10 Neglected Tropical Diseases - Target For End Of Decade

The aim is to eliminate or at least control 10 neglected tropical diseases by 2020 - it is a public and private partnership, including 13 drug companies, the UK, US and United Arab Emirate Governments, the World Bank, The Bill & Melinda Gates Foundation, and some other worldwide organizations.

The partners aim to work together to eliminate neglected tropical diseases (NTDs) in countries where they are endemic. They have pledged to liaise closely with affected countries. According to WHO (World Health Organization), 1.4 billion people are affected by the ten NTDs; the majority of them live in the poorest countries in the world.

In an official announcement made today at the Royal College of Physicians, London, the partners said they would combat NTDs by:

• Expanding or at least sustaining drug donation programs so that demand is met right through to the end of 2020.
• Share knowhow and new active ingredients to speed up R&D of new medications.
• The allocation of over $785 million to improve R&D efforts and support drug distribution and implementation programs.
• The endorsement of the "London Declaration on Neglected Tropical Diseases". The Declaration promises a new level of commitment and collaboration in the tracking of progress.

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, said:

"Today, we have joined together to increase the impact of our investments and build on the tremendous progress made to date. 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 Gates Foundation says it is donating $363 million over the next five years towards NTD product and operational research.

WHO has published its guide on how best to combat NTDs in a new report, called "Accelerating work to overcome the global impact of neglected tropical diseases - A roadmap for implementation" (PDF). The document lays out what target are achievable by 2020.

Dr. Margaret Chan, Director-General of the WHO:

"The efforts of WHO, researchers, partners, and the contributions of industry have changed the face of NTDs. These ancient diseases are now being brought to their knees with stunning speed. 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."

The partners have pledged more funds to close the shortfall gap in the drive to eradicate the following NTDs by 2020:

• Blinding trachoma
• Chagas disease
• Guinea worm disease
• Leprosy
• Lymphatic filariasis
• River blindness
• Schistosomiasis
• Sleeping sickness
• Soil-transmitted helminthes
• Visceral leishmaniasis

River blindness (onchocerciasis) is endemic in some parts of the world. In this picture, children are leading blind adults


Sir Andrew Witty, CEO of GlaxoSmithKline, said on behalf of the partners from the pharmaceutical industry:

"Many companies and organizations have worked for decades to fight these horrific diseases. But no one company or organization can do it alone. Today, we pledge to work hand-in-hand to revolutionize the way we fight these diseases now and in the future."

The IFPMA (International Federation of Pharmaceutical Manufacturers & Associations) has pledged approximately $1.4 billion treatments annually for those in need.

11 pharmaceutical companies and some DNDi (Drugs for Neglected Diseases initiative) collaborators are making their data available to libraries. They are also working together with database companies and libraries to develop WIPO Re:Search, a database of compounds, expertise and knowledge.

The Gates Foundation, The Children's Investment Fund Foundation, and The Carter Center and His Highness Sheikh Khalifa bin Zayed Al Nahyan, President of the United Arab Emirates, have said they are donating $40 million to The Carter Center. The UK Government's Department for International Development (DFID) has pledged £20 million (approx. $30 million) as long as others also donate, as part of a £195 target towards NTDs.

With the extra $89 million announced by USAID, the organization will have given $212 towards the elimination of DNDs.

The World Bank has announced an extension of its financial and technical support for African countries so that they can improve and strengthen their health systems and more effectively eliminate NTDs, or control them. The Bank also says it is, along with other partners, expanding a trust fund to address the problem of river blindness, as well as other NTDs which are endemic in Africa.

Stephen O'Brien, U.K. Minister for International Development, said:

"The world has come together to end the neglect of these horrific diseases which needlessly disable, blind and kill millions of the world's poorest. Britain and other partners are leading the way to provide critical treatments to millions of people, which allow children to attend school and parents to provide for their families so that they can help themselves out of poverty and eventually no longer rely on aid."

The declaration and pledges made today are in response to Working to overcome the global impact of neglected tropical diseases, a WHO 2010 report.

Some national governments where NTDs are widespread, such as Tanzania, Mozambique, Brazil and Bangladesh, said they will implement comprehensive plans to eradicate NTDs - they have pledged government-level commitment towards this ultimate goal.

Dr. Alexandre Manguele, Health Minister, Mozambique, said:

"From the moment the evidence of the very heavy burden of NTDs in Mozambique was understood, the government of Mozambique has taken action and continuously increased its commitment and investment to control or eliminate these diseases. With the resources pledged today in the context of this partnership the government of Mozambique feels ever more assured that the mission can be accomplished."

