To achieve any success in reducing the burden of NTDsthere must be more appropriate ODA funding to supportongoing programmes and for research and development of new tools, drugs, diagnostics and vaccines. In addition togovernments, changing this bias is the responsibility of both prospective recipients and donors.
Issues in health policy and the impact on NTDs
NTDs have received more drug donations from pharma-ceuticalcompaniesthananyotherpublichealthinitiatives. Public
private partnerships have successfully distrib-uted donated ivermectin in onchocerciasis eliminationefforts since 1987, and this method has now been appliedto provide albendazole, donated by GlaxoSmithKline andMectizan, donated by Merck and Co. Inc., for lymphaticﬁlariasis through the Mectizan Donation Programme.Numerous charities, pharmaceutical companies, inter-national programmes and non-governmental organis-ations (NGOs) are involved with various NTDs, eachoffering different opinions on the best strategies to tackletheseproblems.TheGlobalNetworkforNeglectedTropicalDiseasesandtheWHODepartmentforControlofNeglectedTropical Diseases have been set up recently to focus onadvocacy and integrating control efforts. Mass drug administration (MDA) through preventive chemotherapyis the recommended method for helminth management,but at present programmes are inadequately coordinatedto ensure efﬁcient delivery. Drugs to control NTDs throughMDA have been found to be safe in speciﬁc combinations(albendazole, mectizan and praziquantel) and coadminis-tration is less expensive, potentially increasing coverage. Combining NTD interventions with existing malariaprogrammes can reduce duplication of work and unecono-mical management, especially where there is geo-graphical overlap in disease distribution. Increased vectorcontrol can reduce transmission of lymphatic ﬁlariasis inareas where
is the main vector. For inte-grated control methods to be effective there must also beconcurrentmappingofareasatrisk,monitoringtoevaluatethe impact of programmes and surveillance after the inter-vention has been discontinued.
No magic bullet
To achieve integrative control, it is essential that differentgroups, such as health services, communities, pharmaceu-ticalcompaniesandNGOscooperateandformpartnershipsin order to work together effectively. Furthermore, inrural areas with poor infrastructure we must prioritiseaccess to essential medicines. Interventions for these con-ditionshavebeendescribedasthe‘lowhangingfruit’,asmany NTDs have existing, efﬁcacious treatments that aredonatedbypharmaceuticalcompaniesona long-term basis(Table 2). Theseare highly cost effectiveand lead to an
increase in economic productivity and decrease suscepti-bility to other diseases[8,11]. The treatment of NTDs inschool children is a top priority to avoid the subsequentimpact on education and growth restriction. We must buildonrelationshipswithdrugcompaniessuchasMerckandCo.who have donated ivermectin to treat onchocerciasis forover 20 years, GlaxoSmithKline’s long-term pledge of albendazoleforlymphaticﬁlariasisandJohnson&Johnsonwho have come forward and promised donations to treat
Table 1. The 37 key NTDs
, hookworm infection
, strongyloidiasis,toxocariasis and larva migrans, lymphaticﬁlariasis
, food-borne trematodiases,taeniasis cysticercosis, echinococcosisBacterial infections:Bartonellosis, bovine tuberculosis, buruli ulcer
,leptospirosis, relapsing fever, rheumatic fever, trachoma
,treponematosesFungal infections:mycetoma, paracoccidiomycosisProtozoan infections:leishmaniasis
, Chagas disease
, human African trypanosomiasis
,amoebiasis, giardiasis, balantidiasisViral infections:dengue fever, yellow fever, Japanese encephalitis, rabies,haemorrhagic feversEctoparasitic infections:scabies, myiasis, tungiasis
13 core neglected tropical diseases.
Table 2. Overview of NTD drug donation programs active 2003 to 2007
Disease Donated drug Donor company Duration of program Amount of drugs donated 2003 to 2007
Onchocerciasisivermectin Merck & Co., Inc. 1987 to open-ended 990 million tablets
Lymphatic ﬁlariasisivermectin Merck & Co., Inc. 1998 to 2020 385 million tablets
Lymphatic ﬁlariasisalbendazole GlaxoSmith-Kline 1998 to 2020 602 million tabletsTrachomaazithromycin Pﬁzer 1998 to open-ended 266 million tablets
Leprosymultidrug therapy Novartis 2000 to 2010 NAHuman Africantrypanosomiasispentamidine, melarsoprol,eﬂornithineSanoﬁ-Aventis 2001 to 2011 NA (total of 940 000 vials 2001 to 2006)Human Africantrypanosomiasissuramin Bayer Healthcare 2002 to 2012 NASchistosomiasispraziquantel MedPharm NA
NA (14 million tablets 2004)Chagas diseasenifurtimox Bayer Healthcare 2004 to 2012 NA (500 000 tablets 2004 to 2005;2.5 million tablets pledged 2007 to 2012)Soil-transmittedhelminthiasismebendazole Johnson & Johnson 2006 to open-ended NA (30 million tablets 2006)
NA, not available.
330 million treatments, 3 tablets per treatment.
195 million treatments, 3 tablets per treatment.
70 million treatments, 3.8 tablets per treatment.
Trends in Parasitology
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