By Kerry Gallo, Communications Officer, PATH
In 2012, the private and public sectors pledged substantial resources to fight neglected tropical diseases (NTDs) through the signing of the London Declaration. Donations of drugs from the pharmaceutical industry, funding from donors, and supportive policy at the international and national levels are helping to expand the toolkit for combating NTDs.
But important tools are still missing—diagnostic tests to guide efforts to control and eliminate NTDs.
The lack of effective diagnostics has been identified as a critical gap in the ability to achieve the goals set forward by the London Declaration. The NTD community has taken notice of this gap, as evidenced by new support to PATH for the prioritization and development of novel NTD diagnostic tests, which once commercialized, will be critical in the global fight against NTDs.
In many parts of the world, diagnostics are often taken for granted. But in low-resource settings, these tests are a rarity. People living in remote communities may be far from hospitals and clinics where tests are available, trained health workers who know how to properly administer complex diagnostics are often in short supply and there are few facilities where samples can be processed.
These are some of the challenges that the next generation of diagnostics for NTDs will need to overcome.
Diagnostics for NTDs are especially important because they provide data for informed decision-making throughout the life cycle of a control or elimination program. At the start of an NTD control or elimination program, diagnostics are critical to mapping disease and identifying areas in need of treatment. Interventions like mass drug administration (MDA) are the arrows in the NTD program manager’s quiver and diagnostics bring the target into focus so programs know where to aim. Even if current diagnostics are sufficient for this purpose, the need for new tests comes as NTD programs make progress on the path toward disease control and elimination.
Later on during the program life cycle, as MDA programs and prevention efforts are scaled up, levels of infection will decrease. However, current diagnostics for NTDs are not sensitive enough to detect very low levels of infection. Data from insufficiently sensitive tests might result in decisions to reduce or stop MDA prematurely, which can lead to infection levels bouncing back. New, more sensitive diagnostics will be critical to guide control programs for diseases such as soil-transmitted helminthiasis as MDA is scaled up globally.
New diagnostics will also be critical to conducting surveillance for elimination programs for diseases like onchocerciasis, blinding trachoma, lymphatic filariasis, Chagas disease, human African trypanosomiasis (sleeping sickness), leprosy and visceral leishmaniasis. Identifying individual cases of infection will become more challenging as levels decrease, requiring many samples from target populations to be taken. For this reason, simple, effective and field-ready diagnostics that can be used by minimally-trained staff with limited resources will be essential.
In the coming months, PATH and our partners will be working to identify where the introduction and scale-up of new diagnostics will have the greatest impact, evaluate potential technologies and focus on the most promising new tests. Continued commitment from donors and partners will be essential to bring these tests to market so they will be available for NTD program managers worldwide. Some progress has already been made—we worked to develop a new test for onchocerciasis, which will be available in late 2014.
With new diagnostics to hone our vision and guide our decisions, we will move closer to a future free of NTDs.
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Have you ever been curious about how the medicine to treat neglected tropical diseases (NTDs) reaches communities across the world? A new GlaxoSmithKline (GSK) explains how establishing key partnerships and implementing evidence-based supply chain methods enables us to prevent and treat those that are suffering from NTDs across the globe.
Through the 2012 London Declaration on NTDs, pharmaceutical companies, non-governmental organizations (NGOs), and donor and endemic governments dedicated themselves towards scaling up drug supply to over a billion people suffering from NTDs. In 2013, 1.35 billion low-cost treatments for NTDs were donated to more than 70 endemic countries worldwide.
To build upon the successes realized over the past two years and to meet the NTD control and elimination goals by 2020, new approaches on the methodology of supply chain management for NTDs are needed. To answer this challenge, pharmaceutical industries, NGOs and supply chain experts formed the NTD Supply Chain Forum. The team includes pharmaceutical companies (Bill & Melinda Gates Foundation.
Their goal is to simplify complex logistical, manufacturing, and personnel challenges to streamline the high number of drugs being distributed to rural villages, schools, and clinics in need of NTD treatments.
Already through this partnership, 809 million treatments were donated for lymphatic filariasis, 115 million treatments for onchocerciasis, 276 million treatments for soil transmitted helminthes, 52 million treatments schistosomiasis and 51 million treatments for trachoma.
We encourage you to watch GSK’s video on Delivering on Promises & Driving Progress: The Second Report on Uniting to Combat NTDs.
This is a guest post from Angelica Belli*
As a Human Rights and Humanitarian Action Masters student specializing in global health and African studies, having the opportunity to listen first hand to some of the actors that are so often subject of my studies was a particularly exciting experience, which further enhanced my eagerness to explore the field of NTDs.
