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‘The bandwagon has started to run’: lymphatic filariasis and other neglected diseases are finally attracting attention

6 Mar 2008

Tatum Anderson

Source: TropIKA

The world is starting to look differently at drugs for neglected diseases, and one of the area’s long-time proponents, Professor David Molyneux, Director of the UK’s Lymphatic Filariasis Support Centre (LFSC), is perhaps more surprised than most. ‘I would never have believed the bandwagon would have started to run. People are beginning to take notice,’ he says.

David Molyneux is referring to US President George W Bush’s pledge in February to increase funds for neglected diseases from US$15m in 2008 to US$$350m over the next five years. The announcement has brought neglected diseases into the global community’s line of sight after years of a blinkered focus on the Big Three; AIDS, TB and malaria, he says.

For his part, Molyneux has long argued that in contrast to the uphill struggle to find cures and affordable drugs for the Big Three, there are great numbers of people who could already be treated today for other diseases with a set of cheap existing treatments.

Operating under the radar of the international community, the LFSC – based at the Liverpool School of Tropical Medicine – has helped map the disease and worked with endemic country governments to manage LF control programmes and distribute drugs worldwide.

Professor Molyneux’s approach appears be paying off. ‘The reality is that we’ve made a huge impact on public health through the distribution of the two-drug strategy,’ he says. Together with several other LF support centres from Atlanta to Australia, his project has managed the mass distribution of albendazole and ivermectin to sub-Saharan Africa (DEC is distributed in Asia). The drugs, which are donated by pharmaceutical companies Merck and GlaxoSmithKline, are used to treat populations in endemic areas repeatedly over a number of years in an effort to control not only the parasite that causes LF but also the onchocerciasis (river blindness) parasite.

A billion treatments have been issued since the start of the programme in 2000, and around 450 million people have received at least two sets of treatments. Several countries have made impressive progress. The disease is no longer a public health problem in a number of countries including Sri Lanka and Egypt; in many countries children born since the intervention began have not exhibited any infections.

Maximum impact – minimum expenditure

David Molyneux is currently President of the UK’s Royal Society of Tropical Medicine and Hygiene. His expertise in managing large-scale programmes is borne of years working on various neglected diseases. A specialist in medical parasitology, his early research interests were trypanosomiasis and leishmaniasis and while living in Burkina Faso, he ran tsetse fly control programmes; over six years he chaired the committee that oversaw the programme to combat onchocerciasis, as it evolved from a vector-control initiative to one that relied on donated drugs.

More recently, he has played an instrumental role within the Global Alliance to Eliminate Lymphatic Filariasis (GAELF), a group that – initiated by the World Health Organization - comprises over 40 partners including governments, the private sector and academic institutions. In 2000 Molyneux resigned as Director of the Liverpool School of Tropical Medicine, in the north of England, to head the LFSC, which also serves as the alliance’s secretariat.

Professor Molyneux’s particular approach to eliminating lymphatic filariasis is about making maximum impact – particularly on Millennium Development Goal (MDG) 6 -with minimum expenditure. Drugs are donated, which means eradication programmes are for the most part dependent on the cost of distribution only - which can cost as little as 40 cents per person treated per year.

‘The money spent on genomic research would have been able to treat the majority of the population at risk in Asia’

Treating several diseases concurrently is another way of achieving a large impact of the minimum expenditure - and the wider community, including the White House, is starting to heed such advice, he says. The combination of ivermectin and albendazole already removes a host of other parasites on top of those that cause LF and onchocerciasis. But systematically combining them with other interventions, such as insecticide-treated bed nets and home-based malaria management could have a huge impact on rural populations, he says.

With efficient mechanisms in place, Molyneux believes that a focus on other types of research, such as high-level genomic research, is misguided. There are cheap existing drugs that can treat the parasite effectively says Molyneux. ‘This is what frustrates me because it’s meaningless research in the context of what we need for public health perspective, he says. ‘The money [spent on genomic research] would have been able to treat the majority of the population at risk in Asia.’

And resources invested in new drugs, such as Moxidectin, TDR’s new treatment for onchocerciasis, may arrive too late to make an impact on MDGs, he says. A complete change in the focus of public health funding is needed is needed, he believes, because there is still a way to go in eliminating LF.

There are 39 endemic countries that do not have the elimination programmes. Many fragile states in conflict are not targeted at all. Funding problems often stall programmes. Uganda has recently restarted its programme, which had stalled after it ran out of funds to distribute the drugs. A more intense focus is needed in the Pacific area, says Molyneux, because the mosquito which both the disease is so much more efficient.

But a huge problem is that many countries are prioritising HIV or malaria over other ailments, says Molyneux. In several sub-Saharan African countries – like Rwanda - HIV funding is completely disproportionate to other diseases, even when HIV rates are low he says. Operational research must address how to convince governments to prioritise these interventions and provide a bigger proportion of their budgets to neglected diseases, says Molyneux. “I will continue to advocate vigorously for what I believe is right and equitable,” he says.

Key Questions

Briefly, what are the priority concerns of your organisation?

The Global Programme to Eliminate Lymphatic Filariasis has two principle goals:
- to interrupt transmission of infection
- to alleviate and prevent the suffering and disability produced by the disease.
And, more precisely, what goals have you set?

Expand treatments to; all 83 endemic countries, over 1.2 billion people who are estimated to be at risk globally and more than 120 million people estimated to be infected.
What is it about your organisation's approach to these issues that distinguishes you from others in this field?

My mission is clear. There has got to be a re-evaluation of how global health money is spent if we are to address and achieve the millennium development goals.
What progress has been made so far?

In the first year of treatment 9 million people treated, in 2006 258 million, number of treatment since 2000-8 is one billion. Averted 9 million cases of genital hydrocele, 5 million cases of elephantiasis and 27 million people averted Lymphatic damage. The number of children 48-50 million that were treated with albendazole in Africa and Asia will have inadvertently also received treatment for soil-transmitted worms.
What are the main challenges outstanding?

Finance and priority; we've been saying since the UK Commission for Africa in 2000 that these diseases could be treated with $200 million per year.
Which other organisations will you be working with most closely?

Please see the partnerships section of the GAELF website.

More information

The Lymphatic Filariasis Support Centre is funded by the Department for International Development, GlaxoSmithKline and the Bill and Melinda Gates Foundation and provides advice, funding, liaison, training, facilitation and acts as Secretariat to the Global Alliance to Eliminate Lymphatic Filariasis. Further details may be found on the LFSC website.