 Good afternoon and thank you all for coming here on this snowy day to talk about neglected tropical diseases which might seem a bit remote under this current weather. We're thrilled today to have with us Governor Tommy Thompson as our lead speaker here on the work that he's undertaken as a global ambassador for the global network to fight neglected tropical diseases and we're also delighted that we're joined by his colleague Peter Hotez from George Washington University in the Sabin Institute there who's played a key role. There's a Peter and Tommy Thompson that brought to my attention that there's a new editorial that has just appeared in PLOS in January of 9 on waging peace through neglected tropical disease control, a US foreign policy for the bottom billion and I would urge you all to to look for that. We initiated this speaker series here at CSIS in the Center for Global Health Policy. We initiated this back when we launched the Center in September as a forum to try and bring a number of diverse voices that are in leadership positions in different dimensions of global health to come forward and share with us their perspectives, their insights as to the key issues emerging and the way forward. This is meant to reveal also the diversity of personalities that have become really deeply engaged in leading in this effort and I would put Governor Thompson at the top of that list. He served in the Bush administration as the secretary of health and human services prior to that was the longest serving governor of Wisconsin, I believe it was 16 years. In both of those periods brought about major reforms and approaches on health in the state of Wisconsin and domestically within the United States and he became in this tenure as secretary of HHS a pivotal figure on the international side of things and I think one of the most remarkable achievements really was having such a strong guiding hand and getting the global fund up and running and legitimizing and validating and getting the board of that fund to function in a pretty remarkably successful way. We just had here a short while ago one of Governor Thompson's acolytes deputies Bill Stiger was here reflecting on his tenure as the senior advisor for international health affairs at HHS and was talking about the global fund and about HHS about WHO and one of the really impressive aspects of that talk was just how positive and forward-leaning the discussion was about the global fund and the outcome of the of the relationship that has been struck by that. I think this is a very important foundation as we look forward on the agenda for this administration on global health. We'll hear a lot this afternoon about neglected tropical diseases. I'm very very grateful to Peter, to Governor Thompson, to Kari Stover, Daryl Edwards and the other staff here and the other partners for really putting a spotlight on this and putting a lot of new energy. This is an area which we'll hear more about this afternoon where real gains are possible on a very affordable basis with the right combination of political will, a little bit of cash and some some smart implementation strategies so with that I'd like to well please join me in welcoming Governor Thompson to speak. Well thank you very much Dr. Steve Steve Morrison is an outstanding leader. He's I had the privilege of going to Vietnam with him and we traveled from the north to the south and talking about HIV AIDS and how we can contain it and I can't thank you enough Steve for being involved with that project and what you've already done here at CSIS and also of course the most important thing he got his education at the University of Wisconsin. So you got to know that he is an outstanding individual and somebody that I'm very proud to know and thank you very much for putting on this lecture series. I want to talk to you today about a subject that is extremely passionate, something that I personally am passionate about and something that I think is so important. I'm going to be a little bit broad at the beginning. I'm not going to get to neglected tropical diseases until towards the end of my speech and then I'm going to introduce Dr. Peter Hotez who is the number one worm doctor in the world and my friend. But I got very much involved in global medical diplomacy, international health and I want to tell you what I encountered and why I think it would be important for the United States of America to take a whole different tact in regards to foreign policy. I got involved because I as Secretary of Health and Human Services, I wanted to see how we could extend and expand the authority, the power, the influence and the support for the department worldwide. And so I traveled a lot and several individuals who are in the room and Peterson for one, my friends in the front aisle here who were very much involved with me in setting up the global fund or being involved in that and a lot of people have a tremendous lot to say about it. But what I want to tell you today is what I experienced and why it changed my philosophy and changed my life and why I think it's so important for America to get involved in this. That is global medical diplomacy. I went to Africa on a trip and some of the individuals in this room were with me. And we went there and we went to Botswana, a country where 38% of the people were infected with HIV. Country of about 3 million people, a little bit less, a beautiful country. But a country was destined to fail unless we got involved. We then went to South Africa and Tony Fauci was with me and we went to several, Dr. Fauci who is really is the number one research scientist for AIDS in the world. And he was with me and we went to this orphanage that had just been started about a year before we got there. It was started by the Jesuits priests and we went there and we were there and there was approximately 70 children between the ages of six weeks to five years. It was a new orphanage just to set up for children that were HIV positive. And I'll never forget this. I was there and I held this little three-year-old girl and she looked up at me with those beautiful eyes and all she wanted to do was to have somebody hold her and love her and say things are going to be okay. Hank, Kimmel from Pfizer was there and I asked him to pick up a baby boy and he picked them up and Hank is a very rough businessman and very direct and I could see him holding that baby boy and I could see the tears come down his eyes. After we left, he pulled out his personal checkbook and wrote out a check so they could expand the orphanage. I tell you the story because when I left there I on the way back from Africa I turned to Tony Fauci and I says this is something is really bad here. And he says yes there is a medicine called nomoraphene, how do I pronounce it? Novarapine. And it will prevent the transmission of HIV from a mother to a child. And the country of South Africa with the minister of health was opposed to it. And I told Tony Fauci on the way home on the plane that we had to develop a plan and we developed a plan and we took it to the president and he not only accepted that plan but he expanded and expanded it to the PEPFAR program. But it was started on that trip to Africa and the president Bush's legacy is really going to be built around what took place on that trip because the PEPFAR program was a direct result of that and allowing the United States of America to invest in 16 countries worldwide to hold down and try and prevent HIV. It was a wonderful thing. And right after that we got involved with the United Nations and Kofi Annem came down to see me and asked if I could be present when he met with the president and also if I could support a new concept, a concept called a global fund for fighting AIDS tuberculosis and malaria. We started out with just a concept and President Bush was generous enough and as president he suggested that we put in the first 200 million dollars. It was 200 