Drug Development Global Program

How we measure the true impact of diarrheal diseases

By Ibrahim Khalil and Puja Rao, Institute for Health Metrics and Evaluation, University of Washington

The problem: One-time illness or lifelong impairment?

When a child experiences a single episode of diarrhea, they typically feel uncomfortable for a short period of time, but with appropriate care, they recover and continue to live a life free from disability. But when access to safe water and sanitation is limited—and children are constantly exposed to an assortment of bacteria and viruses—what happens when a child experiences frequent bouts of diarrhea without proper remedy? To answer this question, we need to better understand the cyclical relationship of diarrheal diseases and enteric infections during the crucial period of early childhood development and related poor health outcomes that can result over a lifetime.

Close-up of infant

Repeated enteric infections, such as diarrheal diseases, can impair a child’s growth and development and negatively impact long-term well-being. Photo: PATH/Gabe Bienczycki.

We know that repeated and persistent exposure to enteric infections like diarrhea may lead to intestinal inflammation and damage in the gut. Compromised gut health inhibits nutrient absorption in the body and can lead to malnutrition and eventually long-term health consequences, such as stunted physical growth, impaired cognitive development, and/or increased susceptibility to opportunistic infections, including pneumonia, the leading killer disease of children younger than five years. The more we understand about this vicious cycle, the better we are able to make meaningful policy decisions to break the cycle of poor health using primary and secondary prevention strategies.

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Meet the amazing cast behind a life-changing drug

This post originally appeared on the PATH blog

How one consortium is expanding drug options to fight parasitic worms worldwide.

Eugenio de Hostos, seated, holds a mug and talks to a colleague off camera.

Eugenio de Hostos leads PATH’s work in drug research and preclinical development. Photo: PATH/Erika Amaya.

It was well after midnight in San Francisco when Eugenio (“Geno”) de Hostos picked up the phone—but when his colleagues in China answered, he felt the familiar jolt of excitement.

He’d felt the same thrill at dawn, talking to his colleagues in Switzerland. At five, in a call to Maryland with the US Food and Drug Administration (FDA). And the previous week, chugging a cup of coffee while furiously scratching notes in a 6:00 a.m. conference call with project partners.

Geno leads PATH’s work in drug research and preclinical development, and for the last two years, he and his team—with pivotal support from colleagues at Swiss Tropical and Public Health Institute (Swiss TPH), the National Institute of Parasitic Diseases (NIPD) at the Chinese Center for Disease Control and Prevention, and Shandong Xinhua Pharmaceutical Company (XPC)—have been building a cast of global experts, partners, and funders to do something remarkable: get an underutilized, life-changing drug into the hands of communities affected by a debilitating neglected tropical disease.

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Breathing life into medical oxygen ahead of WHO committee decision

By Adam Lewis

This post originally appeared on The Huffington Post.

Mount Kilimanjaro stands nearly 20,000 feet above sea level, its snow-capped peaks providing a stark contrast against northern Tanzania’s otherwise equatorial backdrop. As Africa’s tallest mountain, it draws tens of thousands of climbers a year: some of whom reach the summit successfully, many of whom must stop short because of low levels of oxygen in their blood (the peak’s atmospheric pressure offers about half the breathable air as at sea level). The irony, however, is that in Tanzania – and nearly every country in sub-Saharan Africa – you don’t need to climb a mountain to reach an environment with too little oxygen; you just have to walk into a hospital.

Oxygen is one of the most frequently-required medical interventions in the world, yet it remains in critically short supply in low-resource hospitals. The World Health Organization (WHO) estimates that less than half of health facilities in Africa have reliable access to medical-grade oxygen – let alone the trained staff, supplies and infrastructure to deliver it.

Without medical oxygen, health providers are unable to treat critically ill patients with low levels of oxygen in their blood – an effect of conditions such as trauma, obstetric complications, heart failure and respiratory diseases like pneumonia, a leading cause of death for children globally. As one Tanzanian doctor recently explained to me, oxygen is essential throughout the entire hospital because low blood-oxygen levels – known as hypoxemia – can be both ubiquitous and, in many cases, fatal.

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Time to “decrypt” a wily parasite

By Robert ChoyAssociate Director of Research and Preclinical Development for Drug Development, PATH

Cryptosporidium harms children—we need research and development to stop it.

A still from the video, “DefeatDD: Superheroes vs. Villains.” Cryptosporidium is one of the featured bad guys. Image: PATH.

A lot of ugly things in nature are relatively harmless (Exhibit A: the star-nosed mole)—but Cryptosporidium isn’t one of them.

Unsettling under a microscope and dangerous in the human body, this tiny parasite is one of the most common causes of diarrheal disease (DD) worldwide. Yet for years, attention and research for “Crypto,” as it’s often called, has lagged.

Here’s the story of this “hidden spore”—and why research and development for effective tools should be a global priority, now.

