Postdoctoral Fellowship Position Available with National Institute of Environmental Health Sciences, Social and Environmental Determinants of Health Equity Group

Position Description:

The Social and Environmental Determinants of Health Equity group, led by Dr. Chandra Jackson, is seeking an experienced and well-qualified post-doctoral fellow. The group is part of the Epidemiology Branch in the Division of Intramural Research at NIEHS, NIH. The group investigates how physical and social environmental determinants of health influence racial, ethnic, and socioeconomic disparities in cardiometabolic health. In addition to identifying the biological mechanisms by which factors in the social and physical environments affect health and contribute to health inequities, this group is also interested in the translation of epidemiologic findings into interventions that address structural, macrolevel as well as individual-level barriers to achieving and maintaining optimal health. Ongoing research addresses how physical and social attributes of neighborhood/housing and work environments affect, for example, insufficient sleep duration and inadequate sleep quality as well as subsequent cardiometabolic disease risk.

Post-doctoral fellows in this group will have access to data from the National Health Interview Survey and cohorts such as the Multi-Ethnic Study of Atherosclerosis, Jackson Heart Study, Sister Study, Study of Environment, Lifestyle, and Fibroids, and the Agricultural Health Study. Using existing resources, fellows can develop their own research initiatives within the mission of the research group. Postdoctoral fellows within the Epidemiology Branch are encouraged to build on existing resources to develop new projects that become the basis for transition to independent awards. Initial appointments are two years with additional years possible depending on productivity and availability of funds.

Fellows will be encouraged to take advantage of the rich and varied training and career development opportunities offered at NIEHS. The training environment is enhanced by proximity to the University of North Carolina Gillings School of Global Public Health where many of the Epidemiology Branch investigators have adjunct appointments.

Qualifications: Candidates with an earned doctoral degree in epidemiology or a closely related field or those with a medical degree and advanced graduate training in epidemiology, population health, or biostatistics within the past five years are invited to apply. Applicants must have extensive experience with epidemiologic or statistical data analysis. Preference will be given to candidates with demonstrated research interests in areas currently under investigation (e.g. health disparities; social determinants of health; sleep) in the research group and branch as well as to candidates with superior analytic and communication skills.

To Apply: Applicants should submit the following materials to epifellowships@niehs.nih.gov:
• Letter describing areas of research interest
• Curriculum vitae with bibliography
• Copies of 1-2 recent publications
• Contact information for 3 individuals serving as references
Application Deadline Date: Until filled. Position available immediately.

Learn more about the Social and Environmental Determinants of Health Equity group here:
https://www.niehs.nih.gov/research/atniehs/labs/epi/pi/sedhe/index.cfm

The Future of HIV: Novel Treatment Options & A Possible Cure

As the medical community and those it serves welcomed in a new year, it brought with it the hope of scientific advancements that will alter the course of certain disease states. These advancements include the use of stem cells to treat to treat macular degeneration, novel microscopic techniques to capture images of the brain, the continued observed effectiveness of the experimental Ebola vaccine, and countless other interventions aimed at creating a healthier global society. Included in these optimisms for 2019 is the possibility for novel treatment options and a possible cure for one of the world’s leading causes of death, HIV. The stories of Timothy Brown – the only individual ever to be cured of HIV, the Mississippi baby and Clark Hawley – both having an extended period of time with undetectable HIV viral load with an interruption of Antiretroviral Therapy (ART), and the Boston patients/Mayo Clinic patient – all three having undetectable HIV viral loads for an extended period of time after a stem cell transplant, have brought much sanguinity to health care professionals and patients alike. However, these exciting results have been unable to be replicated in the majority of the population suffering from HIV and remain unique in their respective occurrences. Although ART has been vital to the HIV community in terms of longevity and quality life, there are still certain populations that are seeking other mechanisms to treat this infectious disease – and, of course, always coveting the idea of a cure. The following is a brief glimpse at the vast pipeline that awaits 2019 and the anticipations of the global healthcare community.  

