Peter Hotez On “The Most Important Diseases You’ve Never Heard Of”

Despite the rapid pace of medical advancements like gene therapy, treating many of the world’s most devastating diseases is a matter of economics and political will, not science. That’s according to Dr. Peter Hotez, the dean of Baylor University’s National School of Tropical Medicine.

Hotez says this is particularly true for a group of parasitic and bacterial infections collectively known as Neglected Tropical Diseases, or NTD’s. These diseases, says Hotez, have more to do with economics than climate.

“They’re not even rare diseases. They’re very common,” Hotez said. “ But they’re hidden. They’re hidden among the poor.”

The Centers for Disease Control and Prevention estimates that more than one billion people — approximately one-sixth of the world’s population — suffer from at least one NTD. These diseases, which range from Dengue Fever to Leprosy, don’t always lead to death. But their effects can last a lifetime.

“They tend to be chronic and debilitating infections,” Hotez said. “So they not only encourage the setting of poverty, but they reinforce poverty.”

Hotez and other global health leaders have devised low-cost public health interventions to treat and prevent NTD;s in the poorest regions of the world. Their success has changed the global distribution of these diseases.

“Now, possibly because of the intervention, most of the world’s poverty-related neglected diseases are not necessarily the poorest, most devastated countries of sub-Saharan Africa. They’re certainly there, but on a numbers basis most of the world’s NTD’s are in the poor living in wealthy countries,” Hotez said. In his most recent book, “Blue Marble Health,” Hotez estimates 12 million Americans living at the poverty level currently suffer from at least one NTD.

In addition to tackling NTDs in countries like the United States, Hotez is taking on yet another public health crisis in the developed world: the anti-vaccine movement. His forthcoming book, “Vaccines Did Not Cause Rachel’s Autism,” delves into the neurobiology of autism, in hopes of undoing false associations between vaccines and the disorder.

INTERVIEW HIGHLIGHTS

Hotez on why he decided to coin the term “Neglected Tropical Diseases”:

The term rose out of the Millennium Development Goals. Back in the year 2000, when all global leaders assembled to U.N. headquarters to address the bottom billion and look at poverty reduction… Of the eight goals was one that was specifically tackling infectious diseases, and that was to combat AIDS, malaria and other diseases… And, believe it or not, you didn’t see Bono and Angie Jolie taking on “other diseases.” So we went about and embarked on our branding exercise to identify them and classify them as NTD’s, or Neglected Tropical Diseases, in order to identify them as important targets for intervention.

Hotez on “Vaccine Diplomacy”:

Our research laboratories at Baylor College of Medicine and Texas Children’s Hospital are focused on developing new vaccines for Neglected Tropical Diseases…. And over the last 20 years we’ve built up an extraordinary research group of about 50 scientists that are developing these vaccines, so we have the ability to teach others how to do what we’re doing, as opposed to, if you’re running a big multinational pharmaceutical company, you know a Merck or Pfizer. You can’t walk into Merck or Pfizer and say teach us how to make a vaccine, but we can.

It’s a concept that really began, in my opinion, when Albert Sabin …who discovered the oral polio vaccine. Now, many people don’t realize that he actually did this jointly with the Soviets at the height of the Cold War… So the idea is two countries setting aside their ideologies to work together for making lifesaving interventions.

Hotez on his upcoming book, “Vaccines Did Not Cause Rachel’s Autism”:

There’s not only no link between vaccines and autism, there’s no plausibility…We’ve learned so much about the neurobiology of autism in the last few years. It can show that the changes in the brains of kids on the autism spectrum are beginning prenatally in the prefrontal cortex and temporal lobe, before the baby’s born, well before they ever see vaccine.

FULL TRANSCRIPT

Rebecca Cruise: Peter Hotez, welcome to World Views.

Peter Hotez: Thanks for having me today.

Cruise: Well, you are a medical doctor that focuses on tropical diseases. And let me start by asking what’s probably a very obvious question, but what do we mean by tropical diseases? Is this simply diseases that seem to come about in tropical areas? Or hot areas? Or what are we talking about here?

