Before I begin my latest personal selection of some of the new items featured on the TropIKA.net knowledge platform, may I wish all of our regular readers a very happy New Year. I hope that your own endeavours in the battle against the infectious diseases of poverty will bear fruit this year.

It is heartening to learn that new initiatives continue to be launched to provide funding both for research and for control efforts. However, it is clear that much more financial support is still needed. A US consumer group has reported on government expenditure on neglected infections and says it is not enough. Also in the US, the Institute of Medicine has called upon the incoming President to make health a pillar of foreign policy and to double US funding for global health initiatives within the next four years.

Of the diseases which we feature on TropIKA.net, malaria and tuberculosis attract the most funding and in consequence there is always more for us to report regarding new research findings. However, recent weeks have seen the publication of a number of studies on schistosomiasis. One that we have featured concerns the role of hygienic bathing in the transmission of the disease. (Do visit our Research Articles section to see the other studies that we have recently highlighted.)

We also report that schistosomiasis control in China will benefit from the use of satellite technology and that new funding from the Gates Foundation will be used for operational research on the control of the disease.

The development of effective new interventions against the infectious diseases of poverty is only part of the process. Their effective delivery is also crucial. This is well illustrated by vaccination programmes. Many programmes are still failing to reach targets and a worrying study published in the Lancet now suggests that some programmes over-report their success rates. As we go forward into the New Year it is important to maintain a positive position on what it being achieved but also that we should be realistic; our efforts should be informed by accurate data and not by over-estimates.

What part – if any – can the private sector play in fighting the infectious diseases of poverty? The pharmaceutical industry would of course argue that it is already playing a crucial role in research. A new report from the International Federation of Pharmaceutical Manufacturers says that the number of medicine and vaccine projects undertaken by IFPMA member companies has increased. Two pharma companies have also just announced their intention to market a new artemisinin-combination therapy (ACT) drug for malaria in Africa – see our news story. However, the proportion of industry research devoted to infectious diseases of poverty remains very, very small. As the IFPMA report acknowledges, nearly all the projects currently under way have only been made possible because they involve public-private partnerships. The new ACT antimalarial, Eurartesim, is a case in point, as it was developed jointly with the Medicines for Malaria Initiative.

The role of the private sector in the delivery of care has always been hotly disputed. We link to a debate article on the topic published in PLoS Medicine. Perhaps the biggest doubt as regards what can be achieved through private health care is whether the public sector could ever be able to help reduce health care inequalities. TropIKA.net is particularly concerned with the issue of inequalities and we highlight a review article which discusses the evidence on this question that has been assembled by the knowledge networks set up by the Commission on the Social Determinants of Health.

Reducing inequalities is also central to the health reforms which have been taking place in Venezuela in recent years. As discussed in a TropIKA.net blog, the journal Social Medicine has devoted an entire issue to a discussion of the Venezuelan experience.

Lessons from the experiences of nine countries in health financing are presented in a 530-page report from the World Bank. Community-based health insurance is one approach to financing that has been advocated, with reducing inequalities particularly in mind, but a new study has found that more evidence will be needed before the effectiveness of such schemes can be ascertained.

When health inequalities are discussed it is the differences between rich and poor that one thinks of first. However, gender issues are also of great concern. Another recent study we have highlighted concerns gender difference in knowledge of tuberculosis and associated health-care seeking behaviours.

Recently on TropIKA.net, we have been expanding the number of items added to our blog. We hope that our readers find these usually very brief items to their liking. One advantage of blogging is the interactive aspect. It is very easy to respond to a blog and to maintain a discussion. One recent blog was a response to a request from the Faculty of Medicine Universitas Muhammadiyah Yogyakarta, Indonesia to help make better known their innovative International Tropical Medicine Summer School. The summer school is looking for potential visiting lecturers. Can you help?

Finally, as South-South cooperation is another issue of interest to TropIKA.net, we are very pleased to have published a news story describing the launch of the West African Viral Surveillance Network, which will greatly facilitate cooperation between researchers in that part of Africa.

