RLD THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION · JUNE-JULY-AUGUST 1990 tropical diseases research CE> Target Diseases TDR represents a coordinated attack by the world's scientific community on six major diseases of the tropics: malaria. schistosomiasis. filariasis (including onchocerciasis). trypanosomiasis (sleeping sickness in Africa. Chagas disease in Latin America). leishmaniasis and leprosy. TDR is jointly sponsored by the UN Development Programme. the World Bank and WHO. 2 W ORLD HEALTH, June-July-August 1990 TROPICAL DISEASES RESEARCH Cover: Taking a skin WORLD I-£AUH snip for research in leprosy co ntrol in Eth iopia. Applying WHO/J. Maurice IX ISSN 0043-8502 World Health is the official illustrated what we learn magazine oft he World Hea lth Organ ization. by Dr Hiroshi Nakajima Editor: Director-Genera/ of the Wo rld Health Organization John Bland esearch is one of the achievements. In this last decade of Deputy Editor: corner-stones for the the century, we see ever more clearly Christiane Vi edma development o f that the development of technology is, Art Editor: ]Reffective health care by itself, rarely sufficient. What we Peter Davies policy. Equally impor- learn in the shape of new technology tant is the training and manpower has to be applied in the field to News Page Editor: development needed to carry out that control difficult and dangerous Philippe Stroot research. WHO has always emphasised diseases that strike in an almost World Health appears six times a year in English .• French. Portuguese. Russian and Spanish. and research and training, and these prin­ infinitely varying environment of eco­ four times a year in Arabic and Farsi . The German ciples are clearly developed in the two logical conditions, economic edition is obtainable from: German Green Cross. Schuhmarkt 4. 3550 Marburg, FRG . interdependent objectives of the potentials and political realities. It is Articles and photographs not copyrighted may UN DP/ World for this reason be reproduced provided credit is given to the World Health Organization. Signed articles do Bank/ WHO that WHO is not necessarily reflect WHO's views. The designations employed and the presentation of Special Pro­ intensifying its material published in World Health do not imply gramme for efforts to con­ the expression of any opinion whatsoever on the part of the Orga nizati on concerning the legal Research and trol these tro­ status of any country. territory or other area or of Training in pical diseases, its authorities. or co ncerning the delimitation of its frontiers or boundaries. Tropical by strengthen­ Diseases ing countries' (TOR): capability to - research apply the ef­ and develop- o fective tools Contents ment to obtain ~ which have re­ Tropical Diseases Research: new and im­ sulte d from Applying what we learn proved tools Collecting larvae of the malaria-carrying the research by Hiroshi Nakaj ima . .... .. ...... 3 anopheles mosquito for subsequent for the control carried out Getting wet of major tropi­ laboratory examination. under the by Tore Godal . .. ........ .•. .... 4 cal diseases; auspices of the UNDP: improving the human - strengthening of the research Special Programme. condition capabilities of endemic countries. To have realistic hopes of achieving by Ti mothy Rothermel .. ........ .. 6 Through a global network of partici­ sustainable results, we must realis­ World Bank: a powerful pating institutions and scientists, TOR tically assess the total environment of partnership is promoting the development of an the communities we seek to protect. by Bernhard Li ese . .... .. .. .. .. 7 impressive catalogue of new and This implies new challenges in terms An aim and a hope improved tools for diagnosis, preven­ of diagnosis, epidemiology, planning Interview with Ralph H. Henderson .. 8 tion, patient care, treatment and con­ and evaluation. And, of course, Where the action is trol in relation to its target diseases - nothing can be achieved without the by John Maurice .. .. ..... ...... 10 malaria, schistosomiasis, filariasis, full and active cooperation of our trypanosomiasis, leishmaniasis and international partners and the com­ Vaccines for the Third World leprosy. The Programme's globally munity we serve. All this gives added by Barry R. Bloom . .. ... ... .. 13 coordinated research and research importance to technical develop­ TOR: Training Grants . .. ....... 16 training activities - and their positive ments, to social and economic A good mix results - make us confident that we research, to field support and coop­ Interview with Sune Bergstrom ..... 18 can improve our capability for con­ eration with national governments, Breaking new ground trolling these diseases and provide and to communications. by Carol Vlassoff .... ....... .... 20 real relief from suffering to those TOR has an important place in A global response to climate afflicted. It is heartening, too, to WHO's work. It provides a mature change record that these are achievements of example of international cooperation by Enrique H. Bucher . .. .... .. 