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.
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.
During the month of October, END7 student supporters are celebrating NTD Success Stories from four countries — Haiti, India, Sierra Leone and the Philippines — that have overcome incredible obstacles to make progress towards NTD control and elimination. This week’s success story comes from Sierra Leone, where inspiring efforts are being made to fight NTDs in the wake of the Ebola epidemic.
Six NTDs are found in all 14 health districts in Sierra Leone, threatening nearly the entire population of the country. Sierra Leone faces many health and development challenges, but the government has exerted strong leadership in the fight against NTDs. By 2004, the national NTD program had successfully mapped the prevalence of targeted NTDs nationwide, and in 2005 they launched a mass drug administration (MDA) campaign to treat every at-risk community with the participation of nearly 30,000 volunteer community drug distributors. Supported by the U.S. Agency for International Development (USAID), Sierra Leone’s Ministry of Health had distributed more than 57 million NTD treatments nationwide by the beginning of 2014. As a result of these efforts, the country was on track to begin the World Health Organization process of verifying the elimination of lymphatic filariasis (LF) in eight of 14 health districts in 2014. Unfortunately, when the West African Ebola epidemic reached Sierra Leone in May of that year, all public health program activities were suspended as the country raced to stop the spread of Ebola. As a result, the Sierra Leone NTD Program was unable to carry out MDA in 2014, interrupting progress towards LF elimination.
But today, the government of Sierra Leone and partner organizations are working hard make up for lost time. In May of 2015, on the heels of nationwide malaria and vaccination campaigns, MDA restarted in Sierra Leone. Just this month, from October ninth to 13th
The relaunch of MDA this year required careful preparation, including refresher training session for community drug distributors and program administrators. Extensive social mobilization campaigns, aimed at educating communities still reeling from the Ebola epidemic about the importance of participating in MDA, were conducted through community meetings and radio spots. As a result of this careful preparation, early indications are that Sierra Leone’s 2015 MDAs have been successful.
The consistent key to Sierra Leone’s inspiring success tackling NTDs before and after the Ebola epidemic has been the leadership and commitment of volunteer community drug distributors. Elected by their communities, these volunteers reach the most remote corners of the country, enabling Sierra Leone to consistently achieve treatment coverage above 75 percent in targeted communities.
Given Sierra Leone’s small geographic size, the strong political support of the government and the commitment of the volunteer community drug distributors who form the backbone of MDA programs, the country is in the unique position to become one of the first countries in Africa to control snail fever and intestinal worms and eliminate river blindness and elephantiasis. Sierra Leone’s NTD program has also successfully demonstrated that MDA can be achieved in highly populated urban settings. But additional support is needed. By integrating NTD treatment with schools and other health programs, millions of people at risk for NTDs can live free of these diseases of poverty and their devastating effects including malnutrition, disability, social stigmatization and a loss of productivity.
Sierra Leone’s progress against NTDs despite the challenges posed by the Ebola epidemic should inspire other countries to redouble their efforts to address these diseases. Now more than ever, support for robust public health efforts like Sierra Leone’s NTD Program is needed to build on this impressive progress. END7 supporters are eager to celebrate Sierra Leone’s progress and look forward to celebrating more milestones as the country moves closer to its ultimate goal of controlling and eliminating NTDs.
During the month of October, END7 student supporters are celebrating NTD Success Stories from Haiti, India, Sierra Leone and the Philippines. Each country we are spotlighting has overcome their own challenges, ranging from earthquakes to the Ebola epidemic, to make sure communities receive NTD treatment and progress towards disease control and elimination. The examples of these four diverse countries help communicate not just the scope of the suffering caused by NTDs, but the hope we have of ending these diseases for good. Last week, we celebrated Haiti’s inspiring progress towards the elimination of lymphatic filariasis, and this week we’re looking across the globe to India, a historic leader against that and many other NTDs.
