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REPORT 9TH MEETING OF THE REGIONAL NETWORK FOR ASIAN SCHISTOSOMIASIS AND OTHER HELMINTH ZOONOSES Vientiane, Lao People's Democratic Republic 19-20 October 2009
Manila, Philippines November 2009
REPORT 9TH MEETING OF THE REGIONAL NETWORK FOR ASIAN SCHISTOSOMIASIS AND OTHER HELMINTH ZOONOSES
Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC And REGIONAL NETWORK FOR ASIAN SCHISTOSOMIASIS AND OTHER HELMINTH ZOONOSES Vientiane, Lao People's Democratic Republic 19-20 October 2009-11-12
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines November 2009
NOTE The views expressed in this report are those of the participants in the 9th Meeting of the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses and do not necessarily reflect the policies of the Organization.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Members States in the Region and for those who participated in the 9th Meeting of the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses, which was held in Vientiane, the Lao People's Democratic Republic, from 19 to 20 October 2009.
Acknowledgement This meeting report was developed by the World Health Organization Regional Office of the Western Pacific in collaboration with the Regional Network for Asian Schistosomiasis and other Helminth Zoonoses.
Table of Contents List of acronyms ....................................................................................................................................................i SUMMARY.......................................................................................................................................................... ii 1. INTRODUCTION ...........................................................................................................................................1 1.1 Objectives………………………………………………………………………… ……………………1 1.2 Opening remarks………………………………………………………………………………………1 2. PROCEEDINGS..............................................................................................................................................2 2.1 Objectives and expected outcomes of the meeting ................................................................................ 2 2.2 Updates on the RNAS+ ............................................................................................................................ 2 2.3 Draft WHO regional research strategic plan for communicable diseases, including neglected tropical diseases....................................................................................................................... 5 2.4 Workshop I: Aligning the RNAS+ research agenda with the draft WHO regional research strategic plan for neglected tropical diseases: Review of nine outcomes of the strategic plan ............................................................................................................................................9 2.5 RNAS+ Annual Board Meeting ............................................................................................................13 2.6 Workshop II: Workgroup discussion to identify issues and operational research priorities..........15 2.7 Roundtable discussion: Brainstorming on roles of the RNAS+ in contributing to the development of the research agenda for NTDs in Asia.......................................................................32 2.8 RNAS+ Business Meeting 2009 .............................................................................................................36 2.9 Closing ceremony ...................................................................................................................................37
ANNEXES ANNEX 1: 9th RNAS+ meeting agenda...............................................................................................................a ANNEX 2: 9th RNAS+ meeting participant list................................................................................................. d ANNEX 3: Welcome remarks by Dr Samlane Phompida, Director, Center of Malariology, Parasitology and Entomology, Ministry of Health, Lao People's Democratic Republic, at the opening ceremony………………………………………………………………………………………………………….g ANNEX 4 : Welcome remarks by Dr Remigio Olveda, Outgoing President RNAS+, at the opening ceremony................................................................................................................................................................h ANNEX 5: Welcome remarks by Dr John Patrick Ehrenberg, Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases, WHO Regional Office of the Western Pacific, at the opening ceremony………………………………………………………………………………………………………….i ANNEX 6: Complete revised version: Log frame of the draft WHO regional research strategic plan for communicable diseases, including neglected tropical diseases……………………………………… ……….k
ANNEX 7 : Concluding remarks by Dr Remigio Olveda, Outgoing President RNAS+, at the closing ceremony...............................................................................................................................................................dd
List of Acronyms ADB APEC ASEAN BCC CDs CDC CLTS DALY DBL DDIA DEC ELISA ER FBT GIS HINARI HIV/AIDS ICT IEC ILRI LF LQAS MDA MDGs MVP NGO NIH NTDs PCR RNAS+ RS SLU STAG STH STI TB TDR WHO YLD YLL Asian Development Bank Asia-Pacific Economic Cooperation Association of Southeast Asian Nations Behavior-change communication Communicable diseases Centers for Disease Control and Prevention (USA) Community-led total sanitation Disability-adjusted life year Danish Bilharziasis Laboratory Dipstick dye immunoassay Disease-endemic countries Enzyme-linked immunosorbent assay Expected result Foodborne trematode Geographic information system The Access to Research Initiative (WHO) Human immunodeficiency virus/acquired immune deficiency syndrome Information and communication technology Information, education and communication International Livestock Research Institute Lymphatic filariasis Lot quality assurance sampling Mass drug administration Millennium Development Goals Malaria, Other Vectorborne and Other Parasitic Diseases Unit of WHO Nongovernmental organization National Institutes of Health (United States) Neglected tropical diseases Polymerase chain reaction Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses Remote sensing Swedish University of Agricultural Sciences Strategic technical advisory group Soil-transmitted helminths Swiss Tropical Institute Tuberculosis Special Programme for Research and Training in Tropical Diseases World Health Organization Years lived with disability Years of life lost
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SUMMARY The 9th Meeting of the Regional Network for Asian Schistosomiasis and other Helminth Zoonoses (RNAS+) was held on 19-20 October, 2009, at the Don Chan Palace Hotel in Vientiane, the Lao People’s Democratic Republic. It was hosted by the WHO Regional Office for the Western Pacific and the RNAS+. Over 40 participants from both the academic and public health sectors attended, representing a number of research institutions, ministries of health and international organizations. A full list of participants as well as the agenda are attached (see Annexes 1 and 2). Dr Samlane Phompida, Director of the Center for Malariology, Parasitology and Entomology, gave the first welcome remarks. He thanked WHO for organizing the consultation in the Lao People’s Democratic Republic and highlighted that neglected tropical diseases (NTDs) are a significant burden to the country. He also highlighted the importance of the meeting to operational research in filling programmatic gaps. Welcome remarks were also given by Dr Remigio Olveda, chairman of the RNAS+ and Director IV of the Research Institute for Tropical Medicine, and Dr John Ehrenberg, Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases at the WHO Regional Office. Dr Remigio Olveda outlined the objectives and expected outcomes of the meeting. Dr Zhou Xiaonong, the incoming RNAS+ chairman and Deputy Director of the National Institute of Parasitic Diseases, gave a presentation on the history and development of the RNAS+, as well as its recent achievements. One of the Network's most recent achievements includes being featured in a 2008 volume of Parasitology International in an opening editorial; the volume also included six papers by members of the Network. Additionally, Dr Zhou also gave some highlights from the Expert Meeting on Foodborne Trematode Infections and Taeniasis/Cysticercosis, held on 12-16 October 2009. Dr Ehrenberg gave the second presentation on the draft WHO regional research strategic plan for communicable diseases, including neglected tropical diseases. He commended the achievements of the RNAS+ and highlighted the importance of the Network as a country-driven initiative. He pointed out that development in any country cannot be conceived without scientific development and that there is a need to promote the link between the public and academic sectors. The first version of the draft plan was drafted in December 2007, the overall goal being "to contribute to the achievement of the Millennium Development Goals (MDGs) through research and development to reduce burden of communicable disease". The regional objective is "to reduce the burden from parasitic, vectorborne diseases (including NTDs) and TB in the Western Pacific Region by applying research and development, technology transfer and capacity strengthening." The expected results of the plan include components such as strengthening research capacity; knowledge generation; the development and improvement of new and existing tools, the development of evidence-based and cost-effective strategies; and key stakeholders' engagement in regional research agenda and priorities. The plan promotes the use of operational research to fill programmatic gaps and will also be an important tool in resource mobilization. Dr Ehrenberg also mentioned the potential future success of the research strategic plan because of parallel successes that the WHO Regional Office for the Western Pacific has had with the official endorsement of the malaria and dengue plans of action, each of which include research components. The Regional Office is now working on an NTD plan of action that will also include a research component. After the opening ceremony and presentations, participants split into working groups to review and refine the nine outcomes in the log frame of the draft WHO regional research strategic plan of action and to align the RNAS+ research agenda with the plan. Working Group 1 reviewed Expected Result (ER) 1: Applied and operational research capacity of
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existing academic/research institutions and programmes in Member States enhanced; ER 2: New knowledge for effective control of communicable diseases generated (biomedical, epidemiological, social, behavioural, economic, health systems, etc.); and ER 3: Burden of disease estimated. Major highlights of Working Group 1 changes include changing the title of ER 2 to "Improvement and generation of biomedical, social economic, health systems, behavioural and epidemiological knowledge for effective control of communicable diseases" and ER 3 to "Regional burden of communicable diseases, including NTDs, estimated and regularly updated. Working Group 2 reviewed ER 6: New, evidence-based, cost-effective strategies developed for implementation, and ER 7: Improved mechanisms for sharing and dissemination of research findings and technical research guidelines. One of the major changes Working Group 2 made was changing activity 7.4 to "Conduct national, provincial and local workshops to ensure that evidencebased research and policy is translated into public health practice". Working Group 3 reviewed ER 4: Disease-specific regional research plans developed, and ER 5: New tools developed and existing tools improved. Major changes in Working Group 3 were made to ER 5. Working Group 4 reviewed ER 8: Key decision-makers, stakeholders and donors engaged in regional health research agenda and research priorities, and ER 9: Research findings are translated into programmes and action. A highlight of the changes made in Working Group 4 includes changing the title of ER 9 to "Integration of new evidence-based tools and strategies developed (ER 5 and 6), promoted and supported into existing health systems or population based interventions". During Plenary Session I, the rapporteur from each working group presented changes made to the log frame. The second day started with two presentations given by Dr John Ehrenberg:Brief introduction of issues and research priorities; and Multi-disease, intersectoral NTD prevention and control strategies. The first presentation highlighted the key research priorities and research topics that were identified by the Neglected Tropical Diseases Scientific Technical Advisory Group (NTD STAG) in 2007. The five key areas of research priorities are: 1. Burden and economic impact of NTDs; 2. Pharmacovigilance and surveillance; 3. Epidemiology and public health; 4. Health economics and comparative cost and cost-effectiveness; and 5. Interactions of NTDs with HIV/AIDS, malaria and TB. The MVP unit of the WHO Regional Office for the Western Pacific, headed by Dr Ehrenberg, also did an internal analysis on these issues and identified where they could be inserted into the unit's research agenda. The second presentation served as an entry-point into the discussions in Workshop II on the development of a multisectoral proposal. The presentation outlined a few of the expected results and the activities under the results of the WHO regional plan of action for NTDs that are related to multisectoral and inter-programmatic interventions. These include ER 1: Global framework for integrated approach adapted to the Western Pacific Region, and ER 4: Intersectoral coordination mechanisms established. Dr Ehrenberg then gave some suggestions for the group on how to get started by giving examples of justifications, expected results and indicators. The participants then broke up into five working groups to develop five concept proposals. Group 1 developed a proposal on a model of integrated multisectoral control of NTDs, the objective being to develop a sustainable mutlisectoral, integrated control package for NTDs at the national and sub-national (e.g. high-risk populations) levels. Group 2 drew up a proposal for diagnostics, treatment and vaccine development. The concept of this proposal is that a vaccine placed in the control programme will be essential in the elimination of a particular parasitic disease, but in combination with other control methods, including treatment, targeted use of molluscicides, improved sanitation, and health education. Group 3 developed a proposal for risk mapping of FBT in Southeast Asia using rapid epidemiological assessment. The objective of this proposal is to produce transmission-risk maps for FBT (clonorchiasis, opisthorchiasis, paragonimiasis, intestinal trematodiasis, taeniasis/cysticercosis), using existing data
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where available. Group 4 developed a proposal for the integration of large-scale distribution of praziquantel with control interventions against STH infections in an area with multiple co-endemicity of helminth infections. The objectives of this proposal are to assess the feasibility of the integrated approach from a logistical and managerial perspective, and to assess the impact of the large-scale distribution of praziquantel on opisthorchiasis, and taeniasis/cysticercosis. Group 5 developed a proposal to study the impact of community-led total sanitation (CLTS) on helminth transmission. The objective of the CLTS proposal is to measure the added benefits and costs of instituting CLTS in conjunction with preventative chemotherapy for helminthiases control (+/protozoal and diarrhoeal diseases). During Plenary Session II, a representative from each of the working groups presented their proposals, and feedback and suggestions were received from the other participants. Following Plenary Session II, there was a roundtable discussion on the strengths, weaknesses, opportunities, roles, challenges and future plans of the RNAS+. In his remarks during the closing session, Dr Ehrenberg thanked those present for attending the meeting and expressed his wish to continue working with all the participants in the future. Dr Olveda concluded the meeting by giving a short outline of what had been achieved over the two days, and expressed his happiness with the outcomes of the meeting. He thanked WHO for the help given in organizing the meeting and thanked all the participants for attending.
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1. INTRODUCTION The Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+) was started in 2000 as a small schistosomiasis action network in core endemic areas. The Network now operates in nine countries and targets several helminth diseases in addition to schistosomiasis. The RNAS+ vision is to become the recognized platform for evidence-based information and intersectoral communication in order to bridge the gap between research scientists and control authorities for the prevention of neglected helminth diseases in south-east Asia. The Network has an impressive number of accomplishments in the research and control of schistosomiasis and other neglected parasitic diseases. Representatives of member countries and collaborating international organizations and networks meet every year to share information on research, control strategies and prevention regarding their specific diseases. With various types of support from different donor agencies and local health departments, RNAS+ has been able to meet every year for the last 10 years to discuss these topics. The proceedings from these meetings are published on the RNAS+ website. One of the key challenges in combating schistosomiasis and other neglected parasitic diseases is to strategically link research with disease control activities. Operational research in developing countries is needed to help fill programmatic gaps. The WHO Regional Office for the Western Pacific has developed a draft regional research strategic plan targeting focus diseases of the Special Programme for Research and Training in Tropical Diseases (TDR), such as neglected tropical diseases (NTDs), malaria and tuberculosis. Several RNAS+ members participated in the process of drafting the plan. This plan is expected to contribute to strengthening the capacity of developing countries in the Region to undertake research. The vision of RNAS+ is fully compatible with the WHO research strategic plan, as well as with TDR's global vision. In 2009, RNAS+ and the Malaria, other Vectorborne and other Parasitic Diseases Unit (MVP) of the WHO Regional Office for the Western Pacific have joined efforts in order to strengthen research capacity in the Region by analysing new ways of developing the research agenda for NTDs in Asia, to be discussed during the 2009 meeting. 1.1 Objectives
The 9th RNAS+ meeting was held in Vientiane, the Lao People’s Democratic Republic, from October 19-20, 2009, with the following objectives: (1) to refine and update the draft WHO regional research strategic plan; (2) to identify issues and operational research priorities that address key programmatic gaps in research areas of RNAS+'s target diseases; and (3) to reassess the roles of RNAS+ and define its strategies and future plans in contributing to the development of the research agenda for neglected tropical diseases in Asia. 1.2 Opening remarks
At the opening ceremony participants were welcomed by Dr Samlane Phompida DirectorCenter of Malariology, Parasitology and EntomologyMinistry of Health Lao People's Democratic Republic; Dr Remigio Olveda, Outgoing President RNAS+; andDr John Patrick Ehrenberg, Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases, WHO Regional Office of the Western Pacific (see Annexes 3-5).
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2. 2.1
PROCEEDINGS
Objectives and expected outcomes of the meeting Dr Remigio Olveda Outgoing President RNAS+,
Dr Olveda explained the objectives of the meeting to the participants and outlined the expected outcomes. Although initially concerned only with schistosomiasis, RNAS+ has expanded its area of interest to include other neglected tropical diseases, making the Network stronger and more attractive to sources of funding. He stressed the meeting’s importance in aligning RNAS+ activities with those of TDR and the WHO Regional Office. Participants would look at the outcomes and activities contained in the draft WHO regional research strategic plan and discuss how RNAS+ activities could fit into the plan. They would then discuss how to refine the outcomes and activities and develop concept proposals as to how they could be put into reality. The expertise of RNAS+ members would be very important in refining the draft strategic plan and reviewing the outcomes and indicators and the RNAS+ contribution, which would help in generating future funds for the Network. 2.2 Updates on the RNAS+ Dr Zhou Xiaonong RNAS+ Member Deputy Director, National Institute of Parasitic Diseases Chinese Center for Diseases Control and Prevention
2.2.1 History of the RNAS+ The Regional Network for Asian Schistosomiasis started in 2000 between the Philippines and China. There are now nine countries involved in the Network and this meeting the 9th meeting of the Network. 2.2.2 The three stages of RNAS+ development Stage 1: The first stage was the initiative stage of RNAS. The Network established communication among scientists doing research on Schistosoma japonicum by setting up a network homepage and exchanging information between Chinese and Philippine scientists through regular scientific meetings. They also shared technologies and experiences in diagnosis, surveillance and control strategies. The first RNAS meeting was in the Philippines, with only about 12 participants. Stage 2: In the second stage, the RNAS received a grant from TDR to support the strengthening of the Network. At that time, the first objectives of the Network were to strengthen communication among scientists working on Asian schistosomiasis, which includes Schistosoma japonicum and mekongi, through the RNAS. The second objective was to share the development of technologies for diagnosis and surveys of Asian schistosomiasis through cooperation, research activities, and training activities in endemic areas.
