1. Neglected Tropical Diseases: Control & Research
World Health Organization
22 April, 2017
Neglected Tropical Diseases: Control & Research
P.Olliaro, WHO/TDR

2. NTDs in poor populations
World Health Organization
NTDs in poor populations
22 April, 2017
Previously neglected diseases
Neglected tropical diseases TB
HIV/AIDS
Soil transmitted helminthiasis Schistosomiasis
Lymphatic filariasis
Onchocerciasis
Leprosy
Trachoma
Leishmaniasis
Buruli ulcer
Chagas disease
HAT
Dengue …
Anthrax
Malaria
Bovine tuberculosis
Cysticercosis
Echinococcosis
Brucellosis
Zoonotic trypanosomiasis
Rabies
Neglected zoonoses

3. Global distribution of NTDs
World Health Organization
Global distribution of NTDs
22 April, 2017 .
~ 1 billion people have >1 NTDs

4. Burden of disease (DALYs) for infectious & parasitic diseases
"big three"
= 46.1%
"others"
= 29.6 %

5. Countries affected by NTDs by income group
World Health Organization
Countries affected by NTDs by income group
22 April, 2017
More than 70% of countries and territories affected by neglected tropical diseases are low-income and low middle-income countries
100% of low-income countries are affected by at least 5 neglected tropical diseases

6. World Health Organization
Health and poverty
22 April, 2017
Ill health is both a cause and a consequence of poverty: sick people are more likely to become poor and the poor are more vulnerable to disease and disability
Good health is central to creating and sustaining the capabilities that poor people need to escape from poverty
Good health is not just an outcome of development: it is a way of achieving development

7. Large scale interventions
World Health Organization
22 April, 2017
Large scale interventions
Lymphatic filariasis
Leprosy
Onchocerciasis
Schistosomiasis
Helminthiasis
Trachoma
Yaws
Rapid Impact Interventions
Improving access
Case management and development of new tools
Human African trypanosomiasis
Chagas diseases
Buruli ulcer
Leishmaniasis
Dengue
Focused interventions
Improving innovation 7

8. World Health Organization
Dengue
22 April, 2017
Dengue is the most common mosquito-borne viral disease of humans that in recent years has become a major international public health concern. Globally, 2.5 billion people live in areas where dengue viruses can be transmitted. The geographical spread of both the mosquito vectors and the viruses has led to the global resurgence of epidemic dengue fever and emergence of dengue hemorrhagic fever (dengue/DHF) in the past 25 years with the development of hyperendemicity in many urban centers of the tropics.

9. Human African trypanosomiasis
World Health Organization
Human African trypanosomiasis
22 April, 2017
Spread by the bite of the tsetse fly, the disease flourishes in impoverished rural parts of Africa. Untreated, the disease is invariably fatal. Death follows prolonged agony. In 2006
some people are estimated to be infected.

10. World Health Organization
Leishmaniasis
22 April, 2017
12 millions are currently infected and 350 million people are at risk of infection. Around 1.5 million to 2 million new infections occur each year.

11. World Health Organization
Buruli ulcer
22 April, 2017
BU has been reported from 30 countries, left untreated, the disease progresses to massive destruction of the skin and, in some cases, of bone, eyes, and other tissues. Limb amputations may be needed to save a patient's life.

12. World Health Organization
Trachoma
22 April, 2017
Blinding trachoma affects more than 80 million people around the world. Children are mainly concerned by the infection, and every 4 people blind from trachoma 3 are women. Africa is the continent with the greatest number of endemic countries, but America, Middle-East and Asia are also endemic. SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) has proven its effectiveness in eliminating this scourge from humanity.

13. World Health Organization
Leprosy
World Health Organization
22 April, 2017
Leprosy is considered shameful and people hid their symptoms for fear of ostracism despite free and effective multidrug therapy. Today, the diagnosis and treatment of leprosy is easy. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy.

14. Lymphatic filariasis (LF)
World Health Organization
Lymphatic filariasis (LF)
22 April, 2017
Over 120 million people are currently infected and around 1.3 billion people in more than 80 countries are at risk of infection. Drugs used against lymphatic filariasis are either donated – albendazole and ivermectin, or very inexpensive DEC. Albendazole and Ivermectin are donated by GlaxoSmithKline and Merck & C for mass administration to at-risk populations.

15. World Health Organization
Schistosomiasis
22 April, 2017
Schistosoma haematobium is endemic in 53 countries in the Middle East and most of the African continent including the islands of Madagascar and Mauritius. In sub-Saharan Africa alone there are reckoned to be 112 million infections with S. haematobium. Praziquantel at the single dose of 40 mg/Kg body weight is a very safe and effective treatment against S. haematobium and the cost of treatment is less than 0.15 Euro.

16. World Health Organization
Hookworms
22 April, 2017
Hookworms infect one billion people. It is calculated that 500 million women are infected by hookworms and at globally least 44 million are pregnant and infected at any time. Safe single dose treatment costs < 0.02 Euro a dose.

17. World Health Organization
22 April, 2017
Free and timely access to high-quality medicines
Novartis
Bayer
Merck KGaA
sanofi-aventis
Johnson & Johnson
Merck & Co Inc.
GlaxoSmithKline
Donator
Unlimited quantity by 2012 for human African trypanosomiasis
Pentamidine
200 million tablets for Schistosomiasis
Praziquantel
Suramine
tablets for fascioliasis
Triclabendazole
tablets (120 mg) per year by 2012 for treatment of Chagas disease
Nifurtimox
Melarsoprol
50 million tablets in 2007 for Soil-transmitted helminths control programmes for children
Mebendazole *
Unlimited quantity for Leprosy and its complications
MDT and Clofazimine
Directly to countries for lymphatic filariasis and onchocerciasis
Ivermectin *
Eflornithine
Unlimited quantity for lymphatic filariasis only (not for soil-transmitted helminthiasis)
Albendazole
Conditions
Medicine
* Donation made not directly to WHO
"Industry is present. Your donations of drugs and other support opened an opportunity which public health has seized. Your engagement has given us the tools to take action on an unprecedented scale."
Extract from the opening speech by DG
at the first WHO global partners' meeting on NTD, April 2007

18. Pharmaceutical gap Operational gap
RESEARCH: Develop new tools Existing tools: Optimise Improve use/access
FINANCING RESEARCH
PARTNERING TO CONDUCT RESEARCH

19. Modified from Ridley D. et al Health Affairs 2006
Ascariasis
Trichuriasis
Hookworm disease
Modified from Ridley D. et al Health Affairs 2006

20. Drug R&D investments, pipeline & burden
Vs. R&D costs ?

21. Research needs Health Systems Basic science Product use Development
"Operational"
Research
Innovation/
pharmaceutical
Gap
Basic
science
Product
discovery
Development
(R&D)
Product use
Schools,
Communities
Health
Systems
"Tool deficient"
Human African trypanosomiasis, Chagas dis.
Buruli ulcer, Leishmaniasis, Dengue
"Tool ready"
Lymphatic filariasis, Leprosy, Onchocerciasis,
Schistosomiasis, Helminthiasis, Trachoma, Yaws
(VL in Indian subcontinent)
"Vulnerable diseases"
Lymphatic filariasis, Onchocerciasis,
Schistosomiasis, (Helminthiases)

22. Current global R&D portfolio