India’s diverse population has experienced rapid economic growth over the past two decades, but the country still faces significant health challenges due to its size and high burden of disease. Almost half of the 1.2 billion people at risk of lymphatic filariasis (LF) infection globally live in India. Additionally, NTDs such as soil-transmitted helminths (STH) negatively impact hundreds of millions of children in the country, causing delays in cognitive and physical development. These NTDs take a heavy toll on economic productivity and chronic infections perpetuate the cycle of poverty. However, the Indian government has one of the largest and most successful NTD programs in the world, and treatment scale-up is paving the way towards the elimination of LF and the control of STH infections on the subcontinent.
The Indian government first launched a pilot program to tackle LF in 1949. Over the next four decades, the government supported important research and demonstration studies that became the technical backbone of the World Health Organization’s Global Programme to Eliminate LF, launched in 2000. India’s experience with LF provided the evidence for the operational and technical feasibility of mass drug administration (MDA) to eliminate LF — a strategy that has since been adopted in countries around the world.
Today, India leads the world’s largest MDA program, reaching more than 400 million people with an annual dose of preventative medicine for LF. To date, India is one of only two countries who have achieved MDA coverage at a national level, and the population at risk of LF in the country has been reduced from 600 million to 460 million as a result. The country has also successfully scaled up efforts to control STH infections at the state level, particularly through school-based deworming programs, and recently launched a National Deworming Day to coordinate multiple platforms for deworming into one cohesive push to tackle STH in children under 19. This initiative will encourage coordinated efforts, budgeting, and monitoring to improve the efficacy and reach of deworming programs.
Several districts in India are in the process of undergoing Transmission Assessment Surveys, evaluations designed to register whether LF transmission has been interrupted and annual MDA can cease. Moving forward, bi-annual MDAs will continue in districts with a high burden of LF. Continued efforts aimed at interrupting transmission of diseases, disease surveillance, early diagnosis and response, as well as continued community mobilization and education to change risk behaviors will be critical to reducing the LF burden in India. Managing the disease among existing patients, particularly those disabled by LF with elephantiasis or hydrocele, is also a high priority.
India’s Ministry of Health and Family Welfare worked with the Global Network for Neglected Tropical Diseases in November 2014 to produce a mass media campaign, Hathipaon Mukt Bharat (Filaria Free India) to raise awareness of LF and encourage people to participate in MDAs. The video created for the campaign, entitled Giant Footprints!, won silver at the Cannes Festival of Creativity in 2015. Bollywood star Abhishek Bachchan is also supporting India’s effort against NTDs as the END7 campaign’s first official ambassador in India.
These ongoing social mobilization efforts will be critical to achieving national, regional and global NTD control and elimination goals by 2020. If India’s current NTD efforts can be maintained and expanded, those at risk for NTDs can live free of these diseases of poverty and their devastating effects. And as the leader of one of the oldest and largest programs to tackle NTDs, India can be a leader in assisting other endemic countries hoping to replicate their success around the world.
There’s ample reason to hope that history will repeat itself in India as the country celebrates the elimination of polio and looks towards new goals, like the elimination of LF. The country’s example shows that directing the expertise of different agencies and organizations towards a common goal can be successful even in a country with a large and diverse population. END7 supporters are eagerly following the good news from India — the second success story we’re spreading in a month that’s already offered many reasons to celebrate — and hoping to see it replicated worldwide.
During the month of October, END7 student supporters are celebrating NTD Success Stories — spreading the exciting news that many countries around the world have already made incredible progress towards the control and elimination of some NTDs. In recent weeks, there have been many new successes to celebrate, like the announcement two weeks ago that Mexico has become the third country to officially eliminate river blindness, and the exciting news Monday that William Campbell and Satoshi Omura were awarded the Nobel Prize in medicine for their discovery of ivermectin, a drug used to treat and prevent onchocerciasis and lymphatic filariasis. This month, in addition to these exciting announcements, we want to highlight four countries — Haiti, India, Sierra Leone and the Philippines — that have achieved success fighting NTDs. Each country has overcome their own challenges, ranging from earthquakes to the Ebola epidemic, to make sure communities receive the medicine they need. We think these stories help communicate not just the scope of the suffering caused by NTDs, but the hope we have of ending these diseases for good.
