Status of Biomedical Research and Related Technology for Tropical Diseases

Status of Biomedical Research and Related Technology for Tropical Diseases September 1985 NTIS order #PB87-139614 Recommended Citation: U.S. Congress, Office of Technology Assessment, Status of Biomedical Research and Related Technology for Tropical Diseases, OTA-H-258 (Washington, DC: U.S. Government Print- ing Office, September 1985). Library of Congress Catalog Card Number 85-600508 For sale by the Superintendent of Documents U.S. Government Printing Office, Washington, DC 20402 Foreword Billions of people in less developed areas of the world and a small but growing number of inhabitants of the industrialized countries come into contact with infectious diseases generally characterized as “tropical. ” Though not necessarily geographically limited, these diseases are most common in the tropics because of the social and economic, as well as climatic, conditions that prevail there. In combination with the traditional methods of parasitology and basic research, the new tools of biotechnology and immunology have opened doors to finding methods for controlling tropical diseases. Scientists using both traditional and recombinant DNA techniques are pursuing technologies for the control of insects that transmit diseases and the development of vaccines, diagnostic technologies, and new therapies for tropical diseases. The possibilities for making inroads into the overwhelming morbid- ity and mortality caused by these diseases have never been so promising. The United States continues to make significant contributions toward controlling tropical diseases, even though the resources allotted to these efforts are small: in recent years, less than $100 million per year has been spent by the U.S. Government on tropical disease research out of a total annual biomedical research budget of $4 to $5 billion. As one component of U.S. international activities, research in tropical diseases serves several objectives: social and humanitarian, political, economic, medical (including the protection of American citizens), and scientific. Opportunities for expanding U.S. in- fluence and contributions in this field are great. In the spring of 1983, the Senate Appropriations Committee asked OTA to examine the status of biomedical research and technologies for controlling tropical diseases. The request was precipitated by a question about continued funding of the Gorgas Memorial Institute of Tropical and Preventive Medicine, Inc. and its operating arm, the Gorgas Memorial Laboratory in the Republic of Panama. An OTA technical memorandum, Quality and Relevance of Research and Related Activities at the Gorgas Memorial Laboratory, was released in August 1983 as a response to the immediate question. The larger question is addressed in this full assessment. An advisory panel, chaired by Dieter Koch-Weser, provided guidance and assis- tance during the assessment. A large number of individuals from academia, the Federal Government, the private sector, and the public provided information and reviewed a draft of the report. Five contractors were essential to the completion of the assessment: Paul F. Basch surveyed the use of biotechnology in tropical disease research; Veronica Elliott compiled information about funding; Roger A. Bitar contributed the material on therapies for tropical diseases; and Myron M. Levine and Lydia Schindler prepared case studies on oral dehydration therapy for diarrheal diseases and on the development of a malaria vaccine, respectively. The final responsibility for the content of the report rests with OTA. Key staff in- volved in the analysis and writing were Hellen Gelband, Kerry B. Kemp, Susan C. Tripp, and Steven S. Bjorge. JOHN H. GIBBONS Director /// Advisory Panel for Status of Biomedical Research and Related Technology for Tropical Diseases Dieter Koch-Weser, Pane] Chair Department of Preventive and Social Medicine Harvard Medical School Pedro Acha Francisco Lopez-AntuFiano Pan American Health Organization Pan American Health Organization George Alleyne Arnold Monto Pan American Health Organization School of Public Health University of Michigan Karen Bell Board on Science and Technology for Ruth Nussenzweig International Development Division of Parasitology National Academy of Sciences New York University School of Medicine Richard Cash Richard Riegelman Department of Tropical Public Health Department of Health Care Sciences Harvard School of Public Health George Washington University Medical Center Barnett Cline Gabriel Schmuiiis Department of Tropical Medicine Pan American Health Organization Tulane Medical Center Thomas Simpson Joseph Cook Virginia State Health Department The Edna McConnell Clark Foundation Ronald Vogel Robert Goodland College of Business and Public Administration Office of