In response to a 2010 World Health Organization report Working to overcome the global impact of neglected tropical diseases, this week, the Bill and Melinda Gates Foundation, the World Bank, 13 pharmaceutical companies, the governments of the U.S., U.K. and U.A.E. and other global organizations committed to a new, coordinated effort to advance progress towards controlling 10 neglected tropical diseases by the end of the decade and improve the lives of the 1.4 billion affected by such diseases globally. Guiding this effort, the World Health Organization released targets and a strategy, Accelerating work to overcome the global impact of neglected tropical diseases—A roadmap for implementation.

These neglected tropical diseases include:

• lymphatic filariasis
• blinding trachoma
• sleeping sickness
• leprosy
• soil-transmitted helminthes
• schistosomiasis
• river blindness
• Chagas disease
• visceral leishmaniasis
• guinea worm

Check out the related webcast and infographic

January is Cervical Cancer Awareness Month. Globally, cervical cancer is the second most common cancer in females and the most common cause of cancer deaths in women in the developing world, affecting over 500,000 women and killing more than 250,000 women each year. Fortunately, many are striving to improve these grim statistics.

For example, JHPIEGO is working to protect women and girls with strategies like HPV vaccination and improved screening.

Researchers at the University of Pennsylvania, lead by Dr. Carrie Kovarik, are using innovative techniques like mobile phone based telemedicine to improve screening for cervical cancer in resource-challenged countries.

The Global Initiative against HPV and Cervical Cancer also has several programs to fight against cervical cancer including education, strengthening HPV vaccination programs and improving screening and treatment programs for cervical cancer.

What other innovative programs are you aware of to fight this deadly disease? What approaches do you think will be most successful at eradicating cervical cancer globally?

With World AIDS Day coming up on December 1st, I had the opportunity to join in a call with Stefano Bertozzi Director of HIV and TB at the Bill & Melinda Gates Foundation.

World AIDS Day is a time to renew our commitment to the 34 million people living with HIV/AIDS worldwide and the recent developments revolving around HIV, including several scientific breakthroughs in HIV prevention research and Secretary Clinton’s recent remarks declaring that it is possible to reach an AIDS-free generation, make this an especially exciting time to reflect on the epidemic.

According to Dr. Bertozzi, the strategy of the Bill & Melinda Gates Foundation includes both decreasing new infections and improving quality of life of those currently infected. A large focus of this strategy is on the delivery of current strategies in large part through the Global Fund as well as smaller national programs.

Despite the proven effectiveness of existing prevention approaches, there are limitations. For example, many women are not in a position to insist that their partners wear condoms and daily adherence to prophylactic treatments is difficult. The development of a vaccine and other new prevention options is critical for successfully fighting the epidemic, especially in developing countries. The largest investment in newer technologies is currently in trying to develop a HIV vaccine. As such, a focus is on the success of the RV144 HIV vaccine trial, which recently showed encouraging results in Thailand and advancing that to the next generation of the vaccine with hopes of increased efficacy.

They are also investing heavily on products that can be used by individuals to protect themselves either topically in the vagina or systemically. While daily use of vaginal microbicides has shown mixed results, many reasons may contribute to this, especially lack of adherence which is a common problem with daily use products. To address these challenges, they are working on products which are less dependent on adherence such as a vaginal ring which slowly releases the antiretroviral compound dapivirine and can be left in for up to a month.

Another strategy is systemic daily antiretroviral prophylaxis which has also had mixed results and faces problems with adherence, but looks promising. They are focusing on injectables which can be injected every 1 to 3 months, decreasing the need for adherance. The Gates Foundation is currently supporting clinical trials to evaluate the effectiveness of Pre-exposure prophylaxis (PrEP) such as this for HIV prevention.

