A National School of Tropical Medicine and Neglected Infections of Poverty for North America

The turn of the 20th century witnessedthe creation of the world’s first two schoolsof tropical medicine. The LiverpoolSchool of Tropical Medicine admitted itsfirst student in May of 1899, and theLondon School of Tropical Medicine,which eventually became the LondonSchool of Hygiene & Tropical Medicine,six months later [1]. At the beginning, thetwo British tropical medicine schools werefounded on different principles [1,2]. TheLiverpool School was built to providemedical support for a vigorous shippingtrade between Liverpool, one of England’smost active ports, and the coasts of Africa,Asia, and the Caribbean [1]. Launchedwith an initial gift from Alfred Lewis Jones,who made his fortune from shippinginterests in West Africa and elsewhere,the majority of the Liverpool School’spatients who were admitted to the tropicalward of its affiliated Royal SouthernHospital worked in the shipping trade[1]. From 1899 until the outbreak ofWorld War I a cornerstone of the Liver-pool School was expeditions financed bythe Suez Canal Company, the PanamaCanal Commission, and other overseasshipping concerns [1]. The LondonSchool had a somewhat different focus.Established through the force of personal-ity of Sir Patrick Manson (‘‘the father oftropical medicine’’), the London School’soriginal mission was to train generalcolonial medical officers employed in theservices of a vast British empire, whichincluded the military and the IndianMedical Service [2]. By the early 1900s,it was estimated that 10% or more ofBritish physicians were employed as over-seas practitioners [2].Many of the other Western Europeancountries with large colonial holdingssubsequently created schools or institutesof tropical medicine, including the Bern-hard Nocht Institute for Tropical Medi-cine in Hamburg, Germany (1900), theInstitute of Tropical Medicine in Antwerp,Belgium (1905), the Royal Tropical Insti-tute (KIT) in Amsterdam, The Nether-lands (1910), and the Swiss Tropical andPublic Health Institute in Basel (1943),among others. In addition to trainingmedical practitioners to work overseas, intime both the British schools and Europe-an Institutes evolved distinguished andvital programs of biomedical research thatled to the discoveries of the life cycles ofseveral important human parasites andmany of the drugs and diagnostics forneglected tropical diseases (NTDs) still inuse today. Thus, while some of theseinstitutions may have been founded withcolonialist intentions, in short order theybecame international resources for re-search and development to combat someof the most important NTDs afflicting theworld’s poor. Today, the same institutionsalso maintain strong research trainingprograms in the biomedical sciences withexcellent track records of trainees whopopulate institutions in both the Northand the South.Fast forward 100 years, and at thebeginning of this new Millennium there isstill no fully dedicated school or institutelocated in North America with the depthand breadth in NTDs research, develop-ment, and training, as those maintained bythe two British tropical medicine schoolsor even some of the larger tropicalinstitutes on the European continent. Tobe sure, there are pockets of greatexcellence in research and training forselected tropical diseases in the schools ofpublic health at Harvard, Johns Hopkins,Tulane, University of California, Berkeley,University of Washington, and the Na-tional Institute of Public Health in Cuer-navaca, Mexico. There is also importantbasic research conducted at the NationalInstitutes of Health and the Institute ofParasitology at McGill; superb publichealth training at the U.S. Centers forDisease Control and Prevention; andinnovation leading to the development ofnew control tools at product developmentpartnerships in Seattle, Washington; SanFrancisco, California; and Washington,D.C. However, today in North Americathere is no comprehensive school orinstitute for NTDs that hosts a fullcomplement of these activities, especiallyfor multiple tropical infections. Similarly,there is no equivalent entity located inNorth America that provides extensivetraining in whole-organism biology for therecognition and manipulation of most ofthe major NTD parasitic, bacterial, andviral agents or their vectors. Thus it is notclear whether there is a school in NorthAmerica whose graduates could pass amodern equivalent of the 100-year-oldfinal examination of the London School ofTropical Medicine:‘‘Students were asked to describe themethods for demonstrating the WidalReaction in typhoid and Mediterraneanfever and for purifying water on the march;to distinguish between the Anopheles andthe Culex mosquito and the differentfilarial embryos; to diagnose leprosy,syphilis, lupus and malaria; and to describethe recommended treatments for cholera andDhobi itch. The laboratory practicum testedfor competence and little more. Studentswere asked to describe the steps to identifyan unknown broth in a test tube, to stain