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During this stage, the RNAS achieved a lot. For example, the Network received two grants from TDR, under the leadership of Dr Feng Zheng, the first chairman of the RNAS, and Dr Remigio Olveda, the co-chairperson at that time. The Network also received additional funding from TDR. Records of RNAS meetings over the past nine years illustrate significant growth. The Network started out in two countries and involved six institutions; it has now grown to nine countries, with over 20 international institutions involved. Current activities now mainly facilitate the communication of knowledge concerning Asian schistosomiasis, as well as other helminths. The Network provides direct scientific and operational exchange, as well as cooperation at the regional level, and allows for the sharing of technologies for surveillance, prevention and control. In addition to meetings, the RNAS+ has also held a number of successful training courses. One was a training course on the geographic information system (GIS), held in the Philippines in 2006, during which participants produced a risk map for the Philippines, using NDI modeling. There were more than 10 local participants and another 10 international participants and scientists involved in the training course. Some RNAS achievements include the dipstick dye immunoassay (DDIA) immunodiagnostic kit for animal schistosomiasis diagnostics and standardization of ultrasonography protocols. The DDIA kit is now used in Cambodia and the Lao People’s Democratic Republic, as well as in Egypt in 2004. The standardization of ultrasonography protocols was led by Dr Hatz from STI, and was accepted by WHO/TDR. Stage 3: The third stage of the RNAS was the transition stage. This particular stage started in 2006 because one of the suggestions from the 6th RNAS meeting in Bali, Indonesia, was to expand the Network to include other helminthes and to become the RNAS+. Currently, in addition to schistosomiasis, the Network also includes cysticercosis, clonorchiasis, opisthorchiasis, fascioliasis, and other important helminth zoonoses. The countries later included were Japan, the Republic of Korea, Thailand and Viet Nam. The tasks undertaken by the RNAS+ were also expanded to include training, GIS mapping and advocacy. The organization also decided to become more formal compared with previous stages. The secretariat currently sits in the Research Institute of Tropical Medicine in the Philippines, to facilitate communication as well as secure funding, and the board of the secretariat was also set up. The RNAS+ holds an annual board meeting, during which an individual from one of the Network's member countries is elected as chairperson and serves a term of two years. The Network also has a team of coordinating officers based in the same country as the chairperson. Currently, the chairperson is Dr Olveda, the vice-chairperson is Dr Zhou, and there are coordinators from Cambodia, China, Indonesia, the Lao People’s Democratic Republic and the Philippines. The group also has a number of international partners, including from the Danish Bilharziasis Laboratory (DBL), the Swedish University of Agricultural Sciences (SLU), and the International Livestock Research Institute (ILRI), and a WHO representative from the Western Pacific Region. All previous meeting proceedings, photographs and records are published on the RNAS+ website at http://www.rnas.org.cn/. The RNAS+ is supported by a number of international institutions, particularly the Queensland Institute of Medical Research (QIMR) in Australia, the Danish Bilharziasis Laboratory (DBL) in Denmark, and the Swiss Tropical Institute (STI) in Switzerland. The RNAS+ also receives support from the WHO Regional Offices for the Western Pacific and South-East Asia.
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A recent achievement of the RNAS+ was a special publication highlighting the Network in the journal Parasitology International in a paper entitled "RNAS: A win-win collaboration for the Regional Network". The journal also published six papers written by members of the Network in the same volume. The list of publications is as follows: Leonardo LR, et al. Prevalence survey of schistosomiasis in Mindanao and the Visayas, the Philippines. Parasitology International, 2008. Conlan J, et al. A review of taeniasis and cysticercosis in the Lao People's Democratic Republic. Parasitology International, 2008. Attwood SW, et al. The distribution of Mekong schistosomiasis, past and future: preliminary indications from an analysis of genetic variation in the intermediate host. Parasitology International, 2008. Wu XH, et al. Effect of floods on the transmission of schistosomiasis in the Yangtze River valley, People‘s Republic of China. Parasitology International, 2008. Garjito TA, et al. Schistosomiasis in Indonesia: past and present. Parasitology International, 2008. Lin DD, et al. Routine Kato–Katz technique underestimates the prevalence of Schistosoma japonicum: a case study in an endemic area of the People's Republic of China. Parasitology International, 2008. In addition to journal articles, the RNAS+ also recently published a book entitled Important Helminth Infections in Southeast Asia, and publishes brochures as part of its advocacy activities. In summary, the Network focuses its main activities on control activities supported by research and surveillance activities. It also tries to support and strengthen the regional platform infrastructure to link together more cooperation by using members' expertise and facilities in the Region, and focus on training and GIS mapping, as well as advocacy. 2.2.3 Highlights of the Expert Meeting on FBT Infections and Taeniasis/Cysticercosis On behalf of the RNAS group, Dr Zhou attended the Expert Meeting on FBT infections and taeniasis and cysticercosis. The final recommendations from that meeting mainly focused on disease control and research, which are consistent with the RNAS+ objectives. Several of the recommendations focus on disease control, policy and health services, health promotion, and optimal use and sharing of resources. This raises the possibility of RNAS+ members sharing information on these topics, particularly on disease-specific action, comprehension and validation of risk maps managed by small integrated working groups, and rapid assessments. It was suggested that the risk maps and rapid assessments recommended by the FBT meeting be coordinated through the RNAS+. All participants from the FBT meeting agreed to assign the job to the RNAS+. Additionally there are other activities to which the RNAS+ can lend its expertise, particularly in research targeting mapping on distribution of snails, fish and crab intermediate hosts, and also on LQAS versus traditional sampling methods. For example, the Network could do a comparison of clonorchiasis and opisthorchiasis and the role of other hosts in the potential transmission of these two diseases. The RNAS+ may also help in comparing the efficiency and safety of praziquantel versus niclosamide for treatment of taeniasis. A saying by one of the RNAS+ members, Dr Arve Lee Willingham, nicely summarizes the three stages of the Network: Coming together is a beginning. Keeping together is progress. And working together is success.
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2.3
Draft WHO regional research strategic plan for communicable diseases, including neglected tropical diseases Dr John Patrick Ehrenberg Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases, WHO Regional Office of the Western Pacific
2.3.1 Work of the RNAS+ The work of the RNAS+ has been very impressive and progress has been significant over the past several years in reaching the 9th RNAS+ meeting. The achievements speak very highly of the Network and of its extremely proactive members. The Network has been able to do many things without significant funding and that is very important, especially in getting the notice of donors. 2.3.2 NTD work at the WHO Regional Office for the Western Pacific Another positive event is that the Western Pacific Regional Office’s new Regional Director, Dr Shin Young-soo, is a professor who comes from an academic background. Although his field is not communicable diseases, he was, nevertheless, interested in the RNAS+ meeting and understands research and its importance. It is critical that the Network has this important ally inside the organization. On WHO Regional Office website, there are important two documents: the Review on the Epidemiological Profile of Helminthiases and their Control in the Western Pacific Region, 1997-2008, which was published on the website in 2008; and report of the First Mekongplus Programme Managers Workshop on Lymphatic Filariasis and other Helminthiases, published in 2009. The workshop was the first joint LF and STH meeting of programme managers, who provided official reports on the status of helminths in the Mekong-plus countries. It included Mongolia, the first time that the country was invited to participate in such an event. Echinococcosis is a serious problem in Mongolia, as it is in some parts of China, and even in Australia. These two documents are very important because it is the first time any region has had a database, whether good or bad, of the problem posed by NTDs, and they contain is very valuable information. When researchers take a look at these documents they can see where the information gaps and the operational research needs are. 2.3.3 Challenges and opportunities in research Development in any country cannot be conceived without scientific development. Research and development are key and should not be limited to only wealthy countries. Wealthy countries carry a heavy responsibility to promote research and development in less-developed countries. This is important because, when trying to sell the concept of research, it has to be placed under some sort o roof; clearly, a roof of development fits. This has implications for resource mobilization and, when trying to sell the concept of increasing resources for research, this needs to also be considered as a development issue. There is a great need to promote the link between the public and the academic sectors, and here the RNAS+ has already established a very good platform for this to happen. Present in the meeting are some key leading researchers in their different fields of communicable diseases. There are also programme managers who can exchange information as to the needs are for these programmes, which helps researchers to focus on these and to anchor their approach. Another issue is funding, which is a key challenge. Funds are critical and it is the task of WHO and TDR to come up with innovative mechanisms that mean less reliance on and competition for external funding from the usual funding sources, such as the Bill and Melinda Gates Foundation, the MacArthur Foundation, the United Kingdom Department
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for International Development, etc., and more on those that are actually available incountry. Ministries of science and technology play a critical role here, and WHO is now starting to take a look at the role of the such ministries or the national councils for technology. 2.3.4 Research agenda and work of MVP When Dr Ehrenberg joined the WHO Regional Office for the Western Pacific in 2007, the research portfolio of the unit he coordinates (the Malaria, other Vector-borne and other Parasitic diseases unit - MVP) was rather modest. They had the TDR small-scale grants programme and the TDR had been a very close partner of countries and of WHO throughout its history. The TDR has a tremendous record in strengthening research and promoting development throughout the developing world. Loyal to this tradition, they have supported the Region with TDR small-scale grants, which are small grants in the order of US$ 10 000-US$ 15 000. In 2007, they also had hypovalidation of MDA STH and a number of programmes in the area of malaria. Malaria was by far the most active programme in 2007. The MVP unit has four programmes, including malaria and dengue, but, because there are always critical issues regarding malaria and dengue, other tropical diseases and research are neglected. A wide range of issues continue to be the focus of research in the MVP unit. Even although WHO is not an implementing agency or in the academic sector, it is very much involved in research activities, particularly for malaria. By 2009, the TDR small-grants portfolio had grown slightly. MVP started off with US$ 50 000 and ended up with US$ 70 000. A research component had also been finalized and incorporated into the Malaria Regional Plan of Action. This malaria plan has a very prominent research component within it, and the same was done for dengue. The dengue plan was developed as a biregional plan and was endorsed by the WHO Regional Committees for the Western Pacific and South-East Asia in 2008. It also contains a clearly defined research component. Even although this is not directly under the radar of the RNAS+, it highlights that these two plans of action were developed using the same methodology that is now being employed for the research plan. The plans for dengue and malaria, including the research components that are included and are very prominent, were brought to the attention of the ministries of health and were endorsed. MVP has also developed a Communicable Diseases Research Plan of Action, in which several of the meeting participants were involved, and they are now working on developing one for NTDs. Although it is still in the development phase, MVP would like to take the two plans to the Regional Committees for the Western Pacific and South-East Asia for endorsement. The research component encompasses the key priorities of research for all individual target diseases. Because TB is a TDR target disease, it is also part of the research agenda. As a result of all these activities, the MVP unit has been able to recruit an additional staff member, Dr Jun Nakagawa. The unit will also be getting a new fellow who will be the third MVP fellow to work on the TDR small-scale grants programme. 2.3.5 TDR's new Ten-Year Vision and Ten-Year Strategy There has been a huge change in the global scenario with stakeholders and partners, and the area of research has been no exception. This has forced TDR to change and so they have come up with their Ten-Year Vision that focuses on diseases of poverty, with NTDs obviously fitting into this category. This is a major achievement, because several of the NTDs that were not necessarily among TDR's target diseases are now included. This also gives regions the flexibility to include other diseases that are of public health importance to that particular region. In the Western Pacific Region, for example,
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foodborne trematodes and cestodes are far more important than in other regions, and so they have been included in the portfolio. There are three key pillars to TDR's Ten-Year Strategy. The first is stewardship for research in infectious diseases of poor populations. The second is empowerment of researchers and public health professionals in disease-endemic countries. This was already part of the 2000-2005 plan of action and it is really raising the profile and the importance of having endemic countries, both institutions as well as researchers, take an active role in conducting operational research. The last is the focus on neglected priorities that are not being addressed adequately by other partners. NTDs are not perceived as profitable by the private sector. They have been neglected by the pharmaceutical companies even although there has been great progres in terms of drug donations from pharmaceutical companies to support these programmes. However, in terms of research and development of new products, there are a number of issues to be considered, as there are shortages of drugs in many cases, not just in the human, but also in the animal health sectors. 2.3.6 Overview of the draft WHO regional research plan of action log frame When MVP started working on the draft plan of action, it was decided that some sort of instrument or tool was needed to try to systematize the work of the research sector in a way that did not seem like an ad hoc exercise driven by crisis situations. For example, the crisis of artemisinin-resistance in malaria on the Thai-Cambodian border drives research agendas, because a lot of support that comes down the pipeline and a lot of it is targeted for research. What MVP was trying to do was form a more systematic approach to research development in the Western Pacific Region by developing the log frame. As the name implies, it systematizes the expected results as a road map and then puts up a series of indicators that help to measure these expected results. This is important because, especially in resource mobilization, donors want to see what you are measuring your impact against, and so the process indicators and the impact indicators are all there. There are nine expected results in the log frame. Their development was the result of an informal consultation, which took place in December 2007 with a group of leading researchers from different fields. Overall goal: The overall goal of the draft plan is "To contribute to the achievement of the MDGs through research and development to reduce the burden due to communicable diseases". This goal broad and does not specifically spell out NTDs. Regional objective: The regional objective is “To reduce the burden from parasitic, vectorborne diseases (including NTDs) and TB in the Western Pacific Region by applying research and development, technology transfer and capacity strengthening”. Malaria is also included and this is one of the key pillars of support for countries in resource-constrained environments. The regional objective indicator is "Demonstrated qualitative and quantitative improvements in programmatic activities attributed to uptake of research findings". This is really the implementation of operational research to fill in programmatic gaps.
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Purpose: The purpose goes down to the level of specific activities and outcomes. The purpose is "To capitalize on the Western Pacific Region's comparative advantage to: 1. foster research, development and evaluation of interventions in real-life settings; 2. strengthen the capacity of disease-endemic countries to undertake the research needed to develop and apply new and improve existing tools and; 3. develop and implement new and improved disease control/elimination strategies". Purpose Indicators: (1) "Number of country programmes with implementation policies based on research findings" - This is very important and is a tricky issue because often policies are not set by ministries of health but by ministries of science and technology. This is why it is so critical to get the ministries of science and technology on board. (2) "Number of countries adopting, incorporating and implementing a national research agenda". – Again, probably several countries in the Western Pacific Region and other parts of the world lack a comprehensive public health research agenda and that is something to be worked on. (3) "Number of research institutions per country who undertake research for disease control/elimination programmes/cost-effective strategies". Expected results: (1) Applied and operational research capacity of existing institutions and programmes in Member States enhanced. academic/research
(2) New knowledge for effective control of communicable diseases generated (biomedical, epidemiological, social, behavioural, economic, health system, etc.) (3) Burden of disease estimated. (This brings in the economic health dimension. There are a lot of issues that have to do with risk-mapping and estimating disease burden, and quantifying problems is critical in resource mobilization. One of the key issues for the RNAS+ is to also come up with a resource mobilization strategy and keep it going, and these types of studies are critical in selling it.) (4) Disease-specific regional research plans developed. (5) New tools developed and existing tools improved. (6) New, evidence-based, cost-effective strategies developed for implementation. (7) Improved mechanisms for sharing and dissemination of research findings and technical research guidelines. (8) Key decision-makers, stakeholders and donors engaged in regional health research agenda and research priorities. (9) Research findings translated into programmes and action. Although many may find this exercise tedious, it is an extremely useful tool. Although this will not be the end of the process, it will have to extend to a couple of other consultations until there is a final product, today's meeting should help in really pushing the Plan forward.
