Research Needs and Priorities
Because the diseases in this chapter are targeted for elimination as public health problems, it is sometimes assumed that research for these diseases is no longer necessary and that all available resources should be allocated to elimination efforts. However, research remains critical to address questions pertaining to how to achieve elimination with currently available tools and especially to how to optimize implementation in different epidemiological, sociocultural, and health system settings. Epidemiological questions on the required intervention coverage, frequency, and duration need to be answered to guide elimination strategies, and research on the risk, prevention, and control of recrudescence is crucial to ensure sustained success.
The Special Programme for Research and Training in Tropical Diseases, a joint project of the United Nations Children's Fund, United Nations Development Programme, World Bank, and WHO, recently undertook a systematic analysis of research needs for each of the 10 tropical diseases in its portfolio (Remme and others 2002). This analysis involved assessing the burden of disease and recent epidemiological trends, reviewing current control strategies, and identifying the major problems and challenges for disease control and the research needed to address these challenges. Table 22.4 summarizes the results of this analysis for the four diseases discussed in this chapter.
[Table .]
Chagas disease has two main research priorities. The first is the development of new vector control strategies that will allow the successful elimination campaign used in the Southern Cone countries to be extended to the Central American and Andean countries, where the vectors are often not domiciliated. The second is the development of effective and affordable treatment for the millions of people already infected and the prevention of chronic complications.
For onchocerciasis and LF, the main research priorities are similar: implementation research to improve MDA; epidemio-logical research to determine if, when, and with what treatment coverage the parasite reservoir can be locally eliminated for different vector-parasite complexes; and research to develop a macrofilaricide and improved diagnostics that would facilitate elimination.
For leprosy, the research needs were further reviewed during a Scientific Working Group (Special Programme for Research and Training in Tropical Diseases 2003). The meeting arrived at a clear consensus of three top priorities for leprosy research: implementation research on sustainable and integrated residual leprosy control activities, improved diagnosis of infection, and improved approaches for preventing and managing nerve damage.
These are the current main priorities for research in support of elimination. Eradication is not currently anticipated for any of the diseases; thus, research on better tools and strategies that will allow a permanent solution for these infectious diseases is also needed. Furthermore, currently available control tools may be lost because of factors such as resistance, and research to develop replacement tools is essential now.
