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.

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.

Lancet seminar: lymphatic filariasis and onchocerciasis, NeLM news service
Medications to Treat Human Worms, Amy O’Connell, Live Strong
Merck Provides New Funding to Fight HIV/AIDS in Botswana, PharmaLive
Study of cell division sheds light on special mechanism in egg cells, Lab Spaces

Urine samples from school-aged children from Nérékoro in Ségou region of Mali. Three samples on right show visible haematuria, which indicates infection with S haematobium. Three samples on left are not haematuric at visual inspection but could still contain abnormal number of red blood cells. Urine cloudiness (third sample from left) is early sign of abnormality. Photo Credit: The Lancet

In an editorial in the August 13 edition of The Lancet, authors representing the Sabin Vaccine Institute, the World Health Organization (WHO) and the Imperial College of London call for increased supplies of praziquantel for the African continent.  Praziquantel is the only commercially available treatment for human schistosomiasis, a devastating neglected tropical disease (NTD) affects an estimated 200-600 million people worldwide, with the vast majority of cases occurring in Africa, and causes chronic anemia and inflammation associated with severe disability among children, adolescents and young adults. Schistosomiasis produces a disease burden that could exceed that of malaria.

NTDs are devastating, disabling and debilitating parasitic and bacterial infections that adversely affect the poorest 1.4 billion people worldwide living on $1.25 a day. Such conditions promote poverty because of their impact on child growth and development, pregnancy outcome, and worker productivity, all of which adversely impact the earning capacity of already impoverished individuals and communities.

Authors Dr. Peter Hotez (Sabin Vaccine Institute), Dr. Lorenzo Savioli (WHO), Dr. Dirk Engels (WHO) and Dr. Alan Fenwick (Imperial), emphasize that because an estimated one billion tablets are needed to treat 400 million people annually or every other year, at least 10-20 times the currently donated praziquantel is necessary to increase treatment for schistosomiasis in Africa.

The authors conclude by stating that, “… praziquantel is urgently needed for sub-Saharan Africa now, and the current failure of the global community to provide access to this essential medicine is impeding sustainable development in Africa. The shortages of praziquantel should be treated as an African humanitarian crisis.”

 Read the full article here 

I like good news, and this week has sure been short on it. Today, for example – we have added massive landslides in China to the floods in Pakistan and the forest fires in Russia. We could all use a good success story with interesting implications and – hey – I’ve got one:

The Stop Buruli consortium has successfully gene sequenced the bacteria that transmit Buruli. Buruli ulcer, for the unfamiliar, is a disgusting flesh-eating disease that leads to open sores and deformities. It generally affects children and young people, and it’s primarily found in West Africa (though it also shows up in Asia, Latin America, and Australia. I am hoping they mean some part of Asia far away from Central Asia, where I live.) And – this is fun – we’re not sure exactly how it is transmitted.  It has a mechanism beyond just skin-to-skin contact. It seems to be linked to slow moving water. Maybe.

Efforts to fight Buruli have severely hampered by the confusion over transmission. Eliminating environmental transmission of a disease is a tall order; witness the massive effort that has been required to battle Guinea Worm. Trying it to get rid of the conditions that transmit a disease when you don’t know what they are? Very, very hard.

That’s what is so cool about the gene sequencing. Sequencing the bacteria that causes an ulcer doesn’t seem like a big deal on their surface – well, it didn’t to me when I got the press release, anyway – but if we can gene sequence the bacteria, we can track transmission. We can finally figure out how Buruli infection travels. And then we can figure out how to put a stop to it.

So there’s the good news portion of this blog post. We will now enter the speculative part. The Buruli news got me to thinking in general about disease transmission, and about John Snow. John Snow was the physician who basically invented modern epidemiology by tracking a cholera outbreak. He ended up proving that cholera wasn’t spread through air, but by contaminated water. And he stopped the outbreak by removing access to the infected well.

