenstein, M.D doing community outreach in Aligarh, Uttar Pradesh, India during the successful 1975 smallpox eradication campaign. Photo Credit: Bill & Melinda Gates Foundation

The eradication of smallpox showed that effective vaccines can lead to the ultimate goal: the permanent end of a serious affliction of humankind. Smallpox eradication is our generation’s gift to all future generations.

Polio is the next vaccine-preventable disease targeted for eradication. This terrible disease causes severe, life- long, crippling illness.

As a child, growing up in the United States during the 1950s before polio vaccines were available, I remember the fear and panic that spread through the community at the height of the summer-fall epidemics.

With effective polio vaccines, we eliminated the disease in all of North and South America. Europe and major sections of East Asia have also been certified as polio free. Now, we have the opportunity to finish the job.

Many of the lessons learned from smallpox eradication have been applied to today’s polio efforts. Using a strategy tailored to the specific vaccine coupled with finding and investigating each individual case are critical for success. They also help to measure progress, inform adjusting tactics and identifying the need for continued research to develop new tools to achieve eradication.

The world is very close to being polio free–there has been a 99 percent reduction in cases, compared to when the eradication effort started. We have reduced the number of countries in which polio is endemic from 125 to 4.

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Editor’s Note:  The Global Network for Neglected Tropical Diseases is a major initiative of The Sabin Vaccine Institute. The Sabin Vaccine Institute is proud to convene, along with Fundação Oswaldo Cruz and the Fogarty International Center, a symposium to commemorate the 30th anniversary of smallpox eradication. “Smallpox Eradication after 30 years: Lessons, Legacies and Innovations” will be held August 24-27, 2010 in Rio de Janeiro, Brazil.  Watch a live stream of the SEC 2010 smallpox symposium here. The feed will be available from 5 PM EST August 24, 2010 through 12:30 PM EST August 27, 2010. Please check the agenda for more information.