Examples of partner commitments pledged include:

• NTD drug program donors said they will continue to extend, or at least sustain the programs until 2020.
• Global Lymphatic Filariasis Elimination program - the Bill & Melinda Gates Foundation, Eisai, and Sanofi pledge to donate 120 million DEC tablets. This means supplies should be enough to last until the end of the decade.
• Chagas disease - Bayer says its donation of nifurtimox will double.
• DEC tablets for lymphatic filariasis - Eisai says its donation will extend to 2.2 billion tablets.
• Visceral leishmaniasis - Gilead's AmBisome donation for last year will continue (at cost). The company also pledges to continue investing in R&D and new technologies to help combat visceral leishmaniasis, as well as helping affected, resource-limited nations cope.
• Soil-transmitted helminthes - GSK (GlaxoSmithKline) says its albendazole donation will be extended to 400 million tablets annually for an extra five years (through 2020).
• Lymphatic filariasis - GSK's 600 million tablets per year will continue to the end of the decade.
• Soil-transmitted helminthes - J&J (Johnson & Johnson) says it will extend its 200 million per year mebendazole donations through to the end of this decade.
• River blindness and lymphatic filariasis - MSD says its ivermectin donations will continue through to 2020. The company is also looking into using ivermectin to combat other illnesses and conditions.
• Schistosomiasis (snail fever) - Merck KGaA says its 25 million current donation of praziquantel tablets will increase to 250 million annually. The company adds that this will continue indefinitely.
• Leprosy - Novartis says its commitment to provide rifampicin, clofazimine and dapsone will be extended.
• Blinding trachoma - Pfizer says it will continue donating azithromycin until 2020. The company will also donate the medication and placebo for childhood mortality studies.
• Sleeping sickness - Sanofi says it is extending its donations of eflornithine, melarsoprol and pentamidine. The company says it is also helping local in the logistical support so that patients get their medications free of charge.

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Fake Antimalarial Medications Undermine Africa Malaria Drive

Fraudulent and substandard antimalarial drugs could be wrecking the chances of winning the war against malaria in Africa, researchers from the Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration reported in the Malaria Journal. The authors add that millions of lives could be lost over the next twelve months unless urgent action is taken both within the African continent and elsewhere in the world.

Fake medications are coming onto the scene as a result of deliberate criminal activity, while substandard drugs are becoming more common because of poor manufacturing practice. Not only are scores of patients being inadequately treated, but the presence of these undesirable and illegal medications significantly raises the risk of drug resistance among the malaria parasites.

Approximately 781,000 people are thought to have died from malaria in 2009, says the World Malaria Report 2010.

Artemisinin derivatives are the best antimalarials, experts say. They work faster than other medications, such as chloroquine and mefloquine, and also have fewer side-effects. These drugs can be used on their own to treat malaria, but are more commonly administered alongside other medications, mainly because of the rising problem of drug resistance. WHO (World Health Organization) recommends that for uncomplicated falciparum malaria, combination therapies be used.

The researchers set out to determine how prevalent counterfeit and substandard antimalarials were in Africa. They gathered data from 11 nations in Africa between 2002 and 2010.

They found that some fake drugs contained a combination of erroneous active ingredients, many of which only treated malaria signs and symptoms, but did not cure the disease itself. These unsuitable active ingredients were also found to cause potentially serious side-effects, especially when administered in combination with other medications, such as those used to treat HIV.

Some of the fake drugs had small quantities of artemisinin derivatives - experts believe this was so that they could be passed off as authentic medications during authenticity tests. They contain such small quantities of artemisinin derivatives that there are useless in ridding the body of malaria parasites, and highly likely to promote their resistance to artemisinin. Put simply, the patient derives no benefit, and the parasite becomes more difficult to eliminate.

Scientists managed to trace some of the pollen found in the fake medicines to eastern Asia. In 2001, authorities in Guangshou, China, arrested Chinese and Nigerian men who were accused of producing fake halofantrine, an antimalarial. Investigators say that there is no pollen evidence of fake drug production occurring in Africa. Packaging materials for counterfeit antimalarial medications have been confiscated in Nigeria.

Research leader, Dr Paul Newton, said:

"Public health organizations must take urgent, coordinated action to prevent the circulation of counterfeit and substandard medicines and improve the quality of the medicines that patients receive. We must move finally away from the use of single drugs and towards the exclusive use of combination therapies.

The enormous investment in the development, evaluation and deployment of antimalarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure. Malaria can be readily treated with the right drugs of good quality, but poor-quality medicines - as well as increasing mortality and morbidity - risk exacerbating the economic and social impact of malaria on societies that are already poor.

Worse still, they encourage drug resistance, potentially resulting in the failure of artemisinin treatments, with profound consequences for public health in Africa. Failure to take action will put at risk the lives of millions of people, particularly children and pregnant women."

Dr. Newton says regulatory authorities in Africa need increased investment, so that quality control can be more closely monitored. For the fight against malaria to be effective, people need access to top-quality and affordable artemisinin combination therapies.

Dr Jimmy Whitworth, Head of International Activities at the Wellcome Trust, commented:

"This research is very worrying and should act as an early warning. We have already begun to see the emergence of drug-resistant malaria parasites in South-east Asia; substandard and counterfeit antimalarials and the availability of artemisinin monotherapies threaten to lead to the spread of drug resistance in Africa. If this happens, the effect could be devastating on efforts to control malaria in Africa."

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