Breakthroughs Blog: Malaria

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. Researchers at Rice University have developed a rapid malaria test that uses laser pulse—eliminating the need to draw blood. The test has been found safe in healthy humans and will soon be tested on humans with malaria symptoms. The White House has nominated Dr. Deborah Birx as the next Global AIDS Coordinator and to lead the President’s Emergency Plan for AIDS Relief (PEPFAR). Dr. Birx is currently the director of the Centers for Disease Control and Prevention’s Global AIDS Program and works on PEPFAR implementation at her agency. The US Agency for International Development and GHTC member Population Council have entered into an agreement to develop a non-antiretroviral-based microbicide to block HIV and other sexually transmitted infections. If successful, the partnership could offer a low-risk, easily accessible product for women in low- and middle-income countries. According to the results of an early-stage clinical trial, patients with multi-drug resistant (MDR) or extensively drug-resistant (XDR) tuberculosis (TB) could be treated by using stem cells taken from their own bone marrow. If successful, the treatment could be an alternative for patients with MDR- or XDR-TB who do not respond to conventional drug treatment options.

In this guest post, Jaclyn Schiff—American Society of Tropical Medicine and Hygiene (ASTMH) Director of Communications—highlights news in global health research presented during the recent ASTMH Annual Meeting. Just two week ago, more than 3,700 attendees gathered in Washington, DC, to announce, share, and discuss the latest research findings on a broad range of global health issues, including neglected tropical diseases, surgery in the developing world, and malaria. Just two week ago, more than 3,700 attendees gathered in Washington, DC, to announce, share, and discuss the latest research findings on a broad range of global health issues at the ASTMH Annual Meeting. Credit: ASTMH. Though the meeting attracted one of the largest crowds ever, the absence—due to federal travel budget cuts—of key researchers from the Centers for Disease Control and Prevention, National Institutes of Health, the Army, and Navy was noticeable. This also significantly affected the Annual Meeting last year, and the cuts persist with no sign of letting up. One unfortunate consequence is that scientific collaboration suffers at the Annual Meeting and at countless other research-focused gatherings. When science is stifled, we all lose out. But our colleagues who were able to make it, got on with it, and the media reported extensively on their findings. News coming out of the Annual Meeting covered a lot of ground—from gender bias in global health science to plague surveillance involving traditional healers in Uganda. So just in case you weren’t able to take it all in, here are three critical pieces of research from this year’s meeting: Potential danger from the Plasmodium vivax parasite: The malaria vector may be rapidly evolving to overcome the natural resistance conferred by a blood type found in millions of Africans. Science Now reported on the findings: To enter human blood cells, the parasite usually uses the so-called Duffy blood group protein, a protein on the surface of red blood cells. But because up to 95 percent of the population across sub-Saharan Africa lacks the protein—a genetic trait called “Duffy negative”—they have long been thought to be protected from infection. Yet reports have emerged in recent years of Duffy-negative people who are nevertheless infected with vivax malaria. “If vivax can establish itself in Africa, it can really undo a lot of the malaria progress we’ve made,” study co-author Peter Zimmerman, PhD, of Case Western Reserve University told the New York Times . Moving towards improved hookworm treatments: Researchers presented findings showing that they had completely cured lab animals of parasitic hookworm. To achieve the results, scientists used a modified version of a common human dietary supplement. The findings represent an “important development in our effort to find a safe, affordable and effective way to confront a major global health problem,” the study’s lead researcher said. In its report on the research, Xinhua  notedthat “the only drugs available to treat hookworms in humans were originally developed to combat parasites that infect farm animals.” The study researchers say that current treatments are not effective enough and that drug- resistance is rising. Strange dengue patterns in the United States: As dengue fever continues to spread from Key West north into the Florida mainland, it remains a mystery as to why this dangerous mosquito-borne illness is not yet common around Tucson, Arizona—even though outbreaks routinely occur in nearby Mexico and mosquitoes that can carry dengue are now common in the state. As The Verge reports, researchers think human or biological factors somehow explain why dengue hasn’t spread in Tucson. "It may be that the temperatures in Tucson are so hot," Mary Hayden, a scientist at the National Center for Atmospheric Research, told the BBC . She added “the relative humidity is so low that the mosquitoes may not be able to survive in that climate long enough for the virus to cycle within them.” Additional highlights, original news stories, and interviews are available on the #TropMed2013 Tumblr.

