New York Foundation Strives To Call Attention To Diseases Of The Third World

As different as the developed world is from the developing world, so, too, are the diseases that plague their people. In industrialized countries, AIDS, cancer, and heart disease are prevalent; while in Africa, Asia, and South America, more than 700 million people suffer from one of three widespread tropical diseases: schistosomiasis, onchocerciasis, and trachoma. For the last 16 years, the Edna McConnell Clark Foundation, based in New York City, has done its part to help eradicate these deadly diseases by supporting researchers investigating them, through its Program for Tropical Disease Research. "These diseases aren't getting their share of attention," says Joseph A. Cook, director of the program. "The foundation initiated this program with the intent of drawing the interest of the scientific community to these horrendous diseases." Edna McConnell Clark and her husband, Van Alan Clark, established the foundation in 1950 primarily to help the poor. The husband-and-wife philanthropists began the foundation with stock the family owned in Avon, the cosmetics company founded by Edna McConnell Clark's father, David Hall McConnell. In the 1980s, the foundation diversified its holdings. Today, its total assets are worth $414 million. In the early 1970s, the foundation identified the five programs it currently supports: children, disadvantaged youth, justice, homeless families, and tropical disease research. Although the foundation's support of science is rather restricted, the tropical disease program could actually open the door to funding for an array of scientists. Immunologists, epidemiologists, social anthropologists, molecular biologists, parasitologists, behavioral scientists, pathologists, and a host of other researchers may find some of the support they need from the foundation. But, according to Cook, the fact is "there really aren't that many people working on these diseases." Last year, the foundation awarded 30 of its 191 grants to researchers in tropical disease: a number, says Cook, that has been about the norm for the last several years. In total, $4.3 million (out of a foundation total of $24.2 million) in new grants were awarded to researchers throughout the world (see box on page 27). Unlike a number of other U.S. foundations, the Edna McConnell Clark Foundation doesn't restrict eligibility to American scientists. Rather, any established researcher from anywhere in the world may submit, at any time, a two- or three-page preproposal letter that briefly describes the project and its budget. The program officers read these letters, then invite select researchers to submit a full proposal. Each proposal must include an activity plan that maps out a time frame and anticipated results. The scientific advisory committee and the program officers then present their suggestions to the board of trustees. In the end, says Cook, the board makes all final decisions. Grants, which are awarded in February, April, June, September, and December of each year, are made for one, two, or three years - depending on the size of the grant and the scope of the research. The money does not cover capital costs, construction, operating expenses, fellowships, scholarships, and endowments. Travel expenses, often required in tropical disease research, must be justified separately. "We don't discourage it [travel]," Cook says. "We just need to see" travel plans before approving such funds. From 1974 to 1984, the tropical disease program focused on schistosomiasis, a parasitic disease caused by worms of the genus Schistosoma. The disease - called "snail fever" because fresh-water snails act as the intermediate hosts - affects more than 200 million people in Africa, South America, China, and the Philippines. Since 1984, the foundation has gradually shifted its emphasis from schistosomiasis to onchocerciasis (river blindness) and trachoma, both causes of infectious blindness. Cook, who researched schistosomiasis at the National Institutes of Health and the Rockefeller Foundation before joining the Edna Mc-Connell Clark Foundation 10 years ago, said the foundation shifted its interest because it "felt things had improved" in the battle against schistosomiasis. "There's good science going on," he says. "Five years ago, we looked at other underfunded diseases. We felt our schisto experience would help with onchocerciasis and trachoma." More than 12 million people in the world have gone blind as a result of these two infections. Oncho-cerciasis, which is spread by black flies living near rapidly flowing rivers, is widespread in sub-Saharan Africa and appears in some regions of Central and South America. Some 17 million people are infected with the Onchocerca volvulus worm, and 85 million others have been exposed. The other disease, trachoma, is the most common infectious cause of blindness in the world. An estimated 360 million to 500 million people risk infection by the bacterium Chlamydia trachomatis. Six million to 9 million people have already gone blind as a result of it. The disease, which primarily strikes those living in Africa, the Middle East, and Asia, has also appeared among American Indians on some reservations as well as people living in the southern Appalachian mountains. While still supporting some research in schistosomiasis, the foundation has devised well-structured strategic plans for the war against onchocerciasis and trachoma. "We gathered together people who are active in the field," says Cook. "The research plan is a product of ideas from the scientists working on the problem." The overall goals of both programs are to prevent the spread of infection and to develop vaccines. The plan for onchocerciasis, for example, is divided into four main research efforts: (1) animal models for studies of protective immunity, (2) immunology and molecular biology studies, (3) epidemiology and pathology studies in humans, and (4) a vaccine testing program (scheduled to begin in mid-1991). While Cook acknowledges that the foundation may have been "far too optimistic in terms of a vaccine" for onchocerciasis, he still thinks the plan is necessary. "People who criticize the plan say you can't plan research," he says. "I don't disagree, but I think it's good to have some sort of plan; something you can evaluate." In fact, it was this evaluation process that prompted the foundation to revise the strategic plan for trachoma. Through workshops, foundation officials and scientists determined what the scientific com- munity knew about trachoma and what it still needs to know. "We know about risk factors, immunology, proteins, and antigens," says Cook. "We decided to move on to do some other field studies." Through a previous field study, for example, Tanzanian and American scientists found that the simple act of washing one's face significantly reduced the risk of infection. Grant recipients must submit brief (half-page to full-page) quarterly progress reports and activity plan updates. At the end of each grant-supported year, researchers must also prepare an annual report that the foundation hands over to its expert reviewers to evaluate the progress of the work. Although this may seem to be an abundance of paperwork, Cook says that the foundation is rather liberal about it. And the brief reports, he adds, "let us know what's going on." In addition to providing financial support, the foundation also supplies the tropical disease research community with quarterly bibliographies of scientific articles on schistosomiasis, onchocerciasis, and trachoma. The foundation offers Schisto Update, Oncho Update, and Trachoma Update free of charge to anyone who wishes to receive them. For more information about the publications and the Program for Tropical Disease Research, contact: Joseph A. Cook, director, Program for Tropical Disease Research, The Edna McConnell Clark Foundation, 250 Park Ave., New York, N.Y. 10017; (212) 986-7050.

New York Foundation Strives To Call Attention To Diseases Of The Third World

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