million dollars that really started the global fund. That global fund then went on and we got several countries to contribute and we started out with an idea and a few hundreds of millions of dollars and I was lucky enough to be the chairman of the board for three and a half years and we went from an idea and a concept ladies and gentlemen to a fund that went from nothing to five billion dollars in about 18 months. We had programs in over 127 countries and we had over 200 programs. It was an absolutely huge success. It was for the first time the continent of Africa really felt that the United States and Europe were concerned about the plight facing people in Africa. There was a whole different concept, a belief that people really cared about what was taking place in Africa and we grew that fund and that fund has been extremely successful. I don't know of any corporation in the world that ever started out with an idea that grew to five billion dollars in less than two years and now it's over eight billion dollars. We're now in 135 countries. We have over 300 programs helping to prevent AIDS, tuberculosis and malaria and for the first time people think we are going to be able to contain HIV. They think we have a chance maybe to really reduce impossibly even eradicate malaria and be able to control tuberculosis. Fantastic successes and great dreams and then I went after I was the chairman of the board. I took a group of 104 leaders from all over the world to go and visit Africa. I had individuals that were people in government, from Europe, from America, senators and congressmen, religious. We had people from the United Nations, the World Health Organization, U.N. AIDS. All came on this trip and there were so many huge egos in the plane when we took off from Germany that the plane didn't use any gas once we got up. It just levitated all the way to Africa. We got to Africa and we went to several countries and we went to Uganda finally and in Uganda I made every person on that plane spend the day in a village with somebody that lived with AIDS and we had to go out. We left Kigala at 4.30 in the morning because it was a three and a half hour our trip on a bus and we got out there and we got to a little community called Tororo in the in the state of Busia and at this clinic that was run by CDC actually administered to 650,000 people and we had to get on little motorcycles, Yamaha's and I ride a Harley that was the only downer in the trip. I didn't have a Harley I had to get on one of these other kind of second rate motorcycles but we had we had to take the motorcycles out into the village in order to see the people and I had my daughter Tommy with me and she'll she'll never be the same because of what that trip meant to her and how it influenced her life. We went to the first person that I was there with and a woman by the name of Rosemary and I went there and I saw this woman and she told me her story and I expected to see this African lady that would be very decimated and very sickly because she was supposed to have died in 2001 and when I was there I've instead found this wonderful beautiful ebullient African lady and she told me her story and I'll never forget this. Her husband died in 1994 with AIDS leaving her with three children to raise and next year in 1995 her brother died who lived right next door leaving her with four more children to raise plus an elderly mother and because her husband owned the land but in that tribe the land didn't go to her Rosemary it went to her husband's brother and so she had to pay a rent on these two hectares which is about five acres and she got $70 a year and she was on her deathbed from AIDS in 2001 and was supposed to die and they had already built a crypt to bury her in and then we started delivering antiretroviral drugs and when I was there which was in 2004 I met this lady who was active running the family with seven children and she lived in this mud hut with two rooms one for the children and one she lived in and she invited me in and was so happy and I talked to her and she says Mr. Secretary I want you to go back to America and say thank you to America to the president to Congress and to the people and to your department because what you did you gave us the drugs and you allowed me to live and by allowing me to live I'm going to be able to raise these seven children and they will not become part of the 12 to 14 million orphanage that live in sub-Saharan Africa and that was powerful I went back and I met the 104 people and I said ladies and gentlemen we have got to start a movement in America on global medical diplomacy and that global medical diplomacy is what I really want to talk about today and then get into neglected tropical diseases because it is so powerful and I traveled to 37 countries and in all the countries I went to the women the government leaders were always looking for what they could do to promote good health and I went to Afghanistan four times and as all of you know the women in Afghanistan were traded just like chattel probably worse than the worse than the pets and the animals that the individuals kept women could not go to school they could not to practice medicine could not do anything and women if they wanted to go and and see a doctor they had to go to a veiled doctor they had to bring their own sutures and their own bandages because the hospitals didn't have it and this one place in Kabul I went in and I noticed that in this hospital in all the hospitals there was no running water so therefore woman had to go in and get a cesarean that have to bring a male doctor in and start doing the cesarean without scrubbing up and all of you would know the infection and the death 16 percent of the children died before and childbirth 24th one fourth died before age five and it was the worst second worst country in the world for maternal death and I came back and I talked to the president and condi and and Don Rubis felt and I said we have to do something about it we have to build a hospital for women and children and so I raised two million dollars and we went back and remodeled the hospital just for women and children and I went back there on Easter Sunday 2003 to open it up and in the auditorium were 700 women none of which could understand my language they were not invited but they came for one reason and that reason was to say thank you to America and thank you to me for being there for building a hospital for women and children and that was so powerful and I looked down I said if you really want to win the world war on terror so the hearts and minds of women and those societies and the same thing happened in the tsunami and send the tsunami prior to the tsunami Reuters did a poll in Indonesia 75 percent of the people polls said that they disliked or hated America and Americans and 25% were favorably disposed and you know something the tsunami came in America but this generosity sent money and we in the department sent a ship called Mercy a hospital ship with volunteer help and ports at Jakarta and so on and they spent six weeks there with volunteers and the day the ship left there were thousands of people down on the port waving American flags saying thank you and the next month or so they did another poll the poll was just the opposite 75 percent of the people's polled were favorably disposed to America and 25% were still opposed a tremendous shift a paradigm shift in that country all because of global medical diplomacy a word that I coined and I decided that looking at these examples we have these two giant ships one Mercy and one the comfort ones in Baltimore and ones in San Diego modern shifts that are giants the larger there's largest three football fields and they have enough beds in there with modern equipment you can do brain surgery you can even do transplants and we got them here and I thought to myself what a tremendous opportunity for America if we would allow these shifts to