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PLOS BLOGS Speaking of Medicine

World NTDs Day – a Q&A with our Editors-in-Chief

We are honored to be participating in World NTDs Day!

The Editors-in-Chief sent out a call for questions and comments from our researchers and readers for this interactive blog post. Here is a sampling of what we received. The opinions expressed here are the personal opinions of our Editors-in-Chief and do not reflect the beliefs of their government affiliations or institutions. Questions and comments have been edited slightly for clarification and consistency.

 


  • How can governments in LME (liberal market economies) countries be incentivized by the international community to put more emphasis (including research) on NTDs?
    • Question from Dr. Anita L Michel 

Response from Peter Hotez: Currently too much of the innovation for NTDs falls to the US and UK Governments and a few other European nations. And now for low-cost mass treatments, some of the low- and middle-income nations are expanding their contribution. But ultimately for R&D, we need to recognize that NTDs are widespread among the poor in industrialized and G20 countries, a concept I refer to as “blue marble health.” On that basis, we need all of the G20 nations to support innovation for NTDs. This is now starting to happen with new global health and neglected disease funds in Japan and South Korea (ROK), but we need all of the G20 involved.

Still another component is training and capacity building for science in poor countries of Africa, Asia, and the Americas. Perhaps other than WHO-TDR, Wellcome Trust, HHMI, and a few private philanthropies, this area has not been sufficiently emphasized. There have been some important efforts from the US Government through the NIH Fogarty International Center and EU but we need much more.

Response from Shaden Kamhawi: In addition to what Peter said, we need to ensure that we as a community maintain a sustained and focused effort to keep NTDs in the forefront as a real threat to global health. One way to do this is to encourage public engagement of affected communities. Another is through continued dissemination of facts and figures that demonstrate the heavy toll of NTDs on the quality of life for the poorest of the poor. PLOS NTDs remains committed to this global fight for the right of all humans to healthy and prosperous lives.

 


  • Dr. Hotez, can you please discuss the challenges facing eradication? Many NTDs are approaching this stage, but the efforts to achieve eradication at the end for those last clusters of cases prove to be costly and difficult. Is eradication the right goal for all diseases?
    • Question from Dr. Abraar Karan  

Response from Peter Hotez: I agree that eradication can be very costly, especially the end game. That’s why I prefer to think of elimination as a public health problem, meaning that we reduce transmission below a point where it is a threat. In general, I prefer to think of either eradication or elimination as aspirational goals meant to inspire people to work towards a common goal, rather than the literal interpretation. For example, we probably won’t eradicate (or even eliminate) high prevalence NTDs like soil-transmitted helminth infections or schistosomiasis but we should still strive to provide universal health coverage for antihelminthic drugs and conduct R&D for new control tools, including vaccines. 

 


  • Does antiparasitic drug resistance represent an important worldwide problem like antibiotic resistance? Why is there not an available, effective malaria vaccine to date? This can save the lives of many people and travelers to tropical regions with a high prevalence of malaria.

    • Question from Dr. Haidi Karam-Allah

Response from Shaden Kamhawi: Both antiparasitic drug resistance and antibiotic resistance represent a serious and growing challenge to our ability to control serious infections, and as such are of significance. Though antibiotic resistance is more prevalent and develops faster compared to antiparasitic drug resistance, parasites compared to bacteria present a larger challenge due to their complexity and diversity. 

Why is there not a vaccine against malaria? In fact, to date, there has not been an effective human vaccine against any parasite. Similar to the challenges facing drug resistance, generating protective immunity through a vaccine is complex and multifactorial and requires a deep understanding of the life cycle, and the biological and environmental parameters that may influence its efficacy. Additionally, each parasite has evolved diverse and clever ways to hide from or overcome, the human immune system, developed over thousands of years. Nevertheless, we should give credit to our scientists. Over many decades they have looked for vaccines and have made significant advances in understanding the immune mediators of protection for many parasites. I am optimistic as we are at an exciting time in science, where the use of ever more powerful techniques are bringing us closer towards reaching some of our goals.