The long-term consequences of diarrheal diseases

Worldwide, DD is a leading cause of death among children under five. Even when children survive the disease itself, repeated rounds put them at risk for long-term health and developmental consequences, including malnutrition, stunting, and deficits in cognitive development. Over time, persistent DD can also cause a kind of gut damage known as environmental enteric dysfunction, which contributes to malnutrition and can prevent some vaccines from working properly.

Together, these factors make children more vulnerable to opportunistic infections. In impoverished areas with limited sanitation, hygiene, and clean water, that can kick off a vicious cycle of illness, malnutrition, and reinfection.

Bringing the “hidden spore” to light

It turns out that Cryptosporidium (from the Latin for “concealed spore”) is the culprit behind many cases of DD worldwide—but we didn’t always know that. In 2013, a landmark study, the Global Enteric Multicenter Study, or “GEMS,” identified the viruses, bacteria, and parasites that most often cause DD.

Many of the usual suspects turned up. But so did Crypto—and that was a surprise. Continue reading »

PATH in San Francisco, Eugenio de Hostos

PATH’s team in San Francisco works to advance transformative global health innovations to improve lives of women and children, primarily through our work in drug development. In this post, we learn more about Eugenio de Hostos, director for research and preclinical development for PATH’s Drug Development program.

Eugenio de Hostos stands on a snowy mountain with a bright sky behind him.

On a ski trip in Switzerland. Photo: Eugenio de Hostos.

How would you describe your role? I lead our work on early-stage research and development (R&D) projects and build a pipeline of R&D opportunities.

Do you have any pets? My daughter has five fish in an aquarium. She outsources taking care of them to me.

What is one of your favorite sayings? The more you try to do, the more you actually do.

Who is one of your heroes? Albert Schweitzer, a French-German philosopher and physician. I am inspired by his selfless dedication to helping the sick and neglected, far away from his own home and in a time when few others cared about these things.

What was the last book you read? Lost City of Z by David Grann.

What do you like most about your job? The mission, the variety of things I get to do, and the opportunity to interact with a lot of interesting people.

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Oxygen for the most vulnerable: WFSA supports advocacy initiative

This post originally appeared on the World Federation of Societies of Anaesthesiologists (WFSA) blog.

We need to make this essential medicine available, affordable, and accessible so anaesthesiologists can work as safely and effectively as possible.

Consider a hospital and consider the patients. A child at the facility is suffering with pneumonia, while an elderly man has an exacerbation of chronic obstructed lung disease after his hernia operation. A woman struggles with acute bronchitis on top of a baseline lung disease, and a teenager arrives at the emergency department with abdominal wounds. What do all of these patients have in common? They are all going to need oxygen, because oxygen is an essential and lifesaving medicine.

But what happens when it’s not available? Continue reading »

Witness DREAMS in Kenya

By Heather Kelly, senior program officer, PATH, and Erika Amaya, digital communications officer, PATH

PATH staff gather together in the Kisumu, Kenya office.

PATH staff from the Drug Development, Reproductive Health, and Kenya country programs meet to discuss progress on DREAMS implementation. Left to right: Ellen MacLachlan, Jennifer Moronge, Oluoch Madiang’, Lovena Owuor, Juma Mwatsefu, Francis Onyango, Daniel Okumu, and Heather Kelly. Photo: PATH/Heather Kelly.

Heather Kelly, senior program officer for the Drug Development program, and Ellen MacLachlan, senior research officer with the Reproductive Health program, recently visited with Kenya-based PATH colleagues working on the rollout and implementation of DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women), an ambitious partnership aimed at reducing HIV infections among adolescent girls and young women.* At the PATH office in the Western Kenyan city of Kisumu, Heather and Ellen had the opportunity to learn about progress on DREAMS, as well as the challenges and opportunities that lie ahead. Heather sat down with us to share highlights from the visit.

What prompted the visit to Kenya?

This was an opportunity to meet with our Kenya colleagues and discuss the multifaceted implementation of DREAMS, work that is funded through a PATH-led project called APHIAplus Western (short for AIDS, Population, and Health Integrated Assistance Zone 1). We came to this from the perspective of wanting to know what the learnings and challenges have been so far and also initiating discussions about building on DREAMS to integrate HIV prevention and reproductive health services for high-risk women and girls. We were particularly interested in learning about the rollout of oral pre-exposure prophylaxis (PrEP), which is a component of the DREAMS project. PrEP is an innovation in HIV prevention, and its use in developing countries is new. DREAMS is a great opportunity to see how PrEP works in real life with real people.

In safe spaces created by DREAMS, participants can access information, biomedical services, and a range of resources for training, education, and health. Photo: PATH/Oluoch Madiang’.

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Make handwashing a habit to prevent diarrhea… and grow taller, too

By Michael Arndt, Research Fellow, PATH, Hope Randall, Digital Communications Officer, PATH

This post originally appeared on the DefeatDD Blog

A child gets weighed with clinic staff looking on

Photo: PATH/Gabe Bienczycki.

