By Peter Hotez, M.D. Ph.D.
Last December I was selected as one of four U.S. Science Envoys for the year 2015, along with Drs. Jane Lubchenco, University Distinguished Professor of Marine Biology at Oregon State University and former administrator of NOAA (2009-2013); Arun Majumdar, Jay Precourt Professor, senior fellow, Precourt Institute for Energy, Department of Mechanical Engineering, Stanford University, and former founding director of ARPA-E (2009-2012) and Acting Under Secretary of Energy (2011-2012); and Geraldine Richmond, Presidential Chair and Professor of Chemistry at the University of Oregon and founder of the COACh for women scientists and engineers .
The U.S. Science Envoy Program was first proposed in April 2009 by Sen. Dick Lugar who praised American supremacy in the sciences and technology, correctly observing how our country is widely admired for its scientific achievements even by nations unsupportive of our foreign policies . Subsequently in June President Obama made a historic speech in Cairo, Egypt in order “to seek a new beginning between the United States and Muslims around the world" , later followed by Secretary of State Hillary Clinton’s announcement in November 2009 in Marrakesh, Morocco that she will send prominent scientists to travel to Organization of Islamic Cooperation (OIC) countries for “scientific and technical collaboration” . The first three U.S. Science Envoys selected were Drs. Elias Zerhouni (born in Algeria), former NIH Director; Bruce Alberts, former director of the National Academy of Sciences; and Ahmed Zewail (born in Egypt), a Caltech professor and Nobel Laureate . The envoys are chosen jointly by the U.S. State Department and White House Office of Science and Technology Policy (OSTP).
Over the last six years a total of 13 U.S. Science Envoys have been named, including four in this current class. Each of us has a unique expertise and role, including two envoys in 2015 focused on climate change. My interest and passion is in the area of vaccine development for neglected diseases. I head the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine where we are developing a portfolio of six vaccines, including new vaccines for hookworm infection and schistosomiasis now in clinical trials. Our vaccines are developed in the non-profit sector and typically are of less interest to major pharmaceutical companies because they primarily target diseases of the extreme poor living in low- and middle-income countries. A component of our external outreach activities include capacity building in so-called “innovative developing countries” where there is a sound biotechnology infrastructure, despite severe poverty and endemic neglected infections .
In a March 2015 letter in SCIENCE magazine, I wrote how the Middle East and North African (MENA) region is now highly vulnerable to neglected and emerging infectious diseases arising out of the conflicts in ISIS-occupied Syria, Iraq, and Libya, as well as Yemen . Some of these include MERS coronavirus infection, leishmaniasis, and schistosomiasis. I’ve pointed out previously how Ebola emerged in Guinea, Liberia, and Sierra Leone out of a post-conflict setting associated with breakdowns in health systems and infrastructure, urbanization, human migrations, and deforestation, with similar conditions now in play in conflict-ridden MENA zones . Simultaneously the MENA region has a dearth of regional vaccine development capabilities and is highly vulnerable to diseases that the major pharmaceutical companies will not likely target for vaccines, such as those I highlighted above. Accordingly, we are proposing to develop vaccines jointly between research institutions in selected MENA countries and our vaccine institute in Houston. Since the beginning of the year, I have visited Morocco and Saudi Arabia, countries that were chosen on the basis of their potential to develop vaccine infrastructure together with alignment of U.S. strategic interests.
It’s an exciting opportunity for me to work with the State Department, White House OSTP, and the U.S. Embassies in Morocco and Saudi Arabia. I have been deeply impressed with the expertise and depth of knowledge of my colleagues in the U.S. Government, as well as some amazing scientists in Morocco and Saudi Arabia. I am hopeful there could be some important deliverables in terms of developing new and life-saving vaccines, together with joint capacity building for science and technology in the MENA region. Simultaneously I feel privileged to be asked to provide service to our country!
