Drug companies join forces to combat deadliest tropical diseases

Bill Gates gets pharmaceutical giants to promise drug giveaways and unprecedented pledge to share research on new antidotes

The Guardian, Sarah Boseley, health editor, Monday 30 January 2012

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.