Big idea: 'Vaccine diplomacy' in the Middle East

Idea person: Tropical disease expert Peter J. Hotez, U.S. science envoy to the Middle East.

Idea: We need to develop vaccines for neglected tropical diseases in the Middle East and North Africa.

Where it started: Hotez and his research team were among the first to highlight the problem of the rising number of infections from tropical diseases in populations of poverty in the South and Texas. These so-called "neglected tropical diseases" include Chagas disease, which can cause heart problems; toxocariasis, that can cause lung problems, epilepsy and developmental delays, especially among African-American children living in poor families; and leishmaniasis, a disfiguring skin disease.

Although these diseases are largely unknown, they are not rare: Hotez estimates that 12 million Americans live with at least one neglected tropical disease. For instance, he says, Chagas disease affects an estimated 300,000 Americans, mostly in Texas and adjoining states, as well in California and some large U.S. cities.

One reason these diseases often go unrecognized is because clinics and community health centers in impoverished areas lack the diagnostic tests, and medical personnel aren't trained to recognize and manage the diseases. Take Chagas: A survey from the Center for Disease Control published in 2010 revealed that almost half of U.S. primary care providers and a third of cardiologists never consider Chagas disease as a possible risk factor for their patients, while approximately half of these physicians are unaware of the symptoms of Chagas disease.

To address this public health issue, Hotez, an internationally-recognized physician-scientist, helped found the National School of Tropical Medicine at Baylor College of Medicine, where he also serves as professor of pediatrics. The National School develops new interventions for these neglected tropical diseases and teaches doctors and other health care providers to recognize, diagnose and treat the infections.

How it grew: Hotez, who was appointed U.S. Science Envoy for the Middle East in 2015, brought his knowledge of these neglected tropical diseases to the turmoil in the Middle East and discovered the makings of a new global epidemic.

As in Texas, segments of the Middle Eastern population are enduring extreme poverty in the context of breakdowns in the public health infrastructure. Specifically, the health systems of Syria, Iraq, Libya and Yemen have been weakened by over a decade of conflict and human migration. The link between a broken health infrastructure and the rise in tropical disease helps explain "why kala-azar (also known as visceral leishmaniasis) killed tens of thousands of people in Sudan during the 1980s and 1990s, and why Ebola wreaked havoc in Guinea, Liberia, and Sierra Leone," Hotez wrote in Global Health.

Vaccine-preventable diseases such as polio and measles are appearing along with a dramatic increase in leishmaniasis. Known in Syria as "Aleppo evil" because of its ability to disfigure the faces of young people, leishmaniasis is transmitted by sandflies, Hotez wrote in an opinion piece for the Washington Post. Dengue fever, a mosquito-borne illness, is also now widespread in the Middle East and parts of North Africa, while deadly Middle East respiratory syndrome (MERS) coronavirus infections appear regularly on the Arabian Peninsula.

The Ebola epidemic in West Africa highlights the urgency for immediate action to establish global capacity to prevent, detect and rapidly respond to biological threats such as those appearing now in the Middle East.

Next steps: As part of the larger U.S.-led Global Health Security Agenda, Hotez is using his experiences as a vaccine developer for neglected tropical diseases and as head of the Sabin Vaccine Institute non-profit product development partnership to build and shape regional capacity for making vaccines in the Middle East and North Africa.

Together with Dr. Maria Elena Bottazzi (deputy director of the product-development partnership), Hotez and his team are trying to position public biotechnology institutions in the region that might one day develop vaccines for the potential epidemics that could arise from conflict areas. Such vaccines so far have not been of great interest to multinational pharmaceutical companies, but Hotez is trying to sound the alarm.

The oral polio vaccine that many of us received as children was first developed in the late 1950s through back-channel cooperation between U.S. and Soviet scientists, Hotez notes.

Bottom line: Vaccine diplomacy is needed to solve the global health problem of neglected tropical diseases.