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Editor’s choice

From the range of articles recently featured on, Editor Paul Chinnock offers a personal selection of items of particular importance.

Archive for October, 2009

Oct 19 2009

Neglected diseases in neglected regions

Posted by: Paul Chinnock - Editorial Team

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The infectious diseases of poverty exact a massive burden on the populations of Asia and Africa, but their impact in the Americas is often forgotten. (The extent of this neglect was made clear in a research article published a year ago in PLoS Neglected Tropical Diseases).

It is therefore encouraging to learn that the Inter-American Development Bank and the Global Network for Neglected Tropical Diseases intend to mobilize $30 million from the public and private sectors to raise awareness and funding for the control and elimination of neglected tropical diseases (NTDs) in the region – see Blog. We also report in News of new efforts to eliminate malaria and filariasis from the Americas.

Meanwhile, the Drugs for Neglected Diseases initiative has announced that it has established a cooperative agreement with a pharmaceutical company for the clinical development of a drug that has been shown in lab tests to have activity against Trypanosma cruzi, the pathogen responsible for Chagas disease. This disease is confined to the Americans and kills at least 200,000 people every year. There is no vaccine and no specific treatment. Control of the disease vectors (triatomine bugs) remains the main focus of efforts to fight the disease and findings reported in a new research article will help guide control programmes in deciding when it is best to spray insecticide.

Oceania is another part of the world where infectious diseases remain an important cause of ill-health but receive little attention from the international media. Nevertheless, efforts are being pursued to control or eliminate these conditions and it is heartening to read a recent report of major successes achieved against malaria in Vanuatu and Solomon Islands. continues to highlight and comment upon new research findings, wherever the studies have been conducted. Our recent selections have included an important step forward in understanding how the parasite responsible for leishmaniasis establishes itself in its human host, a prevalence study that confirms the return of yaws to the Democratic Republic of Congo, and a study from China which examines the factors explaining why so many tuberculosis patients fail to complete their course of treatment. An Ethiopian study provides an illustration of the poor performance that is often seen in TB programmes, thus demonstrating the importance of monitoring and evaluation.

The team cannot, of course, identify all the new reports of research into the infectious disease of poverty that are of particular significance. We need the help of our readers. If a new paper strikes you as being of exceptional importance, let us know about it.

One piece of good news is that an increasing amount of research is being conducted in developing countries. There has been an encouraging rise in the number of researchers in these countries, which doubled in a five-year period according to a report from the UNESCO Institute for Statistics. There is still of course a long way to go for the South to catch up. One initiative that should further speed up progress is the African Network for Drugs and Diagnostics Innovation (ANDI). The network aims to increase new health products developed in Africa by Africans. The ANDI 2009 meeting, which took place in South Africa this month, received in-depth coverage on

But sometimes the problem is not a lack of basic research. We highlight an opinion article which argues that the lack of progress against schistosomiasis in Africa represents one of this decade’s greatest failures. Cheap and effective treatments already exist for this disease, the second most common parasitic condition after malaria, but only 5% of Africans who need treatment actually receive it. Progress against the infectious diseases of poverty requires that the needs of neglected people should be met, in whichever part of the world they may live.

Paul Chinnock

Oct 01 2009

A time to honour commitments

Posted by: Paul Chinnock - Editorial Team

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How many research papers have we all read that conclude with a statement that further progress against an infectious disease, while technically possible, is hampered by a lack of “political commitment”?

African presidents, in common with heads of state in other parts of the world, have varied in their level of commitment to the welfare of their people and in their position on the proportion of the national budget that should be devoted to health care. The creation of the African Leaders Malaria Alliance (see News) must therefore be welcomed. ALMA is the first alliance at head-of-state level to combat the disease and has the potential both to improve the efficiency of control efforts, through international cooperation, and to mobilize national populations to work towards the elimination of malaria.

But commitments made by politicians are not always honoured. African presidents have previously pledged to spend 15% of their budgets on healthcare but few have delivered. Western leaders have also in many cases failed to provide the full level of development support that they have promised. Given the continuing global economic difficulties, there may be disappointments ahead. But malaria must surely be regarded as a special case. The disease burden is so great and the prospects for progress towards elimination are so much better than ever before that, if ever there were a time for commitments to be honoured, it must surely be now.

Meningitis also claims many lives in Africa. The latest of our Profile articles features an interview with Marc LaForce, head of the Meningitis Vaccination Project. He describes how, once the final few hurdles have been cleared, a new vaccine designed specifically for Africa will become widely available.

Buruli ulcer (BU) is one of the most severely neglected of all the infectious diseases of poverty, but there have been modest increases in the funding available for research into this dreadful condition. We report on new genomic research on BU and on a planned study that should advance knowledge on the BU disease reservoir.

One way we can increase the attention paid to neglected conditions is to feature them in the media, but this has to be done in the right way – accurately and without scaremongering. Pakistan is one of many countries where the media has rightly highlighted the steady advance of dengue fever, but in such a way that a dengue diagnosis is now often interpreted by patients as being a death sentence. (The case fatality rate with dengue is of course very, very small.) Somehow a balance must be struck by the media to create sufficient public concern to prompt preventive action, without leading to widespread panic.

The blog seeks to highlight items in the news that you may have missed. In recent days, these have ranged from the bizarre to the tragic. Some South African TB patients are reported to be selling their sputum to healthy people, who use it to fake a diagnosis of the disease and to be awarded a disability grant. In Papua New Guinea, which is experiencing its first cholera epidemic on record, fear of the disease is such that patients are said have been left to die at the side of the road, as no one is willing to take them to hospital.

For progress to be made against the infectious diseases of poverty we need, not only commitment, but also a better understanding - at all levels - of the true nature of the dangers they pose.

Paul Chinnock