HISTORY
Dr. Victor George Heiser was orphaned at the age of 16; his parents perished in the great Johnstown, Pennsylvania flood of May 31, 1889. In spite of this, he trained himself as a physician, graduating from Jefferson Medical College, Philadelphia, and devoted his life to the study and treatment of tropical diseases, leprosy in particular. As Associate Director of the International Health Division of the Rockefeller Foundation, he circled the earth 17 times on his medical missions, and recounted his experiences in a best-selling autobiography, “An American Doctor’s Odyssey,” published in 1936 (used copies are available through the Web).
In 1969, Dr. Heiser recalled that “sixty years ago it became my responsibility and duty to gather up 10,000 lepers in the Philippines and transport them to a leper colony. The hope then was that isolation could reduce the incidence of the disease and perhaps eventually wipe it out. It didn’t work. Now we have a new system – the clinic system – and that, too, has had practically no effect whatever in statistically reducing the incidence of leprosy. Indeed, it is apparently increasing in many parts of the world. But we must not sit idly by while so many people suffer from this horrible disease.”
THE SCIENTIFIC ADVISORY COMMITTEE
Patrick J. Brennan, Ph.D., Chairman
Stewart T. Cole, Ph.D.
Jerrold J. Ellner, M.D.
Gilla Kaplan, Ph.D.
Thomas Shinnick, Ph.D.
BACKGROUND
Leprosy is an infectious disease caused by Mycobacterium leprae. Approximately 300,000 new cases are detected each year, predominately in India and Brazil, but also in the Democratic Republic of the Congo, Central African Republic, Madagascar, Mozambique, Nepal and Tanzania. In addition, millions of patients, no longer infectious, still suffer from the permanent disabilities and handicaps that are the particular consequences of leprosy. These people, no longer counted among the registered, inhabit the leprosoria/“lazarios” still found in many countries on all continents and are a reminder to us that clearance of the infection is not the end of the disease. Nevertheless, the current world leprosy situation has vastly improved since Dr. Heiser’s time. Under the World Health Organization’s Global Leprosy Elimination Program, by 1998 the global prevalence rate was estimated at 828,803, an 85% reduction since 1985. Still, global prevalence was 1.4 per 10,000 and, in the top endemic countries, 3.81 per 10,000. The elimination goal of one case per 10,000 was thus reset for the end of 2005, this time not globally, but by country and region. Yet, the goal has not been achieved in all major leprosy endemic regions. According to official reports received during 2008 from 118 countries and territories, the global registered prevalence of leprosy at the beginning of 2008 stood at 212,802 cases, while the number of new cases detected during 2007 was 254,525 (excluding the small number of cases in Europe). The number of new cases detected globally fell by 11,100 cases (a 4% decrease) during 2007 compared with 2006 (http://www.who.int/lep/en/).
Most previously highly endemic countries have now reached the elimination goal. During 2007, both the Democratic Republic of the Congo and Mozambique reached this important stage. Those few countries that remain are very close to eliminating the disease. However, pockets of high endemicity still remain in some areas of Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. The data on high levels of new case detection compared with prevalence figures indicate that in spite of identification and treatment of the vast majority of patients, transmission is still occurring and that individuals other than clinical leprosy patients such as infected contacts or those with preclinical leprosy probably serve as important sources of ongoing transmission.
The fact is that today leprosy is diagnosed solely on the basis of physical symptoms; the simple detection of acid fast bacilli in the skin slit ear lobe, leading to “bacterial index” (BI) and “morphological index” (MI), is now seldom applied. The mixed results of the Leprosy Elimination Program in recent years have led to serious questions on definitions and validity of the common epidemiological markers: “prevalence” (the number of registered and treated patients at the end of a year), and “new case detection” (which can merely reflect the results of intense leprosy elimination campaigns). The call has emerged “for reliable tools to measure the fall in the incidence of leprosy.” Underlying the conundrum of decreasing prevalence and relatively static new case detection rates is lack of knowledge on transmission and incubation time of leprosy. Issues such as primary portal of bacillary entry, transmission from paucibacillary cases, and non symptomatic carriage, are all unresolved. “Wanted: an indicator that directly and accurately measures the level of leprosy transmission at the population level” (Osahon Ogbeiwi, LML, July 5, 2006). Accordingly, the Heiser Program for Research in Leprosy and Tuberculosis has been placing more of its limited resources into the basic research questions of diagnosis of infection, transmission of the disease, and other issues such as nerve damage and leprosy reactions.
