Road blocks in the fight against tropical diseases

Lorenzo Savioli, director of WHO’s department of neglected tropical diseases. Photo by: Eric Bridiers / U.S. Mission Geneva / CC BY-ND

Eliminating Guinea worm and yaws in the coming years is possible, says the World Health Organization’s top expert on neglected tropical diseases. But funding as well as political stability continue to complicate the work of global health groups.

Lorenzo Savioli, director of WHO’s department of neglected tropical diseases, spoke to Devex from Geneva in a phone interview on Wednesday, Jan. 23, days after WHO released a progress report on its year-old roadmap to eliminate 17 tropical diseases.

The conversation highlighted some of the main front lines in the fight against neglected diseases: increasing support from the Global South and the pharmaceutical sector, funding fatigue by cash-strapped Western governments, and the challenges posed by political turmoil and other crises.

WHO is shooting to eradicate Guinea worm – a debilitating parasitic infection known formally as dracunculiasis – by 2015 and yaws – a skin, bone and cartilage disease contracted by skin-to-skin contact – by 2020. Both are treatable diseases if caught in the early stages but if left untreated, can result in illness or deformity.

Continued international funding and support has helped reduce the high prevalence of Guinea worm since the mid-1980s, says Savioli, when the number of cases hovered around 3.5 million. Last year, about 500 people were reportedly infected with Guinea worm, usually by drinking contaminated water. More than 95 percent of the cases were in South Sudan.

Through the Carter Center, a variety of donors have funded the treatment of Guinea worm, including the Bill & Melinda Gates Foundation, the U.K. Department for International Development and the U.S. Agency for International Development. The best way to prevent the disease is to by ensuring clean drinking water.

Yet while funding is not a concern for Guinea worm, it remains a factor for yaws.

“Yes, there is an issue for funding and access for treatment,” Savioli said of yaws. “I don’t think research or developing a new vaccine is really an issue. I just think we need to reach the populations with the tools and really treat people, that is the point.”

A mass campaign from 1952 to 1964 in 46 countries reduced the prevalence of yaws by 96 percent, from an estimated 50 million cases down to 2.5 million using penicillin shots. A single dose of an oral treatment of antibiotics is as effective as penicillin, which could overcome the barrier of having health workers give the shots, WHO found in 2012.

Countries are not mandated to report cases of yaws, which mostly affects children under the age of 15 and is endemic in 14 countries, including Cameroon, the Democratic Republic of Congo, Ghana, Indonesia, Papa New Guinea and Timor-Leste. It is not clear how many people are living with the disease, which materializes as skin lesions and can cause decay in the skin, bone and cartilage.

The main challenges lie in a lack of national political commitments and international funding, Savioli said.

The struggling eurozone economy has prevented European countries from offering strong funding pledges for yaws, an often-neglected disease, Savioli suggested. His hope is that EU countries, as well as Japan, will up their support of the eradication of tropical diseases as the roadmap moves along toward its target year of 2020.

The BRIC countries, on the other hand – Brazil, Russia, India and China – are becoming increasingly engaged in funding, as are endemic countries themselves – largely in sub-Saharan African and the Asia-Pacific region.

“We are seeing more internal financing, and that has been a really big change we have seen in the last year,” Savioli said.

While international pharmaceutical companies as well have invested money in new drugs to eliminate tropical diseases, the drugs have been market failures for human use.

Then again, Savioli said, “building trust with the industry has probably been the biggest success.”

Savioli describes the roadmap, which also includes targets for the eradication of other diseases like rabies and dengue fever, as ambitious yet achievable, with the support of continued funding commitments.

Yet he said that another big roadblock remains ensuring political stability in some endemic countries.

“We need to promote peace to promote health,” he said. “The fact that some of the countries where we are working people are instead of promoting peace are killing each other is really depressing.”

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    Amy Lieberman

    Amy Lieberman is an award-winning journalist based in New York City. Her coverage on politics, social justice issues, development and climate change has appeared in a variety of international news outlets, including The Guardian, Slate and The Atlantic. She has reported from the U.N. Headquarters, in addition to nine countries outside of the U.S. Amy received her master of arts degree from the Columbia University Graduate School of Journalism in May 2014. Last year she completed a yearlong fellowship on the oil industry and climate change and co-published her findings with a team in the Los Angeles Times.