New Push for Tropical Medicine

Abstract

One billion persons, mostly in the world's poorer countries, suffer from intestinal parasite infections; half a billion people have malaria; a quarter of a billion carry parasitic worms in their blood or lymphatic system or both. Leprosy affects more people today, because of population growth, than in biblical times, when it was one of the most widely described and dreaded diseases. These and other ailments, usually lumped together as diseases, have not benefited as much from the recent triumphs of biomedical research as those illnesses more frequent in developed countries, and the World Health Organization (WHO) is preparing to launch a major new attack on these ancient scourges. The reason behind the lag of tropical medicine is not hard to find: Only one percent (some $25 million annually) of all the money spent on medical research is devoted to diseases of tropical and subtropical countries-though more than half the world's population lives in these areas. Increasingly, research in industrialized countries is directed toward the chronic diseases that afflict a population that lives longer than most inhabitants of poorer countries-heart disease, cancer and mental disorders. Even the potentially useful spin-offs of such research are often not applied to improving health in tropical areas because trained personnel and local facilities are missing. After looking into the problem, WHO's Advisory Committee on Medical Research concluded that radical measures are needed to remedy this deplorable situation. The proposed cure is as ambitious as it is radical. Noting the success of internationally sponsored, regional agricultural research laboratories-which produced the Green RevolutionWHO iS planning a similar network of regional medical institutes that would conduct basic research, apply the results to practical health problems of an a!rea, coordinate the work of national labs and train local personnel from technicians to postdoctoral-level researchers. The annual cost of the new program, when operational, will probably run between $10 million and $15 million, far more than the present WHO budget will allow, so outside donors, including governments and foundations, are. being asked to help. A meeting of potential donors is tentatively for March. In an interview with SCIENCE NEWS at WHO headquarters in Geneva, medical officer Howard Goodman described the first step in implementing the program: establishment of a multidisciplinary research and training institute for the study (primarily) of parasitic diseases in N'dola, Zambia. The Zambian government has donated two upper floors of a new, seven-story hospital for the project and officials hope to get the institute operating next year. Goodman emphasizes that this is to be no ivory tower science, but rather a directed effort to develop drug therapy and possibly vaccinations against a specific set of diseases. Recent advances in the study of how the body's immune system recognizes the agents of infection and mobilizes antibodies to attack them may lead to new methods of treating and even preventing diseases involving protozoa, such as malaria and trypanosomiasis (sleeping sickness). The one-celled, animallike protozoans are recognized in the body by certain surface substances called antigens, and research will concentrate on how to strengthen the immune response triggered by these substances. The main problem is that protozoa continually change their antigens and so evade the defending antibodies. Scientists at the new institute will thus concentrate on enhancing immunity by determining the pattern of antigen variations and finding out how various drugs affect these variations. Their research will also involve studies of cell membranes-now a popular topic in Western laboratories because of its importance to understanding the mechanism of cancer. Thus the flow of information between N'dola and established centers of research in developed countries should not be one-sided. A WHO panel setting up research goals for the new program concluded that rapid progress towards a leprosy vaccine is now possible, and recommended a major effort in this direction. Here, research will be concentrated on N'dola hospital, Zambia: Home of new institute for study of parasitic diseases.