John Donnelly

This post, written by John Donnelly, originally appeared in the GlobalPost. Donnelly is a Washington, DC based writer. For those in the global health world—and there are many in the nation’s capital—one common question is why in tight budgetary times should Congress support spending on research and development (R&D) to fight diseases around the world. At a congressional briefing today put on by the Global Health Technologies Coalition (GHTC), a group that represents 40 global health research and advocacy organizations, several experts gave a variety of answers to that question. Katherine “Kemy” Monahan, deputy executive director of the Obama administration’s Global Health Initiative, said, “These global health programs are literally saving lives, and not just a few lives, lots of lives … We are [also] protecting Americans at home and traveling abroad from infectious diseases.” Col. Peter J. Weina, deputy commander of Walter Reed Army Institute of Research, said, “We protect soldiers’ lives … Infectious diseases have ravaged military forces operating worldwide. … It also ravages populations we’ve worked with.” From 2003 to 2008, for instance, US troops in Iraq and Afghanistan had roughly 2,000 confirmed cases of leishmaniasis, a disease transmitted by the bite of a tiny sandfly. The disease causes a broad range of outcomes, some of them fatal. Then US Sen. John Boozman, a Republican from Arkansas, took the microphone from the back of the Kennedy Caucus Room at the Russell Senate Office Building, and gave his case for ongoing global health research. “It’s achievable stuff,” he said. “It represents real calamity. These are difficult problems, but they are very, very solvable. … You have a lot of support on Capitol Hill. We can be very, very proud of what has been accomplished so far.” A GHTC analysis of the Obama administration’s global health budget found a large number of decreases in funding compared to the previous year’s budget. Funding cuts were most glaring in the President’s Emergency Plan for AIDS Relief (PEPFAR), neglected tropical disease programs, and several other programs at the US Agency for International Development (USAID). But the budget also included increases to The Global Fund to Fight AIDS, Tuberculosis, and Malaria and the GAVI Alliance. The National Institutes of Health and the Centers for Disease Control and Prevention (CDC) were funded at the same level. “It’s a time of fiscal austerity,” Kevin De Cock, the director of CDC’s Center for Global Health, said in an interview after the briefing. “The cuts for global health programs might have been less than many people feared. There’s a need now for everyone in government to strive for greater efficiency and to find savings wherever they can in their budgets.” Karen A. Goraleski, the executive director of the American Society of Tropical Medicine and Hygiene who was the moderator at the event, said global health R&D also has economic benefits at home, including the creation of thousands of jobs. “It’s fueling our economy,” she said. For Marc LaForce, director of the Meningitis Vaccine Project, the importance of research could be seen in the story of the fight against meningitis. He said last year’s results were enough to show how US research can have a major impact in saving lives. In West Africa, the often-fatal disease has been so prevalent that the area is referred to by the name of the disease. It’s the Meningitis Belt. His project, a partnership between the World Health Organization and PATH, which included earlier research done by the Walter Reed Army Institute of Research, produced a vaccine that cost less than 50 cents a dose. It was administered to 19 million people last fall in three West African countries. Usually, the countries report thousands of cases of meningitis. Last year, the countries reported fewer than a dozen—all from children who were not vaccinated. “The coverage rates with the vaccine have been extremely good,” LaForce said. “We are probably at the beginning of the end. With sufficient funding, this epidemic is likely to be pretty much over in the next 10 years.”

