Vector-borne diseases greatly contribute to human mortality and morbidity in tropical settings and beyond. Yet, most of them are part of the neglected diseases group given the low levels of resources invested in developing new diagnosis and treatment methods.

As part of our series focusing on vector-borne diseases, Daily Development talks to Dr Bernard Pécoul, Executive Director of the Drugs for Neglected Diseases initiative (DNDi), to see what can be done to mitigate the impact of such forgotten and yet deadly diseases. 

DD: Together with its partners, the Drugs for Neglected Diseases initiative (DNDi) is working towards a very specific objective: treating patients for whom medicines sometimes do not exist, are toxic or are not accessible. Could you tell us more about it?

BP: DNDi was founded in 2003 on the observation that many patients infected with neglected diseases, such as Chagas disease, sleeping sickness and leishmaniasis (or kala azar), were left behind, without adequate treatment. Some were dying because they had no money to purchase the treatments—if they existed—and had no voice to be heard.

Furthermore, most of the patients suffering from such illnesses are very poor and so do not represent a lucrative pharmaceutical market. Therefore, investing in the development of treatments for these diseases is of no real interest to most pharmaceutical companies.

To some extent, this has changed over the past decade. New actors—both from the private and public sectors—have joined the fight, together with DNDi and others to develop new, effective and affordable treatments for millions of patients.

DD: On this year’s World Health Day (7 April) the urgent need to prevent and control vector-borne diseases was highlighted. What is needed to provide an effective response to such diseases?

BP: Of course, prevention and control of diseases like malaria, sleeping sickness, kala azar or Chagas disease is key. We are talking here about one billion people at risk!

People affected by these diseases need access to diagnostics, treatments and vaccines, and such strategies have to be accompanied by vector control and surveillance. Where prevention has not yet kicked in, diagnostics and treatments adapted to the needs of neglected populations are crucial. 

DNDi’s activities focus on developing new treatments, but to contribute meaningfully to the control or elimination of some diseases we know that treatment is not the panacea if not combined with rapid diagnostic tools and comprehensive surveillance, prevention, control and even elimination strategies that are built to last.

DD: What is DNDi concretely doing to reduce the burden of neglected diseases?

BP: Acting as a conductor of a virtual orchestra, DNDi leverages partners’ specific assets, capacities and expertise to implement projects at all stages of the R&D process in order to develop the best treatment options for vector-borne diseases as well as HIV treatment for infants.

One of our objectives is to answer to urgent needs by combining, repurposing or reformulating existing drugs. So far, DNDi and its partners have developed six improved treatments and, in the longer term, we aim to develop six additional entirely new drugs—notably in the form of a simple pill rather than infusions or injections—in order to contribute to changes in the way the diseases are managed in endemic countries. For instance, for sleeping sickness, two oral drugs are currently in clinical development, one being tested in patients in the Democratic Republic of the Congo. To treat this fatal disease with a pill would simplify the life of patients and health workers. This way, the mobile teams could directly test and treat immediately at the village level. Another illustration of DNDi’s work is the new antimalarial treatment, ASAQ Winthrop, developed notably in partnership with the French pharmaceutical company Sanofi. Since its launch in 2007, 300 million treatments of this fixed-dose combination drug have been distributed in 32 African countries.

DD: What does the future look like for patients?

BP: There are encouraging signs for a brighter future for neglected patients. In order to ensure that we “walk our talk”, however, we have to ensure the sustained and even increased commitment of  the actors involved in research and development of new health tools to treat neglected diseases. Drug donations can be part of the answer for certain diseases, but we do need to ensure that drug development and further technological innovation continue and deliver better treatments. The current drug development pipeline should be able to offer patients effective and field-adapted health tools.

We also have to remember that children are particularly vulnerable to neglected diseases. The field of R&D must remember that children are not just small adults and need to be specifically taken into account even very early on in the drug development process. 

DD: What keeps you hopeful?

Twenty years ago, in the field, I could see the despair of patients and doctors who had no choice but to treat sleeping sickness with a drug that was killing one patient out of 20. Today, patients with the same disease, in the same remote areas, are recovering thanks to improved treatment. This gives me hope that further progress can be made, for instance by developing a treatment that could help eliminate sleeping sickness. We just cannot give up the fight!