Several of the speakers and panelists all gathered for a group photo. From left, Joseph McCormick, MD; Karen Goraleski; Bruce Lee, MD; Jennifer Chow, director of global health R&D and public health advocacy at Research!America; Jon Andrus, MD; Peter Hotez, MD, PhD; Harold Margolis, MD; Kristy Murray, PhD; Peter Melby, MD; Susan Fisher-Hoch, MD; Maria Elena Bottazzi, PhD; and Jesus Valenzuela, PhD.
Research!America, in partnership with Sabin Vaccine Institute, Baylor College of Medicine, National School of Tropical Medicine, Texas Children’s Hospital and the American Society of Tropical Medicine and Hygiene hosted a forum, “Global Health Research and Development and the Hidden Burden of Neglected Tropical Diseases in Texas,” on Thursday. The forum, attended by more than 150 people, was held at the Baylor College of Medicine in Houston – the new home to Sabin Vaccine Institute, a product development partnership supported by the Bill & Melinda Gates Foundation, and to the nation’s first school of tropical medicine.
Peter J. Hotez, MD, PhD, dean of the National School of Tropical Medicine at Baylor College of Medicine, made opening remarks for the forum. He talked about the potentially 10 million cases of Chagas disease in North America, and more specifically, he mentioned that almost 5 million Texans live in poverty —one in five!
Joseph McCormick, MD, director of the Center for Tropical Diseases at University of Texas Medical Branch (UTMB), took the stage for a plenary lecture on the 50 years of global health in Africa, Asia, Latin America and Texas. He emphasized that we need to be persistent in continuing to work for global health justice. McCormick stated, “It’s not just a matter of disease hitting our shores, but hitting where there’s enough voices to be heard” and unfortunately that may not be in the southern U.S. or other underserved areas. We have much to learn from other nations and cultures about health and approaches to prevention. “Global health affects us politically, economically and should affect us socially,” he added.
After McCormick, the first of two morning panels took place focusing on neglected parasitic infections. Peter Melby, MD, director of the Center for Tropical Diseases at UTMB, discussed the growing threat of leishmaniasis. He said that even in the most optimistic scenario, “we found that twice as many individuals would be exposed to leishmaniasis in North America in 2080 compared to today.”
Sue Montgomery, MPH, epidemiologist at the Centers for Disease Control and Prevention, explained how more than 8 million people are affected with Chagas in Mexico, Central America and South America. Caused by a parasite found only in the Americas, there is currently no gold standard in diagnostics for Chagas. Montgomery stressed the R&D need for diagnostics, test of cure after treatment and better treatment drugs.
Jesus Valenzuela, PhD, chief of the Vector Molecular Biology Section at the National Institutes of Health, talked about sand flies and leishmaniasis being much more than just flying or crawling syringes. “When they bite, their saliva is very powerful,” he said. He expressed concern that we need partnerships among different disciplines and institutions to stay ahead of these neglected diseases.
During the Q&A, Valenzuela expressed concern about the impact of sequestration. He noted, “With these cuts our team will be smaller and our impact will be severely compromised.” Melby said, “There will be no funds in the labs to support our graduate students; the long-term impact is tremendous.” Montgomery also stated that at state health departments, “they’ve had to let staff go, curtail programs … public health in the state is hurt.” McCormick added that this may also be an opportunity for the community to find more efficient ways of working together with fewer resources.
The second panel focused on neglected viral and bacterial diseases. Kristy O. Murray, PhD, associate professor of pediatrics at the National School of Tropical Medicine, described her research project in depth; Murray’s team has found evidence of acute dengue in individuals without a history of travel. She emphasized that we need better detection, diagnostics and surveillance. Local public health partners are critical links between the research and the tracking and results.
Harold Margolis, MD, chief of the Dengue Branch at CDC, pointed out that dengue is not just a disease of poverty; it lives in places where there is a population — rich or poor — and it’s a domestic and global health problem. Dengue in U.S. travelers is the leading cause of fever/illness in returning travelers from the Americas, the Caribbean and Asia. Twenty two million Americans travel to dengue endemic countries each year. “We need surveillance, education and prevention and control tools,” Margolis said. (He also gave a sneak peek of the future: A vaccine is in the works!)
Susan Fisher-Hoch, MD, professor of department of epidemiology at University of Texas Houston School of Public Health at Brownsville, spoke about the fatal overlap between tuberculosis and diabetes. She highlighted the problem of non-communicable diseases such as diabetes in conjunction with neglected diseases and estimated that the cost of these NCDs, which are largely preventable, will reach $47 trillion by 2030.
The second plenary of the day was conducted by Jon Andrus, MD, deputy director of the Pan American Health Organization; he spoke about the path toward vaccine introduction in the Americas. Andrus mentioned that investment in people, combined with prevention, is key. When new lifesaving vaccines are available, there is a gap between introduction from western countries to others. “We need to close that gap. We need to accelerate the policy process,” he said. “… Time equals money here. In developing countries, time equals people dying.”
In the third panel, entitled “New tools and the strategies for their development: partnership, funding and Texas research,” Rebecca Rico Hesse, PhD, MPH, scientist at Texas Biomedical Research Institute, stressed that there is no animal that develops dengue, therefore there is no other mechanism with which to study dengue, creating an additional research challenge.
Maria Elena Bottazzi, PhD, director of product development for Sabin Vaccine Institute, talked about product development and how to go from data collection to global access and distribution. Bottazzi also mentioned that new technology must be a proper fit for the burden, the country and the research and development needs.
Bruce Lee, MD, associate professor of medicine, epidemiology, and biomedical informatics at the University of Pittsburgh, closed out the third panel talking about the economic modeling to evaluate new technologies. Lee said that these tools contribute to conversations with policy makers and serve as a bridge to assist in decision making. He concluded, “These new technologies can bring hidden economic benefits, perhaps even paying for themselves – bringing cost savings as well as being cost effective.”
In his closing remarks, Hotez said that “these problems [NTDs] are just the tip of the iceberg. But since we don’t have icebergs in Texas, maybe we can call the problem the ears of the armadillo? [In addition to the health burden] there is a high economic burden that is not easy to capture. We are trying to avert morbidity costs and chronic long term conditions associated with NTDs but these do not make for good headlines. The slow burn of resources that falls below the media and policymakers’ radar cause a great burden on society. We need to be able to show this in dollars and cents – literally!”
A video of the event is available here.