Images from the Bill & Melinda Gates Foundation

Additional efforts are on enhancing the delivery of male circumcision and scaling up these programs with fewer resources. Despite three clinical trials demonstrating the protective benefit of the procedure, donors and countries have been slow to invest in voluntary male circumcision for HIV prevention. The foundation is investing in advocacy efforts to encourage more rapid scale-up of male circumcision for HIV prevention and funding research on new technologies and methods for performing male circumcision safely and less expensively. This strategy is so cost effective that it costs more money to NOT implement such programs due to the future treatment savings.

The Gates Foundation is also working towards improving the delivery and effectiveness of current programs. With decreasing funding in a faltering global economy, scale up of treatment has continued at the same pace by improving efficiency of programs. Fortunately this has been happening in HIV treatment. Continuing efforts to reduce the cost of drugs, design and implement more efficient delivery systems and further task shifting and sharing among health providers is needed without compromising care and can even lead to improved quality of care.

Bill Gates and Rotarians make the “This Close” gesture on the steps of the U.S. Capitol in Washington, D.C. on World Polio Day, October 24, 2011, to promote Rotary’s End Polio Now campaign and show how close the world community is to eradicating the scourge of polio

Learn more about World Polio Day and global efforts to eradicate this disease which has been decreased thus far by 99% thanks to efforts including vaccination campaigns.

The African Leaders Malaria Alliance (ALMA) recently launched a new Malaria Scorecard for Accountability and Action.  This tracking tool  allows African leaders, governments and global donors to be held accountable for progress against malaria, encouraging transparency in global health efforts. ALMA is an alliance of African Heads of States and Governments from 40 countries. The new scorecard tracks various stakeholder’s progress toward vital targets such as financing, devlivery of malaria commodities (mosquito nets, etc.), malaria policy, malaria mortality and maternal & child health indicators. The hope is that this new tool will support the achievement of the global goal of near zero malaria deaths by 2015, building on recent successes including the fact that 11 African nations have reduced malaria by more than 50%.

“Africa is pursuing ambitious targets against malaria and having timely, trusted data is critical to reaching our goals,” said Joy Phumaphi, Executive Secretary of ALMA. “Armed with this information, African leaders and partners can make policy decisions and demand action that will help countries rapidly improve their efforts against malaria.”

Last week the annual World Hepatitis Day took place on July 28, 2011. Approximately 500 million people, or 1 in 12 people globally, are infected with chronic hepatitis B and/or C, making these viral illnesses one of the largest global chronic disease threats. There is urgent need to develop more effective therapies and deliver them to those struck around the world. This fourth annual World Hepatitis Day focuses on the theme: “This is hepatitis…Know it. Confront it. Hepatitis affects everyone, everywhere”.

World Hepatitis Day

With the HIV/AIDS epidemic marking its 30th year, over one million Americans are living with HIV today, yet 1 in 5 of those infected doesn’t know his/her status according to the CDC.  Further, one-third are diagnosed at a late stage of infection and go on to develop AIDS within one year. The Huffington Post (6/24, Pearson) reports that almost 40% of Americans age 18 and older have been tested for HIV at some point in their lives, increased from 32.1% in 2000 but still dramatically less than the CDC’s recommendation that everyone between the age of 13 and 64 undergo routine HIV screening. Yet much progress had been made since the epidemic came to light in 1981. A recent New York Times article looks at the progress and research that has occurred in the past 30 years.

The Kaiser Family Foundation recently completed a survey of 2,583 American adults ages 18 and older to analyze public opinion about HIV/AIDS.

According to the survey:

• There is a decreasing sense of national urgency and visibility of HIV/AIDS.
• African Americans, particularly young men, expressed higher levels of concern about HIV than Caucasians.
• After almost a decade of decline, an increased number of Americans reported that they were personally  “very concerned” about becoming infected.
• More than 50% of Americans support increased funding for HIV/AIDS, with  fewer than one in ten reporting that they feel that the federal government spends too much on HIV/AIDS.

A webcast is also available about the survey findings.