Hotez: Well historically that’s right. They were. The term originated out of European colonization of Africa and Asia, and to some extent Latin America. And they still today tend to refer to diseases of what we call the global south, meaning Africa Asia and Latin America, but it’s really changed a lot. And in one of the terms that we help framework that we help develop the concept of what we call Neglected Tropical Diseases or NTD’s, and these are some of the most common afflictions of people living in Africa Asia and Latin America.

Hotez: But, you know really, more than warm climate, it’s poverty that’s the overriding factor associated with these diseases. These are the diseases of the world’s poor, what we used to call the bottom billion– the billion people in the world who live on no money. And an important feature about these diseases, neglected tropical diseases or NTD’s, is they tend to be chronic and debilitating infections. So they not only encouraged the setting of poverty but they reinforced poverty. They make people too sick to go to work. They shave IQ points off of children. They affect pregnancy outcome. So an important rationale for taking on these diseases is not only for humanitarian reasons but also economic reasons. This is… by treating these diseases or preventing them through vaccines is actually a very potent anti anti-poverty measure.

Cruise: So many of these diseases could be prevented or could be treated under the right circumstances. But because of the socio-economics in these areas, they have far-reaching consequences.

Cruise: And you call them neglected. Are they neglected because they seem to afflict the poor? Are there racial issues here? Or what’s what’s the reason that this neglected term has become so used?

Hotez: Well, the term rose out of the Millennium Development Goals. Back in the year 2000 when all global leaders assembled to U.N. headquarters to address the bottom billion and look at poverty reduction there was, of the eight goals was one that was specifically tackling infectious diseases, and that was to combat AIDS malaria and other diseases. And this is what led to President George W. Bush creating PEPFAR, the President’s Plan For AIDS Relief, that put people on anti-retroviral drugs, The Global Fund to Fight AIDS… They added tuberculosis and malaria.

But there was kind of a flaw in that they had that third component of that goal was other diseases, and believe it or not you didn’t see Bono and Angie Jolie taking on other diseases. So we went about and embarked on our branding exercise to identify them and classify them as NTD’s or Neglected Tropical Diseases in order to identify them as important targets for intervention.

Cruise: So what are some of these neglected diseases? Or are these going to be names that we’re going to recognize, or are they so neglected that we may not have even heard of them?

Hotez: I like to call them the most important diseases you’ve never heard of. So they include diseases such as Intestinal Roundworm Infection or Ascariasis, Hookworm Infection or Schistosomiasis, Lymphatic Filariasis which is also known as Elephantiasis… The point is every single person living in extreme poverty has at least one of these diseases. So really all of the bottom billion are affected and now according to the World Bank we have about 750 million people living below the poverty line globally. They’re all infected with these parasitic and related neglected tropical diseases.

Cruise: And I imagine as we also see a rise in migration from some of these areas there’s also the potential for some of this to spread.

Hotez: Well one of the things that we did was help conceive of this package of medicines, and the medicines were being donated by the major pharmaceutical companies. We assembled them together in what’s called a rapid impact package that’s now been administered to more than a billion people. And the package can be delivered for only 40 cents a person per year. So it’s one of the most cost effective and widely used public health interventions that’s out there right now.

So that’s the good news part of the story, but it’s the not so good news it’s like peeling away the layers of an onion, so you solve one problem and then you only to find another one, and one of our most recent findings which was…so the first book I wrote was about these diseases called “Forgotten People, Forgotten Diseases,” the second book which came out in 2016 is called “Blue Marble health,” and I find something quite interesting which is that now, possibly because of the intervention, most of the world’s poverty related neglected diseases are not necessarily the poorest most devastated countries of sub-Saharan Africa. They’re certainly there, but on a numbers basis most of the world’s NTD’s are in the poor living in wealthy countries,  in G-20 countries. So the G-20 economies now account for most of the world’s parasitic worm infections, leishmaniasis, and Chagas disease and Tuberculosis, and Dengue, and leprosy, and the list goes on.