Combination Approaches

  1. The AIDS Clinical Trial Group (ACTG) is currently exploring the option of combining vorinostat, a HDAC inhibitor along with tamoxifen, which is an FDA approved medication the treatment of breast cancer for postmenopausal women. Utilizing this approach is thought to prevent the reactivation of HIV in CD4+ cells that are latent in addition to increasing the latency-reversal effect of vorinostat through tamoxifen.
  2. Researchers from the USA, France, Germany, Italy, Spain, Switzerland, and the UK are collaborating for a trial testing the combination of two HIV vaccine candidates alongside a monoclonal antibody called vedolizumab. This method of treatment is thought to target a certain protein in the body, α4β7 integrin, that plays a role in transmission of HIV into CD4+ cells. In a macaque model, this combination has shown the control of SIV (HIV but in simians) after discontinuing ART.
  3. At the University of Minnesota, researchers are testing infusions of natural killer (NK) cells with the administration of cytokine interleukin-2 (IL-2). The researchers are hoping to add to the evidence of NK cells being able to exhaust HIV reservoirs and to control virus replication.
  4. In a version of the “kick & kill” method of curing HIV, researchers in Oxford and Barcelona are using a medication to active the latent HIV reservoir while boosting the immune response 1000 times stronger than the usual to rid the body of the virus. Preliminary results showed that 5/15 patients had undetectable viral loads for seven months without ART.

Immunotherapy Approaches

  1. Immunocore, a company founded in Oxford with heavy investment by Bill Gates, has designed T cell receptors that seek out and bind with the HIV virus. These receptors then instruct immune T cells to eliminate any HIV-infected cells, even when the levels happen to be extremely low. Since levels can be rather low in the reservoir of HIV virus that exists in an infected individual, this is a promising lead to completely remove this retrovirus from the body. This immunotherapy has shown to be effective in human tissue samples, but no results being tested in humans have been released.
  2. In France, a company known as InnaVirVax has established a vaccine, VAC-3S, that allows the body to stimulate a production of antibodies against the HIV protein 3S. This, in turn, causes T cells to attack the virus. This is considered a novel approach because it encourages the immune system to recover while equipping it with the tools to continue fighting off the virus. VAC-3S has completed Phase 2a trials, and is partnered with a DNA-based vaccine from FIT Biotech, a Finnish company, that both parties believe can lead to a functional cure.  
  3. In a recently initiated trial, IMPAACT 2008, held in the USA, Botswana, Brazil, and Zimbabwe, a broadly neutralizing antibody termed VRC01 is being investigated for its effectiveness in infants with HIV who are also started on ART within 12 weeks of birth. Although the study aims at establishing the safety profile for VRC01, it is also observing the difference in the HIV reservoir compared with only ART.

Novel Antiretroviral Agents

  1. The manufacturer, ABIVAX, believes it has developed a compound that may help the immune system recognize cells infected with HIV by allowing an increased presentation of HIV antigens on the cell’s service. This would lead to an augmented immune response to abolish these infected cells. This compound has been labelled ABX464 and targets the HIV protein Rev, which is responsible for the transcription of HIV RNA. Reductions of measured HIV DNA have been reported from 25% to 50% in eight of the fifteen patients participating in the study; however, no delay in viral load rebound was found when compared with placebo.
  2. Gilead has created a novel mechanism of targeting the HIV virus through the capsid inhibitors class. Capsids are involved in protecting HIV RNA and related proteins, and capsids also breaks down to release the viral contents into CD4 cells which enable reverse transcription to take place. The novel agent by Gilead, GS-CA1, blocks both the assembly and disassembly of capsids that create non-infectious and defective viruses.

Gene Therapy

  1. Chimeric antigen receptor (CAR) T therapy has been re-initiated in the first cure related clinical trial of this approach in people living with HIV who are on ART. CAR T cell therapy involves the modification of an individual’s T cells that can target antigens of interest. The specific cells modified by the initiative in China, called VC-CAR-T cells, have been modified to target HIV gp120. These modified cells were able to induce the destruction of HIV-infected cells, including latently infected cells exposed to latency-reversing agents, in the laboratory setting.  
  2. With the knowledge of knowing that about 1% of the world’s population is immune to HIV due to a genetic mutation on the gene that encodes for CCR5, US-based Sangamo has begun to edit DNA to introduce the aforementioned mutation. The CCR5 protein is attached to the surface of CD4 cells that allows HIV to enter and infect the cell; with the mutation, it would be impossible for HIV to enter cells. This company extracts patient’s CD4 cells in order to use zinc finger nucleases to edit patient’s DNA to make them resistant to HIV.
  3. Although a highly controversial topic amid the recent publication of the use of CRISPER in twin daughters in China, scientists believe that this tool can lead to a cure for HIV as it is believed to be a much easier, faster, and effective approach than other gene-editing methods. However, the majority of the global health community is in agreement that years of laboratory research and ethical standards need to be established before human trials are properly started.