Peter Hotez, M.D., Ph.D., is a member of TAMEST. He is an elected member of the Institute of Medicine (officially National Academy of Medicine on July 1, 2015) and is the Dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas Children’s Hospital Endowed Chair of Tropical Pediatrics, president of the Sabin Vaccine Institute, University Professor of Biology at Baylor University, and Baker Institute Fellow in Disease and Poverty at Rice University. The views herein are those of Professor Hotez and not necessarily those of the U.S. State Department or White House.
By Peter Hotez
Recent testimony to the House Committee on Foreign Affairs hints at more to come on the problem of neglected tropical diseases and poverty in Texas.
The National School of Tropical Medicine, launched at Baylor College of Medicine in 2011, was established to offer a potent North American colleague to the century-old British tropical medicine schools in London and Liverpool and tropical disease institutes in Amsterdam, Antwerp, Basel, Hamburg, and elsewhere in Europe.
An essential cornerstone of the National School is translational research and development, with several core faculty members actively engaged in developing new diagnostics and vaccines for the 17 major diseases of poverty known as the neglected tropical diseases (NTDs). The NTDs represent a group of parasitic and related infections that actually cause poverty because of their long-term and disabling effects on childhood cognition and physical fitness and development, adult productive capacity, and the health of girls and women. They are the most common afflictions of the extremely poor in developing countries.
To jumpstart the National School’s translational R&D activities, we brought to Houston the product development partnership (PDP) of the Sabin Vaccine Institute. PDPs are non-profit organizations that use industry practices in order to make new drugs, diagnostics, vaccines, insecticides, or other products needed for the control and elimination of major global health problems, such as HIV/AIDS, tuberculosis, malaria, childhood respiratory and diarrheal diseases, and the NTDs. Sabin’s PDP emphasizes vaccines for NTDs including hookworm infection, schistosomiasis, Chagas disease, leishmaniasis, and selected viral infections such as arbovirus infections and SARS. The human hookworm vaccine is in phase 1 trials, while the schistosomiasis vaccine is expected to enter clinical testing very soon.
In 2011, the Sabin Vaccine Institute PDP moved into new laboratories at Baylor’s affiliated institution, Texas Children’s Hospital, thereby becoming one of the few PDPs—the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development—embedded in an academic health center. In parallel, an educational program was created so that (just like its United Kingdom counterparts) the National School offers diplomas in tropical medicine for physicians, physicians-assistants, and medical students and will soon start a new summer tropical medicine institute to accommodate growing undergraduate interest in global health.
Shortly after the launch of the National School, the scientists and faculty identified an astonishing level of disease and poverty right here in Texas and even in the poorer parts of Houston. We found that many individuals are afflicted with a variety of parasitic NTDs such as Chagas disease, cysticercosis, leishmaniasis, and even arbovirus infections including dengue and West Nile virus infection. Unexpectedly, transmission of some NTDs occurs in Texas and in Houston, especially among impoverished populations and people of color, as well as several animal reservoirs (including armadillos that transmit leprosy, for example). The key point is that whereas many assumed that NTDs are linked to immigrant populations coming in from Mexico and Central America, a more accurate depiction includes evidence for a previously hidden transmission of these diseases. Thus, unlike the European tropical medicine schools and institutes, the National School is combating NTDs in our own backyard. Accordingly, we have established one of the first comprehensive clinics in the United States devoted specifically to the care of people with NTDs acquired locally. It is located at the Texas Medical Center and home to a talented cadre of clinical and molecular epidemiologists to investigate the extent of the problem here in our own state. Moreover, we are now scaling up efforts to combat NTDs in Texas by developing new diagnostics and vaccines.
These activities were the subject of my recent testimony to a House Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations,1 one of the components of the House Committee on Foreign Affairs.
