Non-profit drug research and development organization, Drugs for Neglected Diseases initiative (DNDi) has launched a special collection of articles entitles ‘Neglected Diseases and Innovation in South Asia’ published today by The BMJ (formerly The British Medical Journal). The collection brings together over 30 authors from across South Asia and internationally, to identify research priorities and recommendations for action to improve the health of neglected patients in the region. The collection maps progress in the control or elimination of neglected diseases such as lymphatic filariasis, kala-azar, and snakebites in the region, and highlights the growing challenge of antimicrobial resistance.
“The unifying theme of the collection is innovation in diagnostics, treatment, and the need to create solutions for neglected patients that are effective, relevant, locally feasible, and sustainable. India has a unique role to play, given the high disease burden and regional expertise in end-to-end solutions, from drug discovery and clinical studies all the way through to regulation, manufacture, and distribution,” said Prof. Balram Bhargava, Secretary, Department of Health Research & Director General, Indian Council of Medical Research (ICMR).
Dr Anita Jain, Clinical Editor of The BMJ, said, “The BMJ is committed to advance dialogue and action on key health issues that affect the people of South Asia. Neglected diseases disproportionately affect poor, marginalized, and rural populations. We expect governments and public health bodies will give due consideration to solutions and next steps proposed in this collection.”
“This collection highlights the notable successes of public health programmes in neglected diseases in South Asia and identifies areas where research and supportive policy are absolutely needed to sustain plans for control or elimination,” said Dr Suman Rijal, Head of DNDi in India.
For example, research conducted by DNDi in India has shown that post-kala-azar dermal leishmaniasis, a skin condition that occurs in estimated 10% of treated patients with visceral leishmaniasis, may be an important reservoir for transmission. New and improved treatments are needed for these patients, and for the first time, there is a rich portfolio of oral drug candidates for visceral leishmaniasis, which may result in a new therapy within a decade.
Notable recommendations from authors of the collection include:
- Lymphatic filariasis: Sixty-three per cent of the population at risk of lymphatic filariasis and 50% of the people infected worldwide live-in South-East Asia. India alone harbours 40% of the world’s burden of disease. Mass administration of microfilaricidal drugs has reduced new infections. Sri Lanka and the Maldives have successfully eliminated lymphatic filariasis through a combined approach of mass drug administration and robust disease surveillance. Current challenges include management of patients with chronic manifestations, such as lymphoedema and hydrocele, and the uneven prevalence, with persisting transmission hotspots. New drugs and regimens that kill adult worms (e.g, triple therapy) and alleviate lymphoedema could help accelerate elimination efforts for lymphatic filariasis
- Kala-azar: Driven by a strategic regional collaboration under the Kala-Azar Eradication programme, Nepal and Bangladesh have eliminated visceral leishmaniasis and India has achieved considerable success in reducing the disease burden. With increasing incidence of post kala-azar dermal leishmaniasis and HIV-Leishmania coinfection low grade transmission continues and there is a risk of outbreaks. For the first time ever, there is a rich portfolio of new orally available chemical entities for visceral leishmaniasis. With adequate support for continued research and development, this pipeline of drug candidates which could result in a new therapy within the next decade.
- Snakebite: South Asia has the highest burden of snakebite envenoming in the world and contributes to 70% of global snakebite mortality. Inadequate first aid, delayed treatment access, and suboptimal treatment contribute to poor outcomes. There is a need to support development of newer antivenoms against locally prevalent snake species and improve production and distribution of antivenom to address shortages in the region.
- Enteric (typhoid) fever: Relentless emergence of antimicrobial resistance has led to treatment failures and limited treatment choices for typhoid fever in South Asia. A new conjugate vaccine approved in 2018 offers an important tool to control typhoid in South Asia. Investments in research and development of rapid diagnostic tests and new treatments must be prioritised.
- Neonatal sepsis: The incidence of neonatal sepsis in South Asia is 4 to 10 times higher than that in developed countries. About 50-88% of common isolates from the health facilities are resistant to first-line antibiotics. Simple, evidence-based interventions can help, such as better asepsis, hand hygiene, and exclusive breastfeeding and the establishment of antimicrobial stewardship programmes, including clearer treatment guidance for clinician.
- India must establish a comprehensive policy on neglected diseases that paves the way for greater funding and mechanisms to support research and innovation. A unified programme on neglected diseases encompassing research and elimination measures is likely to have a greater impact.
The collection was launched at the India International Centre in New Delhi as part of DNDi’s 15-year anniversary celebrations. Prof. Bhargava, Dr Renu Swarup, Secretary, Department of Bio-Technology, and Dr Shekhar C. Mande, Secretary Department of Scientific and Industrial Research (DSIR) &, Director General -Council of Scientific Industrial Research (CSIR) India attended the launch along with researchers, scientists, policy makers, and representatives of national and international NGOs working for neglected diseases.
A not-for-profit research and development organization, DNDi works to deliver new treatments for neglected diseases, including leishmaniasis, filarial infections, human African trypanosomiasis, Chagas disease, and mycetoma, and for neglected patients, paediatric HIV patients and people living with hepatitis C treatment who cannot access treatment. DNDi has delivered eight new treatments to date, including new drug combinations for kala-azar, two fixed-dose antimalarials, and DNDi’s first successfully developed new chemical entity, fexinidazole, approved in 2018 for the treatment of both stages of sleeping sickness.
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