Is it possible to vaccinate against poverty?
According to the World Bank, an estimated 2.4 billion people live on less than $2 per day, while 1.2 billion live on less than $1.25 per day -- a group often referred to as "the bottom billion". We now know that almost all of the bottom billion and many of those living on less than $2 per day remain trapped in poverty because they are chronically debilitated by a group of afflictions known as the neglected tropical diseases, or 'NTDs'.
NTDs are long-lasting parasitic and related infections such as ascariasis, trichuriasis, hookworm, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, Chagas disease, and leishmaniasis. The major point is that these NTDs can actually cause poverty either because they make people too sick to go to work and limit agricultural productivity, or because they strike children at vulnerable times, thereby stunting their physical and intellectual development. NTDs also disproportionately affect pregnant women, making them ill and causing them to produce low birth weight or premature infants.
Beyond their staggering public health impact, the economic losses from NTDs are also impressive: our studies with collaborators at Johns Hopkins University show that Chagas disease results in more than $7 billion lost annually, mostly in the Western Hemisphere. There are similar data available for many other NTDs.
Remember, the NTDs are not rare conditions -- virtually every single person living in extreme poverty is infected with at least one of these conditions.
Science can offer a lot to prevent these infections, thereby making poor people well enough to go back to work, children healthy and intellectually vibrant, and improving pregnancy outcomes. One approach now underway is annual mass treatment with a package of essential medicines that targets several NTDs at once, and costs only 50 cents per person. Although not a true vaccine, the World Health Organization uses the term "preventive chemotherapy" to describe this approach because when used over a period of time, together with other supportive measures, it is actually leading to the elimination of lymphatic filariasis and trachoma, and in some cases even river blindness in dozens of impoverished countries. In collaboration with several international organizations we organized a Global Network for NTDs that is raising awareness about the opportunity for these low-cost preventive chemotherapy approaches.
For other NTDs, however, we need new technologies. In 2011 the Sabin Vaccine Institute allied with Texas Children's Hospital and Baylor College of Medicine to expand its development portfolio of new and novel vaccines to combat NTDs. The result is the expansion of a unique non-profit product development partnership that is located in Houston's Texas Medical Center -- a medical city of 100,000 people -- to transition discoveries from the bench to the clinic and produce the next generation 'antipoverty vaccines', i.e. vaccines that would not only improve health but simultaneously also lift people out of poverty. For example, hookworm infection affects more than 400 million people in Africa, Asia, and the Americas, where it is a leading cause of anemia and childhood malnutrition, and has been shown to reduce future wage earnings. Our product development partnership, through activities led by Dr. Maria Elena Bottazzi, has developed, transitioned, and produced a prototype hookworm vaccine undergoing clinical trials in Brazil, and will soon undergo additional testing in Gabon through a so-called HOOKVAC consortium of European and African partners. We are also working to evaluate and modify the vaccine so it targets additional parasitic infections such as ascariasis and trichuriasis.
Finally, a new schistosomiasis vaccine is under development and will soon begin clinical trials.
Nor is poverty exclusive to developing countries or failed nations. Today, almost two million families in the United States live on less than $2 per day and poverty is rampant in southern states such as Texas and others along the Gulf Coast. We found that NTDs are also widespread among these impoverished Americans. For example 300,000 people in the United States suffer from Chagas disease, a cause of heart disease transmitted by kissing bugs -- our group, which includes a consortium of Mexican institutions, is now working to develop one of the first Chagas disease vaccines for clinical trials.
Dr. Albert Sabin, whose name and legacy our Institute honors once said, "A scientist who is a human being cannot rest while knowledge which might reduce suffering rests on the shelf." Our Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development is one of six major international product development partnerships currently pioneering vaccine development in the non-profit sector. Together we are making the vaccines for diseases that affect millions if not billions but only those living in extreme poverty.
Almost thirty years ago I graduated from New York's Rockefeller University, whose motto is Scientia pro bono humani generis - science for the benefit of humanity. Developing a new generation of antipoverty vaccines is a true expression of that concept.
Peter Hotez, M.D., Ph.D. is president of the Sabin Vaccine Institute and the founding dean of the National School of Tropical Medicine at Baylor College of Medicine, where he is also Professor of Pediatrics and Texas Children's Hospital Endowed Chair of Tropical Pediatrics. Prof. Hotez is also the Fellow on Disease and Poverty at the James A. Baker Institute for Public Policy at Rice University. He is the author of Forgotten People, Forgotten Diseases (ASM Press).
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