And so that’s… Has a lot of policy implications, because it says, if it’s true that it’s the poorest of the rich now account for most of these diseases, the policy implication is that if the G-20 leaders would redouble efforts for their own vulnerable neglected populations we could have a huge impact on getting rid of these diseases.

Cruise: So they’re not getting resources in the G-20?

Hotez: Well, for instance, you know one of the real surprising, profound findings of the book is the hidden poverty and disease right here in the United States especially in the southern United States. So in the book  I estimate there’s 12 million Americans now living with neglected tropical disease…

Cruise: 12 million in this country…

Hotez: So they’re not even rare diseases. They’re very common. But they’re hidden. They’re hidden among the poor so we have no way of finding hookworm infection in Alabama, and probably other southern states. We’re finding widespread Chagas disease transmission among the poor in Texas. Leishmaniasis in Texas, and even in Oklahoma now. But it’s been really tough to raise awareness about these diseases, so one of the big disappointments we’ve had is I had a lot of success getting people to care about neglected tropical diseases in the poorest countries of Asia and Africa. But when I talk about neglected diseases of the poor in the US the lights go out. People…people don’t either want to don’t want to hear the story,  or don’t really, can’t really get their arms around. We seem to have a lack of care about people who live in extreme poverty in this country.

Cruise: Well certainly is the gap between the rich and the poor in the country continues to widen, as we’ve seen, I would imagine that this will continue to be a problem and perhaps even grow.

Hotez: Well for example you know there’s a big push now towards this concept of precision medicine and being able to use genomic data in order to fine-tune interventions. And I think that’s great. It has its important to advance medical science. But I think it comes at a price as well. I think could increase the differential between the haves and the have-nots even further.

Cruise: Now one of the things that you did recently you’ve had a very interesting career, about something that has particularly stood out is that during the Obama administration you served as special envoy focusing on vaccine diplomacy. What is vaccine diplomacy?

Hotez: So it’s another term that I helped coin and it goes something like this: So one of my, my… My most of my day job is spent actually heading a research group that’s developing vaccines for neglected tropical diseases. So our research laboratories at Baylor College of Medicine and Texas Children’s Hospital are focused on developing new vaccines for disease for these neglected tropical diseases, for schistosomiasis, and hookworm, and Chagas disease and leishmaniasis and so forth. And over, over the last 20 years we’ve built up an extraordinary research group of about 50 scientists that are developing these vaccines so we have the ability to teach others how to do what we’re doing, as opposed to, if you’re running a big multinational pharmaceutical company, you know a Merck or Pfizer, you can’t walk into Merck or Pfizer say teach us how to make a vaccine, but we can. So we’re trying to spread this by saying we are now going to work with countries that have no capacity for doing vaccine development and help them to do that.

And one of the big hot zones now for new world’s neglected tropical diseases is the Middle East, Central Asia and North Africa and partly because of the wars and conflicts there. They’ve collapsed the public health structure. So we’ve had a massive resurgence of Neglected Tropical Diseases in the Middle East, Central Asia and Africa. And there’s no… zero vaccine development capacity in those countries, so I took on this role to help other countries learn how to develop vaccines. And it’s a concept that really began in my opinion when Albert Sabin who discovered the oral polio vaccine. Now, many people don’t realize that he actually did this jointly with the Soviets at the height of the Cold War. So at a time when tensions between the U.S. and the USSR was at an all-time high, Sabin was sent to the USSR, to the Soviet Union, to actually work with Russian scientists to jointly develop the oral polio vaccine, and it was tested on 10 million Soviet schoolchildren and shown to be safe and effective. And that’s what ultimately led to licensure of the oral polio vaccine now being used to eradicate polio worldwide. So the idea is two countries setting aside their ideologies to work together for making lifesaving interventions and and trying to apply that to a modern day situation that we face in the Middle East than elsewhere.

