New paper offers insights into key challenges facing R&D for diseases of poverty

In this guest post, Dr. Beth P. Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at the Centers for Disease Control and Prevention (CDC), describes some of her center’s active engagement in global health work. She also highlights an important technology initiative called Advanced Molecular Detection that is proposed in the President’s fiscal year (FY) 2014 budget. This is the first in a four-part series about NCEZID’s global activities focused on the prevention of illnesses and death from infectious diseases. I am pleased to write this inaugural blog from NCEZID for the Global Health Technologies Coalition. We work closely with other CDC centers, federal agencies, and domestic and international partners to protect people from infectious diseases and enhance global health security.We’re excited to have the opportunity to showcase our portfolio of global activities that evidence NCEZID’s research, technology, and program priorities. One example is our work in Uganda, where we helped build laboratories and train staff at the Uganda Virus Research Institute (UVRI). The main UVRI facility is based in Entebbe in central Uganda, and it has a satellite laboratory about 320 miles northwest in the town of Arua, near the border with the Democratic Republic of the Congo (DRC). NCEZID staff based at UVRI in Entebbe collaborates with other UVRI scientists to deliver in-country expertise in diagnosing and preventing viral hemorrhagic fevers, plague, and other infectious diseases.For instance, UVRI staff last year used modern diagnostic technologies while working closely with Atlanta-based CDC response teams, local public health authorities, and other experts to contain four near-simultaneous outbreaks of filovirus disease (caused by Ebola and Marburg viruses) in Uganda and the DRC. Separately, I learned first-hand about the benefit of building local diagnostic capacity in Uganda when I traveled there last fall and spoke with scientists and residents about the successful use of a new plague dipstick test (more on this in our next guest blog).In October 2012, Dr. Bell (far right) visited Uganda and met a farmer (third from left) who had developed symptoms of plague. He was promptly tested with the plague dipstick test and learned within 15 minutes that he had tested positive for plague. He was treated with antibiotics,fully recovered, and was back working in 3 days. Also pictured is Ugandan clinical coordinator Dr. Titus Apangu (center, wearing a tie).  Photo credit: NCEZIDOther examples of NCEZID’s commitment to using innovative technology in response to infectious diseases on the global front include our efforts to develop vaccines for dengue and Rift Valley fever, and to establish safe water projects in places like Malawi and Haiti. And in just the past few months, we’ve helped with a Japanese encephalitis immunization campaign in western Cambodia (with support from the Bill & Melinda Gates Foundation) and assisted India in the development of a pilot outbreak investigation and surveillance for enteric diseases in several states.But as we anticipate new and evolving global challenges in infectious disease, we also recognize the need to strengthen our capacity in using next-generation public health tools. This step is crucial if we are to successfully confront what CDC Director Dr. Tom Frieden calls the “perfect storm of vulnerability: emerging microbes, resistant microbes that outsmart the drugs used to treat them, globalization of travel and trade, and the greater ease of making deadly organisms in a laboratory.”Of particular importance is the need to implement new approaches for strengthening our expertise and capacity in molecular-based sequencing and bioinformatics and applying these advances to public health—both domestically and internationally. Real-time genomic sequencing of pathogens rapidly generates massive amounts of information, and bioinformatics helps us interpret these data and apply the results to public health. To be sure, CDC and its public health partners have had some success with the global application of genetic sequencing and molecular epidemiology—the global polio eradication effort being one example. But much more remains to be done. Advances in these evolving areas will help us to more rapidly and accurately diagnose infectious diseases, investigate and control outbreaks, understand transmission patterns, determine antimicrobial resistance, and develop and target prevention measures, including vaccines.The President’s FY 2014 budget contains an initiative called the “Advanced Molecular Detection (AMD) and Response to Infectious Disease Outbreaks,” which would provide CDC an unprecedented opportunity to build our expertise across all infectious diseases. This initiative can help us move beyond older methods of detecting a microbe and determining its threat to human health. Strengthening our detection and response capabilities with these technologies will help us take bold new steps in protecting the public’s health, both here and abroad. You can read more about the AMD initiative on CDC’s website (see link below).In our next three guest blog posts for Breakthroughs, we intend to show you how technology enables us to extend our reach of work around the globe. For example, one of our scientists who developed the plague dipstick will give a first-hand account of creating this tool that diagnoses plague easily, rapidly, and inexpensively. Other blogs will detail recent efforts to combat rabies in Haiti and the ever-growing challenge of controlling the spread of dengue. I hope you enjoy reading them.For more information about the AMD initiative, click hereTo learn more about NCEZID, click here

