GM bacteria ‘could eliminate’ sleeping sickness


Speed read

  • Sleeping sickness affects 30,000 people and causes yearly loss of US$1 billion in Africa
  • Bacteria that live inside tsetse flies can be engineered to try curb infections
  • A study finds that in some areas such bacteria can help eliminate the disease

Releasing tsetse flies that carry genetically modified bacteria resistant to the parasite that causes sleeping sickness could eliminate the disease in Africa under certain conditions, a modelling study has shown.African trypanosomiasis or sleeping sickness — caused when the parasite is transmitted between livestock and humans via tsetse fly bites — infects 30,000 people, and causes losses of US$1 billion from livestock production a year in Sub-Saharan Africa, according to the study published in PLOS Neglected Tropical Diseases last month (15 August).

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Researchers have been considering genetically modifying bacteria that live inside tsetse flies, to try to eliminate the disease in the wild, a strategy called paratransgenesis.

A group of researchers in the United States modelled the spread of a bacteria (Wolbachia) to see if it could help drive another bacteria (Sodalis) carrying the resistance gene into the wild tsetse population.

Sodalis lives in the gut and Wolbachia lives in the reproductive organs [of tsetse flies]. But they are transmitted together to the tsetse progeny,” Serap Aksoy, co-author of the study and a researcher at the Yale School of Public Health, tells SciDev.Net.

Wolbachia gives the female tsetse flies in which it resides a reproductive advantage over female flies in which it does not, therefore becoming more common over time in the tsetse population. (But its presence in the population of flies also depends on different factors.)

It is this well-known feature of Wolbachia that made researchers think of it as a way to spread the resistance gene inserted into Sodalis, as the link in transmission between the two bacteria species had been shown to work in the laboratory in previous studies.

Sodalis is an ideal carrier of the resistance gene as it resides in the gut, which is where the sleeping sickness parasite first multiplies following infection, researchers say.

The study used data from Sub-Saharan Africa on the transmission of sleeping sickness among tsetse flies, humans and livestock, alongside data from Uganda on the number of wild tsetse flies carrying Wolbachia, to show that paratransgenesis is a promising technique for eliminating the disease.

It shows that a single release of tsetse flies, carrying both Wolbachia and genetically-modified Sodalis, could potentially eliminate sleeping sickness in between one-to-ten years, depending on the exact numbers of flies released.

But because several tsetse fly species exist in the wild, this can only be achieved if the species released comprises at least 85 per cent of the total population in the area of release.

Aksoy also warns that the model works under the assumptions that the anti-parasite gene is not lost from the tsetse population, the parasite does not gain resistance to it and the link between Sodalis and Wolbachia does not break.

François Chappuis, a medical advisor for Médecins Sans Frontières, an NGO involved in the fight against sleeping sickness, says: “Every new control method that is developed can be used alongside existing methods … If this technique of paratransgenesis is applicable on a large-scale while using limited resources, it may prove to be a very useful control method.

“But going from a mathematical model to a pilot study in infected areas and then applications in large, remote areas seems a long way off.”

Aksoy’s lab is now planning to insert the resistance gene into Sodalis, a feat that has been independently achieved by Jan Van Den Abbeele, a senior researcher at the Institute of Tropical Medicine in Antwerp, Belgium.

Van Den Abbeele plans to take the technique a step further by recolonising tsetse flies with genetically modified Sodalis to see if it protects flies from carrying the sleeping sickness parasite.

“So far, we were successful in genetically-modifying Sodalis to express an [anti-parasite gene] that specifically targets bloodstream [parasites]. With this we showed the proof-of-concept that indeed the Sodalis bacterium is able to express and release a sufficient amount of active, functional, parasite-targeting [compound],” Van Den Abbeele tells SciDev.Net.

His team is continuing to identify genes coding for proteins that target the parasite in the tsetse fly gut, and studying the inheritance of the genetically modified bacteria.

“We are now doing more basic research to understand better the mechanism of Sodalis mother-to-offspring transfer in order to use that knowledge to improve [its] transfer to the [tsetse] offspring,” he says.

The aim is to produce tsetse flies that are resistant to human and animal sleeping sickness , says Van Den Abbeele, but a similar approach is also being explored for malaria and Chagas disease, which are transmitted by mosquitoes and Triatoma bugs respectively.

Effect of household and community interventions on the burden of tuberculosis in southern Africa: the ZAMSTAR community-randomised trial.


Background

Southern Africa has had an unprecedented increase in the burden of tuberculosis, driven by the HIV epidemic. The Zambia, South Africa Tuberculosis and AIDS Reduction (ZAMSTAR) trial examined two public health interventions that aimed to reduce the burden of tuberculosis by facilitating either rapid sputum diagnosis or integrating tuberculosis and HIV services within the community.

Methods

ZAMSTAR was a community-randomised trial done in Zambia and the Western Cape province of South Africa. Two interventions, community-level enhanced tuberculosis case-finding (ECF) and household level tuberculosis—HIV care, were implemented between Aug 1, 2006, and July 31, 2009, and assessed in a 2×2 factorial design between Jan 9, 2010, and Dec 6, 2010. All communities had a strengthened tuberculosis—HIV programme implemented in participating health-care centres. 24 communities, selected according to population size and tuberculosis notification rate, were randomly allocated to one of four study groups using a randomisation schedule stratified by country and baseline prevalence of tuberculous infection: group 1 strengthened tuberculosis—HIV programme at the clinic alone; group 2, clinic plus ECF; group 3, clinic plus household intervention; and group 4, clinic plus ECF and household interventions. The primary outcome was the prevalence of culture-confirmed pulmonary tuberculosis in adults (≥18 years), defined as Mycobacterium tuberculosis isolated from one respiratory sample, measured 4 years after the start of interventions in a survey of 4000 randomly selected adults in each community in 2010. The secondary outcome was the incidence of tuberculous infection, measured using tuberculin skin testing in a cohort of schoolchildren, a median of 4 years after a baseline survey done before the start of interventions. This trial is registered, number ISRCTN36729271.

Findings

Prevalence of tuberculosis was evaluated in 64 463 individuals randomly selected from the 24 communities; 894 individuals had active tuberculosis. Averaging over the 24 communities, the geometric mean of tuberculosis prevalence was 832 per 100 000 population. The adjusted prevalence ratio for the comparison of ECF versus non-ECF intervention groups was 1·09 (95% CI 0·86—1·40) and of household versus non-household intervention groups was 0·82 (0·64—1·04). The incidence of tuberculous infection was measured in a cohort of 8809 children, followed up for a median of 4 years; the adjusted rate ratio for ECF versus non-ECF groups was 1·36 (95% CI 0·59—3·14) and for household versus non-household groups was 0·45 (0·20—1·05).

Interpretation

Although neither intervention led to a statistically significant reduction in tuberculosis, two independent indicators of burden provide some evidence of a reduction in tuberculosis among communities receiving the household intervention. By contrast the ECF intervention had no effect on either outcome.