The TropIKA.net News section generally contains a mixture of good and bad. Reports of a possible resurgence of onchocerciasis are extremely alarming. In contrast, the appropriate use of innovative technologies is always encouraging and a story from South Africa of the introduction of miniature aircraft to transport clinical samples makes for interesting reading.

News of the seizure of a vast supply of fake drugs in Southeast Asia is also encouraging, in that it shows the authorities are achieving some success against the counterfeiters, but sadly it underlines just how severe this problem has become. Amongst the drugs seized were many fake artemisinin treatments for malaria that did contain the active ingredient but only in very low doses, raising the risk of the development of resistance.

Meanwhile, new moves are being taken to find ways of increasing the availability and affordability of artemisinin. We report on a recent conference of the Artemisinin Enterprise and on a new publication from this organization.

Other reports published recently include a look at ‘supply-side’ issues in the antimalarials market in Uganda, produced by the Medicines for Malaria Venture, and a discussion of the spread of tropical infections from an Australian perspective published by the Lowy Institute.

We continue our TropIKA.net Profiles series with an interview with malaria researcher Dr Chetan Chitnis of the International Centre for Genetic Engineering and Biotechnology. The work he and his colleagues are doing in New Delhi is a key part of international efforts to develop vaccines for malaria. When work of such importance is being conducted in a disease-endemic nation, there is certainly every reason to feel encouraged.

Two important new features can now be seen on the home page of TropIKA.net. One is a new Featured Meeting – the 2008 Global Ministerial Forum on Research for Health which is now taking place in Bamako, Mali. A TropIKA.net editorial team (six journalists and ten rapporteurs) is present at this major conference and we are providing daily summaries of the sessions, interviews and a blog covering all areas of the meeting. All of our in-depth coverage may be accessed here.

We have also introduced a new section called ‘Toolkits’. Under the Health Research Systems Analysis (HRSA) Initiative, the World Health Organization (WHO) consulted with a range of partners to develop concepts and tools to describe, analyse, and benchmark national health research systems. The collection of tools provides information and resources for systematically collecting health research and national health research systems data. Details will be found here.

A few months ago, I spoke with a leading researcher who is also a user of TropIKA.net and he wondered whether one of our most useful functions might turn out to be alerting the infectious disease community to the publication of new reports. His point was that new journal articles can be located on PubMed and other databases but reports may easily go unnoticed. This is indeed case now that an increasing number of organizations are involved in our field. Within the last few days, we have highlighted four new reports:
- The Global Burden of Disease. The latest update of WHO’s comprehensive assessment of the health of the world’s population.
- The International Response to Highly Pathogenic Avian Influenza: Science, Policy and Politics. A report from the Social, Technological and Environmental Pathways to Sustainability (STEPS) Centre.
- Global Climate Change and Extreme Weather Events: Understanding the Contributions to Infectious Disease Emergence. This document arises from discussions at a workshop held by the Forum on Microbial Threats.
- Ending the R&D Crisis in Public Health: Promoting pro-poor medical innovation. A new analysis by Oxfam.

The content of the other sections of TropIKA.net continues of course to expand. Please visit our News section, where there is good news to be found on declines in malaria prevalence in several African countries, and our Research section where genetics and mathematical modelling are among the recent topics.

The 39th Union World Conference on Lung Health has been held at a time when there are many exciting developments to report on tuberculosis but the need for increased funding for research is nevertheless apparent.

Another important event within the last couple of weeks has been the publication of the annual World Health Report. It appears almost exactly 30 years after the historic Alma Ata conference which led to an emphasis on primary health care (PHC). The World Health Organization says that, to address persisting health inequalities, a return to the spirit of Alma Ata is required.

China has undergone many changes in recent years. The impact of these changes has been discussed in a series of articles in the Lancet. There is no doubt at all that China has much to contribute towards the global battle against the infectious disease of poverty. TropIKA.net has recently highlighted a number of studies on infectious diseases conducted within China from which there are lessons for other nations. For example, a trial has been reported which examined the safety and efficacy of combined praziquantel and artemether treatment for schistosomiasis. Another Chinese trial has shown the drug tribendimidine to be effective against hookworm, roundworm, whipworm, tapeworm and threadworm.

