Peter Hotez, M.D., Ph.D.
December 3, 2010 - Dr. Peter Hotez, M.D., Ph.D., Director of the Sabin Vaccine Institute, Founding Editor-in-Chief of PLoS Neglected Tropical Diseases
Dr. Hotez delivered an impassioned seminar for the CRND, "Innovation in the control of the neglected tropical diseases." The seminar was dedicated to Fr. Thomas Streit, Ph.D. who is the Director of Notre Dame's Haiti Program. Many of Fr. Streit's students were in attendance along with Dr. Kasturi Haldar's CRND students and faculty. There was wonderful news in Dr. Hotez's report on NTDs. Many neglected tropical diseases can be treated at the same time by mass drug administration, which costs about 50 cents per patient. Keep the good news in mind as you read the following tragic highlights from Dr. Hotez's seminar.
Dr. Hotez's address was focused on "The Bottom Billion," a term he coined to describe over 1.4 billion human beings who live on a sum defined by the World Bank as "less than $1.25 per day," but more accurately summarized as "no money." Neglected tropical diseases (NTDs) are infections, which afflict these poorest of our fellows across the plantet. The vast majority of NTDs are seen in less developed nations, but pockets of infestation are found in areas of profound poverty within the developed nations as well. For example, the United States has several million residents with NTDs. Seven of the 17 classified NTDs discussed by Dr. Hotez register these victims in the tens and hundreds of millions worldwide: Ascariasis (807 million), Trichuriasis (604 million), Hookworm (576 million), Schistosomiasis (440 million), Lymphatic Filariasis (120 million), Trachoma (40 million), and Onchocerciasis (20 million). Many people have multiple co-infections of these diseases.
NTDs are generally disfiguring and disabling diseases, which cause terrible suffering, stigma, growth stunting, developmental deficits, and lost working days. The global burden of NTDs in Disability Adjusted Life Years (DALYS) is 56.6 million. This is a staggering loss of productivity for society and accounts for much of the difficulty less developed nations have in catching up with developed nations. According to Dr. Hotez, NTDs "disproportionately" affect the poorest people on subsistence farms and in urban slums. And, NTDs are often "high morbidity and disability but low mortality conditions." Because NTDs cause morbidity but not death, their tragic effects maybe underestimated when compared to fatal diseases. Yet, as Dr. Hotez told his UND audience, "NTDs promote poverty and interfere with economic development" at alarming rates. Children are often the most severely afflicted with NTDs, having the highest burden of intestinal worms (e.g., Hookworm, Ascariasis). Child growth, development and education suffer enormously and the effects often last a lifetime. Dr. Hotez reported the estimate that Hookworm leads to a 40% reduction in future earnings for children.
Throughout his seminar, Dr. Hotez brought these statistical summaries to life with a number of slides of children and adults who bore the obvious signs of parasitical infections and disfigurement. He discussed the stigma and shame suffered by these blameless victims and their families -- people who had the misfortune to be born into poverty in regions where these pathogens are common. Dr. Hotez also pointed out villages in South America where the entire child population is infected with worms. A striking dimension of Dr. Hotez's analysis was the sets of nations, which tend to have severe levels of NTDs: the "Nuclear Weapons States" (India, China, Pakistan, North Korea, Iran, Syria) and the "Catholic World" with hot spots in Angola, Burundi, Congo, DRC, Rwanda, and the Philippines. In areas like Haiti, NTDs are also associated with the enduring legacy of the slave trade.
Dr. Hotez reviewed the history of the Millennium Development Goals (MDG), which were formulated in 2000 under the leadership of then UN Secretary General Kofi Annan. The MDGs were the foundation of an agreement by the international community to dramatically reduce illness, poverty and hunger by the year 2015. Millennium Development Goals include: 1) Eradicate extreme poverty and hunger, 2) Achieve universal primary education, 3) Promote gender equality and empower women, 4) Reduce child mortality, 5) Improve maternal health, 6) Combat HIV/AIDS, malaria and other diseases, 7) Ensure environmental sustainability and 8) Develop a global partnership for development. Much remains to be done to put the MDGs on track for their target date. First, pledges must be honored. Second, the funding for research and development in the NTDs is startlingly small in comparison to the budgets associated with other diseases. Dr. Hotez pointed to the fact that of 3 billion total dollars directed toward neglected diseases research and development, only 20% goes to the NTDs. Note, the term, NTDs, does not include several "neglected diseases" which Dr. Hotez calls the "Big Three" -- Malaria, Tuberculosis and AIDs/HIV.
Back to the good news. Dr. Hotez described "The Rapid Impact Package" for NTDs (RIP-NTDs). The package, designed for mass drug administration includes a combination of drugs, many of which have been donated by pharmaceutical manufacturers. The RIP-NTDs package would target the "Big Seven NTDs": Ascariasis, Trichuriasis, Hookworm, Lymphatic Filariasis, Onchocerciasis, Schistosomiasis and Trachoma. Additionally, diseases such as Strongyloidiasis, Trematodiases, Taeniasis and Scabies would be "bonus" targets of the package. Dr. Hotez estimates that for about 50 cents per person the following could be accomplished: delivery and administration of the drugs, equipment, health education materials, personnel training, monitoring and evaluation.
NTD elimination can be accomplished. It is within our grasp - if we act to make it so. Spread the good news in this Season of Lights!
(Above, Peter Hotez shares a moment of levity with Kasturi Haldar and Katrina Epperson. Photos, W Wall, 2010)
Dr. Peter Hotez, M.D., Ph. D. is a Distinguished Research Professor at George Washington University and the Walter G. Ross Professor & Chair in the Department of Microbiology, Immunology, & Tropical Medicine at the George Washington University Medical Center. Dr. Hotez is also the President of the Sabin Vaccine Institute and founding Editor-in-Chief of PLoS Neglected Tropical Diseases. Currently, Dr. Hotez serves as the Principal Scientist of the Human Hookworm Vaccine Initiative (HHVI), a public private partnership sponsored by the Sabin Vaccine Institute with major funding from the Bill and Melinda Gates Foundation. Dr. Hotez is a leading advocate and educator in the area of NTDs, particularly in his work for PLoS.