The medical biochemistry of poverty and neglect

A Journey in Science: Molecular vaccines for global child health in troubled times of anti-science

My scientific life in translational medicine runs in two parallel, yet often converging paths. The first, is four-decade-long commitment to develop new vaccines for parasitic and neglected tropical diseases, as well as pandemic threats. This includes a vaccine for human hookworm infection that I began as an MD-PhD student in New York City in the 1980s, and a new low-cost COVID vaccine that reached almost 100 million people in low- and middle-income countries. Alongside this life in scientific research, is one in public engagement for vaccine and neglected disease diplomacy to ensure that people who live in extreme poverty can benefit from access to biomedical innovations. A troubling element has been the daunting task of countering rising antivaccine activism, which threatens to undermine our global vaccine ecosystem. Yet, this activity may turn out to become just as important for saving lives as developing new vaccines.

Arboviral diseases and poverty in Alabama, 2007-2017

Mosquito-borne viruses cause diseases of great public health concern. Arboviral disease case distributions have complex relationships with socioeconomic and environmental factors. We combined information about socio-economic (population, and poverty rate) and environmental (precipitation, and land use) characteristics with reported human cases of arboviral disease in the counties of Alabama, USA, from 2007–2017. We used county level data on West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), California serogroup virus, Eastern equine encephalitis virus, and Saint Louis encephalitis virus to provide a detailed description of their spatio-temporal pattern. We found a significant spatial convergence between incidence of WNV and poverty rate clustered in the southern part of Alabama. DENV, CHIKV and ZIKV cases showed a different spatial pattern, being mostly located in the northern part, in areas of high socioeconomic status. The results of our study establish that poverty-driven inequities in arboviral risk exist in the southern USA, and should be taken into account when planning prevention and intervention strategies.

Mosquito-borne arboviruses like West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), California serogroup virus (CSV), Eastern equine encephalitis virus (EEE), and Saint Louis encephalitis virus (SLE) are on the rise globally. Socioeconomic and environmental conditions have played a role in directing in this expansion by creating conditions ideal for mosquito vectors and transmission. In this study, we used 10 years (2007–2017) of county level human arboviral case data from the US state of Alabama to better understand the roles socioeconomics (poverty rate) and environmental (land use, precipitation, land cover) conditions may play in driving patterns of arboviral disease in the southern US. We found a significant association between poverty rate and incidence of WNV, an arbovirus primarily transmitted by Culex spp. mosquitoes, which are known for thriving in contaminated water sources and sewage overflow. Conversely, cases of DENV, CHIKV, and ZIKV, arboviruses primarily transmitted by Aedes spp. mosquitoes, were reported in areas of high socioeconomic status. These findings suggest differential distribution of arboviruses relevant to human health in Alabama, and that poverty in the southern US is a significant factor that should be considered when planning WNV prevention and intervention strategies.

The history of the neglected tropical disease movement

The history of the neglected tropical disease movement is seen through the lens of authors who worked during the last 4 decades in different roles and in different settings, from Western-based laboratories to clinical roles in endemic countries and in critical policy roles in the World Health Organization (WHO). The authors seek to identify key players from the introduction of the word 'neglected' by the late Kenneth Warren in his Rockefeller Foundation-supported Great Neglected Diseases of Mankind movement through to the more recent developments after the London Declaration of 2012. The role of the various actors-endemic countries, major pharmaceutical companies, the WHO, non-government development organizations, bilateral donors and academia-are discussed. The critical events and decisions are highlighted that were essential enabling factors in creating a viable and successful movement and with a resultant massive global public health and antipoverty impact. The importance of advocacy is emphasized in creating the momentum to establish a globally recognized public health 'brand' as a target in the United Nations Sustainable Development Goals.

Crafting your scientist brand

That a scientist might shape and cultivate a personal brand is a relatively new concept but one that is finding increasing acceptance in this new age of rapid communications and social media. A key driver is the abrupt rise in well-funded and organized antiscience movements, especially in North America and Europe, such that society now benefits from scientists with strong personal brands and public personas who are willing to engage general audiences. In this sense, branding itself can advance science, the sharing of information, and the promotion of science as a public good. Still another dimension to branding is that it affords an opportunity to mentor younger scientists and helps you to become an important role model for the next generation. There is also a practical side, as today, fewer scientists spend their entire career at a single institution, so owning a strong brand can sometimes create easier paths for transitions and mobility. However, brand cultivation ideally begins in collaboration with your institutional office of communications and is done in a way that is seen as a win for both you and your university or research institution. Described here are some steps to consider when embarking on brand cultivation and how to avoid some of the potential pitfalls.

High levels of human infection with Trypanosoma cruzi associated with the domestic density of infected vectors and hosts in a rural area of northeastern Argentina

Background

Insecticide spraying campaigns designed to suppress the principal vectors of the Chagas disease usually lack an active surveillance system that copes with house reinvasion. Following an insecticide campaign with no subsequent surveillance over a 12-year period, we implemented a longitudinal intervention programme including periodic surveys for Triatoma infestans, full-coverage house spraying with insecticides, and selective control in a well-defined rural area of the Argentinean Chaco inhabited by Creoles and one indigenous group (Qom). Here, we conducted a cross-sectional study and report the age-specific seroprevalence of human T. cruzi infection by group, and examine the association between human infection, the onset of the intervention, the relative density of infected domestic bugs, and the household number of infected people, dogs, or cats.

Results

The seroprevalence of infection among 691 residents examined was 39.8% and increased steadily with age, reaching 53–70% in those older than 20 years. The mean annual force of infection was 2.5 per 100 person-years (95% CI: 1.8–3.3%). Infection in children younger than 16 years born before the intervention programme was two to four times higher in houses with infected T. infestans than in houses without them and was six times higher when there were both infected dogs or cats and bugs than when they were absent. The model-averaged estimate of the intervention effect suggests that the odds of seropositivity were about nine times smaller for those born after the onset of the intervention than for those born before it, regardless of ethnic background, age, gender, household wealth, and cohabitation with T. cruzi-infected vectors or human hosts. Human infection was also closely associated with the baseline abundance of infected domestic triatomines and the number of infected cohabitants. Two of 43 children born after interventions were T. cruzi-seropositive; since their mothers were seropositive and both resided in apparently uninfested houses they were attributed to vertical transmission. Alternatively, these cases could be due to non-local vector-borne transmission.

Conclusions

Our study reveals high levels of human infection with T. cruzi in the Argentinean Chaco, and the immediate impact of sustained vector surveillance and selective control actions on transmission.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3069-0) contains supplementary material, which is available to authorized users.

The poverty-related neglected diseases: Why basic research matters

Together, malaria and the neglected tropical diseases (NTDs) kill more than 800,000 people annually, while creating long-term disability in millions more. International support for mass drug administration, bed nets, and other preventive measures has resulted in huge public health gains, while support for translational research is leading to the development of some new neglected disease drugs, diagnostics, and vaccines. However, funding for basic science research has not kept up, such that we are missing opportunities to create a more innovative pipeline of control tools for parasitic and related diseases. There is an urgent need to expand basic science approaches for neglected diseases, especially in the areas of systems biology and immunology; ecology, evolution, and mathematical biology; functional and comparative OMICs; gene editing; expanded use of model organisms; and a new single-cell combinatorial indexing RNA sequencing approach. The world’s poor deserve access to innovation for neglected diseases. It should be considered a fundamental human right.