Discussion

We assessed prevalence of tuberculosis in 24 communities in Zambia and South Africa, after 3 years of ECF or household interventions for tuberculosis control. Of 64 463 randomly selected individuals, 894 individuals had active tuberculosis. Averaging over 24 communities the geometric mean of tuberculosis prevalence was 832 per 100 000 population. We also measured the incidence of tuberculous infection in a cohort of 8809 children, followed up for a median of 4 years. The adjusted prevalence ratio for prevalence and the adjusted rate ratio for incidence did not differ significantly for the ECF versus non-ECF or for the household versus non household groups. However, for the household versus non-household groups the upper bounds of the CI for both prevalence ratio and incidence rate ratio were close to unity. The concordance of two robust outcome measures, measured in different population groups and with different methods suggests that the household intervention did have some effect on the burden of tuberculosis in these communities.

The convergence of HIV and tuberculosis has led to an urgent need for an evidence-based public health response to reduce the burden of tuberculosis at the community level. Cluster-randomised trials should provide the gold standard for evidence-based policy making.

A systematic review of published work identified five studies that provided evidence for the effect of interventions on the epidemiology of tuberculosis at community level . Apart from preliminary data from the ZAMSTAR trial, two were randomised trials—the DETECTB trial of enhanced case-finding strategies in Zimbabwe and a trial of a household-level intervention in Brazil. The ZAMSTAR trial is the only study to measure the effect of public health interventions on tuberculosis with a randomised design and direct measurements of the burden of disease as the endpoint. The ZAMSTAR trial covered a population of almost 1 million people and was designed to detect reductions in prevalence of tuberculosis, and incidence of tuberculous infection, of 30%. Our study identified no evidence that the ECF intervention had an effect on the burden of tuberculosis at community level. However, despite not reaching statistical significance, there is plausible evidence that the household intervention did reduce the burden of tuberculosis in these communities.

 

Source: Lancet

Bill & Melinda Gates Foundation.

Sickle Cell Anaemia in a Changing World.


Populations and their health are dynamic. Societal, environmental, and economic changes lead to changes in rates of birth, death, and disease, often described as transitions in mortality, demography, and epidemiology. The notion of epidemiologic transition provides an insight into the relationship between levels of overall mortality and the distribution of its causes [1][3], in which the greatest changes arise from the survival of children and young women. Recent falls in global child mortality are good news [4], but will lead to increases in the relative burdens of morbidity and disability in children who would previously have died, and of congenital malformations and inherited disorders. The work of Frédéric Piel and colleagues on sickle cell anaemia (SCA), published in this week’s PLOS Medicine [5], speaks strongly to this point: SCA is an inherited disease whose global importance will increase in terms of absolute numbers and relative population burden. SCA occurs when individuals are homozygous for sickle haemoglobin (HbS) in place of normal adult haemoglobin, and is the most common form of sickle cell disorder (SCD) [6]. Piel and colleagues have collated HbS allele frequency surveys and used them in models to generate a global distribution map and estimate the numbers of infants born heterozygotic and homozygotic for HbS. Using population and mortality projections, they predict an increase in the numbers of newborns with SCA to over 400,000 in 2050. They also estimate the potential mortality effects of four care-provision scenarios, with a best-case scenario that between 7.5 and 15.5 million newborn lives could be saved, most of them in Africa.

Modelled estimates are a growth area in global health. Whilst useful at supra-national and national levels, their emergence highlights the lack of reliable data on populations, disease, and mortality across most of the world: precisely the sort of information that policy makers and health planners need. The utility of estimates for planning screening programmes, infrastructural and human resource requirements, and clinical care protocols at sub-national levels is likely to be limited where the generalisability of assumptions is challenged by diversity at the local level. Even at a global level, estimates can cause confusion. Research teams using different models may, for example, come to different conclusions [7]. Piel et al. have combined available data, statistical methods, and assumptions to predict current burdens and future trends. Their uncertainties are described clearly, and a preoccupation with methodological critiques can easily distract us from the public health concerns that estimates raise.

The epidemiologic transition has been reframed as a health transition that involves sociocultural, behavioural, and health service factors [8], and policy and health services must respond to changing disease burdens. Unfortunately, the notion of transitions is general. Parallel transitions are happening in different groups within one nation, the best example being differences between socioeconomic groups. Rates of transition vary with local environment, and counter-transition is even possible [9]. Policy makers must set priorities in an environment of multiple burdens, unfinished agendas, competing discourses, and the voices of interest groups[10], a process that has been described as a chaos of purposes and accidents [11]. In an environment of Realpolitik, the generation of estimates of burden is important for advocacy. Characteristically, investigators working in an important public health field that has not received global attention lay down the strategic epidemiology [7],[12], as Piel and colleagues are doing, demonstrating that lack of progress will hinder efforts to attain targets such as those of the Millennium Development Goals.

Quantifying the problem is important, but not sufficient. In a consideration of issue attention for newborn health, Jeremy Shiffman considered four elements: the power of the actors involved, new ideas that can be brought to the table, the characteristics of the issue in terms of attractiveness and tractability, and political context [13]. The kind of strategic epidemiology that the SCA figures exemplify needs to be linked with granular understanding of local epidemiology and service provision [7]. SCA poses a particular challenge in terms of tractability. Haematopoietic stem cell transplantation, an emerging cure, is currently too costly a technology for the countries on which the burden predominantly falls, as is hydroxyurea therapy for children at high risk of illness. Survival, health, and well-being can all be improved substantially, but rely on health care systems with a certain level of functionality. Piel and colleagues suggest that the priority is to identify births of infants with SCA, but that such births could be avoided through genetic counselling and prenatal diagnosis. Termination of pregnancy is one of several options, which include preconception genetic screening and strategic reproductive choices, education for carrier parents, and holistic management from infancy. Quite apart from the logistic and financial challenges, these approaches raise substantial ethical questions summarised in recent work from Ghana [14].

Several interventions would be enormously helpful. Routine newborn screening remains costly—but is likely to become less so—and may miss infants born at home. Penicillin prophylaxis and pneumococcal immunisation are possible in most health care systems. The most beneficial approach involves comprehensive care [15]: family education, routine immunisation, malaria prevention, nutrition and hydration, prophylactic antibiotics, folic acid supplements, transfusion when required, support groups for children and their families, protocols for the management of acute events by health workers and—most importantly—regular follow-up. Human resources for health need to be well trained, and the medicines required need to be affordable and available, including the pain relief required by many people with SCD [16].

Steps towards a systematic approach are being taken [17]. A 2006 World Health Assembly resolution on SCA recommends increased awareness in the international community and emphasises collaboration between countries, including technical support, development of practice models, and coordination [18]. The World Health Organization has published a strategy for the African Region, with targets that include development and implementation of national control programmes in member states with high SCD prevalence, adoption of comprehensive health care management, and establishment of surveillance systems [19]. The estimates from Piel and colleagues underscore the need for both collaborative responses and better data for planning and monitoring.

Source: PLOS

 

Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries.


Cryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks—eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis.

Source: Lancet

THE TWIN EPIDEMICS: HIV AND TB CO-INFECTION.


