Lancet seminar: lymphatic filariasis and onchocerciasis, NeLM news service
Medications to Treat Human Worms, Amy O’Connell, Live Strong
Merck Provides New Funding to Fight HIV/AIDS in Botswana, PharmaLive
Study of cell division sheds light on special mechanism in egg cells, Lab Spaces

Ugandan Man Helps Rid His Community of Onchocerciasis, Carter Center
Can Intestinal Parasites Help Crohn’s Disease?, Mary Desaulniers, AutoImmuneDisease
PLoS ONE is launched by the Public Library of Science, Bio-Medicine
Pakistan flood donations top $26m, The Press Association
Struggle for food as Pakistan floods worsen, Sally Sara, ABC News

Women outside clinic in Gashora, Rwanda. Photo: Lindsay Wheeler

It’s hard to argue against the fact that there are many global health interventions that can go a long way toward the control and elimination of  many neglected tropical diseases (NTDs). Global health initiatives have become an intrinsic part of international aid policy.

At a low financial cost, single disease campaigns  in various countries like Rwanda, Burundi, Mali and Sierra Leone for instance, have seen success in deworming children and treating patients for schistosomiasis, onchocerciasis, and trachoma.

However, a recent study conducted in  Mali by the Antwerp Institute of Tropical Medicine and published in the journal PLoS Neglected Tropical Diseases found that single disease campaigns while beneficial, weakened the overall health care system and interfered with routine healthcare delivery and provision systems.

The Antwerp team examined 16 healthcare centers in Mali that were involved in a large-scale integrated treatment campaign funded by USAID and a number of pharmaceutical companies in order to tackle lymphatic filariasis, river blindness, schistosomiasis, soil-transmitted helminthiasis and trachoma.

They found that of the 16 centers, only two were sufficiently staffed and supported and were able to conduct normal duties during the drug distribution campaign. The other 14 centers faced enormous operational problems. People were getting treated for specific NTDs, but healthcare for their other ailments were not being tended to.

According to the authors, “Several informants also criticized the high priority given to targeted diseases, while more common health problems received little attention; they worried about the campaign mobilising energy and diverting staff’s attention from routine care delivery.”

The authors also found that while training and education helped staff improve specific drug delivery, it did address other disease control strategies, such as sanitation and curative care.

Overall, the authors contend that mass drug administration for NTDs is still crucial and a positive global health initiative, however they stress that health system strengthening must be improved.

“Health system strengthening should rely on country-specific development plans aligned with national policy, and requires a comprehensive approach across diseases and health problems and coordination among GHIs…..Progress towards effective and inclusive health systems will not result from the sum of selective GHI interventions.”

The treatment of NTDs in countries that suffer from a high disease burden is a necessity, there is no argument here.  However we cannot overlook how global health initiatives impact and disrupt existing health systems.

This month marks the 150 millionth treatment against river blindness by international development NGO Sightsavers. Since 1987 when pharmaceutical company Merck & Co., Inc. took the pioneering decision to donate Mectizan® (ivermectin), the treatment that had been shown to effectively and safely treat onchocerciasis (also called river blindness), Sightsavers has been working with its partners to tackle this neglected tropical disease (NTD) and ensure that it is eliminated as a threat to some 120 million people worldwide, 99 percent of whom live in Africa.

Transmitted through the bite of the black simulium fly which breeds in fast-flowing water, river blindness can lead to permanent loss of vision. The onset of blindness tends to affect people in their thirties and forties, meaning that many children miss out on education because they act as full-time carers to older relatives.

New evidence from APOC (the African Programme for Onchocerciasis Control) has found that transmission of the disease can be stopped and the cycle of infection broken if Mectizan® (ivermectin) is taken annually for 15-17 years. This means that in the future this NTD could be eliminated. In the interim, the drugs donated free of charge by Merck & Co., Inc. allow the disease to be treated and controlled.

It’s estimated that as many as one million people are blind or severely visually impaired through river blindness. Another 18 million people are currently believed to be infected. In 2009, Sightsavers was able to treat almost 25 million people in Africa, focusing on Ghana, Nigeria, Sierra Leone and Mali.

Deepak Khanna, Managing Director of Merck Sharp & Dohme Limited (MSD) commented: “This amazing milestone is an opportunity to thank Sightsavers for the support and commitment it has provided to the Mectizan Donation Program. As a result of this partnership, the sight of millions of people in some of the most disadvantaged countries is being protected and the Program is recognised as a model of a successful and sustainable developing world health initiative.”

One of the main challenges in fighting this disease is getting the treatment to remote communities. Sightsavers has helped to introduce the community-based distribution system which uses trained village volunteers to hand out the drugs at a local level. This approach has been adapted to other healthcare activities all over Africa such as Vitamin A distribution, cataract identification, mosquito net distribution and management of other parasitic diseases.

