Inter Press Service - December 4, 2002
Mario Osava

The victims of these diseases and others that afflict the poor do not comprise an attractive market, which means the pharmaceutical industry earmarks little funding for developing the medicines they need.

Between 1975 and 1999, 1,393 new medicines were approved worldwide, including just 13 -- less than one percent of the total -- aimed at treating or preventing tropical diseases and tuberculosis, which account for more than one-tenth of the world's illness and death.

Developing countries account for 80 percent of the world's population, but only 20 percent of consumption of medicines.

The Drugs for Neglected Diseases Initiative (DNDI), aimed at correcting that distortion and creating a global, not-for-profit pharmaceutical industry, was announced earlier this year, and discussed Monday and Tuesday by experts in Rio de Janeiro.

The project, spearheaded by the Paris-based Medecins Sans Frontieres (MSF) -- known in English as Doctors Without Borders -- will be implemented by a small central coordinating committee of "around 15 to 20 people" based in Geneva, and by an international network of research centres, Dr. Yves Champey, director of the DNDI feasibility study, explained to IPS.

The aim of the project is to develop new medicines and improve or combine existing ones to provide more effective and affordable treatment by mobilising the "energy, experience and resources" of an international network of research centres, and improving the disease prevention and treatment capacity of countries where the neglected diseases are endemic, he added.

The objective is to narrow the gap between the needs of poor countries and the availability of effective, affordable drugs -- a problem that accentuates the developing world's social and economic difficulties.

MSF points out that the necessary drugs are increasingly unavailable due to growing drug resistance, discontinued production, or the high cost of medicines, as well as the lack of ongoing research and development on new or innovative treatments for infectious and parasitic diseases.

According to MSF officials, neglected diseases are "seriously disabling or life-threatening diseases for which treatment options are inadequate or do not exist, and for which drug-market potential is insufficient to readily attract a private sector response."

The initiative is headed by MSF in association with the World Health Organisation (WHO), France's Pasteur Institute, Brazil's Oswaldo Cruz Foundation, the Indian Council of Medical Research, and the Malaysian Health Ministry.

The institutions were selected after a year and a half of consultations, due to their solidity, experience with tropical diseases, means and reputations, said Champey.

But "the project is seeking new partners, and the aim is to join forces," said Eloan Pinheiro, director of Far-Manguinhos, the Oswaldo Cruz Foundation's pharmaceutical laboratory.

The first priority will be the "most neglected" diseases: leishmaniasis, Chagas disease, and African sleeping sickness, to which the pharmaceutical industry assigns virtually no resources or research efforts, and which do not receive adequate attention by governments, due to a lack of interest and funding.

Leishmaniasis, which is transmitted by mosquitos, currently affects around 12 million people, while 200 million others are at risk in 88 countries, according to DNDI statistics. Visceral leishmaniasis or kala-azar is fatal if left untreated.

The current treatment of leishmaniasis, based on painful injections, is the same one employed since the 1940s.

Chagas disease, which is caused by the Trypanosoma cruzi parasite, is transmitted by the vinchuca bug (Triatoma dimidiata) or through blood transfusions, and is endemic in most of Central and South America.

Although the disease causes acute symptoms in just one percent of its victims, it often leads to severe cardiac problems and death after lying dormant for as long as 20 years, said Pinheiro.

Health experts estimate that 16 to 18 million people are infected by the Trypanosoma cruzi parasite, while another 100 million -- one-quarter of the population of Latin America -- are at risk of infection. The disease, for which there is no cure, kills between 20,000 and 45,000 people a year in Latin America.

Sleeping sickness or human African trypanosomiasis, a parasitic disease transmitted by the tsetse fly, affects around 500,000 people and threatens a further 60 million in 36 African countries. An estimated 150,000 people die of the disease annually.

The disease, which is prevalent in much of tropical Africa, is marked by fever, protracted lethargy, tremors and loss of weight, and is fatal if not treated.

However, the drugs used to treat it are often unavailable and are highly toxic. The injections, which contain arsenic, are extremely painful, and kill one of every twenty patients treated.

But even those who survive the injections have no guarantee of a cure: growing drug resistance means the treatment ends up failing in one-quarter of all cases treated in some areas.

In the medium-term, DNDI also plans to focus on other diseases that attack the poor, like malaria and tuberculosis, which other institutions are already working against, but with only a fraction of the funding that would be needed.

Malaria, for example, kills more than one million people every year, 75 percent of whom are African children.

There are also less well-known neglected diseases that will require attention, such as the Buruli ulcer, an ulcerative skin disease known as the "new leprosy" that can be deadly if left untreated. The disease is found in African countries like the Democratic Republic of Congo, Angola and Cameroon, said Champey.

The new cooperation by the international research network, "which will focus on social results or public need rather than profits," will help bring about healthier populations with more productive lives who can contribute to development, while reducing the burden of health costs for poor countries, said Pinheiro.

The director of the Far-Manguinhos laboratory also underlined the need to develop the means for early diagnosis of neglected transmissible diseases, in order to curb their spread.

He cited Brazil's success in curtailing the HIV/AIDS epidemic, partly through the production, by the state-owned Far-Manguinhos laboratory, of the antiretroviral drugs that are provided free of charge to all patients.

MSF will contribute five to six million dollars a year to the new project, and its partners will supply their labour and know- how, said Champey.

The DNDI will mobilise around 300 million dollars in its first 10 to 12 years, and its pilot projects, aimed at improving or combining existing drugs, could begin to bear fruit as early as 2005, he predicted.

It is likely that large private drug companies will also contribute technology, instruments and funding, because "it would cost them very little, while they would stand to gain much in terms of image," said Champey. (END/IPS/WD LA/HE/TRA-SO SW/MO/MP/02)

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