Citation: Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Sachs SE, Sachs JD (2006) Authors' Reply. PLoS Med 3(6): e284. doi:10.1371/journal.pmed.0030284
Published: June 27, 2006
Copyright: © 2006 Hotez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors received no specific funding for this article.
Competing interests: PJH is partially supported by the Bill and Melinda Gates Foundation, Seattle, Washington, United States of America, through the Human Hookworm Vaccine Initiative of the Albert B. Sabin Vaccine Institute, Washington, District of Columbia, United States of America. He is an inventor on an international patent application (PCT/US02/33106; filed November 11, 2002) entitled “Hookworm Vaccine.” The patent was filed in the United States, Brazil, India, China, and Mexico. If awarded, the patent would belong to The George Washington University, with an exclusive license to the Human Hookworm Vaccine Initiative of the Albert B. Sabin Vaccine Institute, a nonprofit (501(c)3) organization devoted to increasing the use of vaccines worldwide. Because hookworm is a neglected disease afflicting the poorest of the poor in developing countries, a hookworm vaccine has no anticipated commercial value or income-generating potential. The rationale for filing a patent is to ensure that the vaccine is developed for those who need it in developing countries and to encourage vaccine manufacturers in developing countries to work with the Albert B. Sabin Vaccine Institute for manufacture of the hookworm vaccine. The first-generation hookworm vaccine, the Na-ASP-2 Hookworm Vaccine, was developed entirely in the nonprofit sector through the Human Hookworm Vaccine Initiative of the Albert B. Sabin Vaccine Institute. PJH is also co-chair of the Scientific Advisory Council of the Albert B. Sabin Vaccine Institute (he receives no compensation for this activity). DHM is partially supported by the United Kingdom Department for International Development and by GlaxoSmithKline, London, United Kingdom, and participates in the Mectizan Expert Committee/Albendazole Coordination meetings, which are supported by Merck, Whitehouse Station, New Jersey, United States of America, and by GlaxoSmithKline, London, United Kingdom. AF is director of the Schistosomiasis Control Initiative, which is supported by the Bill and Melinda Gates Foundation, Seattle, Washington, United States of America. EO is supported through the Task Force for Child Survival and Development and the Carter Center, Atlanta, Georgia, United States of America; by the Bill and Melinda Gates Foundation, Seattle, Washington, United States of America; by GlaxoSmithKline, London, United Kingdom; and by the Global Alliance to Eliminate Lymphatic Filariasis, Liverpool, United Kingdom. SES declares that she has no competing interests. JDS is partially supported by the United Nations, New York, New York, United States of America.
We appreciate the comments by our colleagues from the Drugs for Neglected Diseases initiative (DNDi) highlighting the importance of research and development programs for a new generation of control tools (e.g., drugs, diagnostics, vaccines, surveillance instruments) to combat the neglected tropical diseases . Indeed, we have great admiration for the outstanding track record of the DNDi along with its sister organizations, including the Institute for One World Health, TDR-WHO, and the Seattle Biomedical Research Institute, as well as a small but distinguished community of academic and government scientists.
In both our paper cited by Torreele et al.  and an earlier companion paper also published in PLoS Medicine , we went to some lengths to point out that the ultimate elimination of some of the most burdensome endemic neglected tropical diseases will likely require more than simply innovations in preventative chemotherapy, such as our proposed rapid-impact, pro-poor package. Such achievements, especially for diseases such as Buruli ulcer, hookworm, human African trypanosomiasis, and leishmaniasis, will almost certainly also require advances in biotechnology leading to the development and distribution of new drugs and vaccines. It is also for that reason that each of the biomedical scientists who co-authored the PLoS Medicine papers has devoted his or her lifetime to research on neglected tropical diseases and has contributed to the development of new control tools for hookworm, lymphatic filariasis, malaria, onchocerciasis, schistosomiasis, and other diseases of poverty. In addition, Jeffrey Sachs, the health economist on our project, previously led an international call to establish a US$1.5 billion Global Health Research Fund, to finance basic and applied research on the diseases of poverty . In short, we completely agree with the plea by Torreele et al. to embrace research and development as an essential component for any global neglected tropical disease initiative.
The major points of our PLoS Medicine articles are these: (1) the disease burden of neglected tropical diseases has been underestimated and this group of diseases may be as important as HIV/AIDS, malaria, and tuberculosis; (2) there is a moral imperative to recognize the plight of the world's most impoverished who suffer from neglected tropical diseases; and (3) beginning today, we can make a rapid impact on the lives of these populations through an effective, sustainable, rapid, and highly cost-effective intervention package of donated drugs.
Ultimately, control and elimination of some of our most devastating neglected tropical diseases will likely require additional biotechnological solutions. Even then, this will require careful integration of the new with the old, along the lines of the vaccine-linked chemotherapy strategies recently proposed by Bergquist et al. . Therefore, we need to do our very best to achieve sustainable morbidity reductions by using the donated drugs we have in hand today, with the understanding that success in this endeavor must not lead to complacency. We know all too well how the emergence of chloroquine and DDT resistance derailed global malaria eradication efforts during the 1960s  and that we must be ready to simultaneously champion research as well as implementation. We also believe that it would be unethical in the context of the timeframe of the Millennium Development Goals to ignore what we can do for poor people now at such a low cost , as we know that research takes time to come to fruition in terms of products, policies, financing, and practice. Drugs of proven efficacy and quality are available now for some of the neglected tropical diseases, and they can be delivered despite the resource constraints in African health systems. It is gratifying to see a number of countries are now prioritizing the control or elimination of neglected tropical diseases as a national policy and are establishing budget lines to ensure sustainable implementation of the tools we have. There have been too many public health failures in the past—and so it is essential that we take the real opportunity to act on behalf of the world's poor.
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