Sitting in a semicircle in front of me were Bill Gates, Co-chair of the Bill and Melinda Gates Foundation, Margaret Chan, Director-General of the World Health Organization, Dr Tim Evans, Director of Health, Nutrition and Population at the World Bank, Jamie Cooper-John, Chair of the Children’s Investment Fund Foundation, Dr Onésine Ndayishimiye, National Director of the Neglected Tropical Disease Control Program in Burundi and Christopher A. Viehbacher, CEO of Sanofi.
Through their discussion, I was able to reflect upon the role of pharmaceutical companies in the effort to fight NTDs. While pharmaceutical companies need to make a profit to finance most of their activities, it is promising to see them acknowledging the need of those suffering from NTDs.
Companies like Sanofi are modifying their business plans to enable the disadvantaged to receive the NTD treatment they need at more affordable prices. Sanofi has made admirable efforts in this fight, committing itself for ten years to the provision of free drugs for neglected illnesses such as sleeping sickness.
In addition to Sanofi’s commitments, I was also pleased to hear that the French government reaffirmed their commitment to ending NTDs. I hope that the French government will help people across the developing world gain access to treatments donated by Sanofi and other pharmaceutical companies.
Overall, the event was quite general, and I would have appreciated a deeper focus on the challenges faced rather than mainly on the achieved objectives. It was through the Q&A that some thought-provoking obstacles were raised.
Firstly, money is not the sole requisite. As Mr. Viehbacher and Mr. Gates pointed out, the main issue is no longer the availability of medicines, but access to patients. People in remote areas of the developing world are often not easily reachable due to poor infrastructure and weak health systems. It will be interesting to see what solutions are found to tackle this issue.
Secondly, even though the generosity of both public and private actors has led to improved health conditions for thousands, it raises the question as to whether donations are sustainable and if so, for how long. Local governments will have to step in eventually, empowering their people and making decent health care accessible. How these major global health actors will contribute to this necessary transformation is yet to be seen.
As long as there is a bit of heart complementing rational strategies, the empowerment of the most marginalized communities can be a reasonable expectation. As a global health student, I hope this will soon be the case.
To get involved in the fight against NTDs, visit www.end7.org.
*Angelica Belli, Italian-British, grew up in Italy and attended university in the UK, graduating from Warwick University in Philosophy, Politics and Economics in 2013; current Human Rights and Humanitarian Action Master student at Sciences Po Paris School of International Affairs, with concentrations in Global Health and African Studies.
This afternoon, global health leaders new report highlighting gains over the past two years.
Dr. Margaret Chan, Director-General of the World Health Organization; Bill Gates, Co-chair of the Bill & Melinda Gates Foundation; and several other expert panelists including Chris Viehbacher, CEO of Sanofi; Dr. Onésime Ndayishimiye, National Director of Burundi’s Neglected Tropical Disease & Blindness Control Program; and French Minister of Social Affairs and Health, Hon. Marisol Touraine, announced deepened commitments for efforts to control and eliminate the most common NTDs by 2020 including a $120 million pledge from the World Bank, a new collaboration to combat soil-transmitted helminthes (STH) and accelerated research and development efforts lead by pharmaceutical companies in conjunction with nonprofits.
The broad reach and attention of today’s event signals the fact that controlling and eliminating NTDs is embraced by a global community of national leaders, policy makers and donors. In addition, there is broad recognition that addressing NTDs is a crucial component of eliminating poverty and achieving development goals.
Echoing this fact, Dr. Tim Evans, World Bank Director of Health, Nutrition and Population stated during the event that NTDs are major constraints to development and addressing them will boost shared prosperity.
As detailed in the Uniting to Combat NTDs report and score card, progress on NTDs has accelerated quickly over the past two years. Pharmaceutical companies are now meeting 100 percent of requests for drugs, and endemic countries taking ownership of NTD programs. To date, 74 countries – roughly two-thirds of all NTD-endemic countries – have now developed national plans to help guide their control and elimination efforts.
Of particular note, Nigeria and Ethiopia, two countries with high NTD burdens, made national commitments to end NTDs. Nigeria launched its master NTD plan in February with the goal of providing treatment to more than 60 million people annually over the next five years. Ethiopia, the country with the highest trachoma burden, launched its national plan in June 2013. Success in Nigeria and Ethiopia would significantly decrease the global burden of NTDs worldwide.
click to view larger) shows a steady increase in drug donation and delivery, only 36 percent of people in need received all the drugs they needed in 2012. Mobilizing more financial resources to support program implementation, doing more to leverage the value of donated drugs and increasing collaboration across sectors are just a few ways the global community can further accelerate progress.
While donors, pharmaceuticals and NGOs are an integral part of the solution, endemic countries will drive progress forward by continuing to develop, own and implement their programs in a sustainable way.
“I always believe in country ownership, Dr. Margaret Chan said. “Were here to support your efforts.
We applaud the work done by endemic countries, NGOs, pharmaceutical companies, multilateral organizations and the Bill and Melinda Gates Foundation, and look forward to the path towards 2020.
Click to view the full report.