 


  • My view is that the elimination of NTDs is only possible through ownership community engagement that is encouraged and facilitated by country-wide and local leadership. This is the new control/elimination model that is endorsed by stakeholders in Rwanda. It will be launched in the first decentralized MDA to take place in February.
    • Comment from Dr. Mbonigaba Jean Bosco

Response from Shaden Kamhawi: I agree with this view. Without awareness, interest, and participation from local leadership and the communities at risk, it is nigh impossible to sustain long-term control activities in endemic areas. We are looking forward to a positive outcome from the decentralized control campaign beginning in Rwanda. However, we also endorse outside interest in supporting control and elimination efforts in endemic countries. All efforts and resources provided towards control of NTDs in the shortest and most efficient manner should be welcomed. 

 


  • The focus on NTDs over the years is one of the most successful public health innovations of this century. PLOS NTDs serves as a continual reminder of the socio-economic consequences of NTDs amongst populations in disease endemic countries and under-represented communities. With this information dissemination, there is a progressive reversal and decline in the preventable consequences of neglected tropical diseases. As the list of diseases considered NTDs increases, I hope that concerted efforts to address these diseases are launched to help more people regain their fundamental human right to a truly healthy and fulfilling life. 
    • Comment from Professor Danny Asogun

Response from Shaden Kamhawi: We thank you for your comment and for bringing attention to the importance of having a journal dedicated to NTDs. We have updated our list of NTDs to include about 40 conditions, acknowledging the changing dynamics of certain infections. Look out for our editorial containing details of our updated list of NTDs and the rationale behind our choices. 

 


  • PLOS NTDs has made a significant impact in the field of Melioidosis: recruiting me as Deputy Editor, bringing the disease (which is not officially recognized as a NTD) front and center, increasing the number of high-quality publications by different investigators in the field, and helping increase awareness worldwide. Efforts like this might help the WHO recognize the importance of melioidosis and perhaps, officially recognize the disease as an NTD.
    • Comment from Dr. Alfredo Torres (PLOS NTDs Deputy Editor)

Response from Peter Hotez: I agree that PLOS NTDs has an important role in raising awareness for NTDs not ordinarily considered on the WHO’s list of NTDs.  This is why we have updated the list of NTDs for consideration at PLOS that has been expanded to about 40 conditions. It’s always a balance: too restrictive leaves out some important poverty-related NTDs, and if we make it too large and inclusive, the term “NTDs” can lose its meaning. 

 


  • Global climate change is causing new challenges in addressing and combating neglected tropical diseases throughout the world. Researchers throughout the world must collaborate by sharing discoveries and technology to deal with this problem. The presence of journals that focus on neglected tropical infectious diseases is a necessity so that we can disseminate information and research to overcome this global problem. I hope that in the future, journals with the focus on neglected infectious diseases will make a more tangible and broader contribution to this issue of the effect of climate change on NTDs, especially for researchers in developing countries. 
    • Comment from Dr. Leily Trianty

Response from Peter Hotez: Yes, I agree we need to consider modern 21st-century determinants and their role in promoting NTDs. Certainly climate change is critical and I wrote about this last year in a PLOS NTDs editorial, but also there are some critical social determinants including urbanization, human migrations, war, and conflict. I believe these factors will drive the changes in the prevalence and incidence of the high prevalence NTDs in the coming years. 

 


  • As a scientist from the fungal infections field, I think PLOS NTDs plays a key role in bringing attention to a very underestimated and neglected problem: fungal diseases. PLOS NTDs has been supportive of this research, which including the publication of commentaries on the importance of fungal diseases (https://doi.org/10.1371/journal.pntd.0004429, https://doi.org/10.1371/journal.pntd.0006479 and more recently 10.1371/journal.pntd.0007964, which is in production). However, I feel that it is appropriate for PLOS NTDs to issue a formal, editorial position on fungal infections as neglected tropical diseases. It would be highly influential on decision-makers and public health authorities and, consequently, on funding opportunities generating better knowledge. I think PLOS NTDs also needs more editors in the Mycology field. Any comments on this issue?
    • Question from Dr. Marcio Lourenço Rodrigues

