Charles Knirsch, VP of Clinical Affairs and ID Disease Area Lead at Pfizer, explains why eliminating trachoma by 2020 is a realistic goal, yet the elimination of malaria is not currently a viable strategy.
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Charles Knirsch: Personally I’d like to see progress in infectious diseases. HIV is still a raging pandemic. Now, it’s not thought about as much, in a developed world, because in many pharma and public partnerships working with the NIH, and other public entities, we now have turned HIV, in the developed world, into a chronic disease. It is very treatable, not with optimal medicines, so we still have room to go, but the largest part of the planet with HIV, until recently, had no access. And now we’re making great strides with the Global Fund [to Fight AIDS, Tuberculosis and Malaria], PEPFAR [the US President's Emergency Plan for AIDS Relief], other programs that originated out of pharma, to get into some of the issues around access so But there are two, three, four, five after HIV, so tuberculosis, malaria, acute respiratory infections in children, etc., that really deserve as much attention, I think, as HIV. So I wouldn’t want to say one thing, I would say let’s have a grander vision and tackle the top ten, at least the top ten. Trachoma is a historical disease. It’s mentioned in a Greek Papyri and it’s actually mentioned in the bible, and it was in the U.S., in Appalachia and on Indian reservations. After the battle of the Nile, when basically Nelson sank the French fleet, the returning navy and soldiers brought trachoma to Europe. So this has been a disease in the developed world. But with improved sanitation, the disease has gone away, and actually made it on the Indian reservations with some mass antibiotics. So, until the poverty agenda in the north-south divide is really solved, trachoma is going to be a disease that requires other modalities, including antibiotic treatment. But, again, I believe that with the current mobilization that the disease is within reach. Trachoma is caused by a bacteria. It’s usually crowded and poor conditions and with repeated infections of the eyes, scarring occurs over many years that lead to blindness. Malaria is a mosquito transmitted disease and actually, again, the south all the way up to Washington in this country was endemic from malaria. But today 90% of malaria and malaria deaths are in sub-Saharan Africa. And, again, the parasites have the advantage because of their sheer numbers and replication, and that they’ve become quickly resistant to many of the available drugs. I believe, with trachoma, that the global elimination of trachoma is within reach by about the year 2020, and that is our goal. I’m going to the World Health Organization tomorrow evening to be part of that annual meeting. That program is being linked with other neglected tropical disease programs that, again, many people in the field have been working on it. But for about 50 cents a year, with four or five already approved medicines, we can look at eight or nine neglected tropical diseases and imagine, and actually set metrics around the elimination. That’s different from diseases like malaria where, frankly, resistance is some of the biggest concern. And we really do need a full pipeline, from early discovery to full development, to address the continuing evolution of resistance of the parasites have the advantage. There will always be in need for new therapeutics until we eliminate malaria, but I don’t see elimination as a real viable strategy from where we are right now.

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