Neglected disease boost

Fresh funding aims to raise awareness and improve control measures.

The Bill & Melinda Gates Foundation has called for a worldwide push to slash the burden of neglected tropical diseases such as elephantiasis, trachoma and schistosomiasis by 2020.

A programme tackling elephantiasis has prevented infection in millions of people. Credit: R. U. CHANDRAN, TDR, WHO/SPL

On 30 January, Bill Gates announced a US$34-million grant to leverage new funding globally to prevent and treat these illnesses, which affect 1.4 billion people. The money will go to an international alliance, the Global Network for Neglected Tropical Diseases, which aims to raise awareness and bring previously fragmented disease-specific efforts under a common umbrella to better coordinate fundraising and field operations.

The trick, says Gates, is bringing in the substantial new investment needed to drastically scale up control measures using existing tools.

Such scale-up has already proved its mettle: take, for example, lymphatic filariasis, a devastating parasitic disease usually known by its worst manifestation, elephantiasis. Just nine years ago, drugs for lymphatic filariasis reached only 25 million people in 12 countries; more than one billion people in 83 countries are at risk. But a public–private partnership, the Global Programme to Eliminate Lymphatic Filariasis, whose secretariat is at the Liverpool School of Tropical Medicine, UK, is now bringing vital drugs to 570 million people in 48 countries annually. The programme, launched in 2000 and jump-started with a $20-million grant from Gates, estimates that it has prevented the disease in 6.6 million newborns and prevented 2.2 million new serious clinical cases, as well as stopping 9.5 million people already infected from developing severe complications1.

"The alliance has amply demonstrated proof-of-principle that rapid country scale-up makes a difference," says Alan Fenwick, a parasitologist at Imperial College London and head of the board of the Schistosomiasis Control Initiative.

The Global Network, inaugurated by former President Bill Clinton in 2006, is headquartered at the Sabin Vaccine Institute in Washington DC. With the new Gates money it hopes to drastically step up prevention and treatment of the seven most common neglected diseases that can be prevented and treated with existing drugs for about 50 cents per person annually — trachoma, onchocerciasis, schistosomiasis, lymphatic filariasis, trichuriasis, hookworm and ascariasis.

The key is negotiating donations of billions of tablets from drug companies and purchasing others at cheap rates by negotiating bulk deals at a global scale, at prices far below those that would be attainable by any single country. A 'rapid impact package' — a cocktail of four drugs that targets all seven diseases in a single treatment — is then used for mass preventative chemotherapy across entire populations.

The huge logistics are handled by an innovative community-based approach, made up of far-reaching networks of hundreds of thousands of volunteers in individual communities, and local health services. "You can put thousands of drugs on the back of a bicycle," says David Molyneux, a parasitologist at the Liverpool School of Tropical Medicine and executive secretary of the lymphatic filariasis effort. He says that the effects of the drugs in the field are "staggering".

Gates hopes that the new grant will help to catalyse substantial additional funds. The alliance will use the grant to launch End the Neglect 2020, a campaign of high-level political advocacy, public fundraising and wooing industry for drug donations. The idea is to push control of some of the most neglected diseases up the international political agenda and raise public awareness, says Fenwick. "The fight against neglected tropical diseases is at a tipping point," adds Peter Hotez, president of the Sabin Vaccine Institute.

“There is little point focusing on stopping people dying from AIDS or malaria if they are going to be disabled by these other diseases. ”

The network's past advocacy efforts are already paying off. In 2007, the US Congress gave $100 million through the US Agency for International Development to distribute a rapid-impact drug package in nine countries. Last year, the US government pledged a further $350 million, and the United Kingdom offered £50 million ($75 million), over five years, to control neglected diseases, although these commitments have yet to be disbursed. The pharmaceutical companies Merck, GlaxoSmithKline, Pfizer, Johnson & Johnson and MedPharm have also committed to large donations of drugs up until 2020.

"The advocacy has been a big positive aspect," says Bernard Pécoul, head of the Drugs for Neglected Diseases Initiative based in Geneva. But he criticizes the alliance for focusing on the seven diseases that can be easily treated, largely ignoring others such as sleeping sickness, visceral leishmaniasis and Chagas disease.

Such tensions are fuelled by the sheer shortage of resources. Neglected diseases have long faced utter indifference from funders, with the exception of AIDS, tuberculosis and malaria. These three attract billions; the rest, the 'most neglected diseases', get only a fraction.

The first comprehensive audit of research spending on neglected diseases, published last week in PLoS Medicine2, found a similar picture in research and development to generate new therapeutics, with almost 80% of the $2.5 billion invested in 2007 going to AIDS, tuberculosis and malaria. By contrast, other neglected diseases each picked up from 4.4% to less than 1%.

To ease this, the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria should be balanced to include other neglected diseases, says Molyneux. Not only would this increase resources for the most neglected diseases, but the fund's three current targets could also benefit from a more integrated approach, he argues. Schistosomiasis, he notes, can cause vaginal lesions that treble the risk of HIV infection3.

"There is little bloody point focusing on just stopping people dying from AIDS or malaria," says Molyneux, "if they are then going to be disabled and blinded by these other diseases."

In a paper in the Lancet last month4, Molyneux and his colleagues argue further that the distribution of malaria drugs could be greatly expanded by piggybacking on the alliance's vast and established community-distribution networks.

References

  1. 1

    Ottesen, E. A. et al. PLoS Negl. Trop. Dis. 2, e317 (2008).

  2. 2

    Moran, M. et al. PLoS Med. 6, e1000030 (2009).

  3. 3

    Kjetland, E. F. et al. AIDS 20, 593–600 (2006).

  4. 4

    Molyneux, D. H. et al. Lancet 373, 296–297 (2009).

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Bill & Melinda Gates Foundation

Global Network for Neglected Tropical Diseases

Loose Change Initiative

Global Alliance to Eliminate Lymphatic Filariasis

Schistosomiasis Control Initiative

Drugs for Neglected Diseases Initiative

Global Fund to fight AIDS, Tuberculosis and Malaria

Institute for OneWorld Health

The WHO's list of neglected diseases

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Butler, D. Neglected disease boost. Nature 457, 772–773 (2009) doi:10.1038/457772a

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