sail around the world with young medical school students that are just fresh out of medical school be able to go under these ports and be able to administer the needs of individuals can you imagine a giant ship floating into a poor country a port and getting out with young idealistic men and women fresh out of medical school to teach and to administer and to take care of people it would be the biggest public relations who that America could ever have and that is the kind of foreign policy that I envision that I believe medical diplomacy is where we can really make a giant step forward and not have to go to war medical diplomacy is so much power more powerful and so much more lasting than bullets and Iraq or Afghanistan or in Africa and that's what medical diplomacy is all about and I'll get into neglected tropical diseases when I left the government I still wanted to be involved because it's a passion of mine as you can tell to do something and Dr. Hotez and Kerry Stover came to me and says we have another situation that is probably broader and probably affects more people and actually can be controlled easier than AIDS, tuberculosis and malaria and it's called neglected tropical diseases there are 14 of them and there are seven main that are that really afflict 90% of the people and when you consider that worldwide there are six billion people that live there and one billion of those individuals have a neglected tropical disease and that you can administer that those individuals for only 52 cents a year when I tell that people come up and say I'll take three I'll take five I'll take ten but for 52 cents you can cure these diseases and I was in Rwanda in August with Jason Denby was in Tanzania in November and December and I saw what we could do one billion people afflicted by neglected tropical diseases ask ariases trick a riases hookworm schistosomiasis oncocercaiasis trachoma and lymphatic filariases and all of these affect and affect the poorest people in the world people that make less than two dollars a day and individuals that either minds have been somehow stymied their growth as and we could change that and allow these people to have a better quality of life and be able to have an opportunity to make a decent living because these diseases are disfiguring they're disabling and they put on individuals that are afflicted with a sort of an attitude they can't be any better and they're sort of looked at in their villages as people that are unclean like leprosy and they're all based from worms when we were in Rwanda we met with the president president Gagami who is doing a wonderful job and he organized the military the schools the university the villages the education department the health department and he went out to vaccinate deworm and give family planning to five million one half of the citizens in eight days and we accomplished that and in eight days we vaccinated in dewormed over five million children and mothers and everybody was compelled to come to a central place in the village either a clinic or the school and we were there and I'll never forget it went around and the children were so happy to know that somebody really cared and I'll never forget this young man who came up and he was about the size of my five year old granddaughter and he was 16 years of age and he had an extended belly and you could run your hand over that belly and you could feel the worms going up and down this the wall of the stomach and by giving him two pills twice a year that is taking care of but that child is going to be stunted for the rest of his life but he still has two more years to regain some of that growth but he has not been able to learn in skill in school and just what the amount of medicine that's given to us by the pharmaceutical companies the opportunity to deworm and vaccinate these children we can really change the quality of life and the quality of health of villages all over and that's what the fight for neglected tropical diseases is all about and what we're here today is to enroll and enlist and hope that you will travel with us to Africa or the Caribbean we're pretty much taking care of neglected tropical diseases in America even though there are outbreaks every once in a while in some poor areas but it does so much good so much good for the world so much good for those villagers and individuals and it does you so much good and that's what America is all about and you can do this through medical diplomacy whether it be AIDS, tuberculosis, malaria, neglected tropical diseases and that's why I'm so happy the CSIS is putting on this program so we get a chance to get this information out and for 50 cents contribution you can buy enough medicine to treat one person for a year it's not amazing and there are one billion of those individuals in the world that need that help and so I think it's a cause that's worth fighting for and the beauty is we actually can eliminate all of the 14 none of the 14 need to be there they're all worm based and that is why I wanted to bring my partner my friend and the number one worm doctor in the world Peter Hotez to come and talk scientifically and medically about neglected tropical diseases Peter Hotez is a runs the Saban Institute which of course most of you know was started by dr. Saban for polio he also is a distinguished professor of medicine in worms at the University of George Washington he's going to receive a high honor very shortly I'm going to have the privilege to introduce him I hope but he is a he's one of those individuals that is absolutely dedicated his life to really bring a change and make in this world a better place so with that I introduced my friend who used to be six foot six when he started in this quest and now is the size that you see because he's worked so hard and has carried so much weight he has shrunk down to the side he is right now I give you my friend dr. Peter Hotez it's given new meaning to the term heavy lifting hasn't when I agreed to appear with secretary Thompson I thought we had the understanding that I wouldn't have to follow him so he's he's the hardest act in the world to follow so I hope so we kind of reverse things we put the rolling stones ahead of the warm-up act but I hope you'll bear with me I'll try to be brief and just go through a few slides few PowerPoint slides to give you kind of an overview of why these diseases are so absolutely important before I begin I just want to thank my good colleagues at the Saban Vaccine Institute Aaron Hoffelder Karen Palacios Suzanne Levy Chloe Cooney from the endeavor group Lydia de Grazia from George Washington and of course Jason Denby for their help in putting this together and dr. Morrison thank you so much for giving us this very distinguished venue to talk about these conditions if I could get the lights down a little bit in the front that would be a big help because the slides are kind of dark and they're not easy to see so when we talk about these neglected tropical diseases we're really referring to the most common conditions of for want of a better from the bottom billion a term that was partially coined by Paul Collier the Oxford University Economist to refer to the poorest people in the world who live on no money live on less than a dollar a day the World Bank has changed that a little bit now they say there's 1.4 billion people who live on less than a dollar 25 cents a day is the new criteria for the poorest people it's not quite as poetic as the bottom billion but you get the same sense so these are it turns out the most common infections of the bottom billion and most people have never heard of these diseases even though the evidence points to the fact that these diseases in aggregate are as important as AIDS or malaria or TB better known conditions and yet few people have heard of them so the most common infections of the bottom billion all of them are infected let me just give you the quick laundry list of the