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2.4 Workshop I: Aligning the RNAS+ research agenda with the draft WHO regional research strategic plan on neglected tropical diseases: Review of nine outcomes of the strategic plan During Workshop I participants split into two working groups of about 20 participants each to review and refine the nine outcomes in the log frame of the draft plan of action and to align the RNAS+ research agenda with the plan. For this exercise, working groups had about two hours to look at the title of the expected results, the activities under it, and then the outputs. Titles, activities and outputs were modified and refined as was seen necessary by the members of each working group. During the morning session, working group 1 reviewed expected results (ERs) 1, 2 and 3, while working group 2 reviewed ERs 6 and 7. In the afternoon session, participants again split into two working groups of approximately equal sizes. Working group 3 reviewed ERs 4 and 5 while working group 4 reviewed ERs 8 and 9. Following Workshop I was Plenary Session I, during which the rapporteur from each of the working groups presented the changes made by the working groups to each of the expected results that they had reviewed. After each presentation, other participants were able to give their feedback and suggestions on additional modifications or revisions to the expected results. Highlights of the major changes made to each of the expected results, their activities and the outputs during Workshop 1 follow. Titles of expected results that were changed are highlighted in blue. The completed revised version of the log frame for the plan is attached as Annex 6. 2.4.1 Working Group 1 Facilitator: Dr Albis Gabrielli Rapporteur: Dr Luz Acosta Assistant Rapporteur: Dr Jun Nakagawa Expected Result 1 - Applied and operational research capacity of academic/research institutions and programmes in Member States enhanced. Activities: 1.4 - Activity was incorporated into 1.3 and was deleted as a separate activity. 1.6 - Activity was incorporated into 1.5 and was deleted as a separate activity. Outputs: 1.5 – "Number of scholarships and fellowships per country per year per skill area" was added to include activity 1.6. Expected Result 2 – Improvement and generation of biomedical, social economic, health systems, behavioral and epidemiological knowledge for effective control of communicable diseases. Activities: 2.2 – Changed from "Design multidisciplinary/integrated, interprogrammatic research targeting new methods for controlling communicable diseases" to "Design multidisciplinary research targeting improved and new methods for prevention and control of communicable diseases, including NTDs". existing
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2.3 – Changed from "Conduct multidisciplinary research at appropriate locations" to "Conduct multidisciplinary research targeting improved and new methods for prevention and control of communicable diseases, including NTDs". Outputs: 2.2 – "Library of protocol" and "Workshop reports" were removed and "New research projects embracing a multidisciplinary approach approved for funding" was added. 2.3 – "Sustained funding for research and implementation" and "Improved tools to be used in prevention and control of communicable diseases, including NTDs" were added. 2.4 – "Workshop reports" was removed and "Provide recommendations to be considered for policies (e.g. workshops with service providers and consumers to discuss research findings)" was added. 2.5 – "Listing of partners" was removed and "Partnerships established", "Resources mobilized" and "Synergies harnessed" were added. Expected Result 3 – Regional Burden of communicable diseases, including NTDs, estimated and regularly updated. Activities: 3.1 – Changed from "Set up expert working group" to "Set up regional expert working group in coordination with global initiatives on the burden-of-disease study". 3.2 – Became 3.3 3.3 – Became 3.5 3.4 – Became 3.2 3.5 – Became 3.4 Outputs: 3.5 – Added "Comparative analysis with global estimates". 2.4.2 Working Group 2 Facilitator: Dr Allen Hauquitz Rapporteur: Dr Arve Lee Willingham Assistant Rapporteur: Dr Padmasiri Aratchige Expected Result 6 – New, evidence-based, cost-effective strategies developed for implementation. Activities: 6.2 – Changed from "Develop new and existing strategies for vector control" to "Develop new and improve existing strategies for vector and intermediate host (e.g. animal reservoirs) control." 6.8 - Activity was incorporated into 6.7 and deleted as a separate activity. Outputs: 6.2 – "Natural products for vector and intermediate host control" was added. 6.5 – "Strategies with an emphasis on the role of climate change on NTD disease pattern" was added. 6.10 – "Translation of key research findings" was added. Expected Result 7 - Improved mechanisms for sharing and dissemination of research findings and technical research guidelines among researchers. Activities:
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7.1 – Was changed from "Formalize internal policy to include discussion of research findings in programme managers' meetings and similar venues" to "Establish and conduct regional and national forums to provide opportunities for exchange of information, joint planning and policy creation". 7.4 – Was changed from "Conduct end-user workshops to ensure uptake of information systems" to "Conduct national, provincial and local workshops to ensure that evidencebased research and policy is translated into public health practice". 7.6 – Activity was incorporated into 7.5 and deleted as a separate activity. Outputs: 7.2 – "Technical reports, publications and conference proceedings, etc.", "Newsletters, abstracts sent through email", "Dissemination through WHO pouch or other mechanisms" and "Increased access to TropIKA.net and ACTMalaria website" were added. 7.3 – "Dissemination of research findings". 7.5 – "Medical journals delivered and available in targeted libraries" was changed to "NTD-relevant journals delivered and available in targeted libraries, outputs from 7.6 were added, and "Updated WHO regional platform such as the Western Pacific Regional Index Medicus" and "Access to e-libraries at WHO Offices (HINARI)" were added. 2.4.3 Working Group 3 Facilitator: Dr Jurg Utzinger Rapporteur: Dr Muth Sinuon Assistant Rapporteur: Dr Allen Ross Expected Result 4 – Disease-specific national and regional research plans developed. Activities: 4.1 – Changed from "Conduct needs assessment" to "Conduct programme needs assessment in consultation with end-users (e.g. programme managers, Ministry of Health) and stakeholders". 4.2 – Changed from "Formulate research plan" to "Formulate national research plans in consultation with end-users and stakeholders". Outputs: 4.1 – "National and regional needs assessment report" was added. 4.2 – "National and regional research plan development" was added. Expected Result 5 – Improve existing and develop new tools for surveillance, control and prevention. Activities: 5.1 – Changed from "Development of new and improving the existing tools for assessing impacts" to "Develop new and improve existing tools for rapid epidemiological assessment, including intermediate and reservoir hosts" 5.2 – Changed to 5.3. Activity added as "Develop disease-specific risk maps where required (i.e. GIS/RS)". 5.3 – Activity was deleted. New activity added as "Develop new and improve existing diagnostic tools/products for infection, transmission and elimination". 5.4 – Changed to 5.6. New activity added as "Develop vaccines for human and reservoir hosts". 5.5 – Changed from "Develop new and improve existing tools for traditional medicines" to "Develop new and improve existing drugs (including natural products)". 5.6 – Changed to 5.8 as "Develop new and improve existing surveillance and monitoring systems".
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5.7 – Changed to 5.9 as "Develop new and improve existing decision-support tools for NTDs (mathematical modeling)". New activity added as "Improve formulation and utility of traditional medicines as a complementary approach". 5.8 – Changed to 5.10. 5.9 – Changed to 5.12. 5.10 – Incorporated into 5.10 so deleted as a separate activity. 5.11 – New activity added as "Develop and validate new integrated, intersectoral, interprogrammatic, control strategies for elimination of disease". Outputs: 5.2 – New output added as "Up-to-date disease-specific risk maps created". 5.3 – Added "Appropriate and effective tools developed, tested and made available for mass screening of intermediate hosts for infection". 5.4 – New output added as "Validate and make available the vaccines". 5.5 – New output added as "Validate and make available the drugs". 5.6 – Added "Appropriate indicators for monitoring and evaluation developed". 5.7 – Added "Models developed and validated". 5.8 – "Appropriate and effective tools to monitor behavior change and assess impact on disease developed, tested and available" was removed and "Appropriate and effective tools developed to change attitudes, knowledge and behavior" and "Impact on health outcomes validated and quantified added". 5.9 – Added "Develop an algorithm for development of tools". 5.11 – New outputs added as "New integrated, intersectoral, interprogrammatic, control strategies developed, validated and deployed for elimination of disease" and "Appropriate indicators developed". 2.4.4 Working Group 4 Facilitator: Dr John Ehrenberg Rapporteur: Dr Tomas Fernandez Assistant Rapporteur: Dr Le Anh Tuan Expected Result 8 - Key decision-makers, stakeholders and donors are engaged in regional health research agenda and research priorities. Activities: 8.3 – Changed from "Perform a retrospective study to evaluate how funding for research has been allocated and if it has been proportional to programmatic and demographic needs" to "Perform a retrospective study on investments and expenditures in research to evaluate how much funding for research has been allocated for NTDs". 8.5 - Was incorporated into 8.6 and deleted as a separate activity. 8.6 – Changed from "Incorporate the research agenda into the priorities of existing economic bodies (APEC, ASEAN, etc.) for research support" to "Raise the economic profile of the communicable diseases research agenda among existing economic bodies (APEC, ASEAN, SIMED/TROPMED, etc.) ".
Outputs: 8.1 – Added "Relevant national authorities notified". 8.2 – Added "Research priorities identified and funding options agreed upon". 8.3 - "Strategy for equitable access to research funds developed" changed to 8.6 – Added "Presentation of a regional research plan to existing economic bodies/ASEAN secretariat in communicable diseases in addition to H1N1" and "Establish link between research and economic development".
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Expected Result 9 - Integration of new evidence-based tools and strategies developed (ER 5 and 6) promoted and supported into existing health systems or population based interventions. Activities: 9.3 – Activity was changed from "Organize joint technical seminars/workshops with academic/scientific, programme, policy-makers, research community (media?) and private sector for dissemination of research findings" to "Disseminate research findings". Outputs: 9.2 – Added "Unified national research agenda ensuring that CD are included with NTDs identified and responsible parties assigned". 9.3 – Removed "Research/report presentations attended by majority of targeted programme decision-makers reflected in workshop and meeting reports" and added "Joint technical seminars/workshops held within the framework of existing scientific meetings or forums involving participation of the academic/scientific, programmes, policy-makers, and the private sector" and "Success of incorporating CD research into international cooperation health agenda of the developed countries in the Region". 9.4 – Removed "Formal entity established that can tap technologies and functional starting ___200_" and added "National, functional working group/task force established (including terms of reference, budget)" and "Identification of integration of research findings into operations and policies and specific recommendations generated". 2.5 RNAS+ Annual Board Meeting Notes on the Meeting: (1) The Board Members approved the proposed agenda of the meeting. (2) Corrections on last board meeting: a. Dr. Malone’s name was inadvertently missed. b. There was a move (cancelled) to write a strong letter to Bill Gates… (3) President’s report: a. There was no significant event between the last meeting in Jeju, republic of Korea, in 2008 and the present meeting. b. The plan to hold the 2009 meeting in Bangkok, Thailand, did not materialize. c. Instead Dr. Olveda offered RNAS+ to work on the research strategic plan of the WHO Regional Office for the Western Pacific, thus holding the present meeting is being held back-to-back with Regional Office activities. d. Before the present meeting, an expert committee meeting on foodborne infections was held. The present RNAS+ meeting will be followed by a stakeholders’ meeting. e. The present RNAS meeting aims to evaluate the status of RNAS—where it is right now and where it is headed. (4) Other matters: a. Election of new members of the Board of Trustees in order to line up officers to sustain the activities of the organization. b. The additional members of the Board of Trustees can come from the present Board Members or from representatives of member countries. c. There are at present eight members of the Board of Trustees, namely Dr. Olveda, Dr. Acosta, Dr. Leonardo, Dr. Fernandez, Ms. Venturina, Dr. Xiaonong, Dr. Sudomo and Dr. Socheat.
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d. The proposal to add representatives from the Lao People’s Democratic Republic, Thailand and Viet Nam as members of the Board of Trustees was approved. Dr. Banchob Sripa and Dr. Samlane Phompida are the new members of the Board of Trustees. Viet Nam did not send a representative to the meeting. e. Dr. Xiaonong was unanimously selected president of RNAS+. f. Dr. Olveda suggested a four-year plan for the presidency. The next in line after Dr. Xiaonong, Dr. Socheat and Dr. Phompida declined their turn in the presidency because of heavy commitments from their positions. Dr. Sripa agreed to be the next president after Dr. Xiaonong. g. Dr. Olveda said that RNAS+ should be preparing to hold an international scientific meeting, either in China or Bangkok, Thailand. h. Dr. Leonardo was retained as secretary and Ms. Venturina as treasurer. i. Dr. McManus was elected as a member of the Board. j. There was a suggestion to invite Myanmar to the organization. k. The body decided that any organization wishing to be affiliated with RNAS+ should write a letter of intention indicating its goals and objectives and how it could further RNAS+ objectives through its affiliation. l. Dr. Bergquist was requested by the body to inquire from WHO how RNAS+ could be recognized by the World Health Assembly, so it can attend WHO meetings. m. On the expressed desire of a participant in the present meeting to be a member of RNAS+, the body suggested that the prospective member prove commitment to the organization first before admission to the organization. Dr. Ehrenberg will also be consulted about this matter. n. There was a suggestion to organize a pool of advisers who can advise the organization on future direction. o. RNAS+ meetings in the past consisted of scientific meetings, business meetings and board meetings. Business meetings are attended by all RNAS+ members, including all participants who may be interested in the organization, e.g. observers. p. Official membership of RNAS+ will be discussed in the Business Meeting. q. Dr. Fernandez said that the constitution and bylaws of the organization should contain policies on membership to differentiate between honorary members and institutional members. r. Dr. Willingham reported on the availability of funds for the trial of intervention packages for FBT, cysticercosis and NTDs in pilot sites in Mindanao, the Phlippines; Hunan Province, China; the Cambodia-Lao people’s democratic Republic border; Viet Nam and Latin America. There is a need to write three proposals to avail of these funds. s. Tomorrow’s workshop will include the development of proposals for multisectoral, multidisciplinary approaches to NTDs, diagnostics and vaccine. t. There was a suggestion to develop a proposal on poverty alleviation by controlling schistosomiasis with the aim of developing a multicountry and multisectoral approach.
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2.6 Workshop II: Workgroup discussion to identify issues and operational research priorities During the Expert Meeting on FBT Infections and Taeniasis/Cysticercosis, held from 12 to 16 October 2009 in Vientiane, the Lao People’s Democratic Republic, the possibility of funding pilot interventions using preventive chemotherapy and for studies on the following topics were brought up: (1) Comparison between two different disease control options for areas where prevalence of infection with C. senensis or O. viverrini is below 20%; (2) Comparison between two different techniques for classification of areas according to endemicity of C. senensis or O. viverrini (risk-mapping/rapid assessment); and (3) Assessment of the impact of community-led total sanitation (CLTS) on transmission of helminth infections. Because of these possible funding opportunities, the board of the RNAS+ decided that the aim of Workshop II should be to come up with five concept proposals on topics that may possibly receive funding, as well as on diagnosis, treatment and vaccine development. Participants split into five groups to draft five concept proposals with the following components: rationale, objective, methodology, study scale/area, time-frame, and budget. The groups, and their areas for discussion, are listed below: Group 1: Model of integrated multisectoral control of neglected tropical diseases Group 2: Diagnostics, treatment and vaccine development Group 3: Risk mapping of FBT in south-east Asia using rapid epidemiological assessment Group 4: Integration of large-scale distribution of praziquantel with control interventions against STH infections in an area with multiple co-endemicity of helminth infections Group 5: Impact of community-led total sanitation (CLTS) on helminth transmission. As an introduction to Workshop II, Dr John Ehrenberg gave two presentations on some of the issues and priorities in research, and on multidisease, intersectoral NTD prevention and control strategies. Participants then split up into five groups to come up with five concept proposals, which were then presented by a representative of each group during Plenary Session II. 2.6.1 Brief introduction of issues and research priorities Dr John Patrick Ehrenberg Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases WHO Regional Office of the Western Pacific The context of the presentation was to provide a broader picture on the work that has been done by others within and beyond the organization to identify key research issues in neglected tropical diseases. The priorities outlined are in addition to the five priorities selected by the RNAS+ from the Expert Meeting on Foodborne Trematode Infections and Taeniasis/Cysticercosis, which will become part of the research priorities for the WHO Regional Office for the Western Pacific in collaboration with the RNAS+. In 2007, an NTD scientific technical advisory group (STAG) met to discuss research issues related to NTDs. There were basically three main principles guiding the discussions of the group: • Encourages WHO to support increased, quantitative, health-economic analysis given its importance in policy formulation and resource allocation for NTD control.. Firmly endorses the close linkage between successful interventions for NTD control and research in methodology, innovation in delivery, accurate surveillance and evaluation.