With the HIV virus adapting and mutating to evade treatments almost as rapidly as the world is producing novel approaches to treating this infectious disease, the drive for continued research and testing should be relentless. These aforementioned examples of novel treatments and possible cures display the creative and diverse thought processes the medical community has put forth to tackle one of the most stigmatized diseases on this earth. However, the ethics behind these trials need to be sound and forthcoming for all of humanity. The trials that occur need to ensure an assortment of demographics including individuals from both developed and developing nations – a subtle form of medical colonialism has no place in the global health community. In addition, trials that enroll patients who willingly accept the benefits and risks associated with the experimental therapy have the moral obligation to supply lifetime treatment if it happens to be effective. The researchers and medical professionals who monitor these participants need to take extreme caution in ART interruptions/discontinuations and certify that the patients realize what complications could transpire due to them. Finally, and most importantly, the interventions that show promise of novel ways to approach HIV or even a cure have to be accessible, affordable, and available to all humans who suffer from HIV. The health inequalities that plague this fragile planet have already been clearly highlighted in this ailment throughout history; the global health community is in debt to humanity for a cure for all when discovered.  

With the global health community’s commitment, the future of the HIV virus continues to transition from infectious disease to chronic disease. While the step that will advance the chronic disease to a cure is still thought to be unknown, the excitement behind the aforementioned gene editing therapy is substantial. The ability to safely, effectively and ethically modify human cells to prevent the entry of the virus into the immune system is certainly the most promising option recently and possibly from this disease’s initial appearance; although, health care professionals haven’t quite figured out how to combine these aspects yet. A cure or even functional cure may be years away, but the global health community needs to continue to accompany those inflicted by this chronic infectious disease to meet the hopes and expectations of alleviating the burdens of HIV.

2019 World Cancer Day – “I Am and I Will”

Every year on February 4th, World Cancer Day is celebrated by bringing awareness and providing education about the disease. Many of the efforts focus on making the reduction of preventable cancer a global health priority.

In 2018, it was estimated that there were 26,000 deaths that occurred due to cancer across the globe every single day. This rate is only predicted to increase with time due to a variety of factors. To name a few: the age of the world population is increasing, there is a general lack of education about ways to prevent cancer in developing countries, and early detection methods and treatment are scarce in these same developing countries. By 2030, the rate of cancer deaths per year is expected to hit 21.6 million – this is 8.4 million more than the 2010 rate. To put this into perspective with infectious diseases, in 2015 alone, the deaths per year due to malaria was 72,000 while cancer rates met 8.9 million – with the majority of the deaths coming from developing countries.

The largest gaps in rates of cancer survival can be noticed in cancers that are more responsive to early screening and treatment (for example: breast and colorectal cancers). These rates vary greatly between developing and developed nations as well as in different racial groups in the same country.  In the United States and Australia, the 5 year survival rate for breast cancer (2010-2014) was up to 90% compared to only 65% in Malaysia for the same time frame. In the U.S. between 2004 and 2009, there was a difference in the 5 year survival for cervical cancer between whites and blacks, 64% and 56% respectively. These differences in rates can be attributed to differences in prevention and treatment programs. For example, in many developing countries, cancer patients do not have access to radiotherapy facilities near their homes. There are 60 countries across the globe with cancer patients that do not have one radiotherapy facility in the entire country. On the screening side, many developing nations do not have the health care infrastructure or funds to provide regular cancer screenings.  The same gaps in access to care and resources can be said about different areas of socioeconomic status in the United States.

Current efforts to develop prevention and treatment programs across the globe are focused on the WHO’s recommended 4 main approaches or areas of: prevention, early detection, diagnosis and treatment and palliative care… and there have been successful feats! An example of a successful cancer prevention program is in Sudan. Their program focuses on promoting public awareness of breast cancer and early detection through in-home breast exams done by trained female volunteers. Another positive program was implemented in India in 2013. This program increased breast cancer awareness in the study urban area, and a subsequent increase in early stage diagnosed breast cancer increased from 74% to 81% in 3 years (2013-2016). Most cancer prevention and reduction programs in developing nations focus on the initial stages of increasing awareness and education about cancer as they are cost efficient and effective.

To fight these discrepancies in cancer death rates, many use this day to spread social media messages about cancer prevention and early screening, attending festivals or walks that raise awareness or support and encouraging public government officials to make cancer issues a priority in their own countries through policies and research. In general, the day brings people together with a common cause and mission: getting rid of preventable cancer. This map is a great resource to find and join activities anywhere on the globe related to World Cancer Day.

