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Three Neglected Killers
Ten years ago, when the Nobel Peace Prize was awarded to Médecins Sans Frontières, MSF’s president at the time, James Orbinski, said that more than 90 per cent of all deaths and suffering from infectious diseases occur in the developing world because “life-saving essential medicines are either too expensive, are not available because they are not seen as financially viable, or because there is virtually no new research and development for priority tropical diseases.”
MSF dedicated the award’s prize money to its neglected diseases programmes. In the same year the Access to Essential Medicines campaign was launched which became a fundamental aspect of MSF’s work, as did its commitment to improving the quality of drugs available, and ensuring that even the poorest communities have access to them.
Over the years, MSF has been able to report that globally research and development has improved for neglected diseases. Yet the needs of victims of the most neglected diseases are still largely unmet. Together three diseases - Kala Azar, Chagas and Sleeping Sickness - endanger the lives of more than 80 million people every year.
Kala Azar, or visceral leishmaniasis, frequently affects poor communities often in isolated regions. Spread by the sand fly, and fatal if left untreated, the disease is endemic in 88 countries. Ninety per cent of cases occur in Bangladesh, Brazil, India, Nepal and Sudan. Treatment is hampered by drug resistance, high prices, lack of access to existing medicines, and slow progress on research into new cures.
Chagas disease is endemic in many Latin American countries, where it affects an estimated ten to 15 million people and claims up to 40,000 lives every year. The condition damages the heart, nervous and digestive systems in one-third of patients.
Sleeping sickness affects 36 countries in sub- Saharan Africa, where 60 million people are at risk. It was nearly eliminated in the 1960s, but has re-emerged in the 1990s due to war, population movement and the collapse of health systems. Despite a decrease in reported cases due to improved efforts in some areas, sleeping sickness remain undetected and therefore untreated in remote and/or unsafe areas of several countries where it is endemic.
A recent survey produced by the George Institute for International Health revealed that less than five per cent of worldwide research and development for neglected diseases has been directed towards the most neglected diseases, that of, Kala Azar, chagas and sleeping sickness.
In 2008, MSF committed 18 million Euros to the Drugs for Neglected Diseases initiative (DNDi). At the same time MSF will continue to support operational and clinical research through its field programmes, will call for new research into more efficient drugs and demand that governments, companies and agencies take action so that these diseases receive the urgent attention and funding they need.
Kala Azar in India
Many of the worldwide cases of Kala Azar are concentrated in the northeast Indian state of Bihar. The most common treatment is sodium stibogluconate; however, resistance to the drug is a growing problem – especially in India, where as many as 65 per cent of patients become drug resistant. MSF has been working in Bihar’s Vaishali district since 2007, assisting Kala Azar patients with one of the most effective and safest treatments available to fight the disease: liposomal amphotericin B. Medical teams have diagnosed and treated more than 3,000 patients suffering from Kala Azar and achieved a cure rate of 98.4 per cent. The mortality rate is 0.7 per cent and there is a low incidence of adverse reactions.
Armed with this evidence, MSF is calling for liposomal amphotericin B to be included in the Indian treatment protocol as a first-line treatment option or to be used as one of the main drugs in combination therapies in the coming years.
Chagas in Bolivia
In Bolivia, the country with the highest incidence of the disease worldwide, Chagas is a major public health concern. Yet despite a presidential decree in Bolivia which states that Chagas treatment in children needs to be routine, treatment is rarely available and the people most at risk cannot afford it. MSF is treating Chagas patients up to 50 years of age in rural and suburban Bolivia, an important step forward in the fight against Chagas which even today is often not treated. Often this is due to the need for greater access to proper diagnostic tools, for safer, shorter treatments, for paediatric formulas and for early cure rate predictors to monitor the efficacy of the drugs.
MSF is campaigning for the production and availability of two existing Chagas drugs - nifurtimox and benznidazol - to be secured, and for efforts to find simple, less toxic, more affordable and efficient treatments for all forms of Chagas disease, for children and adults alike, to be stepped up.
Sleeping sickness in Democratic Republic of Congo
In Doruma, Ando and Bili, located in northeastern Democratic Republic of the Congo, MSF has been treating more than 1,500 patients with sleeping sickness since July 2007. Disease prevalence in the region is high, above 10 per cent in some villages. Word of MSF’s work quickly spread, and people travelled from up to 90 miles away to receive treatment. The treatment of patients in the second stage of the illness relies on eflornithine, a safe but complicated treatment that requires 56 infusions over 14 days. Over the past 20 years, MSF has screened more than two million people for the disease which is spread by the tsetse fly, and treated 48,000 in several African countries.
In a major step forward in improving treatment options, MSF, Epicentre and DNDi have pioneered a new and easier-to-administer treatment for sleeping sickness based on a combination of intravenous eflornithine and oral nifurtimox. However simpler, preferably oral treatments are still needed.