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Diseases of poverty remain sorely overlooked

Posted on behalf of Amy Maxmen.

A grim update on biomedical progress on the ‘neglected diseases’, which account for more than 2.6 million deaths per year, confirms how appropriate the name is. Just 3.8% of the 756 new drugs approved in the United States and Europe from 2000 to 2011 treat neglected diseases.

The category includes malaria, tuberculosis, lethal childhood diarrhoea and other diseases that kill impoverished people around the world, who tend to lack clean water, secure housing, sanitary waste disposal and access to health care. People who live on less than US$2 per day cannot afford high-priced drugs, and therefore drug companies have little incentive to spend millions to develop the drugs and bring them to market.

“Wherever you find extreme poverty, you are going to find these diseases, be it in Africa, Asia or even the United States,” explains Peter Hotez, an expert in neglected diseases at Baylor College of Medicine and Sabin Vaccine Institute in Houston, Texas.

Cures for these diseases are not stuck in the pipeline; they simply never launch. Of nearly 150,000 clinical trials conducted over the past decade, just 1.4% tested treatments for neglected diseases, according to the report presented this week in New York by the aid organization Médecins Sans Frontières (MSF; also known as Doctors Without Borders) and the Drugs for Neglected Diseases Initiative (DNDi), a not-for-profit research and development programme.

Even so, today’s nearly barren pipeline represents an improvement over the recent past. The last neglected disease report, covering 1975–99, found that 1.1% of 1,393 approvals were for neglected disease drugs, which accounted for 12% of the ‘global burden of disease‘. By comparison, 12.8% of the drug approvals treated cardiovascular disease, with a global disease burden of 11%.

In the coming decade, the ratio of neglected disease treatments to other drugs might not be as minuscule, as long as funding persists for recently launched initiatives like DNDi, which contributed to the increase in medicines between 2000 and today. On the basis of the drugs now in the pipeline, study author Jean-Herve Bradol, a research director at MSF, estimates that 4.7 new neglected-disease products (excluding vaccines) will be approved each year until 2018, compared to a rate of 2.4 per year in 2000–11.

Bradol considers the Gates Foundation and the US National Institutes of Health the most important players in terms of financing research and development in the coming years. Together with other donors from the private and public sector, the budget for neglected disease research stands at $3 billion, according to MSF.

But with most of that sum going towards malaria and tuberculosis, the most neglected of the neglected diseases continue to languish with little or no funds. Among them is Chagas disease, a malady spread by the kissing bug, which kills about 12,000 people per year by causing heart or digestive destruction, the report says. Another, leishmaniasis, kills 60,000 people per year. Hotez points out that these statistics grossly underestimate the problem because many deaths go undiagnosed.

Although drugs and vaccines are an essential step in saving the millions who die each year of neglected diseases, public-health experts point out that they can help only if they reach the most vulnerable populations. Almost 2 million children under 5 years old die each year worldwide from diseases that existing vaccines could prevent.

“Consider the cholera vaccine, that was pre-qualified for use two years ago because it showed beautiful success,” says Christian Loucq, the director general for the International Vaccine Institute in Seoul. “So what is the problem? The vaccine is not enough, you need a sense of emergency to get vaccines to people.”




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