Upholding Germany’s Historic Commitment to Poverty-Related and Neglected Diseases

by Peter J. Hotez and Neeraj Mistry

The German Bundestag has an opportunity to make unprecedented commitments toward the treatment and prevention of the world’s most common poverty-related diseases — a group of debilitating infections known as the neglected tropical diseases (NTDs). They include ancient scourges linked to poverty such as elephantiasis, river blindness, blinding trachoma, schistosomiasis, roundworm, whipworm and hookworm. Today, these NTDs are among the most common afflictions of the poor, and almost every person living in abject poverty suffers from at least one NTD. New research has shown that these NTDs, because of their long-standing effects on the mental and physical health of children and adults but especially girls and women, now rank among the most important reasons why people cannot escape poverty in the “global south,” including Africa and the Middle East, Asia and Latin America.

A man receives medications to prevent neglected tropical diseases

Prince Marah takes ivermectin and albendazole at Levuma community health center in Levuma, Sierra Leone.

For more than 150 years, German science has provided leadership in tropical medicine that makes it possible today to discuss the eventual global elimination of the NTDs. Theodor Bilharz discovered the cause of schistosomiasis (also known as bilharziasis) while working in Egypt in the 1850s; Otto Henry Wucherer conducted studies in Brazil in the 1860s that helped discover Wuchereria bancrofti, which causes 90 percent or more of elephantiasis cases; and Arthur Looss at the turn of the 20th century co-discovered the cause of hookworm, also in Egypt.

Then, in 2005, the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) and the World Health Organization organized a landmark conference in Berlin to integrate the control and elimination of the most common NTDs by combining mass treatments for these diseases in a simple “rapid impact package” of medicines. Today those low-cost (less than one Euro per person annually) packages have reached at least 450 million people. As a result, we are now seeing major reductions in the global prevalence of elephantiasis, river blindness and blinding trachoma. Thus, a decade following that historic Berlin meeting, we have the opportunity to eliminate at least these three NTDs.

The Berlin conference also promoted the importance of research and development so that today new interventions are underway including a human hookworm vaccine now in clinical trials in Gabon through a European HOOKVAC Consortium that includes both the Sabin Vaccine Institute’s product development partnership and the Institut für Tropenmedizin, Universitätsklinikum Tübingen. In the 19th century, both Bilharz and Wucherer trained in Tübingen.

The German Bundestag now has a significant opportunity to build on these successes. New legislation to support non-profit product development partnerships to produce new drugs, diagnostics, and vaccines could create a new generation of ground breaking technologies for the world’s poverty related diseases. In parallel, Germany can join the governments of the United States and United Kingdom in supporting the delivery of low-cost rapid impact packages, now recognized as one of the most cost effective global health interventions known.

Earlier this year, Chancellor Angela Merkel also delivered a historic address to the World Health Assembly about the important role the Group of 7 (G7) nations could have in eliminating NTDs. Her call to the G7 to take on NTDs can now be backed with time-sensitive action. The German Bundestag should reassert its historic commitment to these diseases, in the research and development space and for mass treatment. In so doing, Germany can lead efforts to finish the job it began more than a century ago.

Peter Hotez, M.D., Ph.D., is president of the Sabin Vaccine Institute (Sabin), Texas Children’s Hospital Endowed Chair for Tropical Pediatrics and dean of the National School of Tropical Medicine at Baylor College of Medicine. He also serves as U.S. Science Envoy for the White House and State Department.

Neeraj Mistry, M.D., M.P.H., is managing director of the Global Network for Neglected Tropical Diseases, an initiative of Sabin.

Lymphatic Filariasis: Why mainstream media must take note

by Navneet Anand and Anuradha Singh, GreyMatters Communications

_M6A7431Recently Global Network for Neglected Tropical Diseases (GNNTD) partnered with us at GreyMatters Communications to run a media awareness program on Lymphatic Filariasis (LF) in India. We took a group of journalists to two affected villages in Odisha to provide them exposure about the problem as well as help them evaluate challenges towards its complete elimination.

The Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute, works to raise the awareness, political will and funds necessary to control and eliminate neglected tropical diseases (NTDs).

Often falling beyond the purview of mainstream media, like many other compelling problems in the country, LF has severe enormity and has persisted in India as well as other countries of the world for many years.

Not many would be aware that LF is the world’s second leading cause of long-term disability. Although filariasis does not kill, it causes debility and imposes severe social and economic burden to the affected individuals, their families and the endemic communities. According to one estimate at one point in time 120 million people in 83 countries of the world were infected with lymphatic filarial parasites, and it was estimated that more than 1.1 billion (20% of the world’s population) are at risk of acquiring infection. Over 40 million people are severely disfigured and disabled by filariasis and 76 million are apparently normal but have hidden internal damage to lymphatic and renal systems. According to the World Health Organization, India, Indonesia, Nigeria and Bangladesh alone contribute about 70% of the infection worldwide.

Indigenous lymphatic filariasis cases have been reported from 20 States/UTs across 250 districts which were identified as endemic for filariasis with a population of about 600 million at risk. In India, a special program to eliminate lymphatic filariasis was launched in 2004 covering 202 endemic districts in 20 States/Union Territories and subsequently scaled up to cover all the 250 (now 255) endemic districts targeting a population of about 600 million.The population coverage during MDA has improved from 73% in 2004 to 83% in 2013, according to a document on National Roadmap for Elimination of LF by Ministry of Health.

It is rather heartening to note that the overall microfilaria rate has reduced from 1.24% in 2004 to 0.29% in 2013 (Prov.) at national level. Out of 250 districts 203 districts have reported overall microfilaria rate to less than 1%. Out of remaining 52 districts, 31 need high priority for focussed intervention as these districts have been persistently reporting microfilaria rate above 1%. Ganjam and Puri in Odisha, where we travelled, are also among the high-incidence districts in the country.

It was rather painful to come across two cases of Lakhender Swain and Kointa Swain in Kapileshwarpur village in Puri. Afflicted with this distressing disease, the two have wasted their most productive years attending to deal with this disabling disease. “I had a dream for my life but the tyranny of this disease was such that I was rendered helpless. For over 20 years now, I have lived with this heaviness in the leg and associated problems including social taboos and boycotts,” rued Lakhender, who is 45 only. Kointa, in her 60s, recalls how at one point she was extremely active and used to work “effectively” till destiny willed otherwise.

“NTDs like lymphatic filariasis hold people back not just physically, but also socially. Misunderstandings about what causes the disease, how it is transmitted and what its effects are can lead to stigma and social exclusion. This lack of understanding can cause communities to push LF patients to the margins, excluding them from employment or educational opportunities, from community festivals or celebrations and making it difficult to marry. The impact can go beyond the LF patient to also affect family members of LF patients. Self-stigma is also a problem and can impact a patient’s mental health. Social isolation compounds the impact of the infection, keeping people from trying to achieve their aspirations or have hope for the future. Although LF tends to be visible in rural and poor communities, LF is spread through mosquitos, like dengue and malaria, so anyone can be infected,” said Nandini Pillai, Programs and Operations Officer, GNNTD.

However, thanks to some serious and sustained intervention by the government as well as work by agencies like GNNTD as well as NGOs like CASA (Church’s Auxiliary for Social Action), the problem is well contained and India may well be on the verge of soon eliminating the disease altogether.

One of the key programs of the Government is Mass Drug Administration where all those at risk are administered medicine free of cost.

