The Threshold

In our season finale of The Threshold, we delve into what it will take to end neglected tropical diseases (NTDs), which impact about 1.5 billion people. The World Health Organization considers 21 diseases to be NTDs, a classification that marks a disease as underfunded and prioritized relative to its burden. What is encouraging is that a growing number of neglected tropical diseases are closer than ever to being eliminated. Our episode begins with the personal story of Rehema, whose account was produced by Sharon Kiburi. Rehema’s path towards a diagnosis demonstrates much of what is challenging with neglected tropical diseases. NTDs are sometimes called “last mile” diseases because ending them is largely a matter of access: getting the right treatments and services to the most rural, disadvantaged populations on Earth. Then, host Henry Bonsu speaks with Dr. Ngozi Erondu, the technical director of GLIDE, the Global Institute for Disease Elimination. She describes which diseases she thinks are most likely to be eliminated in the near future. Finally, we interview Dr. Rebecca “Tshidi” Moeti, the recently retired former WHO regional director of Africa. She is a major champion of ending NTDs, including launching the Expanded Special Project for Elimination of Neglected Tropical Diseases. In this conversation, she also reflects about her decades-long career and what she hopes for the future of global health. Thank you for listening to our first season! We would love to hear your thoughts as well as suggestions for new episodes. Feel free to email us at podcasts@foreignpolicy.com. The Threshold is made possible in part through funding from the Gates Foundation. Special thanks this episode to Naima Omondi, a family planning practitioner who got us in contact with Rehema. Guests and organizations: Dr. Rebecca “Tshidi” Moeti, former WHO regional director of Africa Dr. Ngozi Erondu, the technical director of GLIDE, the Global Institute for Disease Elimination

Malaria kills nearly six hundred thousand people every year, with 95 percent of deaths occurring in Africa. Most of them are children under five. While progress on curbing malaria has flattened in recent years, new scientific breakthroughs may bring the world closer than ever not only to controlling malaria outbreaks, but potentially also eradicating the disease. In this episode, we focus on the best mosquito control strategies to eliminate malaria. Host Henry Bonsu interviews Dr. Fredros Okumu, professor at the University of Glasgow in Scotland and a scientist at Ifakara Health Institute in Tanzania. His research evaluates many of the latest tools to combat malaria, including next generation insecticide bed nets, indoor residual sprays (IRS), and spatial repellants, also known as spatial emanators. Then, reporter Paul Adepoju talks to scientists from the UK- and Tanzania-based Transmission Zero project. They have developed genetically modified mosquitoes that could dramatically reduce the transmission of malaria. Paul Adepoju speaks with Dr. Dickson Wilson Lwetoijera, a leading entomologist also at the Ifakara Health Institute in Tanzania, as well as Dr. Nikolai Windbichler from Imperial College London, who leads the molecular genetics side of the Transmission Zero project. The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Fredros Okumu, professor at the University of Glasgow in Scotland and a scientist at Ifakara Health Institute in Tanzania Dr. Dickson Wilson Lwetoijera, entomologist at the Ifakara Health Institute in Tanzania Dr. Nikolai Windbichler, associate professor at Imperial College London

What could end HIV and AIDS as a public health threat? While there is still no vaccine or cure, long-acting tools like Lenacapavir, the recently approved twice-yearly HIV prevention shot, could significantly reduce new infections. Many health experts believe this may get us toward the end of HIV as an epidemic. On today’s show, reporter Leah Kahunde Ndung’u examines what the Lenacapavir rollout will mean for Uganda, which was one of two Lenacapavir trial countries in Africa. She speaks with the Uganda trial’s principal investigator Dr. Flavia Matovu Kiweewa and HEPS Uganda Executive Director Kenneth Mwehonge, among others. Then, host Henry Bonsu interviews Dr. Wafaa El-Sadr, founder and director of ICAP at Columbia University, Executive Vice President overseeing Columbia Global, and MacArthur genius fellow. Prof. El-Sadr has overseen HIV treatment programs in more than 40 countries. She shares her innovative approach to service delivery. The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Wafaa El-Sadr, Founder and Director of ⁠ICAP⁠ at Columbia University, Executive Vice President of Columbia Global Kenneth Mwehonge, Executive Director of ⁠⁠HEPS Uganda⁠⁠ Dr. Flavia Matovu Kiweewa, Director of Research for the Makerere University and Johns Hopkins Research Collaboration (MU-JHU)

Welcome to the first episode of The Threshold, a Foreign Policy podcast about the fight to end infectious diseases around the world and the innovations that could get us there. Host Henry Bonsu speaks with Gates CEO Mark Suzman and WACI Health Executive Director Rosemary Mburu about why they’re both optimistic and concerned about the future of disease elimination. And there is a big deadline on their minds that directly impacts the state of global health—which is in a tough place. More than two million people die every year from the world’s biggest infectious diseases: HIV/AIDS, malaria, and tuberculosis. TB alone claimed more than 1.25 million lives in 2023, overtaking COVID as the world’s deadliest infectious disease. On the surface, the fight to end these epidemics is harder now than it’s ever been. Aid for global health dropped more than 20 percent this year, driven in large part by cuts to USAID and British government programs. But for the first time in decades, science is much closer to ending these diseases. Recent advances—including an HIV prevention shot, TB vaccine candidates, and innovative tools to end malaria—could significantly reduce their prevalence. Over the next seven episodes, we’ll explore how new scientific breakthroughs are making a huge difference in the fight against epidemics like HIV/AIDS, tuberculosis, and malaria. But also, we’ll tackle how we can approach global health funding at this geopolitically fraught moment. At a live panel discussion recorded at Foreign Policy’s Health Forum, Suzman and Mburu explain why they believe we could eliminate HIV, TB, and malaria within our lifetimes. Plus, they discuss why they think the Global Fund’s replenishment round in November is critical. The Threshold is made possible in part through funding from the Gates Foundation. (Photo credit: Jonathan Heisler) Guests and organizations: Gates CEO Mark Suzman WACI Health Executive Director Rosemary Mburu