Global Health Security and the NTDs

Peter Hotez, co-Editor in Chief of PLOS NTDs, comments on President Obama’s call for global action to prepare for future disease outbreaks and to treat biological threats as issues of national and global security.

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Glyn Lowe

In a landmark White House summit last week President Barack Obama addressed health ministers from more than 40 countries, in addition to leaders from several international health organizations.  His welcomed message was that highly lethal and widespread epidemics such as the West African Ebola outbreak are more than public health threats.  Instead these devastating infections when they affect or threaten large populations also have dire economic consequences and themselves are highly destabilizing leading to further breakdowns in already fragile systems and infrastructures.  In this sense Ebola is a direct and serious threat to national and global securities.

This is not the first time we have seen epidemics threaten global security. We saw such connections during the SARS pandemic in 2002-03, again with the emergence of avian influenza, and especially during the H1N1 influenza pandemic of 2009.  These outbreaks together with concerns about bioterrorism were underlying reasons why BARDA (The Biomedical Advanced Research and Development Authority) was established within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services (DHHS).

It is important to point out, however, that infectious diseases are threats to global security for reasons that go beyond perceived or actual high profile and lethal epidemics such as Ebola, SARS, and flu.  Previously in PLOS Neglected Tropical Diseases together with former DHHS Secretary and Wisconsin Governor Tommy Thompson I highlighted the widespread and destabilizing effects of the neglected tropical diseases (NTDs).  A key point is that NTDs such as hookworm, schistosomiasis, lymphatic filariasis, river blindness, and trachoma rank among the most common afflictions of the world’s poor and almost every person living in extreme poverty has one or more of these conditions.  As a result we found that these and other NTDs reduce agricultural productivity even to the point where agricultural lands are abandoned.  Thus NTDs promote food insecurity.  Moreover, certain NTDs such as hookworm damage children by adversely affecting their educational performance leading to sharp drops in future wage earning, while promoting ignorance.  They have a huge impact on the health of girls and women and greatly increase bad pregnancy outcomes for both mother and child.

Through such mechanisms, the NTDs may rival more highly visible threats in terms of their ability to destabilize communities.   Aside from the specific NTDs listed above there are also now well established links between some of the vector-borne diseases such as African sleeping sickness, kala-azar, and cutaneous leishmaniasis, and human survival in a conflict or post-conflict setting.  A big question is whether the equation goes both ways, i.e., we know NTDs flourish among destabilized communities, but could it be that NTDs also promote conflict?

In his address to the world’s health ministers, President Obama was right to point out last week that it is important that the global public health community urgently address this current crisis in West Africa, but not let its guard down with respect to other global health threats.  For NTDs this means continuing integrated mass drug administration for intestinal helminth infections, schistosomiasis, LF, river blindness, trachoma, and yaws; multi-drug therapy for leprosy; and elimination/eradication programs for other NTDs including African sleeping sickness and guinea worm.  In parallel, the same roadblocks that have slowed the entry of new Ebola interventions – drugs, diagnostics, and vaccines – into the clinic are similar to those that have thwarted the development of similar control and elimination tools for most of the NTDs.  In the R&D space it is important that we take lessons learned from this Ebola crisis and apply them effectively to produce a new generation of products for the high burden NTDs.

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PLOS Medicine launches a new Collection on Universal Health Coverage

A new PLOS Medicine collection, Monitoring Universal Health Coverage, provides technical details and country-level experience of the implementation, monitoring, and evaluation of Universal Health Coverage, adding much needed insight to the global conversation on this topic.

Universal Health Coverage (UHC) is the desired outcome for health system performance, whereby all people who need the full spectrum of health services – promotion, prevention, treatment, rehabilitation and palliation – receive them according to need and without resulting in financial hardship.

Image Credit: PLOS

Image Credit: PLOS

The high-profile nature of the event held at The Rockefeller Center (more information here) at which the Collection will launch is fitting for the topic that has emerged as front-runner of the post-2015 development agenda. UHC has been the focus of much work and effort by the international community in order to turn its broad aims into an actionable framework.
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Ebola: a Blind Outbreak

Grazia Caleo of Médecins Sans Frontières (MSF) UK describes her experiences as a medical epidemiologist during the Ebola outbreak in Kailhun, Sierra Leone.

In José Saramago’s book, Blindness, he describes an epidemic of an unknown infection that causes people to lose their sight; a single person remains uninfected to bear witness to the anger, chaos, violence and death generated by the spread of disease.

In the novel, humanity’s descent into blindness represents the loss of reason, and shows how fear can cause dramatic social breakdown; at the same time, the clear vision of one person represents the opportunity to restore light.

What I saw in Sierra Leone as a medical epidemiologist reminded me of Saramago’s book.

I saw ‘blindness’ circulating in villages and amongst local and international Ebola ‘experts’; I saw wisdom among the patients who survived and the doctors and nurses who cared for them.

