The Guardian,
Sarah Boseley, health editor, Monday 30 January 2012
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| A Guinea worm is extracted by a health worker from a child's foot in Savelugu, Ghana. The new initiative is likely to see the disease given the $60m the Carter Foundation says it needs to eradicate it completely. Photograph: Olivier Asselin/AP |
The heads
of 13 of the world's biggest drug companies, brought together by Bill Gates,
one of the world's richest men, have agreed to donate more medicines and,
unprecedentedly, to work together to find new ones in a bid to end many
neglected tropical diseases (NTDs) that kill and maim some of the poorest
people on the planet.
The 10
diseases targeted affect 1.4 billion people. They include lymphatic filariasis,
river blindness, schistosomiasis and Chagas disease. Often the treatments that
exist are ineffective and sometimes they even kill the patient.
The Bill
and Melinda Gates Foundation is putting in $363m (£231m) over five years to
help with the control and elimination of these diseases, while the Department
for International Development has announced £195m until 2015. USAid and the
World Bank are also committing money and help.
"Today,
we have joined together to increase the impact of our investments and build on
the tremendous progress made to date," said Gates. "This innovative
approach must serve as a model for solving other global development challenges
and will help millions of people build self sufficiency and overcome the need
for aid."
The most
likely disease to be eliminated is Guinea worm, which has been the target of
the Carter Foundation for decades. Last year, the former US president Jimmy
Carter said they needed just $60m more to finish the job in the single
remaining endemic country – South Sudan. That money will now be available.
The biggest
contribution of the pharmaceutical companies, including Britain's
GlaxoSmithKline, the US giants Pfizer and Abbott and many others, is in drug
donations. Those that already had donation programmes are extending them to
2020. Millions of tablets will now be distributed.
Unusually,
some of the companies have agreed to co-operate to try to develop badly needed
new drugs. Abbott, Johnson & Johnson and Pfizer are working together, under
the direction of the public/private partnership DNDi (Drugs for Neglected
Diseases Initiative), on new drugs for worm infections, particularly those
causing river blindness and lymphatic filariasis.
All 11
companies have agreed to open up their compound libraries – details of
potential drug treatments that have gone through some tests but not found a
commercial use – to DNDi, which hopes better drugs for neglected tropical
diseases may be discovered.
The
initiative is a response to a World Health Organisation blueprint – a plan to
tackle these diseases that impede development by preventing the poorest
children from accessing education as well as limiting adults' ability to work.
WHO's director general, Margaret Chan, set an ambitious timetable during the
launch at the Royal College of Physicians in London.
"These
ancient diseases are now being brought to their knees with stunning
speed," she said. "With the boost to this momentum being made today,
I am confident almost all of these diseases can be eliminated or controlled by
the end of this decade." Some experts were less optimistic, however, and
critical of the drug donation focus.
Medécins
sans Frontières (MSF), the volunteer doctors' group that helped found DNDi,
said while it was delighted neglected diseases were now getting the attention
they deserved, it wanted to highlight what was missing. Chagas disease,
sleeping sickness, and visceral leishmaniasis were slated for elimination by
2020, but the WHO and others were underplaying the difficulties, it said.
MSF cited
sleeping sickness, caused by the bite of the tsetse fly, as an example. New
diagnostic tools – to catch the disease before it becomes very hard to treat —
as well as new drugs that could be used by healthcare workers with only basic
training in remote areas of Chad, the Central African Republic and South Sudan.
Drugs were
not the only topic on the agenda. "In the Democratic Republic of Congo
(DRC), where about three-quarters of reported cases of sleeping sickness have
been detected, there is a strong national control programme. However the
funding for this programme, provided by the Belgian government since 1997, will
be withdrawn by next year. Nothing offered at the London NTD meeting on 30
January 2012 will address this looming crisis," MSF said. In the Central
African Republic, the national programme consisted of four people for the
entire country.
In a letter
to the Lancet, Dr Tim Allen from the London School of Economics and Dr Melissa
Parker from Brunel University also said that simply providing more drugs was
not enough. They said there were problems with mass drug handouts designed to
prevent disease such as schistosomiasis, lymphatic filariasis, and
soil-transmitted helminth infections.
"These
include the undermining of already fragile and overstretched healthcare systems
with the introduction of large, internationally-funded, vertical programmes
rolling out free drugs to adults and children, irrespective of their infective
status; difficulties with relying on volunteers to assist with the distribution
of drugs in targeted communities; limits in knowledge surrounding the safety
and efficacy of combining drugs for some NTDs; and a growing tendency for those
promoting mass drug administration programmes to overlook the fact that the
evidence base for how effective they are is more limited than often
suggested."
Their own
work in some communities had found that take-up of free drugs in some villages
was much higher than others, because of political, economic and social
circumstances. In some places, people refused out of the belief that the drugs
were intended to harm them. "We are concerned by the way in which
competition for multimillion-dollar grants is closing off debate and restricting
critical analysis of what is actually occurring on the ground," they
wrote.
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