The Role of Neglected Disease-Endemic, Emerging-Economy Countries in Neglected Disease R&D: Latin America on the Rise

Eric StobbaertsEric Stobbaerts, Head of DNDi Latin America
[September 2013]

As DNDi marks its 10 years of existence, the time is ripe to assess the achievements and difficulties experienced in order to move into a new decade with new approaches. For Latin America, in particular, this period is unique, even transformative, as it is marked by unprecedented economic and social strengthening of the region. This growth brings with it the crucial role of Latin America’s public and private sectors in contributing meaningfully to the neglected disease research and development landscape. The activities of DNDi Latin America are focused on contributing to this process and have expanded with increasing opportunities to partner with ministries of health and national control programmes, but also other non-governmental and private-sector actors, to address the needs of patients suffering from neglected tropical diseases endemic in the region.

An example of this is the recently hosted ‘Chagas Week’ in Argentina, at which DNDi entered into an operational relationship with the Mundo Sano Foundation and the pharmaceutical company ELEA, while strengthening ties with the Argentinian Ministry of Science, and other stakeholders. In Mexico, the Carlos Slim Health Award we received this year has allowed DNDi to build greater presence in this country by identifying new partners and advocating for patient access to Chagas treatment. Colombia is also now part of our operations as we gear up for a clinical study on a cutaneous leishmaniasis treatment.

In Brazil, there is an unprecedented bourgeoning of activity that will certainly expand to neighbouring countries. This year, for instance, for the first time at DNDi, a discovery programme is being set up by a regional office in an endemic country. This programme – LOLA, Lead Optimization in Latin America – was inaugurated with a partnership agreement with the University of Campinas (Unicamp) in Sao Paulo, Brazil, to seek optimization of new molecules against Trypanosona cruzi and Leishmania spp for the treatment of Chagas disease and leishmaniasis. A collaboration agreement with the University of Sao Paulo- Sao Carlos is also eminent. As this programme develops, we are optimistic that other regional and international partners will follow suite.

LOLA is one of the many R&D projects currently taking place in the region. In 10 years, the clinical pipeline of projects has substantially grown, for example for Chagas disease, with the Phase II clinical study of E1224 to evaluate safety and efficacy for the treatment of adult patients with chronic indeterminate Chagas disease, and a study on biomarkers as clear and early markers to indicate parasitological treatment outcome and later indicate definite cure.

The scenario for leishmaniasis is similar. The VL study in Brazil, supported by the Brazilian Ministry of Health to assess current treatments for the diseases, is progressing with five active sites and the 2013 milestone of completing the recruitment of 50% of the trial patients was achieved in May. The revised VL treatment guidelines in Brazil, to be released by October, will likely contain changes based on evidence provided by the study.

Two of the six treatments delivered by DNDi overall were developed in the Latin American region: ASMQ for malaria and the paediatric dosage form of benznidazole for Chagas disease – two successes, yet with many barriers to overcome in order to ensure patient access to the treatments. Our advocacy activities are heavily focused on the need for treatment now, and our R&D work on ensuring better, game-changing treatments in the longer term.

As part of the international Chagas Coalition – including DNDi, Carlos Slim Health Institute, Sabin Vaccine Institute, Mundo Sano Foundation, ISGlobal, Ceades, and with support by Doctors Without Borders and FINDECHAGAS patient federation – we aim to boost access to diagnosis and treatment for Chagas patients and accelerate efforts to stimulate innovation for new health tools to fight the disease. The Coalition has taken on the ‘Time to Treat’ mission to ensure further action.

Finally, following the resolution adopted at the World Health Assembly (WHA) last May, a very exciting state-driven, endemic country-led effort to deliver innovation for the health needs of developing countries has engendered discussions on proposals for ‘demonstration projects’ that incorporate the key principles of the resolution. DNDi Latin America and the MSF Access Campaign are partnering to contribute to the architecture of such projects, the concept of which is new to the region.

In short, the region of Latin America holds the potential to play a unique and major role in neglected disease research and development. There are, however, challenges to overcome. We have seen, over a decade, that when neglected-disease endemic countries become emerging economies with clearer agendas to defeat poverty within their borders, there is an incredible window of opportunity to stimulate patient needs-driven innovation. As a regionally embedded organization, we have to catalyse and support this unprecedented moment for Latin America by bringing together the conduct of research, engagement of governments, leveraging of private sector capacities, fundraising opportunities, and civil society engagement, all in support of one key goal: treating the most neglected patients of the region, and beyond.

Eric Stobbaerts, Head of DNDi Latin America