Setting the Scope

An estimated 2 billion people – one-third of the global population – are infected with tuberculosis (TB), and each year, 8.7 million people develop TB disease. TB kills more than 1.4 million people each year and is economically devastating to families and communities worldwide. Although TB is a global problem, its geographic distribution is drastically disproportionate. Ninety-five percent of all TB cases and 98 percent of all TB deaths occur in developing countries. TB is one of the top killers of women and is responsible for 500,000 of their deaths each year. TB is a major killer among women of reproductive age and the leading cause of death in HIV-positive individuals. Only 22 high-burden countries (HBCs) account for 80 percent of the global TB burden, with half of these countries located in Asia. In Africa, 40 countries have an estimated TB prevalence rate greater than 100/100,000 compared to an estimated prevalence rate of <5/100,000 in the United States.

The global resurgence of TB has been fueled by a combination of factors, including increasing rates of HIV/AIDS and multidrug resistance, inadequate investments in public health infrastructure, insufficient political commitment, limited awareness of TB, disparities in access to and quality of health care services, and inadequate investments in new tools, including drugs, diagnostics, and vaccines. The disease threatens the poorest and most marginalized, disrupts the social fabric of society, and slows or undermines gains in economic development.

Progress on the Stop TB Partnership and DOTS Expansion

Significant progress has been made since the Stop TB Partnership was launched in 2000. The Amsterdam Ministerial Conference on Tuberculosis and Sustainable Development, held in March 2000, established global targets of 70 percent TB case detection and 85 percent treatment success rates in smear-positive pulmonary TB cases to be achieved by the year 2005 in the 22 HBCs. The first Global Plan 2001–2005 served to catalyze governments and donors to address TB. The number of countries implementing DOTS (directly observed treatment, short-course), the most effective strategy available for the treatment and control of TB, increased from 112 in 1998 to 184 by 2006.

Building on this momentum, in January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006–2015, which includes the Millennium Development Goal target of halting and beginning to reverse the incidence of TB by 2015, as well as the more ambitious Stop TB targets of reducing TB prevalence and deaths by 50 percent by 2015, relative to the 1990 baseline. TheGlobal Plan describes the actions and resources needed to combat the epidemic and achieve these targets. The World Health Organization (WHO) and other Stop TB partners also launched a more robust technical approach known as the Stop TB Strategy, which builds on DOTS. There is strong global commitment to combat TB and to collaborate on that effort: The Partnership has grown to more than 1,000 members, including endemic countries, donors, nongovernmental organizations (NGOs), research organizations, and other institutions.

To date, much progress has been made in achieving these goals. New cases of TB have been declining each year and fell to >2 percent between 2010 and 2011. The TB mortality rate has decreased by 41 percent since 1990 and is on track to reach the global target of 50 percent reduction by 2015. However, the job is far from done, with an estimated 8.7 million new cases and 1.4 million deaths annually.

HIV and TB Co-infection

HIV/AIDS and TB co-infection present special challenges to the expansion and effectiveness of DOTS programs and the Stop TB Strategy. TB accounts for one-quarter of AIDS deaths worldwide and is one of the most common causes of morbidity in people living with HIV and AIDS (PLWHA). Currently, approximately 34 million people are infected with HIV, and at least one-third of them are also infected with TB. The dual epidemics of TB and HIV are particularly pervasive in Africa, where HIV has been the most important contributing factor in the increasing incidence of TB over the last 10 years. In some countries in sub-Saharan Africa, up to 80 percent of individuals with active TB disease are also HIV-positive. The dual epidemics are also of growing concern in Asia, where two-thirds of TB-infected people live and where TB now accounts for 40 percent of AIDS deaths. Eastern Europe and the former Soviet Union have the fastest growing HIV epidemic in the world, a factor further exacerbating the expanding problem of the multidrug-resistant TB (MDR-TB) epidemic in these regions. The overlap of TB-HIV co-infection with MDR-TB and extensively drug-resistant TB presents a tremendous challenge and threatens progress in controlling TB and HIV and AIDS and in eliminating the mortality associated with these diseases.

Individuals co-infected with HIV and TB are 30 times more likely to progress to active TB disease. Infection with TB enhances replication of HIV and may accelerate the progression of HIV infection to AIDS. Fortunately, TB treatment under the DOTS programs is just as effective in individuals with HIV as it is in people who are HIV negative. In addition, clinical trials have shown that there are anti-TB regimens that can prevent or decrease the likelihood of TB infection progressing to active TB disease in an HIV-infected individual, making it an important intervention for increasing the length and quality of life for those co-infected and their families and communities.

Strategic Engagement with the U.S. President’s Emergency Plan for AIDS Relief

Within the U.S. Government, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), primarily through the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), leads funding and implementation of HIV-TB co-infection activities. Given the importance of TB-HIV as part of a comprehensive TB program, USAID supports TB-HIV activities within the Agency’s TB programs and closely coordinates its efforts with other PEPFAR agencies. Specifically, USAID supports the threefold strategy established in 2004 by WHO to enhance collaborative efforts between TB and HIV/AIDS programs; to decrease the burden of TB in PLWHA; and to decrease the burden of HIV in TB patients.

USAID’s Three-Fold Strategy for HIV/TB

To address the first component of the strategy, USAID supports coordination of TB and HIV/AIDS services by improving collaboration among TB and HIV programs, host countries and donor agencies, NGOs, and research institutions; developing training programs for TB specialists/program managers on HIV counseling and testing and management of co-infected patients; strengthening the links between TB services and HIV testing and HIV care services; and exploring the use of alternative service delivery approaches, such as community- and home-based care and involving faith-based organizations in such approaches. Such coordination is essential in ensuring early diagnosis; appropriate referral; and prompt, quality care for each disease.

To address the second component, decrease the burden of TB in PLWHA, USAID supports improvements in TB screening, prevention, and treatment through links with facilities that provide care and antiretroviral therapy (ART) services. Identification or exclusion of active TB in individuals who are HIV positive is critical to ensuring access to appropriate services. However, in 2006, only approximately 300,000 HIV-positive individuals were screened for TB through the collective efforts of the global TB and HIV communities. By 2010, greatly expanded efforts resulted in the screening of 2.3 million, and by 2011, that number increased by 39 percent to 3.2 million HIV-positive individuals. Identification of these dually-infected individuals enabled access to critical, lifesaving TB treatment for those diagnosed with active TB, and access to preventive TB treatment for those who did not have active TB. USAID also provides assistance to programs that strengthen and expand HIV and TB surveillance to improve the quality and availability of TB-HIV-related data and to those implementing infection control measures in clinical settings with high rates of HIV and TB.

To address the third component, USAID supports programs and operations research that seeks to decrease the burden of HIV in TB patients. Support is provided to increase access to HIV testing and counseling and establish a system of referrals between TB and HIV/AIDS programs, and by training TB program personnel in HIV testing. The efforts of the global community significantly increased HIV screening among TB patients from approximately 4 percent in 2004 to 40 percent globally (and 69 percent in Africa) in 2011. USAID also supports programs to promote the use of therapies proven to diminish the morbidity and mortality associated with TB-HIV co-infection, including co-trimoxazole preventive therapy (CPT) in adults and children living with HIV and AIDS, and ART in eligible TB patients. USAID’s assistance, combined with that of our partners, led to increased uptake of CPT (from 66 percent in 2007 to 79 percent in 2011) and ART (from 30 percent in 2007 to 48 percent in 2011) among co-infected individuals. USAID also supports innovative service delivery models for reaching co-infected patients, monitors and analyzes the effectiveness of such models, and works with partners to scale up successes.