He didn’t need to understand cholera – or germ theory – to stop its spread. He just needed to find a way to interrupt the transmission. I think we can all learn a lot from that. We’re facing global health problems of unprecedented complexity, as a result of climate change and more accessible travel. It’s easy to get overwhelmed by magnitude of the situation.

But the fact is, we don’t have to understand every last detail about NTDs to put a stop to them. We just need to find one tiny method to attack them. With Buruli ulcer, it may be our ability to track disease movement through gene sequencing. With others, it may just be our knowledge that mass drug administration interrupts the spread of disease. But we just need one tiny way in.

We can stack the odds of finding that way, too. Supporting research makes a difference. So does building the capacity in developing countries to respond to all health problems, not just NTDs. And, of course, funding matters. It’s a lot easier to fight disease when you’ve got a reliable budget for it.

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 Living Proof Project was initially concieved to demonstrate successes in global health interventions worldwide. By sharing captivating stories of hope through a wide range of multimedia platforms, “Living Proof”emphasized that targeted interventions do save and improve lives afflicted by poverty and disease.

According to the official press announcement:

“ONE will expand The Living Proof Project to reach new audiences in more countries around an expanded set of development issues, including agriculture and access to clean water. ONE will also broaden The Living Proof Project beyond the U.S. to highlight the impact of European investments. The launch of this effort will include an event in London this fall featuring Bill and Melinda Gates. ONE will also collaborate closely with organizations working on the ground in developing countries to get the word out about the work they are doing to save lives and create opportunity.

With 2 million members globally and a record of creating cutting-edge advocacy campaigns, ONE will lead the next evolution of The Living Proof Project. ONE and its partners will incorporate The Living Proof Project content into their ongoing efforts to inspire and challenge people around the world to help secure long term, sustainable support from G8 and G20 nations for international development.”

We are excited by this news and look forward to seeing the dynamic ways that ONE will shape “Living Proof!” We also look forward to sharing and highlighting stories of optimism and progress here on End The Neglect!

Aid Begins to Trickle in to Flood-Ravaged Northwestern Pakistan, Griff Witte, The Washington Post

Pakistan’s Floods Leaves Millions Displaced, Johnathan Miller, PBS News Hour

NZ Research Targets Lungs for Hookworm Immunity, Otago Daily Times

Rep. Johnson Proposes Bill to Deal with Neglected Infections of Poverty, politicalnews.me

www.youtube.com/watch?v=06v4txfdWms

A makeshift fashion runway. Pulsating music. The flash of strobe lights. The softness from a fog machine.  And a dozen leading pediatricians, scientists, and government officials modeling the latest in Filipino designer fashion wear. 

That was the scene from an evening gala event at the recent 2^nd Asian Vaccine Conference (ASVAC) in Manila, Philippines. It was event intended to inject some levity after a long day of lectures and presentations, and to introduce the audience to an important aspect of Filipino culture (I have come to learn that Filipino women have a strong sense of cultural identity expressed through designer fashion). 

Beyond the haute couture, the willingness of these highly accomplished women (and one man) to model designer clothing in front of their colleagues and mentors is an expression of their confidence to move to a place others might find uncomfortable. This willingness to step out of safe boundaries, to go beyond where one’s professional training dictates, will be critical if we are to achieve the challenge set forth this year at ASVAC: Every Vaccine for Everyone:  Ensuring Equity. This is a challenge that can only be overcome if scientists join their voices in vaccine advocacy.

For scientists, the beauty is in the complexity.  Even the language common to the scientific world – hypothesis testing, statistical significance, confidence intervals – leaves open the possibility for asking one more question and the opportunity to peel back yet another layer of natural wonder.

To health policymakers responsible for life-changing decisions about whether to introduce new interventions, such as a vaccine, the best answers are black and white, yes and no. Will this intervention save lives? Will it save money? How soon will we see the benefit? Is it the best choice that I can make?

