Forgotten People, Forgotten Diseases. Peter J. Hotez
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5. Hotez PJ. 2011. Unleashing “civilian power”: a new American diplomacy through neglected tropical disease control, elimination, research, and development. PLOS NTDs 5:1134.
Preface to the First Edition
Ever since junior high school, I have been fascinated by the application of scientific knowledge for solving tropical public health problems of global importance. Starting with an M.D.-Ph.D. dissertation begun in 1980, my adult life has been a quest to develop experimental vaccines for human hookworm infection. Now, after more than 25 years of laboratory investigation and thanks to the support of the Bill & Melinda Gates Foundation, I have the opportunity and good fortune to head a multidisciplinary team that is developing and manufacturing these vaccines and then testing them in an area of Brazil where hookworm is endemic. While reaching this goal has been intensely satisfying at both a professional and personal level, I have also come to realize that completing early-stage development of a new product for a disease such as hookworm has in many ways been the easy part! Hookworm infects approximately 600 million people worldwide, but they almost all live on less than US$2 per day and only in the poorest regions of sub-Saharan Africa, Asia, and the tropical regions of the Americas. Because the people at risk for hookworm infection cannot afford to pay for a vaccine, unless there is greater general awareness about the public health and economic importance of hookworm and other parasitic infections there will never be the political will and large-scale financial investment necessary to ensure the global access of a hookworm vaccine, or indeed any other product for the diseases of poverty. Simultaneously, as it becomes evident to me that vaccine development is a decades-long process, I feel a need to do more in order to reach out to the world’s poor and provide them with better access to the existing treatments for hookworm, even if our currently available antihookworm drugs are imperfect.
Partly as a means to increase access to essential medicines and innovation, I have begun a concerted effort to raise public awareness of hookworm and other parasitic infections and to advocate for the largely voiceless poor people living in remote and rural regions of endemicity. However, it was only after I met three scientific “soul mates,” medical parasitologists who were simultaneously launching their own advocacy efforts, that I felt an important breakthrough was achieved in terms of placing parasitic diseases on the global radar screen. Since 2003 I have engaged in intense colloquy with Professor David H. Molyneux of the Liverpool School of Tropical Medicine (David is also the Director of the Global Alliance to Eliminate Lymphatic Filariasis), Professor Alan Fenwick from Imperial College, London (Alan is also the Director of the Schistosomiasis Control Initiative), and Dr. Lorenzo Savioli from the World Health Organization (as well as some of his close colleagues there, including Drs. Denis Daumerie, Dirk Engels, and Jean Jannin) about some of the common features of all parasitic infections affecting poor people. During these long and detailed but also joyful conversations, which took place in Washington, DC, Atlanta, New York, London, Liverpool, Glasgow, Geneva, Berlin, and Stockholm, we soon realized that the major parasitic infections, as well as some selected bacterial and viral infections, could be thought of in aggregate as a group under the banner of the neglected tropical diseases, or NTDs for short. The NTDs are the most common infections of poor people, and also among the most important in terms of their health and economic impact. In many respects, their burden of disease rivals those of better-known conditions including HIV/AIDS, even though most people have never heard about the NTDs. This lack of recognition continues to surprise us given that the NTDs are ancient conditions that have plagued humankind for centuries (as documented in many of our earliest writings such as Egyptian medical papyri and religious texts, including the Bible), and they represent one of the most important reasons why the populations living in low-income countries of Africa, Asia, and Central and South America remain mired in a vicious cycle of poverty, destitution, and despair. The continued presence of NTDs in North America represents that region’s most striking health disparity and a sad legacy of the Middle Passage, the Atlantic slave trade between the 15th and 19th centuries.
Professor Jeffrey Sachs and Dr. Sonia Ehrlich Sachs of Columbia’s Earth Institute and Dr. Eric Ottesen (then at Emory University) subsequently joined our informal NTD working group, and in a series of policy papers published in PLoS (Public Library of Science) and the New England Journal of Medicine, we were able to articulate the concept of the NTDs and how we can control or eliminate them through a global scale-up of access to essential medicines. These policy documents also provided a rationale for us to establish a new Global Network for NTDs, which is working to coordinate global advocacy and resource mobilization efforts for these conditions.
