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1 Introduction In 2011, together with a team of 15 scientists, I relocated to Houston, Texas, to launch a new school devoted to poverty-­ related diseases. The National School of Tropical Medicine at Baylor College of Medicine is a joint venture among three biomedical institutions—Baylor, Texas Children’s Hospital, and the Sabin Vaccine Institute—with a mission devoted to research on and training in the treatment of neglected tropical diseases, or NTDs (see box I.1). Today, the NTDs represent the most common afflictions of people who live in extreme poverty. These ailments include parasitic diseases such as hookworm , schistosomiasis, Chagas disease, and leishmaniasis—or, as I often say, the most important diseases you’ve never heard of. Virtually every impoverished individual is infected with at least one NTD. An unusual aspect of Baylor’s National School of Tropical Medicine is that it includes as its research arm a unique type of organization known as a product development partnership (PDP). There are 16 PDPs worldwide. They are international nonprofit organizations that develop and manufacture biopharmaceuticals —drugs, diagnostics, and vaccines—for the NTDs, as well as for HIV/AIDS, tuberculosis (TB), and malaria. Together, the NTDs and AIDS, TB, and malaria are sometimes broadly defined as “neglected diseases .” PDPs develop and test new products for neglected diseases that the major pharmaceutical companies may not have an interest in because they are poverty-­­ related afflictions that will therefore not generate significant sales income. The National School of Tropical Medicine’s PDP is known as the Sabin Vaccine Institute PDP, and it is specifically focused on developing NTD vaccines. Hotez.indb 1 6/22/16 11:02 AM 2 Blue Marble Health Box I.1. The Poverty-­ Related Diseases: Neglected Tropical Diseases (NTDs) and Other Neglected Diseases NTDs: The neglected tropical diseases are a group of chronic and debilitating poverty-­ related illnesses. Most, but not all, are parasitic diseases. An original list of 13 NTDs published in PLOS Medicine in 2005 has since been expanded by the World Health Organization to include 17 major conditions: Soil-­ transmitted helminth infections (including ascariasis, trichuriasis, hookworm infection, strongyloidiasis, and toxocariasis) Lymphatic filariasis (elephantiasis) Dracunculiasis (guinea worm disease) Onchocerciasis (river blindness) Schistosomiasis Foodborne trematodiases Taeniasis and neurocysticercosis Echinococcosis Human African trypanosomiasis (sleeping sickness) Chagas disease (American trypanosomiasis) Leishmaniasis Yaws Buruli ulcer Trachoma Leprosy Rabies Dengue and other arboviral infections PLOS Neglected Tropical Diseases has published a further expanded list that also includes several intestinal protozoan infections, chronic fungal infections, cholera and other bacterial diseases, and ectoparasitic infections such as scabies and myiasis.Types of malaria other than those caused by Plasmodium falciparum (such as Plasmodium vivax) are also sometimes considered to be NTDs. Neglected Diseases: There are several different definitions of neglected diseases. Here I refer to neglected diseases as NTDs together with the“big three”diseases—HIV/ AIDS, malaria, and tuberculosis. A similar usage has been adopted by the G-­ FINDER report on research funding for neglected diseases. There are several reasons that the term“neglected”is used for both groups of conditions, including (1) lack of attention by government leaders and international agencies; (2) the strong links of these diseases to vulnerable populations and to people who live in extreme poverty and are thus often hidden or ignored; and (3) low levels of research funding and support. Hotez.indb 2 6/22/16 11:02 AM Introduction 3 One reason I was so eager to move our scientists to Houston was to take advantage of being located within the Texas Medical Center. The TMC is more than just the world’s largest medical center; it is a medical city comprising more than 50 biomedical institutions and 100,000 employees , occupying building space that exceeds that of downtown Los Angeles. A second reason for the relocation was the generous support we received from Texas Children ’s Hospital (the world’s largest children’s hospital), which also housed the Sabin Vaccine Institute PDP in a modern research building known as the Feigin Center, named for the late Ralph Feigin, MD, one of the giants in the treatment of pediatric infectious diseases. Our goal for moving and becoming linked to the TMC was to increase the number of new vaccines we are creating for the poorest people in less developed countries, as well as to accelerate the pace at which they are produced. It was an amazing opportunity to leverage the facilities of more than 50 world-­class institutions in order to launch an assault on global...


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