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Authors' Response to DNDi: Integrating New Control Tools into Preventative Chemotherapy Strategies for the Neglected Tropical Diseases

Posted by plosmedicine on 30 Mar 2009 at 23:53 GMT

Author: Peter Hotez
Position: Professor and Chair of the Department of Microbiology, Immunology, and Tropical Medicine
Institution: The George Washington University, Washington, District of Columbia, United States of America
Additional Authors: David H Molyneux, Alan Fenwick, Eric Ottesen, Sonia Ehrlich Sachs, Jeffrey D Sachs
Submitted Date: April 28, 2006
Published Date: April 28, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We appreciate the comments by our colleagues from the Drugs for Neglected Diseases initiative (DNDi) highlighting the importance of research and development programs for a new generation of control tools (e.g., drugs, diagnostics, vaccines, surveillance instruments) to combat the neglected tropical diseases (1). Indeed, we have great admiration for the outstanding track record of the DNDi along with its sister organizations, including the Institute for One World Health, TDR-WHO, and the Seattle Biomedical Research Institute, as well as a small but distinguished community of academic and government scientists.

In both our paper cited by Torreele et al (2), as well as an earlier companion paper also published in PLoS Medicine (3), we went to some lengths to point out that the ultimate elimination of some of the most burdensome endemic neglected tropical diseases will likely require more than simply innovations in preventative chemotherapy, such as our proposed rapid impact, pro poor, package. Such achievements, especially for diseases such as Buruli ulcer, hookworm, human African trypanosomiasis, and leishmaniasis will almost certainly also require advances in biotechnology leading to the development and distribution of new drugs and vaccines. It is also for that reason, that each of the biomedical scientists who co-authored the PLoS Medicine papers has devoted his lifetime to research on neglected tropical diseases, and contributed to the development of new control tools for hookworm, lymphatic filariasis, malaria, onchocerciasis, schistosomiasis, and other diseases of poverty. In addition, Professor Jeffrey Sachs, the health economist on our project previously led an international call to establish a $1.5 billion Global Health Research Fund, to finance basic and applied research on the diseases of poverty (4). In short, we completely agree with the plea by Torreele et al to embrace research and development as an essential component for any global neglected tropical disease initiative.

The major points of our PLoS Medicine articles are 1) the disease burden of neglected tropical diseases has been underestimated and that this group of diseases may be as important as HIV/AIDS, malaria and tuberculosis; 2) there is a moral imperative to recognize the plight of the world's most impoverished who suffer from the neglected tropical diseases; and 3) beginning today we can make a rapid impact on the lives of these populations through an effective, sustainable, rapid and highly cost-effective intervention package of donated drugs.

Ultimately, control and/or elimination of some of our most devastating neglected tropical diseases will likely require additional biotechnological solutions. Even then, this will require careful integration of the new with the old along the lines of the vaccine-linked chemotherapy strategies recently proposed by Bergquist et al (5). Therefore, we need to do our very best to achieve sustainable morbidity reductions by using the donated drugs we have in hand today, with the understanding that success in this endeavor must not lead to complacency. We know all too well how the emergence of chloroquine and DDT resistance derailed global malaria eradication efforts during the 1960s (6), and that we must be ready to simultaneously champion research as well as implementation. We also believe that it would be unethical in the context of the timeframe of the Millennium Development Goals to ignore what we can do for poor people now at such a low cost (7), as we know that research takes time to come to fruition in terms of products, policies, financing and practice. Drugs of proven efficacy and quality are available now for some of the neglected tropical diseases, and they can be delivered despite the resource constraints in African health systems. It is gratifying to see a number of countries are now prioritizing the control or elimination of neglected tropical diseases as a national policy and are establishing budget lines to ensure sustainable implementation of the tools we have. There have been too many public health failures in the past - and so it is essential that we take the real opportunity to act on behalf of the world's poor.

Literature Cited

1. Torelee E, Royce C, Don R, Sevcsik A-M, Croft S. To fully tackle gang of 4, needs-driven R and D is essential. PLoS Medicine 2006; submitted.
2. Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Ehrlich Sachs S, Sachs JD. Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Medicine 2006; 3: e102.
3. Molyneux DH, Hotez PJ, Fenwick A. Rapid impact interventions: how a policy of integrated control for Africa's neglected tropical diseases could benefit the poor. PLoS Medicine 2005;2:e336.
4. World Health Organization. Investing in Health for Economic Development, Report of the Commission on Macroeconomics and Health 2001; Geneva.
5. Bergquist NR, Leonardo LR, Mitchell GF. Vaccine-linked chemotherapy: can schistosomiasis control benefit from an integrated approach? Trends Parasitol 2005; 21: 112-7.
6. Hotez PJ. The NIH Roadmap and the developing world (Commentary). J Invest Med 2004; 52: 246-7.
7. Fenwick A, Molyneux D, Nantulya V. Achieving the Millennium Development Goals. Lancet 2005; 365: 1029-30.

Competing interests declared: See competing interests statement at: