April 25, 2010

By Dr. Unni Karunakara, incoming president of MSF's International Council, and Dr. Bernard Pecoul, executive director of the Drugs for Neglected Diseases initiative

By Dr. Unni Karunakara and Dr. Bernard Pecould

Last month, a group of Congress members led by Rep. Donald Payne, D-N.J., wrote to the head of USAID, Dr. Rajiv Shah, with a simple message: We need to do more to fight neglected tropical diseases.

In its Global Health Initiative, the Obama administration has vowed to devote unprecedented resources to the fight against five parasitic and bacterial diseases damaging impoverished and remote communities throughout Africa, Asia and Latin America.

But the historical importance of the initiative is undercut by a bewildering and glaring omission: So far, several neglected diseases - including sleeping sickness, visceral leishmaniasis, Chagas disease and Buruli ulcer - have been completely left out.

The 14 diseases listed as neglected tropical diseases by the World Health Organization affect 1 billion of the poorest people in some of the world's most remote areas. The majority of patients cannot afford to pay for any kind of treatment and thus represent no market for the drug industry's research and development agenda. The Global Health Initiative should include all of these diseases.

As doctors, we cannot simply choose which diseases to treat.

Sleeping sickness and visceral leishmaniasis are both 100 percent lethal without treatment, taking the lives of more than 100,000 people each year in sub-Saharan Africa and South Asia.

Chagas disease kills more people in Latin America than any other parasitic disease, including malaria. Others, including Buruli ulcer, may not be deadly but they affect some of most marginalized people in the world.

Both of us have seen firsthand how neglect from the medical and research community only compounds the heavy toll taken by these diseases. Today, there is scarce access to diagnostics, and the medicines that do exist are unaffordable, have more side effects, and are difficult to administer in resource-poor settings.

Nearly half of all stage 2 sleeping sickness patients, for example, are still treated with melarsoprol, a 1940s-era arsenic-based drug that inflicts searing pain when injected into the bloodstream and kills one in 20 of those receiving it outright. Up to 30 percent of patients fail to respond to the treatment altogether.

Our frustration at having to treat sleeping sickness patients like this spurred us to work for better options. Doctors without Borders/Medecins Sans Frontieres and Drugs for Neglected Diseases initiative spent several years researching and developing a new combination treatment, using nifurtimox and eflornithine, that is safer, more effective, easier to administer and cuts treatment time in half. The new regimen has been adopted by some countries, but efforts for wider use need a jolt, just the sort of thing President Obama's Global Health Initiative could provide.

In the last 10 years, Doctors Without Borders has treated tens of thousands of people for neglected tropical diseases while Drugs for Neglected Diseases initiative and its partners have for the first time created a pipeline for improved medicines. Even if this is just a drop in the ocean, it shows how a relatively small investment can save lives today and help fuel innovation for tomorrow.

Allocating just 10 percent of the Global Health Initiative neglected disease budget toward research and development, for instance, could help deliver better treatments to patients within five years.

The diseases focused on by the Global Health Initiative certainly deserve increased attention and resources. But if such an important venture continues to exclude the bulk of tropical diseases, a historical opportunity will be lost and patients will be doomed to another generation of deadly neglect.

Dr. Unni Karunakara is the incoming president of Doctors Without Borders/Medecins Sans Frontieres' International Council. Doctors Without Borders won the Nobel Peace Prize in 1999. Dr. Bernard Pecoul is the executive director of the Drugs for Neglected Diseases initiative. They can be reached at pmproj@progressive.org.