Hello from Nairobi.

This week we’re following some remarkable medical advances: a potential breakthrough in a long-neglected disease, and new treatments and tests for the world’s deadliest parasite.

We also have an update to last week’s story on American HIV aid, and, at the end, a sci-fi-meets-Ken-Kesey story that combines psychedelic toad-licking, ayahuasca, tobacco, and genetically engineered bacteria. 

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

‘Astonishing discovery’ for a little-studied, disfiguring disease

Scientists believe they may have finally found the root cause of noma, a disfiguring illness in the sad bucket of “neglected tropical diseases,” The Guardian reports.

• Disease breakdown: Noma is a rare but rapidly progressing disease of the mouth and face. It’s largely a children's disease of poverty, with no single, proven cause, but an estimated 30,000 to 140,000 cases a year. Most cases are in children under 6 years old, across a belt of African countries from Mauritania to Nigeria to Ethiopia. Untreated, it kills 90% of those affected, and even with treatment the heartbreaking disease often leaves lifelong facial deformities and scars.

The new discovery was a bit serendipitous. Researchers at the Liverpool School of Tropical Medicine set out to map the bacteria living in the mouths of 19 children with noma across Nigeria. In the process, they uncovered a previously unknown species of bacteria, now called Treponema A. 

The obvious question followed: Could this be the cause of the illness? To make sure it wasn’t a fluke, the researchers went back to “reanalyze older samples from other noma patients” and found the same bacteria there, too.

As The Guardian reports, this “astonishing discovery” doesn’t necessarily prove that the new bacteria cause the disease, but it certainly gives scientists something concrete to chase. As one researcher put it, “we don’t know if [Treponema A] can colonize a noma wound, because of the architecture and the environment, or if it causes the noma wound.” 

Still, it’s an incredible starting point.

I reached out to Stuart Ainsworth, an infection biology and microbiome expert at the University of Liverpool, and part of the team behind the discovery. We discussed what this finding means and what it shows about the value of researching neglected diseases. 

I started by asking Ainsworth how a disease this severe could still have such basic unanswered questions, and how a lead like this could have gone unnoticed for so long. Ainsworth was frank: “There has hardly been any research on noma at all,” he said. 

He pointed to a 2021 review of the history of noma research, which found that there have only been 147 studies done on the disease since the year 1850. “In comparison, there were around 650 papers on rabies in 2021 alone,” he told me.

The core issue is that noma, Ainsworth says, “is the quintessential neglected disease. It only affects the very poorest in society and typically occurs in remote rural regions.” And because those who aren’t killed by the disease are often “left debilitated and scarred and generally hidden from society,” he said, “there is little impetus globally to invest in research.” 

It’s a brutal dynamic, and one that cuts to the core purpose of medical research. “The goal with all diseases is to eradicate them, or at least control them to the point where they are no longer an issue.” And yet, “all of these things are impossible if you do not have at least a very basic understanding of what is the cause of the disease,” he said.

But that bleak starting point is also what gives this kind of scientific work such an incredible upside. “We know so very little” about noma that even “simple targeted research could potentially have a huge impact,” he said. 

Looking forward, Ainsworth says further research could help move beyond the current treatment for noma, which is a shotgun approach of broad antibiotics, and that “we hope that these types of studies will eventually enable us to develop the targeted prevention, diagnostic, and treatment options to eradicate or prevent noma.”

A stalling fight against HIV, part 2

Last week we covered new data that showed U.S.-funded HIV treatment holding steady on paper, but testing, prevention, and case detection dropped sharply, raising fears about a surge in new infections.

Well, there are a few follow-on stories that are worth your time. 

(First, we’re owed a correction. I flagged the State Department’s claim that “20.6 million people” are on HIV treatment, but it appears that the official figures don't actually match the underlying data, which puts the number closer to 20.3 million.)

Second, the person in charge of the science behind that data just left. Mike Reid, the HIV program’s chief science officer, stepped down. He blames a system where American HIV aid is being “entangled with access to critical minerals or geopolitical positioning,” to the detriment of the work, Reuters reports.

Reid posted a full essay on Substack upon his departure, and there are a few sections worth pulling out to understand why he walked.

Reid starts with the core shift:

He follows with a strikingly blunt assessment, which directly contradicts the State Department’s framing, and echoes what many HIV experts have been warning about.

Ultimately, Reid casts his resignation as a break with the core idea of the field itself. “I’ve believed that global health — at its best — is a form of solidarity. Not charity. Not strategy.” And now, that very belief “is why I am resigning my post as chief science officer at PEPFAR in the U.S. State Department.”

