Making progress in fighting Africa’s neglected diseases

A rare skin infection
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  • Africa has about 90 per cent of the burden of NTDs globally
  • Fighting NTDs in Africa has challenges such as lack of coordination and funding
  • Sharing resources and research could help control NTDs, experts say

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Africa needs coordination and more funding to fight neglected tropical diseases (NTDs), writes Gilbert Nakweya.  

The fight against neglected tropical diseases (NTDs) in Africa picked momentum in 2012. There was a WHO global roadmap for implementing actions to control NTDs, a London Declaration on NTDs, and an Accra Urgent Call for Action on NTDs — all in that year.

In September last year, the WHO regional office for Africa also issued a strategic plan to control Africa’s NTDs for the period 2014-2020.

But despite some successes, Africa is still grappling with challenges of controlling NTDs, experts say.

“To truly fight neglected tropical diseases, we must push for more innovation and access to new treatments together with adequate coordination with control programmes.”

Bernard Pécoul, Drugs for Neglected Diseases initiative (DNDi)

“Neglected patients’ 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,” says Monique Wasunna, director of Kenya-based Drugs for Neglected Diseases initiative (DNDi) Africa office.

DNDi, headquartered in Geneva, Switzerland, was formed in 2003 as a not-for-profit organisation to help research and develop innovative and improved treatments for NTDs.

According to its website, DNDi aims to deliver 11 to 13 new treatments by 2018 for targeted neglected diseases, including sleeping sickness, Chagas disease, paediatric HIV, cutaneous leshmaniasis and visceral leshmaniasis — also called kala-azar.

Bernard Pécoul,  the executive director of DNDi, says his organisation is working on 30 projects to develop new drugs for these diseases, citing six new oral treatments that have since 2003 been developed to combat diseases such as sleeping sickness and Chagas disease.

Peter Hotez, professor of tropical medicine at US-based Baylor College of Medicine and a co-editor–in-chief of PLOS Neglected Tropical Diseases, says that integrated NTD control through mass drug administration (MDA) is now under way in about 20 African countries.

He adds that in some cases such activities are leading to the elimination of lymphatic filariasis, onchocerciasis and trachoma, while for other NTDs the prevalence is being gradually reduced.

Africa’s NTDs burden

According to WHO about one billion people are at risk of NTDs worldwide with more than 90 per cent of the NTDs burden occurring in Africa.

The WHO adds that common NTDs in Africa include Buruli ulcer, leprosy, Guinea worm disease, lymphatic human African trypanosomiasis, schistosomiasis, soil-transmitted helminthiasis and kala-azar.

Kala-azar is a major killer disease caused by the protozoan parasites Leishmania donovani and Leishmania infantum. The parasites are transmitted by sand flies. The disease occurs in 98 countries worldwide with Bangladesh, Brazil, India, Ethiopia, Kenya, Nepal and Sudan being the most affected, according to information from DNDi.

“The funding problem is still big. We should get long-term funding from other partners for sustainability.”

Marcel Tanner, Drugs for Neglected Diseases (DNDi)

DNDi says that 20,000 to 40,000 people die of kala-azar worldwide in a year. But according to Wasunna, the actual figures could be higher because the estimates represent only hospital-based deaths.

Njoroge Njenga, a researcher of the Kenya Medical Research Institute based at Kimalel health centre — a clinical trial site for kala-azar — in Kenya, tells SciDev.Net that the disease has been a severe threat to the lives of patients.

“We are conducting clinical trials with an aim of enhancing the treatment days,” he says, adding that diagnostic facilities have become closer to the patients, thus reducing diagnoses days.

Njenga observes that accessibility to all patients is a big challenge when there is lack of diagnostic tests and right treatments.

Sleeping sickness, a disease caused by the parasite Trypanosome brucei transmitted through tsetse flies, also threatens Africa. DNDi estimates 20,000 cases across the continent with 36 countries in Sub-Saharan Africa affected and 97 per cent of the cases in eight countries:  Angola, Central African Republic, Democratic Republic of Congo, Ethiopia, Equatorial Guinea, South Sudan, Sudan and Uganda.

The Democratic Republic of Congo alone contributes to two-thirds of the total cases.

Both kala-azar and sleeping sickness affect mainly people living in remote areas with limited access to health facilities.

R&D challenges for NTDs

One of the outstanding drawbacks noted by scientists and policymakers is inadequate funding for health research.

“The funding problem is still big. We should get long-term funding from other partners for sustainability,” says Marcel Tanner, the chairman of DNDi’s board of directors.

During DNDi’s 10th anniversary conference held in Nairobi in June last year, ministers of health from Congo, Democratic Republic of Congo, Kenya and Sudan promised to support health research.

Lack of data is another major challenge facing the development of drugs to control NTDs. “A key challenge is knowing exactly how many patients are at risk or infected with these diseases,” adds Tanner. “Many of them live in very inaccessible areas, with little or no access to health care.”

According to Hotez, there is a gap in expanding MDA coverage in conflict and post-conflict countries of Africa as well as getting some of the larger and wealthier African countries such as Nigeria and South Africa to expand their commitments to NTD control.

“In Africa an additional threat is the important effects of NTDs in promoting HIV/AIDS and malaria, so that organisations committed to these diseases such as the Global Fund and US President's Emergency Plan for AIDS Relief (PEPFAR) now need to embrace them,” Hotez notes.

Africa’s solutions to NTDs

Tanner says there is high need for strengthening national capacity first, then going regional. “We need to think locally and share globally, [but] get our houses in order first,” he says.

He challenges African governments to invest more in medical research for controlling NTDs. “These diseases are neglected because of the neglect in research and lack of tools,” Tanner notes.

Other experts call for coordination of efforts.

“To truly fight neglected tropical diseases, we must push for more innovation and access to new treatments together with adequate coordination with control programmes. Progress to date shows this can be done in and with countries in Africa,” says Pécoul.

Wasunna agrees. “By harmonizing efforts across Africa, we can strengthen our ability to turn research into concrete solutions for the health needs of the most neglected,” she says.

This article has been produced by SciDev.Net's Sub-Saharan Africa desk.