What will it take for research and treatment of Neglected Tropical

Diseases (Diseases of Poverty) to be adequately funded?

SIMON M. KRSTEVSKIRUPERT E. AZZOPARDIJOSHUA M. MONTALTO

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“We already have the tools. We just need to use them, and use them right.”-Dr Warwick Grant

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Acknowledgments

The team would like to thank the academics Dr Robin Anders and Dr Warwick Grant for kindly giving up valuable time to allow us to interview them, as experts on the topic of Neglected Tropical Diseases. They have been invaluable in our research and the team wouldn’t have completed our research nearly as efficiently without their help.Also, we would like to give a warm thanks to the teachers, Mr Chapman, Mrs Marotta, Mr Horsford and Mrs Engblom for keeping us on track, supporting our ideas and being helpful critics. This project wouldn’t have been tied so neatly together without their support!

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Our reason for researching this:We wanted to find out more about neglected tropical diseases. The term “neglected” made us wonder what developed countries and the countries affected needed to do to stop the causes of suffering in the African, South American and Asian lifestyle.The topic question we chose was centred around the injustice of the supposed unimportance of neglected tropical diseases. We wrote up this question because we wanted to research and investigate why people in the affected regions aren’t getting the treatment they need.The group also wanted the experience of working scientifically in a science based environmentSimon Krstevski, Team Coordinator/Researcher

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We Chose to Present our Research this Way:Our research of Neglected Tropical Diseases and why they aren’t being properly recognised as dangerous is a multifaceted, vast topic that could only be done justice by a presentation both engaging and able to represent the team’s hard work The following is a spin off a “Virtual Museum”, but instead we are making it a Virtual Research Facility. The Facility includes pictures from and around the La Trobe Institute of the Molecular Science. To navigate the museum, click on arrows, square plaques, or hyperlinked words. This whole setup was also part of our team desire to produce a project that will stand out. Rupert Azzopardi, Team Designer.

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What will it take for research and treatment

of Neglected Tropical Diseases (Diseases of

Poverty) to be adequately funded?

What will it take- how far will something go until it is changed by popular demand

Research- investigation and

study of sources in order to gain conclusions

Treatment- Medical care given to a patient for an illness or injury

Neglected Tropical Disease- a diverse group of infections especially common in developing nations amongst the tropics.

Fund- provide money for a cause.

Adequately- something completed

satisfactorily.

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BASICALLY:

• Click on arrows, squares or hyperlinked words to navigate the Research Facility.

• All photos are taken from the La Trobe Institute of the Molecular Sciences.

• This Virtual Research Facility© is licensed to Rupert Azzopardi. Contact razzop18@igs.vic.edu.au for details, legal or otherwise.

IMPORTANT PLACES IN THE VIRTUAL FACILITYTo visit the Bibliography, click the link.To visit the Answer to the question, click the link.To visit the Research Lab, click the link.To view the River Blindness info, click the link.To view the Chagas disease info, click the link.To visit Dr Robin Anders’ office, click the link.To visit Dr Warwick Grant’soffice, click the link.To see the Map, click the link.

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References

Our Team Statements

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References/Bibliography• River Blindness 2012, Video, Schools and Health, World Bank. https://www.youtube.com/watch?v=27F0mH5g-AY.• Centre for Disease Control, (CDC) 2011, Neglected Tropical Diseases, accessed 5 June 2015, http://www.cdc.gov/globalhealth/ntd/• World Health Organisation, (WHO) 2015, Onchocerciasis – or 'river blindness’, accessed 5 June 2015,

http://www.who.int/onchocerciasis/en/• The Carter centre, 2015, River Blindness Elimination Program, accessed 5 June 2015,

http://www.cartercenter.org/health/river_blindness/index.html• Auer Bach, P 2010, Chagas Disease, Health line, accessed 5 June 2015,

http://www.healthline.com/health-blogs/outdoor-medicine/chagas-disease#29• McNeil, D 2013, Chagas Disease Costs U.S. More Than Better-Known Illnesses, The New York Times, accessed 5 June 2015,