You might know that handwashing makes a huge impact when it comes to preventing diarrhea: if everyone made handwashing a habit, diarrhea risk would drop by nearly half! But did you know that good handwashing and hygiene habits can also help children reach their full growth and cognitive potential?

Long-term low-level gut damage, called environmental enteric dysfunction (EED), is an issue that brings WASH, nutrition, vaccine communities together to underscore the importance of a multifaceted approach to defeat the vicious cycle of malnutrition and diarrheal disease and help children grow healthy and strong.

We talked with EED expert and PATH research fellow Michael Arndt to shed some light on these seemingly unlikely connections.

First, tell us a little about yourself. How did you become interested in gut health?

When I came to the University of Washington in 2010, I worked with Dr. Judd Walson, who was running a clinical trial of empiric deworming to delay HIV disease progression in Kenyan adults. I learned a great deal about the immunological effects of soil-transmitted helminths from my master’s thesis and was introduced to the concept of environmental enteric dysfunction (EED) while working on a project for the UW Department of Global Health Strategic Analysis, Research, & Training (START) Center. EED seemed to have such widespread impacts on child health, and there were many unanswered questions.

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Taking parasitic worms out of childhood

What it takes to nurture growing bodies—not tiny predators.

By Dr. Laurence Slutsker, Director of Malaria and Neglected Tropical Diseases programs, PATH

This post originally appeared on the PATH Blog

A young child stands at the front of a gathering of women and children

Soil-transmitted helminth infections are one of many neglected tropical diseases. Photo: PATH/Gabe Bienczycki.

Growing children already have a big job to do: fight disease, grow long bones and strong muscles, and build the sharp minds they’ll need to be teachers, leaders, and possibly parents someday.

Yet worldwide, many little bodies are being held back by supporting parasitic worms.

Imagine a child with two plates to fill—and only enough food for one. Intestinal worms, or helminths, are small thieves that do big harm. They sap the blood and nutrients bodies need to stay strong. They leave children too tired to learn in school and play at home. And they open the door to other diseases.

At PATH, my team, like parents and teachers worldwide, know that’s unacceptable.

The good news? Helminths can be stopped. PATH is working with countries and partners worldwide to turn up the heat on these unwelcome guests: finding the best ways to deploy the worm-fighting tools we already have, advancing new tools, and tackling the root causes of infection so that children and communities can thrive.

The sanitation connection

Children filling buckets at a waterpump

Photo: PATH/Satvir Malhotra.

Soil-transmitted helminths (STHs), especially roundworm, whipworm, and hookworm, are a fact of life for billions of people—almost all of them in communities with very few resources. The World Health Organization estimates that STH infections affect 1.5 billon people—nearly a quarter of the world’s population. Globally, an estimated 880 million children are in need of treatment. Continue reading »

PATH in San Francisco, Lauren Hodsdon

Lauren in Old Delhi, India

Lauren in Old Delhi, India. Photo: Lauren Hodsdon.

PATH’s team in San Francisco works to advance global health innovations to improve the lives of women and children, primarily through our work in drug development. In this post, we learn more about Lauren Hodsdon, who interned with our philanthropic development team in San Francisco.

What did you work on during your internship? I worked on a research project to explore donor-advised funds and the opportunity for PATH to take advantage of their growth. My recommendations include best practices for approaching this type of donor, and part of my research weighed the question of whether PATH itself should become a sponsor organization for a donor-advised fund.

Do you have any hidden talents? I used to be a musical theater actress and worked for Disney Cruise Line as a performer for about eight months down in the Bahamas. I’m not supposed to say which princess or villain I played; you’ll have to guess.

What is your proudest accomplishment? Getting into the Masters in Public Health program at Boston University. Early on in elementary school, I was diagnosed with two learning disabilities, and I have made it a life goal to show others with dyslexia and attention deficit disorder that these disabilities are not defining or restrictive.

What was the last experience that made you a stronger person? When I got dengue fever while working in India. I’m not sure if it made me stronger, but it allowed me to experience the Indian health care system firsthand and helped me understand how persistent one must be to avoid mosquito-borne diseases.

What was the last book you read? Doing Good Better, by William MacAskill, on effective altruism.

What are your hobbies? I grew up sailing on the San Francisco Bay with my parents and two sisters. My parents now live in Santa Cruz, and when we’re all together, we’ll take a boat out to sail on Monterey Bay.

Which words or phrases do you most overuse? The word “totally,” mostly used in a sarcastic sense, but I’m starting to worry it’s slipping into my legitimate verbiage.

Interested in interning with us? PATH values the ability to contribute to the development of future leaders in international global health. Our internships offer a variety of educational experiences and learning opportunities that embody our vision: a world where innovation ensures that health is within reach for everyone. Learn more about what opportunities exist across our global programs by visiting our careers website.