MSF and neglected tropical diseases

Noma - Sokoto, Nigeria.

• Noma is a gangrenous infection which starts in the mouth and eats away at facial tissue, causing life-threatening disfigurement and severe social stigma.
• Without treatment, up to 90 per cent of the people affected are estimated to die in the first two weeks
• It affects mostly children under the age of 10 across Africa and Asia.
• Noma is a completely preventable disease and is easy to treat with antibiotics and wound dressings if addressed in time but there is a lack of knowledge and awareness about the disease in the global health community.
• Noma is mostly reported in Africa and Asia but there is no mapping of its global prevalence.
• In 1998, WHO estimated that noma affects 140,000 people every year and that 770,000 patients who had survived the initial infection. However, these data have not been updated since then.

Noma is so neglected that it only made it on to the WHO’s list of NTD’s last October after a 3 year campaign lead by the Nigerian Ministry of Health, supported by MSF. We have been working together in Sokoto’s noma hospital, in northwest Nigeria, since 2014, where teams provide reconstructive surgery, nutritional support, mental health support and outreach activities.

Since the beginning of the project, 1260 free of charge surgeries were performed for 882 patients. In 2023, surgeons performed 166 surgeries on 133 patients.

Snakebite Envenoming

• Every year, an estimated 2.7 million people are bitten by venomous snakes
• Around 100,000 people die and 400,000 are left with life-long disfigurement
• These are rough estimates as many people bitten by snakes never make it to hospital for treatment.
• Although effective antivenom exists, the vast majority of people affected can’t access it due to lack of supply or cost.  
• Snakebites kill at least 40 times more people each year than landmines and leave at least 60 times more people with severe disabilities.

In recent years MSF has expanded care for snakebite envenoming in its projects in Africa, opening new projects and reopening ones that had previously been closed for security reasons. Our teams have been surprised by the high numbers of patients who had nowhere else to go and seek care.

We treat over 7000 cases of snakebite each year, predominantly in CAR, Ethiopia, South Sudan and Yemen.

Snakebite made it to the WHO’s list of NTD’s in 2017 but they are very concerned about the significant lack of funding. In 2019 they launched a comprehensive snakebite plan that required $88 million from the international community, largely for the scale up of affordable and quality-assured antivenoms. But with financial support remaining low, there is a high risk that it will once again be relegated to being one of the world’s most neglected public health emergencies.

Pharmaceutical company Sanofi-Pasteur used to manufacture a high quality, pan-African antivenom called FAV-Afrique that was effective against multiple kinds of snakebite envenoming and was a hugely important tool in saving thousands of lives. In 2015, they ceased production as it was not profitable enough.

Now access to supplies of good quality antivenom is extremely challenging in sub-Saharan Africa. It’s essential good quality antivenoms are available and, wherever possible, offered free of charge.  Also, with the lack of a pan African antivenom, regular training of medical workers is absolutely essential to ensure the correct treatment is used for particular snakes.

We are, trying to secure a stockpile of antivenom for Africa, testing new treatments and developing an AI app to identify snakes  - but the needs are significant and  more money is needed on the ground immediately.

Much more support is needed to address the crisis thought to cause more death and disability in poor populations than any other NTD.

Visceral leishmaniasis (aka kala azar) and cutaneous leishmaniasis: South Sudan and other countries

• kala azar is one of the most dangerous neglected tropical diseases, fatal in 95% of cases if left untreated
• Over the last 40 years, an estimated 200,000 people have died from kala azar in East Africa.
• The parasite is spread to humans by bites from infected female sandflies.
• It's estimated that there are between 50,000 and 90,000 new cases a year
• 90 % of cases occur in Brazil, Ethiopia, India, Kenya, Somalia, South Sudan and Sudan.