The gap arising from these two world views – complexity and certainty – is often an area of indecision and inaction. To bridge that gap, the worlds of science and advocacy must find a way to effectively work together. And I believe that the scientists themselves can play a critical role in taking the first step towards effective dialogue with policymakers.

Scientists are perceived as objective, reliable, and well informed. For them, reducing the mountains of data and the possibility of the unanswered question to a simple message that is relevant for the decision-maker short on time and pressed to act can be an uncomfortable place. To go to that place requires a willingness to become vulnerable and move beyond objective numbers to envision the impact of their data on families, society, and public health.

Access to vaccines, especially in the poorest countries of the world, is often a matter of life and death for children. With so much at stake, ASVAC’s organizers overcame that fear of vulnerability when it comes to speaking passionately about a child’s right to life. It was no wonder that these same pediatricians and scientists were comfortable with a walk down the fashion runway. 

It is possible for scientists and researchers around the world to express their commitment to advocating for increased access to vaccines in slightly less dramatic ways than parading down a runway. Simpler actions can demonstrate that same commitment: submit an editorial to a local newspaper about the importance of vaccinating children; speak to politicians about data demonstrating the important role of vaccines in saving lives and reducing suffering; sponsor a local event drawing attention to vaccine-preventable diseases; or work with the local professional society to encourage joining forces with like-minded organizations around the world and building coalitions. 

Next stop for me is to attend the 9^th International Rotavirus Symposium in Johannesburg, South Africa.  Scientists from around the world will come together to share the latest information and data showing that rotavirus is responsible for death and suffering in children, most often in developing countries in Africa and Asia, and that the world can no longer neglect its deadly toll. Most importantly, they will hear that new vaccines against rotavirus are already saving lives and keeping children safe by preventing the most severe forms of the disease. I don’t foresee a runway show at this one, but I do anticipate lively conversations with enthusiastic researchers with voices that—if they are ready to step forward—can carry far beyond the conference hall.

Rotavirus is a deadly disease and vaccines are a proven solution to save the lives of children at risk everywhere. Reason enough to go to a place of discomfort, even if it doesn’t involve the latest fashions.

 Dr. John Wecker is the Director of the Vaccine Access and Delivery Global Program, PATH

The Global Network launched the “End the Neglect” blog to serve as a broad, transparent platform through which we as a community can continue to raise the profile of neglected tropical diseases (NTDs) and disseminate stories from the field. End the Neglect is a vital education resource that informs readers of the devastating impact of NTDs and the simple and cost-effective interventions available.

While “End the Neglect” specifically focuses on NTDs, we are also interested in highlighting bloggers with a broader global health perspective. Success stories, personal stories/testimonials from the field, photos, and video are all welcome!

We accept submissions on a rolling basis. If you are interested in blogging for us, please send a writing sample of no more than 500 words and a brief background of your work/educational experience to Anjana.padmanabhan@sabin.org.

Our blog post submission guidelines are as follows:

• Keep length of posts between 200-500 words
• Include links to sites or articles that supplement your topic
• When quoting other blogs or publications in your post, please link to the original material if possible, and denote quoted material using quotation marks.
• Submit a brief biography (2-3 lines) and a photo for inclusion with your post.
• We appreciate suggestions for images to accompany posts. If you have photos available for publication, please submit them along with your post and include caption information and attribution information.
• If you don’t have images available, we will add one from our own photo stocks or from publicly available resources including Flickr or the CDC’s Public Health Image Library
• We encourage you to email your post to colleagues and friends to encourage comment and discussion
• Publication of posts is at the discretion of the Global Network, based on relevance of the subject matter as related to neglected tropical diseases and other global health issues.

Please review the guidelines for submissions below, and contact Anjana.Padmanabhan@sabin.org for more information. Please also visit us on Twitter and Facebook

In Rwanda: Raissa Kalinganire: raissa.kalinganire@gmail.com

In the USA: Karen Schmidt: kschmidt@ei.columbia.edu