Environmental Affairs University of Arizona World Bank Kenneth Warren Abraham Horwitz The Rockefeller Foundation Pan American Health Organization OTA Project Staff—Status of Biomedical Research and Related Technology for Tropical Diseases Roger C. Herdman, Assistant Director, OTA Health and Life Sciences Division Clyde J. Behney, Health Program Manager Hellen Gelband, Project Director Steven S. Bjorge, Analyst Kerry Britten Kemp, Health and Life Sciences Division Editor Susan C. Tripp, Analyst Virginia Cwalina, Administrative Assistant Beckie I. Erickson, Word F’rocessor/P. C. Specialist Carol Guntow, Clerical Assistant Diann G. Hohenthaner, Secretary/Word Processor Specialist Contractors Paul F. Basch, Stanford University School of Medicine Roger A. Bitar, The Johns Hopkins Hospital Veronica Elliott, Alexandria, VA Myron M. Levine, University of Maryland School of Medicine Lydia Woods Schindler, Darnestown, MD v Contents Chapter Page 1. Findings and Options . 3 2. The United States in International Health . 27 3. Funding of Tropical Disease Research. 37 4. Description of Selected Tropical Diseases . 59 5. Strategies and Technologies for Controlling Tropical Diseases . 99 6. Vector Control Technologies: Selected Tropical Diseases . 115 7. Immunization Technologies: Selected Tropical Diseases . 129 8. Diagnostic Technologies: Selected Tropical Diseases . 153 9. Therapeutic Technologies: Selected Tropical Diseases . 181 Case Studies A. Oral Dehydration Therapy for Diarrheal Diseases . 201 B. The Developmen! of a Malaria Vaccine . 225 Appendixes A. Acknowledgments and Health Program Advisory Committee . 249 B. Method for Analysis of Tropical Disease Research Funding . 253 C. Glossary of Acronyms and Terms . 254 References . 267 Index . 287 1. Findings and Options Contents Introduction . 3 Request for the Assessment. 4 Scope of the Report . 4 Structure of the Report . 5 Summary of Options Developed in This Assessment . 5 Background on Tropical Diseases . 6 Health in the Tropics . 6 Tropical Diseases in the United States . 7 U.S. Citizens at Risk for Tropical Diseases . 9 Approaches to Controlling Tropical Diseases . 9 Status of Control for Selected Tropical Diseases . 12 Malaria . 12 Schistosomiasis . 12 Trypanosomiasis . 13 Leishmaniasis. 14 Filariasis . 14 Leprosy . 14 Tuberculosis . 15 Diarrhea] and Enteric Diseases. 15 Acute Respiratory Infections . 15 Arboviral and Related Viral Infections . 16 U.S. Efforts in Tropical Disease Research . 16 Rationale for U.S. Efforts in Tropical Disease Research . 16 U.S. Activities in Tropical Disease Research . 17 U.S. Funding of Tropical Disease Research. 17 Funding of U.S. Researchers in Tropical Diseases . 19 Options . 19 Development of Medical Technologies for Tropical Diseases 19 Information for Congressional Decisions . 21 Research Funding . 23 INTRODUCTION For most of the world’s population in less de- trypanosomiasis, leishmaniasis, and filariasis. veloped countries, mainly in the tropics, good Chronic and debilitating infections with intesti- health is not something interrupted by occasion- nal parasites range, in total, into the billions. al annoying bouts of sickness. One-tenth of the average person’s life in a developing country is Researchers in all corners of the globe have seriously disrupted by ill health (412). Life expect- aided the efforts against tropical diseases, and the ancy at birth is nearly 20 years shorter in the de- United States has played a major role. Through veloping regions than it is in the developed coun- the work of individual U.S. researchers and in- tries, Each year, millions of infants and children stitutions and through international collabora- die from enteric and respiratory infections. Several tions, the United States has contributed to the de- hundred million people are infected with organisms velopment of oral dehydration therapy (ORT) for that cause chronic disabling and often life-threat- the dehydration that accompanies diarrhea] dis- ening parasitic diseases: malaria, schistosomiasis, eases, the rapidly unfolding progress toward de- 3 4 ● Status of Biomedical Research and Related Technology for Tropical Diseases velopment of a genetically engineered malaria funding would probably have forced the labora- vaccine, and other advances in the prevention, tory’s closing. diagnosis, and treatment of tropical diseases. The Senate Appropriations Committee asked ORT and the malaria vaccine fall at opposite OTA to assess the activities of GML and then go poles of biomedical research and of disease inter- on to examine the overall status of U.S.-funded ventions. ORT, developed from research in basic biomedical research for tropical diseases. An OTA human physiology, has saved the lives of hun- technical memorandum fulfilling the first charge, dreds

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