seven most common they include the one that secretary Thompson referred to Ascorias is the large common roundworm so those of you worked in developing countries will recognize this child or a child like it is a picture taken by one of my students working in Haiti where the child is stunted for height and weight he's got a big belly and indeed you could run your hand over the surface of his abdomen and palpate the outline of these intestinal worms 807 million people mostly kids essentially all of the kids of the bottom billion have these worms in their intestine same with trichuriasis which is one of the problems is the pronunciation did a great job secretary is a is the whipworm which are which are in the colon hook worms in the small intestine which cause blood loss 600 million extraordinary numbers schistosomyosis which are flukes that live in the blood vessels and cause blood to appear in the urn in the stool 207 million 120 million with lymphatic filarial worms in the genitals and lymphatics 84 million people with trichoma which is the only non worm neglected tropical disease or NTD on our list which is a huge cause of blindness and say with river blindness or on chisturiasis also a huge cause of blindness so the first point is there are a lot of people with these parasitic worm infection neglected tropical diseases the other is that now through a series of studies that have conducted all over the world when we look at them in terms of disability not so much in terms of death but in terms of ability to ruin the lives using a metric which is sometimes known as the dally the disability adjusted life here the number of healthy life years lost either from premature death or disability these neglected tropical diseases in aggregate are as important as HIV AIDS or malaria TB the better known condition but they also do something which is very interesting they have the ability to not only occur in the setting of poverty but they actually promote poverty and they promote poverty because first of all most of these neglected tropical diseases most of which are worm infections actually impair physical growth the more worms you have the more stunted you are they not only impair growth but they ruin IQ the more worms you have the greater your loss IQ is the more worms you have the greater your loss of memory and cognition so as a result the more worms you have the worst you do on your test of educational performance in school attendance and now a white bleakly who's an international development economist the University of Chicago has done a study this to indicate that chronic hookworm infection in childhood reduces your future wage earning capacity by 43% so these are the stealth reason why the bottom billion can escape poverty it's because they're too sick because these chronic worm infections so the huge impact on intellectual and physical development in children an important impact on pregnancy outcome these are not just pediatric diseases as I'll show you a slide in a minute essentially one third of pregnant women in Sub-Saharan Africa have hookworm why do women get sick in childbirth primarily because of bleeding and blood loss and anemia these are a major underlying causes of anemia and result in poor pregnancy outcome meaning higher maternal morbidity and mortality but also low birth weight so these are why why kids are being born premature and stunted when they're from the day they're born is because of hookworm and schistosomiasis a very huge impact on worker productivity remember these are the diseases of the subsistence farmers and their family people who are just raising enough crops to support their family chronic lymphatic phyleriasis one of the very important NTDs neglected tropical diseases causes one point five billion dollars in economic losses in India alone every year 88% reduction in agricultural productivity in Ghana so these are actually keeping people mired in poverty they not only occur in the setting of poverty but they're promoting poverty as well this is just one example that I could use to we could have spent the whole day talking about why these neglected tropical diseases destroy lives this is just an example the impact on maternal health it was picked up by Don McNeil in New York Times recently who we reported that one-third of pregnant women have hookworm incredible numbers if you think about it seven million pregnant women with hookworm infection 44 million pregnant women with hookworm worldwide now we're here today to not only talk about poverty but because we're at CSIS we also want to talk about the implications of these diseases in terms of global diplomacy and so secretary Thompson and I have written a paper which is now just got published today it's on the public library of science website so it's an open access journal you can go to PLOS.org and just and find that paper and what we've done is to identify not only the impact of these neglected tropical diseases on destroying health and destroying poverty but a very interesting observation showing how these neglected tropical diseases actually seem to promote conflict so I'm going to come back to the slide in a minute but I just wanted to show you what we found was this curious overlap for a number of neglected tropical diseases they occurred in the hot spots of the world where you have conflict what we found is very interesting relationship between the two as which I'll talk to you about now so first of all you can overlay maps of the two that's one on the bottom right is one of these important neglected tropical diseases where we've looked in the Democratic Republic of Congo, Angola, Central African Republic and Sudan and we're in the 1930s we have very high rates of infection through aggressive setsy fly control in the case of sleeping sickness we brought levels down to close to zero but then because of all of the conflicts that were occurring in those four countries that I just mentioned we were for a while back up to 1930s level so very intimate relationship between conflict and neglected tropical diseases now the point of this paper is that things go both ways that not only do neglected tropical diseases emerge in the setting of conflict but it may work the other way around that they actually promote conflict one because they're so incredibly destabilizing so first of all they have an important role in a pivotal role in the world's food crisis and the reason for that is essentially when you're feeding kids you're feeding the worms because these worms compete for the host for nutrients and as a result a lot of the effort that's going into for agricultural development is actually like pouring money down the drain because it's being taken up by the worms a huge impact on reducing education of future wage earning which is another way they promote instability they promote ignorance and very importantly is community destabilization so as rates of lymphatic phyler isis go above a certain point in an endemic village in Africa or India or as a rate of Anka Sarkayas River blindness goes beyond a certain rate what we find is that rates of agricultural productivity decline dramatically and at the same time what happens is farmers abandon their fields they're forced to because the rates of the infections are so high and so endemic so as a result they'll abandon their fields to go to less fertile ground and so there's this there's this horrible synergy between reducing agricultural productivity and abandoning the fields so these are just where to impress upon you some numbers these are all sort of country hotspots that Secretary of State Hillary Clinton will be concerned about in the coming administration and Gola Central African Republic DRC Somalia Iran Burma Cambodia North Korea Colombia Haiti one of the things they share is that they have the highest rates of neglected tropical diseases anywhere else in the world in some cases 70 80 90 in a few cases a hundred percent of the