Sustained engagement, partnership needed to implement new treatments for neglected diseases

Days after two landmark resolutions were adopted at the World Health Assembly - on neglected tropical diseases and on research and development (R&D), financing and coordination for the health needs of developing countries - over 400 scientists, representatives and ministers of health, ambassadors, national control programme representatives, African regulators, health workers, public health experts, and activists from 21 African countries and 10 others from around the world gather in Nairobi to take stock of health innovation for neglected diseases in Africa over the past decade. While progress has been made, and certain diseases are targeted for elimination, the need for strong leadership, coordination, and sustainable funding is as pressing as ever and is critical to achieving much-needed breakthroughs.

Participants in the event - 'A Decade of R&D for Neglected Diseases in Africa' - organized by the Drugs for Neglected Diseases initiative (DNDi) on the occasion of its 10-year anniversary, with its African founding partner, the Kenya Medical Research Institute (KEMRI), will look at progress to date, gaps needing to be filled, and current and future development of new, field-adapted, affordable treatments, diagnostics, and vaccines for neglected diseases and patients throughout Africa.

'Neglected patient medical needs specific to Africa are many, and as scientists and policymakers in Africa, we need to share research and resources across borders to save time and money to help those most in need,' said Dr Monique Wasunna, Director of DNDi Africa, and Assistant Director of Research at KEMRI. 'By harmonizing efforts across Africa, we can strengthen our ability to turn research into concrete solutions for the health needs of the most neglected.'

As an example, ten years ago, patients with sleeping sickness were treated with a century-old regimen of painful injections of an arsenic-based drug, which itself killed one in 20 patients. Today, an improved treatment option developed in 2009, a combination therapy of an oral drug with intravenous injections, has become the treatment of choice in all endemic countries. This improved treatment resulted from years of R&D efforts in sub-Saharan African countries afflicted by the disease. Today a new oral-only treatment is being tested by DNDi in remote areas of Africa, in trials that are of international standards.

'As the African scientific community, we need to strive to build the scientific excellence to take ownership of research for health,' said the Honorable Mr James Macharia, Cabinet Secretary for Health of Kenya. 'I believe Africa is ready to take a step in this field, to develop and implement integrated strategies for neglected diseases. But even with such integrated strategies, and the political will required to propel them, in addition to the resources required from them, we must not forget that the right tools for elimination are necessary to really see the elimination of many of these diseases,' he added.

Despite increased attention and investments over the past decade in research for neglected diseases, a recent analysis in The Lancet reported that only 1% of all health R&D investments in 2010 were for neglected diseases. In a recent analysis, DNDi and MSF estimated that, while progress has been made over the past decade, still only 3.8% of newly approved drugs were for neglected diseases that accounted for 10.5% of the global disease burden.

The current reflection on the progress in R&D for neglected diseases and patients in Africa comes at a time when WHO member states have also reported unprecedented progress in the control of many of these diseases. Elimination goals up to 2020 for several neglected tropical diseases such as sleeping sickness, visceral leishmaniasis, or lymphatic filariasis were set out early last year in the WHO NTD Roadmap, and new health tools are needed to support this strategy.

DNDi and a number of other new partnership initiatives set up during the last decade are bringing together the public and private sectors, in collaboration with WHO, TDR, and others to develop such new health tools. While not the ultimate solution to R&D gaps, these new models contribute significantly to the fight against neglected diseases.

'DNDi has developed six new treatments for four neglected diseases in the past decade, but there are still other neglected diseases that continue to lack good treatment options. While this progress is a good start, the treatments delivered are far from optimal. We have not yet developed new modern drugs which could change the history of certain neglected diseases,' said Dr Bernard P-coul, Executive Director of DNDi. 'To truly fight neglect, we must push for more innovation and access of new treatments together with adequate coordination with control programmes. Progress to date shows this can be done in and with countries in Africa.'

DNDi and partners in Africa have established two regional R&D disease networks: the Leishmaniasis East Africa Platform (LEAP), launched in 2003 in Khartoum, Sudan; and the Human African Trypanosomiasis (HAT) Platform, launched in 2005 in Kinshasa, Democratic Republic of the Congo. LEAP was instrumental in the development of the combination drug SSG&PM (sodium stibogluconate and paromomycin) for the treatment of visceral leishmaniasis (kala azar) in East Africa, while the HAT Platform played a major role in the development of NECT (nifurtimox-eflornithine combination therapy) for the treatment of late-stage sleeping sickness.

'Around the world we are moving ahead in leaps and bounds, as ten years ago, good clinical practice was not the norm. Africa has moved very quickly in in this field and in the regulatory area and in ethics review. We need very strong clinical and regulatory practice to do good R&D,' said Dr Charles Mgone, Executive Director of the European & Developing Countries Clinical Trials Partnership (EDCTP). 'But we have not yet been able to support capacity building from within, and we must be able to. Working together is the key,' he added.