THE NTD VACCINES: Vaccinating against Poverty & Conflict

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1 THE NTD VACCINES: Vaccinating against Poverty & Conflict Peter Hotez MD

2 Disclosures I do not have any conflicts to disclose; however, I would like to mention that I have patents on the vaccines I will be discussing.

3 The Millennium Development Goals 1. Eradicate extreme poverty and hunger. 2. Achieve universal primary education. 3. Promote gender equality and empower women. 4. Reduce child mortality. 5. Improve maternal health. 6. Combat HIV/AIDS, malaria and other diseases. 7. Ensure environmental sustainability. 8. Develop a global partnership for development.

4 Other Diseases The Neglected Tropical Diseases tropical infections: Highly prevalent among the poor Endemic in rural areas of lowincome countries Ancient afflictions Chronic Disabling (growth delays, blindness or disfigurement) High morbidity Stigmatizing Poverty promoting NTDs: The most common afflictions of the bottom billion

5 Global Burden of Disease Study 2010

6 Expected number of cases in 2010 and 95% confidence intervals of the neglected tropical diseases (mean and uncertainty) as extrapolated from the Global Burden of Disease Study Ascariasis 819 million Total number of cases Trichuriasis 465 million Total number of cases Hookworm Disease 439 million Total number of cases Schistosomiasis 252 million Total number of cases Lymphatic Filariasis 36 million* Lymphedema and/or hydrocele Onchocerciasis 30 million Total number of cases (adult worm) Food-borne Trematodiases 16 million* Heavy and cerebral infections CutaneousLeishmaniasis 10 million Total number of cases Chagas disease 7.5 million Symptomatic cases Trachoma 4.4 million* Low vision and blindness cases Cysticercosis 1.4 million* Epilepsy cases only Echinococcosis 1.1 million* Symptomatic liver, lung, CNS cases Dengue 179,000* Incident acute symptomatic cases Visceral leishmaniasis 76,000 Total number of cases African Trypanosomiasis 37,000* Symptomatic cases Rabies 1,100 Incident cases Yellow Fever 100 Incident cases Yaws ND Buruli ulcer ND Ebola ND

7 DALYs vs. Deaths Hotez PJ, Alvarado M, Basáñez M-G, Bolliger I, et al. (2014) The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases. PLoS Negl Trop Dis 8(7): e2865. doi: /journal.pntd

8 Prevalence (%) The Most Widespread NTDs: Ascariasis, Trichuriasis, Hookworm Village of Paquila, Guatemala Age Class (years) Ascaris Trichuris Hookworm Strongyloides

9 NTDs and Child Development Hookworm and Ascariasis Hookworm leads to 40% reduction in future wage earnings Children have the highest worm burdens Child growth, Intellectual Cognitive development Property of the Global Network

10 Economic Costs Chagas Disease: The Costs >$7 billion globally >$1 billion North America

11 NTDs and Poverty The 17 NTDs Chronic & Disabling Conditions NTDs PROMOTE POVERTY Reduce productive capacity Impair intellectual & physical development in children Cause adverse pregnancy outcomes Property of the Global Network Hotez PJ, Fenwick A, Savioli L Molyneux DH. Rescuing the bottom billion through control of neglected tropical diseases. Lancet 2009; 373:

12 Girls and Women HIV Incidence and Mortality

13 NTDs and Conflict: Conflict and Contagion

14 Ebola Virus Infection in West Africa Liberia Sierra Leone Guinea >10,000 cases >5,000 deaths

15 The area known as the Guinea Forest Region, now largely deforested because of logging and clearing and burning of the land for agriculture. Bausch DG, Schwarz L (2014) Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy. PLoS Negl Trop Dis 8(7): e3056. doi: /journal.pntd

16 Scenes of the degraded infrastructure of the Guinea forest region. Bausch DG, Schwarz L (2014) Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy. PLoS Negl Trop Dis 8(7): e3056. doi: /journal.pntd

17 African Sleeping Sickness and Conflict Simarro PP, Jannin J, Cattand P (2008) Eliminating Human African Trypanosomiasis: Where Do We Stand and What Comes Next?. PLoS Med 5(2): e55. doi: /journal.pmed

18 New Cases of Sleeping Sickness Reported for All Africa between 1927 and 1997 Simarro PP, Jannin J, Cattand P (2008) Eliminating Human African Trypanosomiasis: Where Do We Stand and What Comes Next?. PLoS Med 5(2): e55. doi: /journal.pmed

19 Looking beyond Africa: The Large Middle Income Countries in Asia and the Americas Where do the NTDs occur?

20 Blue Marble Health: The poor living among the wealthy. Hotez PJ (2013) NTDs V.2.0: Blue Marble Health Neglected Tropical Disease Control and Elimination in a Shifting Health Policy Landscape. PLoS Negl Trop Dis 7(11): e2570. doi: /journal.pntd