In addition, 2019 introduces the start of a 3-year campaign called, “I Am and I Will”, and focuses on the personal commitments required to help decrease the global burden of cancer as a whole. The American Cancer Society highlights a few ways people can personally decrease the effects of cancer as well as support others in their circles by:

  • Making healthy life choices such as saying no to tobacco products, limiting alcohol, being conscientious about time spent in the sun and eating an overall healthy and wholesome diet
  • Knowing the signs and symptoms of cancer and seeking early treatment when identified
  • Sharing cancer experiences with decision makers in government and advocating for change and funding to go into cancer research
  • Encouraging schools and businesses to adopt healthy practices such as nutrition, physical activity and no tobacco policies to support their students and workers

Visit www.worldcancerday.org before February 4th to learn more about this day and how you can get involved in your own personal way.  Every little action makes a difference in shining a light on the importance of defeating cancer on many different scales. #IAmAndIWill

Global News Round Up

Politics & Policies

Every year, the World Health Organization puts out a list of the most pressing issues that face global health.  They change a bit each time as the WHO tries to emphasize where we need the most progress to be made, and the lists are always enlightening.

Funding to tackle 33 significant diseases has reached its highest level since figures were taken, says a survey which has tracked this for 11 years.

Programs, Grants & Awards

The health of the U.S. population can be affected by public health threats or events across the globe. Recent examples of this include the Ebola Virus outbreak that began in 2014, the 2003 SARS epidemic, and the 2009 SARS epidemic, and the 2009 spread of novel H1N1 influenza. Improving global health can improve health in the United States and support national and global security interests by fostering political stability, diplomacy, and economic growth worldwide.

Research

Results from trials of tafenoquine, a novel anti-relapse medicine for patients infected with Plasmodium vivax malaria, have shown the drug to be effective and safe, according to a pair of studies published in The New England Journal of Medicine.

Diseases & Disasters

There were just 28 reported human cases of Guinea worm disease (GWD) last year, the U.S.-based Carter Center said Thursday.  The nongovernmental organization (NGO) founded by former President Jimmy Carter said the disease is gradually moving toward eradication.

A Pakistani health official says the country has kicked off its first nationwide polio vaccination campaign for the year in efforts to eradicate the crippling disease by the end of 2019.

According to the World Health Organization, the first HIV case appeared in Yemen in 1987, and the number of people living with it was estimated to be around 9,900.  While the prevalence was only 0.2 percent of the population, most Yemenis living with either of the viruses faced stigma and discrimination, even from their families.

At least 11 people have died in Argentina after becoming infected with hantavirus, a disease carried by rats and other rodents, according to a news alert from the World Health Organization (WHO).

The number of Ebola cases recorded each day in the Democratic Republic of the Congo is expected to more than double, with concern mounting that uncertainty over how the virus is being transmitted could result in it spreading to neighbouring countries.

An estimated 1 in 10,000 people are born with hemophilia, a blood disorder caused by lack of proteins needed to stop bleeding. While those in developed countries have access to treatment that allows them to lead normal lives, that is not the case for the more than half a million people in low- and middle-income countries. For them, hemophilia can be a “curse,” a cause for stigma and financial disaster—and, sometimes, a death sentence.

Technology

Solar power is helping make universal healthcare a reality in places where unreliable power supplies regularly affect access to vital services, and can out people’s lives at risk, thanks to support from the United Nations Development Programme (UNDP).

Environmental Health

Leading climate scientists and meteorologists are banking on a new strategy for talking about climate change: Take the politics out of it.  That means avoiding the phrase “climate change,” so loaded with partisan connotations as it is.

Dried fish producers in Cox’s Bazar’s Nazirar Tek village, the largest dried fish producing village in the country, are still using toxins even though an NGO has been putting in efforts to make them switch to organic fish-processing methods.

This weekend, a crucial but barely heralded scientific mission will come to an end in a remote part of Antarctica.  A team of seven Australian and American researchers will conduct the last extraction of ancient air from ice cores drilled as deep as 240 metres.

Equity & Disparities

For her next act, Leland started a venture — called Co-Impact — designed for just such funders. It pools donors’ money and brings them into the decision-making to support proven solutions in Africa, South Asia and South America.

Women, Maternal, Neonatal & Children’s Health

For Indian airline executive ElsaMarie D’Silva, the gang rape that killed a Delhi college student in 2012 was a turning point.  Although the attack stood out for its savagery, D’Silva knew that the rape of Jyoti Singh Pandey was not an isolated event: it fit a pattern of everyday harassment and violence that Indian women endure in public places.

The mosquito-borne virus that causes Rift Valley fever may severely injure human fetuses if contracted by mothers during pregnancy, according to new research.

