Leaders from governments, pharmaceutical companies and charitable organizations have congregated at a five-day summit in Geneva to pledge new commitments to the collective effort to control and eliminate Neglected Tropical Diseases (NTDs).
The summit coincided with the launch of the World Health Organization’s (WHO) Fourth Report on NTDs, showing transformational progress against these debilitating diseases, and a commitment by the United Kingdom to more than double its funding for NTDs.
The meeting comes five years after the launch of the London Declaration on NTDs, a commitment by the public and private sectors to achieve the WHO goals for the control, elimination and eradication of 10 NTDs.
Currently, billions worth of treatments have been donated by pharmaceutical companies and delivered to impoverished communities in nearly 150 countries, reaching nearly a billion people in 2015.NTDs are some of the oldest and most painful diseases, afflicting the world’s poorest communities. One in six people suffer from NTDs worldwide, including more than half a billion children.
NTDs disable, debilitate and perpetuate cycles of poverty, keeping children out of school, parents out of work, and dampening hope of any chance of an economic future.New Report Shows Dramatic Progress. A new report titled Integrating Neglected Tropical Diseases in Global Health and Development by the WHO revealed that more people are being reached with the needed NTD interventions than ever before.
In 2015, nearly a billion people received treatments donated by pharmaceutical companies for at least one NTD, representing a 36 percent increase since 2011, the year before the launch of the London Declaration.
As more districts, countries and regions eliminate NTDs, the number of people requiring treatments has decreased from 2 billion in 2010 to 1.6 billion in 2015.“WHO has observed record-breaking progress towards bringing ancient scourges like sleeping sickness and elephantiasis to their knees,” says WHO Director-General, Dr Margaret Chan. “Over the past 10 years, millions of people have been rescued from disability and poverty, thanks to one of the most effective global partnerships in modern public health.”
The report detailed progress against each disease, citing countries and regions that are reaching the control and elimination goals for specific NTDs. Highlights include:Lymphatic Filariasis (LF): In the last year, eight countries (Cambodia, Cook Islands, Maldives, Marshall Islands, Niue, Sri Lanka, Togo and Vanuatu) eliminated LF, and 10 other countries are waiting on surveillance results to verify elimination. Thanks to strong programs, the number of people globally requiring preventative treatment has dropped from 1.4 billion in 2011 to fewer than 950 million in 2015.
Human African Trypanosomiasis (HAT, or sleeping sickness): in 2015, there were fewer reported cases of sleeping sickness than any other year in history, with fewer than 3,000 cases worldwide – an 89 percent reduction since 2000. Innovative vector control and diagnostic technologies, supported by increasing numbers of product development partnerships, are revolutionizing sleeping sickness diagnosis, prevention and treatment.
There was an eighty-two percent decrease in Visceral Leishmaniasis (VL) cases in India, Nepal and Bangladesh: Since 2008, cases of VL across India, Nepal and Bangladesh have decreased by 82 percent due to improvements in vector control, social mobilization of village volunteers, collaboration with other NTD programs and drug donations from industry partners.Guinea worm disease nearing eradication: Cases of Guinea worm disease have reduced from an estimated 3.5 million in 1986 to just 25 human cases in 2016 in just three countries – Chad, Ethiopia and South Sudan.
Global Donors Pledge Additional Support
Governments and other donors announced new commitments at the summit to expand the reach and impact of NTD programs around the world. The Bill & Melinda Gates Foundation committed $335 million in grants over the next four years to support a diverse group of NTD programs focused on drug development and delivery, disease surveillance and vector control. The commitment includes $42 million to support The Carter Center’s guinea worm eradication initiative, as well as dedicated funding to accelerate the elimination of African sleeping sickness.
“NTDs are some of the most painful, debilitating and stigmatizing diseases that affect the world’s poorest communities. That’s why we helped launch the London Declaration, a historic milestone that led to significant progress in treating and reducing the spread of NTDs and demonstrated the impact that the public sector, the private sector, communities and NGOs can have by working together,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation.
