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Dr. Peter Hotez: There are a group of these diseases. Our original list, which we published in 2005, had 13 or 14 “neglected tropical diseases," and now the World Health Organization has expanded the list to 17, and it’s a good list. I like to call them the most important diseases you’ve never heard of. They’re actually the most common afflictions of poor people. The problem is they’re only occurring among poor people, so there’s no real attention being paid. One of the things that was so powerful for HIV/AIDS was that you had a very strong advocacy group that began in the US, North America, and Europe, and you don’t have that for these diseases, because they’re only occurring among the extremely poor.
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Well, it’s not that they hadn’t before; it’s just that nobody was looking, which is also interesting. One of them is called Chagas disease; it’s a parasitic infection of the heart that’s transmitted by the kissing bug, and this is widespread in Texas.So you think these diseases are ignored specifically because they affect poor people?
That’s right. If these were diseases that were striking the middle class or wealthy people in North America or England, or elsewhere in Europe, we would never tolerate it. But because they’re only occurring among the poorest of the poor they go unseen.With that in mind, how do you approach working on them?
I guess your question is, "How do you get people to care about these diseases?"Yeah—how do you get people to care about them, but also how do you get people to care about it without it becoming a situation in which you're putting yourself forward as some kind of savior figure?
Well, one of the things I say is that these diseases not only occur in the setting of poverty; we now also have strong evidence to show that they have caused poverty. Diseases like Schistosomiasis, which is a parasitic worm infection, hookworm, and another one called Toxocariasis—which occurs among the poor in the US—actually reduce intelligence. They reduce IQ among kids, and there are studies to show that when chronic infections occur in childhood [they can] reduce future wage earning by 40 percent. The others make people too sick to go to work.
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I would say both. We have good days and bad days, and we’ve done a reasonably good job of getting donor support from the EU; they’re supporting our hookworm vaccine. The Carlos Slim Health Institute has been supporting our Chagas and Leishmaniasis vaccines. We’ve had support from the Gates Foundation, the US government, and the National Institutes of Health, and another big one is the Michelson Medical Research Foundation. That’s enabled us to develop the vaccines through early stage clinical testing. The challenge is going to be the later stages of clinical testing and leading to licensure—how that’s going to be financed. So we don’t have all the elements of the business model worked out, but we’ve made enormous progress so far in getting these vaccines into clinical testing.
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Yeah, so this problem is sometimes referred to as global access—how do you ensure global access? And we think we have good strategies in terms of good medicines that we give for de-worming and Schistosomiasis treatment. They seem to be getting to the people who need them. In fact, the US Agency for International Development just celebrated its one-billionth treatment, so people seem to be getting them because they’re fairly simple to use. And that’s how we partly designed the package when we wrote these papers in 2005 and 2006. We thought it would be fairly straightforward and easy, especially when the medicines are being donated and they don't have to be given by a healthcare provider.How does distribution of these medicines in the US compare with the rest of the world?
The irony is, we’re having a tougher time getting people to accept how widespread neglected tropical diseases are in the US. People don't want to admit that we have poor people in this country, but we have 1.65 million American families living on less than $2 a day. So we’ve been working with Congress to get some legislation enacted. Congressman Chris Smith in New Jersey recently submitted legislation to Congress called the End Neglected Tropical Diseases Act, which addresses the problem not only of NTDs like female genital Schistosomiasis across Africa, but also NTDs here in the US.So then the presence of NTDs in the US becomes evidence for something that America doesn’t really want to talk about, which is the existence of widespread poverty across the country?
That’s right, and it’s really flared up again now with this immigrant debate—you know, the 50,000 Central American children now being detained at the border of Mexico. One of their rationales for deporting the kids is that they’re going to introduce all these diseases, but in fact the diseases are here and they’ve been here for a very long time.I'm always fascinated by the number of American kids who want to go off and “save Africa” but don’t understand that there’s an enormous amount of poverty on their doorstep.
I think the impressive part is the extreme poverty we’re seeing. You know, we now have nearly 20 million Americans living at one half of the US poverty level, and so we’re approaching a level of poverty in this country—mostly in the American South, and then the Gulf Coast—that's reaching the level of poverty of many middle-income countries. It’s poverty that is the overwhelming determinate. We call them “tropical diseases” and sometimes it’s a bit of a misnomer. These are diseases of extreme poverty. I mean, climate is a component, but poverty is the overriding determinant.Have you seen an upswing in poverty during your time as a doctor?
Well, an upswing in the way that, before, nobody looked, and now we’re looking. So we came to Texas three years ago to create this National School of Tropical Medicine, which is modeled after similar schools in London and Liverpool. The difference is that we’re working in a disease endemic country, which is the southern part of the US and Houston, so that has been very powerful—the idea that we’re making interventions not only for people in Africa, but also for neglected diseases among the poor here at home. The drug companies have been good at donating the medicines, but then it’s another matter to convince their shareholders to invest in research and development to make new interventions that eventually they’d have to give away. So we feel we have to do that in a nonprofit sector.Follower Oscar on Twitter.