By Dr Monique Wasunna, Eastern Africa Director, DNDi
First published in Africa Arguments on 17 February 2023
As I began my career as a medical researcher, Luke Kanyengareng’ was a 14-year old boy in Kenya who got infected with visceral leishmaniasis, a neglected tropical disease (NTD) caused by a bite of a female sandfly. After malaria, visceral leishmaniasis (also known as kala-azar) is the second deadliest parasitic killer. If left untreated, it will kill 95% of its victims. When Luke fell ill, it took almost five months to get him an accurate diagnosis. When he finally started the treatment that could save his life, it was a harrowing experience of daily painful injections for 30 days with a potentially toxic drug.
I did not know Luke then, but my passion to find better treatments for patients affected by this deadly disease was the reason our paths would cross years later. To alleviate the suffering of people affected by NTDs, such as Luke, I decided to dedicate my life to developing new, better drugs.
Luke’s story is not unique. 1.7 billion people around the world are affected by NTDs and Africa accounts for nearly 40% of this global burden. These diseases can be devastating. They can cause loss of life, severe pain, disabilities, disfigurement, malnutrition, and stunted growth. What these diseases have in common is that they don’t feature enough on the global health agenda, receive little funding, and have historically been ignored by pharmaceutical research.
I eventually met Luke when the organization I work for, the Drugs for Neglected Diseases initiative (DNDi), started conducting research in his hometown of Kacheliba, West Pokot, Kenya. By that time, Luke had beaten incredible odds by surviving visceral leishmaniasis. The encounter with the doctors and nurses who saved his life made such a strong impression on the young man that he decided to study nursing. He became a nurse at the Kacheliba Sub-County hospital, taking care of patients affected by leishmaniasis and other infectious diseases.
Because we need better, safer treatments for people like Luke, DNDi has worked with many partners in East Africa and across the globe, to find and develop new drugs for NTDs, conducting clinical trials in endemic countries and forming partnerships with Ministries of Health, communities, and research institutions.
We are making progress. Last year, we demonstrated that a new, shorter, better treatment is effective against visceral leishmaniasis. New treatments for visceral leishmaniasis are in the pipeline, including an all-oral drug that will hopefully dispense with the need for hospitalisation. From using arsenic that killed 5% of sleeping sickness patients 20 years ago, we have also been able to show that a single-dose oral treatment is effective in treating sleeping sickness.
With these advancements, and more in the pipeline, and partners joining the fight against neglected diseases, the impact of our collective efforts has started to become visible.
The World Health Organization notes that 47 African countries have already eliminated at least one NTD as a public health problem. Key milestones in 2022 include Togo, which became the first country to eliminate four NTDs, namely Guinea-worm disease, elephantiasis, sleeping sickness, and trachoma. In the same year, trachoma was eliminated in Malawi, and Guinea-worm disease in the Democratic Republic of the Congo.
However, more still needs to be done to reach the last mile of elimination of NTDs. Health workers in Africa continue to face glaring challenges that include inadequate tools to test and treat NTDs, low integration of NTDs into national health programmes, unpredictable and inadequate funding, and impact of the Covid-19 pandemic on already overburdened health systems. The continent can – and must – do more to provide solutions for patients like Luke and eliminate neglected diseases.
In the past two years, as we fought the Covid-19 pandemic, we have felt the energy, renewed hope and commitment from governments, healthcare workers, researchers, and community advocates in the continent. The Africa Centers for Disease Control and Prevention brought together member states and stakeholders in the region and beyond to tackle the pandemic. We in the NTD community have learned a lot of lessons from this response.
Great strides to stay on course to tackle NTDs can be seen in the efforts made during the London Declaration (2012), and the Kigali Summit on Malaria and NTDs a decade later, which marked the launch of the Kigali Declaration on NTDs (2022) that has galvanised the political will, country ownership, and commitments (including financial ones) to attain the targets set in the WHO’s 2021 – 2030 NTD road map.
The African Union’s Continental framework and Common Position on NTDs and Africa’s New Public Health Order calls on strengthening efforts towards health security. The year has started on a good note: last week, WHO in collaboration with its partners held a stakeholders meeting to develop a strategic plan for the elimination of leishmaniasis in East Africa.
This is the first time that the elimination of visceral leishmaniasis in Eastern Africa has been discussed. These are conversations I only dreamed would be had in my lifetime.
All these efforts confirm that the basic structures and strategies to eliminate NTDs already exist and we now need to build on them so that we can reach that last mile of elimination. We can eliminate NTDs through the power of partnerships and sustained investment in financing for medical research and programmes.
30 January marked the fourth World NTD Day, which is observed annually to raise awareness on NTDs, celebrate milestones, highlight the gaps, and accelerate the response in the fight against NTDs. I am happy to say that with community voices such as Luke’s, partnerships with key stakeholders such as NTD National Control Programmes, governments, pharmaceutical companies, and investments at continental, national and local levels, we can act now and act together to eliminate neglected diseases once and for all.
Photo credit: Lameck Ododo-DNDi