Houston-based physician and researcher Dr. Peter J. Hotez MD PhD, America’s leading advocate for and internationally recognized expert on tropical diseases and vaccine development, drew attention to the often overlooked issue of how political turmoil in the Arab world is opening the door to greater proliferation of disease, both in the region and potentially the world, in an opinion piece published by Al Jazeera last Friday.
Dr. Peter Hotez is President of the Sabin Vaccine Institute (Sabin), founding Dean of the National School of Tropical Medicine at Baylor College of Medicine, Professor of Pediatrics and Molecular Virology & Microbiology and Chief of the Section of Pediatric Tropical Medicine at BCM, Endowed Chair of Tropical Pediatrics at Texas Children’s Hospital, heads the Children’s Hospital Center for Vaccine Development, and recently named the Fellow in Disease and Poverty at Baker Institute for Public Policy at the Rice University. On June 27 he testified in a presentation, entitled “Addressing the Neglected Diseases Treatment Gap,” regarding Neglected Tropical Disease (NTD) R&D Funding before the United States House of Representatives Committee on Foreign Affairs Subcommittee on Africa, Global Health, Global Human Rights and International Organizations Hearing.
He is also author of the book “Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development” in which he describes how while neglected tropical diseases (NTDs) as being the most common infections of the world’s poor, few people in the developed West know about them and why they are so important.
Dr. Hotez observes in the Al Jazeera article that recent flare-ups of conflict in Egypt, Iraq, Libya, Pakistan, Syria, Tunisia, Yemen, and elsewhere in the Middle East may have sufficiently destabilized national and international public health control measures to a point where several tropical diseases have either emerged and are sickening large populations in the region. He cites The most dramatic example is currently happening in Syria, where Cutaneous leishmaniasis, a disfiguring parasitic skin disease transmitted by sandflies and also known as “Aleppo Evil” (AKA “Aleppo ulcer,” or “Aleppo boil”) is now affecting tens of thousands of innocent civilians both within the country and among refugees fleeing across the border to Lebanon or Turkey. But this disease is also flourishing in Afghanistan, Algeria, and Iraq where breakdowns in public health have allowed sandflies to breed and transmit disease.
As we reported here in June, Cutaneous leishmaniasis (CL) has been quickly spreading in Syria’s besieged ancient second city Aleppo, adding further to the civil war-torn misery there — the number of estimated cases ranging into the thousands or possibly even the hundreds of thousands with children and young people disproportionately affected.
“It should come as no surprise that this disease would re-emerge with a vengeance as a result of a horrific civil war” and a breakdown in infrastructure and public health control measures,” Dr. Hotez wrote in a June 5, 2013, edition PLOS Blog posting entitled “‘Aleppo Evil’: The Ulcer, the Boil, the Sandfly, and the Conflict.”
Dr. Hotez goes on to say in the blog post, “Even in the best of times the Syrian Arab Republic (Syria) has struggled with cutaneous leishmaniasis (CL),” writes Dr. Hotez, noting that that old world or anthroponotic CL caused by the microorganism Leishmania tropica is endemic to Syria and elsewhere in the Middle East, North Africa, and Central Asia, and in Aleppo CL has been present for hundreds of years (if not longer). However, the war has resulted in conditions amenable to its spread in Aleppo and throughout the region carried by displaced persons to refugee camps. Municipal garbage and sewage disposal infrastructure in Syria had already been gradually deteriorating since the early 1990s, but virtually stopped once open civil conflict there erupted in 2011, and mountains of garbage and buildups of raw sewage — ideal breeding habitats of Phlebotomus sandflies — have proliferated. Aside from the immediate misery they cause, Dr. Hotez notes that scars left by CL lesions even after the infection heals can result in permanent facial disfigurement leading to social stigmatization and isolation, particularly among girls and young women who can be rendered unmarriageable, while mothers with CL may not be allowed to touch their children, even though human to human contact does not transmit the infection.
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In the Al Jazeera op-ed, Dr. Hotez reports that several mosquito-transmitted virus infections have also become important public health problems in the region, citing recent estimates of six million cases of dengue fever occurring in Egypt in 2010 — a metric equalling more than seven percent of that country’s population, as well as almost 14 million cases reported that year in Pakistan. He observes that Dengue has also emerged in Saudi Arabia, Syria, and Yemen, and that additionally Rift valley fever has also appeared in both Saudi Arabia and Yemen — the first time that particular mosquito-transmitted viral infection has been seen outside of Africa. He also notes that there is growing concern that such viral infections could affect pilgrims entering Saudi Arabia during the Hajj pilgrimages this coming fall, as could the new MERS coronavirus that has caused international concern about its potential to become a global pandemic, or the recently-discovered Alkhurma hemorrhagic virus, both of which were first detected and identified in Saudi Arabia.
Meanwhile, Dr. Hotez says newly released information reveals that fewer children in the World Health Organisations’ Eastern Mediterranean Region (including the Middle East, Sudan, and Pakistan) receive regular deworming medicine to treat intestinal parasitic worm infections than in any other region, and that overall, just over five percent of the roughly 80 million children who should receive regular deworming are actually treated, including fewer than one percent of school-aged children — a worse situation than even in sub-Saharan Africa.
He observes that In cases of prolonged conflict, destabilized communities, human migrations, and a collapse of public health infrastructure synergize with endemic poverty to promote emergence of tropical diseases, with breakdowns in animal control and veterinary public health infrastructure also contributing to emergence of tropical infections transmitted from animals, such as brucellosis and rabies. He notes that recent reports of the MERS coronavirus possibly being spread from camels could also be relevant to this observation.
Dr. Hotez contends that rapid and decisive global action is called for in order to prevent further spread and emergence of NTDs in the Middle East, and that further delays could have permanent and long-lasting destabilizing consequences for this already volatile region. And while United Nations agencies such as the World Health Organization (WHO) have a key role to play in terms of convening health ministers from the region and implementing meaningful disease control measures that include mass treatments for intestinal worm infections, animal control, and vector control for disease-transmitting mosquitoes and sandflies, the newly launched US State Department Office of Global Health Diplomacy should also be mobilized in order to identify how the United States Government, possibly in partnership with research universities and institutes could provide important technical assistance for disease control and elimination, but also to promote international and diplomatic cooperation across the region for this purpose.
As well he says, some of the wealthier Middle Eastern countries, such as Kuwait, Qatar, Saudi Arabia, and United Arab Emirates have important responsibilities both in terms of providing technical assistance and financial support for such efforts.
You can read Dr. Hotez’s Al Jazeera blog here:
Read our Peter Hotez info page at BioNews Texas