EpidemicsU.S. training foreign health personnel to tackle future epidemics in North Africa, Middle East

In an effort to prevent an Ebola-like disease outbreak in North Africa and the Middle East, Dr. Peter Hotez, a U.S. science envoy, is leading a government-sponsored program which would train foreign health experts on how to produce vaccines in time to prevent an epidemic. Hotez, dean of Baylor College of Medicine’s National School of Tropical Medicine and director of Texas Children’s Hospital Center for Vaccine Development, is concerned that the next outbreak of a neglected tropical disease or emerging infection could strike Islamic State-occupied territories in Syria, Iraq, Yemen, or Libya, because they share the conditions that historically have preceded such events- poverty, conflict, and human migration. Health experts, Hotez said, could have predicted the Ebola outbreak because of the post-war conditions in West Africa. “We can’t wait for catastrophic epidemics to happen and only then start making vaccines…we need to start anticipating the next threat.”

The Houston Chronicle reports that in the 1970s, African sleeping sickness killed 500,000 people following wars in Angola, South Sudan, the Central African Republic, and the Democratic Republic of Congo. Then in the 1980s and 1990s, leishmaniasis killed 100,000 people following the civil war in the Sudan. The deterioration of health care infrastructure and people fleeing conflict preceded the outbreaks, both caused by parasites.

It is uncertain what disease threat might emerge in North Africa and the Middle East, so Hotez wants to be prepared for a number of candidates. He worries most about leishmaniasis, schistosomiasis, MERS, dengue fever, and alkhurma hemorrhagic fever, diseases for which there are no licensed vaccines; and tuberculosis, for which the only vaccine, BCG, offers at best modest protection.

The public health community’s reaction to the West Africa Ebola crisis was rather slow, worsening the effects of the disease in Sierra Leone, Liberia, and Guinea, where at least 10,000 people have died. Western health institutions, for at least a decade, had the technology to produce Ebola vaccine candidates, but major pharmaceutical companies did not conduct a clinical trial on any of the candidates until late last year.

Hotez will meet with government and health officials in Saudi Arabia later this month to access the country’s viability as a partner on the program. He has already met with officials in Morocco, and will soon visit Qatar. The post of U.S. science envoy is designed to promote the nation’s commitment to science and technology as “engines of diplomacy.” “One reason people admire America is the power of our research institutions,” said Hotez, who is also director of the Sabin Vaccine Institute. “People come from around the world to study at Harvard, Stanford, Baylor, but we haven’t exploited that advantage as much as we could. We need to put science diplomacy out there as part of U.S. foreign policy.”

Saudi Arabia, Qatar, and Morocco meet Hotez’s fundamental criteria for project participation: political stability; acceptable science, biotechnology and pharmaceutical capabilities; the will to make the project happen; and regional as well as national interests.

Under the program, scientists from selected institutions would spend time at the Sabin Institute, whose vaccines for hookworm and schistosomiasis are in early-stage human trials; and its vaccines for Chagas, leishmaniasis, and SARS are still in lab development and production.

“There’s a persistent pattern to these outbreaks in the developing world the past 40 years that we can’t keep ignoring,” said Hotez. “Ebola was just version 3.0. We need to be ready for version 4.0.”