COVID-19 has turned the world upside down, but it didn’t appear on the radar of much of the Western world for months after it first emerged in central China. Like panic over Ebola and SARS in recent years, the current pandemic has highlighted a gaping blind spot in our ability to identify — and thus prepare for — public health crises that start in remote locations. Can that change?
When it comes to disease research, the money isn’t where the action is. Many recent pandemics — SARS, Ebola, H1N1 — originated in Asia and the Global South, but those areas don’t have nearly the level of public health infrastructure, disease monitoring, and research attention as in North America and Europe. Richard Wamai, a global studies professor at Northeastern University, says there’s about a “10-90” gap in disease research and drug development: 90 percent of the funds go to diseases that affect about 10 percent of the world’s population.
In many cases, that can mean diseases wreak havoc for years, even decades, unchecked. “When the Ebola outbreak happened [in 2014], people asked, ‘Why don’t we have a drug for this?’” says Michael Pollastri, a chemistry and chemical biology professor at Northeastern. “Well, because we’ve ignored it since the 1970s.”
Pollastri has spent his career studying neglected diseases whose obscurity (to the Western world, at least) belies their devastation — visceral leishmaniasis, an infection that causes about 20,000 deaths annually, mostly in rural, tropical climates; Chagas disease, common in central and South America; drug-resistant strains of malaria. In 2010, Pollastri teamed up with Wamai to form the Integrated Initiative for Global Health, an interdisciplinary project to help slow infections in their tracks on both the local and global level.
There’s a “10-90” gap in disease research and drug development: 90 percent of the funds go to diseases that affect 10 percent of the world’s population.Richard Wamai, Northeastern University global studies professor
On the science side, this means drug discovery — Pollastri’s lab has been at work for years on developing a drug cocktail to treat leishmaniasis. On the public policy front, that means more aggressive health monitoring in global hotspots. One example: In 2017, Wamai and a team of Northeastern undergraduates set up an outpost for education and disease screening for the Pokot tribe in northern Kenya.
“Having good research and disease surveillance, tracking mutations before they eventually spread beyond the borders of those countries is a really important,” Pollastri says.
The Northeastern project joins some government-led efforts to expand disease surveillance on the ground in underserved areas. The Field Epidemiology Training Program, a division of the Centers for Disease Control, trains field workers in 60 countries to identify potential epidemic threats at the source. “Weak health systems anywhere leave openings for disease to take root and spread, turning local outbreaks into global epidemics,” the program’s website reads. “We need protections in place before the next disaster strikes.”
It’s hard to get buy-in. According to Pollastri, private drug companies have arsenals of research muscle and money, but they don’t have as much financial incentive to work on diseases like leishmaniasis, which afflict primarily poor parts of the world. And before COVID-19 hit, government interest in identifying new disease threats seemed to be waning. The Predict Program, an initiative launched during the George W. Bush administration that identified over 1,000 new viruses, was discontinued this past October.
The Big Picture
In some ways, COVID-19 has upended that dynamic of neglect. The virus’ impact on Europe and North America presents an opportunity to think differently about how to prepare for pandemics, Pollastri says. “Global health equals American health — this is a linkage that is usually ignored by U.S. policy makers,” he says. “Until a problem hits our shores and [politicians’] constituencies, things like infectious diseases are ignored.”
But this coronavirus “has become this new anathema that has captured the entire global imagination,” Wamai says. Both he and Pollastri hope that will lead to more attention — and support — for projects like theirs.