http://www.nytimes.com/2013/02/12/health/chagas-disease-costs-us-more-than-better-known-illnesses.html?_r=1• Prize for the Development of New Treatment of Chagas Disease 2008, accessed 9 June 2015,

http://keionline.org/misc-docs/b_b_igwg/prop2_chagas_prize.pdf• Chagas disease costs U.S More than better known illnesses 2013, accessed 9 June 2015,

http://www.nytimes.com/2013/02/12/health/chagas-disease-costs-us-more-than-better-known-illnesses.html?_r=2• Controlling Onchocerciasis 2009, accessed 9 June 2015, http://www.cgdev.org/doc/millions/MS_case_7.pdf• Ending African river blindness 2008, accessed 9 June 2015,

http://nature.berkeley.edu/breakthroughs/archives/break_feature1_su08.php• Chagas disease 2015, accessed 9 June 2015, http://

www.mayoclinic.org/diseases-conditions/chagas-disease/basics/treatment/con-20030854• Ann, M 2014, Neglected Tropical Diseases- Middle East and North Africa, Springer Vienna, Vienna.

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PICTURE CITATIONS

Picture Citations• Warwick Grant | Biotech Learning HubIn-text: (Biotechlearn.org.nz)Bibliography: Biotechlearn.org.nz,. 'Warwick Grant | Biotech Learning Hub'. N.p., 2015. Web. 11 June 2015.• CDC.GOVCDC - Chagas Disease - DiseaseIn-text: (Cdc.gov)Bibliography: Cdc.gov,. 'CDC - Chagas Disease - Disease'. N.p., 2015. Web. 11 June 2015.• IMGKID.COMImages For > Indoor PlantIn-text: (Imgkid.com)Bibliography: Imgkid.com,. 'Images For > Indoor Plant'. N.p., 2015. Web. 11 June 2015.• RSC.ORGOne in the eye for river blindness | Education in ChemistryIn-text: (Rsc.org)Bibliography: Rsc.org,. 'One In The Eye For River Blindness | Education In Chemistry'. N.p., 2015. Web. 11 June 2015.• UNIVERSITY, L.Staff profile, College of Science, Health and Engineering , La Trobe UniversityIn-text: (University)Bibliography: University, La. 'Staff Profile, College Of Science, Health And Engineering , La Trobe University'.Latrobe.edu.au. N.p., 2015. Web. 11 June 2015.

REFERENCES

Our Team Statements

• Joshua Montalto

• Simon M Krstevski

• Rupert E Azzopardi

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Joshua Montalto’s Statement:

I decided to study Neglected Tropical Diseases because I did not know much about it and wanted to learn more. In main stream media little is said mentioning the plight of the developing world. Especially after Dr Warwick Grant’s lecture he really captured my imagination with his passion for the subject. He said that 1 billion people were affected and I knew nothing about these diseases it, to be honest made me worried at my lack of knowledge. My want to know more about the topic made the research easier and the time here has really flown by. The research was aided by several academic forums who we are very grateful for donating their time to help us. The overall University experience was very positive and the reasonably priced food made the experience better. However I think that the teachers had a great deal to do with it giving us so much freedom to do what we want when we want. I would also like to thank all the teachers from Ivanhoe for creating such a rewarding experience. I would also like to thank the academics who gave us their time and allowed us to use their new university building.

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Simon M Krstevski’s Statement

At La Trobe we were presented with many options as to what we are to research for our two weeks here but none of them appealed to me as much as Neglected Tropical Diseases did. Our lecturer Dr Warwick Grant opened my eyes to the hardships and suffering experienced by these neglected Africans and South American’s every day. I just had to find out more. So I began my research mainly on the internet, however, I did extract some incredibly important points from my 2 interviews with Robin Anders and Samuel Amoo working with Warwick Grant. My main tasks were to conduct research on Funding and on the African Governments’ impact on these diseases as well as scanning the news for news articles and conducting interviews with academics. Overall the La Trobe experience has been something I truly enjoyed: the lectures were both interesting and informative and the research days were fun. The freedom that was given to us also really tied the whole University experience together. I would like to express huge thanks to all of our lecturers for giving up there to both teach us and do interviews as well as the teachers for making this experience so great.

