Neglected Diseases: Why I Care, Why You Should.

Neglected Diseases which primarily affect poverty-stricken individuals receive a disproportionately small percentage of global health resources. Researchers like Dr Peter J. Hotez are fighting against this worrying imbalance by working to ease the global burden of poverty-associated diseases.

In recent years the problem of poverty-associated diseases – also termed neglected tropical diseases (NTDs) – has been garnering more and more attention, with researchers and activists showing growing concern over the inordinately small amount of global resources allocated towards NTDs.

This problem with resource allocation has been termed by many as the 10/90 gap, as it can be summarised by the statistic that only 10% of global health science resources are directed towards 90% of the global disease burden. (1)

The problem is rooted in the fact that pharmaceutical companies are businesses, and so must be profitable. This means that diseases which affect the most affluent populations – those who are able to afford drugs and treatments – receive significant attention from drug companies, whilst diseases which affect poverty stricken populations tend to go neglected.

Whilst this approach may make good business sense, it is obvious from both an ethical and humanitarian perspective that it is problematic; the scientific community has an obligation to ensure that poverty-associated parasitic infections are not ignored, but instead receive the interest and attention they are due.

One researcher who is fighting for this issue to be addressed is Dr Peter J. Hotez, Dean for the National School of Tropical Medicine at Baylor College of Medicine.

Neglected Diseases - Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Neglected Diseases - Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Neglected Diseases - Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Neglected Diseases - Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Peter Hotez, MD, Ph.D and Maria Elena Bottazzi, Ph.D are leading product development partnership efforts at the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development. They are also Dean and Associate Dean, respectively, of the National School of Tropical Medicine at Baylor College of Medicine.

Dr Hotez has brought significant attention to the plight of poverty-stricken Americans, who he explains are suffering under the “hidden burden” of neglected parasitic infections (NPIs) which “disproportionately affect impoverished and under-represented minority populations.”

Emphasising the scale of the problem, he has described the difference in infection rates across wealth classes as “some of the greatest health disparities in the United States.” (2)

The statistics are in clear support of these claims made by Dr Hotez; data provided by the CDC shows that more than 60 million Americans are infected with Toxoplasma gondii, the causative parasite in toxoplasmosis, whilst a further 300,000 Americans are infected with Trypanosoma cruzi, the parasite which causes Chagas disease. (3)

Neglected Diseases: Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, PLoS]

Neglected Infections of Poverty in the United States

In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis. These diseases occur predominantly in people of color living in the Mississippi Delta and elsewhere in the American South, in disadvantaged urban areas, and in the US–Mexico borderlands, as well as in certain immigrant populations and disadvantaged white populations living in Appalachia. Preliminary disease burden estimates of the neglected infections of poverty indicate that tens of thousands, or in some cases, hundreds of thousands of poor Americans harbor these chronic infections, which represent some of the greatest health disparities in the United States. Specific policy recommendations include active surveillance (including newborn screening) to ascertain accurate population-based estimates of disease burden; epidemiological studies to determine the extent of autochthonous transmission of Chagas disease and other infections; mass or targeted treatments; vector control; and research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent congenital CMV infection and congenital toxoplasmosis.

Neglected Diseases: Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, PLoS]

Neglected Infections of Poverty in the United States

In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis. These diseases occur predominantly in people of color living in the Mississippi Delta and elsewhere in the American South, in disadvantaged urban areas, and in the US–Mexico borderlands, as well as in certain immigrant populations and disadvantaged white populations living in Appalachia. Preliminary disease burden estimates of the neglected infections of poverty indicate that tens of thousands, or in some cases, hundreds of thousands of poor Americans harbor these chronic infections, which represent some of the greatest health disparities in the United States. Specific policy recommendations include active surveillance (including newborn screening) to ascertain accurate population-based estimates of disease burden; epidemiological studies to determine the extent of autochthonous transmission of Chagas disease and other infections; mass or targeted treatments; vector control; and research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent congenital CMV infection and congenital toxoplasmosis.

