Dengue fever, chikungunya and other “neglected tropical diseases” have attracted growing media attention – and international funding – as global warming helped them spread to Europe. But money isn’t everything, especially for deprived populations in Africa’s remote regions that are the most affected by them, warns a WHO expert in an interview with EurActiv.
Over the past decade, Europeans have started feeling the direct effects of global warming on their health, including deadly heatwaves and the propagation of mosquito-borne viral diseases.
Among those are chikungunya, a tropical fever which hit south eastern France in 2010, as mosquitos carrying the disease reached Europe for the first time. Others include dengue fever, and Leishmaniasis, which saw a major outbreak in Madrid in 2011.
“Many of these diseases are transmitted by vectors, usually insects,” says Jean Jannin, a specialist on rare tropical diseases at the World Health Organization (WHO) in Geneva.
“For example, in southern Europe there is a significant change in the distribution of vectors – perhaps due to climate change – which makes diseases appear in places where they were not present before,” Jannin told EurActiv in an interview [French only].
Europe keeps risks under control
Some like Chagas disease were once entirely confined to Latin America but have now spread to other continents due to migration and trade. A mosquito larva carrying dengue fever can survive up to 8 months on bamboo and tyres stored in South-East Asia, Jannin says.
As a result, there are currently 10,000 people infected with Chagas disease in Spain and more cases have been detected in Italy and Japan.
With growing trade exchanges, tropical diseases can now turn global more easily, posing new risks to unaware populations in Europe and America.
But Europeans shouldn’t worry too much, Jannin says. “In our countries, things are pretty well taken charge of. In Spain and Italy, many universities have mobilised on this issue,” he remarks.
Indeed, public authorities have responded swiftly to prevent those diseases from spreading. In Southern France, insecticides are being sprayed seasonally on mosquito breeding grounds. In Madrid, a sandfly surveillance system was implemented and detection tests were carried out on thousands of dogs and household pets, the main known reservoirs for Leishmaniasis.
WHO focus on Africa's poorest regions
The issue however is very different in the world’s poorest and most remote areas, where such diseases can become deadly.
“When you are in complete misery, when you're a pygmy kid in the depths of the Congo, it is inevitably more complicated,” Jannin says. For the WHO, these deprived or isolated populations are the main focus group.
As Jannin explains, the problem is not so much about the lack of treatment but the heavy logistics involved in bringing them to patients. Immunisation campaigns can be highly effective for some diseases but still require heavy logistics.
“How do you give a tablet to one billion people every six months?” Jannin inquires.
If administering a tablet can generate logistical problems, consider a more complex and deadly disease like sleeping sickness. First, establishing a correct diagnosis requires taking at last two or three blood samples, Jannin says. Then treatment quickly becomes a nightmare – two perfusions per day over a ten-day period – requiring a hospital-like environment. For extremely deprived populations living in the depths of the African bush, this is practically insurmountable, Jannin says.
“To decide leaving your village to join a clinic 80km away, you must be very ill. So you must already be at an advanced stage of the disease,” he remarks. “The revenues from these populations are so low, the means of transport non-existent – it inevitably complicates everything.”
And when patients do manage to reach out to a clinic, proper medication is not always on offer. “Even if the drug is at the quarter of the price, it is often unavailable,” Jannin says.
From rags to riches
Despite those difficulties, considerable progress has been made in fighting neglected tropical diseases.
Thanks to awareness campaigns and ambitious eradication programmes, the World Health Organization has managed to bring neglected tropical diseases “from obscurity into the limelight”, according to Dr Margaret Chan, the the WHO’s director-general.
"Renewed momentum has shifted the world closer to eliminating many of these conditions that take their greatest toll among the poor," the WHO said as it presented its second report on neglected tropical diseases in Geneva last year. In 2010 alone, 711 million people received treatment for at least one of the four diseases targeted for preventive chemotherapy, the WHO said.
Big pharma companies have also seen this an opportunity to show their goodwill and work on their image. Some, like Merck or Pfizer, make donations to the WHO or even give away drugs for free and cover distribution and logistics themselves, Jannin says, referring to treatment of Trachoma disease.
Others simply make cash donations and leave the WHO to manage the logistics, training and monitoring aspects, which is Jannin’s preferred option. “For sickness disease, Sanofi agreed to give us cash to take into account the fact that giving a drug is not enough. You also need to get to the patient”.
Public private partnerships (PPPs) have multiplied, including The Global Network for Neglected Tropical Diseases, the Norvartis Vaccines Institute for Global Health, and the MSD Wellcome Trust Hilleman Laboratories, to name just a few. Large non-profit organisations like the Bill and Melinda Gates Foundation have also thrown their weight into the battle by funding programmes and organising a round-table of CEOs around neglected tropical diseases.
“There is now a big cake in terms of funding,” Jannin says. As a result, “these Cinderella diseases, long ignored and under-appreciated, are a rags-to-riches story,” the WHO’s Chan said in a 2012 speech.
But this newly-found fame also comes at a price, Jannin adds, with a multiplication of partners – NGOs and private initiatives – which is becoming difficult to manage. “If you set up an NGO and USAID [US Agency for International Development] announce that they are willing to put $80 million ... We would like it to be more structured to make it more effective.”
Funding is not everything
Even so, “things have improved a little,” Jannin admits. “But funding is not everything,” he warns, saying political and administrative issues often hinder efforts to tackle neglected tropical diseases, especially in Sub-Saharan Africa.
“I happened to refuse cheques of $ 100 million,” Jannin says, “because countries must have the capacity to absorb this money, which is often not the case.”
According to him, tackling neglected tropical diseases takes three things – personnel, money and, most importantly, organisation, especially for programmes involving several countries or regional authorities. “Governments sometimes have difficulty accepting to work together. This is a real problem.”
At the end of the day, Jannin says governments in Africa’s most deprived regions have hard choices to make about their funding priorities.
“Is it better to build a road or a hospital?” Jannin asks. “If you put the road in the right place, I would go for the road”.
- 2020: WHO target date to eradicate diseases such as yaws and sleeping sickness