“Thanks to this partnership, these neglected diseases are now getting the attention they deserve so fewer people have to suffer from these treatable conditions. There have been many successes in the past five years, but the job is not done yet. We have set ambitious targets for 2020 that require the continued commitment of pharmaceutical companies, donor and recipient governments, and frontline health workers to ensure drugs are available and delivered to the hardest to reach people.”
The Belgian government also pledged an additional $27 million, spread equally over the next nine years, toward the elimination of sleeping sickness in the Democratic Republic of the Congo (DRC). This amount will be matched for the next three years by the Bill & Melinda Gates Foundation, establishing a platform for increased collaboration between Belgium, the DRC and the broader NTD partnership.
As part of its commitment to eliminating HAT, Vestergaard pledged to donate 20 percent of its insecticide-treated “tiny targets” used to control the tsetse flies that carry the disease, scaling over the next three years towards 100 percent as elimination nears.
These commitments build on the UK Government’s announcement earlier this week, in which it pledged almost $450 million over 5 years to support NTD control and elimination efforts around the world.
Industry Contributions Expand Scale and Reach of NTD Program
Progress against NTDs has been enabled by the large-scale donation of medicines by 10 pharmaceutical companies. In the five years since the London Declaration, companies have donated over 7 billion treatments that, with the support of partners, now reach nearly 1 billion people every year. These donations, worth an estimated $19 billion from 2012 through 2020, greatly multiply the impact of donor investments; USAID estimates that each dollar invested in delivery leverages $26 worth of donated drugs.
Industry leaders in a statement reaffirmed their 2012 pledge to do their part to beat these diseases and encouraged other sectors to maintain their commitments as well.“The London Declaration is a powerful example of the impact of successful partnerships,” said Haruo Naito, CEO of Eisai, an original signatory of the London Declaration.
“By leveraging our resources and focusing on a common goal, we are already making unprecedented progress towards eliminating these horrific diseases. The work we are doing today is a long-term investment into a healthier and more prosperous future.”In addition to donations, pharmaceutical companies are working together with research institutes to discover and develop new tools to prevent, diagnose and treat NTDs.
A report released today by the International Federation of Pharmaceutical Manufacturers and Associations collected the full scope of industry investment in NTD R&D, including:Sanofi and the Drugs for Neglected Diseases initiative (DNDi) are developing a new oral drug candidate for HAT called Exinidazole, which would replace the current mixed oral-intravenous drug regimen. Fexinidazole could represent a therapeutic breakthrough which will support sustainable elimination efforts as per the WHO roadmap for 2020. The drug is expected to be submitted for regulatory approval later in 2017.
Several companies are working to develop pediatric formulations of existing NTD medicines, including Bayer (Nifurtimox, for Chagas disease), Merck KGaA (Praziquantel, for schistosomiasis), and Elea/Mundo Sano (who are working with DNDi to develop a second pediatric source of benznidazole, for Chagas disease), while Johnson & Johnson (mebendazole, for soil-transmitted helminths) developed a new chewable form of mebendazole, recently approved by the FDA, for children too young to swallow.
AbbVie, Bayer, Eisai, Johnson & Johnson and Merck KGaA are part of the Macrofilaricide Drug Accelerator Program, an initiative aimed at identifying and generating new drug compounds that can kill the adult worms that cause onchocerciasis and lymphatic filariasis.
Bayer is working with DNDi to develop Emodepside, an oral treatment for lymphatic filariasis and river blindnessEisai is working with DNDi to develop Ravuconazole, a new oral drug currently in clinical trials for Chagas disease, and is partnering with DNDi to develop Ravuconazole in a new disease area, mycetoma.
GlaxoSmithKline and DNDi have agreed to jointly pursue the pre-clinical development of the two novel candidates for the treatment of Visceral Leishmaniasis; the candidates were developed by a collaboration between GSK and the University of Dundee’s Drug Discovery Unit, and the work was funded by Wellcome. The agreement for pre-clinical development will be conditional on signing an additional agreement.
