The Sanaria Institute for Global Health and Tropical Medicine (SIGHTM) maintains a flexible agenda that allows the Institute to address what we determine to be key tropical medicine / global health objectives. These objectives must be both timely and offer the possibility of profoundly transformative progress. Among all public health interventions, high efficacy vaccines often fit these criteria, providing transformative solutions to problems in public health that are persistent or, at best, show minor incremental progress threatened by the possibility of backsliding if there is donor fatigue, civil disturbance or climate disaster. For example, high efficacy vaccines that block infection and prevent ongoing transmission open the possibility of mass vaccination campaigns and regional (and eventually global) eradication. If this is achieved, the heavy burden of financing ongoing control efforts and disease mitigation can be lightened or removed altogether, and a society can graduate to a new level of health and prosperity.
SIGHTM is currently focused on three such disease areas, malaria, diarrheal diseases, and chronic diseases of the liver, that have the potential for being impacted by transformative technologies:
Malaria: High efficacy malaria vaccines that completely block blood stage infections and prevent transmission. In September 2022, the World Health Organization called for the development of high efficacy vaccines against Plasmodium falciparum (Pf) malaria, noting as Strategic Goal #1 the development of vaccines that prevent Pf infection in >90% of individuals. Pf is prioritized by WHO because it is responsible for the large majority of malaria cases and deaths. SIGHTM has determined that this goal is timely and within reach and currently focuses most of its resources on this objective.
Diarrheal Diseases: Vaccines that prevent diarrheal diseases. Diarrheal disease is the third leading cause of death in children 1–59 months of age. It is both preventable and treatable. Each year diarrhea kills around 440,000 children under 5 and an additional 50,000 children aged 5 to 9 years. Globally, there are nearly 1.7 billion cases of childhood diarrheal disease every year. Diarrhea is a leading cause of malnutrition in children under 5 years old. The two leading bacterial causes of diarrhea in the developing world are Shigella sp. (shigellosis) and enterotoxigenic Escherichia coli. There are no licensed vaccines for these pathogens. SIGHTM is focused on supporting development of such vaccines.
Chronic Disease of the Liver: Immunotherapeutics and vaccines that treat diseases of the liver. There are ~250 million individuals in the world with chronic hepatitis B infection and at least 500,000 new cases of liver cancer per year, many caused by chronic hepatitis B infections. Most of those affected live in low and middle income countries. Chronic hepatitis B, liver cancer and numerous other diseases of the liver do not have any reliably curative interventions. The liver plays a central role in human physiology and infectious diseases, a portal to the body from the GI tract, an organ with key immunological properties, and a frequent site of disseminated cancer. A common theme in many chronic or incurable diseases is suppressed or misdirected immune responses in the liver. SIGHTM believes that developing immunotherapeutics and vaccines that target the liver is critical. Malaria sporozoites (SPZ) exhibit a precise tropism for hepatocytes and, using CRISPR-CAS9 and related technologies can be modified to express immunomodulatory molecules and critical antigens for inducing protective immunity. SIGHTM believes this has the potential to be a transformative technology with broad public health applications including the cure of chronic hepatitis and liver cancer.