Nobel Honors for Medicine Elevate NTD Elimination to the Next Level

by Baroness Helene Hayman

In an age when sophisticated medical breakthroughs routinely redefine what we once thought was possible, a humble set of pills serves as a reminder that low-tech heath interventions can have a massive impact on much of the world’s population, particularly those living in extreme poverty.

Nearly 40 years ago, William C. Campbell and Satoshi Ōmura found that a drug used to treat parasites in animals could be adapted to treat people for two devastating parasitic diseases, onchocerciasis (river blindness) and lymphatic filariasis (elephantiasis), ultimately resulting in the creation of the drug ivermectin. For their achievements, Drs. Campbell and Ōmura shared the 2015 Nobel Prize in Physiology or Medicine with another groundbreaking researcher, Tu Youyou, who discovered the first drug treatment for malaria.

Ivermectin has since become part of an array of safe and effective drugs that treat a range of parasitic and bacterial diseases, commonly known as neglected tropical diseases (NTDs), which also include hookworm, ascariasis, trichuriasis, schistosomiasis and trachoma.

Today, we are on the cusp of controlling and eliminating several NTDs in countries around the world using these simple, low-cost drugs, which are being donated by the billions from pharmaceutical companies.

The United States and the United Kingdom have demonstrated remarkable leadership and commitment to the fight against NTDs through the support of the 2012 London Declaration, which calls for the control or elimination of ten NTDs by 2020. Germany put neglected and poverty-related diseases in the spotlight by including them as a key discussion item at this year’s G7 Summit. And the recent announcement of the Ross Fund — a £1 billion fund for malaria and other infectious diseases, including NTDs, created by the UK’s Department for International Development (DFID) and the Bill & Melinda Gates Foundation — is another step in the right direction.

Reaching the 2020 control and elimination targets for NTDs set by the World Health Organization would be one of the greatest public health victories of our time, but we are at risk of letting this potential triumph slip through our fingers if urgent action is not taken for more countries to join the United States, United Kingdom and Germany in supporting global NTD programs.

It comes down to this: governments — of both donor and endemic countries — must dedicate more funding to ensure that donated drugs reach at-risk communities on a timely and consistent basis. Given the links that NTDs have with HIV/AIDS and malaria, now is the time to have a sensible discussion about including NTDs as part of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The best news is that, largely due to the generosity of the pharmaceutical companies, the gap for funding global NTD programs is remarkably small — estimated at only $US220 million per year for the next five years. In a time of economic austerity, investing in this global health bargain would deliver transformative results, ridding a billion people of the daily burden of preventable parasitic diseases while providing real hope for significant improvements in economic development and equity.

Baroness Helene Hayman is a Crossbench Member of the House of Lords, Vice Chair of the All Party Parliamentary Group on Malaria and NTDs, and a Trustee of Sabin Foundation Europe.

Nobel Prize Awarded to Scientists Who Discovered NTD Medicine

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Rabi, who suffers from LF, and his children, Sanjay and Mamali, in Ganjam District, Odisha, India. Photo: Naveen Pun / Global Network for NTDs

Today the Nobel Prize in Physiology or Medicine was awarded to two scientists for the discovery of a drug that treats two common neglected tropical diseases (NTDs).

William Campbell and Satoshi Ōmura were honored for their work developing a new class of anti-parasitic drugs. The prize was shared with Tu Youyou for her discovery of a new malaria drug. The Nobel committee noted, “The global impact of their discoveries and the resulting benefit to mankind are immeasurable.”

Ōmura isolated a promising soil bacteria he found in a Japanese golf course, from which William C. Campbell discovered a component that proved remarkably effective against parasites. The component, named Avermectin, was subsequently chemically modified to be even more effective and called Ivermectin.

Her grand-daughter Adamsay Turay, 8, helps Lucy Bangura, walk in the town of Masongbo, Sierra Leone on Thursday July 12, 2012.