John Donnelly is a writer who accompanied the GHTC on its recent trip to Kenya. One of the most overlooked benefits of US-funded global health research is the training provided to scientists to do the work in their own communities.During the GHTC’s trip to Kenya last month, this type of capacity building was evident in several stops. One was from conversations with scientific investigators who have been researching the RTS,S malaria vaccine candidate. The first Phase 3 efficacy results of RTS,S—which is a public–private venture between the PATH Malaria Vaccine Initiative (MVI) and the pharmaceutical company GlaxoSmithKline (GSK), supported by funding from the Bill & Melinda Gates Foundation—found that it reduces the risk of clinical and severe malaria by roughly half in African children ages five to 17 months over a 12 month period.At one of the 11 trial sites, the Kombewa Clinical Trial Centre in western Kenya, the research has helped build a large staff of Kenyan researchers, doctors, nurses, and field workers. The Mal 55 trial, which was the main RTS,S research project at Kombewa, employed 124 Kenyans and just a handful of Americans.“Americans should know that we are not just giving people fish—we are teaching them how to fish,” said Dr. Louis Macareo of the US Army Medical Research Unit-Kenya and director of the Kombewa trial centre. “The biggest thing we are leaving behind is intellectual capital. They are becoming some of the best researchers in the world, even better than people in our own organization because of the volume of the work in the trials that they are involved in.”One of the most overlooked benefits of US-funded global health research is the training provided to scientists to do the work in their own communities.The research also provided the opportunity for many of the scientists to access education and training. In one case, physician investigator Dr. Lucas Otieno received his master’s degree in public health at the London School of Hygiene and Tropical Medicine partially due to support from the project. In return, Dr. Otieno agreed to stay for several years on the project.The RTS,S trial was just one example of capacity building. Dr. Pauline Mwinzi, a Kenyan, is the principal research officer at the neglected tropical diseases branch at the KEMRI-CDC office in Kisumu. The Kenya Medical Research Institute (KEMRI) and the US Centers for Disease Control and Prevention (CDC) have been partnering together in Kenya for more than 30 years. She said US training made all the difference for her.“We have benefitted from US government funding in terms of capacity building,” she said. “I was trained through the CDC. I wouldn’t be here without the CDC training that allows me to design these experiments that we are conducting at the moment and it’s not just me, but my entire department, my colleagues, and the funding that continues to come from the US government through the CDC” and the US Agency for International Development (USAID).Mwinzi added: “Without the US funding, we wouldn’t have moved much. We wouldn’t be able to move the sophisticated research that we do now.”Lynn Adrian, USAID’s health team leader in Kenya, told us that the training of Kenyan staff was one of those little-told stories that will have impact for years to come.“If I look at my own office, to start, in Nairobi, I have 38 staff and just three are Americans. The rest are Kenyans with incredible educational backgrounds and who very, very dedicated, very able to be able to influence policy and oversee programs,” she said. “This is not just true of the people in our office but as I go to the Ministry of Health I am also surrounded by technical experts who deliver leadership in fields like tuberculosis, in fields like malaria, maternal child health.”Adrian said the results of these trainings are being seen now, but will be even greater in just a few years.“For me as an American, as a taxpayer, and as a mom, these are the kinds of investments that we want to be making to be able to see out in five years or 10 years and see that the kinds of capacity building means institution strengthening going on all over this country,” she said. “It really will have a long-lasting effect.”

John Donnelly, a writer working with the GHTC, is blogging following our trip to visit global health research projects in Kenya. This is his third post from the field. KISUMU, Kenya – The shortcomings in the tools to fight tuberculosis (TB) are stunning. There is no effective TB vaccine beyond childhood. The most common TB diagnostic tool was developed in the 1880s and fails to detect the bacterium in half of the cases. And the drugs needed to treat TB are also ancient – the most recent ones were developed more than 40 years ago. As a result, resistance to TB drugs has run wild in parts of the world. There are an estimated 440,000 cases of multi-drug resistant TB globally, and at least 58 countries have reported cases of extensively drug resistant TB, which can be incurable. “TB is an example of what happens if you fail to invest in research,” said Kevin Cain, TB Branch Chief at the KEMRI/CDC Research and Public Health Collaboration in Kisumu. The Kenya Medical Research Institute (KEMRI) and the US Centers for Disease Control and Prevention (CDC) have been partnering together in the country for more than 30 years. “It means you end up with a diagnostic tool that is over a century old, you are using drugs from the 1960s and older. And you end up with the situation we are in: many cases of extensively drug-resistant TB, which can be untreatable.” But in western Kenya, and in several other research sites around the world, clinical trials