poorest people living in these areas are chronically infected and that's an important point about these diseases these are not acute infections like you get with a crop with a common cold when we have them for a couple of weeks and then they resolve when people have these neglected tropical diseases unless they're treated they harbor these infections for years frequently decades frequently the entire life of the individual these parasites have managed to look learn to live a long time in the in the intestines and in the blood vessels of these individuals so the we're looking at a situation where people are affected for years and it has these long-term effects so what we have found is how lands are abandoned in Sub-Saharan Africa how how lymphatic phyleriasis festers among ethnic minorities in Burma, leishmaniasis and gorilla areas of Columbia guinea worm in the Sudan and then the ubiquitous hookworms schistosomiasis river blindness in Sudan Central African Republic DRC and Angola that's the bad news the good news is that at our global network for neglected tropical diseases and we're very proud of our little worm in the globe over there on the upper right-hand corner we have with our partners which include most of the major public-private partnerships working in the developing world I developed a package of drugs that can simultaneously target the all all of the seven most common neglected tropical diseases and quite interestingly the drug companies are donating these drugs with the exception of a couple which are available as low-cost generics as an example where the drug companies are actually the good guys so Merck is donating ivermectin, GlaxoSmithKlinus donating albendazol, Pfizer's donating azithromycin and we can put these four drugs together to in a package to simultaneously target the seven most common neglected tropical diseases and as secretary Thompson said we can do this for 50 cents a person per year so imagine taking on the most common infections of the bottom billion which in aggregate produce disability as high as AIDS as high as malaria but instead of doing this for hundreds of dollars a year for antiretrovirals or 50 dollars a year for direct observed therapy for TB or even 10-20 dollars a year for antimalarials and bed nets we can do for 50 cents a person per year what's more is that by distributing these drugs several of our partners like the african program for oncocerciosis control has mobilized an army of 470,000 community drug distributors volunteer community drug distributors that are delivering the package what's really neat now is we hand them a bed net to go along with it and the use of antimalarial bed nets goes at nine fold which was published a couple of years ago so that now we can piggyback all sorts of interventions onto this neglected tropical disease rapid impact package not only the neglected tropical disease drugs but childhood vaccinations vitamin A antimalarials and bed nets it's really a great story so we've got treatment programs now going on in in sub-saharan africa southeast asia latin america we are going to announce in a few days a major initiative that i can't say too much about that's going to be supported by some of our investors but the point is that even without large-scale investments even with small-scale investments we can go a long way a school child someone in high school could donate 50 cents and make a huge impact on the life of an individual finally i'll end here the other part of the business of the saven vaccine institute is we not only deliver drugs but we also develop new generation products for neglected diseases one of the problems that we're having with hookworm a very important one is that we think we may be seeing the beginning of drug resistance so we think we have to develop a vaccine so one of the things that we've done now is to create an organization that with laboratories at george washington university that's actually developing a new first-generation recombinant hookworm vaccine which if you think about a scientific hurdles aside which i won't go into today you can imagine the economic challenges of this trying to make a product for that's guaranteed to fail financially because by definition if you only get hookworm if you're a member of the the bottom billion so this is almost like a guaranteed money losing company based here in washington we can't call it that of course so we call it a product development partnership but it's basically a guaranteed money losing company and the reason i bring that up in this context is that there's an additional opportunity for medical diplomacy that goes beyond delivering treatments and that is joint medical research opportunities very few people are aware of it but the oral polio vaccine that many of received as children was actually developed jointly by the americans and the soviets at the height of the cold war so what happened was uh... nineteen fifty six are certainly after sputnik the soviet union was developing was having massive polio outbreaks through back channel diplomacy soviet virologists came to albert sabin's laboratories which were then at syncedy children's hospital sabin got permission from the state department to go back to russia with those polio strains and jointly develop the bat world polio vaccine which was tested on sixty million soviet school children before it was uh... brought back to the u.s. for licensure and then widely deployed throughout the united states it was a great example of how to uh... diametrically opposed countries you can imagine what it was like in nineteen fifty six on both sides would put aside their ideologies for purposes of joint vaccine development and so we're also very interested in looking at the possibilities of how we can apply that model today to uh... some of our countries uh... that uh... we may not have the very best diplomatic relationship so uh... i'll stop here uh... just to uh... ask you to join our fight for the global network uh... it's go to global network dot org and learn more about the countries in which uh... where we work we've created a loose change initiative again fifty cents a person per year and we're hoping to uh... really make this uh... very important global health a priority issue over in the next uh... few years so thank you so much for your time and thank you secretary thompson for your enormous we'll take uh... peter dr peter to myself to take questions uh... from anybody in the audience on uh... global medical diplomacy neglected tropical diseases uh... global fund or anything else you'd like to talk about and i'd just like to uh... one conclusion uh... that i would like to point out one point is that uh... for half a billion dollars five hundred million dollars we could absolutely strike a blow for freedom on neglected tropical diseases and uh... that is that is how big the problem is but how we can actually achieve a victory in this field questions go ahead sam resmen with the uh... national subcommittee on africa and global health uh... my question is to dr hotas uh... you're mentioning briefly uh... resistance and i was wondering if you had concerns about a program that would implement uh... widespread you know lots of drugs into to an area and then if that area descended into uh... civil conflict uh... those drugs would be unavailable is that sort of ebb and flow of drugs that were you in terms of uh... building resistance to them so the answer to your question is yes it worries me but not as much as uh... some other diseases one of the reasons is these worm infections are very slow slowly replicating so that the likelihood of resistance is inversely proportional to the replication time so this is not like a virus like hiv or even a malaria parasite uh... which is rapidly replicating so the time frame for resistance to develop is extremely slow so uh... we've been you know at the only one drug after some fifteen twenty years and uh... fragmented