FOREWORD

Throughout the year, we were grateful for the many opportunities to join with partners – in Latin America, East and West Africa, South and South-East Asia, Japan, North America, and Europe – to celebrate our collective successes in putting equity at the heart of medical innovation.

We were truly honoured that the impact of our collaborative model took centre stage when DNDi was awarded the 2023 Princess of Asturias Award for International Cooperation. We extend our appreciation to the Princess of Asturias Foundation for recognizing the achievements of our partnerships and shining a light on the needs of neglected patients around the world. 

Progress during our anniversary year was a testament to the tremendous value of investing in medical innovation for neglected diseases, bringing new hope for patients with new tools that also accelerate the prospects for sustainable elimination of two diseases at the centre of our programmes from our earliest days.

Twenty years ago, the drugs used to treat sleeping sickness were so toxic they killed 1 in 20 patients. But through the dedication of our R&D teams and partners, we have steadily improved upon the treatment options available to patients and their doctors. Initially approved in 2018 for use against the T.b. gambiense form of sleeping sickness, fexinidazole became a game-changer as the first all-oral treatment for the disease. In December 2023, the European Medicines Agency extended fexinidazole’s indication for use against the less common but more acute form of sleeping sickness caused by T.b. rhodesiense, paving the way for discontinuation of the toxic first-line treatment that has been in use for over seven decades and marking the 13th new treatment we have delivered with our partners.

In 2023, Bangladesh became the first country to officially eliminate visceral leishmaniasis (VL) as a public health problem, thanks in part to the improved treatment options DNDi and our partners have also delivered. After years of sustained commitment to improving VL screening, testing, and treatment, other South Asian countries are also set to follow suit. In Eastern Africa, health authorities and policymakers have also recently launched a new comprehensive framework to guide action on elimination.

While these are significant achievements in the fight against sleeping sickness and VL, we cannot afford to become complacent. Continued investment in new tools specifically designed to sustain disease elimination is critical. Now progressing in Phase II clinical trials in India and Ethiopia, DNDi’s new all-oral treatment for VL – LXE408 – puts hope on the horizon for treatments that are simpler, safer, and easier to administer to patients at the point of care, even in the most remote and rural settings. It is one of seven new molecular entities for leishmaniasis in our portfolio with the potential to become powerful tools in reaching global elimination targets.

We also seized upon our anniversary milestone to look ahead.

While the future may increasingly be defined by the climate crisis and the rise of climate-sensitive diseases, geopolitical uncertainty, and the inevitability of new pandemics, it will also be shaped by the tremendous potential for scientific progress and medical innovation that transforms lives and livelihoods. 

Adding dengue to our R&D portfolio in 2022 proved to be prescient. In 2023 and early 2024, countries in South America, South Asia, and Africa experienced unprecedented outbreaks of the disease. The scenes the world witnessed – tented hospitals overflowing with patients for whom there was no cure – were painfully reminiscent of the COVID-19 pandemic, reminding us once more of the importance of our work today and for the 20 years to come. 

Our partnerships in countries most impacted by neglected diseases are the bedrock of the progress we are making to meet the treatment needs of people affected by dengue and other climate-sensitive diseases. Together with our Dengue Alliance partners from Brazil, India, Malaysia, and Thailand, our teams continued advancing research in 2023 to find dengue’s missing cure. As our experience with sleeping sickness and leishmaniasis has shown, treatment solutions will be indispensable for successfully confronting the disease, together with vaccines, vector control technologies, and other essential tools. 

Our commitment to equity in medical innovation is a pledge to address the unmet treatment needs of people facing the most neglected diseases – including mycetoma, a chronic disabling disease about which too little is known. DNDi and partners conducted the world’s first double-blind, randomized clinical trial to find a treatment for the fungal form of mycetoma and shared results in 2023 showing the drugs fosravuconazole and itraconazole to be effective when combined with surgery, with fosravuconazole having practical advantages including weekly versus twice-daily administration. Our teams were thrilled to share these encouraging results while advancing partnerships and new initiatives to conduct much-needed epidemiological research, expand access to treatment, and prepare the way for future clinical trials. 

If there is a single highlight to look back on from 2023, it is the phenomenal power of partnership, which has been the highlight of every one of our 20 years: collaborations addressing today’s most pressing global health challenges within and between neglected disease-endemic countries and with research and industry allies around the world. No new research effort and no new medical tool can truly meet the needs of neglected patients without the support and collaboration of affected patients and communities, industry stakeholders, academic experts, healthcare workers, and national decision-makers and health authorities. 

As we look back on a momentous year, we would like to extend our sincere thanks to our partners, supporters, and staff who have walked with us through 20 years of innovating together and who will continue to play a critical role in putting equity at the heart of medical innovation in the years to come.