The poorest country in the Western hemisphere, with the highest infant mortality and lowest life expectancy, Haiti is a country with many challenges. But the story of Haiti’s success against NTDs is a powerful reason for hope. Nearly the entire population is at risk of contracting lymphatic filariasis (LF), a mosquito-borne NTD. Caused by thread-like filarial worms that live in the lymphatic system, LF causes painful swelling of the extremities (a condition known as elephantiasis) and genitals (a condition known as hydrocele). The high prevalence of NTDs like LF persists, in large part, because of poor access to water and sanitation. About nine out of ten Haitians in rural areas do not have access to clean, safe water, and almost half lack access to adequate sanitation facilities. These circumstances were compounded in the wake of the 2010 earthquake that killed at least 200,000 people and destroyed much of the nation’s infrastructure. Despite these challenges, Haiti is making incredible progress against NTDs and expanding its national NTD control program with the goal of eliminating LF for good.
Under the leadership of the Haitian government, a range of partners have assisted with the annual distribution of drugs to help prevent the spread of four NTDs: LF, whipworm, hookworm and roundworm. A critical aspect of the success of these efforts has been the training of more than 30,000 local community leaders to organize, promote and carry out mass drug administration (MDA), distributing medicine to everyone in at-risk communities.
Until the 2010 earthquake, Haiti’s Neglected Tropical Disease Control Program conducted MDAs only in the areas of the country where LF was most prevalent. The crowded capital city of Port-au-Prince, with relatively low levels of LF infection, was thought to be too difficult a setting to carry out MDA. But after two million people were left homeless following the earthquake, internal migration threatened to redistribute the disease. The Haitian government then decided to focus on national MDA coverage, with the aim of completely eliminating the disease and preventing redistribution.
By late 2011, at least one round of MDA had been conducted in all endemic areas of Haiti except the capital, Port-au-Prince. From November 2011 to February 2012, an MDA was conducted for the first time in the crowded metropolitan area. delivered its one billionth treatment worldwide at a ceremony in Saint-Louis-du-Sud, Haiti, a testament to the country’s commitment and progress in the fight against NTDs.
Haiti is also an example of an integrated approach to combating NTDs, having successfully integrated its LF and soil-transmitted helminth (STH) control programs, which previously operated in separate units at the Ministry of Health. To supplement expanded MDA efforts, the country is also scaling up efforts to address the needs of Haitians already incapacitated by LF and to fortify table salt with medicine to prevent LF, an approach that has helped countries like China eliminate the disease. These efforts are supported by dedicated partners including the Pan American Health Organization, the Inter-American Development Bank, the U.S. Centers for Disease Control (CDC), USAID, the University of Notre Dame Haiti Program, IMA World Health and CBM.
Haiti is one of just four countries in the Americas where LF remains endemic, accounting for 80% of people at risk of the disease in the region. If the country can succeed in their effort to eliminate LF by 2020, it would be a major milestone in global efforts to end the disease. As Dr. Patrick Lammie, an immunologist with the CDC, told NPR, “If a country like Haiti, with all of the challenges that theyve faced over the last few years, is able to achieve full national coverage, I think that is an important example for other countries, which are struggling to scale up their programs as well.”
Certainly, a country that has not just maintained, but expanded efforts against NTDs in the face of political instability and crippling natural disasters is a powerful example to the rest of the world. Haiti’s success demonstrates the power of country ownership, government leadership, partnerships and integrated and holistic public health programs in the fight against NTDs.
END7 supporters are excited to celebrate Haiti’s unfolding success story, a narrative of perseverance in the face of challenges — and the first of four inspiring NTD Success Stories in a month that’s already offered many reasons to celebrate!