Two turning points swivelled the spotlight
onto neglected tropical diseases: Doctors
Without Borders won the Nobel Peace Prize
in 1999 for their behind-the-scenes work in
this area. And the Bill & Melinda Gates
Foundation was established in 2000.
hey have strange names, such as yaws, Dumdum fever, river
blindness and schistosomiasis. Others, like leprosy, are more
familiar. What they have in common is this: they all belong to
a group called neglected tropical diseases, or NTDs – chronic
infectious conditions that together cause serious disability and
developmental deficits in more than one billion people, mainly
the world’s poorest of the poor. Collectively, NTDs rank sixth
in the top 10 global causes of life-years lost to disability and
Endemic to Africa, Asia, Latin America and the Pacific
Often they overlap with other NTDs or with one or more of the lethal
Big Three – HIV/AIDS, malaria and tuberculosis – with which they
collaborate to swamp the immune system and spur premature death.
Although they cost developing countries untold amounts in reduced
quality of life and lost productivity, the dollars allocated to eradicating
the diseases are minuscule compared with the number of people affected.
“There is little incentive for pharmaceutical companies to develop new,
cheap and easy-to-administer treatments,” says Carlos Morillo, a cardiol-
ogist, N TD researcher and professor of medicine at McMaster University.
But now there is hope. In Canada and other developed countries, a
small but growing number of researchers are working to control, if not
eradicate, these infections. Despite sparse funding, researchers are motivated by the sheer numbers of very poor people whose childhoods are
blighted and life spans shortened by NTDs.
Moreover, Western governments and pharmaceutical companies alike
are becoming more sensitive to their responsibility to provide affordable
medicines. In the past decade, global health groups have come together to
plan strategic action and major drug makers have committed to donating
28 / www.universityaffairs.ca / January 2011
drugs or supporting research to eliminate these scourges.
“Serious global research awareness about NTDs really dates only
from about the late 1990s. There was research going on as far back as the
1960s, but NTDs were not really on the general radar, and there wasn’t
much money for research,” says Kishor Wasan, a professor of pharmaceutical sciences at the University of British Columbia.
Dr. Wasan cites two turning points that swivelled the spotlight over
to NTDs: “One, Doctors Without Borders won the Nobel Peace Prize in
1999 for their incredible work behind the scenes in this area. And two,
the Bill & Melinda Gates Foundation was established in 2000.”
In the past decade or so, many academic centres have established
research programs in global diseases. UBC’s Neglected Global Diseases
Initiative is one such example. Its funding comes from a variety of sources,
including the Canadian Institutes of Health Research, the World Health
Organization and various philanthropic foundations. In fact, the emerging
phenomenon could be termed “Pharmaceuticals Without Borders” for the
move in developed countries to design and deliver medicines to under-
served populations in the Third World.
In this milieu of heightened global awareness, Dr. Wasan is working
on a cheap oral form of the drug Amphotericin B to target visceral leishmaniasis (or VL, known colloquially as Dumdum or black fever). Caused
by tiny single-cell protozoan parasites transmitted by the female sand fly,
VL is the second-largest parasitic killer in the world after malaria and
strikes an estimated 500,000 people annually. In its less serious forms, it
appears as a skin or mucous-membrane infection, but the parasites often
migrate to vital organs such as the liver, spleen, lymph nodes and bone
marrow. Left untreated, it can cause death.
Traditional treatment is based on the heavy metal antimony, which is
cheap and effective but has toxic side effects. Amphotericin B therapy is
currently given intravenously – with all the attendant costs of sterile clinic
conditions, needles, IV bags and technical personnel. A cheap oral form
would greatly facilitate treatment.
“The new product has been signed on to UBC’s Global Access Initiative,
which supports wider access to medicines and better delivery systems,”