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A CDC researcher prepares reagents that would be used in a CDC-developed Zika diagnostic test. Photo: CDC/Sue Partridge, CDC- Ft. CollinsOn Wednesday, 26 current and past presidents of the American Society of Tropical Medicine and Hygiene (ASTMH) sent a letter to the leadership of the US Senate and House of Representatives urging policymakers to pass an emergency spending bill to combat the Zika virus as soon as possible, calling failure to do so “imprudent and reckless.”Six months have now passed since the White House first requested US$1.9 billion in emergency funding for the Zika virus response, yet Republicans and Democrats in Congress have failed to reach a compromise position, and last month Congress adjourned for summer recess without passing a funding bill. As a result, US agencies involved in the response, including the US Centers for Disease Control and Prevention and the National Institutes of Health, have been forced to repurpose funds from the Ebola response and other accounts to continue financing efforts to curtail the spread of the Zika virus. But President Obama and agency leaders have voiced mounting concerns that federal funds to fight Zika are quickly running out and lack of funding could delay vaccine research and development.In the letter to congressional leaders, ASTMH’s current and past-presidents note that, “The science is clear, the call to action is clear and yet, political infighting has carried the day while the outbreak continues….Patchwork and inadequate funding will not do the job—plain and simple.”The letter continues: “Without proper funding, researchers cannot sustain surveillance, planning, mosquito control, or research and development efforts to protect our most vulnerable populations, including women and children.” It ends by urging Congress to “get this job done now.” This collective leadership letter is the first of its kind for the Society, which is the largest international scientific organization of experts dedicated to reducing the worldwide burden of tropical infectious diseases and to improving global health.Click here to read the full letter.

Reducing unnecessary antibiotic use is widely considered a priority action in combating the spread of antimicrobial resistance. In the United States, one-third of antibiotic prescriptions are unnecessary and each year, there are 27 million gratuitous prescriptions for respiratory infections alone. Rapid, point-of-care diagnostics that can discern if an infection is bacterial could significantly reduce this practice, preventing antibiotic prescriptions for viral, parasitic, or fungal infections. There are now several tests in the pipeline which evaluate the level of C-reactive protein (CRP) in the bloodstream, a molecule associated with inflammation. CRP levels increase significantly in response to bacterial infections, but only slightly in response to viral infections. Not only have several of these tests proven reliable, but new research conducted by the Oxford University Clinical Research Unit in Vietnam indicates that such a test can successfully decrease antibiotic prescriptions for respiratory infections in low-resource settings. The study monitored antibiotic use for 2,000 patients at ten primary health centers, and use of the test reduced prescriptions from 78 to 64 percent, without impacting clinical recovery or patient satisfaction rates. Scientists have identified a compound that shows promise in treating three different parasitic diseases—Chagas disease, sleeping sickness, and leishmaniasis—that effect 20 million people and result in 50,000 deaths each year. The three diseases are caused by distinct parasites and transmitted by different vectors. Chagas disease results in cardiac complications, sleeping sickness causes neurological symptoms, and leishmaniasis manifests as skin sores and liver and/or spleen damage. Existing treatments are toxic, expensive, and difficult to administer in low-resource settings. The compound—GNF6702—was developed by pharmaceutical company Novartis and discovered after screening 3 million molecules in the company’s compound library. The molecule was then modified, resulting in a drug with 20 times the original potency. The compound targets proteasome—which breaks down waste—in all three parasites, but does not have the same effect in mammal cells. The drug has proven effective in mice, and will undergo additional safety tests before the initiation of human clinical trials.  The US Agency for International Development (USAID) announced last week the initial winners of its Combating Zika and Future Threats Grand Challenge, through which the agency will be providing more than US$15 million for the development and introduction of 21 innovative tools and interventions. In just two months, USAID received and reviewed nearly 900 applications, addressing various parts of outbreak prevention, detection, and control, including vector control, personal and household protection, vector and disease surveillance, community engagement, and diagnostic innovations. The winners include an electric force field to repel mosquitoes; a flip phone–based app that can distinguish between mosquito species, enabling crowdsourced vector surveillance; insecticide-treated sandals; and a human-scented mosquito trap. The agency will announce additional winners in the next month and will invest up to $30 million total.

