National Institute of Allergy and Infectious Diseases, NIH: Volume 2;Impact on Global Health PDF
Preview National Institute of Allergy and Infectious Diseases, NIH: Volume 2;Impact on Global Health
National Institute of Allergy and Infectious Diseases, NIH Volume 2 Impact on Global Health Infectious Disease VassilSt. Georgiev Forfurthervolumes,goto www.springer.com/series/7646 National Institute of Allergy and Infectious Diseases, NIH Volume 2 Impact on Global Health VassilSt.Georgiev,PhD Office of Global Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA Forewordby AnthonyS.Fauci,MD Director, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA VassilSt.Georgiev,Ph.D. NationalInstitutesofHealth DepartmentofHealthandHumanServices 6610RockledgeDrive BethesdaMD20892 USA [email protected] ISBN978-1-60327-296-4 e-ISBN978-1-60327-297-1 DOI10.1007/978-1-60327-297-1 LibraryofCongressControlNumber:2009920698 (cid:2)c HumanaPress,apartofSpringerScience+BusinessMedia,LLC2009 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorinpartwithoutthewrittenpermissionof thepublisher(HumanaPress,c/oSpringerScience+BusinessMedia,LLC,233SpringStreet,NewYork,NY10013, USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnectionwithanyformof informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdevelopedisforbidden. Theuseinthispublicationoftradenames,trademarks,servicemarks,andsimilarterms,eveniftheyarenotidentified assuch,isnottobetakenasanexpressionofopinionastowhetherornottheyaresubjecttoproprietaryrights. Whiletheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoingtopress,neither theauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityforanyerrorsoromissionsthatmay bemade.Thepublishermakesnowarranty,expressorimplied,withrespecttothematerialcontainedherein. Printedonacid-freepaper springer.com Dedication To theNationalInstituteofAllergyandInfectiousDiseases,NIH, a worldleader insupportingbiomedicalresearch in servicetohumanity formorethan50 years. Foreword TheNIHspeakstheuniversallanguageofhumanitarianism...[it]has recognizednolimitationsimposedbyinternationalboundaries;has recognizednodistinctionsofrace,orcreed,orofcolor. —U.S.PresidentFranklinD.Roosevelt,NationalInstituteofHealth, Bethesda,Maryland,31October1940 IndedicatingtheNIHcampusin1940,PresidentRooseveltcouldlookbacktoaproudsci- entificerathatbeganaroundthetimeofhisbirthin1882.InthosedaysofKochandPasteur,the causesofimportantinfectiousdiseases,suchascholera,tuberculosis,anddiphtheria,weredis- covered,andmanyvaccinesandtherapeuticswererapidlydeveloped.ItwascleartoRoosevelt andtoscientistsofhistimethatinfectiousdiseaseswereanimportantglobalproblem.Manyof themostsignificantinfectiousdiseasediscoveriesofthelate19thandearly20thcenturieshad come from Africa, the Middle East, South America, and elsewhere in the developingworld. For example,the discoveryof the cause of yellowfeverand the first successes in its control came frompartnershipsbetween American and foreignscientists workingin Cuba, Panama, andotherlocales. Roosevelt’s inspiring words on that autumn day on the NIH campus indicate that he was looking not just to the past, but boldly ahead to the future as well. Viewing the future with optimism, rather than trepidation, he expected significant new challenges and imagined that NIH would do whatever necessary to meet them. Nearly seven decades later, the world’s populationhasgrowntomorethan6 billionpeople,from2.3billionin Roosevelt’sday,and the world is significantly more complicated. Hundreds of new diseases have emerged, and theyhavecreatedanenormousburdenonhumankind.AIDS,emerginginfluenzastrains,and drug-resistantmalariaandtuberculosishavecollectivelykilledhundredsofmillionsofpeople. Immunologic and immunodeficiencydiseases have assumed a much greater role