I saw the under-estimation of the risk and consequences of Ebola in an area bordering three countries; the fear caused by rumours; the late communication with villagers about Ebola and its spread; the huge numbers of patients dying in front of us without our being able to provide them with treatment; the missed opportunity to trace contacts and to apply the simple rule of previous outbreaks: ‘time, place, person’. All of these contributed to a blind response.

Image credit: MSF

Image credit: MSF

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In Honor of Dr. Elisabetta Ullu

Kasturi Haldar, PLOS Pathogens Editor-in-Chief, reflects on Elisabetta Ullu’s pioneering contributions to the understanding of molecular mechanisms of RNAi in T. brucei.

Dr. Elisabetta Ullu.  Image credit: Yale

On the eve of 25th anniversary of the premier Molecular Parasitology Meeting (MPM) held at the Marine Biological laboratory at Woods Hole MA, we reflect on the tremendous accomplishments of the field presented at this meeting, ranging from leading therapeutics in global parasitic diseases as well as fundamental mechanisms enabling development of treatments in seemingly disparate disease states, like tumor biology and autoimmunity.  But the excitement is burdened with hearts full of sadness that Dr. Elisabetta Ullu, a beacon in the field and past MPM organizer, passed away on September 8, 2014 after a heroic battle against cancer.

Dr. Ullu joined the faculty of Yale University School of Medicine as an Assistant Professor in 1984, where she rose through the ranks to Professor of Medicine and Cell Biology.  Her laboratory pioneered in molecular mechanisms of RNA biology in the protozoan parasite Trypanosoma brucei, the causative agent of African sleeping sickness and a portal for RNA based mechanisms at cellular and organismal levels.  Professor Ullu and Prof. Chris Tschudi (her partner in science and life) discovered the novel mechanism of ‘RNA interference’ (RNAi) by which T. brucei blocks the expression of its genes.   Broad acceptance of the central role of RNAi for cells in general, was a 2006 Nobel Prize shared by Andrew Fire and Craig Mello, for their work in nematodes.  Ullu’s findings were transformational to determine functions of proteins encoded by parasite genes, which is key to the discovery of new therapies urgently needed for sleeping sickness. She received many honors and accolades for her work, the most recent being the American Society for Biochemistry and Molecular Biology’s inaugural Alice and C. C. Wang award in 2012, for seminal contribution to the field of Molecular Parasitology.
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When Implementing Universal Health Coverage, Context Matters

As the WHO’s Millennium Development Goals reach their final phase, Sara Gorman reflects on what we have learned about how political, cultural and financial contexts impact the success of universal health coverage systems. 

Image Credit: Edith Soto, Flickr

Image Credit: Edith Soto, Flickr

In May of 2013, Margaret Chan affirmed the WHO’s commitment to achieving universal health coverage worldwide, proclaiming “universal health coverage is the single most powerful concept that public health has to offer”. For Chan, public health measures such as universal health coverage represent a key component of development work in the 21st century. As the Millennium Development Goals (MDGs) begin to wind down with their 2015 expiration date looming, the WHO has turned its attention toward the next set of goals for world health. With statistics revealing that more than 100 million are pushed into poverty each year due to excessive health care costs, it seems ever more urgent to advocate for universal health coverage, spreading the costs across entire populations.
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When Retroviral Research Goes Viral

The PLOS Pathogens team reflects on their most widely shared article and the benefits and pitfalls of sharing science research on social media.


Image credit: Pixabay

Social media has taken the science world by storm. Or maybe it’s the other way around; but regardless, if you are reading this, you are likely a scientist engaging in social media (this is a science blog). Scientists are participating in all types of social media— blogs, Facebook, Twitter, reddit, Tumblr, Flipboard — showing that science discourse is not limited to conference rooms and laboratories.

Prominent and famous scientists from the Nobel prize winning climatologist Dr. Michael Mann to television-show sensation Bill Nye use social media (see famous scientists on Twitter at Business Insider as well as  scientists on the reddit Ask Me Anything Series). However, social media isn’t just for Principle Investigators in the public eye or distinguished science journalists. Scientists in any field can and are using social media on a daily, even hourly, basis— just check out Vincent Racaniello, the host of the TWiV podcast and an active twitter user. PLOS Biology has even published An Introduction to Social Media for Scientists instructing scientists why and how to showcase their research using social media and PLOS Computational Biology more recently published Ten Simple Rules of Live Tweeting at Scientific Conferences.
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Further Integration: The latest update to the MHTF & PLOS Maternal Health Collection

In November 2013, PLOS Medicine and the Maternal Health Task Force (MHTF) called for submissions to the third year of the MHTF-PLOS Collection on Maternal Health. Today we announce an exciting new update to the Year 3 Collection, including original 11 research articles and a policy forum, all recently published in PLOS.

This continued collaboration between the MHTF at Harvard School of Public Health and PLOS Medicine is reflected in this latest collection update, highlighting recently published work that ties in with the current theme, “Integrating Health Care to Meet the Needs of the Mother–Infant Pair”. 