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Rupert E Azzopardi’s Statement

The La Trobe University experience was one I won’t soon forget. To start off, the lectures were eye-opening and engaging. The sense of freedom and insight into a Uni student’s life was but one of the factors of the fortnight that I enjoyed. The research was made interesting by the simple reason that I enjoyed the topic. The person who got me hooked was Dr Warwick Grant back on day two of La Trobe tour with his particularly inspiring lecture on Neglected Tropical Diseases. I was immediately hit with the burning question: Why are these diseases allowed to stay neglected? Why isn’t a real effort being put into changing the situation?

When I was teamed with Simon and Joshua, I felt the team worked incredibly well. My tasks were chiefly to design the Virtual Research Facility Tour we had thought up, and to manipulate the raw data into paragraphs and legible sentences.

The experience at a university was fantastic, and it sparked a longing in my heart to actually attend University someday. The project the team and I worked on functioned well… not the least without many thanks to the vital help of Dr Robin Anders and Dr Warwick Grant who answered many unanswerable questions regarding our topic. It saddens me to leave and return to school, and I leave La Trobe reflecting on the great memories and experiences.

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THE ANSWER TO:What will it take for research and treatment of Neglected Tropical Diseases (Diseases of Poverty) to be adequately funded?

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After research aplenty, the team has finally reached a general conclusion:The plan of action for Neglected Tropical Diseases to be treated and researched, and for funds to come forth in earnest to complete those actions is multifaceted, which is why there are 8 ways in which the NTDs can be stopped. To do so, the following moves must be taken:1. Drugs must be developed that can kill parasites that are both non-resistant and

resistant to the drug.2. Treatment must be cheaper, so poorer patients can afford to be cured.3. Developed nations must be willing to remove substantial amounts of money from their

own interests and put it towards Foreign Aid.4. Every last parasite has to be eliminated. To do this, treatment and eradication has to be

conducted intelligently.5. The global focus on Neglected Tropical Diseases must increase, and other diseases such

as Malaria cannot be prioritised above them.6. Improve general hygiene and sanitation to a satisfactory standard worldwide, and not to

rely on vaccines to get the job done.7. Request African governments to devote more money to disease control.8. Have mosquito nets readily available for every family in NTD affected areas.“We already have the tools. We just need to use them and use them right.” –Dr Warwick Grant

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BASICALLY:

• Click on arrows, squares or hyperlinked words to navigate the Research Facility.

• All photos are taken from the La Trobe Institute of the Molecular Sciences.

• This Virtual Research Facility© is licensed to Rupert Azzopardi. Contact razzop18@igs.vic.edu.au for details, legal or otherwise.

IMPORTANT PLACES IN THE VIRTUAL FACILITYTo visit the Bibliography, click the link.To visit the Answer to the question, click the link.To visit the Research Lab, click the link.To view the River Blindness info, click the link.To view the Chagas disease info, click the link.To visit Dr Robin Anders’ office, click the link.To visit Dr Warwick Grant’soffice, click the link.

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River Blindness Chagas Disease

Neglected Tropical Disease definition

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Further up corridorDr

Warwick Grant

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*PhD Student Samuel Amoo also provided knowledge.

To completely eradicate?

NTDs a problem for developed?

Humans Immune?

My Research Team…

My name is Dr Warwick Grant. Neglected

Tropical Diseases are a serious matter. Here are some of the notes I’ve

collected over the years.

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What impact is your research team having on Neglected Tropical Diseases?Dr Warwick Grant and co are working on the following:• Drug resistance and comparing the non-resistant parasites to the

resistant ones. They do this so they can see what the difference is so they can stop the resistant parasite.• Eventually producing a better drug that kills both resistant and non-

resistant parasites.• Making treatment for the infected cheaper.

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Can humans become immune to Neglected Tropical Diseases before getting infected?Humans are believed to be able to catch the worms without showing symptoms, also without help from drugs.However there is no evidence or research conducted so far.

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Will Neglected Tropical Diseases ever be a problem for developed countries?The answer to that is a simple and abrupt NO.The climate and temperature mean that these diseases will not thrive, as they have adapted to survive specifically in humid places with poor sanitation.Also, Blackflies cannot carry disease outside of Africa.