In 1972, the will of Dr. Heiser established the Heiser Grant, to be administered by The New York Community Trust for charitable purposes, and has operated since then under the leadership of Dr. Maclyn McCarty, Dr. W. Lane Barksdale, Dr. Barry Bloom, Dr. Charles C. Shepard, Dr. Roy Curtiss III, and present membership, as succeeding Scientific Advisory Committees. Since its inception, the Program has contributed to research on the control of leprosy through research grants and post-doctoral training fellowships, and continues to do so. However, in more recent times, it has invested sizable amounts from Dr. Heiser’s bequest in major research projects, such as sequencing of the genome of Mycobacterium leprae, the Rifampin-Ofloxacin-Minocycline intervention trial in South India, and start-up funds for IDEAL (Initiative for Diagnostic and Epidemiological Assays for Leprosy), a worldwide consortium of basic researchers working on the application of new antigens for detection of sub-clinical leprosy and new genetic markers of the leprosy bacillus for molecular epidemiological studies.
Leprosy and tuberculosis are caused by the same genus, Mycobacterium, namely M. leprae and M. tuberculosis, respectively. According to the World Health Organization (www.who.int), the estimated number of new cases of tuberculosis worldwide in 2003 was 8,810,000 of which 3,897,000 were sputum positive; 674,000 of the patients were coinfected with HIV. Deaths from tuberculosis were 1,747,000 including 229,000 coinfected with HIV. There were a total of 15.4 million cases, of which 6.9 million were sputum positive. It is estimated that there are currently 2.1 billion people worldwide who are infected with the tubercle bacillus in whom the infection could be reactivated. Several regions of the world are experiencing severe epidemics of multidrug-resistant TB (MDR-TB) that threaten TB control and translate into low cure rates under DOTS programs. New estimates suggest that there are about half a million MDR-TB cases each year, including new and previously treated cases. In countries with historically good control programs, resistance to isoniazid, the major drug, is 10-15 percent, but in parts of Central Asia and Eastern Europe, resistance to isoniazid is virtually 100 percent. A particularly dangerous form of tuberculosis is so-called XDR-TB, resistant to second-line drugs.
The Heiser Program for Research in Leprosy and Tuberculosis regards itself as supportive and complementary to major tuberculosis research programs, such as those of the National Institute of Allergy and Infectious Diseases, National Institutes of Health (http://www.niaid.nih.gov/dmid/tuberculosis/) and the Stop TB Partnership (see The Global Plan to Stop TB 2006-2015, Actions for Life, Towards a World Free of Tuberculosis, World Health Organization, 2006). It will continue to commit funds in the form of post-doctoral fellowships for research on tuberculosis, particularly in the areas of the molecular basis of disease pathogenesis, diagnostics, vaccine, and new drug development.
THE AWARDS
In accordance with Dr. Heiser’s stipulation at the time that he set up his fund in The New York Community Trust, the income is used, not for treatment of patients, but for basic laboratory research directed at a better understanding of the diseases and their bacterial agents. The ultimate aim is to find measures for the prevention and cure of these diseases that will serve to bring them under control.
Two types of awards have been established to foster these objectives:
(1) research grants that will support the training efforts of laboratories involved in research on leprosy, or that will provide funds for the initiation of new leprosy research projects in the field;
(2) postdoctoral fellowships, designed to attract qualified and highly motivated young biomedical scientists to train in the relevant fields of research in leprosy and/or tuberculosis.
Details regarding these awards are set forth below:
(1) RESEARCH GRANTS IN LEPROSY
PURPOSE
To provide support to basic scientists to allow them to contribute to the global goal of leprosy elimination, in particular, the application of new and available tools toward diagnosis, transmission and the extent of drug resistance, but also: (1) investigation of mechanisms of nerve damage and reactions and the means to predict and to prevent leprosy; (2) development of more effective chemoprophylaxis, immunoprophylaxis, and more rapid bactericidal drugs; and (3) basic understanding of the organism, its origins, its pathogenicity and immunological spectrum. Other areas of importance are: use of the genome of M. leprae to develop new drug targets and identify immunologically important molecules.
TYPES OF RESEARCH GRANTS AVAILABLE
a) Small research grants of up to $50,000. These are generally limited in duration to one year, but may be renewed based on evidence of satisfactory progress after the first year.
b) In exceptional circumstances, the Scientific Advisory Committee will consider larger awards for multi-year/multi-component/multi-institute projects involving leprosy research in endemic sites.
Deadline for research grant applications: All types: March 2, 2009
a) Submit full proposal; requirements listed below.
b) Submit a letter of intent. The letters will be reviewed by the Advisory Committee and, if appropriate, proposals will be invited and these will be evaluated by Committee members by the end of September, 2009.