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Emphasis on the importance of supporting operational research should be made to governments and funding agencies in addition to the need to support discoveries in biomedical research. –
There were five key areas of research priorities identified by the STAG: (1) Burden and economic impact of NTDs Focus on: a review of DALYs and their appropriateness as a health impact measure for NTDs; work on better data acquisition for burden-of-disease and disability assessment; the psychological impact of NTDs; gender disaggregation of DALY calculations. (2) Pharmacovigilance and surveillance Focus on: drug efficacy, safety and resistance; assessment and monitoring of the impact and safety of combination treatments, including multiple drugs and vaccines; clinical studies of side-effects and pharmacokinetics, plus dynamics in multiple therapy delivery. (3) Epidemiology and public health Focus on: distribution mapping of disease co-endemicity; trials of combination interventions; new diagnostic and surveillance tools (e.g. for foodborne trematodes and Onchocerca); health systems for effective delivery; healthseeking behaviours. (4) Health economics and comparative cost and cost-effectiveness Focus on: new methods for quantitative health economic evaluation for NTDs; detailed cost-effectiveness studies in different country locations; development of key indicators and data capture tools for health economic evaluation. (5) Interactions of NTDs with HIV/AIDS, malaria and TB Focus on: large-scale longitudinal studies for these interactions with fine stratification for the many confounding variables, such as age, gender, nutritional status, pathogen burden and stage of disease. The group went into a careful discussion of select research topics, which are outlined here from within the five strategic areas: • Critical re-evaluation of DALYs, including methodology to elucidate the socioeconomic impact of NTDs; More work needs to be done on this and new types of economic indicator need to be developed. Cost-benefit analysis of treatment interventions for the control of NTDs including delivery; Investigation of drug efficacy, including methodology; Development of sensitive and affordable diagnostic procedures for NTD,s including foodborne trematodiases;
• • •
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Operational research into the most effective and innovative systems for the delivery of NTD control; Critical review of the putative association between HIV/AIDS, malaria and TB and NTDs; Even although these associations have been talked about for the last 10 or 15 years, they need to be looked at more carefully. Especially now this also has economic implications when talking about piggy-backing on global funds. Papua New Guinea, for example, is a recipient of a US$140 million grant for malaria. An example of one link would be trying to piggyback lymphatic filariasis with vector control and to determine the impact that impregnated bednets are having on LF transmission. Operational research into the most effective and innovative systems for the delivery of NTD control; The issue of health systems strengthening and using health systems for drug delivery should not be neglected. In settings withuot strong health systems, community health workers and community health distributors are relied upon, for example in the case of onchocerciasis. In these places, such as the Mekong countries, where health systems are in place, effective ways for incorporating this into the health system need to be found. The morbidity component and residual morbidity, for example in LF and the FBT, tends to be forgotten. Instead focus is concentrated on the interruption of transmission and the morbidity component is often forgotten. Interactions between drugs and vaccines used in NTD control; This issue was brought up in the FBT meeting and needs to be carefully monitored for this and other parasitic diseases. Psychological impact of NTDs; This is particularly relevant in those NTDs, such as LF, that have disabilities tied to very important stigma. It is also an issue in leprosy and in onchocerciasis in some areas of Africa. Identification of interventions; simple indicators on the effectiveness of NTD control
•
•
•
• •
Preparation of basic epidemiological packages to quantify the distribution of NTDs; The need for rapid epidemiological assessments in humans, animals, and intermediate hosts was discussed. Cost-effectiveness of vector-control methods where no other options are available for NTD control; Development of a training package for vector control, to include mapping.
• •
These ideas should be taken advantage of because an important group of researchers discussed them. The MVP unit in the WHO Regional Office for the Western Pacific has an extensive research agenda in malaria and dengue, for which the unit is actively seeking funds. Last year the unit also picked up other issues, like STH, FBT, LF and schistosomiasis. Because they had not really done an internal analysis on foodborne trematodes and cestodes, it took a year to bring them on to the NTD agenda. Including those issues and operationalizing them required a lot of work, but it was finally done because FBT, in particular, are a serious public health problem in some countries.
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The MVP team did an internal analysis of the priority research areas in STH, FBT, LF and schistosomiasis, put a matrix together and had all the regional advisors at the Regional Office provide some feedback. Priority research areas in STH, FBT, LF and schistosomiasis (1) Diagnostics: Rapid tests for FBT Validation of antibody test for W. bancrofti (2) Treatment: Triclabendazole for paragonimiasis (3) Surveillance: Cases, burden of diseases: Validation of tools for post-MDA surveillance inareas endemic for W. bancrofti Monitoring of reintroduction of LF parasite by migrants in countries that have reached the elimination target Validation of tools for post-MDA surveillance is very important. There has been significant progress on post-MDA surveillance tools, especially in the Pacific island countries. It is very important and the WHO Regional Office for the Western Pacific now hopes to be able to use and apply these to some extent in the Mekong countries, as well as in other countries that are approaching LF elimination. On monitoring the reintroduction of LF parasites by migrants, the question here is that if, for example, one country has reached the elimination target and a neighbouring country has not, then how long does the country without LF keep this system in place? For example, Jamaica had eliminated LF but it was reintroduced with the movement of illegal Haitian immigrants into Jamaica. Even although at first it was only a small focus of LF, because they also had the vector, it was eventually not just imported but actually reestablished. The question is should these surveillance systems be kept in place in a resource-constrained environment? There is a need to come up with innovative, integrated surveillance systems that leave space for the reintroduction of diseases that have been eliminated. (4) Vector control and personal protection: Development of innovative strategies for effective control of Aedes polynesiensis (+++) (5) Behaviour-change communication, community-based interventions: Impact of behavioural-change interventions for FBT control There is a very interesting scenario in the Republic of Korea and there are a lot of lessons to be learnt from them and what they have done. (6) New strategies for: (a) Vulnerable populations (ethnic minority groups, migrant/mobile people…) (b) Integrated approaches (c) Engaging the private sector Integration of LF pos- MDA surveillance strategies with other programmes One of the issues highlighted was the integration of LF post-MDA surveillance strategies within other programmes. For example, how do you sustain post-MDA surveillance as part of an integrated surveillance system with other programmes?
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(7) Cost-effectiveness: Cost-effectiveness of large-scale MDA (for STH or schistosomiasis) When thinking about piggy-backing or synergizing between LF or other programmes, it makes sense to determine cost-effectiveness, because the same human resources and financial resources may be used. The focus of the Western Pacific Region is really on a number of issues. Although the WHO Regional Office is not a research institution or an academic institution, they do have a responsibility to strengthen research institutions and individuals in the leastdeveloped countries in the Region. The dependency of these countries needs to be lower and their own potential needs to be built up. The Regional Office also needs to continue to contribute to building up a critical mass of researchers in relevant fields. Some fields in particular have been totally neglected, for example entomology, malacology and ichthyology. Dr Madsen is running short-courses on malacology in Thailand and this is something that should be taken advantage of; that is capacity-building in areas that really need to be worked on and in which there are weaknesses. Another important aspect for researchers is optimizing the input from collaborating centres. WHO has a series of collaborating centres working in different areas, including helminths. The question is how to optimize the work that they do, within and beyond the Region, for capacity-building and transfer of technology? This is something that Dr Olveda has been exposed to continuously. How does he keep, in terms of quality, control of the work that they do in clinical diagnosis, development of new tools, etc? This is an area in which he has been lucky enough to get support and interest from collaborating institutions outside, but eventually this capacity needs to be built up to the point where reliance on outside sources can be reduced. It is very important that the RNAS+ has this information and takes advantage of it. The RNAS+ has also generated a whole range of additional information that is extremely valuable and should be added to the list of priorities. The list is not all-inclusive. There is quite a bit more information, and brainstorming would generate even more.
2.6.2 Multi-disease, intersectoral NTD prevention and control strategies Dr John Patrick Ehrenberg Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases WHO Regional Office of the Western Pacific The health sector is not used to working intersectorally and very often it is easier said than done. It is very easy to write up a number of concepts and issues but then the question is how to operationalize them? This is critical so that it does not remain as purely talk. The WHO Regional Office for the Western Pacific has developed, in conjunction with some individuals present at the meeting, a draft regional plan of action for NTDs. This plan was also developed by going through the same painstaking log-frame exercise and so it is divided into components, and each has a series of expected results. There is quite a bit of overlap on a number of issues as far as research is concerned. For example, Expected Result 2 is to identify opportunities to piggy-back NTD programmes and activities. This especially is something that the RNAS+ can seriously think about.
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Examples of indicators and activities that could be used are shown in the following for Expected Result 2: Indicators: Inventory of potential Partners for interprogrammatic and multisectoral programmes In-country programmes tapped for joint activities (e.g. Malaria, Dengue, Maternal and child health, etc.)
Activities: Conduct bilateral and multilateral meetings to identify relevant programmes.
Another component in the draft plan is new strategies. Here there are a number of expected results; those highlighted in blue directly address the issue of multisectoral interventions. • • • • ER 1: Global framework for integrated approach adapted to the Western Pacific Region ER 2: Existing WHO technical guidelines translated / adapted at the national level ER 3: Avenues for advocacy at the highest-level government officials are created ER 4: Intersectoral coordination mechanisms established.
For ER 1, there is a global framework that was worked out at WHO Headquarters; in terms of integrated approaches, the concept is slightly more restricted to within health systems. Because it was more integrated in the sense of multidisease and was integrated within health systems in terms of surveillance, laboratory, etc., the concept for the Western Pacific Region was to go beyond that. ER 4 addresses issues of intersectoral coordination mechanisms. Examples of this include influenza A(H5N1) or severe acute respiratory syndrome (SARS). With H5N1, intersectoral task forces were established at the country level. Programmes had to establish intersectoral task forces in their national plans and there was a consultation process through regular meetings between ministries of health, ministries of defense, and ministries of agriculture. There were at least six or seven different sectors involved in these multisectoral task forces that in principle, and according to international health regulations, had to be in place. Perhaps this model can be reproduced or could even be piggy-backed upon, since they exist, at least on paper, in pretty much all of Member States. The types of activities for these two expected results are listed below. ER 1: • Create a network of experts with field experience in economics, agriculture, veterinary medicine, aquaculture, education, environmental management, NTD, and community organization. • ER 4: • • • Identify ministries that can realistically be engaged. Establish coordination arrangements and procedures. Implement programmes of mutual interest. Form a working group of experts for the Region who will critically review the evidence and identify gaps (epidemiological and research).
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The first activity under ER 4 looks at whether ministries can be engaged and this of course changes from country to country. For example, in some countries at the upper level it is very difficult for ministries to coordinate intersectorally. Coordination usually occurs down at the grassroots or community level. When talking about pilot interventions and feasibility it may be that those that have the highest chance of having that type of intersectoral collaboration between ministries are the ones that are picked. Under the third activity, there is a great deal of discussion going on regarding implementing programmes of mutual interest. FBT are a classic example of this because they are of interest to both the human and animal health sectors. In principle it should not be difficult to get these two sectors together, as well as perhaps even the environmental or education sectors. Suggestions on how to get started: Very good justifications have to be written, especially when talking to donors. examples include: • • Some
Poverty and neglected diseases: Poverty, lack of basic services, low educational level, precarious food supply, deficient basic sanitation, etc. contribute to NTDs. Productivity and nutrition: The lack of adequate knowledge, attitudes and practices in livestock and agricultural production and manufacturing to guarantee a good diet is one of the leading causes of malnutrition, aggravated by a high incidence of common diseases, such as diarrhoea and parasitic diseases. Quality of life: The majority of affected population groups live in extreme poverty, characterized by a lack of basic services, such as drinking water, housing, health, and education, economic opportunities, and participation in decision-making. Infrastructure: Insufficient infrastructure (roads, telecommunications) restricts economic growth. electricity, water, and
•
• •
Information: There is limited information on the incidence and prevalence of NTD, and on the status of water supply, health services, and hygiene promotion in marginalized population groups. Civil society participation, governance, and NGOs: Development efforts are often limited due to the low level of social participation by the affected people. Environmental degradation: Deforestation, inappropriate use of natural resources, the constant expansion of the agricultural frontier, as well as the use of inappropriate livestock techniques, lead to significant environmental degradation.
• •
Examples of expected results: • • Managerial and operational linkage mechanisms with Malaria, TB and HIV/AIDS, and other health programmes established. Risk-factor control linked to neglected diseases and strengthening of protective factors implemented (risk prevention and management). (This is really the strengthening of prevention and management that goes beyond the health sector because these diseases have multideterminants of health.) A comprehensive information system for monitoring and evaluation of the epidemiological status of the target NTD established. Improved environmental sanitation coverage and basic housing conditions. A consensus-based community land-use plan. (This could be a highly political issue. In many countries, land use is not regulated. There are also those
• •
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countries in which landlords will not allow individuals to construct latrines in the ground because that implies or entitles those individuals to property rights, and so they are forced to make other types of arrangement.) • Sustainable practices implemented to increase productivity, appropriate to the culture, climate, etc. (Because these are diseases of poverty there is a link between poverty, nutrition/malnutrition, and the worms, which needs to be looked at.) Increase in food security throughout the year. (Here FBT needs to be looked at because it is a food-security issue.) Development of microenterprises at the community level. (For the community, these are important. It is not for the health sector to devise strategies on income-generating activities, but the health sector should work with the sector that is used to working in this field developing such enterprises. There have been extremely successful experiences in Bangladesh.)
•
Examples of indicators: • • • • A local-level intersectoral committee established by X (date) to manage the project. A comprehensive, local, intersectoral action plan aimed at improving health and quality of life and emphasizing prevalent neglected diseases prepared by X (date). Work plans on health with itersectoral, interprogrammatic approaches emphasizing neglected diseases, the environment and production by X (date). A communication and social participation plan prepared by X (date).
2.6.3 Concept proposals The following are the concept proposals drafted by the participants in Workshop II and the comments made on them during Plenary Session II. Group 1: Model of integrated multisectoral control of neglected tropical diseases Facilitator: Dr Remigio Olveda Group members: Dr Allen Ross Rationale: NTDs have common risk factors (socioeconomic, environmental, modes of transmission) and overlapping endemic areas. Hence, a multisectoral integrated control programme is potentially cost-effective and sustainable at the local level. Single vertical interventions, such as mass drug administrations (MDA), on their own are challenging to maintain (cost, compliance, re-infection rates, rebound morbidity). Objective: To develop a sustainable multisectoral integrated control package for NTDs at the national and subnational (e.g. high-risk populations) levels. Methodology: (1) Map sectors and stakeholders working at the international, national and community levels (desk-top exercise).
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(2) Carry out a retrospective health assessment (including health systems), economic, socioeconomic, environmental profiles, etc. (3) Carry out risk analysis and disease mapping. (4) Select endemic pilot intervention sites. (5) Assemble intersectoral task force. (6) Develop a proposal for a pilot multisectoral integrated intervention with the following components: MDA, sanitation, irrigation, health education/promotion, vector control, animal health and husbandry, economic assessment, agriculture, and nutrition. (7) Develop a tool package (8) Conduct a pilot intervention. Timetable: Year I : items 1-6 Year II: items 7-8 Five-year budget: Items 1. Sector mapping (3 months) 2. Retrospective assessment (3 months) 3. Risk analysis & mapping (in-country) 4. Select pilot sites (included in 3) 5. Assemble intersectoral task force (included in 6) 6. Proposal development Subtotal 7 Development of package 8. Pilot testing Total (1-6) Comments on Group 1 proposal: The following comments were made by participants during Plenary Session II: Suggestion to invest slightly more to get high-quality GIS risk maps. An integrated, multisectoral control and prevention programme can be sustainable and cost-effective because it targets several NTDs at the same time. May want to look at China's experience with schistosomiasis in regard to multisectoral control. US$ 3000 6000 12 000 0 0 11 000 32 000 200 000 200 000 432 000
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Group 2: Diagnostics, treatment and vaccine development Facilitator: Dr Don McManus Group members: Dr Sara Lustigman, Dr Robert Bergquist, Dr Lydia Leonardo, Ms Marilou Venturina, Dr Muth Sinuon, Dr Le Anh Tuan, Dr Duong Socheat, Dr Luz Acosta The members of Group 2 discussed the need for vaccines to be developed for all the targeted diseases and decided that, since several concepts could be suggested, they could only develop concepts and not proposals. The members first discussed the issues and gaps in vaccine development, treatment and diagnostics for several NTDs, as well as possible study opportunities in these areas. Following the discussion they came up with a short concept proposal. Vaccine development: The place of vaccine in the control programme will be essential in the elimination of a particular parasitic disease, but in combination with other control methods, including treatment, targeted use of molluscicides, improved sanitation and health education. The following vaccines need to be developed: (1) Schistosomiasis For Schistosoma japonicum, the development of an animal vaccine is a long-standing research goal. It is felt that such a vaccine would reinforce the effect of animal chemotherapy by permanently reducing animal eggexcretion. This concept is proven in China and may be appropriate in the Philippines, but the role of carabao in transmission of schistosomiasis needs to be determined. Vaccine development is supported in the long term, but is not a priority at this time. Priority is treatment and diagnosis. For Ascaris, hookworm and Trichuris, vaccine development is supported. Hookworm vaccine is being developed in the United States of America, and will enter clinical trials next year in Brazil. It was suggested that the vaccine could be tested subsequently in selected populations in south-east Asia.