A malaria drug for newborns

For the first time, there’s a malaria drug for newborns, Deutsche Welle reports. 

• Disease breakdown: Malaria is the world’s deadliest parasitic disease. The parasite spreads almost entirely through mosquito bites, then moves into the blood and causes cycles of fever, chills, and severe anemia. Young children are hit hardest because they have little natural immunity. The disease is preventable and treatable. Vaccines exist, but they reduce risk rather than eliminate the threat altogether. 

The treatment was just approved by the World Health Organization for “babies weighing less than 5 kilograms (11 pounds).” Its development closes what was previously a “medical care gap for 30 million babies born each year in malaria-endemic areas across” Africa, which is by far the hardest-hit continent. 

Technically, it’s a new formulation of two existing treatments: artemether and lumefantrine, which were developed thanks to a secret Chinese military project in the ’60s and ’70s to aid the North during the Vietnam war. (Really!)

Together, the drugs hijack the malaria parasite’s eating process, so that the blood molecules (hemoglobin) that should feed it actually end up destroying it.

You may be asking: If this is the first ever treatment, how have sick infants been treated until now? Well, routinely “infants have been treated with drugs developed for older children,” an imperfect workaround, as these drugs can “expose newborns to risks of dosing errors and toxicity.”

My takeaway: It’s encouraging that medical science keeps providing tools to fight and treat this disease. Earlier this month, the WHO also approved three new rapid tests for “malaria parasites [that] have evolved to become harder to detect,” as they stopped producing the molecule that older tests relied on. 

Very timely! In some countries in the Horn of Africa (like Ethiopia, Djibouti, and Somalia), those tests started missing “up to 80% of cases.” 

India’s largest pharma deal

India’s largest drugmaker, Sun Pharmaceutical Industries, has just made the country's “largest pharma deal,” Reuters reports. 

The company has agreed to buy the U.S. company Organon & Co. It’s an $11.75 billion all-cash deal, the most expensive overseas acquisition ever by an Indian company. 

Why does this matter?

Let me pepper in a bit of context: As we’ve written before, India, the “pharmacy of the world,” is where a fifth of all generic drugs and well over half of all vaccines are manufactured. And Sun Pharma is India's biggest drugmaker by revenue, churning out over a thousand separate medicines and drug ingredients. A true generics giant, those drugs include everything from diabetes treatments and psychiatric drugs to cancer therapies and dermatology medicines. 

Meanwhile, Organon (which started as an insulin producer over 100 years ago) makes specialty medicines: contraceptives and drugs for pregnancy and menopause, along with a variety of other hormone-based therapies. Although it’s a minnow in the American market, it produces “70 women's health and general medicines ​sold across about 140 countries.”

If you scan through the link you’ll see that the Reuters story is a business one, full of debt figures and deal details. To me, what’s more interesting is what this deal reflects about India’s pharma sector more broadly. 

The big takeaway is this: India’s pharmaceutical sector is enormous, and only growing. Many projections have the entire sector doubling in value from 2025 to just 2030. Much of that growth is expected to come from a shift out of cheap generics into specialty medicines, and so this is exactly the kind of deal that will help make that shift real.

Whatever you do, don’t smoke this

Let's end on a fairly wild story from New Scientist: A research group based at the Weizmann Institute of Science in Israel has "engineered tobacco plants to produce five powerful psychedelic compounds,” all in a single plant. 

As the authors argue, this could offer a more sustainable way to produce psychedelic drugs, “which are increasingly in demand for research and medical uses.”

What I find particularly interesting about this story isn’t just the tie dye-inducing tobacco plant. It’s the fascinating technique the scientists used, which lands just shy of permanent gene-editing. Here’s the explainer from the story:

Ultimately, those bacteria induced the tobacco plants to produce psilocin and psilocybin, two compounds found in “magic mushrooms”; DMT, which is found in the psychoactive drink ayahuasca; and bufotenin and 5-methoxy-DMT, which are secreted by Colorado river toads. 

The researchers argue that their method is a much easier way to produce these molecules for medical testing than, say, raising cages full of toads. And it’s doing it across biological kingdoms, creating compounds from fungi, plants, and animals in a single organism.

The takeaway: As the article outlines, “the idea of growing drugs through pharmaceutical farming, or ‘pharming,’ certainly isn’t new.” As far back as 2002, we’ve had corn engineered to produce trypsin, a digestive enzyme. But doing it temporarily, without forever altering the plant’s genome, limits the risk of these traits escaping or persisting in the wild.

And heck, it makes the infamous “Simpsons” “tomacco” plant look as everyday as a steamed ham. 

Until next week,

William