ways of being used and with lots of interruptions is some evidence now drug failure for my bendizol so we're concerned about it we think you know an important part of the message is to continue to innovate continue to develop new products but uh... the overall but but certainly not withhold these drugs for this theoretical risk uh... to deny access to these essential medicines obviously would be a huge moral and ethical failing uh... dr hotas i'm dave tarantino with the u.s navy and currently on a fellowship here i'm wondering if you see any of the ntds as good candidates for eradication either in a given locale or region or even globally so that that's an excellent point so the question is of the seven do we stand a chance to actually eliminate we don't tend not to use the word eradicate as much but eliminate as a public health problem uh... certainly the two that look very promising our lymphatic phyleriasis in trochoma so for instance now in many middle income and so low some low-income countries when we've gone through two to six rounds of the drug used for lymphatic phyleriasis which is either ivermectin donated by merker diethyl carbamazine which is available for zero point four cents tablet four to six rounds meaning once a year every year for two to six years we've now eliminated those diseases in at least twelve countries so and and and now looks egypt like it might be close as well so that's very exciting to that which is something that you're never going to do with hiv age you're never going to do with malaria you're never going to do with tb actually eliminate these diseases morocco just became the first country to eliminate trochoma and we expect others to follow as well so for at least those two we have a great prospect of eliminating with the others making a big impact in terms of control secretary yes there are these various drugs you don't really need the health infrastructure that you might need for hiv and malaria or the health professionals and that community trained professionals can administer is that am i getting that right and is there a question of kind of the storage and the supply of the drugs in terms of shelf life and that kind of issue yeah the the drugs are very stable they're also very safe in addition to being very inexpensive and you're right these are we're talking we're not talking about an anti retro viral that you have to administer every day we're talking about once a year but having said that now that we've got these there is some degree of training required not a lot but now that we've got this army of community drug distributors we're starting to think you know maybe this is really capacity building now we can fold in other interventions and i think there's going to be a lot of parallels particularly with malaria and the opportunity to add anti-malarial bed nets are to miss an in combination therapy too uh with these community drug distributors in place so it is there it is capacity building absolutely um it it varies um you know days you know a couple of sessions it's it's fairly simple partly because the safety profile is so high for these drugs christy lobinski infectious diseases society of america a question for governor tomsen actually related to the global fund um as i'm sure you're well aware the latest round of funding for the global fund has had to be delayed for lack of resources and notwithstanding the tremendous progress made through pep far and the global fund there is a tremendous amount of work still to be done on hiv tv and malaria um and many of us are worried about the obvious uh we're in the middle of a worldwide economic crisis um a tremendous amount of time and energy and money are going into trying to get us out of that domestically and at the same time we have tremendous commitments overseas in developing countries and many of us would like to expand our work on hiv tv malaria as well as the important neglected tropical diseases so i guess i'd like your thoughts on um whether you think uh the u.s uh commitment to these diseases as well as the neglected diseases under discussion today is sustainable can be expanded and and how you know what are your thoughts about how we can make those arguments both to the new administration as well as to a very worried congress interested in bailing their own states and communities out i certainly hope so um the truth of the matter is is that it is such a tremendous investment and foreign policy to to fight these diseases i i had the privilege of being on the board of the world health organization and the african countries the ministers of health were so pessimistic about their future and their country and their whole continent prior to pep far prior to the global fund and the global fund and pep far changed their attitudes and changed you know the dynamics and and the whole continent of africa that people were concerned and it was so important and just like my examples in afghanistan i mean if you really want to win the war in afghanistan it's through it's through changing the the minds and hearts of the people there and and medical diplomacy is a lot cheaper than building bombs and tanks and so on and so forth so uh gradually have to have a strong military but if you really want something permanent the fight for the hearts and minds of people in various countries that don't particularly care for us i think it's through healthcare and i think it's through medical diplomacy and it's such a wonderful investment and it's it's so long lasting so nobody knows what's going to happen with this recession and downturn it's it's serious and we all know that and it's global and anytime you go into a recession like this countries you know hunker down and they don't give the contributions necessary but i can make a a very valid argument and will to anybody that will listen that this is not the place to cut this is the place to expand and it's cheaper and it's a long-term investment in the future of of our country in the world and that to me it's worth the expenditures seven days a week i think the analogy we gave us for the cost of two f-18 fighters we could take on the neglected tropical diseases and all the and all the conflict countries of africa so the add-on cost is is trivial and the impact is you know think of it for an extra five percent extra two percent you can double your impact for five hundred million dollars we could have a fantastic victory in the field of neglected tropical diseases and and peter's right i used the example there was a a development called the apache it was a was a airplane that was being being developed and the united states of america was committed 32 billion dollars for it and after expenditure of eight billion dollars they scrapped it and i thought to myself my lord for eight billion dollars give me give me half of that and i could win the hearts and minds of a of a whole continent in africa or indonesia or whatever and that to me is you know i think we get our priorities a little bit mixed up question for secretary thompson some of the country especially in africa affected by a neglected tropical disease have been friend of us since the 60s and some of those countries have us embassy have us at the program what are you suggesting now what would be different from having us embassy us at the development program in both countries i think the i think that's happening we uh jason and i just came back from tansania and um the ambassador there mark green was fully involved in the fight on aids tuberculosis malaria in neglected tropical diseases and he went out with us out to the villages the minister of health uh of tansania was with us and i was there on a sunday and people from cdc and from us a id and from uh other federal departments all came out on a sunday i mean and uh to see me i can understand when i was secretary but i'm nothing now i'm just just tommy thompson and they came out to see me to to tell me what they were doing