(2) Foodborne trematodes
(3) Soil-transmitted helminths
(4) Cysticercosis An excellent vaccine for use in pigs has been developed and could be tested in south-east Asia. Treatment: The development of new drugs is supported as there are very few drugs available for treatment of NTDs. (1) Schistosomiasis The only drug of choice for schistosomiasis is praziquantel. The cost is US$0.30 per treatment. Mass treatment is conducted once a year in endemic areas. However the issue is that mass treatment does not stop re-infection.
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(2) Foodborne trematodes The drug of choice for FBT is also praziquantel. There is a need to undertake operational research to determine how long or how often mass treatment should be carried out before it is stopped. Mathematical modeling could provide the answer to this question. This would require good data collection, including data on prevalence, number of treatments, improved sanitation, education, baseline (before and after), and interventions. The mathematical model should be validated.
(3) Soil-transmitted helminths The drug of choice is albendazole. Again, there is a need to carry out operational research to determine how long and how often mass treatment should be done. There is also a need to develop mathematical modeling, which would require good data collection including data on prevalence, number of treatments, effect of improved sanitation and education. There is a need for intervention studies to include baseline information and longitudinal studies to show the impact of various interventions for control. Data can then be imported into the model for verification. STH control programme managers require basic epidemiological information that includes data on prevalence, incidence, number of treatments, time of treatments, coverage, and other control strategies, such as improved hygiene and sanitation, and these data can then be fed into the mathematical model. The end-point is control rather than elimination.
Activities: Train regional mathematical modelers in the methodology. Enter data from countries in the Region for the modeling. Identify the candidates to be trained from the Region in consultation with regional and international collaborators.
Expected outcomes: Mathematical model developed and validated. Diagnosis: (1) Schistosomiasis Accurate diagnosis of infection is always a problem for schistosomiasis. For serology, specificity is an issue and seroconversion takes time. Polymerase chain reaction (PCR) as a diagnostic tool is expensive. Endemic areas don not usually have enough resources for surveys. Ultrasonography screening is helpful, particularly in the field
(2) Foodborne trematodes Surveillance and appropriate sampling design are important. There is a need for basic epidemiological knowledge, as well as community diagnosis. Data management is also important. A quick assessment tool that includes questionnaires can be used. Fecal examination is still used for diagnosis of foodborne trematodes. Lack of funding is a perennial problem in endemic countries. It is critical to determine prevalence using, not only fecal examination, but new diagnostic tools. Although fecal examination is the
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gold standard for diagnosis, lack of sensitivity is a problem. Enzyme-linked immunosorbent assay (ELISA), on the other hand, lacks specificity. Ultrasonography screening may be useful for detection of advanced disease. (3) Soil-transmitted helminths Proposal: That WHO and RNAS+ train young investigators from the Region in mathematical modeling techniques, either regionally or internationally. Time-frame: It will take three months to identify suitable candidates. At the same time, appropriate experts in mathematical modeling techniques will be contacted. Suitable candidates will be sent to appropriate institutions for training for a period of six months. Qualifications for candidates would include knowledge of parasitology and field-based procedures, as well as some bi statistical knowledge. Comments on Group 2 proposal: The following comments were made by participants of the meeting during Plenary Session II: Funding for new diagnostics may be available from the Gates Grand Challenges with available funds between $100,000 and $1 million. There is also an NIH grant for infectious diseases worth $100,000 a year for a period of 4 years. The closing date for submission of a proposal is September 2010. Although PCR is an expensive tool, it may come handy for rapid assessments on snails and when elimination needs to be verified. Suggestion to test the cysticercosis vaccine in the Western Pacific Region. Treatment with praziquantel in non-symptomatic population living in coendemic areas causes adverse effects and is an issue of concern. Concern that mathematical modeling may not yet be specific enough to predict how long mass treatment should be carried out for. Fecal examination remains the diagnostic tool for STH.
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Group 3: Risk mapping of FBT in south-east Asia using rapid epidemiological assessment Facilitator: Dr Zhou Xiaonong Group members: Dr Banchob Sripa, Dr Sung-Tae Hong, Prof Tai-Soon Yong, Dr Henry Madsen Rationale: FBT and taeniasis/cysticercosis are prevalent in many parts of the Region and constitute a major health problem in south-east Asia. For disease control, high-risk areas should be targeted first and therefore it is imperative that these are identified through a variety of rapid assessment tools. Objective: To produce transmission-risk maps of FBT (clonorchiasis, opisthorchiasis, paragonimiasis, intestinal trematodiasis, taeniasis/cysticercosis) using existing data where available. Study Scale: China, Republic of Korea, Thailand, Viet Nam Methodology: (1) Develop rapid epidemiological assessments for humans, animals and intermediate hosts (desktop exercise). This will involve convening a meeting of experts in relevant fields for one week to prepare a draft protocol. Experts will include professional working in epidemiology, veterinary science, malacology, parasitology, diagnosis, agriculture, farming, etc. (2) Search available data sources and maps (demographics, ethnicity, education, health facilities, environment, water bodies, sanitation, and agricultural activities). (3) Use above-mentioned data to overlay and conduct the risk predictions using GIS/RS. (4) Test rapid-assessment tools in the high-risk areas identified above, and validate the risk map. One county /district for each country will be selected for field assessment/validation. (5) Analyse the data and write a report. A dissemination workshop will be arranged to validate and write the study results. Timetable: Two years. First year 1 2 3 4 5 1 x 2 x 3 x x 4 Second year 1 2 3 4
x x x x x
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Budget: Item 1. Development of rapid epidemiological assessments (12 experts) 2. Searching of data sources and maps (multi-sources) 3. Risk predictions using GIS/RS (GIS lab and 4 experts) 4. Testing of rapid assessment tools, and validation of the risk map (4 counties/ districts ) 5. Analysis of data and writing of report (1 workshop) 6. Purchase of remote sensing data (4 counties/ districts ) Total US$ 10 000 1000 10 000 20 000 10 000 2000 53 000
Comments on Group 3 proposal: The following comments were made by participant during Plenary Session II: Suggestion that the proposal could be carried out up to risk prediction for US$30 000 to get things started first, before testing the rapid assessment tools.
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Group 4: Integration of large-scale distribution of praziquantel with control interventions against STH infections in an area with multiple co-endemicity of helminth infections Facilitator: Dr Albis Gabrielli Group members: Dr Jun Nakagawa, Dr Muth Sinuon, Dr Hiroshi Ohmae, Dr Samlane Phompida Justification/Rationale: Area endemic for multiple helminth infections: STH infections, schistosomiasis (focal area), opisthorchiasis, taeniasis/cysticercosis Ethnic minority with food habit of eating raw fish and raw pork. Current interventions: large-scale intervention mebendazole for STH, of albendazole/DEC for LF, focal distribution of praziquantel. Need to expand control of opisthorchiasis, taeniasis/cysticercosis in an integrated manner by piggy-backing on existing control activities (expand target for praziquantel to cover all those affected by the two infections.) LF,
Target area: Two districts in the following provinces: Stung Treng Province, Cambodia (Population: 150 000) Champasak Province, Lao People’s Democratic Republic (Population: 500 000 ) Other suggested provinces include: Yunnan province, China Mindanao, the Philippines Binh-Dinh, Viet Nam Objectives: To assess feasibility of the integrated approach from logistical and managerial perspective To assess the impact of the large-scale distribution of praziquantel on opisthorchiasis, taeniasis/cysticercosis
Methods: Rapid Assessment of endemic situation via questionnaire on food habits validated by stool examination Stratification of high-risk area Selection of appropriate intervention strategy Identification of sentinel sites Implementation of integrated interventions (treatment, IEC/BCC) by national programme managers Monitoring and evaluation: performance (coverage) and impact (prevalence, intensity of infection, etc)
Time-frame: 36 months Budget: US$ 30 000 per pilot intervention Comments on Group 4 proposal: The following comments were made by participa during Plenary Session II: STH were chosen because STH covers the whole province and provides an opportunity to piggy-back on this specific intervention. A suggestion for both Group 4 and Group 2 to look at the impact of LF programmes on STH.
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Group 5: Impact of community-led total sanitation (CLTS) on helminth transmission Facilitator: Dr Arve Lee Willingham Group members: Dr Jurg Utzinger, Dr Antonio Montresor Objective: To measure the added benefits and costs of instituting CLTS in conjunction with preventive chemotherapy for helminthiases control (+/- protozoal and diarrheal diseases) Community-led total sanitation: • • • Innovative methodology for mobilizing communities to completely eliminate open defecation. Empowering local people to analyse the extent and risk of environmental pollution caused by open defecation. Advocates the construction of toilets/latrines by: o participatory facilitation; o community analysis and action; o no hardware subsidy . Preferred usage of subsidized toilets
CLTS encourages sustainability by empowering communities to stop open defecation without subsidies. Settings (potential sites): • • • • Northern Viet Nam: linked to ongoing MDA campaign for taeniasis and other parasites. Yunnan Province, China: minority populations that do not use fresh human waste for fertilizer. Northern Lao People’s Democratic Republic: opisthorchiasis prevalent in areas about to institute CLTS in a few months. Mindanao (or Eastern Visayas), the Philippines: co-endemic areas for FBT, schistosomiasis, taeniasis/cysticercosis.
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Methodology: Each study site testing preventive chemotherapy +/- CLTS (1) Conduct community cross-sectional survey on parasitic and diarrhoeal diseases using diagnostic procedures (parasites) and questionnaires (diarrhoea): soil-transmitted helminths (Kato Katz); strongyloidiasis (Baermann); intestinal protozoa e.g. Giardia intestinalis, Entamoeba histolytica (formalether concentration); foodborne trematodes (Kato Katz); taeniasis (Coproantigen testing); porcine cysticercosis (Ab-ELISA; post-mortem examination).
(2) Carry out intervention with CLTS. (3) Measure the incidence of parasitic and diarrhoeal diseases after 6 and 12 months (longer—5 years—if funds are available, to get a real sense of the added sustainability) Include porcine cysticercosis as a measure of transmission (4) Collect data on costs to community in attending triggering sessions and building of latrines (material costs, loss of productive time for agricultural work, etc.). Evaluation: • • Communities certified as Open Defecation Free Impact on incidence of parasitic and diarrheal diseases, including porcine cysticercosis as sentinel of transmission Cost of adding CLTS investment and maintenance costs
12 Time-frame: onths Budget: US$ 30 000 per site
Comments on Group 5 proposal: The following comments were made by participants during Plenary Session II: • • A strategy that combines MDA with CLTS with a timeline for sustainable control may help when looking for resources and selling the package to donors. Questions on whether or not the scale and size of the area, the time period of the evaluation, and whether it will be an individual follow-up or a community followup were discussed. Suggestion that the project should be part of the larger integrated, intersectoral pilot intervention instead of a sub-component or separate project. This proposal will be an opportunity to demonstrate and generate evidence that community-based interventions work.
• •
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2.7 Roundtable discussion: Brainstorming on roles of the RNAS+ in contributing to the development of the research agenda for NTDs in Asia Facilitators: Dr Arve Lee Willingham and Dr Remigio Olveda Rapporteur: Dr Lydia Leonardo Assistant Rapporteur: Dr Marilou Venturina The working document presented to the body for comments was put together in 2007 by RNAS+ members Dr. Olveda, Dr. Bergquist, Dr. Zhou Xiaonong, Dr. Sripa, Dr. Leonardo and Dr. Acosta. It includes the vision, mission, goals, strengths, weaknesses, threats, opportunities and plans of the RNAS+. Each of the components was first presented by Dr Olveda and then commented on by the participants. The major points of the discussion following each section are highlighted in the bullet points below. Vision: To become the recognized platform for evidence-based information and intersectoral communication, bridging the gap between research scientists and control authorities for the prevention of neglected tropical diseases in south-east Asia. • The coverage of the Network could be broadened from south-east Asia to the Asia Pacific area. It was felt that this should be done to avoid bias in project and agenda selection by the RNAS+. For example, Mongolia should not be ignored since there are significant problems with echinococcosis and taeniasis. The issue of expanding the Network too broalyd too fast was mentioned. Despite the fact that the RNAS+ is working with institutions in Australia, Denmark and Japan on endemic diseases in south-east Asia, the Network may not have the capacity to expand so quickly. The RNAS+ should include other countries that are not part of the Network's board in their projects in order to represent the interests of the whole region.
•
•
Mission: To provide a forum for the exchange and dissemination of information about current researches and developments on prevention and control of Asian schistosomiasis and targeted, neglected tropical diseases (clonorchiasis, cysticercosis, fascioliasis, opisthorchiasis, paragonomiasis) through intersectoral collaboration and communication among scientists and control authorities. • • • The mission should include echinococcosis and STH. The brackets should be deleted and the diseases not specified inorder to allow for broadening of the scope. The reasons why these specific diseases were targeted included the addition of new diseases to the RNAS+ agenda at the time that new member countries that are endemic for the additional diseases were added, such as the Republic of Korea, Thailand and Viet Nam . Other neglected diseases might be included. There are at least 35 NTDs, however, so the focus should probably be limited to only a few diseases. The scope of activities could possibly be expanded, but the name should be retained. Taeniasis/cysticercosis should be added to the disease coverage. The word "selected" should be used instead of "targeted". After ‘intersectoral collaboration’, ‘human and animal scientists’ should be added.
• • • • •
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Strengths: Expertise in: diagnostics, vaccine development, GIS, control strategy. Legal framework for networking. Capacity to develop training packages: GIS, diagnosis, healthmetrics (e.g. burden assessment), molecular biology, vaccine, etc. Available mechanisms for sharing of information: website database, publications, meetings. Capacity to develop multidisciplinary approach, multicountry proposals, for disease control. Direct linkage with different academic and research institutions. Competitive advantage. Strong linkage with control programmes of endemic member countries. Intercollaboration with international agencies like WHO/TDR, ADB and others. Country–driven and regional expert-driven initiative. Strong communication, collaboration and coordination between RNAS+ members for the past 10 years. At the forefront of the link between the animal and human health sectors.
• • • •
Weaknesses/Challenges: • Lack of funding. The RNAS+ operates on very small grants from TDR and the WHO Regional Office for the Western Pacific. There is a need to look forward to see how the operations of the RNAS+ can be supported and sustained. Lack of minimum target areas for possible funding and areas of interest. Members should try to avoid bias in the selection of projects. The RNAS+ may want to look back and see what has been done in the last five years and become more involved in targeting certain vulnerable population groups, countries and research/academic institutions. Lack of a legal framework for the whole of the Western Pacific Region. The Network is, however, a legally registered organization recognized by the Securities and Exchange Commission of the Philippines. Lack of a resource mobilization plan and a good marketing strategy. The website is outdated and could be improved.
• •
•
• •
Opportunities: Trend towards policy development based on evidence. International initiative addressing neglected tropical diseases. Increase in resources for health development. Changing TDR policy to strengthen research capacity of disease-endemic countries. Increasing awareness and concern on changing environmental conditions (e.g. climate change) resulting in more research, particularly on the emergence of tropical diseases in previously non-endemic countries. The Network should try to establish links with Ministries of Science and Technology and broker support from them at the country level. In many countries, money that goes towards research first goes through the Ministry of Science and Technology.
•
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• •
The International Atomic Energy Agency has money for health to promote the use of radioisotope markers in safe conditions. There is also money from the United Nations Environment Programme for communicable diseases, such as malaria and other vectorborne diseases, and possibly the International Fund for Agricultural Development, especially for fishborne trematode diseases. The new RNAS+ President was referred to a new opportunity with the Rockefeller Foundation for Pandemic H1N1 2009, which is one possible health approach to zoonotic diseases, especially for a project in the Mekong Delta. The Network could submit a concept note for a proposal to the Foundation's website to see if they would support what the Network wants to do in the Mekong Delta region. Other sectors, like the agricultural and private sectors, should also be tapped, as long as there is no conflict of interest.
