Latin America Takes a New Look at Neglected Diseases

The rise of emerging economies in Latin America is an opportunity to improve strategies for fighting neglected illnesses and increase the region's contribution to the global struggle against them, says the regional director of an organisation devoted to this purpose. "Our region is going through a major transformation in economic and social terms," said Eric Stobbaerts, the Latin America director of the independent Drugs for Neglected Diseases initiative (DNDi), mentioning the progress that has been made in Argentina, Brazil, Colombia, Chile and Mexico. Advantage should be taken of this positive change to "redefine the way these diseases have been addressed in the past," he said. Several of them are endemic in the region, like Chagas disease and visceral leishmaniasis or kala azar. These maladies are classed as "neglected" because they are not researched by large international pharmaceutical laboratories that regard them as "poor-country diseases", without much profit incentive to develop drugs against them. The rise of the emerging economies on the world scene "means more resources are available for development, industrial production and innovation in the fight against forgotten tropical diseases," he said. Stobbaerts talked to IPS after a meeting on "Uniting to Combat Neglected Tropical Diseases" held in London Jan. 30 and organised in support of "Accelerating work to overcome the global impact of neglected tropical diseases - A roadmap for implementation," released the same day by the World Health Organisation (WHO) which intends to eradicate 10 of the diseases this decade. A DNDi communiqué after the London meeting celebrated global achievements in this field, but called for gaps in research and development to be filled, so that better diagnostic methods and new medicines are created before 2020. A non-profit research and development NGO, DNDi has worked since 2003 developing medicines and treatments for neglected diseases. It concentrates especially on illnesses with high mortality rates: African trypanosomiasis (sleeping sickness), helminthic (parasitic worm) infections and infantile HIV/AIDS, as well as Chagas disease and leishmaniasis. Stobbaerts emphasised that Latin America has traditionally been a highly endemic region with vast reservoirs of the neglected diseases, so there is "excellent technical and scientific knowledge" in the region. "But there are still enormous needs in the face of the number and variety of diseases neglected because of market laws, and a great many patients are still without treatment," he said. Among DNDi's partners in Latin America are the Brazilian Fiocruz Foundation and state laboratories like Farmanguinhos and Lafepe. Outside the region, notable partners include the Institut Pasteur in France and Médécins Sans Frontières (Doctors Without Borders). The partnerships have allowed DNDi to enter into agreements with the private sector and academic institutions for current projects in Argentina, Bolivia, Brazil and Colombia. Worldwide, six treatments have been developed for malaria, sleeping sickness and leishmaniasis. A children's medicine for Chagas disease, paediatric benznidazole, was developed in Latin America. "Political support at all stages of research and development has been vital for these achievements," Stobbaerts said. However, "we know that efforts to develop pharmaceuticals alone, are inadequate. "Regulations, distribution and health systems are all essential for the success of innovation. There are many barriers that can cause a new drug to be left on the shelf," he said. The number of people in Latin America who - often without knowing it - are infected or carriers of the parasite Trypanosoma cruzi which causes Chagas disease is over eight million, he said, taking this case as an example. Chagas disease especially affects Argentina, Bolivia, Brazil, Mexico and Paraguay, and causes some 12,000 deaths a year, although the real number of fatalities may be much higher because "there is clearly under-reporting," Stobbaerts said. The lack of adequate diagnostic methods for Chagas disease is another problem. "There is an urgent need for a reliable diagnostic test to institute successful treatment," he said. "Without it, treatment is applied in the dark, without knowledge of the patient's parasite status over the long term. This requires intensive medical monitoring which is costly for the primary and secondary health services," he said. "The challenge is to produce diagnostic tests that are applicable in the field, often in remote and isolated places. They must be easy for local health personnel to use and manage; and they must be cheap, because public health budgets are limited," he stressed. At the London meeting, DNDi highlighted, among other key aspects for the battle against neglected diseases, the promotion of innovation; open exchange of knowledge and research; and the creation of public- private institutional partnerships for the development of effective drugs. It was said at the meeting that in Latin America, activists from civil society to the most advanced levels of science have worked to demand open minds and pragmatic solutions in international forums like the World Health Assembly (the decision-making body of the WHO) or the Group of 20 (a forum of the largest industrialised and emerging economies). In Stobbaerts' view, "the region is set on an encouraging course. "Universities are mobilising their resources, opening their libraries and laboratories on a non-profit basis; the private pharmaceutical sector is showing signs of greater interest in issues of social responsibility; and there is a wind of private philanthropy that may show more interest in health issues," he added. From the point of view of the DNDi, regional platforms for clinical research into specific diseases that bring together researchers, doctors, regulators, national controllers and ideally, patients themselves "are vital to ensure that our work is based on patients' needs," Stobbaerts said, and he mentioned the Chagas Clinical Research Platform (CCRP), founded in 2009, that includes a large number of Latin American partners. The DNDi indicated that it is essential to guarantee the participation and leadership of endemic countries, in order to respond to patients' needs, and to secure sustainable and diversified funding to expand development and research. "Our region has a two-fold interest here: to lead at the global level, contributing new ideas, and to overcome health emergencies that are being suffered locally," Stobbaerts said. "The daily task is to stimulate reflection and break down the unfounded belief that little or nothing can be done," he concluded.