and they were absolutely committed to organizing village by village and getting the medicines out to the people whether it be antiretroviral drugs or the drugs to defeat neglected tropical diseases and what i what i really found is the attitudes of the ministers of health of the african countries they they have changed completely and they are looking for ways that they can work closer and cooperation with the american departments and american agents to to really do this it is it it's it's wonderful to see because i've been involved in this now for eight years and i can remember back eight years ago when you wouldn't find that cooperation and i can remember when us a id wouldn't have anything to do with the department of health and human services and i can remember when they were all fighting over the turf battles and i can remember when the global fund was uh resented by some people and the federal government and uh and so on and that's all seems to have dissipated and there's a you know i'm sure there's still some of it there but the the degree of harmony in country along with the in country in the united states with the people and the embassies there and with the federal departments in that various country or in the various countries has just been heartwarming for me to see and see the tremendous progress is being made great progress doesn't mean that we don't have a long ways to go but there's been great progress in the last eight years sir this is a secretary what is the status about intellectual property rights and the issue of development because about 10 years ago i was in korea when the institute of vaccine was established internationally and we just opposed it and uh basically that development was focused on the needs of tropical countries and the pharmaceutical industry was not willing to focus on their needs uh i before that i was in india uh basically as a science officer with the state department in both places uh this was always a big problem it's always it always has been and it's and it continues to this day but much less though the pharmaceutical industry made some terrible mistakes about six years ago when they brought a lawsuit in several countries in africa and that was you know that was probably one of their dumbest moves ever because it turned the whole world against big pharma in america but since that time a big pharma has in the case of neglected tropical diseases you know we everything we asked for pretty much is given to us you know you can't administer these drugs for 50 cents a person for a year without the generosity and the charitable giving of pharmaceutical companies because the drugs cost more but they're giving them to us at cost or giving it to us uh you know as a as a contribution so the intellectual property rights you gotta have intellectual property rights for for scientists biotechs and and pharmaceutical companies develop new drugs and and everybody knows that these drugs have a life cycle in which they the viruses and the bacteria grow stronger and you have to come up with new medicines and you have to find medicines you know for new diseases so you have to have intellectual property rights but i i find that there's a much more harmonious feeling in the world towards pharmaceutical companies much more giving and contribution and much more sharing not enough of the sharing but it's getting much better and i'm i'm very happy about that and i think it's goes a long ways towards getting the drugs to people that need it in africa and other some in some of the countries you know you know i i should just just to reinforce what he just said and that uh the issues regarding intellectual property for the neglected tropical diseases i won't say are zero but they tend to be much less acute than other global health problems in the sense they're not dual use in the sense that these are not diseases that occur at all in the us or europe in japan so there's there's no militant and there's not even much of a military market or a traveler's market because you only get these diseases when you're living for a long time in these developing countries so um you know we for we're funded for our hook warm vaccine by the bill melinda gates foundation they ask us to put forward a global access roadmap which includes a detailed discussion of intellectual property primarily and they put that into place for things like aids and malaria where there are both us and and developing country markets it's really not so much of an issue we like to say if some guy in india wants to copy what we've done in vaccinate all of india well then god bless him you know where so we so we we file patents we're often not sure why we do it couple quick observations and a question one observation is that seems that when you talk about river blindness and guinea worm you've got two fairly dramatic success stories of the last period with fairly complex partnerships involving carter center of pharmaceutical companies and different agencies and yet it doesn't seem to those success stories don't seem to translate in the popular mind too much as powerful examples that prove the concept and why is that so that's the first point is there more to be gained by that by by looking at those stories second is you didn't really talk much about china and india when you put the figures up it wasn't emerging it wasn't emerging large emerging countries that were the focus the focus was really the most broken of places the numbers that you put up for drc of for angola for cambodia those are the places where you've got really deep concentrated problems and the obstacles are really formidable and so maybe that's part of the problem is trying to convince folks that directed neglected tropical diseases should be should be a priority within a broader global health strategy which gets to my last point where if you would have peter and and governor thompson if you were to identify the small subset of states in africa or outside africa where you think the biggest gains could be made by a concentrated investment in the next five to ten years in order to prove the point that you can have big gains on six or seven of these what would those be what would those countries be because i doubt that you get much traction by saying drc and angola you can't ignore those countries there has to be an investment but you're going to get a much better bigger payback here in washington and a constituency around this by picking picking three or four that are more co that rolandes or tanzanese or gonas where you're going to be able to make dramatic gains and what would the strategy look like in your mind thank you well you asked about three questions and the answers could be quite long winded but i'll try to just summarize a few points first over to guinea worm you're right it's a great success story and the carter centers and and our partners including who have taken this on it's worth pointing out that if it's worse guinea worm had three point two million infections worldwide so we're talking about now something much more ambitious hundreds of millions of billion people so i think the carter center provide important proof of concept that with the political will of the president and and uh... and who that you can make a big impact on a disease now we're going to go after the big one the the one that's hundreds of millions with regard to the distribution middle and low income countries you're right these are diseases in india and china and brazil uh... but i should mention they're only in the very poorest segments of of those countries so uh... they're very unevenly uh... distributed so you don't go into beijing or shanghai and see these diseases quickly you have to go into you non-province in guangxi and uh... in parts of situan province non-province real poor rural areas offer you to see them regarding where do you begin uh... i think you're right the the conflict and post-conflict countries are the most