For decades, the journey to treat gambiense human African trypanosomiasis, or gHAT — commonly known as sleeping sickness — was a grueling ordeal for patients and providers alike. In the Democratic Republic of Congo, home to the world’s heaviest burden of gHAT, the standard of care once relied on melarsoprol, an injectable regimen that was notoriously difficult to administer and associated with serious adverse reactions, requiring prolonged hospitalization and careful monitoring.
Today, that medical landscape is being fundamentally reshaped. A new documentary from Devex, produced in partnership with the Gates Foundation as part of the Escape the Neglect series, chronicles one of the most significant transformations in global health.
The documentary takes viewers into the heart of the DRC, where, for generations, gHAT has taken a heavy toll on rural communities, causing debilitating neurological symptoms that eventually lead to death if left untreated.
The film traces a clear arc of scientific progress. A major step forward occurred in the mid-2000s with the introduction of nifurtimox-eflornithine combination therapy, or NECT. While NECT was a safer alternative to older, more dangerous drugs, it remained a logistical challenge, requiring dozens of IV infusions and mandatory hospitalization — a difficult requirement for families living in areas with limited infrastructure.
The real paradigm shift arrived in 2018 with fexinidazole. Developed through a landmark partnership between Sanofi and the Drugs for Neglected Diseases initiative, DNDi, fexinidazole became the first all-oral treatment. For the first time, a 10-day pill regimen replaced the need for needles and hospital beds. But the scientific community continued to push for even simpler solutions.
Researchers are now fast-tracking acoziborole, a single-dose oral cure currently under review by the European Medicines Agency. If recommended for approval, acoziborole will allow health workers to treat patients on the spot in their own villages with a single pill, effectively removing the final logistical barriers to disease elimination.
As fexinidazole is rolled out across the DRC and acoziborole nears a critical regulatory milestone, the film captures a sense of momentum that extends beyond the clinic. Eliminating the disease means easing the strain on fragile health systems and allowing communities to thrive without the shadow of a preventable illness.
The gHAT story provides a blueprint for the promise of private-public partnership to drive innovation. These breakthroughs were made possible through a dedicated ecosystem involving Sanofi, DNDi, Epicentre MSF, French National Research Institute for Sustainable Development, Institute of Tropical Medicine Antwerp, Malawi’s Ministry of Health, Makerere University in Uganda, NOVA University Lisbon, PLNTHA, the Swiss Tropical and Public Health Institute, Uganda National Health Research Organization, the World Health Organization, and the leadership of endemic countries. Their work has meant that, within a single generation, sleeping sickness has gone from a widespread, deadly threat to a disease on the brink of elimination.
Visit Escape the Neglect — a series exploring the extraordinary progress that countries are making in eliminating neglected tropical diseases, or NTDs, and showcasing promising opportunities to build on recent wins.
This content is sponsored by the Gates Foundation as part of our Escape the Neglect series. Click here to learn more.
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