Posts Tagged ‘chagas disease’

Global Health: The Marketing and the Programming

October 19th, 2010

By: Alanna Shaikh

One of the most challenging things about global health is the need to keep telling our stories. Our work isn’t funded by the people who benefit directly from our efforts. Instead, it’s supported by a whole network of donors: individuals, foundations, governments, UN agencies, and more. None of these donors gets much direct benefit from their support.

That means, in practice, that an awful lot of global health work involves talking about that work. Donors need proof that their money is being well-spent. They need to know the works it supports is important. And they need to be reminded of the benefits they reap from improved global health. That means conferences where program results are trumpeted. Success stories for donors to publish. High resolution pictures suitable for reprinting and as much media coverage as you can generate and still implement your program simultaneously.

It’s tough.  Showing your donors that their money is being carefully husbanded and efficiently used is probably the easiest part of the task. For one thing, you don’t have to collect any new data. Any good program knows where their money goes, and what its impact is. Packaging that information into a form that your donor can understand is time-consuming, but rarely all that difficult. » Read more: Global Health: The Marketing and the Programming

New Drug for Chagas Disease?

July 8th, 2010

By: Alanna Shaikh

Right now, two drugs are approved for Chagas disease, benznidazole and nifurtimox. Count them. 1. 2. Doesn’t exactly insure confidence, does it? Also, as an added bonus, they’re 30 years old, which means that there is plenty of resistance to the drugs. They only work in 60-85% of adults, although, thankfully, they do better on children. It’s clear, though, that in terms of Chagas treatment, there is really nowhere to go but up.

That’s why this press release is such good news. “Merck today announced plans to initiate a Phase II investigational proof-of-concept clinical study to evaluate its oral antifungal agent posaconazole for the treatment of chronic Chagas disease.” (Don’t worry, I’ll translate.)

After spending some quality time with Wikipedia and google. I can tell you that a proof of concept study is what they do to determine that a drug can work. It’s the small, brief, study with carefully selected participants that comes before a bigger clinical trial. So, if posaconazole turns out to be effective in this small study, it will go on to broader testing.

The proposed study will be randomized and placebo controlled. It will test the effectiveness of 60 days of posaconazole treatment in 160 adults in South America.* It will follow the participants for 360 days. They’ll test the participants’ blood for the presence of the parasite that causes Chagas disease.

images.com/corbis

If posaconazole is effective in the proof on concept study, it will go on to full trials. That will mean more participants in more locations, and possibly longer periods of time. However, posaconazole is already on the market for other diseases. It is being used in the US to treat Aspergillus and Candida infections in immunocompromised patients 13 years and older. That means we already have safety data on the drug. We don’t have to do a million studies to see if it has horrible side effects. We just have to find out if it really works for Chagas disease.

So, maybe we’re not too far away from a third drug for Chagas disease. That’s a 50% increase in available treatments. Everybody cross their fingers and knock on wood.

It also makes me wonder – how many existing drugs might work on other NTDs? If there is a drug that works for Chagas already in use, what else might be out there? Are we going to find out that Tamiflu works on encephalitis? Prilosec for elephantiasis? Triclosan for trachoma?

Probably we’re not going to find an NTD miracle cure in the bathroom cabinet. But I am awfully glad for the reminder that pharmaceutical companies are still hard at work seeking treatments, even for neglected tropical diseases.

*This is a great example of drug research done right in the developing world. They’re testing the drug in South America, which is also where the drug will have the most impact. That’s not medical exploitation. It’s responsible testing and responsible medicine.

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.’

Chagas – Not So Tropical After All

June 23rd, 2010

by: Alanna Shaikh

I just read an impressively scary article about Chagas disease. You should read it too, if you have access. It’s only eight pages long and it provides a clear glimpse into the future of communicable diseases. Once Chagas was a Latin American problem; it is now in the process of becoming global. On the off-chance you don’t have the article, or aren’t up to eight pages of journal reading , I’ll summarize it here for you.

In short, Chagas is spreading across the planet in a surprising way. The cause of this globalization is not, as you might expect, global warming (although that is increasing the natural habitat for Chagas.) Instead, the disease is being spread by emigration from Latin America. The disease has traveled with emigrants to Australia, Europe, Japan, and Canada.

T. cruzi, the protozoan that causes Chagas disease, can stay dormant in the human body for years. So, when emigrants travel, the disease goes with them. It started out as a novelty – a surprise to physicians. It’s now included in standard medical screenings. The article recommends training physicians on the diagnosis and treatment of Chagas disease and that policymakers develop national plans for prevention and treatment.

The article goes into more detail on the statistics of Chagas infection and transmission. They’ve got data on infection rates in Europe and Australia, broken down by the country of immigrant origin. What really interests me, though, is the trend we’re looking at here.

People move around. They travel for vacation, they take business trips, and they leave their homes in search of better prospects elsewhere. And they take their infections with them. Global air travel means the end of region-specific diseases. During the swine flu pandemic, we saw exactly how fast an infection can spread. Geographic distance is not the protection it used to be.

Right now, Chagas is still a Latin American disease, but this article, as discussed, shows that’s changing. The larger point is that other diseases are expanding, too, because of both climate change in the increased accessibility of air travel.

The wealthy world is already stepping up malaria control to stay ahead of the territorial expansion caused by climate change. Yellow fever, dengue, and encephalitis are other likely candidates for growth as the weather becomes more and more to their liking.

And that effect of climate change is exacerbated by the airplanes. Drug resistant TB is brewed in a few hot spots, like Baku, Azerbaijan, and then dispersed by travel and emigration. The WHO reported on this three years ago, looking at infection transmission in airline cabins.

Between human migration, climate change, and actual disease spread in airplanes, the NTDs aren’t going to remain tropical for long. Right now, it’s easy for wealthy countries to ignore their impact since they assume that the diseases won’t come home. That won’t be true for much longer. There is a moral imperative for the countries who can afford it to fight NTDs, but it’s increasingly obvious there is blatant self-interest as well. If we can lower disease rates in the NTD endemic countries, there will be less to transmit to everyone else.

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.”