Addressing neglected parasitic diseases: Moving towards the development agenda

amidst change : partnerships, networks and global health policies

David Molyneux, Laura Dean, Russell Stothard, Tosin Adekeye, Sally Theobald

Liverpool School of Tropical Medicine

… … … … … …

Goal 3:Ensure healthy lives & promote well-being for all at all ages

A 2030 agenda: The sustainable development goals (SDGs)

The dichotomy

Evidence for the Anthropocene epoch

Climate and ConflictMeta analysis of studies since 1950 - for each one standard deviation (1σ) change in

climate toward warmer temperatures or more extreme rainfall, the frequency of interpersonal

violence rises 4% and the frequency of intergroup conflict rises 14% (Hsiang et al Science 2013)

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CHANGES WATER

RESOURCES

AGRICULTURAL

DEVELOPMENT

HABITATCHANGE

LEISHMANIASISAFRICAN TRYPANOSOMIASIS

CHAGAS DISEASEDENGUE

YELLOW FEVER

MALARIAGUINEA WORM

SCHISTOSOMIASISLYMPHATIC FILARIASIS

ONCHOCERCIASIS

MININGIRRIGATION

FARMINGMICRODAMS

FIRES

DEFORESTATION

REAFFORESTATIONMIGRATION

URBANIZATION

The new bottom billion

• The "bottom billion" were people living in the poorest countries (fragile and failed states)

• The "new bottom billion" are the poorest people living in middle-income countries

From "diseases of the

poor" to diseases of

the bottom 40%?

• Stigma and

discrimination

• Physical and sexual

abuse

• Restrictions on political

and civil rights

• Unable to participate fully

in society

• Unable to access

essential health and

social care

• Barriers to education and

employment

• Experience disability and

premature death

Systematic review: FGS widespread but under-reported

COUNTDOWN implementation research

Sanofi AventisSupport for drugs for

sleeping sickness,

leishmaniasis treatment

Merck & Co Inc“Mectizan for as long as

needed” for onchocerciasis

and filariasis in Africa

GlaxoSmithKlineAlbendazole for lymphatic

filariasis at least to 2020 and

for deworming

PfizerAzithromycin for

trachoma 120 million

doses

NovartisContinuing commitment

to MDT for leprosy;

tricladbendazole for fascioliasis

Johnson & JohnsonMebendazole for intestinal

worms

Merck SeronoDonation of 250 m tablets

annually of praziquantel

(100 m treatments)

EisaiProvision of DEC for filariasis

GileadAmbisome for visceral

leishmaniasis

Global Alliance for the Elimination of Lymphatic Filariasis

A-WOL Industry Collaborations

Control Reduction of disease incidence, prevalence, morbidity or mortality to a

locally acceptable level as a result of deliberate efforts; continued

intervention

Elimination of disease Reduction to zero of the incidence of a specified disease in a defined

geographical area as a result of deliberate efforts; continued intervention

measures are required

Elimination of infection Reduction to zero of the incidence of infection caused by a specified

agent in a defined geographical area as a result of deliberate efforts;

continued measures to prevent the re-establishment of transmission are

required

Eradication Permanent reduction to zero of the worldwide incidence of infection

caused by a specific agent as a result of deliberate efforts; intervention

measures are no longer needed

Extinction The specific infectious agent on longer exists in nature or the laboratory

Importance of knowing the local transmission biology

The need for a more sensitive human diagnostic is obvious i.e. CAA

Aedes aegytpi-The ancient threat

• Dengue

• Chikungunya

• Zika

• Yellow fever

Plus Aedesalbopictus

Cell phones

Individuals missed for treatment are on the periphery of the village social network

Profiles of missed individuals for pzq, alb, & ivm

• Minority tribes

• Minority religion (Muslim)

• Low social status

• Poor home quality

• No home latrine

Chami et al. 2016 Clinical Infectious Diseases Chami et al. 2017 Social Science & Medicine

Common factor? • On periphery of village

social network, i.e. in households with few friendship ties

Illustrative example of full friendship network in a rural Ugandan village

The SDGs or Global Goals

Africa Population in sub Sahara circa 800 million in 2016

• By 2030 50% will live in cities

• Projected Population circa 4 Billion by 2050

• Decline in crop yields by 2050 projected to be circa 20-50 %

• High levels water stress in North Africa

• Circa 30% increase in thermal stress

NTDs and the post 2015 agenda

• See NTDs through lens of poverty, equity and gender, human rights, universal access to essential medicines-markers of poverty index

• Innovation-progress dependent on non- technical innovation

• Time scale to new product development is decades-low expectations for any magic bullet

• Importance of advocacy and linking to other diseases-malaria, HIV, polio

• Economic case-best buy, numbers treated, essential drugs, universal health coverage

• Expected the unexpected-always surprises

The Changing Global Landscape of NTDs

The Health SystemLeadership and Governance; Financing; Health Workforce; Medical Products and

Technologies; Information and Research; Service Delivery

Communities

Biological and Technological Political Social and Environmental

+ Creation of new drugs and diagnostics

- Emergence of resistance- Need for vector control

+ NTD Brand, Partnerships, Drug Donation, Advocacy

- Intersectoral Complexities

+/- Changing Disease Distribution- Global Shocks/Natural

Disasters- Emergent Infections (Ebola/Zika)

+ Improved Pharmacovigilance+ Innovative community

solutions for drug delivery- Loss of vector control capacity- SAEs, Side Effects, Rejection of

MDA

+ Committed health workforce dedicated to community change

- Lack of appropriate remuneration/recognition for

health workforce

+ Wide Reach of MDA- Limited consideration of

patient voice, equity, mental health

- Violence and Disease Exposure

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