In this guest post, Regina McEnery from IAVI Report writes about the planned closure of the New England Primate Research Center and its effects on the community of HIV researchers who conduct primate studies. As animal facilities go, the New England Primate Research Center (NEPRC) had attained a legendary status on the roster of US biomedical research institutions. A good number of important discoveries have been made within its walls in the half century it has been around. Researchers working there generated some of the earliest evidence that AIDS is a viral disease, and subsequently discovered the simian immunodeficiency virus (SIV), which causes the monkey version of AIDS. It was there, as well, that scientists demonstrated that a vaccine can prevent the transmission of SIV, suggesting that an HIV vaccine is possible. Nor were the NEPRC’s contributions to science confined to HIV and AIDS. The facility has hosted research of profound relevance to everything from cancer to neurological disease and addiction. But lately it had become increasingly clear that this storied institution’s best days were behind it—so far behind it, in fact, that the Harvard Medical School (HMS), which oversees the center, decided it should be shut down. Its decline was slow and fueled largely by management and money problems, rather than the quality of its research. The NEPRC has, for example, been cited at least four times since 2010 by the US Department of Agriculture (USDA) for failure to comply with the requirements of the Animal Control Act. The most recent citation, issued last year, related to a cotton-top tamarin found dehydrated after an employee neglected to provide sufficient water to the squirrel-sized monkey. After examining its recent health history, the NEPRC veterinarian decided to euthanize the monkey, according to the USDA report. The New England Primate Research Center, which had attained a legendary status on the roster of US biomedical research institutions, will be closing. Photo courtesy of IAVI Report. John Harding, acting director of the Division of Comparative Medicine within the Office of Research Infrastructure Programs (ORIP)—the National Institutes of Health arm that provides the core grants for all national primate research centers—notes that it is “ very uncommon to find violations of the sort where animals died.” Still, HMS’s decision to wind down the facility by 2015 has upset the close-knit community of primate researchers. “We were all shocked,” says Ron Veazey, a professor of pathology at the Tulane National Primate Research Center in Louisiana. “Very few people can say, ‘we saw this coming.’ In an ideal world, all those [NEPRC] investigators will be able to transfer projects to other primate centers and everything will go on. But we can’t be sure.” The NEPRC decision to phase out its research also raises serious questions about the future of the approximately 130 projects it hosts—many of which relate to AIDS. Ditto for the 2,000 or so primates housed at the facility in Southborough, MA. The closure is likely to be widely felt throughout the field of HIV research, especially in the areas of vaccine and drug development. “Literally every class of HIV drug, with the exception of protease inhibitors, was first tested in monkeys,” noted Veazey. Louis Picker, a professor of pathology/molecular microbiology and immunology affiliated with the Oregon National Primate Research Center, says he was upset by the decision to shut down the NEPRC—where he did research during his laboratory and pathology medicine residency at Beth Israel Deaconess Medical Center in Boston. But he wasn’t surprised. “You could see the writing on the wall when this first started, two to three years ago, with the mishandling of the animal issues.” Picker says that Harvard’s response to the animal care issues—replacing NEPRC director Ron Desrosiers and two on-site veterinarians—served to drive investigators away rather than fix the problem. HMS, however, did not single out the animal care issues in explaining its decision. In evaluating its long-term needs, HMS says, it concluded that closing NEPRC would be more beneficial and efficient than pouring more resources into maintaining and renewing its supporting grant. “We were surprised,” says Harding. Yet Harvard’s decision, he says, should not be viewed as a signal that interest in funding nonhuman primate research is waning. “In fact, we see a continued need for this.” If anything, says Harding, the recent termination of the large HVTN 505 trial suggests more nonhuman primate research is needed. Still, even researchers personally unaffected by the closure of the NEPRC find its disappearance from the HIV research map hard to take in. “Personally, I see it as a loss for Harvard and for the New England research committee,” said Ana Aldovini, a scientist at Boston Children’s Hospital who once used the NEPRC, but now collaborates with Tulane. “I can’t imagine it not being a loss.” A longer version of this article is available at www.iavireport.org.