ECAS 2013

Despite their wide-spread impact, neglected tropical diseases (NTDs) have been marginalized in the Millennium Development Goals (MDGs) as "other diseases" on the global health and development agenda. Yet, they affect over 1.4 billion of the most impoverished people on earth. A new research effort by Hudson Institute and the Sabin Vaccine Institute provides documentary evidence that 28 countries have either eliminated or controlled 4 of 7 NTDs—at pennies per person served, often for $0.50. Another major finding is that the pathway to the MDGs lies in the effective treatment of NTDs. They disproportionately strike during childhood, causing a cascade of debilitating consequences through their lives, affecting their future wage-earning potentials. For instance, MDG #2 is the attainment of Universal Primary Education, a difficult one to reach when soil-transmitted helminths substantially reduce a child's school attendance and attention span while in class. And, while NTDs have low mortality rates, they are among the highest in morbidity rates, particularly within the lowest income groups in rural areas, ensuring that they remain locked into a poverty profile. Yet, of the billions expended on global health initiatives, only 0.12% has been allocated to NTDs. This research effort has finally moved NTDs out from the shadows by documenting for policy-makers that they are not only global health issues but also of a global macroeconomic concern.

In 2012 the World Health Organisation approved a resolution calling on countries to work towards elimination of schistosomiasis. In this paper the progress made by several countries will be presented. However as at 2013, there are certain countries which are far from achieving national coverage with control measures and the constraints to achieving elimination, and the status of schistosomiasis control in the problematic countries will be discussed. Mass Drug Administration to either school aged children or populations using the oral drug praziquantel has been the main control measure to date, but perhaps a greater effort should be made to implement other measures in parallel if eliminations is to be achieved.

The development of new therapies against 'neglected' tropical diseases (NTDs) requires, we are told, new forms of collaboration between private and public actors. Pharmaceutical companies, academic research institutions and philanthropic organizations must join forces in drug development. Over the last decade, a plethora of public-private partnerships have emerged to tackle perceived 'market failure'. Along with patent pools, online databases of proprietary assets, and 'open laboratories', these arrangements are changing the landscape of property relations across the distributed networks of NTD research. They not only challenge the modernist distinction between public and private, but also highlight the 'complex domaining effects' (Hayden 2010) these categories themselves entail.

On the basis of ethnographic research into global health collaborations, documentary analysis and interviews with participating actors, this paper explores the work afforded by the discourse of the virtual. Drawing on the sociology of expectations, we interrogate the promissory nature of drug development partnerships, and linked to this, their ability to colonize the future landscape of global pharmaceutical markets. We explore the traditional exclusionary function of property rights in this world of seemingly unfettered collaboration. When 'partnering' becomes the operative term and sharing the constitutive mechanism of expanding research collaborations, how are the limits of the network produced, where and how is the network cut? We turn to the anthropological literature on gift-giving and inalienable possessions to understand the boundaries of participation in the moral fold of partnership, and how the definition of these boundaries transform both the targets and agents of drug development initiatives.

Attempts to understand and control African trypanosomiasis are bound up in the longue durée of African development, encompassing the entire twentieth century. The historical scholarship on African trypanosomiasis has set the extension of Western science, medicine and power in Africa during the early colonial period amongst the changing theories of disease aetiology, control and treatment. This paper builds upon this work to examine the latter twentieth century, when increased funds for 'development' brought a renewed emphasis on tropical disease prevention and control activities, including the expansion and reorganisation of research capacity. Over these years, Trypanosomiasis research and control has been approached from a multitude of different perspectives, including vaccine research, environmental m! anagement, vector control, human and veterinary medicine (i.e. prophyl axis or treatments) and insecticides. All of these approaches had political, economic and environmental dimensions to them that pertain in distinct, yet linked, ways from the late colonial period through independence. Scientific and medical research into the many facets of sleeping sickness continued through the political transitions while also witnessing changes to the institutional and funding regimes for vector-borne tropical diseases (and specifically zoonoses) more generally. This paper will transit the varied institutional structures of late-colonial Africa directed at the sleeping sickness problem with a view to describe a foundation upon which, or in spite of, later interdisciplinary research structures were formed.