In 2015, Eisai, Shionogi, Takeda, AstraZeneca and DNDi launched the NTD Drug Discovery Booster, a multi-company effort to accelerate the discovery of new drugs for Leishmaniasis and Chagas disease. In 2016 they were joined by Celgene Global Health. Merck KGaA announced today that it will join the consortium.Many companies – including AbbVie, Astra Zeneca, Bayer, Bristol-Myers Squibb, Celgene, Chemo, Daiichi Sankyo, Eisai, Elea, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck KGaA, MSD, Novartis, Pfizer, Sanofi, Shionogi, and Takeda – have given DNDi and other non-profits access to their compound libraries and/or contribute scientific and technical expertise to DNDi and conduct pre-clinical and clinical studies to facilitate the development of new drugs to combat various NTDs.
Gilead is collaborating with the US Department of Defense, Centers for Disease Control and Prevention, and National Institutes of Health as well as multiple academic institutions to discover and develop novel antiviral drugs for highly pathogenic infections and neglected/emerging viral diseases, including dengue fever.
GS-5734, Gilead’s most advanced investigational agent, is currently being studied in Ebola survivors.Companies are also working with partners to solve supply chain problems, develop program strategies and build in-country capacity to ensure that drugs, tools and other interventions reach those who need them most.
Addressing the Challenges Ahead
Though tremendous progress has been made in reducing the burden of NTDs, global control and elimination targets cannot be met without increased financial support, stronger political commitment and better tools to prevent, diagnose and treat the diseases. This week, partners from private philanthropy, affected country governments and cross-sector partnerships recommitted to leveraging their respective resources and expertise to fill critical gaps.
Although nearly a billion people received NTD treatments in 2015, more funding is needed to ensure that NTD programs reach all people and communities affected by the diseases. WHO estimates that 340 million people in Sub-Saharan Africa could be covered by new investments of $150 million per year through the year 2020.
In addition to government commitments, private philanthropy is helping to address these gaps by supporting drug delivery and surveillance programs, as well as research and development into new medicines, diagnostics and other health tools. The END Fund, founded shortly after the London Declaration, has raised over $75 million to target the five most common NTDs, helping to treat over 145 million people around the world.
Strong leadership from affected countries is vital to sustaining progress against NTDs, particularly in the face of shifting economic climates and competing health priorities. Despite these challenges, some countries are increasing financing for NTD programs and integrating them into national health systems. Among other countries, Ethiopia has made significant strides in fighting trachoma by including progress against the disease as a target in its national health plan, providing significant domestic funding, participating in the Global Trachoma Mapping Project and training surgeons to conduct eye-lid surgeries to correct the effects of trachoma.
“Ethiopia is fully committed to realizing ambitious, yet achievable, elimination targets for trachoma and other NTDs with proactive program coordination,” said H.E Professor Yifru Berhan Mitke, Ethiopian Minister of Health. “An increased direct program financial contribution by the government to NTDs, as high as 3 million USD by 2016, is a big step forward in alleviating the burden and stigma of these diseases.”
New Tools and Innovations
To meet control and elimination targets, more research and development is needed to provide NTD programs with improved tools to prevent, detect and treat the diseases. Promising new therapies are in the pipeline: A new three-drug regimen for LF known as triple therapy has the potential to dramatically accelerate the pace of elimination in affected countries and is currently on large-scale safety trials in India.
R&D organizations such as PATH and partnerships like DNDi and the Global Health Innovative Technology Fund have catalyzed the development of better and more cost-effective tools. These innovations, which include new drugs and rapid diagnostic tests for sleeping sickness and river blindness, are especially critical in the low-resource settings most burdened by NTDs. Several new vector control tools are under development and being piloted to address the growing problem of diseases transmitted by the Aedes mosquito.
Rest of NTDs are: Onchocerciasis (River blindness); Schistosomiasis; soil-transmitted helminths; Chagas and Leprosy.