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HEALTH-AFRICA: Neglected Diseases Under the Microscope

Joyce Mulama

NAIROBI, Jul 6 2009 (IPS) - Neglected diseases, neglected people. Marcel Tanner uses the phrase to emphasise the attitude of drug developers towards tropical diseases that primarily affect the marginalised poor.

Of the 1,556 new drugs developed between 1975 to 2004, only 1.3 percent were for Neglected Tropical Diseases (NTDs), despite these ailments accounting for 12 percent of the global disease burden, according to the Drugs for Neglected Diseases Initiative (DNDi), a non-governmental agency committed to researching and developing new and improved treatment for NTDs.

No profit healing the poor

The diseases in question account for the deaths of 500,000 people annually, mostly in sub-Saharan Africa, but drug development is biased towards the prospect of high profits, which diseases of the poor like sleeping sickness and visceral leishmaniaisis are unable to offer.

“The pharmaceutical industry does not see neglected diseases as a market, because these diseases affect poor people with few resources. Therefore they are not a big market,” said Tanner, chairman of the DNDi board of directors. He spoke to IPS on the sidelines of a Jun. 23-24 meeting in Nairobi, convened by his organisation to discuss innovative solutions of tackling the diseases.

Better treatments are desperately needed by millions of people vulnerable to these diseases, mostly living in Africa, Asia and Latin America. Existing therapies are often toxic, prohibitively costly and difficult to administer.

Such is the case for sleeping sickness, a fatal disease that claims an estimated 48,000 people a year in sub-Saharan Africa. The first new treatment for the disease in 25 years was included on the World Health Organisation’s list of essential medicines this year. DNDi and its partners developed the nifurtimox-eflornithine combination therapy (NECT), which is well tolerated and effective against sleeping sickness. This disease causes 48,000 deaths in the region annually.

Previous treatments for sleeping sickness included melarsoprol, which is painful and toxic, killing five percent of those who receive it. The drug is also ineffective, with up to 50 percent resistance and failure rate.

The same is true for eflornithine, which is difficult to administer and has to be given by skilled personnel. It requires constant hospitalisation with 56 round-the-clock injections over 14 days, unlike the new NECT where the number of injections has been reduced from 56 to 14. NECT is also less burdensome for the healthcare personnel to administer.

New drugs needed

Health personnel are overwhelmed by the problems posed by current treatment for NTDs. Take the case of visceral leishmaniasis, a parasitic disease that affects the internal organs of the body, mainly spleen, liver and bone marrow. This illness causes about 51,000 deaths across the world every year, with 12 million people currently infected worldwide, mostly in remote settings particularly in Africa and parts of Asia.

“I have been treating patients for the last 27 years for visceral leishmaniasis using just one drug, sodium stibogluconate. This drug is toxic; it can affect the lungs, kidneys and even the heart. It is also fatal if not administered correctly,” Asrat Hailu, professor of immunoparasitology at the University of Addis Ababa in Ethiopia said in an interview with IPS.

The drug has to be administered for a minimum of 30 days in a hospital setting.

“You can imagine what it means in terms of cost. Again, the process has to be done by a highly skilled medical personnel, and you know how health facilities particularly in the villages are ill-equipped,” added Hailu, who is also an official of the Leishmaniasis East Africa Platform. The network serves seven countries including Kenya, Uganda, Sudan, Ethiopia, Eritrea, Somalia and Djibouti, and attends to about 30,000 cases every year, half of these coming from Sudan.

Hailu was one of the 250 researchers and scientists from 24 countries worldwide who were present at the Nairobi event to review limitations of available treatments for NTDs like in the case of leishmaniasis. They underscored the need for research into shorter, cheaper courses of treatment. Currently, the cost of leishmaniasis treatment is about 260 dollars.

Prevention is better than cure

Cost constraints have prompted Sudan to explore other measures to address the disease. “We try to advise people on the use of treated bed-nets, and we are distributing them free. We are also spraying to reduce the vector,” said Mustafa Elsayed, the health minister for Al-Gadarif State in east central Sudan, where 80 percent of Sudan’s cases of kala-azar occur.

Shing Chang, DNDi’s research and development director, told the meeting that the organisation expects to deliver five new leishmaniasis treatments by 2014. The therapies are expected to be cheaper, offer shorter courses of treatment and better tolerability, as well as reduce the load on health systems.

Others argue that improving sanitation is key to addressing NTDs. James Kakooza, Uganda’s State Minister for Health said creating public awareness on sanitation would go along way towards preventing such diseases.

“Most of these diseases are because of lack of sanitation in homes. Simple messages on the importance of observing cleanliness must be disseminated even to the hard-to-reach areas, the remotest of parts in our countries,” he observed.

Such a programme is already under way in Uganda, where community health workers equipped with bicycles and motorcycles go to the villages to talk about sanitation. This, Kakooza said, followed a 1997 outbreak of kala-azar in Nakapiripirit district in the northern part of the country.

However, it emerged that research and development of new drugs was the most effective way of addressing neglected diseases, with simultaneous calls on developed countries to meet their part of bargain. “We do not live in the first, second and third world, we only live in one world. Developed nations need to join hands with developing countries to tackle problems of neglected diseases,” stated Tanner.

One celebrated initiative involves Swiss pharmaceutical company Novartis and the World Health Organisation. In 2001, Novartis agreed to supply Coartem, a highly effective anti-malarial drug, to WHO on a not-for-profit basis. This has allowed for distribution of millions of doses of the drug in malaria-endemic countries at $2.40 per treatment – just 90 cents for a special sweet-tasting version for children.