in creating humanmisery,whilesuchneglectedtropicaldiseasesasschistosomiasiscontinuetoexactan immense toll on morbidity,mortality and the economiesof developingnations. At the same time,humanmovementhasincreasedandbecomemoreefficient,transportingmicroorganisms fromcontinenttocontinentwithinhours.Technologicaladvances,suchasvaccinesanddrugs, have been counteredby the rapid emergenceof microbialresistance. Biological warfare has beenrebornfromitsmilitarygraveyardasacivilianthreat.Andthegapbetweenrichandpoor haswidened,leadingto healthdisparitiesso glaringthatonemightdividethe worldintothe healthyandthe unhealthy.Thechallengefor the NationalInstitute of AllergyandInfectious Diseases(NIAID),nowthesecondlargestNIHinstitute,istorespondtothefoundingvision ofPresidentRooseveltandto thehopesandexpectationsofthose scientistsandleaderswho camebeforeus. We hope that this detailed summary of NIAID’s global research efforts will be useful to bothscientistsandhistoriansofscienceandalsoremindusofthespiritandoptimismthatled tothecreationofNIH,includingNIAIDanditsforebears.Whileexaminingthemanyspecific detailsdescribingtheapproaches,initiatives,programs,andscientificactivitiesrelatedtoour globalresearchmission,wealsorememberthelargerworldwithinwhichwework.Wewish vii viii Foreword to make severalpoints that address not only what we do scientifically, but how and why we doit. We are global citizens, and our world view remains humanitarian. President Roosevelt’s dedicationofNIHmanyyearsagoreflectednotonlyanunderstandingofAmericansciencebut alsoanationalcommitmenttoglobalcitizenship.Forsevendecades,thisglobalcommitment has been manifested in NIH’s globalscientific efforts,includingthose of NIAID. For exam- ple, NIAID playeda leadingrole in finding the causes of, and understandingthe pathogenic mechanisms of AIDS and in developing, testing, and bringing into use an armamentarium of drugs that have improved and prolonged the lives of millions of patients. Because these remarkable achievements were most urgently needed in the developing world, NIAID drew upon the international AIDS research infrastructure it had created and fostered, partnering with other governmentsand philanthropicorganizationsto begin the slow process of saving livesandpreventingnewinfectionsineveryregionoftheworld.Theseeffortswereintegralto ThePresident’sEmergencyPlanforAIDSRelief(PEPFAR),alarge-scalehumanitariancom- mitmenttodevelopingnationstopreventandtreatHIV/AIDSandtocareforinfectedpeople. Althoughmuch remains to be done in the fight againstAIDS, PEPFAR has been a triumph. The programis an affirmationof traditionalAmerican valuesand a strong confirmationthat scientificaccomplishmentcanalsobeahumanitarianinstrument. In a global village, it is no longer possible to geographicallycompartmentalize biomedi- cal research. The spread of West Nile virus into the Western Hemisphere in 1999;the 2003 AmericanoutbreakoftheimportedAfricandiseasemonkeypox;andwidelypublicizedcases of multidrug-resistant tuberculosis remind us that the “our disease/their disease” paradigm is untenable. Most infectious disease threats Americans have faced in the past few decades, from exotic tropical diseases to antibiotic-resistant strains of bacteria to emerging strains of influenzaviruses,havecomewhollyorpartiallyfromabroad.Obviously,tounderstandthese diseasesand the threatstheypose, we mustbeable to studythe causativeorganismsin their naturalenvironmentsandtoworkcollaborativelywithforeignscientistswhohavethecapacity toisolatemicrobialstrainsandconductstudiesintheirownendemicareas.Inthepastdecade, NIHhasembarkeduponanunprecedentedglobalizationofitsresearchbyfocusingonspecific diseases, such as AIDS, tuberculosis, and malaria, by more than quadrupling direct foreign research awards and foreign