A debate published this week in PLoS Medicine examines new approaches to tackling neglected tropical diseases (NTDs), with three viewpoints from experts in the field arguing which approach shows most promise.
Jerry Spiegel and colleagues from the University of British Columbia argue that there has been too much focus on biomedical mechanisms and drug development for NTDs, which has come at the expense of the social determinants of health such as clean water, sanitation, good housing, and community education. They make the case for integrating biomedical and social approaches through a "social offset" analogous to the "carbon offsets" that compensate for air travel. They propose that whenever research into an NTD innovation is funded, a proportion of that money (the "social offset") should be set aside for prevention measures that address socio-environmental and health system aspects.
Burton Singer of the Emerging Pathogens Institute at the University of Florida argues that the recent designation of a set of tropical diseases as "neglected" has led to strategies for control that are inappropriately "overmedicalized." He cites the emphasis on drug administration alone to alleviate schistosomiasis as an example. In contrast, Peter Hotez of George Washington University and colleagues say that the best return on investment will continue to be mass drug administration for NTDs. "In terms of both health impact and cost-effectiveness, few other interventions can rival mass drug administration for NTDs, and increasingly this approach is being recognized for its beneficial effects on strengthening health systems, improving economic development, and achieving the Millennium Development Goals," they say.
Funding: No specific funding was received for this piece.
Competing Interests:KW has received funding provided by the Consortium for Parasitic Drug Development via the Bill/Melinda Gates Foundation) toward the development of a safe and efficacious oral AmB formulation, but has no competing interests since he is not an employee of iCo Therapeutics Inc., the company that has licensed the technology from UBC and is not working with any other companies that are developing Amphotericin B products. PJH is partially supported by the Bill & Melinda Gates Foundation, Seattle, Washington, United States of America, through Human Hookworm Vaccine Initiative of the Albert B. Sabin Vaccine Institute, Washington, District of Columbia, United States of America. He is an inventor on an international patent application (PCT/US02/33106; filed November 11, 2002) entitled ''Hookworm vaccine.'' Additional provisi onal patents have been filed for hookworm and schistosomiasis vaccines. The patent was filed in the United States, Brazil, India, China, and Mexico. The patents belong to The George Washington University, with an exclusive license to the Human Hookworm Vaccine Initiative of the Albert B. Sabin Vaccine Institute, a nonprofit (501c3) organization devoted to increasing the use of vaccines worldwide. Because hookworm and schistosomiasis are neglected diseases afflicting the poor in developing countries, these vaccines have no anticipated commercial value or income generating potential. The rationale for filing a patent is to ensure that the vaccine is developed for those who need it in developing countries, and to encourage vaccine manufacturers in developing countries to work with the Albert B. Sabin Vaccine Institute for manufacture of the hookworm vaccine. PJH is Chair of the Department of MITM at GWU and is President of the Albert B. Sabin Vaccine Institute. The other author s declare no competing interests.
Citation: Spiegel JM, Dharamsi S, Wasan KM, Yassi A, Singer B, et al. (2010) Which New Approaches to Tackling Neglected Tropical Diseases Show Promise? PLoS Med 7(5): e1000255. doi:10.1371/journal.pmed.1000255
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CONTACTS:
Jerry Spiegel
University of British Columbia
Liu Institute for Global Issues
Vancouver, BC
Canada
jerry.spiegel@ubc.ca
Burton Singer
Emerging Pathogens Institute
University of Florida
Gainesville, Florida
United States of America
bhsinger@epi.ufl.edu
Peter Hotez
George Washington University,
Department of Microbiology, Immunology
Tropical Medicine, and Sabin Vaccine Institute,
Washington, D.C.,
United States of America
PHotez@gwu.edu
Journal
PLoS Medicine