Human African Trypanosomiasis, i.e. sleeping sickness, affects Angolans at least since the XIXth century and continue to do so in the present day. This ailment was the main colonial disease as well as the epitome of the neglected disease. This presentation examines the prevalence of this disease, from a ravaging epidemic to a neglected disease, and the traits of the health programs put forward to stamp out over the 100 years under scrutiny.

The nature of historical processes, such as colonialism and globalization, local responses and global agendas all played a key role in molding the nature of these health actions. While the mantra of effective occupation and good management of colonies was the corollary of the scramble of Africa carried out at the Berlin conference (1884-1885) by the imperial powers, shaped colonial medicine; the local response to these hyper-vertical programs, which entailed diagnosis and forced treatment and hospitalization, together with the emergence of new medical and anti-vector drugs and later on independence and the fading under the radar of HAT, helped to further shape these programs into the global health agenda.

Departing from historical, ethnographic, medical anthropology and public health perspectives, this presentation aims to carry out a biography of anti-HAT health actions, and in doing so, hope to highlight the factors active in molding these programs, the actors involved, local responses, as well as its results and failures.

The nature of research and control of tropical and infectious diseases has dramatically changed over the past few decades. New approaches to drug discovery, new funding mechanisms, new approaches to science, new priorities and new health threats means that the networks of institutions and experts that conduct research, develop technologies and attempt to control disease have become markedly more international, flexible and complex. Understanding how these networks are evolving in relation to Africa is important given the disease burden and weak health systems to be found there. Understanding the intent, scope, and dynamics of these research networks is important as we await their outputs, which in many instances are decidedly ambitious: new knowledge and tools to assist in the elimination of an ancient zoonotic disease, which has served to perpetuate poverty and underdevelopment across Africa.

Social network analysis is a methodological approach that facilitates new ways of conceptualising the actors and institutions involved in researching complex systems. This paper will present preliminary results from our analysis of the networks that engage with the neglected tropical disease African trypanosomiasis, and of understanding their relationships to one another. We searched academic databases for publications on African trypanosomiasis; then used text mining tools to retrieve the institutional affiliations of the publications' authors and co-authors, and to establish the themes of the research; finally we used UCINET, a software package for the analysis of social networks, to create visual representations of the global African trypanosomiasis research network. We present and interpret our findings here.

This paper argues that an increased emphasis on local methods of control for neglected tropic diseases (NTDs) is essential towards meeting the goals of the London Declaration.

Much activity in tackling NTDs in the last decade has focused on developing new treatments, vaccines, and, to a lesser extent, diagnostics. As importance as these interventions are, there is a risk overstating both their feasibility, and the ease of which they can be implemented. In contrast, control measures may offer much cheaper and more cost effective solutions.

Using the case study of African trypanosomiasis, a survey of academic and non-academic literature demonstrates that a wide variety of techniques are used to minimise disease exposure. Practices as diverse as clearing vegetation, trapping insects, controlling cattle movements, and different forms of insecticide spraying are just some of the valuable tools used to mitigate African trypanosomiasis.

However, such techniques are often sidelined in various ways: they are seldom given sustained attention by researchers, making it difficult to precisely gauge their effectiveness. They have in many (but not all) cases detached from coordinated control programmes, instead becoming more diffuse, privately organised activities, with mixed consequences. And the ways in which local knowledges and innovations could be supplemented and expanded by international resources has been conspicuously neglected by the NTD policy community.

In conclusion, the example of African trypanosomiasis demonstrates that, with certain limitations, local methods of control and mitigation offer a significant pathway towards tackling NTDs: potential that should be explored further in future research.