by Karen Goraleski, ASTMH Executive Director

In a recent conversation with Peter Hotez, MD, president, ASTMH, he shared with me his thoughts on the important events in tropical medicine in 2010, what he referred to as a landmark year. 

There was extraordinary progress on two fronts: one, providing global access for the world's poorest people to essential medicines for neglected tropical diseases, and two, in the areas of research and development. In addition, we saw a new awareness about the importance of tropical diseases in the United States.
 
In 2010 we witnessed an extraordinary scale up in mass drug administration for the seven most common neglected tropical diseases:

• the three soil-transmitted helminth infections
• schistosomiasis
• lymphatic filariasis (LF)
• onchocerciasis, and
• trachoma 

Under the auspices of the federal U.S. Global Health Initiative an estimated 162 million people had been treated by year four of the U.S. Agency for International Development’s NTD Program, using a rapid impact package of drugs comprised of albendazole/mebendazole, ivemrectin/diethylcarbamazine citrate, praziquantel and azithromycin.

Together with activities supported by the British Department for International Development and partners of the Global Network for NTDs, more than 14 countries are being targeted with national control programs for NTDs, with plans to increase this number to 20 or more. This demonstrates that NTD programs can be scaled nationally to help countries achieve their control and elimination targets – a wise use of resources and an example of developing programs that work.
 
Simultaneously through programs such as the Global Programme to Eliminate Lymphatic Filariasis (GPELF), African Program for Onchocerciasis Control (APOC), International Trachoma Initiative (ITI), Schistosomiasis Control Initiative (SCI), and Deworm the World, hundreds of millions more are receiving essential NTD drugs with new commitments by GSK and Johnson & Johnson to provide additional drug donations, on top of their existing commitments as well as long standing drug donations from Merck & Co., Pfizer, Novartis, sanofi aventis, MedPharm and Merck KgAA. 
 
Another noteworthy event in 2010 was the WHO’s first report on NTDs. This significant document, "Working to Overcome the Global Impact of Neglected Tropical Diseases," summarizes key accomplishments to date and outlines targets for control and elimination. 
 
Recent research in NTD control has revealed important links and opportunities between NTD control with HIV/AIDS and malaria. This includes an important Cochrane analysis of randomized clinical trials showing that deworming has an important impact on reducing HIV viral loads and increasing CD4+, new studies looking at the opportunity of preventive chemotherapy with praziquantel for reducing the incidence of female genital schistosomiasis as a means to interrupt the transmission of HIV/AIDS, and further studies demonstrating an important impact of deworming on the risk of acquiring malaria and its clinical severity. 
 
Lastly, in the area of product development for NTDs, a number of new drugs were evaluated for important kinetoplastid infections such as leishmaniasis, Chagas disease, and human African trypanosomiasis, as well as new anthelminthics for onchocerciasis, soil-transmitted helminth infections, food-borne trematode infections and schistosomiasis. Vaccines for several NTDs including dengue, leishmaniasis, hookworm, schistosomiasis and enteric bacterial infections either underwent clinical testing or are about to enter clinical trials. 

by Karen Goraleski, ASTMH Executive Director

With 2010 coming to a close, I asked the ASTMH leadership for their thoughts on the most important tropical medicine and global health news stories of the year.

Council member James Hughes, MD, cited a few good news stories in a year that will also be remembered by many for the earthquake and continuing crisis and suffering in Haiti. Hughes reminds us that the mortality rates for those under age five is at an all time low (2009 data published this year). This is both a sign of hope and a sign that our efforts and investments in this area are paying off. 

Secondly, he is encouraged that the WHO theme for its 2011 World Health Day will be antimicrobial resistance. Such a selection can be an important step in building the necessary political will to address this increasing global clinical and public health crisis.

A third comes to mind for Hughes, the declaration of a Decade of Vaccines by the Bill & Melinda Gates Foundation is encouraging and like the WHO theme selection, will go a long way to build momentum and draw much needed attention and resources to what many refer to as the silver bullet – vaccines.

by Karen Goraleski, ASTMH Executive Director

As we wrap up 2010, I am continuing to share some of the ASTMH leadership’s thoughts on what they regard as the most important events in tropical medicine and global health.

Council member Ken Stuart, PhD, commented that we are in the midst of an evolution in the global health community’s thinking regarding what is “global health and tropical medicine.” There is a shift from a focus on infectious diseases to one that is broader and includes non-communicable diseases (chronic diseases) and has an increasing emphasis on nutrition and health systems.

