A New European Neglected Diseases Center for Greece?

Following the recently evolving downturn in the Greek economy, there is an opportunity to build a new Hellenic scientific institution for neglected infections of poverty located at the geographic center of Europe, the Middle East, and North Africa.

While today populations who live in poverty in sub-Saharan Africa and Southeast Asia suffer from the largest public health impact from the world’s neglected tropical diseases (NTDs) [1], [2], it is astonishing to some that many of these same diseases also disproportionately strike the impoverished populations living in Europe, the Middle East, and North Africa.

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A National School of Tropical Medicine and Neglected Infections of Poverty for North America

Several North American schools of public health and medicine have launched training partnerships with institutions in low- and middle-income countries. These include important “twinning” opportunities between North American institutions and sister schools in sub-Saharan Africa. Through the Fogarty International Center, the U.S. National Institutes of Health has just announced a Medical Education Partnership Initiative (MEPI) with the President’s Emergency Program for AIDS Relief (PEPFAR) to further support such U.S. and African training partnerships [5], which will also offer enormous potential for capacity-building in the region. At the same time, I believe there remains a strong need to have a centralized facility in North America for training in tropical medicine, i.e., one that embraces whole-organism biology of key NTD pathogens, new and appropriate health technologies and their introduction into global public health practice, and clinical tropical medicine. A National School of Tropical Medicine or the equivalent based in North America would address an important gap in training in the region.

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“Manifesto” for Advancing the Control and Elimination of Neglected Tropical Diseases

With a combination of funds from the group of eight (G8) nations, emerging economies (e.g., Brazil, India), multinational companies, and private philanthropic sources, together with a community of scientists, physicians, and other healthcare workers, global public health experts and policy makers committed to NTDs have begun to deliberate about how future resources and investments should be best allocated, particularly in terms of an appropriate balance between implementation and R&D. The leadership of key international agencies such as WHO, ministries of health in disease-endemic countries, and the communities themselves is key to achieve any ambitious strategy. With a global dialogue now underway, this is an appropriate time to present an eight-point manifesto (“a public declaration of motives and intentions by a government or by a person or group regarded as having some public importance” for NTDs.

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The Global Health Crisis and Our Nation’s Research Universities

On September 14th, 2009, the presidents of five United States universities—Boston University, Brown, Duke, Johns Hopkins, and the University of Washington—and representatives of over 50 North American institutions convened for the first meeting of the Consortium of Universities for Global Health (http://www.cugh.org). The meeting was in response to the demonstrated passion and interest of students in the field of global health and the responses needed from universities to cope with increasing student interest in this field. Of 37 institutions surveyed that feature global heath programs, the number of undergraduate and master’s level students studying in the field has doubled since 2006. In this arena, growing student movements have helped lead the way. Organizations such as Clinton Global Initiative Universities have also successfully tapped into university student interest in global public health outreach and research. To be sure, universities are well poised to lead such a movement for global health: They are independent organizations, boast central missions to promote public welfare, and possess copious resources and knowledge to share with partner institutions globally.

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Tropical Diseases Research: Thirty Years and Counting

TDR, the Special Programme for Research and Training in Tropical Diseases, was launched in 1978, more or less the same year I began my career in science as a Yale undergraduate working on the then nascent molecular biology of antigenic variation in African trypanosomes. Over the next two decades as a MD PhD student working on hookworms at Rockefeller University, and then back at Yale as a postdoctoral fellow and a member of the junior faculty there, I was told on multiple occasions that the likelihood of my making a career in scientific research on neglected tropical diseases was not very promising. After all, neglected diseases were neglected for a reason, including the fact that the most promising options for my obtaining long-term support at that time were (by today’s standards) relatively modest funds from the Rockefeller Foundation, the John D. and Catherine T. MacArthur Foundation, the Burroughs Wellcome Fund (BWF), and the US National Institutes of Health (NIH) tropical medicine and parasitology study section. However, it turned out that through the establishment of some innovative networks, the stewards of those funding organizations were remarkably adept at leveraging those modest dollars into keeping alive a sustained effort for neglected tropical disease research. This carried the US neglected disease research community all the way until 1999, when funding scaled up dramatically with the entry of the Bill & Melinda Gates Foundation. Today, the support of the Gates Foundation is now being used to successfully leverage much of that earlier Rockefeller, BWF, MacArthur, Wellcome Trust, and NIH driven fundamental research into the development of new products and clinical testing for the major neglected tropical diseases.

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Training the Next Generation of Global Health Scientists: A School of Appropriate Technology for Global Health

The MPH degree, while important for many aspects of public health, is simply not adequate for providing most of the the skills we need to staff the PDPs and PPPs for global health technology innovation. We need additional programs of instruction in US schools of public health, and possibly a new type of school of appropriate technology for global health. Graduates of such a curriculum should be highly sought after by the PDPs and PPPs, as well as the pharmaceutical industry, NIH, US Centers for Disease Control and Prevention, and the World Health Organization and other United Nations agencies committed to global health. It may be that even the establishment of a single major school of appropriate technology for global health would be sufficient to begin addressing current needs, and then elements of such instruction would in time diffuse to more conventional schools of public health. Equally important, we need to address training needs in middle- and low-income countries where the neglected diseases are endemic by identifying centers of excellence in global health technology and expanding the opportunities for young scientists to obtain training in core competencies relevant to product and clinical development, GXP, and global access.

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