Breakthroughs Blog: NTDs

  “A small, modest investment from the US government could truly transform the lives of people around the world and make a serious public health impact,” Rachel Cohen from the Drugs for Neglected Diseases initiative said yesterday at a congressional briefing focused on neglected tropical diseases (NTDs). NTDs are a group of 17 diseases that infect more than one billion people around the world, most of whom live on less than $1.25 per day. The briefing focused on how the US government has played a significant role in combatting NTDs globally through programs like those at the US Agency for International Development (USAID), which has helped deliver more than half a billion treatments in six years to more than 250 million people. At the same time, Cohen and other panelists stressed that significant changes are needed to make US NTD programs even more successful. For instance, several speakers argued that while USAID’s NTD program has been remarkable in its efforts to provide NTD patients with access to existing therapies, the agency must expand the program to include funding for research into new NTD drugs, vaccines, and diagnostics. The fact that USAID does not currently support NTD product development “is a serious gap in USAID’s efforts against NTDs, as most NTDs do not have adequate prevention, diagnostic, or treatment options,” moderator Kaitlin Christenson, GHTC’s coalition director, pointed out. She added that “many existing NTD drugs are toxic, expensive, and difficult to administer in resource-poor settings.” Christenson and other panelists added that congressional support is critical for USAID to expand its mandate into NTD research and product development. Panelists at a Congressional briefing on Monday discuss the US response to neglected tropical diseases. From left: Kaitlin Christenson, Brian D'Cruz, Rachel Cohen, and Larry Buxbaum. Credit: Research!America Panelists also highlighted that USAID’s program—which currently addresses only seven NTDs—should expand to include research and control efforts for all 17 diseases. Dr. Brian D’Cruz, an emergency physician who has served with Médecins Sans Frontières (MSF), discussed his experience providing treatment for sleeping sickness in the Central African Republic and Democratic Republic of the Congo to illustrate the need for expanded US support. D’Cruz told the story of Natasha, a 12-year-old girl in the Congo who died of sleeping sickness before his MSF team could provide adequate diagnosis and treatment. He added that MSF physicians are hindered in their efforts to treat patients like Natasha by cumbersome diagnostics and outdated, lengthy treatment regimens. Dr. Larry Buxbaum with the Philadelphia Research and Educational Foundation also highlighted that many NTDs, such as Chagas, are increasingly affecting populations in the United States. “Climate change is moving many tropical diseases north,” he said, adding “So while research is needed to help people with NTDs in Africa and South America, this research will be useful right here in the US as well.” D’Cruz also said that he has treated patients with Chagas disease in his capacity as a physician in Northern Virginia: “These NTDs exist just a few metro stops away.” Finally, all the panelists urged US policymakers to become increasingly involved in an ongoing global discussion about how to redefine NTD research and product development efforts. All three of these changes—investing in NTD product development, expanded support for all 17 NTDs, and engaging in global discussions about NTD research—will help ensure that the US makes the greatest impact possible against NTDs worldwide. “We need breakthrough, completely modern therapies and diagnostics for these diseases,” Cohen said, adding, “They are literally in the pipeline. US support could help us get closer and closer to elimination.”

In this guest post, Richard Hatzfeld, communications director for the Sabin Vaccine Institute, writes about a special report on neglected tropical diseases in the Financial Times, and the need for increased research, partnerships, and support to combat these diseases. Last Thursday, October 11, the Financial Times featured a special report on neglected tropical diseases (NTDs). Despite the fact that NTDs impact about one in six people around the world, many people—even some of those working in global health—have never heard of them. We’re hopeful that the efforts of organizations in our community, as well as features in publications such as the Financial Times, are helping to change this. As the report describes in a number of comprehensive articles, global partnerships to combat these diseases have made huge strides in changing the way the public views NTDs. Research investment in NTDs has increased from $268 million in 2007 to $418 million in 2011. In January, the London Declaration hosted by the Bill & Melinda Gates Foundation represented a new era of cooperation in the work to address NTDs, with leaders from 13 pharmaceutical companies, governments of the United States, United Kingdom, and United Arab Emirates, as well as the World Bank and other global health organizations offering increased support. These recent efforts are a big step in the right direction, but there is still great need in the fight to eliminate NTDs. Despite increased awareness, donations, and effort, only 0.6 percent of international development assistance for health issues is given to NTDs, according to the Financial Times report. The Financial Times special section led off with an article on the economic impact of NTDs, and pinpointed this as a reason behind the increased interest in exploring investment solutions. The Honorable John A. Kufuor (president of the Republic of Ghana, 2001-2009), NTD special envoy for the Global Network for Neglected Tropical Diseases—a program of the Sabin Vaccine Institute—highlighted this in one of the report’s articles, saying “[i]f the people are not healthy, they cannot be productive.” Drs. Peter Hotez and Maria Elena Bottazzi in the Sabin PDP lab in Houston, Texas. Photo credit: National School of Tropical Medicine at Baylor College of Medicine. Several articles in the special section reported on research and development projects that are being led by Sabin and our partners—particularly those addressing neglected diseases such as Chagas disease, dengue fever, and leishmaniasis. For most of these projects, partnership is the rule rather than the exception. Currently, the Sabin Vaccine Institute Product Development Partnership (Sabin PDP) has commenced Phase 1 clinical trials for a hookworm vaccine, and is projected to reach that point in 2013 for a schistosomiasis vaccine. And through our partnership with Eisai, Co. Ltd., Sabin has initiated pre-development and research phases for vaccines for Chagas disease and leishmaniasis. Increased research and funding has done more than raise NTD awareness—it has also led to opportunities across the global health sphere. For example, the Financial Times highlights leishmaniasis research that may have cancer treatment implications. It is important to continue such research efforts, not only for the goal of reducing the burden of NTDs on poor communities, but for the greater benefit of advancing scientific discovery that carries the potential for broad-reaching improvements in global health and development. Read the full Financial Times report here.

