The Schistosomiasis Research Agenda—What Now?

As relatively new schistosomiasis researchers, we awaited with eagerness the publication of the ‘‘Schistosomiasis Research Agenda’’ (SRA) put forward by Colley and Secor in the December 2007 issue of PLoS Neglected Tropical Diseases [1]. The SRA is a comprehensive, well-organized list of research activities that reflects the impressive diversity of interests that make up current schistosomiasis research. Colley and Secor went to admirable lengths to solicit the interests of researchers the world over, with special efforts to solicit the opinions of scientists in countries or regions where schistosomiasis is endemic, such as Brazil, China, and Africa. Having attended some of these meetings (11th International Congress of Parasitology, held in Glasgow, United Kingdom in August 2006; and the 55th Annual Meeting of the American Society of Tropical Medicine and Hygiene, held in Atlanta, United States in November 2006) and received the emails, we are confident that the SRA indeed reflects the richness and breadth of current schistosomiasis research. As noted by Colley and Secor [1], many of these areas of interest in the SRA are applicable to the study of almost any neglected tropical disease (NTD). However, while research into other tropical diseases such as malaria and a number of the NTDs—most notably hookworm disease, cysticercosis, and leishmaniasis—are currently enjoying a ‘‘renaissance’’, with increased funding from major philanthropies such as the Bill and Melinda Gates Foundation [2], research into schistosomiasis remains one of the truly neglected areas of NTDs. This problem exists despite the fact that schistosomiasis is arguably the most important human helminth infection in terms of global morbidity and mortality as measured by disability-adjusted life-years (DALYs). Recently, King et al. [3] revised upwardly the DALY estimates for schistosomiasis, by including not only gross organ pathology as a disability, but also the anemia, pain, diarrhea, exercise intolerance, and under-nutrition that result from chronic infection with schistosomes. In 2003, the Gates Foundation provided a grant of US$30 million to create the Schistosomiasis Control Initiative (SCI), an organization that facilitates mass administration of praziquantel (PZQ) currently in six African countries [4]. The use of PZQ as a safe, inexpensive, and efficacious method to resolve current schistosomiasis infection and morbidity is admirable; however, there has developed an unexpected, yet serious, long-term side effect—the spurious perception that widespread use of PZQ makes schistosomiasis a problem of the past [5]. This misconception has promoted the belief amongst some funding bodies that we already have all the requisite tools to control schistosomiasis (i.e., PZQ), and development of new control strategies is unnecessary. Given the extensive burden of disease related to schistosomiasis, relying solely on mass and repeated treatment of exposed populations with PZQ is not enough to sufficiently control, let alone eradicate, this disease [6,7]. Diversity versus Divisiveness