Stuart went on to say that in terms of important events in 2010, the ongoing commitment to global health by many organizations and federal agencies is very significant, especially in view of the global economic crisis. This signals the realization that global diseases have both practical and humanitarian importance. Associated with this is the increasingly important role of countries with emerging economies.

Another important aspect seen in 2010 is progress in drug and vaccine discovery and development; the associated translational research by the non-profit sector, the complementary role of the corporate sector in drug donation and the efforts of drug distribution for infectious disease are impressive, as is their “integration” with control efforts. There are multiple examples including ACT, bed nets and the RTS,S trials for malaria, drugs for VL (also called Kala-azar or black fever), helminths (parasitic worms) and other pathogens. These activities have saved numerous lives. At the end of the day, the big news is progress in reducing disease incidence.

Read more from leading experts tomorrow…

by Karen Goraleski, ASTMH Executive Director

In each of these last days of 2010, we’ll share the ASTMH leadership’s thoughts on what they considered the most important events of the year in tropical medicine and global health.

High on the list of importance for both Peter J. Hotez, MD, president, and Ed Ryan, MD, DTM&H, immediate past president, is cholera. In yesterday’s PBS NEWSHOUR story on the shortages of cholera vaccine in Haiti, Dr. Hotez commented that "we normally think of [cholera] as a short term problem that will burn itself out in a couple weeks, so a vaccine wouldn’t be appropriate," he said. "The length and scope of these epidemics has increased, so now it’s different."

Sharing his thoughts with me, Dr. Ryan offered that the “explosive reappearance of cholera in Haiti is a very potent reminder that much still needs to be done in global health. Cholera is a disease of impoverishment and displacement, and its reappearance underscores our deficiencies, but also our opportunities and challenges. Responding to the global cholera situation requires both scientific and public health expertise and action.”

To that list I would add political will and champions in the United States' 112th Congress for these issues as well as for science and health overall. ASTMH is at the ready to work with Congress to advance evidence-based policies and programs that work. A strong U.S. investment in tropical medicine/global health/research is the right thing to do for the world and the smart thing to do for the U.S.

In "Diseases we can stop, but don't," an op ed piece published in the Los Angeles Times Sunday, ASTMH President Peter J. Hotez discusses the need to address neglected tropical diseases in The Global Strategy for Women's and Children's Health.

"Some of the world's most glaring health problems affecting impoverished girls and women are also some of the easiest to address," writes Hotez. "The fact that we consistently fail to do so is puzzling."

The Global Strategy was launched this fall, and is dedicated to stopping women and children from dying of preventable causes.

According to Hotez, "it is possible to deliver medicines for the most common neglected tropical diseases — including not just hookworm and schistosomiasis but elephantiasis, river blindness and trachoma — with just one annual dose. Success in combating the diseases can be achieved for less than $1 a patient annually."

Learn more about neglected tropical diseases.

ASTMH in partnership with Research!America, the University of Illinois at Chicago Tuberculosis Institute and the Washington Global Health Alliance on a Capitol Hill briefing -- Global Health R&D: An Economic Driver in Your State -- yesterday that called attention to the often-unrecognized domestic benefits of U.S. global health research and development efforts. ASTMH Executive Director Karen A. Goraleski moderated the briefing. Illinois and Washington states’ efforts were profiled as models for building global health R&D efforts within each state as an economic driver.

The briefing was held in cooperation with Senator Richard J. Durbin (IL-D) and Congresswoman Janice D. Schakowsky (IL, D-9th).

"This is a very tough time for federal discretionary spending, making it more important than ever for ASTMH to advocate for this investment in our nation as well as the  health of the world," said Goraleski. "Increased funding for research is vital to the United States not only because of the global impact of tropical diseases, but because of the number of jobs that would be created and maintained."

View "A New Picture of Health," a documentary from the United Nations Foundation about the work of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The documentary premiered this Fall, and is narratted by Jane Goodall, founder of the Jane Goodall Institute and UN Messenger of Peace.

The film, shot in Spring 2010 by filmmaker David Evans, includes personal stories from community health workers, patients, and community leaders to show the impact of the Global Fund's programs in Ethiopia, Rwanda and Indonesia.

“In less than a decade, close to six million lives have been saved by Global Fund programs,” said Timothy E. Wirth, President of the UN Foundation. “This documentary paints a compelling picture of why continued support will help the Global Fund save and improve the well-being of mothers and children across the globe.”

The film shows evidence that when the United States invests in global health, that investment pays off not only in lives saved but in increased global stabilty and an improved global economy. We live in an increasingly connected world, so tropical diseases affect us all. Through research, education and proper funding, we can eradicate and lessen the effects of  these diseases.

Learn more about The Global Fund.