Forgotten People, Forgotten Diseases summarizes in mostly nontechnical language the major concepts about the NTDs and how they cause human suffering, as well as their global importance and the unique and unusual opportunity we now have to lift the world’s poorest people out of poverty through low-cost and highly cost-effective control measures.
Peter Hotez
Washington, DC
Acknowledgments
This book and my career in tropical medicine owe so much to so many people. I had the unique opportunity to thank many of them during my 2011 Presidential Address to the American Society of Tropical Medicine and Hygiene.1 Here I will provide just a few highlights.
First, I have the most amazing group of bosses a person could ever hope to have. These individuals have made it possible to realize a lifelong dream of heading a school (National School of Tropical Medicine [NSTM] at Baylor College of Medicine) and institute (Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development) devoted to neglected tropical diseases (“NTDs”), in addition to my policy role at the James A. Baker III Institute at Rice University, all located in Houston, Texas. They include Drs. Paul Klotman and Mark Kline, Mark Wallace, Ambassador Michael Marine, Brian Davis, and Ambassador Edward Djerejian. Mort Hyman, the Chairman of the Board at Sabin Vaccine Institute, and his wife, Chris, have been unwavering in their support of my career family, as have the Sabin Board of Trustees. Major General Phil Russell on the board has been an incredible scientific mentor and friend, as have Dr. Ciro de Quadros, Mike Whitham, Peter Thoren, and Marc Shapiro (the Baylor representative) and Gary Rosenthal, the representative from Texas Children’s Hospital. The Baylor College of Medicine, Texas Children’s Hospital, and Baker Institute boards also represent an impressive and supportive group of individuals.
Dr. Maria Elena Bottazzi, the NSTM Associate Dean and head of product development at the Sabin Vaccine Institute, has been an important source of wisdom and support, as has our NSTM founding faculty, including Profs. Bin Zhan, Elena Curti, Michael Heffernan, Kathryn Jones, Rojelio Mejia, Kristy Murray, Rebecca Rico-Hesse, Bin Zhan, Oluwatoyin Asojo, Jose Serpa, and Laila Woc-Colburn, and the founding scientists and support staff, Drs. Coreen Beaumier and Chris Seid, Brian Keegan, Portia Gillespie, Cliff Kwytin, Lori Center, Meagan Barry, Cheryl Basile, Monica Cazares, Lori Center, Shivali Chag, Wen Chen, Ashish Damiana, Dr. Larry Ellingsworth, Rodion Gorkachev, Anna Grove, Sheila Gurwitch, Molly Hammond, Elissa Hudspeth, Alan Kelleher, Jocelyn Kemp, Maylene Leu-Bent, Zhuyun Liu, Brandon Malone, Sandra Torres, Diane Nino, Melissa Nolan, Jeroen Pollet, Wanderson Rezende, Simone Tiu, Qian Wang, and Junfei Wei. Back in Washington, DC, are a talented group of scientists and staff at Sabin Vaccine Institute headquarters and George Washington University, too numerous to mention. I am deeply grateful to Elizabeth Jordan for donating one of her extraordinary photographs from her “Colors of Poverty” collection for the book cover and to CNN’s Soledad O’Brien for her willingness to champion the NTDs. Alyssa Milano, Mr. and Mrs. Len Benckenstein (Southwest Electric Energy Medical Research Institute), and Mr. and Mrs. Howard Harpster have also been stalwart champions, as have my close NTD colleagues and mentors Jan Agosti, Miguel Betancourt, Anthony Fauci, Alan Fenwick, Roger Glass, Lance Gordon, David Molyneux, Trevor Mundel, Eric Ottesen, Mark Rosenberg, Regina Rabinovich, Roberto Tapia, and Marco Antonio Slim. Tara Hayward and Erin Knievel have been great colleagues at the Sabin Vaccine Institute. I personally want to thank the long-standing support of the National Institute of Allergy and Infectious Diseases and Fogarty International Center of the U.S. National Institutes of Health, the Bill & Melinda Gates Foundation, the Carlos