The recent NTD Summit in Geneva was held to celebrate progress achieved since the London Declaration of 2012, when governments, pharmaceutical companies and other stakeholders in neglected tropical diseases set themselves the ambitious target of controlling or eliminating 10 NTDs by 2020.
Truly, in many aspects the progress accomplished is considerable. To cite just two achievements: there are now fewer than 3,000 new cases of sleeping sickness, the lowest number in 70 years; and Bangladesh, India and Nepal have achieved a 75% drop in visceral leishmaniasis cases, down to just over 10,000, the lowest number since the elimination target was set. New commitments were also announced at the Summit, including sizeable renewed funding pledges from the UK, Belgium and the Gates Foundation.
As one of the 20 original signatories of the London Declaration, DNDi too has much to celebrate. Our clinical trials investigator, Dr Wilfried Mutombo, spoke at the Summit of his astonishment at how the tools available in the fight against sleeping sickness have been revolutionised in such a short period – from toxic melarsoprol, to NECT, and, as our clinical trials wrap up, potentially from NECT to fexinidazole. The promise of a new all-oral treatment that cuts out the need for hospitalization and complex lumbar punctures gets ever closer, and if fexinidazole is successfully registered, it could lay the foundation for elimination of the disease in the future.
Ambitious targets serve the obvious purpose of galvanising the NTD community around a shared goal, and the London Declaration succeeded in bringing new actors to the table and casting a much-needed spotlight on the neglect of these diseases. But the job is far from done, and we should not be lulled into a sense of security or complacency by too much celebrating of good news.
The innovation needs are critical for many NTDs – treatments and diagnostics remain woefully inadequate for Chagas disease. Mycetoma is a disease so neglected that it doesn’t even make it on the list of ten diseases slated for control and elimination. For visceral leishmaniasis, the role of asymptomatic infections and PKDL is not well understood, and could jeopardise elimination efforts without greater understanding of how they can fuel transmission. Existing treatments have severe limitations: some are toxic, or are difficult to administer, posing a burden for health systems and for patients alike; for others, affordability and access are seriously issue. The mass drug administration programmes for lymphatic filariasis and river blindness, backed by large-scale donations from the pharmaceutical industry, leave complex scientific and medical issues unaddressed, as existing drugs do not kill the adult worms and people co-infected with loa loa cannot be treated.
It is vital the World Health Organization continue to demonstrate technical and political leadership in NTDs. Over one billion people, often the world’s poorest, are infected with a neglected tropical disease. Despite our best efforts, these diseases continue to debilitate, disfigure and kill. As much as we have progressed, the Summit was also a forum to remind us that we are not yet at the end and that beyond large donation programmes, more innovation is needed in the fight against neglected diseases.
By Bernard Pécoul, Executive Director, DNDi