Neglected Diseases: Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, PLoS]

Neglected Infections of Poverty in the United States
In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis. These diseases occur predominantly in people of color living in the Mississippi Delta and elsewhere in the American South, in disadvantaged urban areas, and in the US–Mexico borderlands, as well as in certain immigrant populations and disadvantaged white populations living in Appalachia. Preliminary disease burden estimates of the neglected infections of poverty indicate that tens of thousands, or in some cases, hundreds of thousands of poor Americans harbor these chronic infections, which represent some of the greatest health disparities in the United States. Specific policy recommendations include active surveillance (including newborn screening) to ascertain accurate population-based estimates of disease burden; epidemiological studies to determine the extent of autochthonous transmission of Chagas disease and other infections; mass or targeted treatments; vector control; and research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent congenital CMV infection and congenital toxoplasmosis.

Neglected Diseases: Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, PLoS]

Neglected Infections of Poverty
in the United States
In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis. These diseases occur predominantly in people of color living in the Mississippi Delta and elsewhere in the American South, in disadvantaged urban areas, and in the US–Mexico borderlands, as well as in certain immigrant populations and disadvantaged white populations living in Appalachia. Preliminary disease burden estimates of the neglected infections of poverty indicate that tens of thousands, or in some cases, hundreds of thousands of poor Americans harbor these chronic infections, which represent some of the greatest health disparities in the United States. Specific policy recommendations include active surveillance (including newborn screening) to ascertain accurate population-based estimates of disease burden; epidemiological studies to determine the extent of autochthonous transmission of Chagas disease and other infections; mass or targeted treatments; vector control; and research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent congenital CMV infection and congenital toxoplasmosis.

The problem has recently begun to draw attention from official bodies in the United States, with the CDC last year announcing the commencement of an initiative to tackle the growing prevalence of NPIs amongst poverty-stricken Americans. (4)(3)

As part of the initiative, the CDC announced that five NPIs – Chagas disease, cysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis – are now considered “priorities for public health action.” (3) Dr Hotez described the announcement as “extremely welcome” and praised the CDC’s “renewed commitment” to fighting NPIs.

The Food and Drug Administration (FDA) has also taken steps to combat the issue, recently creating a priority voucher program which attempts to encourage pharmaceutical companies to invest in developing drugs aimed at treating NTDs. The program ensures such drugs are rushed to the front of review lines, speeding up the development and approval process considerably. (5)

The Priority Review Voucher (PRV) allows for a developer of a treatment for a neglected or rare pediatric disease to qualify for FPA approval within 6 months (standard review usually takes about 10 months). The PRV reduces two types of inefficiency: 1) it speeds up approval of potential blockbuster therapies in the US, getting US patients access to these treatments more quickly; 2) the PRV motivates more treatments for neglected diseases. The PRV holder must pay the FDA an additional fee ($2,562,000 as of 2015) to mitigate the review cost and provide the Administration with supplementary resources (otherwise FDA standard reviews would suffer). The PRV is transferable.

The Priority Review Voucher (PRV) allows for a developer of a treatment for a neglected or rare pediatric disease to qualify for FPA approval within 6 months (standard review usually takes about 10 months). The PRV reduces two types of inefficiency: 1) it speeds up approval of potential blockbuster therapies in the US, getting US patients access to these treatments more quickly; 2) the PRV motivates more treatments for neglected diseases. The PRV holder must pay the FDA an additional fee ($2,562,000 as of 2015) to mitigate the review cost and provide the Administration with supplementary resources (otherwise FDA standard reviews would suffer). The PRV is transferable.

The Priority Review Voucher (PRV) allows for a developer of a treatment for a neglected or rare pediatric disease to qualify for FPA approval within 6 months (standard review usually takes about 10 months). The PRV reduces two types of inefficiency: 1) it speeds up approval of potential blockbuster therapies in the US, getting US patients access to these treatments more quickly; 2) the PRV motivates more treatments for neglected diseases. The PRV holder must pay the FDA an additional fee ($2,562,000 as of 2015) to mitigate the review cost and provide the Administration with supplementary resources (otherwise FDA standard reviews would suffer). The PRV is transferable.

The Priority Review Voucher (PRV) allows for a developer of a treatment for a neglected or rare pediatric disease to qualify for FPA approval within 6 months (standard review usually takes about 10 months). The PRV reduces two types of inefficiency: 1) it speeds up approval of potential blockbuster therapies in the US, getting US patients access to these treatments more quickly; 2) the PRV motivates more treatments for neglected diseases. The PRV holder must pay the FDA an additional fee ($2,562,000 as of 2015) to mitigate the review cost and provide the Administration with supplementary resources (otherwise FDA standard reviews would suffer). The PRV is transferable.