Response from Shaden Kamhawi: PLOS NTDs acknowledges the importance of fungal diseases, and we list several deep mycoses as NTDs in the journal’s scope statement. We are also updating our list of NTDs in an upcoming editorial and will now consider cryptococcosis and histoplasmosis in association to extreme poverty in low and middle-income countries. We try to remain open to consider any disease that fits the definition of an NTD: “a prevalent chronic and/or debilitating infection that disproportionately affects the poor.” We also welcome the interest in serving as editors for PLOS NTDs. PLOS NTDs is a community journal and we are continuously working to expand our editorial board aiming to ensure scientific excellence while endeavoring to maintain gender equity and geographic diversity. 

 


  • Many neglected tropical diseases are consequences of socio-economic conditions in tropical countries meaning that environmental and demographic knowledge are necessary to tailor the appropriate response for the eradication of the diseases. Currently, the research in the ecology of parasites should be a priority, but most economic resources are directed to molecular research. Knowledge of the biology and ecology of parasites prevents illness, while molecular and chemical research is conducted to find cures for illness and is reactionary rather than preventative. Why is this the case and why are there less financial resources provided for fieldwork that can be conducted to find solutions to prevent neglected tropical diseases? 
    • Question from Professor Ricardo Guerrero

Response from Shaden Kamhawi: Thank you for this question and I understand your frustration, however, this attitude is changing as funding agencies acknowledge the importance of field-based investigations for both control and elimination efforts as well as to provide important and current information about pathogens and their environments. To be fair, however, historically, a significant number of conducted field studies were purely descriptive and did not provide the type of information and analyses that can be used to inform control strategies, possibly constrained by poor funding. Therefore, I advocate for field-based, multi-disciplinary studies that are carefully planned to address pertinent questions and I fully support the need to fund such studies. 

 


  • With over a century of research on some NTDs, better tools and approaches for control and eradication have been developed. Diagnosis is faster than ever before. Why do just a few countries report control or eradication successes while many do not? Is this due to implementation or knowledge translation challenges?
    • Question from Professor Elizabeth A. Opiyo

Response from Paul Brindley: We cannot know why few countries report; likely there are political and national security considerations, which remain generally and unfortunately inscrutable to the majority of readers of PLOS NTDs… However, the WHO does try to keep track and provide updated information, e.g.,

https://www.who.int/gho/publications/world_health_statistics/2019/en/

http://apps.who.int/gho/data/node.sdg.3-3 

 


  • PLOS NTDs has been very important for my research since it has given me the possibility to present the scientific findings of my group and access to different discoveries from other groups. My research line is focused on understanding the T. cruzi-host interaction with a systems biology view. In particular, we apply proteomic and computational approaches to study the molecular rewiring induced by the pathogen for adhesion, invasion and survival in the host. PLOS NTDs is a reference in the area of neglected tropical diseases. It is important to support its growth in order to foster more collaborations of professionals with different expertise and offer better diagnostic and chemotherapeutic solutions. 
    • Comment from Dr. Giuseppe Palmisano

Response from Peter Hotez: Thank you for that comment. I agree that systems biology offers a lot of new promise in studying NTDs pathogens and their host. I look forward to seeing additional papers in this area for our journal and also the application of OMICs and big data technologies!

 


  • PLOS Neglected Tropical Diseases is an indispensable journal because it publishes important articles about neglected tropical diseases that generally occur in low-income populations. My very recent relationship with PLOS NTDs has been very satisfactory.
    • Comment from Dr. Achilea Bittencourt

Response from Peter Hotez: Our editors are so glad to hear about this.  We deeply appreciate your commitment to NTDs and the world’s poorest people! 

Response from Shaden Kamhawi: We thank you for your comment. At PLOS NTDs we strive to serve the needs of our community and we need your support to achieve this. When researchers engage with the journal, either as authors or editors, they ensure that PLOS NTDs thrives and remains a strong voice for NTDs, one of the main challenges to global health in the coming decade. 

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