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What will it take to completely eliminate an NTD?The most important step in eliminating an NTD is to raise awareness for these diseases so they can be funded for sufficiently.Currently, Europe and America is doing more to help eradicate NTDs than Australia. This is a trend in the disease funding world.Scientifically speaking, we need to get rid of resistant and non-resistant parasites to eradicate disease, because even if one pathogen is on hand, it can reproduce to make itself dangerous again.It is vital to find new, cheaper forms of treatment to do this.We need not only have good drugs but also to be smart about distributing and treating everyone, otherwise a single parasite could remain hidden and re-emerge. To quote Dr Warwick Grant: “We already have all the tools. We just need to use them and use them right.”

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Dr Robin AndersBACK

Funding

No-one is caring about

NTDsMosquito nets Africa & NTDs

Hello, my name is Dr Robin Anders. How can I help you? I see you want to gain more knowledge about Neglected Tropical

Diseases!

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Funding for NTDs

There is not enough funding for Neglected Tropical Diseases. History shows that if funded Neglected Tropical diseases could be eradicated, such as the Smallpox pandemic.Compared to Australian health care, almost no money is spared for African health care. Politicians and ethicists alike have labelled the cuts to foreign aid “Savage”. All of this points to the alarming fact: In general, Australia cares more about itself than foreign countries to so much extent they would remove funding for disease in developing countries to make way for more local spending.

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Are Neglected Tropical diseases becoming more neglected?The simple answer is YES. In the eyes of many, Malaria is seen as a bigger problem as it is a disease that does kill. Neglected Tropical Diseases don’t necessarily kill, but they do change their host’s life for the worse. NTDs also affect the economy as crippled workers infected with a disease are unable to better Africa’s economy and trade.Drug development with malaria can help with NTDs because the research of malaria can provide insight to cures of NTDs. There is a lot of money going towards NTD’s although from huge sponsors such as the Carter and Gates Foundations. WHO is attempting to make these diseases more public. For example, Carter foundation has managed to raise awareness and cure guinea worm despite also helping with malaria.A common trend in eradicated diseases is that hygiene and sanitation cure the disease more effectively than vaccines.Back

What does Africa need to do to limit the spread Neglected Tropical DiseasesAfrica’s problem is not so much in the health care system as it is what the government needs to do. For example, malaria gets worse during wars so if the government avoided that it would improve conditions for people across the continent.As well, if African nations invested more in Health and education and spend less on guns and armies then it will be beneficial. Western countries at the moment have more influence on the work to cure NTDs through the following ways:• Research• Testing• Funding• Diagnostics• Bed netsAfrica’s problem can be solved mainly through economical, government and educational improvement.

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Mosquito Nets- How have they impacted?Firstly, mosquito nets have reduced infant mortality rates by 60%. This helps as children can grow up and have the opportunity to become educated.Mosquito nets have to be donated, and they are. 100 million have been donated as of 2015. As a bonus, the nets are laced with insecticides as an extra barrier between humans and a nasty disease.People can’t begin to charge for the supply of mosquito nets. They must be given for free or the wealthy in Africa will buy them, leaving the poverty-stricken and poor without the protection needed.

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NEGLECTED TROPICAL DISEASES-

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Neglected Tropical DiseasesNeglected Tropical Diseases (NTD’s) are parasitic or bacterial and affect 1 billion people worldwide. These NDT’s diseases do not always kill and can lead to a life of misery, due to their debilitating effect. The diseases limit the work force of the country and cut the Gross Domestic Products (GDP) trapping the country in a cycle of poverty. Most of these diseases have medical help available but people are unable to gain access to it because combined effective efforts to counter the disease need money which for most people affected, is not available. Developed countries such as the USA, Sweden, UK and Australia aren’t putting forth help because the diseases does not affect them, thus hence the name neglected tropical disease. E.g. Chagas disease, river blindness and rabies.

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RIVER BLINDNESS-ONCHOCERCIASIS

RIVER BLINDNESS (Onchocerciasis)River blindness is a parasitic disease found in sub Saharan Africa. First discovered in 1874 by John O’Neill when he examined skin snips from patients in Ghana. The disease is spread by bites from the the black fly. The black fly spreads the disease, and once infected millions of tiny worms hatch, and start to crawl around inside the person.

