The Gates Foundation-hosted conference held in London Monday, ‘Uniting To Combat Tropical Diseases,’ draws attention to devastating tropical illnesses that have been neglected for too long. However, the ambitious goals to eliminate or control 10 neglected tropical diseases will only be credible when some critical remaining gaps are filled, according to Médecins Sans Frontières (MSF).

“Though we are delighted that the World Health Organisation (WHO), donors and development agencies are finally drawing attention to neglected tropical diseases, we are concerned that challenges for some of these diseases are being glossed over,” says Daniel Berman, deputy director of MSF’s Access Campaign. “Expanded drug donations from the pharmaceutical industry will be part of the solution, but it is not possible to eliminate and control diseases such as Chagas, kala azar or sleeping sickness without increased support for programs to identify and treat patients and increased investment for new and better diagnostic tests and medicines.”

Ethiopia © Michael Tsegaye
A kala azar patient receiving injections for his treatment in an MSF project in Abdurafi, Ethiopia.

For diseases like these to be sustainably eliminated, new diagnostics and treatments must be developed that can be used by healthcare workers with basic training in remote areas. For example, treating sleeping sickness still requires a painful lumbar puncture and there is not yet an oral treatment. Injections and intravenous drips are required, which are unsuited to basic clinics in rural areas and also difficult and painful for patients.

Not only the drugs but also the healthcare programs themselves suffer from chronic under-funding. If government agencies such as the Department for International Development in the UK and USAID, as well as WHO and other external actors are going to champion elimination of these diseases, they will need to address the critical need to scale up programs and invest in strengthening surveillance systems. At present there are still ‘blind spots’, areas where neglected tropical diseases like sleeping sickness are likely to be prevalent but insecurity and lack of funding mean people go undiagnosed and untreated.

“All the talk about ambitious goals and elimination will not make a difference unless we put our full support behind national control programs and national health systems in countries where the disease is endemic,” says Andreas Lindner, a physician and member of MSF’s inter-regional mobile sleeping sickness team, working to combat this neglected disease in countries like Chad and Central African Republic. “We have to realize that, ultimately, it is the national control programs – and not MSF, or any other organization – that will get this disease under control, and they need all the support and cooperation they can get.”

By putting so much emphasis on drug donations, MSF is concerned that strategies for eliminating these diseases are at risk of being influenced by what products companies are offering. The commitments outlined by Gilead, Novartis and other companies reflect the policies of the companies, but do not necessarily reflect public health priorities.

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