Her grand-daughter Adamsay Turay, 8, helps Lucy Bangura walk in the town of Masongbo, Sierra Leone on Thursday July 12, 2012. Photo: Oliver Asselin / Global Network for NTDs

Great progress has been made through annual mass treatment with the drug. Last year, more than 270 million treatments were donated to people in impoverished communities to treat onchocerciasis (also known as river blindness) and lymphatic filariasis (or elephantiasis). Some areas are now close to interrupting transmission and eliminating these two devastating NTDs which lead to blindness and debilitating swelling.

We celebrate the scientific discovery that made this possible and honor and applaud the efforts of all those who contribute to the fight against NTDs — from the companies that donate the medicine and the community volunteers who distribute it to the donors who sustain these programs.

After the discovery of the bacterial compound, it took decades to mass produce and secure the donation of Ivermectin. But in the next five years we can protect millions from onchocerciasis and eliminate lymphatic filariasis around the world by ensuring those in need have access to this Nobel Prize-winning drug.

TAKE ACTION: Please donate now to help us raise awareness, funding and political commitments to make sure NTD medications reach those in need.

Oplan Goodbye Bulate: Philippines Says Goodbye to Worms

The Philippines’ deworming campaign this year, Oplan Goodbye Bulate, was incredibly successful. More than 11 million children were dewormed in the campaign, beginning July 29, 2015, with most areas of the country reaching at least 75% of the children enrolled in public schools, the WHO recommended target for mass drug administrations (MDAs) for soil-transmitted helminths (STH). The Department of Health has planned for the school-based deworming program to occur biannually, with deworming days every July and January.

The Philippines was heralded in the third progress report of the London Declaration, Country Leadership and Collaboration on Neglected Tropical Diseases. Along with Bangladesh, Brazil, Honduras, and other NTD-endemic countries, the Philippines has demonstrated laudable leadership in mobilizing domestic resources to support their own NTD programs. Of the entirety of the Philippines’ NTD program budget, an impressive 94% is domestic.

A banner encouraging parents to ensure their children are dewormed on July 29, 2015.

A banner encouraging parents to ensure their children are dewormed on July 29, 2015.

The leadership demonstrated by the Philippines is particularly exciting considering the NTD burden in the Western Pacific Region and worldwide. While NTDs exist in 122 countries, an overwhelming majority of the burden rests on a handful of countries, including the Philippines. Ten countries are home to roughly 70% of the global population that requires treatment for NTDs, including the Philippines, which ranks as having the eighth-highest burden globally.

Intestinal parasites, including soil-transmitted helminths, are a significant health burden in the Western Pacific Region. According to the WHO, 32 of 37 countries and areas in the region are affected. If Oplan Goodbye Bulate continues successfully, the Philippines could soon meet the WHO target, significantly reducing the NTD burden in the Western Pacific Region — and worldwide.

To learn more about how the Philippines accomplished this recent success, we spoke with Division Chief of the Infectious Disease Office, Dr. Leda Hernandez, about Oplan Goodbye Bulate.

Q: Congratulations on your successful deworming campaign – an effort that reached over 11 million school-aged children in one day. What do you think contributed to this impressive accomplishment?

The Philippines’ deworming campaign done by the Department of Education and Department of Health has been ongoing since 2006, using established guidelines and protocols. There is one major difference between previous campaigns and the July 2015 National School Deworming Day (NSDD). This year’s Oplan Goodbye Bulate campaign was conducted in one day simultaneously all over the country. Then, we have one week of “mopping up,” which means that we make sure to treat children who were absent on the campaign day.

Q: What did the departments observe about this year’s deworming campaign, compared to previous ones?

The final report was issued 30 days after the one day launch, held on July 29, 2015. Approximately three months of effort was concentrated on one day, making the NSDD more efficient and practical. Another difference was that this was teacher administered and health worker supervised. There are at least three important lessons that we learned from this experience.

First, a lot of resources (time, money and manpower) can be saved by strategically integrating and harmonizing the implementation period. Secondly, timeliness of reporting can be significantly improved to promptly elicit available evidence-based data for decision making. And thirdly, the Integrated Helminth Control Program can now focus on integration of complimentary interventions such as water, sanitation and hygiene (WASH) and social and behavior change communication (SBCC), because of the time and financial savings.