Significant progress in mitigating the TB-HIV epidemic has been made over the past several years through coordinated, collaborative efforts to diagnose HIV among TB patients, diagnose TB among individuals with HIV, and conduct research in new technologies and methodologies to improve both diagnosis and treatment. New diagnostics, particularly Xpert MTB/RIF, which can quickly (<2 hours) identify susceptible and resistant TB and is almost twice as accurate identifying TB in HIV-positive individuals compared with traditional methods, offer great possibilities for rapid diagnosis and treatment of those co-infected. USAID, together with its U.S. Government and global partners, is introducing and expanding access to this technology, particularly in areas of high HIV prevalence. Additionally, for the first time in many years, multiple new TB drugs and drug regimens appropriate for use in both HIV-negative and HIV-positive individuals are being evaluated and are expected to be available in the next several years. These innovations, in conjunction with advances in the delivery of care and improved partnerships with communities and the private sector, are key to further progress in reducing the morbidity and mortality TB and HIV-TB co-infection.

Source: http://www.usaid.gov

THE TWIN EPIDEMICS: HIV AND TB CO-INFECTION.


Setting the Scope

An estimated 2 billion people – one-third of the global population – are infected with tuberculosis (TB), and each year, 8.7 million people develop TB disease. TB kills more than 1.4 million people each year and is economically devastating to families and communities worldwide. Although TB is a global problem, its geographic distribution is drastically disproportionate. Ninety-five percent of all TB cases and 98 percent of all TB deaths occur in developing countries. TB is one of the top killers of women and is responsible for 500,000 of their deaths each year. TB is a major killer among women of reproductive age and the leading cause of death in HIV-positive individuals. Only 22 high-burden countries (HBCs) account for 80 percent of the global TB burden, with half of these countries located in Asia. In Africa, 40 countries have an estimated TB prevalence rate greater than 100/100,000 compared to an estimated prevalence rate of <5/100,000 in the United States.

The global resurgence of TB has been fueled by a combination of factors, including increasing rates of HIV/AIDS and multidrug resistance, inadequate investments in public health infrastructure, insufficient political commitment, limited awareness of TB, disparities in access to and quality of health care services, and inadequate investments in new tools, including drugs, diagnostics, and vaccines. The disease threatens the poorest and most marginalized, disrupts the social fabric of society, and slows or undermines gains in economic development.

Progress on the Stop TB Partnership and DOTS Expansion

Significant progress has been made since the Stop TB Partnership was launched in 2000. The Amsterdam Ministerial Conference on Tuberculosis and Sustainable Development, held in March 2000, established global targets of 70 percent TB case detection and 85 percent treatment success rates in smear-positive pulmonary TB cases to be achieved by the year 2005 in the 22 HBCs. The first Global Plan 2001–2005 served to catalyze governments and donors to address TB. The number of countries implementing DOTS (directly observed treatment, short-course), the most effective strategy available for the treatment and control of TB, increased from 112 in 1998 to 184 by 2006.

Building on this momentum, in January 2006, the Stop TB Partnership launched the Global Plan to Stop TB 2006–2015, which includes the Millennium Development Goal target of halting and beginning to reverse the incidence of TB by 2015, as well as the more ambitious Stop TB targets of reducing TB prevalence and deaths by 50 percent by 2015, relative to the 1990 baseline. TheGlobal Plan describes the actions and resources needed to combat the epidemic and achieve these targets. The World Health Organization (WHO) and other Stop TB partners also launched a more robust technical approach known as the Stop TB Strategy, which builds on DOTS. There is strong global commitment to combat TB and to collaborate on that effort: The Partnership has grown to more than 1,000 members, including endemic countries, donors, nongovernmental organizations (NGOs), research organizations, and other institutions.

To date, much progress has been made in achieving these goals. New cases of TB have been declining each year and fell to >2 percent between 2010 and 2011. The TB mortality rate has decreased by 41 percent since 1990 and is on track to reach the global target of 50 percent reduction by 2015. However, the job is far from done, with an estimated 8.7 million new cases and 1.4 million deaths annually.

HIV and TB Co-infection

HIV/AIDS and TB co-infection present special challenges to the expansion and effectiveness of DOTS programs and the Stop TB Strategy. TB accounts for one-quarter of AIDS deaths worldwide and is one of the most common causes of morbidity in people living with HIV and AIDS (PLWHA). Currently, approximately 34 million people are infected with HIV, and at least one-third of them are also infected with TB. The dual epidemics of TB and HIV are particularly pervasive in Africa, where HIV has been the most important contributing factor in the increasing incidence of TB over the last 10 years. In some countries in sub-Saharan Africa, up to 80 percent of individuals with active TB disease are also HIV-positive. The dual epidemics are also of growing concern in Asia, where two-thirds of TB-infected people live and where TB now accounts for 40 percent of AIDS deaths. Eastern Europe and the former Soviet Union have the fastest growing HIV epidemic in the world, a factor further exacerbating the expanding problem of the multidrug-resistant TB (MDR-TB) epidemic in these regions. The overlap of TB-HIV co-infection with MDR-TB and extensively drug-resistant TB presents a tremendous challenge and threatens progress in controlling TB and HIV and AIDS and in eliminating the mortality associated with these diseases.

Individuals co-infected with HIV and TB are 30 times more likely to progress to active TB disease. Infection with TB enhances replication of HIV and may accelerate the progression of HIV infection to AIDS. Fortunately, TB treatment under the DOTS programs is just as effective in individuals with HIV as it is in people who are HIV negative. In addition, clinical trials have shown that there are anti-TB regimens that can prevent or decrease the likelihood of TB infection progressing to active TB disease in an HIV-infected individual, making it an important intervention for increasing the length and quality of life for those co-infected and their families and communities.

Strategic Engagement with the U.S. President’s Emergency Plan for AIDS Relief

Within the U.S. Government, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), primarily through the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), leads funding and implementation of HIV-TB co-infection activities. Given the importance of TB-HIV as part of a comprehensive TB program, USAID supports TB-HIV activities within the Agency’s TB programs and closely coordinates its efforts with other PEPFAR agencies. Specifically, USAID supports the threefold strategy established in 2004 by WHO to enhance collaborative efforts between TB and HIV/AIDS programs; to decrease the burden of TB in PLWHA; and to decrease the burden of HIV in TB patients.

USAID’s Three-Fold Strategy for HIV/TB

To address the first component of the strategy, USAID supports coordination of TB and HIV/AIDS services by improving collaboration among TB and HIV programs, host countries and donor agencies, NGOs, and research institutions; developing training programs for TB specialists/program managers on HIV counseling and testing and management of co-infected patients; strengthening the links between TB services and HIV testing and HIV care services; and exploring the use of alternative service delivery approaches, such as community- and home-based care and involving faith-based organizations in such approaches. Such coordination is essential in ensuring early diagnosis; appropriate referral; and prompt, quality care for each disease.