“The treatment is a weight-based dose of diethylcarbamizne (DEC), and a single pill of albendazole, to everyone over the age of 2 years and not ill or pregnant. Both drugs are anti-parasitic medications which prevent and expel parasites. These medicines also protect from intestinal worm infections. The treatment is safe and free and delivered to communities through ASHA workers and other community-based drug distributors. The drugs are donations from major pharmaceutical companies, like GlaxoSmithKline (GSK), or procured in India from WHO approved companies. They are completely safe,” informed Shaliesh Vaite, National NTD Advisor, GNNTD.

The 2015 MDA is underway nationwide from December 14-20.

The medical approach to defeating NTDs is through a set of medications donated by major pharmaceutical companies for free distribution to communities in need. “In India, state governments locally procure some medications and submit their requests for donated drugs to the central government, which then works with WHO to order and deliver the drugs. Community drug distributers are responsible for going door to door to hand out the drugs and ensure that people take them properly. This grassroots method for treating and protecting against NTDs takes the partnership of the whole community working in tandem, and ensures that nobody is left behind,” added Kelly Toves, Communications Officer, GNNTD.

Along with this, if media also undertakes to write more often and inform people about the ways to deal with this scourge, the process of elimination will be faster.

This post was originally published on Communicate, Connect.

Eliminating Lymphatic Filariasis in Odisha

ASHAs in Ganjam District, Odisha, India

ASHAs in Ganjam District, Odisha, India. Photo: Naveen Pun / Sabin Vaccine Institute

by Dr. Madan Mohan Pradhan

During the late 1990s, I was infected with lymphatic filariasis (LF), or elephantiasis, a neglected tropical disease (NTD) that can cause extreme pain, crippling disability and disfigurement. LF is one of 17 NTDs recognized by the World Health Organization (WHO) as a group of parasitic and bacterial infections, which primarily affect people living in extreme poverty.

The incident occurred after I completed my medical degree. I was eager to work in Odisha and help some of its most vulnerable and under-served communities. It was during this time that I began working on an LF project, making nightly visits to endemic villages to collect blood samples from fevered patients. I knew how LF was transmitted, but had limited knowledge on the preventive aspect. As is typical in most cases, I didn’t present symptoms until years later. When I saw my right foot swelling with redness and pain four years later, I immediately diagnosed the disease and took the full course of diethylcarbamazine (DEC) tablets. I was cured and never had a recurrence again. Though I was fortunate enough to stop the disease at an early stage, many are not as lucky.

During my tenure as a medical officer in rural Odisha, I saw a number of patients with LF. Many of them lived in the poorest communities, with limited resources and support from their families. Social stigma and discrimination, along with misconceptions about transmission of the disease, often made matters worse.

As we observe National Filaria Week from December 14 to 20, it is important to raise greater awareness about this disease, which threatens nearly 352 million people in India. It is particularly important to know the source of transmission of LF. It is not caused by a curse or deeds from a past life. And it is not hereditary.

Lymphatic filariasis is caused by a tiny parasite, which is transmitted by Culex mosquitoes. Globally, more than 120 million people are affected by this disease. People living in poor environmental and unhygienic conditions are vulnerable to the infection as the Culex mosquito breeds in these places. Most LF infected people may not have any symptoms and are found apparently healthy. But the LF parasite can be transmitted from these asymptomatic people to healthy people through mosquitoes. LF affects the lymphatic channels of the body due to which there occurs swelling of breast, lymph nodes, genital organs, and at later stage these swellings can result in disfiguration.

Although LF isn’t fatal, it can lead to disfigurement, disability and chronic pain. As a result, many people with LF are unable to make a living for themselves and their families. Social stigma and discrimination also limit the quality of life for those affected by LF. It is not uncommon for parents to be unable to marry off children with LF.

To facilitate greater progress in combating the disease, the WHO launched a global program to eliminate LF by 2020. They adopted the intervention known as mass drug administrations (MDA), in which two drugs — DEC and albendazole tablets — are co-administered in a single dose. These drugs are cost-effective and safe, and can be administered by trained community volunteers.