are ongoing for a new vaccine, drugs, and diagnostics. On GHTC’s trip to Kenya, we were able to see participants of a Phase II trial of a TB candidate sponsored by Aeras, a GHTC member and non-profit product development partnership (PDP) dedicated to the development of an effective and affordable TB vaccine for all age groups. Currently, the Bacille Calmette-Guérin (BCG) vaccine, which is over 80 years old, is only partially effective; it provides some protection against severe forms of pediatric TB, but is unreliable against adult pulmonary TB. The trial in western Kenya involves giving two doses to children: one on the initial visit and a second 28 days later. Dr. Samuel Ouma, a physician working on the TB trial, said that 144 children have enrolled at his clinic in Boro. The trial offers free health care to the babies enrolled in the study. We met with one of the mothers of the children in the study. Sharon Akinyi Olunga, 27, said she asked many questions before enrolling her baby, Winfrey Atieno Juma, now 13 months old. She said she was very happy she had enrolled her daughter. “It’s good for our babies,” she said. “I loved that my child should go into this research project first because if anything happened to her, whether she was sick with a cold or pneumonia, she would immediately receive free medical care. Here, funding for medical care is really difficult to get. So it put me at ease.” Olunga said there was another reason she wanted her daughter to be part of the trial: it served a greater good for children around the world. “I think of so many babies, so many children in Africa and around the world, have been helped by vaccines,” she said. “If this vaccine works, that means all those children will be helped by my baby’s participation. That makes me feel very good.” Watching Olunga was her grandmother, Hilda Auma Juma, who was in her 70s. Juma also said she was glad to see medical research in her village and in neighboring villages. “I am happy because it helps the health of all babies,” said Juma, who had nine children. She said health care has dramatically improved for mothers and children compared to the situation a half-century ago. “In my time, when I gave birth, mothers only had the faith of God to take care of the babies,” Juma said. “Now mothers have all these vaccines. Babies and children are living. We hope we may soon have more vaccines. It’s wonderful.”

John Donnelly, a writer working with the GHTC, will be blogging this week from our trip to visit global health research projects in Kenya. This is his second post from the field.ELWESERO, Kenya -- In the year 2000, Kenya had just a handful of HIV-positive people taking antiretroviral drugs.Today, just 11 years later, the country has a half-million people on these drugs, which have saved many from an early death.While much of the focus of this feat has gone to the extraordinary efforts to expand the access to treatment—the government of Kenya, the US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria take much of the credit—little acknowledgment has been given to the research that made it possible.On GHTC’s trip through Kenya this week, the impact from research of years ago is being felt throughout the country. And the promise of today’s research is being eagerly talked about among health workers, as well as mothers and fathers who are hopeful for more lifesaving innovations.At the Elwesero Men Initiative Support Group on Thursday in western Kenya, about 10 members came to meet us. A few stood to tell stories of nearly dying from AIDS and then recovering rapidly because of the medication.Photo: Evelyn Hockstein/PATHPeter Owiti Omotsi, 39, father of five, was a former bus driver in Nairobi. He said he began to feel sick. At first, he said, it felt like malaria, with fevers and chills. “Then I felt I was bewitched,” he said. “My body was wasted.” He dropped from 175 pounds to 125 pounds.In 2008, he tested positive for HIV. His wife tested negative. His CD4 count was 95; anyone under a 200 count at the time was put on antiretroviral drugs. He started treatment, and he improved dramatically.“I carry these drugs with me everywhere I go,” he said, holding up a packet of the medicine. “The rest of my life is because of these drugs. My life has changed. I used to drink a lot and smoke. Now I do none of that. I eat nutritious foods. With God and these drugs, my life can be prolonged.”Another member of the support group, Peter Lumumba, 49, thanked researchers for saving his life.Lumumba, a father of six, was first diagnosed with HIV in 1987 and started antiretroviral treatment in 2006.“I am now well,” he said. “People are totally astonished. I helped start this support group, and when we are telling people we are (HIV) positive, they will say, ‘No, you are lying." Without the research that led to this lifesaving medicine, he said, “I would have already died. “ Photo: Evelyn Hockstein/PATH Later in the day, Omotsi took us to his home on a hillside in a village named Ematsayi. He showed off his garden of spinach, maize, onions, kelp, watermelon, peppers, bananas, papayas, and a local vegetable called managu.“Everything in the garden has high nutritious value,” he said as he waited for his children to return home from school.He said if he could talk with the researchers who produced the various antiretroviral medicines, “I would tell them that they can see right here the benefits of what they created. They can see my life. These drugs work. I believe before I die, I will see my grandchildren. Without these drugs, that probably wouldn’t happen. But I have some years to live now. I can at least be proud of my grandchildren.”

John Donnelly, a writer working with the GHTC, will be blogging this week from our trip to visit global health research projects in Kenya. This is his first post from the field. Inside a large room at the US Embassy in Nairobi, Robert F. Breiman, MD, the country director for the Centers for Disease Control and Prevention (CDC) in Kenya, explained a portion of the US-funded research in Nairobi’s largest slum, Kibera. He referenced the recent hit movie, Contagion, in which an infectious disease speeds around the world, spread by air travelers and killing people within days of contact. “It’s not that Contagion couldn’t happen like in the movie,” Breiman said. “But what we are doing in Africa is changing the whole game in detecting infectious diseases.” During the beginning of the Global Health Technologies Coalition’s 10-day trip to Kenya to look at US-funded global health research and development (R&D), Breiman took us to Kibera to illustrate the use of technologies to control the spread of infectious disease and also to act as a warning system for the emergence of possible epidemics. As we walked in CDC-issued gumboots over ground inside the slum that was literally human refuse, garbage, plastic bags and mud, Breiman said the US government started efforts to hold clinical trials and track infectious disease in Kibera in 2004. Before, it had only worked in rural areas in Kenya. He said the shift into Kibera came because of the rapid urbanization of the country and the knowledge that a new disease such as SARS “would spread in a far different way in a rural area than it would in a tinderbox like this.” CDC officials held many meetings with residents about the project. “At first, we didn’t have their trust,” Breiman said. “Some people thought we would just be here for a few studies and then go.” Photo: Evelyn Hockstein/PATH He said that the purpose of CDC’s studies in the area was clear: Collecting data to impact policy. He also told them that CDC was committed to starting a program and staying. The program gave study participants the benefit of free health care, which later led to the building a health clinic in the slum. Of the many projects in two of Kibera’s 12 villages, Soweto and Gatwikera, one was a door-to-door HIV testing campaign, using rapid HIV tests; 80 percent—an astounding number—accepted the tests. A second larger project has been an ongoing disease surveillance of 28,500 residents. CDC community health workers visit each resident’s household every two weeks, using hand-held PDAs to record detailed information on family members’ health. They collect data on fevers, diarrhea, tuberculosis, pneumonia, and jaundice. Any sick member of the family is referred to the health clinic. “In the big cholera outbreak in 2010 in Nairobi, we detected it immediately because of our surveillance,” Breiman said. “Our team immediately jumped on it and started a safe water campaign.” The CDC team also has detected a daunting number of typhoid cases, which was virtually wiped out in the United States in the late 19th century. “By the age of 10, one out of every five children has had typhoid in their blood in Kenya,” he said. “It’s extraordinary, almost unimaginable.” Using population modeling, CDC estimated that 30,000 to 40,000 people contract typhoid every year in Kenya’s slums. It presented the data to the government of Kenya. “This kind of early detection of dangerous pathogens is important before they wreck havoc in these communities and around the world,” he said. Residents who have participated in the studies told us that they had their doubts at first, but now trust the CDC research. Photo: Evelyn Hockstein/PATH “For me, I was distrustful at first,” said Margaret Opondo, 42, a widow with three children. “There are people who try to take advantage of those of us in the slums. They do tests or take photos and they benefit. But I do trust them now. I believe their work is very important.” Last week, she said her son had a major nose bleed, and the clinic referred her to a hospital for treatment. He recovered, and Opondo didn’t pay anything. CDC covered the cost. “I was very happy about that,” she said. Another resident, Agribina Asingwa, 47, said when CDC workers came to her door for HIV testing, everyone agreed to be tested – all 11. “If they hadn’t come and done that, it would have taken us a longer period to get tested. CDC made it easy for us. “And,” she said, “I was really excited afterward. None of us tested positive.” Next: A trip to the western Kenya city of Kisumu.