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Paying Attention To Neglected Diseases - 2003-08-12

Advances in medical treatment and prevention have revolutionized health care around the globe. Many diseases have been brought under control. Some have even been eradicated. But there are some diseases in the developing world that remain to be conquered. A medical initiative launched recently in Geneva aims to find cures for life-threatening tropical diseases that afflict the poorest of the poor. The initiative hopes to raise awareness of the need for safe cures and treatments, and spur release of funds for research.

The Nobel-prize winning aid group, Doctors Without Borders (Medecins Sans Frontieres) and five other organizations set up the not-for-profit drug research organization in early July to tackle diseases found only in the developing world.

The Drugs for Neglected Diseases Initiative, as the project is known, aims to harness cutting-edge science to develop medicines to treat sleeping sickness, leishmaniasis and Chagas disease. These three diseases alone threaten an estimated 350-million people every year in the developing world. The treatments available to date have been antiquated and even toxic, often with fatal side effects.

Davey Koech of the Kenya Medical Research Institute -- Africa's largest such institution and partner agency in the Initiative -- says drug development for these diseases is long overdue.

He says, "There are drugs for diseases, like sleeping sickness, whose drugs are highly toxic and were developed more than 50 years ago; and we are still using them. There has never been any direct attempt to develop drugs for these diseases."

Dr. Koech says sleeping sickness and leishmaniasis afflict the majority of those who come to his institute for treatment.

The World Health Organization says that from 300-thousand-to-500-thousand people in 36 African countries suffer from sleeping sickness, a disease carried by the tsetse fly. Leishmaniasis is carried by the sandfly, and is found in 88 countries throughout Asia, East Africa and Brazil. It causes weight loss, enlargement of the spleen and liver, and anemia.

Chagas disease kills an estimated 50-thousand people every year in South America. It is carried by blood-sucking insects that invade most organs of the body, often causing heart and intestinal damage and progressive weakness.

Doctor James Orbinsky worked with Doctors Without Borders -- known by its French acronym M-S-F -- in Africa and Asia over the past decade. He says the dilemma doctors face in choosing between not treating patients afflicted by these tropical diseases, or treating them with drugs that could kill them is the main motivation behind the new drug development initiative.

He says, "I personally, and most, if not all of the M-S-F field workers, have seen people dying of diseases, for which there is poor or no treatment. And that's simply unacceptable. African sleeping sickness, for example relies currently on a treatment that is an arsenic-based treatment. I know when I treat a patient with African sleeping sickness that between five-to-10 percent of those patients will die of the treatment, and not of the disease. But without the treatment, virtually all of them will die."

The director of the World Health Organization's Tropical Disease Research unit, Carlos Morell, says, while his unit has been involved in drug development over the past 27 years, funding has always been low.

He says, "Because they are diseases of the poor, therefore, they are not on the radar screen of most people who take decisions, or who have the funds to do that. Second, they are not seen as emergency health (problems), because there is no danger of them propagating to other countries. People who die of SARS (Severe Acute Respiratory Syndrome) are less than those who die everyday from neglected diseases, and despite that, no one pays attention to them."

Although some critics accuse large pharmaceutical companies of failing to fund research on drugs to treat diseases of the developing world, Dr. Morell says the problem is not that simple.

He says, "The present economic and global structure led to the pharmaceutical companies taking up the task of developing drugs. And they have no way but to be profit-driven, because that is their business. If they decide to become charities, then their shareholders would not accept that. But one also has to think about there being a public health failure. There was not enough initiative that drugs, which are not going to yield a profit, should have other mechanisms to be developed."

The Drugs for Neglected Diseases Initiative say it will not only commit its own experts to creating affordable and effective new drugs to combat the diseases of the poor, but it will welcome the research and resources major pharmaceutical companies are willing to provide.

Initiative board chairman Yves Champey says pharmaceutical giants Merck, Novartis and Glaxo-Smith Klein have offered access to their drug compound libraries of molecules that can aid in developing new drugs.

Dr. Champey says it may cost pharmaceutical giants up to 800-million dollars to create an innovative drug, for say cancer or arthritis, because of the long testing periods and marketing factors involved. But he says that will not be the case for new drugs to treat sleeping sickness, leishmaniasis or Chagas disease, which will keep costs down.

He says, "With parasitic diseases, comparative drugs are not many, or non-existent sometimes. Duration of administration will be one, two, three weeks. Measuring the outcome of these (drugs) is relatively simple. Finally, we will do this in countries where we will not have to pay the investigators by case report, as is the case in the U-S or in Europe. So, it is a huge difference with what is happening for innovative drugs in North America or Europe. The cost will be radically different."

Dr. Champey says Doctors Without Borders is using its Nobel Prize money to help fund the Initiative, but it is seeking cooperation on a global scale. He says the Initiative plans to spend about 250-million dollars over the coming decade to develop six or seven new drugs, and support a number already in development.