The delegation checks out the mosquitoes that CDC is studying at its lab in Atlanta. Photo: Courtney Carson/GHTCLast month, Global Health Council (GHC) and PATH led a delegation of global health advocates to the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta.Since the founding of CDC more than 70 years ago, this US federal agency has played a vital role in global health. Its laboratories routinely work with some of the most deadly germs in the world.While many Americans tend to only hear about CDC during the flu season or epidemics like Ebola and Zika, the agency leads an impressive array of efforts that are vital to protecting the lives of US citizens and promoting the health and security of communities around the world.The delegation of advocates met with leaders across the agency’s divisions, including Dr. Tom Frieden, Director of CDC, and Dr. Rebecca Martin, Director of the Center for Global Health, to learn more about CDC’s work and to share their perspectives from Capitol Hill. They gained new insight into the agency’s science, policy, partnerships, and evidence-based public health programs, and learned more about the agency’s work in immunization, health research and development (R&D), global health security, HIV and AIDS, tuberculosis, and malaria. The delegation also had the opportunity to tour the CDC’s Emergency Operations Center and the Insectary and Parasitic Diseases Laboratory. They ended their trip with a presentation to CDC staff on how their global health advocacy efforts in Washington, DC support the CDC.We asked the delegation of global health advocates to share what they learned from the trip. Here’s what they had to say:“CDC’s Global Disease Detection program detects 30–40 outbreaks a day. The reason we don’t hear about those outbreaks—and why they don’t transform into epidemics and pandemics—is due to CDC’s swift response and ongoing capacity building programs that train local epidemiologist to detect, prevent, and respond to new and emerging disease threats.” — Bob Noziglia, Lutheran World Relief “Every CDC center is involved with Zika. It’s the most complicated response they’ve ever mounted, particularly because this is the first mosquito-borne disease with fetal birth defects since Rubella. But CDC is coordinating its response with other agencies, including a CDC-designed diagnostic that has been distributed to more than 100 countries around the world alongside lab training to use it.” — Lissy Moskowitz, Gavi, the Vaccine Alliance “The world is on the verge of one of the greatest public health achievements in human history: the eradication of polio. CDC has played a key role in these efforts, helping to develop a global network of polio surveillance, health workers, and laboratories that have become the backbone of many developing countries’ health system. This infrastructure goes beyond polio to support a wide range of essential health services, including providing vitamin A supplements, measles vaccinations, and surveillance of other diseases, like neonatal tetanus, and CDC continues to play a key role in ensuring health services continue.” — Brian Massa, United Nations Foundation/Shot@Life “CDC’s greatest resource is their people. Staff have an incredible career longevity—spending decades with the agency—which results in a depth of expertise across global health issues, tight coordination across teams, and development of unique skill sets. For instance, CDC has two staff that can identify unknown pathogens within an hour—morning, noon, and night—while others help countries with surveillance, lab capacity, and training, or serve as key health advisors across multilaterals. This is one reason CDC is internationally recognized as “the world’s 9-1-1,” serving as the first line of defense for health departments and ministries globally.” — Brandon Ball, PATH “Unless Congress acts, funding for global health security at CDC will reach a fiscal cliff in FY19. To truly build and sustain the global networks to prevent, detect, and respond to disease threats, predictable long-term funding is needed; while emergency supplemental funds are valuable, they often come too late. Targeted, but flexible funding is needed so that local experts are resourced to act quickly to stop threats in their tracks.” — Erin Fry Sosne, PATH The delegation checks out the mosquitoes that CDC is studying at its lab in Atlanta. Photo: Courtney Carson/GHTC“CDC's malaria and parasitic disease program not only conducts research to advance new diagnostics, vaccines, and countermeasures for malaria, but also works to make sure we are using existing malaria interventions effectively. In their insectary, CDC tests bednets to determine how many, and where tears and holes can exist before the nets are rendered ineffective. This work is vital to leveraging US investments in the Presidents Malaria Program and ensuring we are using US global health funds responsibly and productively.” — Erin Will Morton, Global Health Technologies Coalition “CDC’s Center for Malaria and Parasitic Diseases works every day to improve treatment and develop new tools to address diseases that kill an estimated 534,000 people worldwide, but many Americans never see up close—neglected tropical diseases (NTDs). Not only does CDC leverage donations from pharmaceutical companies to administer drugs for treatable NTDs at less than fifty cents per person per year, but they also conduct research to develop new diagnostics and treatment regimens to more effectively combat hard or expensive-to-treat NTDs. For example, CDC is working to transform a laboratory diagnostic for NTD schistosomiasis to a point-of-care urine test that is both more cost effective and more appropriate for use in low-income, rural settings where the disease is most prevalent.” — Courtney Carson, Global Health Technologies Coalition “Through the CDC Foundation, CDC is able expand the reach of its work through partnerships with corporations and individuals. Established by Congress as an independent nonprofit organization, since 1995 the CDC Foundation has raised over US$680 million, launched 800 programs around the world, and interacted with over 200 private sector entities. Most recently, through its Global Disaster Fund, the foundation raised $56 million from donors to assist with the response to the Ebola outbreak.” — Lanice Williams, Global Health Council “Although CDC had been working on the global response to HIV and AIDS since 1999, PEPFAR changed how CDC worked globally. With the inception of PEPFAR in 2003, CDC expanded its global work by opening more country offices and working closely with ministries of health. Today, through its regional offices, CDC continues to monitor Ebola in West Africa, trains epidemiologists through its Field Epidemiologists Training Program, and work on the Zika response. And its work in PEPFAR continues: providing over 7 million men, women, and children with antiretroviral treatment (ART) and care, as well as support for 5 million orphans and vulnerable children and the training of over 140,000 health care workers.” — Danielle Heiberg, Global Health Council “Through the use of lab technology advancement, CDC has significantly driven down the cost of genome sequencing testing. CDC’s Advancing Molecular Detection (AMD) initiative focuses on using the latest technology advances in pathogen identification to protect Americans from infectious disease outbreaks. This initiative is fundamentally changing how CDC scientists conduct lab work and diagnostics on diseases such as tuberculosis, malaria, Zika, and tropical diseases such as leishmaniasis, and by providing a thousand times more information in a shorter time frame.” — Karen Goraleski, American Society for Tropical Medicine and Hygiene This blog was originally published on The Collective Voice, the blog of the Global Health Council.