GHF2010 – PS13 – Neglecting Neglected Diseases: More of the Same?

Session Outline

Parallel session PS13, Tuesday, April 20 20120, 14:00-15:30, Room 3
Chair(s): Ole Olesen, Scientific Officer for Neglected Infectious Diseases, Directorate for Health Research, European Commission, Belgium
Implications of Global Health Strategies on Neglected Tropical Diseases: Perspective from the Field
Abiy Tamrat, Medical Director, Médecins sans frontières, Switzerland
Obstacles to the Reintegration of Sleeping Sickness Control Activities in Primary Health Care Facilities, DRC
François Chappuis, Associate Professor, Division of International and Humanitarian Medicine, University Hospitals of Geneva & Medical Advisor, Médecins sans frontières, Switzerland
Leishmaniasis Control in Kenya: Current Challenges and Future Strategies
Joseph Njau Gatuna, Ministry of Health, Kenya
DNDi R&D Model: Innovation through Collaboration Instead of Competition 
Shing Chang, Research and Development Director, DNDi, Switzerland

Session Documents

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Session Report

Submitted by: Maushami Kabra (ICVolunteers); Contributors: Anne Descours (ICVolunteers), Christoph Wirth (ICVolunteers)

Photo by John Brownlee, ICVolunteers.org

The huge range of tropical diseases, which come under the umbrella of 'Neglected Diseases', are often masked by malaria, TB and HIV/AIDS in developing countries. Human African trypanosomiasis (HAT/sleeping sickness), Viseral Leishmaniasis (VL), primary health care (PHC) in regions of sub-Saharan Africa, particularly Democratic Republic of Congo (DRC) and Kenya, were some of the main issues discussed in this session.

Abiy Tamrat, Medical Director from Médecins sans Frontières (MSF), Switzerland, began the session with his insights on Implications of Global Health Strategies on Neglected Tropical Diseases: Perspectives from the Field.

Neglected Tropical Diseases (NTD) affect more than 1 billion people and are responsible for more than 500,000 deaths per year. Mr. Tamrat shed light on the necessity to introduce a new classification of NTDs to better tackle these very different diseases. Depending on the organisation classifying them, the number of NTDs varies drastically from 3 to 45. Instead of the usual classification that separates simple (widespread, mass treatment, low cost) from complex diseases (endemic, needing individual medical care, high cost), he proposes to range NTDs among three overlapping classes of diseases, namely those with:

  • Existing effective treatments and control strategy.
  • Social or economic implications such as stigmatisation;
  • Complex management or tool deficiency.

This grouping would help in developing adapted health care strategies and orientating funding mechanisms. No competition between the various diseases should occur and an integration of funding mechanisms at all stages should be put in place. This would foster a better optimisation of resources, a more holistic approach to patients and a better lead optimisation. The speaker concluded that one should absolutely avoid continued neglect of NTDs.

François Chappuis, Associate Professor, Division of International and Humanitarian Medicine, University Hospitals Geneva and Medical Advisor for Médecins sans Frontières, stood in for Ole Olesen, Scientific Officer for Neglected Infectious Diseases at the Directorate for Health Research at the European Commission. Prof. Chappuis show photographic images of screening processes which have not changed in 84 years.

Sleeping sickness in Africa, also known as Human African Trypanosomiasis (HAT), is transmitted by the tsetse fly. The disease presents two phases: before and after Central Nervous System infection. Whereas the first stage can be easily treated by pentamidine, the second one needs treatment by infusion, which is not well suited to field conditions. Like most NTDs, HAT occurs in poor areas in low-income countries (Central Africa in this case). There is limited global impact of this disease and thus there has been a lack of diagnosis and treatments. Thanks to WHO-Sanofi Aventis agreements and better controls, the disease has stepped back in the last decade. However, a lack of sophisticated diagnostic and treatment tools and the weakness of Primary Health Care structures are still big hurdles to a long-lasting decrease in the number of cases. Furthermore, there is a lack of adequate numbers of properly trained health care workers and irregular drug supplies to contend with. There are considerable difficulties simply in reaching remote populations and the region suffers from political instability. There is an urgent need for more simple tools (diagnostics and treatments) and a vertical approach for HAT control cannot be avoided.

François Chappuis also presented on behalf of Joseph Njau Gatuna, Ministry of Health, Kenya, on Leishmaniasis Control in Kenya: Current Challenges and Future Strategies.

Leishmaniasis (also known as kala-azar) is a chronic vector borne disease and exists in two forms as visceral leishmaniasis and cutaneous leishmaniasis. Kenya alone reports 600 cases annually of patients suffering with the disease. VL is prevalent in arid areas characterised by ant hills and deep crevices in the ground. Rainfall is the only remedy. The main challenges facing this NTD include limited knowledge of the disease among health workers and a lack of diagnostic facilities. A revision of the 2001 guideline for control of VL is due to be published, but has been delayed due to lack of resources. Supplies of the effective treatment, Pentostam, SSG/Sodium Stibogluconate (from Albert Davis, India), are available in Kenya. Research questions to be addressed include vector identification, drug assessments and diagnostics tests. Funding problems arise due to a limited overall budget, a lack of a specific budget to control the disease and a lack of stakeholders providing funds. Key players, such as KEMRI, MSF, Merlin, UNICEF and WHO, have been collaborative however. The speaker presented a strategy for the elimination of leishmaniasis which a participant in the meeting contended was far from realistic.

Shing Chang, Research and Development Director from DNDi, Switzerland, presented DNDi R&D Model: Innovation through Collaboration Instead of Competition, and discussed his organisation’s promising R&D product portfolio.

DNDi was established in 2003 with a mission to collaborate with partners in order to address the needs of patients suffering from neglected diseases. Their objective is to deliver 6-8 new treatments for neglected tropical diseases (NTD) by 2014 and build an overall robust pipeline. Successful pharmaceutical drug development comes at a high cost and usually patent busting approaches and competitive innovation are the routes pharmaceutical companies take to generate revenue. DNDi’s model is to innovate for the patient’s benefit and develop cost effective drugs through successful partnerships with public sector, humanitarian and international organisations. A vital part of DNDi’s success comes from its collaborative approach at an early stage conducting compound mining and biological screening with pharmaceutical and research institutions. Clinical trials, registration and good manufacturing practices are developed in association with partners such as Médecins sans Frontières and Sanofi Aventis. In conclusion, despite limited spending, DNDi has been able to add two anti-malaria drugs and one anti-HAT drug to its portfolio, and has promising new Chagas and HAT fixed-dosed combination products under development.

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