Neglected Tropical Diseases:

Control & Research

Neglected Tropical Diseases:

Control & Research

P.Olliaro, WHO/TDR

Soil transmitted helminthiasis

SchistosomiasisLymphatic filariasis

OnchocerciasisLeprosy

Trachoma Leishmaniasis

Buruli ulcerChagas disease

HATDengue

…

Malaria

TB

Neglected zoonoses

HIV/AIDS

Previously neglected diseases

Neglected tropical diseases

NTDs in poor populations NTDs in poor populations NTDs in poor populations NTDs in poor populations

Cysticercosis

Echinococcosis

Rabies

Anthrax

Bovine tuberculosis

Brucellosis

Zoonotic trypanosomiasis

Global distribution of NTDsGlobal distribution of NTDsGlobal distribution of NTDsGlobal distribution of NTDs.

~ 1 billion people have >1 NTDs

Burden of disease (DALYs) for infectious & parasitic diseasesBurden of disease (DALYs) for infectious & parasitic diseases

HIV/AIDS, 84.5, 23%

malaria, 46.5, 13%

tuberculosis, 34.7, 10%

neglected tropical diseases, 56.6,

16%

helminth infections, 49.9, 14%

others infectious diseases, 87.2,

24%

"big three"= 46.1%

"others"= 29.6 %

Countries affected by NTDs by Countries affected by NTDs by income groupincome group

Countries affected by NTDs by Countries affected by NTDs by income groupincome group

More than 70% of countries and territories affected by neglected tropical diseases are low-income and low middle-income countries

100% of low-income countries are affected by at least 5 neglected tropical diseases

Health and povertyHealth and poverty

Ill health is both a cause and a consequence of poverty: sick people are more likely to become poor and the poor are more vulnerable to disease and disability

Good health is central to creating and sustaining the capabilities that poor people need to escape from poverty

Good health is not just an outcome of development: it is a way of achieving development

Rapid Impact InterventionsImproving access

Focused interventionsImproving innovation

Large scale interventions

Lymphatic filariasis Leprosy Onchocerciasis Schistosomiasis Helminthiasis Trachoma Yaws

Case management and development of new tools

Human African trypanosomiasis Chagas diseases Buruli ulcer Leishmaniasis Dengue

DengueDengueDengueDengueDengue is the most common mosquito-borne viral disease of humans that in recent years has become a major international public health concern. Globally, 2.5 billion people live in areas where dengue viruses can be transmitted. The geographical spread of both the mosquito vectors and the viruses has led to the global resurgence of epidemic dengue fever and emergence of dengue hemorrhagic fever (dengue/DHF) in the past 25 years with the development of hyperendemicity in many urban centers of the tropics.

Human African Human African trypanosomiasistrypanosomiasisHuman African Human African

trypanosomiasistrypanosomiasisSpread by the bite of the tsetse fly, the disease flourishes in impoverished rural parts of Africa. Untreated, the disease is invariably fatal. Death follows prolonged agony. In 2006 some 70 000 people are estimated to be infected.

LeishmaniasisLeishmaniasisLeishmaniasisLeishmaniasis12 millions are currently infected and 350 million people are at risk of infection. Around 1.5 million to 2 million new infections occur each year.

Buruli ulcerBuruli ulcerBuruli ulcerBuruli ulcer

BU has been reported from 30 countries, left untreated, the disease progresses to massive destruction of the skin and, in some cases, of bone, eyes, and other tissues. Limb amputations may be needed to save a patient's life.

TrachomaTrachomaTrachomaTrachomaBlinding trachoma affects more than 80 million people around the world. Children are mainly concerned by the infection, and every 4 people blind from trachoma 3 are women. Africa is the continent with the greatest number of endemic countries, but America, Middle-East and Asia are also endemic. SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) has proven its effectiveness in eliminating this scourge from humanity.

LeprosyLeprosyLeprosyLeprosyLeprosy is considered shameful and people hid their symptoms for fear of ostracism despite free and effective multidrug therapy. Today, the diagnosis and treatment of leprosy is easy. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.

Lymphatic filariasis (LF)Lymphatic filariasis (LF)Lymphatic filariasis (LF)Lymphatic filariasis (LF)Over 120 million people are currently infected and around 1.3 billion people in more than 80 countries are at risk of infection. Drugs used against lymphatic filariasis are either donated – albendazole and ivermectin, or very inexpensive DEC. Albendazole and Ivermectin are donated by GlaxoSmithKline and Merck & C for mass administration to at-risk populations.