In the past, the United States has contributed to important breakthroughs in global health—from the eradication of smallpox to a 74 percent drop in measles deaths worldwide. Because of longstanding US leadership and support for global health research and development (R&D), Americans and millions around the world no longer live in fear of diseases like polio and measles, and many more are on treatment for diseases like HIV and AIDS and malaria. In fact, the US government is the largest supporter of global health R&D in the world, supporting the development and delivery of vaccines, drugs, diagnostics, microbicides, and devices. However, as we sit at a very important moment in global health product development, the political and economic environment in the United States is causing some to worry. Budget constraints have put funding at risk at many of the federal agencies involvement in global health R&D. Because of longstanding US leadership and support for global health research and development (R&D), Americans and millions around the world no longer live in fear of diseases like polio and measles, and many more are on treatment for diseases like HIV and AIDS and malaria. Photo: PATH/Evelyn Hockstein Today, the GHTC launches a new fact sheet outlining the important contributions the US government has made to global health R&D and why it’s critical the United States continues to robustly support the global health research pipeline. There are currently more global health products in the pipeline than ever before—with more than 365 new tools under development as of April 2012. Contributing to the success of many of these products is the US government’s partnerships with nonprofit product developers. These organizations partner with the public and private sectors to maximize resources and create tools for patients in low- and middle-income countries. Increased investments in global health research by the United States have the potential to increase the amount of tools combating global diseases. Just some of the products currently in the research pipeline include: The RTS,S malaria vaccine candidate, which is currently being tested and a policy recommendation for its use could be issued as early as 2015. Such a vaccine could reduce the burden of sickness and death from malaria. A new oral drug for sleeping sickness, fexinidazole, which recently entered late-stage clinical trials in patients in the Democratic Republic of the Congo. As a simple, short-course oral pill, fexinidazole could transform care for African sleeping sickness, which is fatal without treatment, and could potentially reduce its incidence among the most afflicted populations and accelerate elimination of the disease. Cost-effective diagnostics that are under development for malaria, tuberculosis, and neglected tropical diseases. These diagnostics could be administered in a variety of health care settings and could rapidly and accurately identify sick patients. An antiretroviral‐based microbicide which offers hope for women’s HIV prevention. Though more testing is needed following promising results from a 2010 advanced clinical trial, a microbicide could give women the power to protect themselves with or without their partners’ cooperation. In sub-Saharan Africa, where the epidemic has hit hardest, women 15 to 24 years old are at least twice as likely to be infected with HIV as young men.   In the research pipeline for global health products, 200 of the 365 products under development have some sort of US government support. With so much investment from the United States, there is even more at risk if funding is cut. Over the past several years, the US Congress has not been able to agree on a long-term budget for the federal government. Policymakers have allowed sequestration, or widespread automatic budget cuts, to affect all federal programs. These constraints have the potential to push back or halt promising research supported by several federal agencies involved in global health R&D—including the Centers for Disease Control and Prevention, the Department of Defense (DoD), the US Food and Drug Administration, the National Institutes of Health (NIH), and the US Agency for International Development (USAID). Due to sequestration: DoD is expected to receive budget cuts between 8 and 10 percent in fiscal year (FY) 2013. The DoD has been instrumental in the development of several global health technologies, many of which are used to protect Americans soldiers serving abroad. These cuts could affect the Walter Reed Army Institute of Research, the Naval Medical Research Center, and the Military HIV Research Program. NIH, the largest funder of global health R&D in the world, was forced to cut $1.7 billion from its budget by the end of FY 2013. NIH conducts nearly half the early-stage global health research, and supports thousands of domestic jobs all around the United States. USAID—with a presence in more than 100 countries—is best suited to support the clinical trials in low- and middle-income countries that ensure basic research is translated into appropriate health products. USAID is the largest supporter of HIV vaccine and microbicide development—both of which will be essential to achieve an AIDS-free generation. For many of the products currently in the global health research pipeline, continuous US support is essential. Without it, much of the breakthrough research that pushed these products to later-stage development will be lost—sometimes forever. US leaders should seize upon the recent successes in global health R&D and pass a long-term budget that ensures America’s legacy as a leader in innovation and science is not forgotten.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. At the annual Grand Challenges meeting in Brazil this month, the Bill & Melinda Gates Foundation announced a new partnership with pharmaceutical companies to accelerate vaccine research and development (R&D). For the first project, the Gates Foundation will partner with GlaxoSmithKline on early-stage research for vaccine thermostability. According to studies published in Nature, a potential new HIV treatment has a "profound and unprecedented" impact on the virus. The trials were performed by Harvard Medical School and the National Institute of Allergy and Infectious Diseases. GHTC member Treatment Action Group released a new report on tuberculosis (TB) research funding. The report finds that after seven years of slow and unsteady increases in funding, TB R&D investors reported a drop in spending in 2012 that threatens to undermine the tenuous gains made since 2005. The Centers of Disease Control and Prevention released a report stating that the number of malaria cases in the United States is at the highest level in forty years. Nearly all the cases were Americans or foreign travelers bringing it into the country. About two-thirds were infected in Africa, where malaria is common. A new analysis published in The Lancet Global Health found that only 37—or four percent—of the 850 drugs and vaccines registered from 2000 to 2011 were for neglected diseases. The study also found that just 1 percent of existing clinical trials are for the development of tools for neglected diseases.