As well as tackling the issue of NTDs amongst poverty-stricken Americans, Dr Hotez has emphasised the importance of addressing the problem of on a global scale. In his position as the fellow in disease and poverty at the Rice University’s Baker Institute for Public Policy, Dr Hotez recently published a policy paper suggesting the 2016 presidential administration should aim to “reinvent America’s commitment to global health” by championing “science and vaccine diplomacy.” (6)

As awareness of the issue grows, it is hoped that the relevant government bodies and scientific institutions around the globe will continue to be pro-active in working towards a solution, with the ultimate aim of protecting some of most vulnerable individuals on Earth.

Dr Peter J. Hotez of the Sabin Vaccine Institute details key challenges in vaccine development (“among the most cost-effective and powerful life-saving technologies”) and misperceptions about NTDs (“Every single person living in extreme poverty is afflicted by at least one neglected tropical disease”).

Dr Peter J. Hotez of the Sabin Vaccine Institute details key challenges in vaccine development (“among the most cost-effective and powerful life-saving technologies”) and misperceptions about NTDs (“Every single person living in extreme poverty is afflicted by at least one neglected tropical disease”).

Dr Peter J. Hotez of the Sabin Vaccine Institute details key challenges in vaccine development (“among the most cost-effective and powerful life-saving technologies”) and misperceptions about NTDs (“Every single person living in extreme poverty is afflicted by at least one neglected tropical disease”).

Dr Peter J. Hotez of the Sabin Vaccine Institute details key challenges in vaccine development (“among the most cost-effective and powerful life-saving technologies”) and misperceptions about NTDs (“Every single person living in extreme poverty is afflicted by at least one neglected tropical disease”).

MMRF Initiative Page

References

  1. Diseases of Poverty and the 10/90 Gap [2004-11; Philip Stevens, Director of Health Projects, International Policy Network]
  2. Neglected Infections of Poverty in the United States of America [2008-06-25; Peter J. Hotez, Public Library of Sciences: Neglected Tropical Diseases]
  3. Parasitic Infections also occur in the United States: Millions of people infected [2014-05-08; Centers for Disease Control and Prevention]
  4. The CDC’s New Initiative on Parasitic Infections [2014-05-08; Peter Hotez, M.D, Ph.D, The Huffington Post]
  5. We Must Work Together to Fight Neglected Diseases [2012-12-08; John Hoffmire, Deseret News]
  6. Baker Institute Expert Lays Road Map for Next US President to Combat Poverty-related Diseases [2014-11-19; Jeff Falk, RICE University]

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Christopher Edward Jones is a biochemist and writer currently affiliated with Queen Mary University of London, where he is part of a research group focusing on the restriction factors of HIV. In the past he has worked with multiple biomedical research groups in both industry and academia. He has a research interest in the biochemical mechanisms of virus restriction and a general interest in all areas of science.

Christopher Edward Jones is a biochemist and writer currently affiliated with Queen Mary University of London, where he is part of a research group focusing on the restriction factors of HIV. In the past he has worked with multiple biomedical research groups in both industry and academia. He has a research interest in the biochemical mechanisms of virus restriction and a general interest in all areas of science.

Christopher Edward Jones is a biochemist and writer currently affiliated with Queen Mary University of London, where he is part of a research group focusing on the restriction factors of HIV. In the past he has worked with multiple biomedical research groups in both industry and academia. He has a research interest in the biochemical mechanisms of virus restriction and a general interest in all areas of science.

Christopher Edward Jones is a biochemist and writer currently affiliated with Queen Mary University of London, where he is part of a research group focusing on the restriction factors of HIV. In the past he has worked with multiple biomedical research groups in both industry and academia. He has a research interest in the biochemical mechanisms of virus restriction and a general interest in all areas of science.



The Michelson Medical Research Foundation's Viewpoint blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.

The Michelson Medical Research Foundation's Viewpoint blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.

The Michelson Medical Research Foundation's Viewpoint blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.

The Michelson Medical Research Foundation's Viewpoint blog is brought to you thanks to the generous support of Dr. Gary K. Michelson and his wife, Alya Michelson.