If more than 85 percent of the eligible population of at-risk communities consume the drugs once annually for five to seven years, the risk of LF infection will be minimal to zero. That is why the Indian government has prioritized efforts to eliminate LF through the National Vector Borne Disease Control Programme.

Besides the MDA, there are other components for LF elimination and morbidity management, including hydrocele operations. Government and non-profits are working to increase the knowledge and skill of LF-affected persons and family members on home care. For the success of both MDA and morbidity management, community involvement, participation from other government departments and active involvement of civil society organisations is essential. This requires high level political and administrative commitment and raising awareness through community participation

In Odisha, the MDA will be conducted on December 19, followed by two days of mop up rounds. Following 10 districts: Deogada, Boudh, Angul, Dhenkanal, Bhadrak, Jajpur, Jagatsinghpur, Nayagarh, Ganjam and Jharsuguda will be covered under 2015 MDA. During this time, drug administrators such as ASHA workers and other community volunteers, will make door-to-door household visits to administer the two drugs used in MDA. They will explain the safety and importance of taking the drugs and ensure that people consume drugs after eating; and monitor any adverse effects. If we continue our momentum and efforts in Odisha, we can eliminate LF within the next few years. Together, we can help create a filaria-free reality in Odisha and India.

Dr. Madan Mohan Pradhan is the joint director of health services for the National Vector Borne Disease Control Programme in Odisha, India.

This story originally appeared in the Orissa POST and the Political and Business Daily.

Introducing Jessica Ellis, November’s END7 Student of the Month

jessicaellis

Each month, END7 honors one student who has made a significant contribution to our growing movement of student advocates dedicated to seeing the end of NTDs. We are very proud to introduce our November 2015 Student of the Month, Jessica Ellis, a sophomore biology major at the University of Texas at Austin. Jessica is the president of END7 at UT and a member of the END7 Student Advisory Board. She shares:

“I discovered END7 at UT during my freshman year, the day that I quit the track team and was frantically looking for new activities to get involved in at a campus organization fair. Right away, I was hooked by the idea of ending seven diseases, and was blown away by the statistics about NTDs and developments in the control and elimination effort that I learned about at END7 meetings. The scale of this effort and potential for transformation of entire communities through disease elimination fit with my view of – and hopes for – the world.

“By the end of my freshman year, I knew that my involvement in global health and NTDs couldn’t just be an extracurricular activity for me. I wanted to do as much as I could for this cause as a student, and hopefully someday make it my career. So, it’s been really exciting to serve as the president of END7 at UT and as an END7 Student Advisory Board representative this year.

“In October, I had was given the incredible opportunity to travel to Philadelphia to attend the American Society of Tropical Medicine and Hygiene (ASTMH) annual conference with the support of a scholarship from the END7 campaign. I got to hear presentations by NTD experts from all over the world at the event, and left the “NTD bubble” I had been immersed in for three days excited to communicate this information back on campus. I shared much of the new information I learned a talk I gave at an event hosted by UT student organization Advocates for Awareness, trying to instill the sense of urgency and excitement around this cause that I took away from my time with the powerful global health community that I met in Philadelphia.

“It was definitely a busy fall semester for END7 at UT. We hosted two new (and hopefully annual!) events on campus. We held an evening advocacy event – lit by candles, Christmas lights, and the iconic UT Tower – and collected more than 100 messages from students urging the UN to prioritize NTDs in the Sustainable Development Goals with a target and indicator. We also organized a variety of student organizations from across the UT campus to come together and fundraise for non-profits on Giving Tuesday. I can’t wait to see what these events turn into over the next few years. Next semester, we are looking forward to hosting our annual benefit concert – a must for any non-profit hoping to fundraise in music-loving Austin!”

We are so grateful for Jessica’s commitment to the fight against NTDs, and we are excited to see our community of student supporters like her grow. If you are ready to get your school involved in END7’s work, contact the END7’s student outreach coordinator at Emily.Conron@sabin.org to learn how you can get started!