by: Alanna Shaikh

Photo Courtesy of doh.gov.ph

The Center for Global Development (CGD) released a new report on drug resistance this week, and it’s sobering. Counterfeiting, poor production, and misuse have eroded the power of many of our lifesaving drugs. In response to the problem, they call for cooperative action from governments, drug companies, donors, and health care providers.

While the report doesn’t specifically refer to neglected tropical diseases, the drugs we use to treat them are highly at risk for resistance. Many of the NTD drugs are old, which means there has been plenty of time to develop resistance. They are also provided through mass administration, another vehicle for resistance, and there is very little research going on right now on new drug alternatives.

In other words, NTDs are primed for a serious resistance problem in the near future. Scaling up treatment is going to save lives but it’s also going to increase resistance and we don’t have any other drugs lined up to take the place of current treatments.

So, how can we apply the CGD recommendations to neglected tropical diseases?

1) Collect and share drug resistance information across disease networks.

The world of neglected tropical diseases is pretty well connected. The major organizations working on NTDs already share information and coordinate efforts. Expending that coordination to include information on resistance will not be all that difficult. I do wonder what form would be most useful for that information sharing – I would love to see an online database with shared inputs and the data free for everyone to access.

2) Secure the drug supply chain to ensure quality products and practices.

This is one of those recommendations that is a whole lot more complex than it sounds. Securing a drug supply chain while maintaining access to those drugs is not an easy task. Especially when you want to keep prices down while keeping drugs moving to both the government and the private sector. You need multiple suppliers to maintain lowest prices, which means more companies to regulate. You also need to make sure drugs aren’t diverted for the wrong purpose at the pharmacy level. That’s challenging in the public sector, and in the private sector – in totally different ways.

There are a lot of initiatives to secure drug supply chains for everything from anti-malarial to ARVs. So far we’re still struggling, especially in Africa where NTDs are most prevalent. So this recommendation isn’t going to come into practice any time soon.

3) Strengthen national drug regulatory authorities in developing countries.

Photo Courtesy of http://www.popsci.com/

I like this recommendation. It’s going to have an impact on pharmaceutical supply well beyond just reducing resistance; it also strengthens the health system as a whole. The trick is how you do it – you can train regulators, and that’s important, but what you really need in this situation is regulators with the authority to take action and impose penalties. That authority comes from a government with the will and the capacity to support it, and not every government has a sufficiently powerful Ministry of Health to make that happen.

4) Catalyze research and innovation to speed the development of resistance-fighting technologies.

In the case of NTDs, I think the focus should be on new drugs. They’re the tech we need most right now. Other resistance-fighting technologies, like cheaper faster bacterial cultures can wait. The NTD drugs are old. We need new ones before we exhaust the effectiveness of what we have.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.”

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