Another resource to track the HIV epidemic is AIDSVu, which was created by researchers at the Rollins School of Public Health at Emory University. This site shows the number of individuals living with HIV, HIV testing sites and National Institutes of Health-funded HIV prevention and vaccine trial sites throughout the US.

According to the World Health Organization, approximately 2.4 million children die from vaccine-preventable disease yearly. On a domestic level, recent coverage of the largest US measles outbreak in the past fifteen years has been in the headlines with much discussion of voluntary refusal of immunization in the United States. A study in the Journal of the American Medical Association found that from 1991 to 2004, the number of unvaccinated children more than doubled in states allowing philosophical exemptions. On the other hand, children in middle- and low-income nations often do not receive immunizations because of lack of access. According to the Global Alliance for Vaccines and Immunizations (GAVI) 33% of all unvaccinated children under one-year-old live in China and India, and another 47% of unvaccinated children live in middle-income countries, with only 17% living in low-income countries.

Two studies from the Johns Hopkins Bloomberg School of Public Health were recently published in Health Affairs‘ June issue on Strategies for the Decade of Vaccines. The studies examined the impact of expanding immunization against pneumococcal pneumonia; Haemophilus influenzae type b (Hib);  bacterial meningitis; diphtheria; pertussis; tetanus; measles; rotavirus and malaria to cover 90% of children in 72 countries. They found that increasing vaccine development and delivery over the next 10 years in these 72 countries could prevent 6.4 million children from dying with an economic savings of $231 billion in the value of statistical lives saved and over $151 billion saved through reduced treatment costs and increased productivity. The issue brief audiocasts offer more insight into these and other contents of the June issue.

From the Bill and Melinda Gates Foundation website

While this looks promising, another study from the GAVI Alliance suggests that developing nations will be challenged to pay for expanded vaccine delivery without substantial outside support. In order to procure the projected benefits of increased immunization efforts, creative vaccine financing strategies will be needed. One such effort comes from the Bill & Melinda Gates Foundation’s commitment over the current decade–the Decade of Vaccines–to promote childhood immunization in the developing world.

In the book Twelve Diseases That Changed Our World, Irwin Sherman describes how microbes have impacted populations, altered history, devastated populations, felled great thinkers and, in the process, transformed politics, public health, and economics. He discusses how smallpox, tuberculosis, syphilis, AIDS, influenza, bubonic plague, cholera, malaria, yellow fever, hemophilia, porphyria, and the plant disease behind the Irish Potato Famine have altered history in an informing and entertaining manner.

US News and World Report interviewed Sherman about his book and about What Disease Mean in the Modern World. A related article from Nursing Degree.net’s blog entitled 10 Diseases That Totally Changed the World similarly discusses the ways in which diseases have impacted the course of history.

According to a study published in the May 13th edition of Science, researchers at the Johns Hopkins Bloomberg School of Public Health have identified a bacterium in mosquitos caught in the wild in Zambia which halts the development of Plasmodium falciparum. This Enterobacter bacterium occurs naturally in the mosquito’s gut microbial flora and kills the parasite which causes malaria in humans by producing reactive oxygen species (free radicals). The bacterium killed 99% of plasmodium both in the mosquitoes and in test tubes. Around 25% of mosquitoes caught in the sample had Enterobacter in their guts.

Field workers in Macha Zambia capture mosquitoes with traps.

Image from JHSPH website

According to the study’s senior author George Dimopoulos, PhD, “We’ve previously shown that the mosquito’s midgut bacteria can activate its immune system and thereby indirectly limit the development of the malaria parasite. In this study we show that certain bacteria can directly block the malaria parasite’s development through the production of free radicals that are detrimental to Plasmodium in the mosquito gut.”

This finding suggests that mosquitoes of the same species and strain sometimes have different resistance to the Plasmodium parasite. Scientists hope that this discovery could lead to new methods to reduce the spread of malaria, for example, by exposing mosquitoes in the wild to this bacterium.

For more on malaria and recent developments in the fight against this global killer, check out our recent blog posting on World Malaria Day.