21 NTDs in Texas & Southern United States >12 million Americans with NTDs Toxocariasis 3 million Chagas disease 1 million Trichomoniasis 7 million Cysticercosis 0.2 million Toxoplasmosis 1 million Dengue 0.1 million

22 NTDs and the OIC Hotez PJ (2014) Vaccine Diplomacy : Historical Perspectives and Future Directions. PLoS Negl Trop Dis 8(6): e2808. doi: /journal.pntd

23 NTDs and Conflict: Aleppo Evil One Year Sore >100,000 new cases Aleppo Evil : حلب Theقرحة Ulcer, the Boil, the Sand-fly, and the Conflict

24 NTDs and the Middle East and North Africa region. 400 million people 65 million in poverty Hotez PJ, Savioli L, Fenwick A (2012) Neglected Tropical Diseases of the Middle East and North Africa: Review of Their Prevalence, Distribution, and Opportunities for Control. PLoS Negl Trop Dis 6(2): e1475. doi: /journal.pntd

25 The Valley of Death URGENCY FOR BIOTECHNOLOGY FOR NTDs Strong clinical trials capability Strong basic science But something missing

26 PDPs Work across Different Diseases and Modalities Vaccine Human hookworm vaccine initiative Vaccine Development Program Microbicides & preventatives Therapeutic product Diagnostics HIV/AIDS TB Malaria NTD 2 Diarrhea 3 Respiratory Aeras: Aeras Global TB Vaccine Foundation DNDi: Drugs for Neglected Diseases Initiative FIND: Foundation for Innovative New Diagnostics GATB: Global Alliance for TB Drug Development Sabin/HHVI: Human Hookworm Vaccine Initiative IAVI: International AIDS Vaccine Initiative IDRI: Infectious Disease Research Institute IOWH: Institute for One World Health IPM: International Partnership for Microbicides IVCC: Innovative Vector Control Consortium IVI: International Vaccine Institute MMV: Medicine for Malaria Venture MVI: Malaria Vaccine Initiative (PATH) MVP: Meningitis Vaccine Program (PATH) PDVI: Pediatric Dengue Vaccine Initiative PATH VAC: PATH's Vaccine Development Program 1. PVS includes Rota Vaccine Program (RVP), Pneumo Vaccine Project (PVP), Enteric Vaccine Initiative (EVI), Influenza Vaccine Development Program (IVDP) 2. Includes HAT, visceral leishmaniasis, Chagas, hookworm, and dengue 3. Includes cholera, typhoid, and rotavirus Sources: Combating Diseases Associated with Poverty, FSG, Nov 2004, Health partnership Review, Global Forum for Health Research, May 2008 BMGF

27 A scientist who is also a human being cannot rest while knowledge which might reduce suffering rests on the shelf. Dr. Albert B. Sabin Sabin Vaccine Institute

28 Sabin Vaccine Institute (PDP) & Texas Children s Hospital Center for Vaccine Development Sabin PDP is located in state-of-the-art process development laboratories in the Texas Medical Center of Houston Texas Sabin PDP in 15,000 sq. ft. in the Feigin Center of the Texas Medical Center

29 PRODUCT DEVELOPMENT METHODOLOGY Quality Control 29

30 Human Hookworm Infection Highly prevalent neglected tropical disease 440 million people 3.2 million DALYs A leading cause of maternal and childhood anemia in low- and middleincome countries

31 Targeting Blood-feeding in the Hookworm Gut in Phase 1 Trials Hotez, Bethony, Diemert, Pearson, Loukas (2010) Nature Rev Microbiol

32 HOOKVAC: A New European-African Consortium Albert Schweitzer Hospital The purpose of human life is to serve, and to show compassion and the will to help others

33 Hookworm and Schistosomiasis Co-Infections A MULTIVALENT VACCINE TARGETING LEADING CAUSES OF ANEMIA

34 Slim Initiative for Chagas Disease Vaccine Nanoparticles

35 Leishmaniasis Vaccine Bivalent recombinant vaccine NH36 Sandfly antigens: LJM19 LJM143 GLA or CpG Status Preclinical in Houston and NIH Supported by Carlos Slim and TCH

36 Organisation of the Islamic Conference & NTDs Hotez PJ (2014) Vaccine Diplomacy : Historical Perspectives and Future Directions. PLoS Negl Trop Dis 8(6): e2808. doi: /journal.pntd

37 Origins of Vaccine Diplomacy

38 Thank You! NIAID, NIH European Union Dutch Ministry of Foreign Affairs Gates Foundation Carlos Slim Health Institute Texas Children s Hospital SWEEMRI Michelson Medical Research Foundation (MMRF) Chao Family Foundation Blavatnik Family Foundation Mort a& Chris Hyman