Research that will lead to the development of new vaccines is often reported on TropIKA.net but the development of an efficacious vaccine should never be regarded as the final goal. There are many diseases which can be prevented by vaccines already available, but strategies must still be found to deliver those vaccines to those who need them. Pneumococcal disease is one of the biggest infectious killers of poor people, particularly children. There is now a vaccine and it is coming into use in richer nations. A UK parliamentary group is campaigning for the vaccine to be introduced in developing countries, and also for other action to be taken against this infection.

And of course even effective vaccines can be improved. Encouraging news comes from Nigeria where a polio vaccine that only requires one dose, instead of three, has been shown to be effective.

Amongst the recent research that has been the subject of commentaries on TropIKA.net, have been two important genomic studies on malaria. The completion of the P. vivax genome provides the scientific community with a valuable resource that can be used to advance investigation into this relatively neglected species. The genome of the simian and human malaria parasite P. knowlesi has also been published. Both studies were published by Nature which is not of course an open-access journal. However, Nature has taken the decision to make these two articles freely available.

Other important studies on which we have commented include a systematic review which looked at hookworm-related anaemia during pregnancy. Based on their findings, the reviewers call for improved deworming programmes for pregnant women. And there is good news from Peru, where a study found that extensively drug-resistant tuberculosis could be successfully managed in out-patients. (The patients in the study were not HIV infected.)

TropIKA.net continues to provide in-depth coverage of key meetings relating to the infectious diseases of poverty. The latest such meeting is the First Meeting of the African Network for Drugs and Diagnostics Innovation(ANDI).

Malaria has been much in the news during the last couple of weeks. We have seen a three-billion dollar boost to funding for the global battle against the disease and the launch of Global Malaria Action Plan (GMAP). A five-year plan has also been announced by the Medicines for Malaria Venture. The journal Nature has expressed concerns that basic research is not receiving enough attention but, as we note, basic research is only one of many issues that must be addressed. A report from Médecins Sans Frontières sounds a salutary note; improved control programmes often fail to reach the very poorest people, unless diagnosis and treatment are free.

While more funding is still needed, the attention malaria is now receiving does makes it quite clear that it can no longer be described as a neglected tropical disease (NTD). While the NTDs receive grossly inadequate attention from the international community, their profile also may be starting to rise. A series of excellent films from the BBC is focusing on these diseases and will surely raise awareness. NTDs have even emerged as an issue in the debates between the two US presidential candidates. One neglected disease in Africa, guinea worm disease, is to receive new funding and it is claimed that it could be eradicated within five years.

It is too easy to think of NTDs as confined to Africa and Asia but they are important causes of sickness and death elsewhere. A recent article has highlighted the disease burden due to NTDs in Latin America and the Caribbean. An encouraging development has been the announcement of plans by the Carter Center, Haiti and the Dominican Republic to eliminate lymphatic filariaisis and malaria from the island of Hispaniola, their last reservoir in the Caribbean.

There have been other developments which have caught my eye in the last few days. Diarrhoeal disease is still one of the biggest infectious killers of poor children; rotavirus is often the disease agent responsible. Many countries are considering whether they can afford to introduce rotavirus vaccine to their national programmes. A study from Mexico, which found that such a move would be cost-effective, is of great interest. The use of ivermectin in the control of onchocerciasis is now well established but a study in Ecuador has shown there can be beneficial side effects; the drug is also active against some soil-transmitted helminths.

Examples of the innovative use of new technology to help to control the infectious diseases of poverty are often featured on TropIKA.net. The mobile phone is a piece of new technology that has been adopted enthusiastically across the developing world and the ready availability of these now ubiquitous devices has been put to good use by a team of software developers. An application which can be downloaded to mobiles has been used within a successful campaign to bring under control Kenya’s first polio outbreak for 21 years. See Mobile phone technology helps contain disease outbreak.

