By Dr Monique Wasunna, Eastern Africa Director, DNDi
First published in The Conversation Africa on 26 January 2023
Togo had reason to celebrate in 2022 when it became the first country in the world to eliminate four neglected tropical diseases. The west African nation stamped out Guinea worm disease in 2011, lymphatic filariasis in 2017, sleeping sickness in 2020, and trachoma last year.
These diseases are transmitted in various ways. Guinea worm disease, for instance, is water-borne while sleeping sickness is transmitted by the tsetse fly.
They are just a few among a host of neglected tropical diseases, which mostly affect impoverished communities and that are exacerbated by instability, climate change, and poor living conditions. Every year, 1.7 billion people are affected by these diseases. They cause immense suffering, stigma, disability – and sometimes death.
Togo achieved its milestone through a combination of measures. These included door-to-door mass drug administration, training of healthcare staff, sustained financing, and strong political support.
Other African countries also made significant progress in tackling neglected tropical diseases in 2022. Benin, Rwanda and Uganda managed to eliminate sleeping sickness. Malawi eliminated trachoma and the Democratic Republic of Congo (DRC) eliminated Guinea worm disease.
On another continent, in India, Prime Minister Narendra Modi applauded his country’s success in eliminating smallpox, polio and Guinea worm disease, while expressing confidence it could “soon” eliminate another neglected tropical disease, visceral leishmaniasis.
All of this means there’s plenty of reason to celebrate. But the global health community cannot rest on its laurels. These diseases are still present in some areas.
The insects that transmit many of these diseases don’t respect borders – so no one is safe until everyone is. The COVID-19 pandemic gravely disrupted control programmes, delaying the achievement of elimination goals by years for some diseases. Some countries are also struggling to tackle neglected tropical diseases because of instability and conflicts that hinder control efforts, or because they have large remote regions that are difficult to reach.
Adequate funding is needed to support drug distribution, training of healthcare staff, and raising awareness. Funding for research and development is crucial, too, so that the promising innovations emerging from African laboratories and clinical trial sites can reach doctors and patients.
One of the challenges in tackling many neglected tropical diseases is the absence of adequate treatments. Existing medicines are often not effective enough or are difficult to administer, such as regular injections that require hospitalisation. Some treatments are very painful. Others are downright toxic. For some diseases, such as a fungal infection called mycetoma, which is endemic in Sudan, there are no effective treatments at all – amputation is often the only option.
Because these diseases affect the poorest communities and there is little profit to be made from developing new drugs, they have been historically ignored by traditional pharmaceutical research.
But the abundance of good news last year has given me hope. 2022 was an incredible year for visceral leishmaniasis, which is endemic in eastern Africa and is my field of expertise as a physician and specialist in infectious diseases and tropical medicine.
The disease is fatal if left untreated. It’s the deadliest parasitic killer after malaria. Those infected with visceral leishmaniasis suffer from fever, weight loss and intense fatigue. Many are unable to work, which means a loss of income for their families.
But in September 2022, a shorter, more effective new treatment was announced. Developed with several partners, including Médecins Sans Frontières, this treatment partially removes the need for daily injections.
In June, the World Health Organization also recommended an improved treatment specifically for people who are co-infected with HIV and visceral leishmaniasis. This gives hope for the thousands of patients – often young seasonal migrant workers – who respond poorly to standard treatment.
Promising results for a new, one-dose drug for sleeping sickness were also announced last year following clinical studies conducted in the DRC and Guinea by Congolese and Guinean researchers. This new medicine would be a significant improvement over existing drugs and could open the door to sustainably eliminating the disease. This is a remarkable achievement. I still remember when the only drug available to my fellow doctors in the DRC was an arsenic derivative so toxic it killed 5% of their patients.
Collaboration and partnerships
However, research and development efforts alone are not enough. Collaboration and partnerships are key. These are not just buzzwords: past successes in tackling neglected tropical diseases have been rooted in close-knit partnerships between national health authorities, international donors, medical research institutes, universities and industry.
The new treatments I mentioned above were all developed thanks to such coalitions. I am the director of the Eastern Africa office of a global non-profit medical research organization called Drugs for Neglected Diseases initiative, which took an active role in all these research and development collaborations.
The good news is that new partnerships keep being formed. In 2022, we established LeishAccess, a regional collaboration in Eastern Africa working to promote access to visceral leishmaniasis treatments and remove the obstacles that still prevent half of patients from accessing the life-saving drugs they need.
All these advances give me hope. These extraordinary efforts will eventually pay off. I am convinced that, in a not-so-distant future, people will stop dying from leishmaniasis, and will be safely cured thanks to simple oral drugs.
Many gaps remain, with millions of people still suffering from diseases that could be cured. And neglected tropical diseases that are slowly disappearing can suddenly come back with a vengeance, fuelled by conflicts, economic crises, increased poverty, or climate change.
But if sustained investment is coupled with African political leadership and scientific excellence, there’s good reason to hope for the elimination of neglected tropical diseases on the continent.
Photo credit: Rowan Pybus-DNDi