In this guest post, Rachel Cohen—regional executive director of the Drugs for Neglected Diseases initiative (DNDi) North America—writes about the need for research to develop new health products for neglected tropical diseases (NTDs). This post originally appeared on the US Agency for International Development’s (USAID) Impact blog . The United States government and its country partners should be commended for the tremendous achievements in the fight against neglected tropical diseases (NTDs) as part of the USAID NTD Program. When it comes to research, the US government also plays a major role in NTDs: the National Institutes of Health is by far the largest funder of basic research for NTDs. The commitment to NTD implementation programs and research has spanned several presidential administrations, receiving widespread bipartisan support from both sides of the congressional aisle. However, not all NTD research is created equal. Beyond basic research, much more research and development (R&D), including late-stage product development, for new drugs, vaccines, and diagnostics is urgently needed for those NTDs where adequate tools do not exist. Without such new tools, disease control and elimination will not be possible for certain NTDs—greater investments in research are urgently needed. For example, when it comes to the filarial parasitic-worm diseases of river blindness (onchocerciasis) and elephantiasis (lymphatic filariasis), which together infect over 150 million people, the standard treatment of ivermectin, alone or in combination with albendazole, can lead to brain damage or death in people co-infected with loiasis (Loa loa, also called African eye worm). Also, current drugs kill only juvenile and not adult worms, which continue to infect, requiring repeated mass drug administrations. The Drugs for Neglected Diseases initiative (DNDi)—a nonprofit R&D organization—is looking to develop a new macrofilaricide (a drug targeting adult worms) to address this gap in NTD treatment. Of the 17 NTDs defined by the World Health Organization, DNDi focuses most of its attention on the three with the highest case fatality rates—African sleeping sickness, Chagas disease, and kala azar (visceral leishmaniasis, or black fever). These diseases are not yet included in the USAID NTD Program. Although cases of African sleeping sickness (human African trypanosomiasis) have dropped over recent years, this fatal disease continues to infect people in remote, conflict-ridden pockets of the Democratic Republic of Congo, among other hotspots. Diagnostic tools are inadequate—painful lumbar punctures must be performed—and the current treatment requires hospitalization and intravenous infusions, which are difficult in unstable, resource-poor settings. DNDi is therefore aiming to develop an easy-to-take oral pill for sleeping sickness, which can treat both stages of the disease and do away with the need for painful lumbar punctures. This would go a long way in helping eliminate the disease once and for all. While continuing to provide existing medicines for NTDs, greater commitment to developing new NTD treatments and other tools is sorely needed if disease control or elimination is to be achieved. Patients infected now with these neglected afflictions are anxiously waiting.

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. The US Food and Drug Administration has announced it will give priority review to a new treatment for multi-drug resistant tuberculosis. The announcement came after the drugmaker applied to the European Medicines Agency for approval. Nils Daulaire, director of the Office of Global Affairs at the US Department of Health and Human Services, writes about the agency’s first-ever global health strategy. Reuters recently examined several scientific breakthroughs in HIV and AIDS in recent years, and how the global financial crisis could impact progress against the disease. An article looks at how the US presidential candidates would handle foreign aid and international development if elected in November. A related piece examines the social, political, and financial issues at play ahead of the presidential election and their implications for domestic and global health programs.