daunting uh... wouldn't be our trip if we wanted to go out start with a home run you wouldn't necessarily pick d r c which is half the size of the united states and uh... it's it's it's very difficult to work work there so that we've the global network has identified a list of priority countries uh... but we don't shy away from conflict or post-conflict countries necessarily because even there are community the community drug distributors have been working there and have and have had some great success stories in in places like sudan and angola as well so we have a priority list but we haven't totally written off the conflict of post-conflict countries yet i would uh... i would only add to what peter said about the uh... the countries that we can have the biggest impact on you've got to realize that certain certain groups in the congress and uh around washington dc that are really individuals that can influence power uh... our individuals and groups that have certain attachments to certain countries rwanda is a big one because of the genocide and uh... rwanda is one that we're gonna have huge success in just because the cut in the the government is stable and there's a great deal of uh... sort of remorse in america that we didn't do more in the genocidal period and so that's one immediately jumps out south africa you know we haven't uh... uh... dwelled much on south africa but south africa's minister of health you know really didn't uh... didn't uh... do as much as uh... they should have and fighting AIDS tuberculosis and malaria and now that administration has changed the minister of health has changed much more active and much more involved which in south africa is always one that has great support in america and that one has got tremendous opportunities to improve especially in AIDS tuberculosis and malaria zimbabwe you know as soon as if ever megabi ever leaves which uh it can't go on forever he's 84 years old and uh he has destroyed that country and uh that is soon as they have a change of leadership you're going to be uh i think somewhat shocked by the amount of capital that wants to go in and help out zimbabwe Botswana is a country that is fairly wealthy it's got a lot of natural resources and it's a small population it's a huge country and very diversified but it's got great great opportunities to improve the health care because they have a government that wants to to influence and change tanzania is another one uh you know mark rena we were there and it was just an amazing thing to me uganda uh uganda is a one that i would think is just ready to be helped even more so so those are the countries that i would think of but i wouldn't i wouldn't give up on the kongo because the kongo uh who's the basketball player the kime matumo matumo is building a hospital there and is really developing a great deal of following he wants me to go with him this summer and i i hope i can crystal crystal for williams georgetown university uh you talk about treatment of individuals who are already infected but what kind of preventative measures are you taking that a non-chemotherapeutic to prevent infection so that's a that's a great question well first of all i should mention that the the medicines even though they're treatments we sometimes call them preventive chemotherapy because for instance the drug for lymphatic phyleriasis doesn't directly treat the individual it lowers the number of circulating microfilaria required for transmission so they actually interrupt transmission in that particular instance for trachoma we also recommend what's known as the safe strategy which includes simple surgery in addition to the antibiotics and environmental control clean water and sanitation of the mom and apple pie of global health they can be extremely expensive interventions what we have found is that when you use sanitation alone in the absence of economic development has a very minor trivial impact on reducing the prevalence of these diseases and whenever possible we encourage clean water and sanitation in the world health assembly resolutions all support that as well but it can be very expensive and very costly but it's a great question this uh i wanted to introduce a young naval doctor who is with us andy baldwin is in the audience how are you handy thank you you're going to be fine i just like to say that you had a question go ahead now i'm really on the hook i'm judith koffman i'm an independent consultant i was privileged to work with secretary tovson on things like the global fund and i want to ask you something on global medical diplomacy as you know i come from the state department so the other side of the equation and your thoughts on how diplomacy itself the state department the more traditional tools of foreign policy can be engaged in promoting global health first off not only did you assist me you led the way you and your husband were absolutely the world bank and with the setting up the global fund her husband was was my candidate to run the global fund we didn't win but uh but uh he was uh he was an ambassador and just a fantastic american um i think the state department has got to be much more aggressive you know they um you look at the you look at the maps and you see the the need out there and uh with secretary clinton now with her notoriety she could just be a world leader a role model for trying to transform the state department into leading with medical diplomacy and i think president obama wants to get away from the militaristic uh type of things that are taking place in afghanistan and iraq and what better place than to try something new it's like it's like the marshal plan all over again and you could rebuild the marshal plan only use medical diplomacy the ships uh the global fund the president's pep far program and president bush's legacy is really uh the strongest part of his legacy is going to be what he did in in medical diplomacy and uh i i'm very happy that i played a small role i'm very happy scoffing that you were there helping to lead the way and the state department could make uh the obama administration you know the the foremost leaders in global medical diplomacy if they want to lead and to me it there's there's there's just no down turn in the opportunities for that it just uh it's just an upward opportunity for this administration as it was for the bush administration uh it was interesting i just got to give you a little factoid of the of the seven countries in the last eight years that like america the best all come from africa all come from africa you know why it's the president's pep far program it's a global fund it's medical diplomacy now if you would ask that on a quiz i bet the 90 percent of the of the people that you would ask that would say that's not true but if you look at the at the statistics and the polling seven of the 10 countries that value america the most it's africa and that's strictly because of global medical diplomacy and if you really want to win the war on on terrorism i'll say it once again it's through the hearts and minds of women and children in these countries because no matter of the 37 countries i visited in four years while i was secretary uh there was one common denominator that common denominator was good health for themselves and their families and that you know is permeates throughout the whole society and that's why global medical diplomacy works can work will work and should work and is the way that i think the state department should change in order to try and attract more information more resources and more development in that area the good news is the global network for neglected tropical diseases was launched at the clinton global initiative in 2006 and uh uh next to secretary thompson the only two political leaders who know almost as much as about neglected tropical diseases as president clinton and secretary clinton so hopefully that that will make a big impact thank you very much