To address the second component, decrease the burden of TB in PLWHA, USAID supports improvements in TB screening, prevention, and treatment through links with facilities that provide care and antiretroviral therapy (ART) services. Identification or exclusion of active TB in individuals who are HIV positive is critical to ensuring access to appropriate services. However, in 2006, only approximately 300,000 HIV-positive individuals were screened for TB through the collective efforts of the global TB and HIV communities. By 2010, greatly expanded efforts resulted in the screening of 2.3 million, and by 2011, that number increased by 39 percent to 3.2 million HIV-positive individuals. Identification of these dually-infected individuals enabled access to critical, lifesaving TB treatment for those diagnosed with active TB, and access to preventive TB treatment for those who did not have active TB. USAID also provides assistance to programs that strengthen and expand HIV and TB surveillance to improve the quality and availability of TB-HIV-related data and to those implementing infection control measures in clinical settings with high rates of HIV and TB.

To address the third component, USAID supports programs and operations research that seeks to decrease the burden of HIV in TB patients. Support is provided to increase access to HIV testing and counseling and establish a system of referrals between TB and HIV/AIDS programs, and by training TB program personnel in HIV testing. The efforts of the global community significantly increased HIV screening among TB patients from approximately 4 percent in 2004 to 40 percent globally (and 69 percent in Africa) in 2011. USAID also supports programs to promote the use of therapies proven to diminish the morbidity and mortality associated with TB-HIV co-infection, including co-trimoxazole preventive therapy (CPT) in adults and children living with HIV and AIDS, and ART in eligible TB patients. USAID’s assistance, combined with that of our partners, led to increased uptake of CPT (from 66 percent in 2007 to 79 percent in 2011) and ART (from 30 percent in 2007 to 48 percent in 2011) among co-infected individuals. USAID also supports innovative service delivery models for reaching co-infected patients, monitors and analyzes the effectiveness of such models, and works with partners to scale up successes.

Significant progress in mitigating the TB-HIV epidemic has been made over the past several years through coordinated, collaborative efforts to diagnose HIV among TB patients, diagnose TB among individuals with HIV, and conduct research in new technologies and methodologies to improve both diagnosis and treatment. New diagnostics, particularly Xpert MTB/RIF, which can quickly (<2 hours) identify susceptible and resistant TB and is almost twice as accurate identifying TB in HIV-positive individuals compared with traditional methods, offer great possibilities for rapid diagnosis and treatment of those co-infected. USAID, together with its U.S. Government and global partners, is introducing and expanding access to this technology, particularly in areas of high HIV prevalence. Additionally, for the first time in many years, multiple new TB drugs and drug regimens appropriate for use in both HIV-negative and HIV-positive individuals are being evaluated and are expected to be available in the next several years. These innovations, in conjunction with advances in the delivery of care and improved partnerships with communities and the private sector, are key to further progress in reducing the morbidity and mortality TB and HIV-TB co-infection.

Source: http://www.usaid.gov

 

 

Research topic trends are useful for Africa.


 

 

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Analysis of scientific trends can help policymakers target limited resources where science and development collide, argues Linda Nordling.

  • A list of trendy research topics undermines the case that global science ignores African interests
  • But the main actors in these areas aren’t African
  • The list can help to identify topics where science and development priorities meet



Last month, Thomson Reuters released a report identifying 100 ‘front lines’ in research. These are topics seeing rapid growth in publications and citations — a measure of scientific activity and importance.

The list contains several topics relevant to Africa, such as assessments of maternal and child health, ocean acidification and the impact of climate change on food crops.

This is good news for African researchers working in these fields, as it might increase the international visibility of — and funding for — their work. But it also highlights important commonalities between the global research agenda and African priorities and challenges.

In Africa, we sometimes believe that global curiosity-driven research — studies driven by researchers’ inquisitiveness rather than political or strategic directives — is at odds with the continent’s development priorities.

Many articles — and I’ve written some of them — argue that Africa’s dependence on international research funding means its own priorities are overlooked.

While there may be a degree of truth to such beliefs, it has led to a culture of isolation among some African science policymakers. These people speak of wresting the scientific agenda away from international trends.

They long for the ‘domestication’ of science in Africa, arguing thatinternationally driven science — aiming for publication in top journals and Nobel prizes rather than to solve real-life problems — won’t improve the lives of ordinary Africans.

False dichotomy

I have always felt wary of this ‘Africanising’ ideology for science and innovation. Research is inherently collaborative, and is becoming more so, bridging national and cultural boundaries.

Making African scientists turn away from these international collaborations, and away from the recognition of their peers in other countries, will only make Africa’s best scientists leave for greener pastures.

If Western science values aren’t contributing to making the developing world a better place to live, I believe the fault doesn’t lie with developing country scientists being lured away from national challenges by international funding priorities.

Rather, it is the failure of local governments, businesses and development efforts to help drive the international science agenda by putting their own resources into relevant research areas. These governments also have a responsibility to take the new knowledge into account, turn it into locally applicable solutions that can then be implemented on the ground.

Led from outside

The Thomson Reuters report is significant because it highlights several trends that argue against the false dichotomy of ‘African’ and ‘international’ science. It shows that curiosity-driven international research can tackle subjects of relevance to developing regions.

But even where research trends are relevant to African problems, the main actors are, still, not African. An example of this is ‘polymer solar cells’ — one of the trendy research areas identified by Thomson Reuters.

Rather than using silicon-based technology, polymer solar cells convert sunlight to electricity using organic polymers. This technology is cheap, durable and environmentally friendly, and could help bring electricity to remote rural areas in developing countries.

The technology has been pursued by a project called the Lighting Africa initiative. This joint project between the International Finance Corporation and the World Bank aims to provide electricity to areas not reached by the national grid.

But the key researchers in the field are not African. They are Danish, led by Frederik Krebs of the Technical University of Denmark. And Australians dominate another trendy subject of high relevance to Africa: ocean acidification caused by burning fossil fuels. This threatens coral reefs in tropical seas with unknown, but potentially significant, effects on fishing and tourism.

Growing influence

However, it is not just countries with established research capacity that drive the trendy subjects. China and South Korea are big producers in the fashionable subject of how climate change will affect food crops. This shows that, as a country’s scientific standing grows, it gets a stronger say over the direction of global research.

This is something that African policymakers should take into account before deciding that international and African research priorities are at odds.

It is easy to blame Western scientific values for science failing to have an impact in developing countries. It is also easy to blame developing country scientists for being blinded by the ‘publish or perish’ imperative, and for failing to make sure their research meets local needs.

But it is difficult to tackle the real challenges: boosting local support for research and making sure to link this with wider development efforts. In a scenario where resources are limited, such as in most developing countries, it might be hard to decide where to target such investments.

However, scientific trend analyses — such as the one provided by Thomson Reuters — can help policymakers identify areas where cutting-edge science and development priorities collide.

These are likely to be crucial areas where their investments might make the most difference. Firstly, to science, by giving national researchers a fair chance to get into an internationally growing field. But it can also make a difference to development, as funding for technology adaptation and engineering skills can help a country make use of fresh technologies in the field.

