Global Health Histories

Lunchtime seminars series on tropical diseases: lessons from history


Seminar 29: Leprosy: Why is elimination so elusive?
Prof. Michael Worboys, Manchester University, England

Today marks the start of a new series of Global Health Histories seminars that will discuss lessons learned from the history of tropical diseases, and the implications for current health policy-making. The opening seminar focuses on leprosy, one of the world's oldest-known diseases, which still affects more than half a million people in Africa, Asia and Latin America. Today, leprosy diagnosis and treatment is easy, yet the disease remains stubbornly resistant to the final phases of elimination. The reasons why will be examined by Professor Michael Worboys, director of the Wellcome Unit for the History of Medicine at the University of Manchester, England, and Dr S. K. Noordeen, former director of the WHO Leprosy Elimination Programme and former President of the International Leprosy Association.

No Audio file available for this seminar

Seminar 30: End of the ancient dragon? Eradicating guinea worm disease
Prof. Anne Marie Moulin, Directeur de recherche CNRS-UMR, Paris, France.

Dracunculiasis - Latin for "affliction with little dragons" - is as ancient as smallpox, and may soon also be dispatched to history. After a campaign lasting over 20 years this parasitic disease, better known as Guinea-worm, is close to eradication. Transmitted through drinking water and easily diagnosed by the appearance of a long worm from skin ulcers, the condition has caused pain and misery to huge populations for thousands of years. The remarakable story of how it has now almost been destroyed, largely by volunteers and without resort to drugs or vaccines, will be discussed in this seminar. The main speaker are Professor Anne Marie Moulin, research director, Centre National de la Recherche Scientifique (CNRS) Paris and Dr Dirk Engels, co-ordinator of preventive chemotherapy at the Department of Control of Neglected Tropical Diseases, WHO, Geneva.

Seminar 31: Sleeping sickness - the controversy continues
Dr Guillaume Lachenal, University of Paris, France

Attempts to eliminate sleeping sickness from central Africa in the middle years of the 20th century created a controversy that still continues today - as does the latest epidemic. Mass campaigns involving millions of doses of prophylactics posed major issues of safety, efficiency and drug resistance. Using this troubled history as an example, this seminar shows why it is so difficult to sustain the elimination of tropical diseases. The presenters are Dr Guillaume Lachenal, Lecturer at the Department of the History and Philosophy of Science at the University of Paris Diderot, and Dr Jean Jannin, Coordinator of Innovative & Intensified Disease Management at the Department of Control of Neglected Tropical Diseases, WHO, Geneva.

Seminar 32: River blindness – the keys to control
Dr Jesse Bump, Harward University, USA

River blindness, or onchocerciasis, is the world’s second leading infectious cause of blindness - about 18 million people are currently infected. The disease has often left vast tracts of arable land abandoned in infected areas. In this seminar, Dr Jesse Bump, of Harvard University, reveals the fascinating detective work that defined the disease in the first place and then explores how political and historical forces gave it an international focus. Dr Janis Lazdins-Helds, from TDR at WHO, explains how research has always been the key to success in the international control effort.

Seminar 33: Malaria Treatment and Control: A Cultural History of Institutions, Methods, and Metaphors
Prof. Peter Brown, Emory University, Atlanta, Georgia, USA.

After a summer break, the Global Health Histories seminar series returns to examine further the lessons learned from the history of tropical diseases and their implications for current health policy. This latest seminar focuses on malaria, a disease that has defied a global eradication programme and continues to resist countless major public health interventions. Professor Peter Brown uses an anthropological approach that emphasizes the historical context of cultural beliefs and values shaping malaria control policies. He considers the role of institutions , including the WHO, in defining the problem of malaria and the technologies of appropriate solutions.

Peter Brown is a professor of Anthropology and Global Health at Emory University, Atlanta, Georgia, USA. His work has focused on the historical relationship of malaria, malaria control and culture. He serves on the scientific advisory board for TDR projects on home management of malaria.

In a response to his presentation, Professor Brown will be joined in this seminar by co-speaker Dr Andrea Bosman, a medical expert on the disease. Dr Bosman is a senior member of the WHO Global Malaria Programme in Geneva.

Seminar 34: 100 Years of Chagas Disease: A Continuing Public Health Challenge
Professor Simone Kropf, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

Chagas disease, caused by a parasite transmitted by a blood-sucking insect, affects an estimated 10 million people in the Americas today, and causes over 10 000 deaths every year. In recent years international travel and migration of populations has led to cases in countries such as Australia, Canada, France, Germany, Italy, Japan, Spain and the United States.