ELIGIBILITY
Applications for leprosy research grants should come from laboratories that have experience in leprosy research and have demonstrable ongoing, productive interactions with corresponding laboratories in endemic regions and/or leprosy field sites/workers.
REQUIREMENTS
Applications for a Research Grant must include:
1. The Research Grant Face Sheet and the Grant Payment form. (see downloads below)
2. A detailed description of the proposed project, not to exceed five single-spaced, typewritten pages (15 pages in the case of larger, multi-component applications), exclusive of bibliography, tables, and figures. Follow the NIH guidelines for margins, font and size of type (11 point type or larger; ½” margins, etc.).
3. A proposed budget must accompany the application.
4. Curriculum vitae and relevant bibliographies of scientists participating in the project(s).
5. Statement of current grant support available to the laboratory/laboratories.
DIRECTIONS
Download the Research Grant Face Sheet, fill it out as well as the Grant Payment form, and e-mail to lm@nyct-cfi.org. All remaining parts of the application package should be contained in one pdf file and submitted electronically to Len McNally at lm@nyct-cfi.org Your last name and the word “Heiser” should appear on the subject line of your e-mail. (e.g., Jones – Heiser)
Notes:
All applications will be acknowledged. Awards will be announced by June 5, 2009 and successful applicants must activate the grant between July 1 and December 31, 2009. No more than 10 percent of the award will be used for the salaries of senior personnel. As a charitable endeavor, the Heiser Program cannot pay institutional overhead costs. Grants will be paid through the institution’s fiscal office. A final report is required at the end of the grant year. If you wish to apply for a second year (also in the amount of $50,000), a preliminary report should be submitted by March 5, 2010
(2) POSTDOCTORAL FELLOWSHIPS IN LEPROSY AND/OR TUBERCULOSIS
PURPOSE
To support biomedical scientists in early postdoctoral training for research in leprosy and/or tuberculosis.
Deadline for fellowship applications: March 2, 2009.
ELIGIBILITY
Applicants should have an M.D., Ph.D., or equivalent degree. Although there is no age limit, candidates should be at an early stage of postdoctoral research training. Generally, postdoctoral training should be planned in an institution other than that in which the applicant obtained his or her doctorate or is currently employed. No more than one application will be considered from any one mentor.
REQUIREMENTS
All applications must include:
1. The Application for Fellowship Face Sheet and the Grant Payment form. (see downloads below)
2. The research proposal, which should be a detailed description of the proposed research, not to exceed five single-spaced, typewritten pages. Follow the NIH guidelines for margins, font, and size of type (11 point type or larger; ½” margins, etc.). Literature may be cited separately, and figures and tables may also be added. This application should be prepared by the applicant but if the Principal Investigator or others contribute to the preparation of the application, the extent of involvement should be explained in the application or in the support letter from the Principal Investigator or others.
3. Specific plans for the application of knowledge and experience gained through fellowship training and expected future in the field of research in leprosy and/or tuberculosis.
4. Curriculum vitae.
5. Letter from proposed supervisor, indicating acceptance in the laboratory if the fellowship is awarded, and degree of contribution in selecting and/or writing the proposal. (No more than one application will be considered from any one mentor.)
6. List of sponsor’s publications during the last five years.
7. Letters of support from three former teachers or supervisors to be forwarded directly to: The Heiser Program, c/o The New York Community Trust, 909 Third Avenue, New York, NY 10022, U.S.A.
DIRECTIONS
Download the Application for Fellowship Face Sheet, fill it out as well as the Grant Payment form, and e-mail to lm@nyct-cfi.org. All remaining parts of the application package should be contained in one pdf file and submitted electronically to Len McNally at lm@nyct-cfi.org Your last name and the word “Heiser” should appear on the subject line of your e-mail. (e.g., Jones – Heiser). The letters of support should arrive separately.
Notes:
All applications will be acknowledged. Awards will be announced by June 5, 2009 and successful applicants must activate the grant between July 1 and December 31, 2009. These awards are generally for two years, $40,000 each year. The second year will not be paid, however, until the scientific advisory committee has received a satisfactory interim report at the end of the first year. Successful applicants for these fellowships will be paid through the host institution.
ADDRESS INQUIRIES TO:
Len McNally, Director
The Heiser Program for Research in Leprosy and Tuberculosis
The New York Community Trust
909 Third Avenue
New York, New York 10022 U.S.A.
Tel: (212) 686-0010, ext. 556; FAX: (212) 532-8528
lm@nyct-cfi.org
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