We are at the beginning—the National School and its PDP and clinic are positioned to combat an indigenous NTD disease burden through a multidimensional approach that incorporates R&D, education, and clinical activities. Public policy is the fourth component of the National School, and in a recent June publication in PLOS Neglected Tropical Diseases, scientists from the National School collaborated with several other Texas institutions to advance a concept known as the “ears of the armadillo.”2 It is the disease equivalent of the “tip of the iceberg” idea and borrows from the “ears of the hippopotamus” (mostly submerged in the river) metaphor sometimes used to refer to the undetected malaria disease burden in sub-Saharan Africa. According to the ears of the armadillo, we have a hint that there is a lot of tropical disease and pathology among the poor in Houston and in Texas, but we need to work aggressively to understand its full extent and the basis for its links to extreme poverty.
Today, Texas may have more people living below the poverty line than any other state. An unfolding scenario of NTDs linked to our own indigenous poverty will occupy the National School for years to come.
Peter Hotez, M.D., Ph.D., was inducted into TAMEST in 2011. He is the founding dean of the National School of Tropical Medicine at Baylor College of Medicine where he also serves as president and director of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development and Baker Institute Fellow in Disease and Poverty at Rice University. His book, Forgotten People, Forgotten Diseases (ASM Press), was released this spring.
2. Andrus J, Bottazzi ME, Chow J, Goraleski KA, Fisher-Hoch S, Lambuth JK, Lee BY, Margolis H, McCormick J, Melby P, Murray KO, Rico-Hesse R, Valenzuela JG, Hotez PJ. Ears of the armadillo: global health research and neglected diseases in Texas. PLOS Neglected Tropical Diseases 7 (6): e2021.
Our state and nation invests a considerable amount of time and money in the preparation and training of our graduate students and postdoctoral fellows in the sciences. We know that the future of our leadership in medicine, science, and engineering depends on recruiting the world’s most talented students and providing them state-of-the-art education and training at the very cutting edge of our respective disciplines. Ideally, the best, brightest, and most talented candidates are expected to achieve success and become the next generation of leaders. Unfortunately, the curriculum for predoctoral and postdoctoral training often excludes a critical component—guidance on how to be an effective “citizen of science.” As a biomedical researcher, my career depends on a steady source of federal funding from various agencies such as the National Institutes of Health (NIH), the National Science Foundation (NSF), and others.
Throughout my career, I have been stressed by the uncertainty of available grant dollars during the up and down years and the “rags to riches” mentality of the federal budgeting process. Clearly, even in the best of times, not all deserving research gets funded and some years are much worse than others. It was not until later in my career, when I became active in my professional organizations, that I came to realize that scientists need to become more directly engaged with the public and with policymakers in government. In the beginning, I was not a very effective spokesperson when given the opportunity to testify at public gatherings or at congressional hearings. Moreover, many of my colleagues were either reluctant to speak or were also ineffective spokespersons. After all, our training and background in scientific research did not include guidance on becoming effective spokespeople and advocates for science in the public arena.
As I became more formally involved with graduate and postdoctoral education as chair of a department, and later as dean of a graduate school of biomedical sciences, I began to think more about the importance of encouraging graduate students and faculty to become effective “citizens of science.” One approach was to form a partnership with Research!America, the nation’s largest not-for-profit public education and advocacy alliance committed to making research to improve health a higher national priority. My dream was to prepare graduate students to become more effective advocates and to take more trainees on trips to Washington to visit “The Hill,” walk the halls of Congress, and learn how to sit down with powerful legislators and become effective speakers and advocators.
A remarkable group of Houston citizens known as Baylor Research Advocates for Biomedical Science (BRASS) elected to support my plan and to fund an annual trip to Washington D.C. accompanied by several of our student “BRASS Scholars.” Typically, we spend two or three days on Capitol Hill visiting our local representatives and various key committee members in the House and Senate. Prior to the trip, I also give a public policy lecture to graduate students and postdoctoral fellows and show a Federation of American Societies for Experimental Biology (FASEB) video on how to meet with your congressman. It is only a small beginning, but I am very encouraged that students understand the need to articulate the value of science to our governmental leaders and share my belief that it should be part of every training curriculum for scientific researchers.
William (Bill) R. Brinkley, Ph.D.
2012 TAMEST President