components of domestic awards, by doubling the foreign visi- tor program,and by joiningforceswith manydevelopingnationsto create a numberof new andinnovativeresearchpartnerships,suchasNIAID’sInternationalCentersforExcellencein Research(ICER)andtheIndo-U.S.HIV/STDProgram,amongmanyothers. The roles of microbial agents and of human hosts in disease occurrence are inextricably intertwined. The sequencing of the human genome and that of a large number of microbial pathogensand disease vectorsis leadingus to a much better understandingof howand why diseasesoccurandwhatcanbedonetocontrolthem.Humansthemselvesandtheirbehaviors, actions, movements, commerce, and environmentalperturbationsare the selection pressures thatdrivepathogenemergenceandevolution.Genomicsandproteomicsoffernewopportuni- tiesnotonlyforpathogendiscovery,diagnostics,anddrug/vaccinedevelopment,butalsofor understandingmicrobialemergenceandhost-switchingatthegenomelevel.Studyingthehost response to microbes is critical for a number of reasons: Understanding the genetics of the immuneresponsetoinfectionsallowsmorerationaldesignofdrugsandvaccinesandprovides clues to therapy with existing drugs. Host responses may themselves be overexuberantand even pathogenic, and we need to better understand these immunopathogenic phenomena in ordertopreventandtreatthem.Moreover,abetterunderstandingofthegeneticvariationsin hosttargetsmayallowustopredictandevenpreventdiseaseemergence. Complexproblemsrequirecomplexapproachesandcreativepartnerships;newchallenges can be met by taking advantage of new opportunities. Many major human infectious dis- eases are complex and difficult to prevent and control with traditionally successful scien- tific approaches. For example, each of the three major infectious disease killers worldwide, HIV, Plasmodium falciparum malaria, and Mycobacterium tuberculosis, all have complex Foreword ix “life cycles,” all cause chronic and persistent or recurrent disease, and none has been con- trolled bya successfulvaccine.The greatburdenof mortalityfromthese threediseases falls disproportionately on the poor, who live in resource-poor countries. What little money is availabletoaddresssuchoverwhelmingproblemslocallyisspentintreatmentandprevention, whilemanydrugandvaccinemanufacturersinwealthynationsremainunmotivatedtoinvest multimillion-dollareffortstoproducevaccinesanddrugsthatfewcanaffordtobuy.Ittherefore makessenseforbiomedicalresearch,publichealth,publicpolicy,andphilanthropytoengage eachotherinnewandcreativeways.AlthoughNIHisthepreeminentfunderofglobalinfec- tious disease and immunology research, important philanthropic organizations, such as the Bill &MelindaGatesFoundation,andmanysmallandlargenongovernmentalorganizations (NGOs)haverecentlyappearedandexpanded.Thesedevelopmentsprovidenewopportunities toaddressmedical,social,andhumanitarianaspectsofhumanhealth,andtheybringscience closer to the frontlines ofthe war againstinfectiousdiseases. Increasingly,NIAIDhas been working collaboratively with foreign governments and scientists, NGOs, and philanthropic organizations to coordinate comprehensive approaches to important health problems in the developingworld.Astheworld“shrinks”duetoincreasedtravelandmoreefficientcommu- nication, and as concentrationsof wealth are brought about by the emerging and realigning economiesof nationssuch as China and India,new opportunitiesfor scientific progresswill undoubtedlycontinue to appear. We must remain flexible and retain a capacity to form new allianceswithavarietyofpartnersinpursuitofever-changingdiseasethreats. The biomedical science pathway begins with basic research findings and ends with their translationintolife-savingtoolsandapproaches.AsPasteurfamouslyobserved,“theredoes not exist a category of science to which one