While kala azar in south Asia is on track for elimination as a public health problem,  in Africa it is far from being controlled and remains a major public health problem and a significant focus of our work on the ground. In the past 20 years, in Abdurafi, Ethiopia alone, we have treated more than 7,000 people with kala azar.  UK Aid used to be the #1 donor for control of kala azar in East Africa, and the budget cuts were pretty harmful and yet another example of how UK aid cuts directly affect the lives and treatment of some of the world’s poorest people fighting some of the most neglected diseases.  We also work in Pakistan to curb the more prevalent cutaneous leishmaniasis.  CL is a widespread and deeply neglected condition, and although it is not fatal, without treatment it can leave disfiguring or debilitating scars which lead to psychological distress and stigmatization. MSF treats many thousands of patients with this disease every year in Pakistan & we have launched a clinical study to compare different treatment options.

Dengue Fever: Honduras

• Dengue is a viral infection transmitted through the bite of infected mosquitoes.
• It is mostly found in urban areas in tropical climates.
• Symptoms include fever, headache, body aches and nausea.
• People suffering from severe dengue need care in a hospital and it can be fatal.
• Dengue is a public health crisis in Honduras with more than 10,000 cases reported each year.

• It is also an important global health threat and is rapidly spreading, with reported incidence, increasing 30-fold over the past 50 years.

• Today, more than half the world’s population is at risk, and it is expected that another billion people will be exposed to dengue fever in coming decades due to climate change.  

MSF has been working with the Honduran Ministry of Health and other local and international organisations to implement innovative new strategies in the fight against dengue which includes releasing Aedes Aegypti mosquitos carrying the natural Wolbachia bacteria which reduces mosquitos’ ability to transmit arboviruses.

More information on UK funding cuts

In 2015, WHO estimated that $18 billion would be needed to achieve it’s 2020 Roadmap goals but funding didn’t get close to that number.

In June 2022, MSF joined public health organisations and global leaders in signing the Kigali Declaration a new roadmap aiming to ensure that these diseases are eradicated, eliminated or controlled by 2030. It hasn’t been costed yet, though with more diseases included and further reduced funding for NTDs in the wake of the pandemic, we know there is a chronic lack of money.  

Despite affecting 20% of the world’s population, NTDs only receive 1.7% of the total funding allocated to the research and development of new drugs.

The WHO’s 2023 report on NTDs reported that only 1.3% of total funding for infectious diseases in low and middle income countries is dedicated to NTDs and although the UAE have stepped in to champion the cause, the aid cuts from the UK have had a huge impact as we were previously one of the world leaders in funding NTDs. 

Last year Sightsavers who led the Accelerating the Sustainable Control and Elimination of Neglected Tropical Diseases, or ASCEND, program in West and Central Africa, said it ended early as a result of the UK government’s aid reductions, which left a £38 million ($51.47 million) funding gap. They estimated 72 million people with NTDs would miss treatment because of UK aid cuts.

Unlike malaria, HIV or TB, there are no global initiatives to promote the cause of NTDs, or to coordinate and distribute funds. This means individual countries are left to fend for themselves while donors pick and chose where and when they will provide support resulting in highly unequal allocation and attention for different diseases and contexts.

MSF’S ROLE

Funding for research and development into NTDs has stagnated in the last decade. This is despite an increase in global funding for basic research and product development for diseases that affect low and middle-income countries.  The private for-profit sector continues to have limited interest in developing new tools for NTDs as they overwhelmingly affect people with extremely limited financial resources. The global R&D system is skewed towards the development of highly priced drugs for diseases most prevalent in high-income countries.

DNDi are currently working on a report summarising drug development for tropical diseases from the last decade but we know that:

• From 1975 to 1999, only 1.1% of all the new drugs developed were for tropical diseases and TB
• Between 2000 and 2011, only 3.8% of all new drugs developed and approved were for tropical diseases, TB or other neglected infections.

The majority of R&D for NTDs comes from public and philanthropic sources. A number of new drugs and diagnostic tests developed in recent years and now available in endemic countries are the result of collaborative efforts catalysed by not-for-profit product-development partnerships such as DNDi, FIND, Medicines for Global Health with field actors such as MSF, research institutions and manufacturers.

We will continue to help develop new drugs, diagnose and treat patients with NTDs wherever we can and share our expertise and experience. We will advocate for increased funding and to reduce financial barriers to access to care. We will participate in clinical trials and conduct operational research.