Of the diseases on the TropIKA.net priority list, it is tuberculosis that has been most in the headlines over the last few weeks. We have summed up some of the most important developments in our article, Tuberculosis profile rising. Malaria also receives more attention from the international media than was previously the case. The World Malaria Report for 2008 was reported by many newspapers worldwide and (as I write this latest Editor’s Choice column) news is coming in of agreement at the UN for major new funding for malaria control.

However, the excitement over new developments and innovations should not mean that the lessons of history are forgotten – see Malaria control: ‘faulty intelligence’ led to mistakes.

One such lesson is that gains made in infectious disease control so easily can be lost. Having brought rabies under control for several years, China now seems to be facing a resurgence of the disease – see Renewed rabies vigilance needed in China.

The increasing number of dengue fever cases is a major problem affecting a much wider area. The situation in the Asia-Pacific region and also Latin America is of increasing concern. One recent research article that has been the subject of a commentary on TropIKA.net is a systematic review examining dengue outbreak prediction and detection tools – see What does dengue disease surveillance contribute to predicting and detecting outbreaks and describing trends?

As well as commenting on recently published research article, TropIKA.net highlights review articles of particular importance. Sleeping sickness and Chagas’ disease are often featured on our knowledge platform and a recent review is relevant to both of them – see Trypanosomiasis vector control in Africa and Latin America. An infectious disease that also takes a major toll but which is often forgotten and has not previously appeared on TropIKA.net is bacterial sepsis – see Strategies to Reduce Mortality from Bacterial Sepsis in Adults in Developing Countries.

News
The deliberations of politicians and senior officials at major conferences may sometimes seem irrelevant to what happens in the real world. Nevertheless, when the topic under discussion is aid and making it more effective, then there will be implications in the long-term for all of us who are concerned with the infectious diseases of poverty. TropIKA.net News has therefore provided extensive coverage of the Third High-level Forum on Aid Effectiveness, held in Accra 2nd-4th September. We have published a pre-meeting briefing, and reports on the main meeting and on a side event that looked specifically at health.

We also have stories on new initiatives concerning both funding and research. You can view our entire News section here.

Research
Mathematical modelling is increasingly used by infectious disease researchers. An example is provided by a recent study that we have highlighted in our Research Articles section. Researchers in Mali showed that modelling methods can help to interpret the trends of schistosomiasis infection. Such information can help predict epidemics and aid in the implementation of control strategies.

Many of the research articles highlighted on TropIKA.net recently have an immunological focus. New findings that will aid in the development of vaccines have been reported for human African trypanosomiasis, dengue fever and tuberculosis.

Reports
TropIKA.net also highlights recently published reports relevant to the infectious disease of poverty. One such document is the final report of the World Health Organization’s Commission on the Social Determinants of Health.

Blogs
Finally, don’t forget to read the latest contributions to the TropIKA.net blog. Responses to what our bloggers are saying are always welcome.

As well as original articles, TropIKA.net highlights interesting items that have been recently published elsewhere. Development economist Jeffrey Sachs always seems to be in the news. As an economist he is often inclined to consider health care interventions in terms of whether they offer a good bargain. In a recent article in Scientific American he says that the estimated $3 billion needed annually for effective malaria control is ‘one of the world’s great bargains’. Not for the first time, he argues that treatment and preventive strategies already available can bring about huge cuts in mortality and morbidity. According to Sachs, ‘The challenge of controlling the disease in Africa by 2010 is fundamentally organizational, not technical.’

Leprosy has not appeared frequently on TropIKA.net but we have recently published an in-depth interview with Yohei Sasakawa, chairman of the Nippon Foundation, who highlights the human rights aspects of the fight against the disease. Yohei Sasakawa’s account of his life-long personal involvement in this cause makes for compelling reading.

Our recent news stories also include coverage of the imminent announcement of a new funding mechanism – the Advance Market Commitment (AMC) – intended to stimulate the development and manufacture of new vaccines against the infectious diseases of poverty. But the AMC already has its critics, as discussed in our article.