Neglected Tropical Diseases and Drug Donation Programs: Successes and Challenges
by Zeena Nackerdien, PhD
Published 7/15/2008; © 2008 Zeena Nackerdien
Pharmaceutical companies have engaged in corporate philanthropy by donating drugs to developing countries, where an estimated 1 billion people suffer from one or more neglected tropical diseases.
Preventing River Blindness
Blind man and child
The successful treatment of onchocerciasis (also known as river blindness), the world’s second leading infectious cause of blindness, illustrates the medical benefits of corporate giving. Merck was the first company to make such a commitment, by donating Mectizan, a human formulation of the veterinary drug ivermectin, for the treatment of river blindness in sub-Saharan Africa.
The Mectizan program, initiated in 1987 and now jointly operated by several agencies, has achieved major successes in West Africa, preventing an estimated 600,000 cases of total blindness and eliminating other debilitating side-effects of the disease. Because this program has been in place for more than twenty years, it has provided operational lessons for streamlining drug management and incorporating broad partnerships as well as community-directed treatments.
Other companies followed suit. Pfizer provided the antibiotic azithromycin to control trachoma (another infectious cause of blindness) in developing countries. SmithKline Beecham distributed albendizole as part of a 20-year collaboration with the World Health Organization to treat lymphatic filariasis, a parasitic disease. And Glaxo Wellcome initiated a "controlled donation program" of the antimalaria drug, Malarone.
Table. Drug Donation Programs for Neglected Tropical Diseases
Drug donation programs play an important role in the global health initiatives currently evolving to fight neglected tropical diseases. However, the specter of resistant infectious agents hovers over success stories.
Suboptimal responses to ivermectin have already been reported in Ghana and the Sudan.[5,6] A recent study identified an ivermectin-tolerant subpopulation of Onchocerca volvulus, the worm responsible for onchocerciasis. Multi-drug resistant strains of Plasmodium falciparum, the infectious agent responsible for malaria, are already a fact of life. Are azithromycin-resistant strains of Chlamydia trachomatis inevitable in regions where affected patients are treated with this antibiotic?
Drug-resistant infections have been a feature of the ongoing competition between humans and infectious agents all over the world. How can current health initiatives targeted to the developing world be improved?
Non-drug alternatives like bed nets have reduced all-cause childhood deaths by 20%. Sanitation and clean water are also part of the answer, but do not directly address the emergence of resistant infectious agents. Drug-screening collaborations (already underway with pharmaceutical companies), studies in appropriate animal models, harnessing genomic information and scaled-up field research are cornerstones of an ongoing strategy to ultimately eradicate tropical diseases.
1. World Health Organization. Control of Neglected Tropical Diseases. Geneva; 2007. www.who.int/neglected_diseases/en/
2. World Bank. Global Partnership to eliminate river blindness. Washington, DC. www.worldbank.org/afr/gper/partnerships.htm
3. Thylefors B, Alleman MM, Twum-Danso NA. Operational lessons from 20 years of the Mectizan Donation Program for the control of onchocerciasis. Trop Med Int Health 2008;13(5):689-96. PubMed abstract
4. Wehrwein P. Pharmacophilanthropy. Harvard Public Health Review. Boston. www.hsph.harvard.edu/review/summer_pharmaco.shtml
5. Bourguinat C, Ardelli BF, Pion SD, et al. P-glycoprotein-like protein, a possible genetic marker for ivermectin resistance selection in Onchocerca volvulus. Mol Biochem Parasitol 2008;158(2):101-11. PubMed abstract
6. Bourguinat C, Pion SD, Kamgno J, et al. Genetic selection of low fertile Onchocerca volvulus by ivermectin treatment. PLoS Negl Trop Dis 2007;30(1):e72. Full article
7. Ringwald P. [Current antimalarial drugs: resistance and new strategies]. Bull Acad Natl Med 2007;191(7):1273-84; discussion 1284. PubMed abstract
8. Cattani J, Lengeler C. In: David TJ, editor. Paediatrics. Volume 16. London: Churchill-Livingston; 1998. p 105-119.
9. Ridley RG, Fletcher ER. Making a difference: 30 years of TDR. Nat Rev Microbiol 2008;6(5):401-7. PubMed abstract
About the Author
Zeena Nackerdien, PhD, is senior research associate in the Lederberg Laboratory at Rockefeller University, New York, and also works as a freelance science and medical writer. She can be reached at firstname.lastname@example.org.
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