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RIVER BLINDNESS

Eventually the skin cells, due to the damage caused by the worms lose pigmentation. The worms soon crawl into the cornea, which causes scarring and so the person almost definitely becomes blind. Some of these worms also grow up and start to reproduce giving birth to more worms.

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RIVER BLINDNESS

These worms live for ten to fifteen years. It is possible that some cattle are affected by this disease meaning that there are large animal reserves of the disease making it much harder to cure.

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RIVER BLINDNESS TREATMENTTreatment already exist for River blindness it is a tablet evolved from a heart worm tablet for dogs. The tablet kills the baby larva and gets rid of the itching but it does not restore sight to victims. It is possible that the disease can be eradicated by 2025 but the donors to APOC, the chief organisation is set to stop funding in 2015. There is no stopping the adult worm, although it can stop reproducing, and it must be surgically removed.

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CHAGAS DISEASE

CHAGAS DISEASEChagas disease was discovered by Carlos Chagas in 1908. The disease is spread mostly by the Triatomone bug (kissing bug). It affects mostly South America but has spread due to improved transportation between continents.

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CHAGASChagas disease has two stages: chronic and acute. The acute stage has little or no symptoms. However the most noticeable symptom is the swelling of the eye lid called the Romana’s Sign, which occurs usually on the side of the face where the person was bitten or where the bug faeces were rubbed into the eye. The Chronic phase can stay dormant for years or the host’s entire life but the main symptoms are: cardiac complication and intestinal complications, both of which can result in death.

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CHAGASThe Chagas Disease has large animal reserves because the disease is contagious through animals. The bugs live in the roof or crevices of the poorly built mud and wood houses susceptible hosts live in. The bugs are strictly nocturnal.

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CHAGAS TREATMENT

Chagas Disease can be treated as well, however only in the acute stage where there are several drugs which can kill the disease. In the acute stage the person does not need to be hospitalized as they are common in areas worst hit, but in the U.S the drugs are only available in centres for disease control facilities. In the chronic stage the disease is untreatable as of now. A drug can however be given to patients under 50 years old to help slow the growth of disease.

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What is the continent of Africa doing to help- with the problem of NTD’s?They are resuming societal normality once an area is free of the parasite, and then making sure that all the infected are cured by monitoring who is taking pills. Also, once people are cured they are resuming farming and making an income for themselves and their country. Educating communities on how River Blindness is caused and how to prevent it will go a long way; however, this will be difficult to achieve as it will require people who know and understand the disease to help by teaching individual members of the community who can then teach the whole community.

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How much will curing an NTD cost and why aren’t they receiving sufficient funds (note: these figures were taken in relation to river blindness)?

Currently APOC is receiving a total of $180 million per annum. Of these funds $135 million dollars is paid and accounted for by private donors and different countries, mainly from the developed world. The final quarter of the funding needed (or the $45 million) is paid for by the separate African governments. This has been enough to help small communities across Africa get back on their feet and resume their normal lives. While this is a good thing it also has many downfalls and negatives, for example if investors lose interest and don’t continue donating to this cause, problems will arise.

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What will the negative effects both short and long term of us not curing NTD’s?

As investors are seeing results they no longer see the need to invest, because as far as they are concerned it is not severe anymore, but if it is not treated completely, (much like a bacterial infection that hasn’t been fully treated) it will come back only stronger and more resistant to treatments, so making it a larger and even more pressing issue than before. NTD’s such as River Blindness can be wiped out by 2025 as long as funding continues until then. Some of the short term effects of neglecting NTDs will be that diseases such as River Blindness will be insignificant in the beginning, but it can and will build itself back up.