23 a "special programme" that does not from which much can be learnt. This Planetary responsibility operate independently of the rest of issue of World Health describes some Interview w ith Pierre Joly ... ....... 25 WHO but is thoroughly integrated with aspects of its activities, and explains Developing new drugs its other relevant programmes. why we can have every confidence in by David E. Davidson J r. ..... ... 28 However, the TOR Programme its continued success in the future. • cannot rest on the laurels of its past Hiroshi Nakajima, M.D., Ph.D. News Page .... .... .. .. 30-31 WOR LD HEALTH . June-July-August 1990 3 Getting wet by Dr Tore Godal Director of the Special Programme for Research and Training in Tropical Diseases ou hear a shout from parasitology research programmes within the brain. And we have identi­ the river. A man is were set up by private foundations and fied some of the molecules that the struggling in midstream. government agencies. And WHO parasite uses to make these red cells So you jump in and started its TOR programme, not only stick to the capillary walls. pull him out. A fev.~ days to mobilise scientists throughout the - We now know that the sleeping later,Y another man is in the river. So in world to seek ways of improving the sickness parasite changes its coat of you go again and pull him out. After a health of the tropical populations but surface molecules so as to avoid fev.~ days of this, you wonder: "Isn't it also to involve those populations in the recognition and attack by the human about time I found out who's pushing research process. immune system, and that it does so by all these people into the river?" shuffling its genes. We have also This was how Or Adetokunbo learned that the disease itself is partly Lucas, my predecessor as director of due to over-production by the infected the UNDP/World Bank/ WHO Special person of a molecule known as Programme for Research and Training cachectin, or "tumour necrosis factor," in Tropical Diseases (TOR), saw the used by the body to "summon" need for research on tropical diseases. immune cells to tissues under attack by For centuries, millions of people in the parasite. the Third World have been struggling with diseases that are unknown or just * * * historical curiosities in the developed ~ So we are beginning to find out world. Some people, like those in the ~ what is pushing the people into the river, have been saved through the ~ river. Can we now use this knowledge successful build-up of their own 1 to prevent it from happening? And to immunity. Or through the discovery of ~ find ways of pulling them out? "natural" remedies like quinine or its :g. Since TOR appeared on the scene, modem derivatives. Or simply through ~ research, with direct or indirect support the tender loving care of their families - ~ from TOR, has come up with about 60 and communities. Millions - particu- ~ different tools that could be life-saving: larly children - have died and many l...----------------" drugs, diagnostic kits, vaccines and millions more are still dying or suffer­ vector control substances, devices or ing because of these diseases. Clearly, The tsetse fly - biting vector of sleeping strategies. Most of them are still being it's time to take a closer look at how sickness. tested. But about 20 are actually in the disease-causing micro-organisms use. Some examples: do their damage. These initiatives began to produce - A combination of the antileprosy Around the turn of the century, in results during the last decade. First, drugs dapsone, rifampicin and clofazi­ the infancy of modem biomedical some unquantifiable effects: mine, known as "multidrug therapy," is research, scientists and physicians - We know much more about how being used in all but a half-dozen of identified the causative agents of most the parasites cause disease. We know, the 150 countries in the world with of these diseases and worked out how for example, much more about how leprosy cases. It has released more they were transmitted. Interest in tropi­ the malaria parasite attaches to and than 800,000 patients from long cal diseases, however, subsequently penetrates human red cells. We have months, even years, of treatment and waned. even begun reproducing in the labora­ in the last five years has brought the By the middle of the century, scienti­ tory some of the parasite's genes and number of registered leprosy cases in fic research into disease had become a the molecules that it uses to invade the world from over five to under four major discipline in northern countries. these cells. This research is a basis for million. But with some notable exceptions (the work on malaria vaccines. - Mefloquine and halofantrine, two Institut Pasteur in France is one), most - We have identified molecules and nev.1 anti-malarial substances related to scientists were concentrating on the mechanisms that enable malaria para­ quinine, are potential alternatives to so-called diseases of the "West" - sites to resist the effects of drugs, and chloroquine, whose effectiveness is cancer, heart disease, diabetes and we are finding clues as to how we diminishing with the spread of malaria the like.