Professor Peter Hotez is the international poster boy for Neglected Tropical Diseases (NTD’s), and having sat in the audience of one of his lectures, it is easy to see why. Though eminently humble and diminutive in stature, his intellect, charm, and distinctive look instantly rally eye, ear and mind. He is the archetypal antihero; a Bilbo Baggins to your Smaug the Chiefest and Greatest of Calamities.
“Other diseases get Bono and Angelina as their champions, hookworms only get Peter Hotez”
Hotez and his colleagues coined ‘Neglected Tropical Disease’ as a catch-all description for a range of diverse diseases that lead to disability, disfigurement, stigmatisation, and poverty across the world; diseases which are rampant across the poorest communities, within the poorest Countries. Part of the problem is that there is no economic driver for NTD drugs given the lack of market. The poorest in our world can’t buy food to eat, never mind pharmaceuticals. We can’t blame profit-driven companies for ignoring these diseases either, the issue is much larger, drawing source from socio-political, and scientific challenges. Despite all of these issues, Hotez has risen admirably to champion the cause of NTD research globally. His efforts have undoubtedly had an impact in terms of public understanding, perception, and also I am quite sure in the strategic investment of funds from research councils and philanthropic charities.
One does not simply kill Brugia malayi
Drawing attention to NTDs and dealing with them are two different things of course. However, significant strides have been made in some instances. Prof Mark Taylor works at the Liverpool School of Tropical Medicine, developing new drugs to kill Wolbachia, an endosymbiotic bacterium with a major bad boy crush on the NTD filarial nematode Brugia malayi (http://www.a-wol.com/science/). We still don’t fully understand why or how, but the growth and viability of B. malayi is heavily dependent on Wolbachia. To borrow from Tolkein’s now memetic vernacular, One does not simply kill B. malayi, no, no. Killing the nematode can release the Wolbachia bacteria into the host triggering an extremely damaging inflammatory response, such that chronic infection can in some cases be preferable to effective pharmaceutical intervention. The development of drug resistance is also an ever-present issue, alongside well known issues with drug efficacy in general.
Mark has been working to develop novel antibiotics which will specifically target Wolbachia, and do so in a way which kills the bacterium first, slowly killing the parasitic nematode in the process. Sitting in one of Mark’s plenary talks recently, I had to fight periodic urges to jump up and bark / clap like a seal. It is really cool stuff, which might also yield some new general antibiotics – watch this space. Developing new drugs from scratch is a huge task, and hearing Mark describe the many significant moving parts to his research program had me swaying between buoyant optimism, and distant resignation. Even when you get a drug (set aside a decade or so), you need to be pushing the policy machine into overdrive in order to actually get your drug to people that need it. One thing which Mark and I have in common, though huge differences in scale and scope lie between us, is the privilege of working with the Bill and Melinda Gates Foundation. In Mark’s case this has proven absolutely key to progress. You need an extremely exclusive kind of benefactor to be able to get the major pharmaceutical companies and NGOs, policy makers and many middle-men around one table in order to progress something of this scale and complexity. The task is huge, but not insurmountable.
As we launch an exciting new MSc course in Parasitology and Pathogen Biology this year at QUB (http://www.qub.ac.uk/Study/Course-Finder/PCF1617/PTCF1617/Course/ParasitologyandPathogenBiology.html), my mind is drawn to our need for talented, exciting and creative scientists who can bring about the kind of step changes we need to control these parasites, and others. As Hotez himself mentioned, we need researchers who are prepared to step up and be ambassadors for their cause. A full ten years prior to my hearing Hotez deliver that plenary talk at the British Society for Parasitology spring meeting in 2016, he wrote about the need for celebrity endorsement of the NTD cause, “…there is as yet no Bono or equivalent celebrity to champion its cause”. I like to think of him hanging on that sentence for a few minutes, sitting back in his chair, and resolving there and then to do something about it.