SchistosomiasisSchistosomiasisSchistosomiasisSchistosomiasis

Schistosoma haematobium is endemic in 53 countries in the Middle East and most of the African continent including the islands of Madagascar and Mauritius. In sub-Saharan Africa alone there are reckoned to be 112 million infections with S. haematobium. Praziquantel at the single dose of 40 mg/Kg body weight is a very safe and effective treatment against S.

haematobium and the cost of treatment is less than 0.15 Euro.

HookwormsHookwormsHookwormsHookwormsHookworms infect one billion people. It is calculated that 500 million women are infected by hookworms and at globally least 44 million are pregnant and

infected at any time. Safe single dose treatment costs < 0.02 Euro a dose .

"Industry is present. Your donations of drugs and other support opened an opportunity which public health has seized. Your engagement has given us the tools to take action on an unprecedented scale."

Extract from the opening speech by DG

at the first WHO global partners' meeting on NTD, 19-20 April 2007

Free and timely access to high-quality Free and timely access to high-quality medicinesmedicines

Novartis

Bayer

Merck KGaA

sanofi-aventis

Bayer

sanofi-aventis

Johnson & Johnson

Novartis

Merck & Co Inc.

sanofi-aventis

GlaxoSmithKline

Donator

Unlimited quantity by 2012 for human African trypanosomiasisPentamidine

200 million tablets 2008-2017 for SchistosomiasisPraziquantel

Unlimited quantity by 2012 for human African trypanosomiasisSuramine

600 000 tablets 2007-2009 for fascioliasisTriclabendazole

500 000 tablets (120 mg) per year by 2012 for treatment of Chagas diseaseNifurtimox

Unlimited quantity by 2012 for human African trypanosomiasisMelarsoprol

50 million tablets in 2007 for Soil-transmitted helminths control programmes for childrenMebendazole *

Unlimited quantity for Leprosy and its complicationsMDT and Clofazimine

Directly to countries for lymphatic filariasis and onchocerciasis Ivermectin *

Unlimited quantity by 2012 for human African trypanosomiasisEflornithine

Unlimited quantity for lymphatic filariasis only (not for soil-transmitted helminthiasis)

Albendazole

Conditions Medicine

* Donation made not directly to WHO

RESEARCH:

Develop new tools

Existing tools: Optimise Improve use/access

RESEARCH:

Develop new tools

Existing tools: Optimise Improve use/access

Pharmaceutical gap

Operational gapFINANCING RESEARCH

PARTNERING TO CONDUCT RESEARCH

Modified from Ridley D. et al Health Affairs 2006

Ascariasis

Trichuriasis

Hookworm disease

Leishmaniasis

Malaria , 15

Tuberculosis , 7

African Trypanosomiasis

Chagas disease

Schistosomiasis

Lymphatic filariasis

Onchocerciasis

Trachoma

Intestinal nematodes

0

1

10

100

0 50 100 150 200 250

Drug R&D investments (million $)

log

DA

LY (m

illio

ns)

Drug R&D investments, pipeline

& burden

Drug R&D investments, pipeline

& burden

Vs. R&D costs ?

Research needsResearch needsInnovation/

pharmaceutical Gap

Basic science

Product discovery

Product Development

(R&D)Product use

Schools, Communities

HealthSystems

"Operational"Research

"Tool ready"Lymphatic filariasis, Leprosy, Onchocerciasis,

Schistosomiasis, Helminthiasis, Trachoma, Yaws (VL in Indian subcontinent)

"Tool deficient" Human African trypanosomiasis, Chagas dis.

Buruli ulcer, Leishmaniasis, Dengue

"Vulnerable diseases"Lymphatic filariasis, Onchocerciasis,

Schistosomiasis, (Helminthiases)

Current global R&D portfolioCurrent global R&D portfoliodisease potential candidates DEVELOPMENT OPTIMIZATION

Onchocerciasis emodepside moxidectin (Ph3)[WHO/TDR + Wyeth]

albendazole/Loaloa

lymphatic filariasisSchistosomiasis L-praziquantel praziquantel dosing

praziquantel combos?Soil-transmitted Helminths

product from animal health?

Human African Trypanosomiasis

DB backupsfexinidazole backups

fexinidazole (Ph1)[DNDi + sanofi-aventis]

Nifurtimox+eflornithine (approved EML)pentamidine shortened Rx

Chagas disease pediatric benznidazole

Leishmaniasis buparvaquoneoral AmphoB

combinations:AmBisome+MiltefosineAmBisome+ParomomycinMiltefosine+Paromomycin

Dengue options considered