Nigeria is the most endemic country in the world for river blindness, with an estimated 27 million people needing treatment. In Kaduna state, everyone understands the importance of taking the drug annually. Blessing, aged 10 from Anguwan Aku Village, is responsible for fetching water from the stream for her family, making her susceptible to the bite of the black fly that spreads river blindness. Her grandfather Kugiya has lost his sight from this disease, but Blessing is protected by taking Mectizan® (ivermectin).

Caroline Harper, Chief Executive of Sightsavers comments: “River blindness is a disease that could – and should – be consigned to medical history just like smallpox. Together with our local partners, other international organisations and the immeasurable support of Merck, we’ve come a long way since we started distributing Mectizan® 23 years ago, but we still have more to do to help eliminate river blindness as a public health threat.”

The Neglected Tropical Diseases department of the World Health Organisation identifies 13 NTDs which are believed to affect one billion of the poorest and most vulnerable people in the world.  Together, many NTDs cause severe disability, resulting in billions of dollars of lost productivity.  River blindness, is one of these diseases as is trachoma, another blinding condition, and Sightsavers maintains that treating such diseases is one way to help alleviate poverty in some of the world’s poorest communities.

For further press information, a more detailed briefing document, case studies or photographs please contact Rachel Heald on 01444 446754, rheald@sightsavers.org. For media inquiries out of hours, please call 07775 928253.

Photo Credit: Lindsay Wheeler

By: Tara Hayward, Resource Development Officer, Sabin Vaccine Institute

The economy has started to thaw and donors of the world are beginning to relax. Bill and Melinda Gates, along with Warren Buffett, have a launched an epic challenge for the world’s billionaires – Give away half of what you have.  While The Giving Pledge is specifically focused on billionaires, it feeds on inspiration from philanthropic efforts that encourage everyone – of all financial means and backgrounds. We all can help make the world a better place, right?

In the context of all the millions and billions of dollars floating around, as donors, we naturally start to wonder if we can do anything, if we can make any impact with a $20 donation to our favorite cause. The answer? Yes!

The beauty of working to treat and eradicate Neglected Tropical Diseases (NTDs) is that it can be done. There are inexpensive, safe and effective treatments available for the seven most common NTDs. The impact of a $20 gift to the Global Network for Neglected Tropical Diseases is measurable and meaningful. For a $20 investment in the Global Network, 40 people can be treated for one year – at an average of 50¢ each – with a ‘rapid impact package,’ a combination of four drugs that effectively treat the seven most common NTDs.

Infectious and neglected tropical diseases are diseases of poverty.  They disable, disfigure, and stigmatize, helping to lock nearly 1.4 billion people into a cycle of poverty, disease, and untapped potential.

The World Health Organization notes in a 2003 report to the United States Congress that treatment of schoolchildren with deworming drugs can reduce absenteeism in primary school by 25% and can lead to higher wages later in life.

With $20, you can impact the lives of 40 people. That’s 40 people that will stay in school and earn wages to support their families. That’s 40 people who won’t be impaired by adverse outcomes of NTDs, like anemia, malnutrition, physical and cognitive impairment, and infant mortality. That’s 40 people that won’t suffer from worms.

Manuel Claros, winner of the Global Network’s individual Campus Challenge, recently wrote on End the Neglect about the impact that treatment for parasites had on his life. Because he was regularly given treatment for parasites during childhood in Colombia, his worms went away, his health improved, and eventually, Manuel became a doctor. His experience was an impetus to join in the fight against NTDs and HIV/AIDS, and most recently, to work to complete an MPH in Global Health Policy.  Imagine this change to the lives of 40 children with potential to thrive like Manuel.

It’s natural to wonder what a single person can really do to ease global poverty and disease. Unfortunately, we can’t all give away millions. It’s good to be critical of your investments and serious about the kind of impact you can make. It also feels good to make a positive impact with as little as 50¢.

Tara Hayward is a Resource Development Officer at the Sabin Vaccine Institute. She has a M.A. in International Development and served as Peace Corps Volunteer in Romania. She is enthusiastic about organic gardening and loves to travel.

Leaders Weigh In On Global HIV/AIDS Funding, Medical News Today
Number of HIV-positive in treatment rose by a quarter last year, Chicago Tribune
More than five million people receiving HIV treatment, Webwire
Lymphatic filariasis: education leads to big increases in numbers who comply with treatment, Paul Chinnock
Uganda: Riverblindness Falls to 7 Percent, Eriosi Nantaba, All Africa

Potential TB Drugs Investigated Against Multiple Neglected Diseases, Medical News Today
Urinary schistosomiasis in pre-school kids in Nigeria, Robert Herriman, The Examiner
Miracle Medicine Mends Nigerian Tailor’s Eyesight, The Carter Center

By: Bill Brieger

Roll Bank Malaria (RBM) was launched in 1998, but actual scale up to universal coverage is only happening in 2010. By Comparison, the African Program for Onchocerciasis Control (APOC) took off in 1996 and has been scaled up for several years in all but a few of its endemic countries. Granted, APOC has a relatively smaller target area, but it now regularly reaches over 127,000 African villages with annual doses of ivermectin.