•
•
RNAS+ future plans and activities: Goal: Reduction of disease burdens due to schistosomiasis and other neglected tropical parasitic diseases (clonorchiasis, cysticercosis, fascioliasis, opisthorchiasis, paragonomiasis). Objective: To contribute to the reduction of the burden of neglected tropical parasitic diseases through training, research and information dissemination. Activities: (1) Production of training packages on diagnostics, molecular biology and immunology related to the development of new diagnostic tools and vaccines. (2) Facilitation of research activities on diagnostics and vaccine development, health metrics, and strategies for disease control. (3) Conducting information dissemination and sharing activities. (4) Conducting workshops leading to multidisciplinary research proposals. • • The proposals that were developed already recognize some future activities. In regards to a legal framework, the RNAS+ and the WHO Regional Office for the Western Pacific will look into whether memorandums of understanding or arrangements similar to those with collaborating centres are available for networks. NGOs that have been recognized by WHO are allowed to send representatives to attend WHO meetings. The RNAS+ should look into these mechanisms in order to become officially recognized by WHO and other international organizations. The Network may want to look into becoming tax-deductible. The Network should also be able to show donor agencies that it is capable of managing funds through an internal and external auditing system. The Network should draw up a resource mobilization plan to present to donors and come up with a good marketing strategy so that donors will want to invest in the Network's projects. The RNAS+ should highlight how their research has been transformed into policies in order to attract donors. One objective of the Network should be engaging donors on areas in which they are interested. Donors like the Bill and Melinda Gates Foundation and the Rockefeller Foundation should be invited to future RNAS+ meetings. There should be mapping of research donors who might be interested in financing work on NTDs.
• • •
•
•
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•
Research strategies should be developed well and put together to be attractive to grant agencies. The Network should think and plan on how it can piggy-back on global funds through links with malaria, or how to synergize with HIV and malaria. To raise the visibility of the Network, other organizations' websites (such as the Global Network for Neglected Tropical Diseases or TDR) should have links to the RNAS+ website.
•
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2.8
RNAS+ Business Meeting 2009
The following officers were elected during the Business Meeting of the Network: President: Dr. Zhou Xiaonong of China Vice-president: Dr. Banchob Sripa of Thailand Secretary: Dr. Lydia Leonardo of the Philippines Treasurer: Ms. Marilou Venturina of the Philippines Dr. Xiaonong will hold office President. The new RNAS+ challenging and there may be for all their recommendations, for two years, after which Dr. Sripa will take over as President said that the transition stage is hard and difficulties to face in the future. He thanked the members which will be taken into account.
The members discussed plans for the celebration of the 10th anniversary of the Network. For the next meeting of the Network, the following countries were suggested: China; Australia, where the International Congress of Parasitology (ICOPA) meeting is going to be held; Thailand; Singapore; and Malaysia. Dr. Olveda and Dr. McManus will check for the possibility of holding the meeting as a session in ICOPA, although the request may be too late. The Bill and Melinda Gates Foundation is reported to be awarding travel funds for ICOPA participants coming from developing countries. There were reservations about choosing Singapore or Malaysia as the site for the next meeting, since these countries are not members of the Network. There were suggestions to celebrate the 10th anniversary of the Network in the annual meeting. An international symposium on schistosomiasis can be held, just like in 2006 in the Philippines, with the marking of the 100th year of discovery of schistosomiasis in the country. It was also suggested that the anniversary be celebrated in China, where the Network was first conceived. A scientific publication on the history of RNAS+ can be published to mark the celebration. There was discussion on membership of the Network. Prospective members will be required to fill up application forms. They should have experience in working on targeted neglected diseases. Two board members should endorse the application of each prospective member. Membership to the Network will be decided in a Board meeting. Participants present at the RNAS+ Business Meeting were invited to fill up application forms. At present, there are 17 members of the Board, but no general membership as yet. The decision on general membership would allow the Network to know how many members to expect in annual meetings.
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2.9
Closing ceremony
In his closing remarks, Dr Ehrenberg thanked those present for attending the meeting and expressed his wish to continue working with all the participants in the future. Dr Olveda concluded the meeting by giving a short outline of what had been achieved over the two days, and expressed his happiness with the outcomes of the meeting. He thanked WHO for the help given in organizing the meeting and thanked all the participants for attending (see Annex 7).
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Annex 1: 9th RNAS+ Meeting Agenda DAY 1 (Oct 19) 0730 – 0830 0830 – 0900 Registration Opening Ceremony
Welcome remarks Representative from LAOS President of RNAS+, Representative from WPRO Dr. Samlane Phompida Dr. Remigio Olveda Dr. John Ehrenberg Dr. Remigio Olveda
Objectives and expected outcomes of the meeting –
0900 - 0930 0930 -0945
Updates on the RNAS+ - Dr Z. Xiao-Nong WPRO Research Strategic Plan Draft in Communicable Diseases, including Neglected Tropical Disease - Dr. J. Ehrenberg
0945 – 1000
Tea/Coffee Break
Workshop 1
Aligning RNAS+ research agenda with WPRO Research Strategic Plan draft on Neglected Tropical Diseases: Review of nine outcomes of the Strategic Plan Mechanics of the Workshop: Dr. Villamor Vital Guidelines for working group – Dr.V. Vital Working Group 1: ER 1. Strengthening our research capacity ER 2. Knowledge creations ER 3. Estimation of burden of diseases Facilitator: Dr.A. Gabrielli Rapporteur: Dr. L. Acosta Assistant Rapporteur: Dr. J. Nakagawa ER 6. Development of evidence-based and costeffective strategies ER 7. Improved mechanism for sharing research findings Facilitator: Dr. A. Hauquitz Rapporteur: Dr. A. Willingham Assistant Rapporteur: Dr. P. Aratchige
1000-1230
Working Group 2:
1230 – 1330
LUNCH
1330 - 1530
Working Group 3:
ER 4. Development of disease specific regional research plans ER 5. Development of new tools and improvement of existing tools Facilitator: Dr. J Utzinger Rapporteur: Dr. M. Sinuon
a
Assistant Rapporteur: Dr. A. Ross Working Group 4: ER 8. Key stakeholders' engagement in regional research agenda and priorities ER 9. Integration of new evidenced-based tools and strategies into health systems Facilitator: Dr. J. Ehrenberg Rapporteur: Dr. T. Fernandez Assistant Rapporteur: Dr. L. Tuan
1530-1545 1545-1745 1745-1800 1800-1900
Tea/Coffee Break PLENARY Session 1Presentation of Outputs: Groups 1, 2, 3 & 4 (20 minutes presentation + 10 minute discussion each) Wrap up – Dr. V. Vital RNAS+ Annual Board Meeting
DAY 2 (Oct 20)
Workshop 2
Workgroup Discussion to identify issues and operational research priorities Mechanics of the Workshop: Dr. Remigio Olveda Brief introduction of issues and research priorities – J. Ehrenberg, R. Bergquist Group work Group 1: Multi-diseases, intersectoral prevention and control strategy Facilitator: J. Utzinger/J. Ehrenberg, Rapporteur: T. Fernandez Assistant Rapporteur: D. Stewart Group 2: Diagnosis, treatment and vaccine development Facilitator: R Bergquist Rapporteur: D. McManus Assistant Rapporteur: L. Leonardo
0830 – 0840 0840 – 1100
1000 – 1015
Tea/ Coffee Break
1100 – 1200
PLENARY Session 2 Presentation of Groups 1 & 2 (20 minutes presentation + 10 minute discussion each)
1200 – 1300
LUNCH
1300 – 1500
Roundtable discussion: Brainstorming on Roles of RNAS+ network in contributing to development of Research Agenda of NTDs in Asia Chairs: A. Willingham and R. Olveda Rapporteur: L. Leonardo Assistant Rapporteur: M. Venturina Strengths of RNAS+ Opportunities for RNAS+ Roles of RNAS+ Challenges (e.g. sustainability, funds, etc.) Future Plan 2010 and beyond
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Priorities in research RNAS+ next steps
R. Bergquist, S.T. Hong, N. Ohta, B. Sripa, J. Utzinger, Z. Xiao-Nong, D. Socheat, S. Phompida, D. McManus 1500 – 1515 1515 – 1525 1525 – 1540 Tea/ Coffee Break Wrap up of key actions – Dr. R. Olveda Closing Ceremony President of RNAS+, Representative from WPRODr. John Ehrenberg 1540 - 1725 RNAS+ Members Business Meeting Chair: Dr. Z. Xiao-Nong 1900 Dinner hosted by WHO and MoH Lao PDR
Dr. Remigio Olveda
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Annex 2: 9th RNAS+ Meeting Participant List RNAS+ Members and Temporary Advisors Dr Alan Hauquitz Senior Lecturer, School of Public Health, Tropical Medicine and Rehabilitation Sciences James Cook University Townsville, Queensland 4811 AUSTRALIA Alan.hauquitz@jcu.edu.au Dr Duong Socheat (RNAS+ Member) Director National Center for Parasitology, Entomology and Malaria Control 372 Monivong Blvd, cor Street 322 Phnom Penh, CAMBODIA socheatd@cnm.gov.kh Dr Muth Sinuon Helminth Control National Center for Parasitology, Entomology and Malaria Control 372 Monivong Blvd, cor Street 322 Phnom Penh, CAMBODIA sinuonm@cnm.gov.kh Dr Zhou Xiaonong (RNAS+ Member) Professor and Deputy Director National Institute of Parasitic Diseases Chinese Center for Diseases Control and Prevention 207 Rui Jin Er Road Shanghai 200025, PR CHINA ipdzhouxn@sh163.net Dr Arve Lee Willingham (RNAS+ Member) WHO/FAO Collaborating Centre for Parasitic Zoonoses Section for Parasitology, Health and Development Department of Veterinary Pathobiology Faculty of Life Sciences University of Copenhagen Dyrlaegevej 100 1870 Frederiksberg, DENMARK awi@life.ku.dk Dr Nobuo Ohta (RNAS+ Member) Division of Environmental Parasitology Tokyo Medical and Dental University 1-5-45 Yushima Bunkyoku Tokyo, Japan matata.vip@tmd.ac.jp Dr Sung-Tae Hong (RNAS+ Member) Professor Department of Parasitology and Tropical Medicine and Institute of Endemic Diseases Seoul National University RO KOREA hst@snu.ac.kr Dr Tai-Soon Yong Director Environmental Medical Biology, Institute of Tropical Medicine Yonsei University College of Medicine 250 Seongsanno, Seodaemun-gu, Seoul 120-752 RO KOREA tsyong212@yuhs.ac
Dr Samlane Phompida (RNAS+ Member) Director Center of Malariology, Parasitology and Entomology Ministry of Health Vientiane, LAO PDR p.samlane@gmail.com Dr Remigio Olveda (RNAS+ Member) Director IV Research Institute for Tropical Medicine Filinvest Compound, Alabang Muntinlupa City, PHILIPPINES remi_olveda@yahoo.com.ph Ms Marilu Venturina (RNAS+ Member) Executive Director/COO Asian Foundation for Tropical Medicine, Inc. RITM Compound, Alabang Muntinlupa City, PHILIPPINES malu_venturina@yahoo.com Dr Luz Acosta (RNAS+ Member) Head Department of Immunology Research Institute for Tropical Medicine Filinvest Compound, Alabang Muntinlupa City, PHILIPPINES lpacosta@yahoo.com Dr Tomas Fernandez (RNAS+ Member) Professor/Dean College of Veterinary Medicine Leyte State University College of Veterinary Medicine Vizca, Baybay, Leyte 6521-A PHILIPPINES tjfernandez0423@yahoo.com Dr Lydia Leonardo (RNAS+ Member) College of Public Health University of the Philippines 625 Pedro Gil St., Ermita, Malate Manila, PHILIPPINES leonardolydia7@gmail.com Dr Robert Bergquist (RNAS+ Member) Ingerod 407 Brastad, SWEDEN robert.bergquist@yahoo.se Dr Juerg Utzinger (RNAS+ Member) Assistant Professor in Epidemiology Swiss Tropical Institute Public Health & Epidemiology / Ecosystem Health Sciences 4002 Basel, SWITZERLAND juerg.utzinger@unibas.ch Dr Banchob Sripa (RNAS+ Member) Coordinator, Asian Liver Fluke Network Division of Experimental Pathology Department of Pathology, Faculty of Medicine and Liver Fluke and Cholangiocarcinoma Research Center Khon Kaen University Khon Kaen 40002, THAILAND banchob@kku.ac.th Dr Do Trung Dung Vice-head of Parasitology Department
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National Institute of Malariology, Parasitology and Entomology Luong Thé Vinhstreet Hanoi, 10200, VIET NAM giudung77@gmail.com WHO Secretariat Dr Albis Gabrielli Preventive Chemotherapy and Transmission Control (PCT) Control of Neglected Tropical Diseases (NTD) World Health Organization Geneva, SWITZERLAND gabriellia@who.int Dr John Ehrenberg Regional Adviser Malaria, Vector-borne, and other Parasitic Diseases (MVP) WHO Regional Office for the Western Pacific Manila, PHILIPPINES ehrenbergj@wpro.who.int Dr Le Anh Tuan Technical Officer Malaria, Vector-borne, and other Parasitic Diseases (MVP) WHO Regional Office for the Western Pacific Manila, PHILIPPINES leanht@wpro.who.int Dr Jun Nakagawa Technical Officer Malaria, Vector-borne, and other Parasitic Diseases (MVP) WHO Regional Office for the Western Pacific Manila, PHILIPPINES nakagawaj@wpro.who.int Mrs Teresita Casupanan Secretary Malaria, Vector-borne, and other Parasitic Diseases (MVP) WHO Regional Office for the Western Pacific Manila, PHILIPPINES casupanant@wpro.who.int Ms. Sascha Meijeres Intern Malaria, Vector-borne, and other Parasitic Diseases (MVP) WHO Regional Office for the Western Pacific Manila, PHILIPPINES meijerss@wpro.who.int Dr. Villamor Dr. Vital Consultant Vice President of Academic Research and Graduate School Dean Asian Social Institute Manila, PHILIPPINES vivital@yahoo.com Dr Padmasiri Eswara Aratchige Medical Officer Malaria, Vector-borne, and other Parasitic Diseases (MVP) World Health Organization, Laos Office Vientiane, LAO PDR aratchigep@wpro.who.int
Dr Chitsavang Chanthavisouk Technical Officer Malaria, Vector-borne, and other Parasitic Diseases (MVP) World Health Organization, Laos Office Vientiane, LAO PDR chanthavisoukc@wpro.who.int Observers Mr Stéphane P. Rousseau Regional Coordinator Asian Development Bank Greater Mekong Subregion Communicable Diseases Control Project Room 2104, 21st Floor, Thanh Cong Tower, 57 Lang Ha Street, Ba Dinh District, Hanoi, VIET NAM gms.cdc.rc@gmail.com Mr Andrew Pearlman ADB Consultant Greater Mekong Subregion Thanh Cong Tower, 57 Lang Ha Street, Ba Dinh District, Hanoi, VIET NAM arpearlman@gmail.com Dr Wang Tianping Director Anhui Institute of Parasitic Diseases 207 Dongjiao Road Wuhu 241000, Anhui, PR CHINA wangtianping@hotmail.com Dr Chen Jiaxu Vice Chief Department of Health Education and Consultation National Institute of Parasitic Diseases Chinese Center for Disease Control and Prevention Shanghai 200025, PR CHINA chenjiaxu@yahoo.com Dr. Yuichi Chigusa Department of Tropical Medicine and Parasitology School of Medicine, Dokkyo Medical University Mibu, Shimotsuga, Tochigi 321-0296431, JAPAN ychigusa@dokkyomed.ac.jp Dr Allen G. Ross Chair of Public Health, Griffith University Director, Population Health Research GIHMR University Drive, Meadowbrook QLD 4131 AUSTRALIA a.ross@griffith.edu.au Dr Donald Stewart Head, School of Public Health Vice-President, SW Pacific Region, IUHPE Room 4.14A L05 - Logan Campus Griffith University University Drive, Meadowbrook QLD 4131 AUSTRALIA Donald.Stewart@griffith.edu.au Dr Chen Zhao Officer Division of Schistosomiasis Department of Disease Control, Ministry of Health 1, Xi Zhi Men Wai Nan Lu Beijing, PR CHINA 100044 chzh0509@163.com
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Dr. Mihoko Kikuchi Lecturer Nagasaki University Center of International Collaborative Research (CICORN) Institute of Tropical Medicine 1-12-4, Sakamoto, Nagasaki 852-8523, JAPAN mkikuchi@nagasaki-u.ac.jp Dr Hiroshi Ohmae Head Laboratory for Parasitic Diseases in the Tropics Dept of Parasitology National Institute of Infectious Diseases Toyama 1-23-1 Shinjuku-ku Tokyo 162-8640, JAPAN h-ohmae@nih.go.jp Dr Sara Lustigman, Member and Head Laboratory of Molecular Parasitology, Lindsley F. Kimball Research Institute New York Blood Center 310 East 67th Street New York, NY 10065, USA slustigman@nybloodcenter.org Dr Don McManus Head, Molecular Parasitology Queensland Institute of Medical Research, Infectious Diseases PO Royal Brisbane Hospital QLD 4029, AUSTRALIA Don.McManus@qimr.edu.au Dr Qiu Dongchuan Director Sichuan Institute of Parasitic Diseases, Sichuan CDE 6 ZhongXue Road, Chengdu, Sichuan 610041, PR CHINA qiudongchuan@163.com Dr Peter Odermatt Swiss Tropical Institute Department of Public Health and Epidemiology Socinstrasse 57, 4002 Basel SWITZERLAND Peter.Odermatt@unibas.ch Dr Henry Madsen Senior Researcher Department of Veterinary Disease Biology/ DBL - Centre for Health Research and Development Faculty of Life Sciences University of Copenhagen Thorvaldsensvej 57 1871Frederiksberg C, DENMARK hmad@life.ku.dk
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ANNEX 3: Welcome Remarks by :Dr Samlane Phompida, Director, Center of Malariology, Parasitology and Entomology, Ministry of Health, Lao People's Democratic Republic, at the opening ceremony Professor Remigio Olveda, Chairperson of the RNAS+; Dr John Ehrenberg, Regional Advisor for Malaria, other Vectorborne, and other Parasitic Diseases; Dr Albis Gabrielli, Medical Officer of Neglected Tropical Diseases, WHO Headquarters, Geneva; and other WHO staff; honorary members of the RNAS+; distinguished invitees; Partners; Ladies and Gentlemen: It is an extreme honor to address such distinguished guests at the inauguration of the Ninth Meeting of the Regional Network for Asian Schistosomiasis and other Helminth Zoonoses. Many thanks to the organizers for selecting Lao PDR as the venue for this meeting. I am happy and proud that with assistance from WHO, Lao PDR is able host this meeting. I welcome you all to this friendly and beautiful country. Lao PDR was a founding member of the RNAS when it was started in 2000 as a small schistosomiasis action network in core endemic areas. Since then Lao PDR has been actively involved in RNAS activities. Schistosomiasis and other helminth zoonoses are important public health issues and Lao PDR has a long history of attempting to control them within the available limited resources. RNAS+ forms a very important link and a technical network for Lao PDR in its efforts to progress with the control of these diseases. The selection of Lao PDR as the venue for this important meeting is in fact a fitting recognition of the problems faced by the country from these diseases and its efforts to control them. The presence of favorable ecology with the presence of parasitic agents, intermediate and reservoir hosts and human behavioral risk factors make our people vulnerable to infection. A low level of sanitation also contributes to the spread of infections. However, despite the presence of these favorable conditions for parasites, Lao PDR has demonstrated in schistosomiasis control, that with regular mass chemotherapy it can reduce the transmission. It reduced a high endemicity level of schistosomiasis from over 60 percent in endemic areas to less than 2%. However, we also learnt a lesson that withdrawal of regular chemotherapy can give rise to resurgence of infection within a few years. This happened when we stopped mass chemotherapy against schistosomiasis in 1999 and we are thankful to WHO for helping Lao PDR to recommence mass treatment in 2007. We are keenly interested in continuing research on schistosomiasis and other parasitic zoonoses in order to find ways to ease the burden from these diseases. We are thankful to the international research organizations, partners and donors who collaborated with us in this regard. I realize that this meeting has an interesting agenda on the strategic plans for research. We look forward to the outcomes that will be generated by discussions in this meeting. I thank WHO for supporting to organize this meeting and RNAS+ for selecting Lao PDR to host this meeting. I hope you have a pleasant stay and enjoy the culture and hospitality in Lao PDR. I wish this meeting all success. Kop chai lai lai.
