Eliminate the Neglect: U.S. Support Needed to Expand Assault on Neglected Diseases

Guest post by Bernard Pecoul and Peter Hotez

If you asked the average American if they’ve ever heard of sleeping sickness, river blindness, or elephantiasis, you’d likely get a puzzled look. But ask a Congolese, Sudanese, or Bangladeshi about these parasitic diseases, and you might get a nod of the head or perhaps even a point in the direction of someone behaving erratically and slipping into a coma due to sleeping sickness, being led by stick by a child because of river blindness, or barely able to walk due to grossly swollen legs or genitalia caused by elephantiasis.

This weekend in Boston, health workers, researchers, donors, and social innovators from around the world will convene to discuss current efforts to treat patients and develop new drugs and vaccines for neglected tropical diseases (NTDs) such as these. Most of us have never heard of these diseases, although they are the most common infections of the world’s poor, debilitating or killing more than 1 billion people in the developing world.

This first-ever NTD meeting of the International Society for Infectious Diseases offers an opportunity for U.S. policy-makers and the public to better understand the devastating toll these illnesses exact on the world’s poorest and most vulnerable people. It may also shine light on the commendable achievements — as well as some limitations — of the current approach the U.S. government is taking to tackling NTDs.

The elimination of certain NTDs has been set as a goal by the U.S. Global Health Initiative (GHI) and World Health Organization (WHO). Great progress in reaching these elimination targets is being achieved through a program of mass treatment. To date, more than 100 million people have received access to essential medicines for NTDs thorough funding from the U.S. Agency for International Development (USAID).

However, for many NTDs, elimination will not be possible using existing drugs because they are limited in effectiveness and safety, are difficult to use, or come with serious concerns about resistance. Therefore, while continuing to provide existing medicines for NTDs, there is an urgent need to implement a parallel program of development, manufacture, and clinical testing of new drugs, diagnostics, and vaccines.

While basic research and early-stage product development is supported by the National Institutes of Health and should continue to be funded at ever-increasing levels, late-stage product development, including for drugs, diagnostics, and vaccines, is urgently needed to bring new health technologies through the “pipeline” to patients. This would help bridge the gap between innovation and access and would align NTDs with other USAID programs in malaria, HIV/AIDS, and tuberculosis, which currently allocate a percentage of their funding for late-stage product development.

Neglected disease researchers are trying to do their part. At the ISID-NTD meeting in Boston, the Drugs for Neglected Diseases initiative (DNDi), a non-profit R&D organization focused on sleeping sickness, Chagas disease, and leishmaniases, will announce the start of a new project testing the drug flubendazole in people suffering from either river blindness or elephantiasis. If effective, this drug could dramatically improve case management and simplify mass drug treatment of patients throughout Africa and Asia. The Sabin Vaccine Institute will describe new vaccines in development for hookworm, schistosomiasis, and Chagas disease, one of which will soon enter clinical trials.

Up to 600 million people are infected with hookworm and schistosomiasis, and 120 million with elephantiasis throughout the low- and middle-income countries of Africa, Asia, and Latin America, Another 26 million have river blindness, while up to 10 million people have Chagas disease, a leading cause of heart disease in Latin America.

The U.S. has led the way in ensuring the poorest people receive urgently needed treatments for NTDs, while simultaneously supporting programs of basic research. This commitment has spanned several presidential administrations, receiving widespread support from both Democrats and Republicans in the U.S. Congress. This weekend, we will join with other leading NTD experts in Boston to call for the expansion of the U.S. government’s approach to NTDs so that it includes new investments in R&D to develop and test new products for a wider range of neglected diseases. Only then will we be able to eliminate the neglect of millions of poor people in need and at risk.

Bernard Pecoul, MD, MPH is Executive Director of the Drugs for Neglected Diseases initiative, and Peter Hotez, MD, PhD is President of Sabin Vaccine Institute at Texas Children’s Hospital and Baylor College of Medicine, and Editor-in-Chief of PLoS Neglected Tropical Diseases

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