 

REFERENCES

[1] King, C. and Pendlebury, D.A. Web of knowledge: Research fronts 2013 — 100 top-ranked specialties in the sciences and social sciences (Thomson Reuters, April 2013)

Source: SciVx

‘We are killed, we are hunted’: Albino activist fights witchcraft murders.


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African Voices is a weekly show that highlights Africa‘s most engaging personalities, exploring the lives and passions of people who rarely open themselves up to the camera. Follow the team onTwitter.

 

Carefully maneuvering around a jumble of slippery rocks, Josephat Torner slowly steps inside a cluster of dark caves in northeast Tanzania.

Ahead of him, leading the trail with an air of assurance, walks a local witchdoctor.

Aided by a couple of artificial lights, the two figures venture deeper into the darkness, running their hands along the cavern’s limestone walls for guidance. Bats meandering above their heads, the men enter a vast cave chamber dotted with a handful of rocks.

“What I want to know is,” Torner breaks the silence,” have you ever seen anyone pray for something evil down here?” he asks the witchdoctor. “So they can get hold of someone? Like an albino?”

An albino himself, Torner has been traveling around Tanzania to debunk the widespread misconceptions about the congenital disorder. Dozens of albinos have been mutilated and slaughtered in the country in recent years, because of rumors being spread that their body parts can bring wealth and good luck.

To stop the atrocities, Torner thought he needed to confront the group he believed was the source of these rumors: witchdoctors.

And that’s what brought him to the depths of this cave, face to face with his “enemy.”

“We call you a spirit because a white person like you is the devil,” readily admits the witchdoctor.

“You’re saying I’m a white demon?” Torner hits back, “we are demons?”

The reply: “Yes, because you’re white.”

In the Shadow of the Sun

This dramatic confrontation is one of the most intense moments captured in a new documentary, called “In the Shadow of the Sun.”

The independent film, shot by director Harry Freeland, chronicles the life story of Torner and his fight for acceptance of albinos in a country where little is known about the genetic disorder.

“My heart always is still looking the recognition of people with albinism in this world,” says Torner, who’s been an advocate for albino rights since 2004. “Just to recognize that we are here.”

Torner and Freeland spent six years creating the film. The director’s inspiration to make a documentary on albinism came nearly a decade ago, when he had one of his first encounters with someone with the disorder in Senegal.

It’s my dream in my life that people with albinism are respected and given all rights which other human beings are being given.
Josephat Torner, albino activist

 

“A woman approached me in the street, held out her child and said ‘here, take it back, where it comes from,” remembers Freeland. “She had a child with albinism and because I’m white, she thought the child belonged to me in some way — her husband had left her for having a white child and accused her of sleeping with a white man.”

Leading man

People with albinism are born with genes that do not make the normal amounts of the pigment called melanin. Those born with the disorder, which affects people from all races, inherited the genes from their parents who may or may not have any of the associated traits.

But many people don’t understand the effects of the condition and as Freeland discovered, in parts of Africa albinos often suffer social stigma, prejudice and even attacks.

Read this: Slave trade ghost town

Keen to make a film documenting the plight of this group of people, Freeland headed to Tanzania, the country reported to have one of the biggest albino populations in the world. There, he came across many amazing stories, but he didn’t find his leading man until he met Torner.

“I just heard him speak and instantly, I just knew he was the one to lead the film,” says Freeland. “I think so many stories that come out of Africa are negative, and everything about Josephat is positive.”

Despite growing up with a disorder that left his skin and hair pale, as well as his strength and eye sight weak, Torner has succeeded in making the best of his situation.

Over the years, he’s overcome struggles and discrimination to receive an education and get married. A father of two, Torner’ has even climbed Africa’s tallest mountain, Kilimanjaro, to prove that albinos can achieve greatness.

“It was really very difficult to climb,” he admits. “But I was climbing because at that time I had an agenda behind for what is happening to this world,” he adds. “We are killed, we are hunted, we are chopped. So I climbed with a special message … to the African countries: that we are able. But [also] protect us, give us a chance, don’t stigmatize, don’t isolate, don’t hide us to the darkness room — just open the way.”

‘Why are they killing us?’

In Tanzania, there’s been 72 reported people with albinism killed over the last five years.
Harry Freeland, director

 

In 2009, the Tanzanian government embarked on a campaign against the killers of albinos, particularly in the Lake Victoria region. Freeland says at the heart of the problem are witch doctors making claims that albino body parts can bring wealth.

“In Tanzania, there’s been 72 reported people with albinism killed over the last five years,” says Freeland, noting that the actual number could be higher. “And there’s been 34 people left mutilated that have survived attacks.”

Some of the victims were people Torner used to know.

“I was angry,” says Torner, recalling the moments following his confrontation with the witchdoctor.

“He answered it to me directly, without even trying to hide anything. So I was angry, of course, because I remember my brothers and sisters whom I lost, because I will not see them forever and while he’s there he’s continually surviving,” he adds. “So, you ask yourself, ‘what’s the problem? Why are they killing us? Why are they hunting us?'”

Torner realizes he may never get a suitable answer to those questions. Yet, this doesn’t stop him from doing all he can to bring attention to his message of creating a more inclusive society.

He hopes that his community work and the documentary focusing on his efforts, coupled with the outreach from other organizations and the government, will eventually make Tanzania a place where albinos aren’t forced to stay in the shadows.

“It’s my dream in my life that people with albinism are respected and given all rights which other human beings are being given,” he says.

“This is what is in my heart — when I would see justice to people with albinism; when I would see the lifespan of people with albinism is increasing, this is still a dream to my life.”

Source: CNN

Novartis collaboration aims to eliminate rheumatic heart disease (RHD) in Zambia, Africa.


  • novartisRHD has been eliminated in most developed nations, but sub-Saharan Africa studies show at least 2-3% of school-age children suffer from this often fatal disease.

  • Collaboration between Novartis physicians, Zambian healthcare providers, cardiologists from Massachusetts General Hospital (MGH) and the Pan-African Cardiology Society will promote RHD prevention by treating children with streptococcal infections and silent RHD
  • The collaboration will screen 3,000 Zambian children by echocardiography and provide monthly penicillin injections to children with silent RHD to prevent recurrent strep throat and associated cardiac damage

Novartis today announced that it has launched an effort to eliminate rheumatic heart disease in Zambia in collaboration with the Lusaka University Teaching Hospital (UTH), the Ministry of Health in Zambia, the Pan-African Cardiology Society and Massachusetts General Hospital (MGH).

RHD is a complication of untreated streptococcal infections in which the valves of the heart are scarred and eventually degenerate, leading to heart failure. Eliminated by antibiotic treatment in most developed nations, in the developing world an estimated 15 million children suffer from this debilitating and often fatal disease[1].

“The toll of heart failure in young children with RHD in Zambia is immense, for the patient, their families, and the nation,” said Mark C. Fishman, Cardiologist and President of the Novartis Institutes for BioMedical Research (NIBR). “It is entirely preventable. For the past several years Novartis has been working with colleagues in Lusaka to help understand and treat asthma in young children. We are expanding the collaboration to raise awareness, educate, and provide antibiotic therapy to prevent RHD.”