Historian Professor Simone Kropf of the Oswaldo Cruz Foundation; Rio de Janeiro, Brazil, describes how it was first identified in 1909 by Brazilian physician Carlos Chagas, and became a major public health problem during the 20th century. The new ailment was characterized as ‘the disease of Brazil’, symbolic of a ‘diseased country’. It was also an example of how Brazilian scientists contributed original knowledge to the world of tropical medicine, stirring continuing debates about the relationships between diseases, poverty and national identity. Professor Kropf’s presentation marks the 100th anniversary of discovery of the disease, traces its history and offers new insights into the complex relations between science, public health and society.

Her co-speaker is Professor Gabriel Adrián Schmunis, formerly of the Communicable Diseases Unit of the WHO American Regional Office in Washington, DC. He will discuss the current global status of the disease and efforts to interrupt vector transmission in some countries in South and Central America.

Seminar 35: Kala azar: Can visceral leishmaniasis ever be controlled?
Professor Robert Killick-Kendrick, Honorary Research Fellow at Imperial College, London, UK

Visceral leishmaniasis, also known as kala azar (meaning “black fever”) is an ancient parasitic disease that continues to resist modern control efforts. Transmitted by sand flies, it is most common in south-east Asia, east Africa, and Brazil, but cases also occur in southern European countries. Worldwide there are some 500 000 new cases and 60 000 deaths a year. Left untreated, it can have a fatality reaching 100%.

Two eminent experts share their decades of experience in today’s presentation. Professor Robert Killick-Kendrick, Honorary Research Fellow at Imperial College, London, is a leading parasitologist specializing for many years in the disease, while Dr C.P. Thakur, Emeritus Professor of Medicine and former Minister of Health in India, helped revolutionize treatment of the condition.
Together they trace the history of attempts control it back to the 18th century and pose questions about current efforts. Sandflies were proven to be the vectors in the 1940s, and the main response was house-spraying with DDT. More recently, increasing concerns about environmental contamination mean spraying is constantly under critical challenge, leading to the search for other solutions.

Seminar 36: Tropical disease vectors: Identification and control "How malaria became a vector borne disease" - 4 November 2009
Professor Randall Packard, of the Institute of the History of Medicine at Johns Hopkins University, Baltimore, USA

Medical knowledge about malaria in the 19th century led to a variety of control strategies during the first half of the 20th century, including attacking mosquitoes, the parasite, and improving overall health and development. However, from the late 1930s the focus switched towards reducing or eliminating transmission by attacking mosquito populations. This underlay the WHO global eradication programme in the 1950s and 60s, but the programme failed to achieve its goals. Different approaches during the 1970s and 80s were also unable to bring malaria under control. The resurgence of the disease has driven current efforts to eliminate it, with the focus largely on vector control.

Professor Randall Packard, of the Institute of the History of Medicine at Johns Hopkins University, Baltimore, discusses the limitations of the Roll Back Malaria approach and the consequences for the prospects of malaria elimination. His co-speaker, Dr Axel Kroeger, a TDR scientist at WHO, will talk about “institutional memory loss” in the history of vector control efforts, citing the example of indoor residual spraying with insecticides.

Seminar 37: Essential and inessential medicines: The changing role of pharmaceuticals in world health - 2nd December
Professor Jeremy A. Greene, of Harvard University, USA

The post-war drug boom that brought “miracle cures” such as penicillin, cortisone and streptomycin also launched many other medicines that were less impressive. In 1977, WHO designated a list of 186 “essential drugs” in an attempt to place medicines alongside clean water, adequate housing, and a safe food supply in a short list of things necessary to ensure basic living conditions. Since then the methods, metrics, and politics of procuring essential medicines have become increasingly important to global health concerns. Professor Jeremy A. Greene, of Harvard University and Brigham & Women’s Hospital and Harvard Medical School, describes the evolution of the essential medicines concept within a longer history of pharmaceutical standardization at the WHO.

The presentation of former director of TDR, Dr Adetokunbo Lucas will critically examine the initial strategy adopted by TDR following its foundation by WHO in 1975 as a Special Programme for Research and Training in Tropical Diseases, and evaluate the impact on control of leprosy, onchocerciasis, and Chagas’ disease. Lucas also discusses how TDR's success in obtaining Merck 's commitment to the donation of ivermectin to control onchocerciasis "for as long as is needed" led to a new phenomenon of “pharmaco-philanthropy”, in which the pharmaceutical industry seeks partnerships in promoting the health of poor people in poor countries.

No Audio file available for this seminar