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ANNEX 4 : Welcome remarks by Dr Remigio Olveda, Outgoing President RNAS+ at the opening ceremony Good morning everyone, members of the RNAS+, guests and observers: On behalf of the RNAS+ I would like to welcome all of you to the 9th Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses meeting. This is really an opportunity for us to take a look at where the RNAS+ is at present, what we have done, and what our directions are for the future. You will notice that this is the first time that we have held this kind of meeting. Usually we hold informal workshops, scientific meetings, and small group workshops. However, this meeting will be an activity that will put the RNAS+ into international recognition, particularly our role in the Western Pacific Region as well as our role in other activities that are going on globally. I would like to thank Dr Samlane Phompida and Lao PDR for hosting this meeting. Dr Padmasiri Aratchige, head of the WHO Office in Lao PDR, and of course Dr John Ehrenberg of Western Pacific Regional office working in Malaria, other Vector-borne and other Parasitic Diseases, and also the others who really contributed to making this project successful. This meeting would not be possible without the support of the office of Dr Steven Wayling and the office of Dr John Ehrenberg. Again I would like to say welcome to all of you to this 9th RNAS+ meeting. Thank you very much.
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ANNEX 5: Welcome remarks by Dr John Patrick Ehrenberg, Regional Advisor for Malaria, other Vectorborne and other Parasitic Diseases, WHO Regional Office of the Western Pacific, at the opening ceremony Good morning everyone, it is a pleasure being here with all of you. On behalf of the new Regional Director of the Western Pacific Region, Dr Shin Young-soo, I would like to thank each and every single one of you to this meeting. Particularly I want to thank Dr Samlane Phompida, Director of Malariology, Parasitology and Entomology of the Ministry of Health of the Lao People's Democratic Republic, for his hospitality and providing the venue for this meeting. Lao PDR is a beautiful country and there are a number of beautiful things here in Vientiane. I would also like to thank Dr Remigio Olveda, the president of RNAS+, for having invited us and WHO to participate in this meeting. .I have to say that I am personally very motivated and excited by the prospect of having been able to work with RNAS+. I certainly also want to thank all of the participants who came from far away, not just from this region but from other regions as well. We've got people from the US and Europe as well as a very distinguished group of researchers from the Asia-Pacific region. We know that you are very busy so thank you for having made space in your agendas to come here. I think there is a tremendous value that RNAS+ brings to the table. First of all, this should not be perceived as, and I think was never conceived as such, as a WHO or TDR initiative. The RNAS+ is a network that is country-driven and driven by prominent scientists from this region, with the support, technical and otherwise, from researchers from other parts of the world. Research is in many ways a neglected issue and anybody who has been working in research knows how difficult it is to get funding for research. Having a country-driven initiative such as this really sets the pace for raising the profile of research in this particular part of the world. Here we are talking about two regions for WHO, the South-East Asia Region and the Western Pacific Region. One of the key things that we are trying to do here is to raise the profile of research in the Region and for the need of conducting operational research in order to fill programmatic gaps. This is an interesting combination of people because we've got scientists and researchers as well as programmatic people coming together here. Normally these two sectors do not come together and this is a tremendous loss of expertise to countries that have very few resources to begin with. There is a tremendous amount of information that the academic sector brings to the table that is not taken advantage of by the public sector. I think this forum puts these two sectors together and we are able to learn from each other and to understand the value that the academic sector brings to the table in filling in programmatic gaps through operational research. I just wanted to acknowledge the work of TDR here. We are going to have a meeting on Friday the 23rd of October 2009 with TDR and it is mainly to disseminate TDR's new tenyear vision and business lines. TDR has had to change because there is a changing environment out there. There are now many stakeholders, competing priorities, parallel systems that make it very complicated for us to work in public health, and research is not an exception so it is a good thing that TDR has changed. Dr Bergquist has been with TDR for many years and knows how good the work of TDR has been over many years. Many of us were actually TDR fellows or grantees and are here thanks to that support, but TDR had to change, and so part of the challenge here is to make sure that we harmonize the plan that we are going to be talking about with TDR's new vision. That is not determined by TDR and Dr Robert Ridley but primarily by its board, the Joint Coordinating Board, that comprises some key donors and the Member States who decided that TDR had to take a new direction, and that is one of the things that is going to be discussed on Friday.
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For us here the purposes of this meeting are to make sure that initiatives are harmonized because that is going to continue to be a source of financial support and in a resource-constrained environment and financial crisis I think we really have to harmonize with them. So having said that, again on behalf of Dr Shin, let me wish us all success in this meeting. We have high expectations. I just want to close by saying that I think the log frame of the Research Strategic Plan should not just be perceived as a roadmap for the Region to strengthen research, development, and promote transfer of technology and capacity building, but also as a resource mobilization tool. We have done so in developing a log frame for malaria and it was endorsed by the Ministries of Health a couple of weeks ago. We have also done so for the dengue programme and it was endorsed by the Regional Committee and the Ministries of Health last year, which is basically synonymous to political blessing of a plan. Therefore you will see that it is a very useful instrument and is a necessary exercise that we have to go through. Additionally, it is possibly one of the most useful tools because it is also used by the bilateral agencies, so you instantly have an instrument in your hand that is a common language and tool which you can use in interacting with some of the principal donors. Thank you very much for coming, I wish you success in this meeting and we will be seeing you all here over the next two days.
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ANNEX 6: Complete revised version: Log frame of the draft Western Pacific research strategic plan for communicable diseases, including neglected tropical diseases
Summary of Objectives Overall goal
Indicators
Verification sources
Assumptions
To contribute to the achievement of the Millennium Development Goals (MDG) through research and development to reduce the burden due to communicable disease. Regional objective To improve programmes targeting parasitic vectorborne diseases (including NTDs) and TB in the Western Pacific Region by applying research and development, technology transfer and capacity strengthening. . 1. Demonstrated qualitative or quantitative improvements in programmatic activities attributed to uptake of research findings 2. Cost per diseaseadjusted life-year (DALY) for NTDs that cause chronic disability Country programme reports Political commitment and funding for research secured
Independent surveys and/or evaluation reports
Purpose To capitalize on the Western Pacific Region's comparative advantage to foster research, development and evaluation of interventions in real-life settings and strengthen the capacity of developing endemic countries to undertake the research needed to apply new tools, develop and implement new and improved disease control/elimination strategies. 1. Number of country programmes with implementation policies based on research findings RCM resolutions Copies of national treatment and control/ elimination guidelines Copies of national research agenda Political commitment and funding for research secured. Availability of resources Commitment to evidence-based practice
2. Number of countries , adopting, incorporating and implementing a national research agenda 3. Number of research institutions per country that undertake research for disease control/elimination programmes/costeffective strategies
Institute annual reports
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Expected Results 1. Applied and operational research capacity of existing academic/research institutions and programmes in Member States enhanced. 1.
Indicators Number of institutions/programmes with staff receiving postgraduate scholarships/year Number of postgraduates receiving re-entry funds or equivalent upon completion of postgraduate programmes per year Number of trained research staff conducting applied and operational research on target diseases per year Number of institutions engaged in collaborations / partnerships within or outside the Region per year Number of regional training sessions/workshops on priority diseases attended by majority of targeted participants
Verification Sources Enrolment records
Assumptions Relevant institutions are willing to provide information and support
2.
Reports of research progress
Copies of publications
3.
Partnership agreements
4.
Workshop reports
5.
2. Improvement and generation of biomedical, socioeconomic, health systems, behavioural and epidemiological knowledge for effective control of communicable diseases
1.
Number of research projects that improve or generate new knowledge per country per year Number of programmes per country where the improved or new knowledge helps bridge programmatic gaps Number of peer-reviewed publications, patents, etc. Number of intersectoral partnerships per country
Research project reports
2.
Programme reports
Copies of publications
3. 4.
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Expected Results 3. Regional burden of communicable diseases, including NTDs, estimated and regularly updated 1.
Indicators Number of countries engaged in diseaseburden estimates Number of diseases analysed to estimate disease burden per country Number of research projects to determine disease burden per country Number of programmes that have incorporated a research component Number of improved existing tools (such as innovations, polymerase chain reaction [PCR], real-time-PCR assays etc.) Number of diseasespecific new tools/products developed, including diagnostic, control and surveillance tools, as well as methodological frameworks Number of peer-reviewed publications Number of patents, intellectual property rights for new tools Number of new costeffective strategies developed, validated and ready for adoption/ implementation
Verification Sources Country reports
Assumptions
2.
Country reports
Research project reports
3.
4. Disease-specific regional research plans developed 5. New tools developed and existing tools improved
1.
Copies of programmes and plans Technical guidelines
1.
2.
Product guidelines and technical writeups
Copies of publications Copies of patents, copyrights
3. 4.
6. New, evidence-based, cost-effective strategies developed for implementation
1.
Documentation reports
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Expected Results 7 Improved mechanisms for sharing and dissemination of research findings and technical research guidelines 1
Indicators Number of countries that have easy access to research findings using ICT Number of diseases that have regional and up-todate database of research findings Number of available information-sharing mechanisms in use (e.g. dengue-net) Number/ frequency of face-to-face interactions (e.g. workshops, exchanges)
Verification Sources Internet links Reports on specific diseases Feedback from survey Workshop reports
Assumptions
2.
3.
4.
8. Key decision-makers, stakeholders and donors engaged in regional health research agenda and research priorities
1. Number of stakeholders, donors and country decision-makers who have incorporated the regional research strategic agenda into their funding priorities 2. Number of decisionmakers, donors and stakeholders committing to an equitable allocation of resources for applied and operational research 3. Number of grants and total funding committed to applied and operational research 4. Number of countries that make regulatory research guidelines available
Fund allocation report
Fund allocation report
Record of funds released
Grant agreements
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Expected Results 9. Research findings are translated into programmes and action
Indicators 1. Number of programmes in Member States using evidence from research to inform policy and programmes, resulting in action 2. Number of programmes in Member States adopting research recommendations in policy formulation and programme implementation 3. Number of programmes publishing operational research findings 4. Number of countries with effective mechanisms for dissemination of research findings to all relevant sectors 5. Number of countries that have established research priorities based on programme needs 6. Number of countries that conduct/ support research to address identified programme needs
Verification Sources Programme reports
Assumptions
Programme reports
Publications
Programme/ Country reports
Programme/ Country reports Programme reports
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Expected Result 1 Activities 1.1 Conduct inventory /situation analysis of existing activities, capacities, training needs and opportunities .
Applied and operational research capacity of existing academic/research institutions and programmes in Member States enhanced Outputs By June 2010, diseasespecific research network identified training needs and opportunities By 2011, pertinent information available including: capacity assessment results of Member States, including inventory of trained staff; scholarship priorities of national and international granting institutions; inventory of WHOaccredited institutions and those that could be accredited that can provide costeffective training in fields facing a shortage (e.g. health economics, medical entomology, GIS priority areas); training programmes offered by relevant institutions
Responsible Primary: WHO Disease-specific research network In coordination with relevant partners Local and international partners Ministry of Health, Ministry of Education, Ministry of Science and Technology or equivalent Ministry of Foreign affairs Embassies National/State universities and research institutes Scholarship-granting institutions Websites of international institutions Collaborating centres and accredited training programmes and institutions
Resources Financial resources Human resources
By 2011, pertinent information available including: mapping of research institutions engaged in partnerships list of recent (last year) postgraduates per institution per country receiving financial and technical support for research
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Expected Result 1 Activities 1.2 Prepare a Member-State researchoriented humanresource development plan for communicable diseases, including NTDs
Applied and operational research capacity of existing academic/research institutions and programmes in Member States enhanced Outputs Research-oriented human-resource development plan indicating staffing/skills requirements available Training needs and opportunities in communicable diseases, including NTDs, identified by research network At least two workshops per year based on situation analysis Distance-learning programmes started by 2010 in top priority needs identified At least two collaborative arrangements in place starting 2011 A number of participants benefiting from collaborative arrangements A number of scholarships and fellowships per country per year per skill area Primary: WHO With collaborating centres Financial resources Human resources Primary: WHO With collaborating centres Financial resources Human resources
Responsible Primary: Member States
Resources Funds from Member States Expertise
1.3 Organize capacitybuilding activities within the Regional Network in areas of identified need
1.4 Facilitating national and international research and training arrangements and collaboration (e.g. scholarships, fellowships, exchange programmes)
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Expected Result 2
Improvement and generation of biomedical, social, economic, health system, behavioural and epidemiological knowledge for effective control of communicable diseases.
