Hotez et al.
An onchocerciasis vaccine for Africa would build on past investments in OCP and APOC and support future investments planned under PENDA to help achieve elimination of onchocerciasis. TOVA has begun to explore innovative financing mechanisms from major foundations, governments in North America, Europe, and elsewhere, as well as some of the major development banks committed to poverty reduction in sub-Saharan Africa. We strongly encourage the global public health community to embrace the prospect of an onchocerciasis vaccine and to incorporate plans for a vaccine’s development into future public policy and strategic plan considerations.
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Is it possible to vaccinate against poverty?
According to the World Bank, an estimated 2.4 billion people live on less than $2 per day, while 1.2 billion live on less than $1.25 per day — a group often referred to as “the bottom billion”. We now know that almost all of the bottom billion and many of those living on less than $2 per day remain trapped in poverty because they are chronically debilitated by a group of afflictions known as the neglected tropical diseases, or ‘NTDs’.
NTDs are long-lasting parasitic and related infections such as ascariasis, trichuriasis, hookworm, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, Chagas disease, and leishmaniasis. The major point is that these NTDs can actually cause poverty either because they make people too sick to go to work and limit agricultural productivity, or because they strike children at vulnerable times, thereby stunting their physical and intellectual development. NTDs also disproportionately affect pregnant women, making them ill and causing them to produce low birth weight or premature infants.
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The flattening in support for biomedical research as well as other research fields in the United States over the last decade is having serious consequences for American science and scientists. Ultimately, we need a new generation of scientist-advocates and policy experts if we expect to reverse this trend.
The losses are real. The most recent news is that through sequestration there is a looming $1.6 billion cut to the budget of the National Institutes of Health (NIH), by far the largest public funder of biomedical research. Since 2003, the NIH budget has risen only 15 percent to just over $30 billion. Even before sequestration (taking inflation into account) the NIH provides 20 percent less in support for biomedical research annually than it used to 10 years ago.
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The large extracellular loop of the Schistosoma mansoni tetraspanin, Sm-TSP-2, when fused to a thioredoxin partner and formulated with Freund’s adjuvants, has been shown to be an efficacious vaccine against murine schistosomiasis. Moreover, Sm-TSP-2 is uniquely recognised by IgG1 and IgG3 from putatively resistant individuals resident in S. mansoni endemic areas in Brazil. In the present study, we expressed Sm-TSP-2 at high yield and in soluble form in E. coli without the need for a solubility enhancing fusion partner. We also expressed in E. coli a chimera called Sm-TSP-2/5B, which consisted of Sm-TSP-2 fused to the immunogenic 5B region of the hookworm aspartic protease and vaccine antigen, Na-APR-1. Sm-TSP-2 formulated with alum/CpG showed significant reductions in adult worm and liver egg burdens in two separate murine schistosomiasis challenge studies. Sm-TSP-2/5B afforded significantly greater protection than Sm-TSP-2 alone when both antigens were formulated with alum/CpG. The enhanced protection obtained with the chimeric fusion protein was associated with increased production of anti-Sm-TSP-2 antibodies and IL-4, IL-10 and IFN-γ from spleen cells of vaccinated animals. Sera from 666 individuals from Brazil who were infected with S. mansoni were screened for potentially deleterious IgE responses to Sm-TSP-2. Anti-Sm-TSP-2 IgE to this protein was not detected (also shown previously for Na-APR-1), suggesting that the chimeric antigen Sm-TSP-2/5B could be used to safely and effectively vaccinate people in areas where schistosomes and hookworms are endemic.
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On May 5, 2009, the Obama Administration announced its intention to launch an ambitious United States governmental strategy for global health. The US Global Health Initiative (GHI) proposes US$63 billion over 6 years (FY 2009–FY 2014), US$10.5 billion annually on average, approximately 70% of which would be spent on the US President’s Emergency Plan for AIDS Relief (PEPFAR). If appropriated each year by Congress, the GHI would represent a significant response to calls by the Institute of Medicine of the National Academies for the US government (USG) to invest US$15 billion annually on development assistance for global health by 2012.
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