Looking Ahead: Global Health Threats in 2019

The past year felt turbulent across many facets of life- global health included. Between threats to health from climate change, infectious disease outbreaks, the opioid crisis, threats to healthcare in war zones, and the ever-present health risks of noncommunicable diseases, global health resources are stretched thin. The coming year promises to be just as challenging.

Many global health organizations, such as the World Health Organization and IntraHealth, release reports on health risks to look out for at the start of each year. Between these lists, there is significant overlap, suggesting that the problems in global health are not a matter of lack of data or direction, but poor prioritization and lack of resources. Pollution and climate change rank high on almost all such lists; the WHO reports that 90% of people breathe polluted air on a daily basis. As a result, the WHO considers air pollution the greatest environmental threat to health for 2019- a significant step considering the threats of water pollution and other environmental contaminants. As with most global health issues, the world’s poorest people are hit the hardest. Nearly nine in ten of global deaths due to inhaled pollutants are in low- and middle-income countries (LMIC), due to entirely preventable causes like poor regulation of transport emissions and using gas-powered cookstoves in homes.

Another problem heavily featured in the forecasting reports for 2019 include health risks due to conflict. More than 1 in 5 people across the globe (22%) live in a conflict-affected environment. These are the populations least likely to meet health and development targets, like the Sustainable Development Goals. Specific conflicts are high on the radar of global health officials, especially Yemen and Syria. Both countries have experienced heavy destruction of their existing health infrastructure, brain drain of medical personnel, and tangential struggles that bode poorly for health, such as food insecurity and poor sanitation. Dogged efforts by both local and international humanitarian workers have been able to stave off many public health disasters in such environments, but as wars proliferate and donor attention drifts, only the most pressing issues can be addressed. For example, in Yemen, an unprecedented multi-wave cholera outbreakled to more than 1 million cases of cholera. Of these cases, 30% were children. An effort by many international and local NGOs to distribute vaccines to these cases likely decreased the death toll, but the existing malnutrition of the population coupled with factors like destroyed water supplies exacerbated the outbreak and accelerated the need for resources and personnel.

Risks from infectious disease are typically present throughout global health forecasts, and this coming year was no different. In fact, for the first time, the WHO considers vaccine hesitancy, which they define as the reluctance or refusal to vaccinate despite the availability of vaccines, to be a public health risk that threatens to undo decades of work eradicating diseases that, until quite recently, affected people around the world. Vaccine hesitancy is thought to be one of the factors that has led to a 30% increase in global measles cases. Outbreaks of Ebola have shown how dangerous and fast-moving an infectious disease can be, even with the health workers tasked with treating ill patients. Resurgence of polio in war-torn Syria was only dissipated through a massive vaccination effort. The growing threats from influenza, Dengue, Zika, MERS, SARS, and many other diseases have raised the alarm as to how well global public health processes are able to deal with a potentially catastrophic pandemic. Unfortunately, another global health risk identified by the WHO is antimicrobial resistance for the types of antibiotics that, for decades, have saved the lives of millions. This could cause currently treatable infections like pneumonia, gonorrhea, and salmonellosis to be as dangerous as in times before antibiotics were available. One such infection, tuberculosis, affects 10 million people per year and kills almost 20% of those afflicted. In 2017, almost 500,000 cases of tuberculosis were classified as “multi-drug resistant.”

It’s not all bad news. Overall, global health trends are moving in a generally positive direction. Global life expectancy has increased by 5 years since 2000. Every day, more people will be able to access clean water, electricity, and the internet. Global child mortality has fallen by almost 15% since 1960, while global extreme poverty has fallen to less than 10%, an almost 30% decrease from just three decades ago. Almost 90% of children receive the DTP vaccine before their first birthday. However, progress is uneven, and for many is too slow. Many experts believe that some of the long-simmering global health concerns of the past few decades may be coming to a head as 2019 begins.

For anyone concerned with global health, these risk forecasts can seem dire. Even under the best of conditions, most initiatives set to tackle these risks can at best hope to minimize, and not completely eradicate, the threats from these challenges. The MDGs and SDGs are an important first step in setting a global agenda that puts the social welfare of populations at the front and center, and such efforts must continue. Yet, policymakers cannot ignore the many countries around the world that continuously fail to meet minimum standards of health and well-being. We cannot decouple the political and economic circumstances that lead to failures in global health progress. Short-term aid packages are a necessary salve, but not a sustainable solution. Many global health advocates contend that putting health and well-being at the center of state strategic planning would cascade into positive indicators in all aspects of life, such as food security, education outcomes, economic development, and inter-state diplomacy and coordination. To ensure that we are poised to meet the known and still unknown risks that may come in the coming years, global health must be a primary consideration.