Major Activities 2.1 Identify researchers by discipline
Output/s Listing/inventory by country, disciplines and institutions
Responsible Primary: WHO With Ministry of Health, and research councils/ academic institutions
Resources Funds Human resources
2.2 Design multidisciplinary research targeting improved and new methods for prevention and control of communicable diseases, including NTDs
Agreements and agenda between institutions New research projects embracing a multidisciplinary approach approved for funding
Primary: Ministry of Health authorized Research institutions
Funds Discipline experts
2.3 Conduct multidisciplinary research targeting improved and new methods for prevention and control of communicable diseases, including NTDs
Published research reports Sustained funding for research and implementation Improved tools to be used in prevention and control of communicable diseases, including NTDs Provide recommendations to be considered for policies (e.g. workshops with service providers and consumers to discuss research findings)
Primary: Academic institutions and/or research institutes Communities
Funds Experts Community support
2.4 Seek feedback from different stakeholders, service providers and consumers on key research findings (especially where there are research products that can be commercialized e.g. botanical molluscicides)
Primary: WHO With TDR, and research councils/academic institutions
Funds Experts Human resources
2.5 Facilitate intersectoral partnerships, including the private sector, to mobilize resources and synergies for research and control measures
Partnerships established Resources mobilized Synergies harnessed
Primary: WHO With Ministry of Health, Ministry of Science and other ministries e.g. Environment Academic and scientific institutions
Funds Experts
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Expected Result 3 Activities 3.1 Set up regional expert working group in coordination with global initiatives on the burden-ofdisease study 3.2. Develop methodologies to estimate prevalence, incidence, mortality, disability weights and sequelae from available data 3.3. Conduct incountry training of trainers in disease-burden and cost-ofillness methods 3.4. Conduct diseaseburden studies
Regional burden of communicable diseases, including NTDs, estimated and regularly updated.
Outputs Work plan and scientific protocols Regional reference centres for disease burden and health economics
Responsible Primary: WHO With scientific/ academic sector
Resources Experts from Region funds
Estimated population data for national disease burden analysis including disability weight and sequelae
Primary: WHO with Member States, Ministry of Health, funding source and country expert groups
Country experts/ Consultants Funds
Expanded capacity in disease-burden methods Cost of illness
Primary: WHO with Member States and Ministry of Health with scientific and academic sector Primary: WHO with Member States, Ministry of Health, funding source and country expert groups
Qualified trainers from Member States Funds
Mortality (YLL), morbidity (YLD) and DALY, by cause Comparative analysis with global estimates
Country experts/ Consultants Funds
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Expected Result 3 Activities 3.5. Health information situation analysis and management
Regional burden of communicable diseases, including NTDs, estimated and regularly updated.
Outputs Information on coverage and quality of morbidity and mortality data, including geographic distribution and vulnerable populations within countries Information on national health surveys Information on national health care claim data or hospital discharge data Epidemiological data from sample survey National household expenditure survey GIS as risk analysis (e.g. poverty maps) Reliable data on mortality and morbidity rates on CD available and updated annually
Responsible Primary: WHO with Member States, Ministry of Health and funding source Ministry of Labour and Security and its equivalent
Resources Country experts/ Consultants Funds
3.6. Conduct diseasecosting and costeffectiveness analysis 3.7 Publish, disseminate and advocate disease-burden studies
Disease cost by cause and cost-effectiveness data by intervention Publications, dissemination and advocacy activities Information available on website Primary: WHO with Member States, Ministry of Health, funding source and country expert groups Financial resources Human resources Country experts/consultants Funds
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Expected Result 4
Disease-specific national and regional research plans developed. Outputs National and regional needsassessment report
Activities 4.1 Conduct programme needs assessment in consultation with end-users (e.g. programme managers, Ministry of Health) and stakeholders 4.2 Formulate national research plans in consultations with end-users and stakeholders.
Responsible
Resources
National and regional research plan development
Expected Result 5 Activities 5.1 Develop new and improve existing tools for rapid epidemiological assessment, including intermediate and reservoir hosts 5.2 Develop disease-specific risk maps where required (i.e. GIS/RS) 5.3 Develop new and improve existing diagnostic tools/products for infection, transmission and elimination
Improve existing and develop new tools for surveillance, control and prevention. Outputs Appropriate and effective tools for rapid epidemiological assessment are developed, validated and made available Up-to-date diseasespecific risk maps created Appropriate and effective diagnostic tools developed, tested and available Appropriate and effective tools developed, tested and made available for mass screening of intermediate hosts for infection Primary: WHO Privates sector for drug discovery
Responsible Primary: WHO Private sector for drug discovery
Resources
5.4 Develop vaccines for human and reservoir hosts 5.5 Develop new and improve existing drugs (including natural products) 5.6 Develop new and improve existing tools to assess drug resistance
Validate and make available the vaccines. Validate and make available the drugs Appropriate and effective tools to assess drug resistance developed, tested and available Primary: WHO Private sector for drug discovery
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Expected Result 5 Activities 5.7 Improve formulation and utility of traditional medicines as a complementary approach 5.8 Develop new and improve existing surveillance and monitoring systems
Improve existing and develop new tools for surveillance, control and prevention. Outputs Appropriate dissemination of traditional medicines Appropriate and effective surveillance and monitoring systems developed, tested and made available Appropriate indicators for monitoring and evaluation developed
Responsible Primary: WHO Private sector for drug discovery Primary: WHO
Resources
5.9 Develop new and improve existing decision-support tools for NTDs (mathematical modeling) 5.10 Develop new and improve existing tools to change attitudes, knowledge and behaviour and assess impact on disease outcomes
Models developed and validated
Primary: WHO
Appropriate and effective tools developed to change attitudes, knowledge and behaviour Impact on health outcomes validated and quantified
Primary: WHO
5.11 Develop and validate new integrated, intersectoral, inter-programmatic control strategies for elimination of disease
New integrated, intersectoral, interprogrammatic control strategies developed, validated and deployed Appropriate intersectoral indicators developed
5.12 Develop criteria for verification/certification of disease elimination
Appropriate criteria for verification/ certification of disease elimination developed and available Algorithm for development of tools developed
Primary: WHO
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Expected Result 6 Major Activities 6.1 Develop new and improve existing strategies for disease prevention 6.2 Develop new and improve existing strategies for vector and intermediate host (e.g. animal reservoirs) control
New, evidence-based, cost-effective strategies developed for implementation. Outputs Responsible Resources Developed, tested, validated and published strategies for disease prevention Developed, tested, validated and published strategies for vector control Natural products for vector and intermediate host control Developed, tested and validated programme, with appropriate monitoring and evaluation Timely monitoring and evaluation reports.
6.3 Develop programme, planning, monitoring and evaluation
6.4 Develop new strategies to address vulnerable groups (e.g. ethnic minority groups and other economically disadvantaged population groups) 6.5 Develop sustainable integrated interprogrammatic, intersectoral strategies in partnership with key stake holders
Developed, tested, validated and published strategies for disease prevention
Developed, tested ,validated and published integrated, interprogrammatic, intersectoral strategies
Ministries of Health, Environment, Agriculture, Education, Finances and the private sector
Strategies with an emphasis on the role of climate change on NTD disease pattern Assessment of clinical management practices Improved global, regional and national clinical management guidelines Developed, tested, validated and published knowledge, attitudes and behavior-change strategies Developed, tested, validated and published strategies for integrating traditional medicine into control programme
6.6 Develop and/or assess and improve global, regional and national clinical management guidelines 6.7 Develop strategies for education, promotion and behaviour change
6.8 Develop strategies for integrating traditional medicine in humans and animals into control programme
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Expected Result 6 Major Activities 6.9 Develop new and improve existing strategies for surveillance and monitoring 6.10 Develop strategies for dissemination of research findings at global, regional, national and local levels
New, evidence-based, cost-effective strategies developed for implementation. Outputs Responsible Resources Developed, tested, validated and published strategies for surveillance and monitoring Developed, tested, validated and published strategies for dissemination
Translation of key research findings
Expected Result 7
Improved mechanisms for sharing and dissemination of research findings and technical research guidelines among researchers
Activities 7.1 Establish and conduct regional and national forums to provide opportunities for exchange of information, joint planning and policy creation
Outputs Participation of key researchers in programme managers’ meeting to disseminate research findings Programme managers’ meeting reports showing approval of research-based recommendations Consultative meetings involving both sectors (e.g. public health, academia, CDC) Current programmatic research needs reported
Responsible Primary: Ministry of Health With the WHO Regional Office for the Western Pacific and research institutions
Resources Funds Experts and facilitators Human resources
x
Expected Result 7
Improved mechanisms for sharing and dissemination of research findings and technical research guidelines among researchers
Activities 7.2 Set up and/or update web-based virtual networks for communications, information storage and dissemination
Outputs Regional/country-based information system accessible and attractive to target audiences and providing updated information Internet hits increasing significantly every year Disease-specific information mechanism developed and updated e.g. Dengue-net Regional database of disease-specific research findings Technical reports, publications and conference proceedings, etc. Newsletters, abstracts sent through email Dissemination through WHO pouch or other mechanisms
Responsible Primary: WHO With research institutions Academic institutions Ministry of Health
Resources Research findings Supportive research institutions Funds Information technology structure Political commitment
Increased access to TROPIKA and ACTMalaria website 7.3 Provide/ organize venues for collaborative review and development of technical research guidelines and dissemination of research findings Participation of researchers in workshops to develop technical research guidelines Disease-specific technical research guidelines developed and approved Dissemination of research findings 7.4 Conduct national, provincial and local workshops to ensure that evidence-based research and policy is translated into public health practice Trained end-users able to access web-based information system Primary: WHO Research/Academic institutions Ministry of Health Funds Facilitators Trainers Primary: WHO Research/Academic Institutions Ministry of Health Funds Experts Human resources
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Expected Result 7
Improved mechanisms for sharing and dissemination of research findings and technical research guidelines among researchers
Activities 7.5 Assess awareness/ availability/ accessibility of website and/or use of hard copies of publications arising from research, including translation into local languages, and make available to libraries of developing countries
Outputs NTD-relevant journals delivered and available in targeted libraries Dissemination through WHO pouch or other mechanisms Newsletters, abstracts sent through email Updated WHO regional platform, such as Western Pacific Regional Index Medicus Increased access to TROPIKA and other websites Access to e-libraries at WHO Offices (HINARI)
Responsible
Resources
Expected Result 8 Major Activities 8.1 Identify international and national key stakeholders/donors/ country decision-makers for each country and/or disease, as well as what they have contributed and continue to contribute to disease research 8.2 Organize international and national high-level meetings that bring together decisionmakers, donors, health ministries, academic sector and private sector to build alliances and agree on research priorities and funding mechanisms
Key decision-makers, stakeholders and donors are engaged in regional health research agenda and research priorities Output Reliable and readily available database to list potential allies and advocates for mobilizing resources to support regional research agenda Relevant national authorities notified Public-private partnerships Amount of funding committed to research Increased involvement of other sectors (e.g. environment, agriculture etc.) Resolutions, agreements from high-level meetings
Responsible Primary: WHO With identified suitable partner NGO
Resources Time Funds Human resources
Ministry of Health, Ministry of Science Banks (World Bank, Asian Development Bank, etc.) Ministry of Finance
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Research priorities identified and funding options agreed upon 8.3 Perform a retrospective study on investments and expenditures in research to evaluate how much funding for research has been allocated for NTDs Report on research funding for specific programmes and/or diseases in the last five years Regional and national strategies to assign funds proportional to CD burden, including NTD Comparative analysis report on research investment and expenditures across the health sector 8.4 Create a communication strategy to raise the profile of the Region’s research priorities and needs 8.5 Raise the economic profile of the CD research agenda among existing economic bodies (APEC, ASEAN, SIMED/TROPMED etc) Communication strategy developed and implemented Primary: WHO Consultant provided by WHO
Commitments for funding from economic bodies obtained
Primary: WHO SEAMEOTropMed
Presentation of a regional research plan to existing economic bodies/ASEAN secretariat in CD in addition to H1N1 Establish link between research and economic development
8.6
Facilitate sharing of international bio-medical research ethical guidelines among countries and adoption of these guidelines in human and animal subjects
Adopted international biomedical research ethical guidelines across the Region National ethical committee established according to internationally acceptable standards.
Primary: WHO with volunteers and/or NGO
Consultants for countries without current guidelines
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Integration of new evidence-based tools and strategies Expected Result 9 developed (ER 5 and 6) promoted and supported into existing health systems or population-based interventions Major Activities Outputs Responsible Resources 9.1 List relevant departments/instit utions involved CD research and programmes within regions Conduct joint meetings/worksho ps involving programmes, the academic community and decision-makers to establish operational research priorities Listing and inventory of CDresearch-oriented organizations and institutions and their research Primary: WHO In cooperation with Ministry of Health Ministry of Science and Technology or its equivalent Meeting reports Agreement on country operational research priorities formalized by decisionmakers /research organizations Unified national research agenda ensuring that CD are included, with NTDs identified and responsible parties assigned Annual institutional research plans Annual plans of research organizations incorporating priority research needs of programmes 9.3 Disseminate research findings Joint technical seminars/ workshops held within the framework of existing scientific meetings or forums involving participation of the academic/scientific sector, programmes, policy-makers and the private sector Success of incorporating CD research into international cooperation health agenda of the developed countries in the Region Primary: WHO With cooperation from Ministry of Health Researchers and Key stakeholders (NGOs, etc) Funds Human resources Experts Primary: WHO with Ministry of Health Academic research organizations Funds Human resources Experts Funds Human resources
9.2
Feedback from programme/policy-makers regarding usefulness of research findings
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Integration of new evidence-based tools and strategies Expected Result 9 developed (ER 5 and 6) promoted and supported into existing health systems or population-based interventions Major Activities Outputs Responsible Resources 9.4 Establish a working group/task force (involving programmes and academic institutions/liaison focal points) to coordinate, monitor and evaluate the integration of research findings into operations and policies. Strengthen collaboration between research institutes and programe managers National, functional working group/task force established (including terms of rerference, budget) Identification of integration of research findings into operations and policies, and specific recommendations generated Ministry of Health Funds Human resources
9.5
Research protocol agreed upon and jointly developed Project reports Publications Formal intersectoral collaborations formalized and funded Funds raised for programmatic activities directly attributed to research findings
Primary: WHO with Ministry of Health and researchers
Funds Human resources
9.6
Promote utilization of research findings to leverage funds for implementation
Primary: WHO Ministry of Health, researchers, Ministry of Science and Technology, Ministry of Finance Donors
Funds
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ANNEX 7 : Concluding remarks by Dr Remigio Olveda, Outgoing President RNAS+, at the closing ceremony We had a very good attendance this year. We were missing a few people because of events that they had to attend but we are very happy that about 98 percent of those we invited are here. I think we covered very vital activities on the fist day. We tried to refine the log frame of WPRO's Research Strategic Plan and I think we were successful in doing so. On the second day we were able to come up with five concept proposals. Originally we were only aiming for two concept proposals but we ended up with five concept proposals. Three of these proposals were announced last week and we have the possibility in getting a grant if we work hard and develop these proposals further. I am very happy with the outcome of this meeting and at this point I would like to thank those who made the meeting possible. We had the support from TDR through the office of Steve Wayling. This meeting also would not have been possible without the support from WPRO and the help of Dr John Ehrenberg's office in supporting the counterpart office and arranging the four back-to-back meetings. This would not have been possible also without the support of the local people here headed by Dr Padmasiri Aratchige, and of course our host represented by Dr Samlane Phompida. I hope you will not get tired of joining us and helping us to make this organization really viable because we know that this is an important network which can be a vital implementing arm of the WHO regional research strategic plan and of TDR changing our approach in terms of strengthening research capacity of endemic countries. I would like to thank those who really helped in the preparation of these workshops, particularly those in the secretariat, like Dr Jun Nakagawa, Dr Le Anh Tuan, Dr Marilou Venturina, and also those who worked on the documentation of the preceding meetings. Thank you for the support from WHO HQ, TDR, and the local support from WPRO and for the delicious lunch/dinner and many dinners to come. Thank you.
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