can give the name applied science. There are scienceandtheapplicationsofscience,boundtogetherasthefruitofthetreewhichbearsit.” In recent decades, biomedical science has been driven by technological advances, but basic science discovery itself is only the beginning of a process. An example of the successful progressofscientificendeavorinaddressinganimportantproblem,notedabove,isthesequen- tial clinical-epidemiologic recognition of AIDS, followed by the discovery of the etiologic agent,HIV,followedbythedevelopmentofascreeningdiagnostictest,followedbyscientific characterizationofthevirus,thedevelopmentofantiviraldrugs,thedevelopmentoftreatment strategies, and ultimately to the organization of large-scale programs based on accumulated scientific knowledgeandeffectivedrugsto preventand treatHIVinfections.The “products” ofscienceincludenotonlythediagnostictests,vaccines,drugs,andpreventionstrategieswe havedeveloped,butalsotheknowledgeandexperiencewehaveacquiredtousethemwisely. NIAID’seffortsarepartofalargerprocessthatextendsbeyondthepurelyscientifictoinclude themedical,societal,andhumanitarian.Scienceisnotavaluesystembutarationalmechanism fordiscoveringtruths;itacquiresmeaningandvaluewhenweuseittoservehumanity. For the 54 years of our existence, NIAID has carried on the tradition of NIH and its antecedentorganizationsinmaintainingaglobalandhumanitarianperspectiveandinviewing andsupportingbiomedicalscienceasaninstrumentofhumanprogress.Inrecentdecades,we havemadeenormousstridesineradicatingandcontrollingdiseases,butwehavealsosuffered discouragingsetbacksintheemergenceofnewdiseasesandthere-emergenceofoldones.We are in an era in which enormouschallenges,both old and new,are likely to confrontus, but alsoanerainwhichwewillfindnewopportunitiestomeetthesechallenges.Asdocumentedin thepagesofthisvolume,ourapproachtothechallengesofinfectiousdiseasesremainsbroad, flexible, and energetic. We deal with highly complexand technical issues at the level of the cell,thegene,andthemolecule.Butweseekalsotounderstandthewaysinwhichinfectious organismsinteractwith,andevolveinresponseto,theirhumanhosts;andwecoordinateour researchfindingswithcolleaguesinpublichealthandwithpartnersinsocietyatlarge.Indoing so,weremainfocusedonalleviatinghumansufferingwhereveritoccursandcommittedtoour foundingprinciples,articulatedintheuniversallanguageofhumanitarianism. Bethesda,Maryland AnthonyS.Fauci,M.D. Acknowledgments DeepappreciationandgratitudeisexpressedtothefollowingcolleaguesfromNIAIDfortheir helpandencouragementduringthepreparationofthisvolume: Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Diseases (NIAID),NIH HughAuchincloss,Jr.,MD,PrincipalDeputyDirector,NIAID,NIH JohnJ.McGowan,PhD,DeputyDirector,NIAID,NIH F.GrayHandley,MSPH,AssociateDirectorforInternationalResearchAffairs,NIAID,NIH, andStevenSmith,JD,Director,OfficeofGlobalResearch,NIAID,NIH,fortheirunderstand- ingandconstantsupportduringthepreparationofthisvolume; Division of Microbiology and Infectious Diseases (DMID), NIAID, NIH: Carole Heilman, PhD,Director,forhercommentsandsupportofPartIofthisvolume; DivisionofAIDS(DAIDS),NIAID,NIH:CarlDieffenbach,PhD,Director,andJeffNadler, PhD,JoanRomaine,MPH,VanessaElharrar,MD,FulviaVeronese,PhD,CarlaPettinelli,MD, andMarjorieDehlinger,DNSc,fortheircommentsandsupportofPartIIofthisvolume; DivisionofAllergy,Immunology,andTransplantation(DAIT),NIAID,NIH:DanielRotrosen, MD,Director,andCharlesHackett,PhD,DeputyDirector,fortheircommentsandsupportof PartIIIofthisvolume; OfficeofCommunicationsandGovernmentRelations(OCGR),NIAID,NIH:Dr.VedaChar- rowforeditingofPartsIandIIofthisvolume; OfficeofCyberInfrastructureandComputationalBiology,CustomerServiceBranch:JamesT. Mitchellforhistimelyhelpinsolvingcomputerissues. xi
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