To measure RHD prevalence and identify those in need of secondary prophylaxis, teams of health care professionals from Lusaka UTH, the MGH, and Novartis will use portable echocardiography machines to evaluate 3,000 children, ages 9-10, in Lusaka-area public schools. Echocardiography screening is estimated to detect more than 10 times as many cases as clinical screening[1].

Images from the echocardiography screens will be analyzed in Zambia and at the MGH using a cloud-based electronic registry developed by Dimagi Inc, a Cambridge, MA-based company that designs open-source electronic healthcare systems for low resource environments.

Children identified as having RHD will be treated with monthly penicillin injections (termed “secondary prophylaxis”) to prevent recurrent streptococcal infections and additional valve damage.
Primary prevention, the treatment of children with streptococcal infection to prevent RHD, is key to elimination of the disease. To this end, all children diagnosed with strep throat will be treated with injectable penicillin in the community-based study sites. Prevalence of RHD and adherence to secondary prophylaxis will be determined via the mobile electronic registry.

“We have assembled an experienced team from MGH who are excited to bring the mobile heart imaging technology to Zambia,” stated Michael H. Picard, MD, Director of Echocardiography at the Massachusetts General Hospital and a Past President of the American Society of Echocardiography. “We are creating a model for country-wide screening through schools that will not only raise awareness of the magnitude of this disease but also offer a simple method to identify those who will benefit from a very simple and safe treatment. The MGH Cardiology Division and its Cardiac Ultrasound Laboratory are delighted to be a partner in this initiative.”

The Pan-African Cardiology Society will assist with the development of the study protocol and ethics approval. Based on the experience of the initial Lusaka-based effort, Novartis plans to support the rollout of the RHD training and treatment effort to Provinces across Zambia, with the ultimate goal of eliminating RHD in Zambia.

“Rheumatic heart disease is the most common acquired heart ailment in Zambian children, but statistics are spotty and the disease is certainly diagnosed late when damage to the heart valves has already reached advanced stage,” said John Musuku, Principal Investigator and UTH pediatrician. “Our hope is that the collaboration with Novartis will lay the foundation to detect the disease early so preventative measures are instituted.  This is an effort to eradicate the disease across Zambia in our life time.”

 

Source: Novartis

What Neandertal DNA can teach about race, autism, and more?


london-bicycle-elevated-highway-screenshotPaleoanthropologists used to pray that they would unearth big troves of intact Neandertal skeletons and well-preserved artifacts that they could comb for clues to the origins of the human race. But these days, they can often get as much or more information straight from the DNA in bone fragments.

Case in point: the newly published genome study in Science from Matthias Meyer and Svante Pääbo of the Max Planck Institute for Evolutionary Anthropology and their international team of colleagues. Using a novel DNA sequencing technique that works particularly well with degraded specimens, they examined the genome of a seven-year-old girl who died more than 74,000 years ago, using a surviving sliver from one of her finger bones. That girl’s bone fragment was one of the few pieces of evidence that in 2010 revealed the existence of the ancient Denisovan people — contemporaries of the Neandertals who overlapped with them in eastern Asia.

 

Matthias Meyer at work in the laboratory. (Credit: Max Planck Inst. for Evol. Anthro.)

Yet from that extraordinarily humble source, the Max Planck scientists have drawn a wealth of insights. They learned, for instance, that the Denisovans were probably dark-skinned, unlike the pale Neandertals. Because the girl had two X chromosomes, one from each parent, the scientists were able to infer that the Denisovan population had relatively little genetic diversity. Living natives of Papua New Guinea, Australia, and some southeast Asian islands derived about 6 percent of their genes from the Denisovans, yet the Denisovans seem to have contributed nothing of lasting value to the DNA of people in other parts of the world. Comparison with the Denisovan DNA also allowed the researchers to recognize that Europeans carry somewhat fewer genes from Neandertals than do East Asians and Native Americans.

Such discoveries are endlessly fascinating to some of us. But I can also understand that many people might reasonably question why any of these details matter. After all, Neandertals and our other ancient ancestors have been extinct for 30,000 years or longer. Why should we care so much about their DNA? Is there any practical value to be had from these studies?

I’ll argue that there is, and that it might be especially useful in helping us to develop more enlightened attitudes about racial differences and autism. To explain why, it may be useful to start by reviewing some of the major current ideas about how humans evolved in the first place.

Overview of our origins

Fifteen or 20 years ago, it might have been easier to find a rough consensus among paleoanthropologists about this topic than it is today precisely because of the recent bounty of fossil and DNA discoveries. All that information has answered some important questions and filled in a level of detail that might once have seemed inconceivable, but curiously enough, some of the broad strokes in the big picture have become less clear.

Roughly speaking, in Africa 1.7-2 million years ago, the earliest primitive members of the genus Homo appeared. They were small, hairy people who might look a bit apelike by our standards of beauty, but they had bigger brains and more tools than the upright Australopithecus species before them. The Homo erectus people were successful enough to spread out of Africa and migrate across Asia, and are responsible for some of the ancient fossils given names such as “Peking man.” Nevertheless, they were probably something of a false start for the spread of humanity as we now it.

 

The more relevant development came between 400,000 and 800,000 years ago, with a new wave of African emigration into the Middle East and Asia by a group of people with even bigger brains and better tools. They gave rise to the brawny, brow-ridged Neandertal people, Europe’s first inhabitants. Yet they also spawned at least one other Asian group, the Denisovans. (It wouldn’t be too surprising anymore if still more sibling groups contemporary to the Neandertals and Denisovans turned up elsewhere in Asia.) Meanwhile, humans also continued to prosper and evolve in Africa, and by 80,000 years ago, ones with a fully modern appearance had appeared and started their own exodus into the rest of the Old World.

What happened next is the stuff of archaeologists’ heated arguments. The oldest theory is the multiregional hypothesis strongly advocated by Milford Wolpoff of the University of Michigan in Ann Arbor. It claims that as different in appearance as moderns, Neandertals, Denisovans, and even the early Homo erectus might seem, they were all still members of the same human species. Over time, the modern traits predominated but some of the traits in local populations that had adaptive value (such as shorter, thicker bodies in cold climates) were retained and might bear some connection to physical differences seen in populations around the world today.

In the 1980s, however, a starkly opposing theory emerged largely, though not exclusively, from studies of mitochondrial DNA in living populations. (Mitochondria, the organelles in animal cells that create chemical energy, carry their own unique sets of genes, completely separate from the DNA in the nucleus for the rest of the cell’s genes.) Those analyses suggested that the maternal bloodlines of everyone alive today converged back on Africa less than 100,000 years ago, with no trace of a genetic contribution from local groups elsewhere. That conclusion spawned the “out of Africa” model, according to which scientists such as Chris Stringer of the Natural History Museum in London argued that when the anatomically modern humans colonized Asia and Europe, they displaced the Neandertals and other ancient residents without breeding with them. Whether the moderns had directly exterminated the ancients or simply outcompeted them for resources was anybody’s guess, but interbreeding was effectively nonexistent.

The out-of-Africa model and its mitochondrial DNA evidence proved highly persuasive to many anthropologists. Disagreements remained fierce, but during the 1990s it was often presented as the default explanation for human origins, even though almost everyone acknowledged how counterintuitive it seemed that modern humans would so completely refrain from mixing with creatures that looked so much like them. Mostly, scientists chalked it up to some obscure biological or behavioral speciation barrier.

