The non-profit medical research organization Drugs for Neglected Diseases initiative (DNDi) is partnering with dengue-endemic countries on a project which aims to find a safe, affordable and effective treatment for dengue within five years. The first research institution to join is the prestigious Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Dengue, a climate-sensitive neglected tropical disease, is one of the top ten threats to global public health worldwide. Despite an estimated 390 million infections each year in more than 100 countries, there is no specific treatment available.
‘There is no more time to lose in addressing the need for safe and effective dengue treatments that are affordable and accessible for all patients,’ said Dr Bernard Pécoul, Executive Director of DNDi, at an event in Bangkok. ‘To succeed it is critical that dengue-endemic countries are in the lead, and we are excited to be working with Thailand as our first partner.’
‘Finding treatment solutions is all the more critical as dengue spreads at rapid pace – in part as a result of climate change predicted to further intensify the impact of dengue in endemic areas as well as to see it spread to previously unaffected areas.’
Dengue symptoms can include fever, nausea, vomiting, aches, and muscle, joint or bone pain so excruciating that the disease is also known as ‘breakbone fever.’ If infection progresses to severe dengue, affected people may experience shock, internal bleeding and organ failure – there is also a risk of death. The disease places significant pressure on public health systems in endemic countries.
More than 70% of the disease burden is estimated to be in Asia, with rapidly growing incidence in other parts of the world – in particular the Americas which exceeded 3.1 million infections in 2019. There has also been a significant increase in cases in parts of Africa. Thailand sees tens of thousands of dengue cases every year, with major outbreaks every 2-3 years, such as in 2019 when Thailand saw more than 131,000 cases.
‘Even in the midst of the COVID-19 pandemic, it is important we don’t lose sight of our efforts to tackle other diseases which affect millions of people around the world,’ said Dr Prasit Watanapa, Dean of the Faculty of Medicine Siriraj Hospital, Mahidol University.
‘Despite extensive research and development of treatments for dengue fever and progress on vaccines, we have not yet achieved sufficient results. The collaboration with DNDi is a critical first step toward working with international organizations to promote and develop the potential of Thailand as one of Southeast Asia’s most dependable medical research and development facilities, as well as to contribute to the control of dengue fever in Thailand permanently.’
Globally, the number of dengue incident cases increased by 85% from 1990 to 2019. Rising temperatures linked to climate change are predicted to see faster viral amplification of the disease, as well as increased survival, reproduction and biting rate of the mosquitoes which carry it. The number of people at risk of dengue is predicted to reach 60% of the world’s population by 2080 as a result of climate change, rapid urbanization and population growth.
The new partnership therefore aims to find a new therapeutic solution to help treat dengue fever, prevent progression to severe disease and help relieve pressure on overburdened health systems.
DNDi and its partners will work together on joint projects to progress preclinical investigations of potential dengue treatments, test the efficacy of several repurposed drug candidates and implement clinical trials of the most promising drug candidates. At the same time, they will coordinate efforts to help overcome knowledge gaps and expedite clinical research and regulatory approvals, including addressing unmet needs on diagnostics. The partnership will also focus on raising funds and mobilizing resources while openly sharing research knowledge.
DNDi is in the process of signing a similar agreement with the Translational Health Science and Technology Institute (THSTI) in India and is fast progressing discussions with the Institute of Medical Research (IMR) in the Ministry of Health, Malaysia and the Oswaldo Cruz Foundation, Brazil to develop therapeutics. Meanwhile, the organization will bring African countries, such as the Democratic Republic of Congo and Ghana, on board to carry out epidemiological studies to better understand the disease in these areas.
The scientific response to COVID-19 has seen major rapid scientific advances in global health but has also thrown into sharp relief the serious power imbalances in global health. The dengue partnership, building on DNDi’s experience in South-South cooperation with hepatitis C and COVID-19, aims to show how global health R&D coordination, collaboration, and financing can be re-imagined to support a more distributed, decentralized, and democratic approach to the production of knowledge and innovation as global public goods.
Since its creation in 2003, DNDi has developed and registered nine new treatments for neglected diseases such as sleeping sickness, visceral and cutaneous leishmaniasis, Chagas, and paediatric HIV. This is the first time its researchers will dedicate efforts to dengue.
Living with dengue: ‘It’s everywhere and there’s nothing we can do about it.’
To hear more about people’s experiences, we visited recovered dengue patients in the historic city of Malacca in Malaysia, living in the highest risk areas for dengue, known as ‘red zones’.
We met 31-year-old Ma Tan Jhii Lian (Jhii), who in 2020 was infected by dengue twice in just three months.
A not-for-profit research and development organization, DNDi works to deliver new treatments for neglected patients, those living with Chagas disease, sleeping sickness (human African trypanosomiasis), leishmaniasis, filarial infections, mycetoma, paediatric HIV, and hepatitis C. DNDi is also coordinating the ANTICOV clinical trial to find treatments for mild-to-moderate COVID-19 cases in Africa. Since its inception in 2003, DNDi has delivered nine 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. dndi.org
The dengue programme will in particular build on DNDi’s experience with hepatitis C, which thanks to a successful collaboration with Malaysia’s Ministry of Health and other partners now sees Malaysian patients have access to the lowest treatment costs in South-East Asia. At the same time, the gross inequity in the global response to COVID-19 led DNDi to launch a series of initiatives, including one of the largest clinical trial networks for early COVID-19 treatments, led by low- and middle-income countries.
Frédéric Ojardias (Geneva)
+41 79 431 62 16
Photo credit: Luke Duggleby/www.lukeduggleby.com