Time to Prioritize Neglected Diseases?

In recent years a greater effort has been made by international healthcare organizations and governments to tackle diseases that have their heaviest impact in the developing world. In particular, the pharmaceutical industry has come under considerable pressure to increase its R&D activities for such diseases and provide drugs at affordable prices to those in less affluent countries. Many of these diseases have been called ‘neglected diseases’ as few new drugs have been launched to tackle them during the last 20 years.

Shifting attitudes

Although progress on the provision and development of drugs for neglected diseases has been slow, often due to negotiations being hampered by politics and legal technicalities, there has been a shift in how these issues are now perceived. Media coverage of the access to essential medicines issues is at an all time high and the approach by the pharmaceutical industry to dealing with them is less confrontational than in the past. In particular, the legal battles with the South African and Brazilian governments over affordable AIDS treatments were highly damaging for the image of the pharmaceutical industry and led to accusations by its critics that it placed ‘profits above lives’.

This public criticism of the pharmaceutical industry continues, but there has been a noticeable change in how companies approach the access to essential medicines issues and this is partly due to those within such organizations who do wish to see the industry play a more proactive and benevolent role. There are now a number of international partnerships between major healthcare organizations and pharmaceutical companies, such as Public-Private Partnerships (PPP), that are devoted to developing treatments for diseases of the developing world. The biggest progress in these areas has been for diseases such as AIDS, malaria, tuberculosis and meningitis.

Diseases that remain neglected

Interestingly, although there have been calls by pressure groups for governments and the industry to pay greater attention to diseases in the developing world, certain observers believe that the current focus is skewed and may result in a number of regional diseases becoming even more neglected.

In a high profile editorial in the Lancet in July 2004, Professor David Molyneux of the Liverpool School of Tropical Medicine in the UK outlined how the concentrated approach to certain, specific diseases in developing countries was obstructing improvements for a variety of tropical viral, bacterial, and parasitic infections, and acute respiratory infections and diarrhoeal diseases of children (1, 2). Professor Molyneux argued that this was a lamentable situation as the cost to treat these other tropical diseases was low and the approaches needed were known and could be easily implemented (1, 2). Furthermore, by effectively ignoring these diseases Professor Molyneux expressed his concern that policy makers would inadvertently disrupt the efforts being made to tackle them and thus leave people in developing countries at further risk. As an example, Professor Molyneux referred to river blindness (onchocerciasis), which he stated could be treated for a cost as low as 10 cents (3).

Even research into these neglected tropical diseases has occasionally run into problems when it comes to applying the results. This occurred in April 2004, when researchers at St. George’s Medical School in London developed a blood test for sleeping sickness (trypanosomiasis) that had the potential to identify the disease earlier than existing approaches (4). Sleeping sickness is caused by trypanosomes, which are protozoan parasites, which are transmitted to humans through the bite of the tsetse fly (5). The infection can lead to irreversible neurological disorders and without treatment the disease is fatal (5). Africa continues to be particularly hard hit by the disease, with the World Health Organization (WHO) estimating that it presents a daily threat to 60 million people on the continent. Unfortunately, only 3 to 4 million people are under surveillance and so better diagnosis of the disease is needed. The system developed by St. George’s Medical School involved the extraction of serum from the blood and analysis by mass spectrometry for a specific pattern of proteins associated with the disease. This was considered to hold an advantage over conventional methods that involved blood tests to detect antibodies or the presence of the parasites themselves (4). However, other scientists were worried about the economic and medical practicalities of the test, although they recognized it as step forward in terms of sleeping sickness research. They suggested that the high tech nature of the approach would place restrictions on how it could be applied, particularly as few centres would be able to afford and use the equipment required (4).

Renewing attention

The Special Programme for Research and Training in Tropical Diseases (TDR) represents the most high profile international effort to tackle neglected diseases (6). It was established in 1975 and is co-sponsored by the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and WHO. TDR aims to improve overall global cooperation to develop medicines for neglected diseases and ensure that effective disease control measures are developed and implemented. It has drawn up a list of ten neglected diseases where it intends to concentrate its efforts (6). Rather than running research facilities itself, TDR encourages and funds the research efforts carried out by others in this important field (6).

In May 2004, the International Federation of Pharmaceutical Industry Associations (IFPMA) published a report entitled “Building Healthier Societies Through Partnership” which described how the pharmaceutical industry was becoming more involved in initiatives to tackle diseases of the developing world (7). Many of these projects have focused on HIV, malaria, tuberculosis, but there are also initiatives targeting areas such as Dengue, leprosy, polio, leishmaniasis and Guinea Worm (dracunculiasis) eradication (7).

With the commercial know-how of successful product development and years of international experience, the pharmaceutical industry has an important part to play in researching and providing treatments for these diseases. According to the report, since 1998 ten major pharmaceutical companies have donated products worth US$2.7 billion as part of the Partnership for Quality Medical Donations (PQMD) (7). PQMD is a nonprofit association that aims to raise the standards for medical product donations globally. IFPMA strongly believes that simply providing free or affordable drugs is not the answer to tackling these diseases and that time and money must be invested in developing collaborations with international, governmental and local agencies so that a long-term benefit can be achieved.

Although there are concerns over the current approaches to diseases of the developing world, research is being carried out in this area and there are an ever-growing number of collaborations between interested parties in the field of healthcare. More attention will need to be given to the results so that it encourages further work on the entire class of diseases that are considered ‘neglected’ and encourages greater cooperation and funding of relevant projects.

References

1.      Diseases forgotten in wake of HIV. BBC News. 12 July 2004. http://news.bbc.co.uk/1/hi/health/3886973.stm

2.      Call for investment in prevention of ‘neglected diseases' to improve global health. Medical News Today. 23 July 2004. http://www.medicalnewstoday.com/medicalnews.php?newsid=11135

1. Diseases are being neglected in the wake of HIV, TB and malaria, warns tropical expert. The Liverpool School of Tropical Medicine. http://www.liv.ac.uk/lstm/about/newsDiseasesNeglected.htm
2. Test hope for sleeping sickness. BBC News. 23 April 2004. http://news.bbc.co.uk/1/hi/health/3651033.stm

1. African Trypanosomiasis Control. World Health Organization. http://www.who.int/emc/diseases/tryp/trypanodis.html

1. The Special Programme for Research and Training in Tropical Diseases (TDR). http://www.who.int/tdr/index.html

1. Building Healthier Societies Through Partnership. May 2004 Update. The International Federation of Pharmaceutical Manufacturers Associations. http://www.ifpma.org/