Gregory Petrossian
B.S. BioResource Research and
B.A. International Studies
Internship Abroad in India 2009
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Analyze the differences in infectious disease
burden between developed and developing
world
Highlight the burden of Neglected Tropical
Diseases (NTDs)
Examine ways to spur drug development for
NTDs
Compare strategies of disease elimination
between developed and developing worlds
“It
is time to close the book on
infectious diseases and pay more
attention to chronic ailments such as
cancer and heart disease”
- Surgeon General William H. Stewart,
late 1960s
• In response to smallpox, polio, and rheumatic
fever tamed by vaccines or antibiotics
 The epidemiological transition
• Progress in healthcare between 19th and 20th century
• Significant advances leading to dramatic declines in
death rates due to infectious diseases
 Sanitation & hygiene
 Immunizations
 Antibiotics
• Vaccines had greatest impact
 1977 after a decade-long campaign involving 13 countries
which lead to the eradication of smallpox from the world
 Today, pertussis (whooping cough) has made resurgence due
to populations choosing NOT to immunize their children due to
misinformed stigma
 Not
as successful as developed world in
implementing control strategies
• World Health Organization (WHO) describes
immunization coverage as “challenging due to high
population growth rates, limited infrastructure and
resources, and fluctuating demand for services”.
 Estimated
mortality from infectious
diseases accounts for >25% of deaths
worldwide and over 40% of deaths in
developing countries
 Slower
progress in life expectancy and
control of infectious disease
• Socioeconomic discrepancy of population growth
and limited resources
 Estimated if “under the age of five” mortality rate in
poorest 80% of the population of the developing world
was reduced to that of the richest 20%
= global mortality would be reduced by 40%
theoretically
 WHO
describes three confounding factors to
progress
• 1) failure to use existing tools effectively
 Lack of education, incomplete treatment regimens, broad
spectrum antibiotics, and repeated trial-and-error
prescriptions
• 2) inadequate or non-existent diagnostic tools
 Diagnoses primarily made without diagnostics to save time
and money
• 3) insufficient knowledge of diseases
 Little to no attention to disease awareness programs
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Subset of infectious diseases called Neglected
Tropical Diseases (NTDs) plague developing world
• 1-3) helminth infections
(ascariasis, hookworm, and whipworm)
• 4) lymphatic filariasis (elephantiasis)
• 5) onchocerciasis (river blindness)
• 6) dracunculiasis (guinea worm disease)
• 7) schistosomiasis (gut parasite from snail - Trematodes)
• 8) Chagas disease
(parasite from bite of insect - Trypanosoma cruzi)
• 9) human African trypanosomiasis (sleeping sickness)
• 10) leishmaniasis
• 11) Buruli ulcer
• 12) leprosy
• 13) trachoma (bacterial infection of eye)
 “Neglected” =
lack of attention to diseases
of the developing world due to the focus
on tackling HIV/AIDS, tuberculosis, and
malaria
 Top
ten leading causes of healthy life lost
to long-term disability and premature
deaths worldwide are due to NTDs
 Sub-Saharan
Africa bears the largest
burden of many NTDs with over 90% of the
world’s burden
 NTDs have severe consequences on population
• long-term illness, disfigurement, social stigma, immuno-
suppresion, and decreased productivity
• Leprosy = stigma and disfigurement
• Leishmaniasis and Tuberculosis = long-term illness even
with treatment
• affect worker productivity
 households and firms must adapt their productive activities in
response
• coping strategies can lead to low savings and investment,
lost capital and purchasing power, and inefficient labor
substitution
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Treatments lacking for NTDs because they do not
offer sufficient financial returns for the
pharmaceutical industry to engage in R&D
NTDs represent 11.4% global burden
• Only 1% of the 1393 new chemical entities marked
between 1975 and 1999 were registered for these diseases

Innovation gap for novel antibiotics is evident in
the dramatically reduced number of new
antibiotic approvals by the United States Federal
Drug Administration (FDA) over the past two
decades
• Termed “antibiotic drought”
 New
paradigm for drug development
• Public-private partnerships (PPPs) attempt to
meet the needs of developing countries
through establishing public-private
collaborations, networks, and partnerships
• intricately structured to shift the industrial
strategy from maximizing profits to
establishing equitable pricing policy
worldwide
 Maintaining
imperative
low cost for NTD control
 Low cost determined by 4 factors:
• Commitment of pharmaceutical companies to
provide subsidized medicines
• Scale of the programs
• Potential for synergizing delivery methods
• Volunteer contribution of communities for
distribution
 Highest
burden of three major NTDs
• Leprosy, lymphatic filariasis, and leishmaniasis
• Several factors make eliminating these NTDs an
attainable goal by the WHO
• WHO working with partners such as The World
Bank and Special Programme for Research and
Training in Tropical Diseases
 Observational
medical internship for 10 weeks
visiting 6 different cities in Northern India
 Focused
 Also
 Saw
on communicable diseases
observed traditional medicine
first hand the devastation caused by NTDs
 Immersed
in the culture
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Leprosy
• Caused by bacterium Mycobacterium leprae
• Not very contagious with long incubation time
• Symptoms: skin sores, nerve damage, and muscle
weakness
• Control
• 67% of cases detected globally in 2008 in this region
• Multidrug therapy to treat and cure reservoir
• Free global supply provided by partnership with Novartis
• Cured 12.8 million cases of 15 million reported in 2010
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Leishmaniasis
• Parasitic disease spread by bite of female sandfly
• Symptoms include: skin sores, breathing difficulty, ulcers, and
erosion in mouth, tongue, gums, lips, and inner nose
• Death happens within two years
Control
• Use of rapid dipstick diagnostic screening rK39
• Drugs available (antimony-containing compounds)
• Sandfly vector control by indoor residual spraying
• Pilot exercises in 11 districts of India expanded to all 52
endemic districts by 2010
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H1N1 pandemic response by United States
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First emerged in Mexico in April 2009 and rapidly
spread in following months
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Mass vaccination most effective and utilized method
• Quaranting and antiviral agents slow spread
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Currently, more than 20 manufacturers in various
stages of vaccine
• Effective vaccine was ready by September 2009
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U.S., surveillance at federal and state level
• U.S. departments CDC, NTSB, NIH
• Swift response and control
 Developing World
 Developed World
• Requires partnerships
• Funding within
and outside funding
• Distribution relies on
volunteer work
• Countries must work
with limited
infrastructure
• Slow response,
delayed control
privatized
pharmaceutical
industry
• Distribution centers
and hospitals
• Advanced surveillance
infrastructure
• Fast response,
effective control
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Shifted focus from infectious diseases in the
developed world may allow vulnerabilities for
emerging infectious diseases due to globalization
promoted by ease of travel and climate change
Necessity for new drug development targets and
new strategies for equitable pharmaceutical
distribution on a world-wide scale
Fostering the same progress previously
experienced by the developed world in the
developing world could relegate the overwhelming
burden of infectious diseases to something of the
past
Subsurface Biosphere Initiative (SBI)
summer undergraduate internship
Intervet/Schering Plough Animal Health
Dr. Kerry McPhail
Nick Fleury
Dr. Mark Zabriskie
OREGON STATE UNIVERSITY