Cruise: So very much diplomacy in the sense that we would think about it, just focusing in on health… It’s so interesting, too, that you’ve been looking at some of these diseases in countries, the Middle East, war- torn areas, but the vaccine issue is a much larger one. And it seems to be interesting that as some are pushing to get more vaccines in developing parts of the world, in the developed world or the global north there seems to be a new debate in the last decade or so, kind of the anti-vaccine philosophy that’s come forward. and we’ve seen diseases that we thought were at least a quieted, or perhaps eradicated, starting to come back. A major outbreak of measles recently in Europe. What’s going on here? I know you’re doing some research on a forthcoming book, but what’s the process here and what’s happening?

Hotez: So thank you for the questions. So you’re absolutely right. You know, we’ve made… in the last 20 years we’ve made enormous progress partly through the creation of this amazing organization called GAVI, the Global Alliance for Vaccines and Immunization. And GAVI was started with 750 million dollars of Gates Foundation funding, and now they get support from a number of countries. And they’ve made great strides in vaccinating the world’s children, so that for instance, measles, which in the 1980s was the single leading killer of children in the world…Two million children died every year from measles. Now that’s down to 68,000 children dying every year. So an extraordinary decline, more than 90 percent decline through through the activities of GAVI… And also introducing some new vaccines.

That’s the good news part of the story. The bad news part of the story is around the time the GAVI was launched, 1998, is the start of this modern day anti-vaccine movement that makes the phony allegation that vaccines cause autism, even though there’s no link between vaccines and autism. And this spread across Europe, and now it’s into the United States. So in Europe last year there were 21,000 measles cases and 35 deaths. And, as you point out, last year we had a terrible measles outbreak in Minnesota. We have one ongoing right now in Kansas. And we have now 18 states in the U.S. that allow so-called non-medical exemptions for personal belief or philosophical belief reasons. I believe Oklahoma may be one of them certainly Texas.

So we’ve got now pockets where we’ve got schools were 20, 30, 40 percent of kids are not being vaccinated, and we know that the vaccine coverage rates goes down the first thing we see breakthrough is measles because it’s one of the most highly contagious diseases known. So I’ve been going around the country and internationally saying that we’re going to reverse global gains because of this anti-vaccine movement making phony assertions about vaccines.

Cruise: So, just to clarify that, the scientific evidence completely supports the safety of vaccines. There is no link between vaccinations and autism or other, other concerns.

Hotez: There’s not only no link between vaccines and autism, there’s no plausibility. And so I get involved in this because I’m not only a vaccine scientist I’m also an autism dad. So my… I have four kids and they’re all adults now, and my youngest daughter, Rachel, has severe autism and other mental disabilities, and I have a new book coming out at the end of the summer called “Vaccines Did Not Cause Rachel’s Autism,” and it explains not only the massive evidence showing there is no link between vaccines and autism but also the fact that we will, we’ve learned so much about the neurobiology of autism in the last few years. It can show that the changes in the brains of kids on the autism spectrum are beginning prenatally in the prefrontal cortex and temporal lobe, before the baby’s born, well before they ever see vaccine.

So this is a genetic and epigenetic condition. In fact we’ve recently done genetic testing on Rachel, and we found a new a new gene that’s been, been linked to autism. So this is where we have to focus the emphasis on doing things like whole genome sequencing on kids on the autism spectrum to fully understand the extent. And, unfortunately, this is being fueled by social media. It’s being fueled by a few aggressively anti-vaccine websites that make a lot of phony assertions. But it’s very real, and parents… you know the the the Google vaccines and they see these anti these anti-vaccine Websites spewing out misinformation. And so we’re making began the arduous task of trying to counteract the phony information by writing this book.

Cruise: Well what is very real is that the rising increase, as you mentioned, of measles and other diseases that have come about because of a lack of vaccination. So definitely something to, to consider. Well there are so many things that we could go over today and unfortunately, we are at an end of time. But thank you so much for the important work that you’re doing for your vaccine diplomacy and for all the other things that you do and for spending some time with us today.

Hotez: Well thank you again for having me.

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