Q: You created short videos and flyers about Oplan Goodbye Bulate to spread the word about the campaign. Why were these communication materials important to encourage participation? Were there other materials and outreach efforts that helped raise awareness of NTD treatment?

Advocacy and a lot of lobbying were vital to influencing local government unit participation. The Department of Interior and Local Government offered its people to provide manpower (health workers) to supervise the mass drug administration especially in geographically disadvantaged and isolated areas. Team work and collaboration by the three government agencies, support from partners, plus active community participation made a lot of difference and became our winning formula for good public service delivery.

However, as you know, misinformation can have damaging effects. It made us realize how fast information can spread like wildfire and that we should be prepared for that. However, it also made us realize that working together and solving issues early on was one of the strengths of this organization in times of crisis.

Q: Can you describe a particular community that has seen remarkable progress?

All regions were competitive and showed enthusiasm to beat their own previous records. There was a spirit of healthy competition and a desire to perform better, which is a good sign for everybody. All regions are now looking forward to the next round where they can apply good practices that they learned from one another during our consultative meeting last October.

Eight Million Toilets and Counting

By Alice Carter

world toilet day 2015Normally, we don’t like to talk about bathrooms. That is a private space that most of us would largely like to avoid thinking about. But on World Toilet Day, we give thanks for our sanitary facilities and celebrate the invention of the toilet, which has saved countless lives as a disease control mechanism, and gives us privacy to, you know, go.

There is a Sesame Street song, a global “urgent run,” and an art show in New York. All of these types of events are celebrations for the often overlooked efficiency of the mundane technology that is a toilet, but also are opportunities to spread awareness of just how precious our access to toilets really is. One in three people around the globe don’t have access to adequate sanitary infrastructure, leaving them at increased risk for neglected tropical diseases (NTDs) that are spread through contact with fecally-contaminated soil. Half of the people who practice open defecation globally live in India, where 1.1 million liters of human excrement enter the Ganges River every minute. Recognizing the toll that open defecation takes on health, education and economic output, the government of India is trying to increase access to sanitation infrastructure and put an end to open defecation.

Prime Minister Modi has pledged that India will be open defecation free by 2019, and under his leadership the government has set up incentives for toilet construction and usage. Swachh Bharat Abhiyan — the Clean India Mission — is a sanitation campaign run by the Indian government, with the joint objectives of reducing open defecation and changing behavior to increase the use of sanitary facilities. Prime Minister Modi launched Swachh Bharat on Mahatma Gandhi’s birthday in 2014. The government also plans to raise Rs 3,800 crore (approximately 550 million USD) from the public to support this initiative, which gives subsidies for toilet construction and helps villages become certified as open defecation free. As of August 2015, 8 million toilets have been constructed as part of the campaign.

Unfortunately, it is tricky to measure the prevalence of open defecation and people’s toilet usage. Simply constructing a toilet in every home and school won’t make people start exclusively using toilets, especially if they don’t know the benefits of sanitation infrastructure and the risks of open defecation. For this, public awareness campaigns are also needed, and people need to be given plenty of reasons to use the toilet exclusively. One motivating factor for people to switch from open defecation to toilet use is awareness of the health risks of open defecation.

In communities that continue to practice open defecation, children playing outside or walking to school with no shoes can be exposed to contaminated soil, putting them at risk for infection by soil-transmitted helminths (STH). Similarly, clean drinking water sources and uncooked fruits and vegetables can be contaminated, increasing the risk of infection.

On the other hand, access to a household latrine has been found to reduce the risk of infection with STH by 40%. Nadia, a district in West Bengal, India, was the first district to be certified as open defecation free, and has since noted a decreased incidence of diarrhea and malnutrition. Reduced NTD infection is a strong indicator of the success of the Swachh Bharat campaign. Including an NTD indicator in Swachh Bharat would give the mission concrete targets to measure exclusive toilet use in communities where the campaign has built toilets, and it would help spread awareness of the negative health impacts of open defecation.

Perhaps on Gandhi’s 150th birthday, in 2019, India will have achieved its goal of ending open defecation. He would be proud, as he often stressed that a society’s approach to private and public sanitation reflects its commitment to true freedom and dignity.

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