DNA twists the plot

Ironically, one type of DNA evidence helped put the out-of-Africa model on top but later DNA evidence helped knock it back down. If brief, when Svante Pääbo and other researchers began the painstaking work of recovering nuclear DNA from Neandertal bones and sequencing it, they discovered that on average about 4 percent of living people’s genes are derived from Neandertals. (The telling exception was in people of modern African descent, whose genes were generally less than 1 percent Neandertal, which is what one might expect if the mixing would have occurred primarily outside Africa.)

Four percent might not sound like much, but it is substantially more than an out-of-Africa scenario with strict replacement rather than interbreeding would seem to allow. It’s remotely possible that this mixture is an artifact of old, unequal mixing of what became Neandertal genes within the ancestral African population (although anthropologist John Hawks has explained on his blog why that situation seems unlikely). The more likely explanation, though, is that some level of interbreeding did occur. For that reason, Stringer and other defenders of the concept now refer to a modified “mostly out of Africa” model that acknowledges some interbreeding but considers it largely trivial in extent and consequences.

That same evidence has, of course, only reinvigorated the multiregional hypothesis (though one might wonder why the percentage of ancient humans’ genes in us isn’t then higher). It has also nourished a popular new “assimilationist” school of thought that pragmatically splits the difference between multiregionalism and out-of-Africanism. The assimilationist model says that when the anatomically modern humans left Africa 80,000 years ago, they retained their own identity but also mixed to a degree with the older human populations they encountered. Both the modern and ancient groups became locally varying patchworks of physical traits and technologies. In the end, the ancients’ societies were too disrupted to survive but some of their genes persist in us.

The question of when and how humans emerged over the past few hundred thousand years is therefore considerably more complicated and less settled than it might have seemed a couple of decades ago. The same can be said for the closely related question about whether Neandertals, for example, represent their own species (Homo neanderthalensis) or just a subspecies (Homo sapiens neanderthalensis) alongside our own (Homo sapiens sapiens) – or whether, as Wolpoff would have it, virtually all of Homo has been one big species that has varied overtime.

Why we should care

Even if the science of human origins is still a work in progress, the accumulating information about how we got here and indeed what constitutes a member of the human race offers some useful perspectives on matters of scientific and ethical importance.

Perspective on the age of humanity. One small point that studies of the DNA of Neandertals and other ancient people illuminate is just how old or young we humans are as a species. The paleontological record indicates that the mean survival time for a mammalian species is about a million years, though some have lasted ten times that long. If we emerged only within the past 100,000 years or less, then Homo sapiens is indeed an amazingly young and precocious lot. And a loose, handwaving argument might therefore be made that we also probably have a commensurately long future ahead of us.

On the other hand, if Wolpoff is right and we are part of a species that has been around for two million years, then we are much more senior. It might make us look at the extinction rates with a little more sense of urgency.

Perspective on our nonprogressive evolution. The molecular study of our evolution also helps to drive home how unexceptional our biological history has been. Many icons of human evolution unintentionally reinforce a misleading sense of progress — witness the classic March of Progress illustration by Rudolph Zallinger that shows a modern human leading a Neanderthal and other “less evolved” ancestors.

But that sense really changes if we and Neandertals are seen as sibling groups, diverging but also sometimes re-merging throughout history. Our evolutionary history looks much less progressive and more like that of other species.

Perspective on race. For centuries (at least), arguments over race have invoked inappropriate biological concepts to make or defend distinctions among peoples — and distinctions in how they should be treated. They have likened races to subspecies to justify their inherent biological reality, along with some allegedly biological superiority, inferiority, or “otherness.”

A simple refutation of that idea has been the proof that the diversity of genetic characteristics within racial groups is greater than the diversity separating them: human races are not well enough defined and different enough to be meaningful biological groups. For that reason, many scientists now argue that race is not a biological concept but rather a social concept that sometimes carries biomedical consequences.

(Here’s what that means, if it isn’t immediately clear: In a society that mistreats the dark-skinned in general, for instance, black people may be at higher risk for diseases of poverty without having an intrinsic susceptibility to them. But an example that is perhaps less obvious is that of sickle-cell anemia, which is more common in those of black African descent than in those of white European descent. That’s because many people whose ancestors lived in regions where malaria was prevalent carry mutations for sickle-cell anemia that offer some protection from the parasite. But not all of those people are racially black and not all blacks carry the mutation. Sickle-cell information campaigns target predominantly black populations because society doesn’t accurately group people in terms of “ones whose ancestors had a lot of malaria.” In this case, race is a flawed but useful proxy for that nonexistent classification — but not because of the biological characteristics of the race as such.)

The foregoing is all true only in terms of race as we understand the concept today, however. If the multiregionalists and the assimilationists are right, then the Neandertals, Denisovans, and other ancient people we displaced may not have been separate species of person at all. They may instead have been races so different from modern humanity that they really were akin to other subspecies. Differences in their anatomical, genetic, behavioral, and intellectual traits would surely dwarf any seen in the world today among Homo sapiens. Color me naïve, but I would like to think that these insights might help to strengthen the spirit of color-blind brotherhood we ought to feel for one another.

(And in anticipation of a query I can feel coming: no, hypothetically, I would not be in favor of summarily treating Neandertals as second-class citizens if ever we could use technology to clone one. Neandertals were people and therefore, in my opinion, would deserve to be fully enfranchised. However, the question shows how ethically fraught such high-tech resurrections could be.)

Perspective on neurodiversity. In the course of their recent analysis of the Denisovan DNA, Meyer and Pääbo identified 23 highly conserved areas of the human genome that seem to be unique to our kind. Eight of those contain genes that previous studies have tied to nerve growth and other aspects of brain function. And three of the conserved genes — ADSL, CBTNAP2, and CNTNAP2 — have been implicated in some forms of autism.

Those correlations are not entirely surprising. Looking at the artwork and artifacts left by Neandertals, some archaeologists have argued that they seemed to lack a capacity for symbolic thought. Others such as John J. Shea disagree and suggest that the differences between modern and ancient thinking may have been exaggerated. Nevertheless, whatever evolutionary changes marked the emergence of modern humans, it’s likely they involved at least some important changes to our cognitive, linguistic, and social abilities. One might expect to find genes for those traits to be altered or absent in older types of humans.

I want to be perfectly clear on this point: this discovery absolutely does not mean that the Denisovans, Neandertals, and other ancients were autistic. Nor does it mean that autistic people exhibit prehistoric thinking. Rather, what it underscores is that normal modes of human thought occupy a broad continuum.

The “neurotypical” way in which most people see the world today is only one way of doing it. As enlightened studies of autism repeatedly drive home, we need to appreciate those variations as part of our human spectrum rather than just labeling them defective or abnormal.

With or without all our cognitive abilities, the Neandertals and Denisovans survived under amazingly hostile conditions for hundreds of thousands of years. Their different ways of thinking may have been dominant throughout long stretches of the past, and might even have had advantages over our own under their circumstances. The lesson that these ancients offer is that we should broaden our minds about how broad minds can be.

Source: Smart Planet