Image credit: Jack Zalium, Flickr

Image credit: Jack Zalium, Flickr

Chosen with the aim to contribute to a better understanding of how and when to comprehensively integrate maternal and infant health care, this year’s theme includes work on conditions such as HIV, malaria, exposure to environmental risks, and other situations that have a significant impact on both maternal and infant health.

Featured work in this latest update

A policy forum by Jenny Hill and colleagues highlights the importance of prioritizing pregnant women, as a high risk group, for delivery of long lasting insecticide treated nets through antenatal clinics. Delivering free or subsidized long-lasting insecticide treated nets (or vouchers) to pregnant women is a key approach for controlling malaria and increases coverage and use by both pregnant women and their infants.
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PLOS Resources on Ebola

Virginia Barbour, Medicine & Biology Editorial Director at PLOS, on the urgent need for Open Access research into the Ebola outbreak in West Africa.


This post was updated on September 19th to include new content from PLOS Currents Outbreaks and Speaking of Medicine


The current Ebola outbreak in West Africa probably began in Guinea in 2013, but it was only recognized properly in early 2014 and shows, at the time of writing, no sign of subsiding. The continuous human-to-human transmission of this new outbreak virus has become increasingly worrisome.

Analyses thus far of this outbreak mark it as the most serious in recent years and the effects are already being felt far beyond those who are infected and dying; whole communities in West Africa are suffering because of its negative effects on health care and other infrastructures. Globally, countries far removed from the outbreak are considering their local responses, were Ebola to be imported; and the ripple effects on the normal movement of trade and people are just becoming apparent.

There is an urgent need for research into all aspects of this Ebola outbreak.  PLOS is addressing this need today through two channels.  First is the rapid publication of important early research in PLOS Currents OutbreaksThe second is a new PLOS Collection that pulls together all the current published articles in the PLOS corpus, which are, like all our content, freely and openly available for download, use and reuse. The Collection is available on Flipboard as well as being described below.
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Who Should Contribute to Funding of Global Health R&D and How Much?

The international community recently gave WHO a mandate to advance global health R&D by creating a pooled international fund for a first set of four Demonstration Projects. Mari Grepstad, Suerie Moon and John-Arne Røttingen consider how it could be funded.

This May, the 67th World Health Assembly (WHA) made important progress on strengthening research and development (R&D) of medicines and other technologies for diseases that affect the world’s poor by agreeing to establish an international fund for R&D. The fund builds on the 2012 report of the WHO Consultative Expert Working Group on Research and Development (CEWG), which recommended a framework for more sustainable and equitable financing of R&D that aims to “de-link” innovation costs from product prices through approaches such as open knowledge innovation and prizes (see an earlier blog post).

WHO has been mandated to take forward at least four projects selected by Member States and experts to apply these new approaches to neglected diseases such as Cutaneous and Visceral leishmaniasis, present in the Americas, Middle East, Africa, Central Asia, Mediterranean and southern U.S. Seen as a step towards demonstrating the opportunities of de-linkage models, this move was warmly welcomed by international NGOs.

A recent report commissioned by the Drugs for Neglected Diseases initiative (DNDi) suggests guiding principles, policies and governance arrangements for the pilot fund. The fund would mobilize and deploy resources with assistance from independent advisory committees, and could be governed by a Board hosted by an existing organisation. The WHA asked WHO to examine the feasibility of establishing the fund at the Special Programme for Research and Training in Tropical Diseases (TDR).
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Why ICART, a New Research Center in the D.R.Congo, is Needed

An International Center for Advanced Research and Training (ICART) has been launched in Panzi, Bukavu, in the South-Kivu Province of the DR Congo. This province has suffered many wars over decades and is trying to recover. ICART is organizing its first symposium. How is scientific research of help for the recovery?

Good research usually requires well-trained scientists, infrastructure and equipment. Africa is the continent least resourced in these elements. Yet there are many issues on the continent that need the kind of solutions that come from research. Poverty and lack of research are related, one favoring the other, but it is possible to break this vicious circle. First, there are now many well-trained Africans, living either on the continent or in the diaspora, who can sustain some level of research work. Secondly, some types of research do not necessarily require great capital investment. Thirdly, international collaborations offer access to mutually beneficial shared expertise and resources. Finally, some problems in Africa can best be addressed by the unique experience of the African researchers themselves. Such problems are illustrated by the current epidemics of hemorrhagic fever or the persistent high prevalence of genital fistulae or child malnutrition.

On the scientific research front Africa displays a large diversity. There are continental superpowers such as South Africa and Egypt, which by themselves account for nearly 50% of all research output of the continent. On the other hand, there are countries, especially war-torn nations such as the DR Congo, where research activity is very low or has been declining for decades. It is a big challenge in the latter countries to embark in viable research activities. In the case of the Eastern part of the DR Congo, the war situation, administrative mismanagement and corruption have led to a disintegration of nearly all systems. Recently, increased political stability has seen efforts to help hasten the recovery from the destructions of war. In this respect, the establishment of institutions such as the Panzi Hospital or of an international research center such as ICART (International Center for Advanced Research and Training) should serve as powerful instruments to help in the recovery.
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