Both programs have in common the need to sustain their scaled up for many years into the foreseeable future if disease elimination is to be achieved.

This need for a long term perspective causes concern when one reads about a threat to continued funding for APOC’s Borno State, Nigeria project, and raises speculation whether malaria efforts may face the same threat a few years down the line.

Photo Courtesy of http://www.malariafreefuture.org/blog/?p=972

APOC started with a very clear vision of sustainability. APOC, a government entity (state, province, district, or country) and a non-governmental development agency (NGDO) would enter into a financial and programmatic 5-year partnership to establish community directed treatment with ivermectin (CDTI – see photo of CDTI in Cameroon at right). APOC’s financial contribution would be largest in the first year, when the overall budget would be largest because of start up costs.

Over time, program costs were to reduce, as would costs per person treated because of economies of scale. APOC’s share of the budget would decrease relative to that of the government partner, though the overall budget to maintain the program into the future was expected to be smaller and more manageable to the government partner with some continued support from the NGDO.

Free supplies of ivermectin from the Mectizan Donation Program would continue as long as there was need, but by the sixth year of operation, it was hoped that countries could sustain their own CDTI efforts. Apparently this has not been easy.

Evidence of problems with Borno’s CDTI project surfaced in 2007 at a meeting of APOC’s Technical Consultative Committee where the following report was shared. “Borno has maintained a good geographic and therapeutic coverage. However, the project has the following challenges:

* Non-release of funds by state and LGAs
* Inadequate number of FLHF staff
* Selection and training of more CDDs
* Obtaining funds from the government

IRIN now reports that after 11 years of operation “The (Borno State) government was supposed to provide counterpart funds to run the river blindness programme, but it has not done so, (according to) Borno State’s onchocerciasis coordinator Galadima.” Hellen Keller International (HKI) is Borno’s NGDO partner for CDTI and has been trying to make up the slack.

Unfortunately “HKI funding has been hit by the global recession, says (a representative). ‘Since the recession our donors have turned their attention elsewhere with little consideration for Africa and this affects the volume of funds for intervention projects like the onchocerciasis.’

Project staff complained to IRIN that, “We have been crippled financially due to lack of state counterpart funding. We sometimes find it hard to fuel our vehicles and go for supervision in the affected communities.”

There were hopes that another four years of government funding would put Borno within reach of elimination goals, but project staff lament that, “If the project stops at this stage, the effects will be devastating. It will turn the tide of the success we have achieved which will be quite disastrous.”

Let’s move this scenario forward to 2015 and change the disease to malaria. Let’s assume that talk of funding ceilings by donors has become a pressing reality and countries need to contribute more to sustain malaria interventions and achieve elimination. Let’s hope we don’t wind up again like malaria control did in the 1950s and ‘60s – eliminating the programs, not the disease.

PS – The IRIN article does have some potential technical problems. It referred to the CDTI as a program to create ‘immunity’ to onchocerciasis, whereas ivermectin actually is a drug to kill the microfilaria of the parasite and keep infection at a low level until such time as adult worms die and transmission in the community stops. There is also concern about the figure of $18 per person treated. Normally at this advanced stage of the program we should be talking in terms of cents, not dollars. These technical problems with the article do not detract from its serious financial message.

Bill Brieger is currently a Professor in the Health Systems Program of the Department of International Health at Johns Hopkins University as well as the Senior Malaria Adviser for JHPIEGO, JHU’s family and reproductive health affiliate. He was a Professor in Health Education at the African Regional Health Education Centre, University of Ibadan, Nigeria, from 1976 to 2002. His research interests have focused on the social and behavioral aspects of tropical disease control, and in the area of malaria research, funded by the Unicef/UNDP/World Bank/WHO Tropical Disease Research program (TDR) and USAID implementing partners, this has included acceptability of pre-packaged antimalarial drugs, urban malaria, role of patent medicine sellers in malaria treatment, and community and cultural perceptions of malaria as a basis for village health worker training and health education.

Millions could be spared with funding increase, VOA News
Researchers Call for ‘Social Offset’ to Tackle NTDs, Science Daily
Neglected diseases: Teach or treat?, Megan Scudellari, The Scientist
WHO says under-5 deaths drastically reduced, Afrique en ligne
Nigeria: When Water Becomes a Curse, World News
South Africa: Benefits of Working Together on Water, Terna Gyuse, All Africa