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News article: http://www.who.int/neglected_diseases/9789241564861/en/

Neglected tropical disease and their presence (or absence) can be seen as a measure for how well developing countries have helped. If there is a large presence of NTD’s there is a clear need for developed countries to step in and help. The world focus needs to shift on to NTD’s by creating achievable goals and reaching them. By doing this we may be able to eliminate an NTD for good. If we follow the procedure on prevention, control, elimination and eradication it will make such goals more achievable. The investors in this cause last met in 2013 to discuss the eradication of these diseases and came to the conclusion only “wise investments” will go a long way to the cause of eradicating NTD’s. Words of progress have come from the report letting all those who contributed know that their money has gone a long way towards finally removing them. However, it was not all positives: there will be climate change that will spike an increase in vector-borne (insect-borne) diseases. However it is believed that their ultimate goal is still to insure that all people who are suffering NTD’s are properly treated and accounted for and can be supported through their tough times. Eventually, the plan is to remove NTDs from society and the participants in the conference believe that goal is very reachable.

First QuestionPrevious Question

What defines an NTD?

2 types of neglected tropical disease?

WHO funds them?

What treatments exist?

Why aren’t they being treated?

RESEARCH LABORATORY

What defines an NTD?

They are parasitic or bacterial and affect 1 billion people worldwide. These NDTs do not always kill and can lead to a life of misery. The diseases limit the work force of the country and cut the GDP trapping the country in a cycle of poverty. Most of these diseases have medical help available but people are unable to gain access to it because combined effective efforts to counter the disease need money which is not available. Developed countries are unwilling to help because the diseases does not affect them. Hence the name neglected tropical disease. E.g. Chagas disease, river blindness and rabies.

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2 types of neglected tropical disease?

• Chagas disease was discovered by Carlos Chagas in 1908. The disease is spread mostly by the Triatomone bug (kissing bug). It affects mostly South America but has spread due to improved transportation between continents.

• River blindness is a parasitic disease found in sub Saharan Africa. First discovered in 1874 by John O’Neill when he examined skin snips from patients in Ghana. The disease is spread by bites from the black fly. The black fly spreads the disease, and once infected millions of tiny worms hatch, and start to crawl around inside the person.

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WHO funds them?

NTD have lots of money being sent in by lots of different organisations: the two most noteworthy are the Bill and Melinda Gates foundation and the Carter Centre. The world health organisation has also set up a special branch just dealing with River Blindness. It was created in 1991 to empower villages to help cure the disease themselves. However due to loss of donations it is being prematurely shut down in 2015. Also the drug used to cure River Blindness is donated by the company and so it just can’t get distributed. Also an organisation has been set up called the END fund which is focussed on ending 5 of the most neglected tropical diseases.

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What treatments exist?

• Treatment already exist for River Blindness: it is a tablet evolved from a heart worm tablet for dogs. The tablet kills the baby larva and gets rid of the itching, however it does not fix the blindness. It is possible that the disease can be eradicated by 2025 but the donors to the organisation is set to end in 2015. There is no drug for the adult worm and it must be surgically removed.

• Chagas Disease can be treated as well, however only in the acute stage where there are several drugs which can kill the disease that are mostly anti-parasitic. These drugs are available in the regions where Chagas disease is active.

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Why aren’t they being treated?

Firstly, developed countries have little interest in curing these diseases. Since these diseases rarely get into developed countries their health agencies are more concerned about helping their own countries. Also the people who are effected are of the poorest in the world. They have no political voice and lack organisation to bring them into the global media. As well, these diseases rarely kill people, rather they greatly increase the chance of death if another parasite entered the body. Someone just looking at stats would overlook these diseases and focus on more deadly diseases, and so NTDs aren’t being treated.

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THE TEAM HOPES YOU ENJOYED THE RIDE AS

MUCH AS WE DID!

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PRODUCER-DESIGNER-HEAD RESEARCHER-HEAD CITATIONER- INTERVIEWER-QUESTION DEVISOR-PROFFESOR 1-PROFFESOR 2-RECEPTIONIST IN FACILITY-

RUPERT AZZOPARDIRUPERT AZZOPARDIJOSHUA MONTALTOJOSHUA MONTALTO

SIMON KRSTEVSKISIMON KRSTEVSKIDr ROBIN ANDERS

Dr WARWICK GRANTTHOMAS KAUFMAN (non member)

THANK YOU FOR WATCHINGSINCERELY

SIMON M KRSTEVSKIRUPERT E AZZOPARDIJOSHUA M MONTALTO

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