The Threshold

• The Path Toward Eliminating Neglected Tropical Diseases

  In our season finale of The Threshold, we delve into what it will take to end neglected tropical diseases (NTDs), which impact about 1.5 billion people. The World Health Organization considers 21 diseases to be NTDs, a classification that marks a disease as underfunded and prioritized relative to its burden. What is encouraging is that a growing number of neglected tropical diseases are closer than ever to being eliminated. Our episode begins with the personal story of Rehema, whose account was produced by Sharon Kiburi. Rehema’s path towards a diagnosis demonstrates much of what is challenging with neglected tropical diseases. NTDs are sometimes called “last mile” diseases because ending them is largely a matter of access: getting the right treatments and services to the most rural, disadvantaged populations on Earth.  Then, host Henry Bonsu speaks with Dr. Ngozi Erondu, the technical director of GLIDE, the Global Institute for Disease Elimination. She describes which diseases she thinks are most likely to be eliminated in the near future. Finally, we interview Dr. Rebecca “Tshidi” Moeti, the recently retired former WHO regional director of Africa. She is a major champion of ending NTDs, including launching the Expanded Special Project for Elimination of Neglected Tropical Diseases. In this conversation, she also reflects about her decades-long career and what she hopes for the future of global health. Thank you for listening to our first season! We would love to hear your thoughts as well as suggestions for new episodes. Feel free to email us at [email protected]. The Threshold is made possible in part through funding from the Gates Foundation. Special thanks this episode to Naima Omondi, a family planning practitioner who got us in contact with Rehema.  Guests and organizations:  Dr. Rebecca “Tshidi” Moeti, former WHO regional director of Africa Dr. Ngozi Erondu, the technical director of GLIDE, the Global Institute for Disease Elimination

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• How to Stop Diseases from Spreading

  What are the best ways to stop the spread of infectious diseases? One key element is diagnostics. For diseases like tuberculosis, there are millions of people unaware that they have the disease. So improving diagnostic tests and making them accessible are critical.  Thankfully, new scientific breakthroughs could dramatically improve rapid TB diagnostic tests. These tools may soon transform countries like India, where the toll of TB looms large.  Reporting from Mumbai, India, journalist Chhavi Sachdev speaks with Dr. DJ Christopher, professor of pulmonary medicine at Christian Medical College, Vellore, a top ranked teaching medical college. Christopher and his R2D2 TB Network colleagues recently published significant findings in eBioMedicine about the potential of tongue swab-based tests to detect TB. Sachdev also talks to Dr. Soumya Swaminathan, a principal advisor for India's National Tuberculosis Elimination Programme, and Ashna Ashesh, a TB survivor and advocate, about what is needed to improve TB diagnostics.  Then, we dive into another critical part of halting disease spread: surveillance. This requires governments to have access to high quality health data about people in a given region. This information is vital to making decisions quickly, including those that pertain to cross-border disease spread.   Producer Eunice Maina talks with malaria community health workers on the Kenya-Uganda border who monitor disease prevalence, including Emily Onyango Auma. Then host Henry Bonsu speaks with Dr. Abdisalan Noor, Executive Director of AHADI, Applied Health Analytics for Delivery and Innovation. AHADI works with health institutions, particularly in Africa, to strengthen their self-reliance in public health analytics. Before AHADI, Noor helped the World Health Organization develop global guidelines on malaria surveillance.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. DJ Christopher, Professor of Pulmonary Medicine at Christian Medical College, Vellore Dr. Abdisalan Noor, Executive Director of AHADI, Applied Health Analytics for Delivery and Innovation Dr. Soumya Swaminathan, Principal Advisor for India's National Tuberculosis Elimination Program Ashna Ashesh, TB survivor and advocate Emily Onyango Auma, community health worker

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• Out-of-the-box Innovations Against Malaria

  Malaria kills nearly six hundred thousand people every year, with 95 percent of deaths occurring in Africa. Most of them are children under five. While progress on curbing malaria has flattened in recent years, new scientific breakthroughs may bring the world closer than ever not only to controlling malaria outbreaks, but potentially also eradicating the disease.  In this episode, we focus on the best mosquito control strategies to eliminate malaria. Host Henry Bonsu interviews Dr. Fredros Okumu, professor at the University of Glasgow in Scotland and a scientist at Ifakara Health Institute in Tanzania. His research evaluates many of the latest tools to combat malaria, including next generation insecticide bed nets, indoor residual sprays (IRS), and spatial repellants, also known as spatial emanators.  Then, reporter Paul Adepoju talks to scientists from the UK- and Tanzania-based Transmission Zero project. They have developed genetically modified mosquitoes that could dramatically reduce the transmission of malaria. Paul Adepoju speaks with Dr. Dickson Wilson Lwetoijera, a leading entomologist also at the Ifakara Health Institute in Tanzania, as well as Dr. Nikolai Windbichler from Imperial College London, who leads the molecular genetics side of the Transmission Zero project. The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Fredros Okumu, professor at the University of Glasgow in Scotland and a scientist at Ifakara Health Institute in Tanzania Dr. Dickson Wilson Lwetoijera, entomologist at the Ifakara Health Institute in Tanzania Dr. Nikolai Windbichler, associate professor at Imperial College London

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• Turning the Page on Tuberculosis

  Tuberculosis claimed more than 1.25 million lives in 2023, overtaking COVID as the world’s deadliest infectious disease. For the last century, there has been a vaccine protecting children from TB. Now, there is hope for a new solution: a potential vaccine for adolescents and adults.  On this episode, reporter Elna Schütz visits an M72 TB vaccine trial site in Worcester, South Africa, one of the world’s TB epicenters. First, Elna speaks with participants about their experiences in the M72 trial and with TB more generally. She also interviews South Africa Tuberculosis Vaccine Initiative (SATVI) Director Mark Hatherill and Angelique Luabeya Kany-Kany, SATVI’s chief research officer. SATVI runs part of the M72 trial in Worcester.  Then, journalist Chhavi Sachdev interviews Soumya Swaminathan, principal advisor on tuberculosis for the health ministry of India and former WHO chief scientist, about what is needed to end TB as an epidemic. Dr. Swaminathan is also the head of the MS Swaminathan Research Foundation, a nonprofit advancing sustainable rural development and climate resilience.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Soumya Swaminathan, former WHO chief scientist and current principal advisor on TB for the health ministry of India. Prof. Mark Hatherill, University of Cape Town and Director of SATVI, the South Africa Tuberculosis Vaccine Initiative. Prof. Angelique Luabeya Kany-Kany, University of Cape Town and Chief Research Officer of SATVI, the South Africa Tuberculosis Vaccine Initiative.

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• The Promise of PrEP for HIV

  What could end HIV and AIDS as a public health threat? While there is still no vaccine or cure, long-acting tools like Lenacapavir, the recently approved twice-yearly HIV prevention shot, could significantly reduce new infections. Many health experts believe this may get us toward the end of HIV as an epidemic.  On today’s show, reporter Leah Kahunde Ndung’u examines what the Lenacapavir rollout will mean for Uganda, which was one of two Lenacapavir trial countries in Africa. She speaks with the Uganda trial’s principal investigator Dr. Flavia Matovu Kiweewa and HEPS Uganda Executive Director Kenneth Mwehonge, among others.  Then, host Henry Bonsu interviews Dr. Wafaa El-Sadr, founder and director of ICAP at Columbia University, Executive Vice President overseeing Columbia Global, and MacArthur genius fellow. Prof. El-Sadr has overseen HIV treatment programs in more than 40 countries. She shares her innovative approach to service delivery.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Wafaa El-Sadr, Founder and Director of ⁠ICAP⁠ at Columbia University, Executive Vice President of Columbia Global Kenneth Mwehonge, Executive Director of ⁠⁠HEPS Uganda⁠⁠ Dr. Flavia Matovu Kiweewa, Director of Research for the Makerere University and Johns Hopkins Research Collaboration (MU-JHU)

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