Community workers distribute antibiotics in Ethiopia/Community Eye Health Flickr
In January last year, the world’s biggest drug companies pledged vast quantities of drugs to treat ten neglected tropical diseases. It was a moment for celebration; cheap, effective treatments would be available in regions of the world where health systems are often sketchy.
While, a year on, the programme appears to be progressing well, there are still questions remaining for the neglected tropical diseases. “Some of us were slightly concerned at the meeting a year ago,” says David Mabey, professor of communicable diseases at the London School of Hygiene and Tropical Medicine. Drug availability is a key hurdle in tackling NTD’s, but it is by no means the only one. Who do you give the drugs to? Where are the people who need treatment? And since people are often infected with more than one NTD, is there a good way to diagnose and treat them together
To help answer these questions, Imperial College, the Natural History Museum and the LSHTM have come together to establish the London Centre for Neglected Tropical Diseases. The “centre” is a virtual hub, intended to augment existing partnerships. Scientists from these institutes, all within three miles of each other, already work together on several projects. With initial funding from GlaxoSmithKline, this centre will encourage further collaboration.
The closer collaboration should allow institutes to share expertise. Many people have not just one neglected tropical disease, but several, and Mabey stresses the importance of developing integrated programmes to tackle the diseases together. Specialists in schistosomiasis from Imperial could have much to learn from trachoma specialists at LSHTM, and so on.
Trachoma, an eye infection that is endemic across much of Africa and South-East Asia, epitomises some of the research questions facing researchers. The Chlamydia trachomitis bacteria is spread by flies. The natural human response to painful eyes is to rub them, but the infected discharge also passes the disease. The consequences can be life-changing; repeated infection scars the eyelid, which can turn inwards. Eyelashes then scar the eye itself, leading to blindness if untreated.
Fortunately, there is a treatment, in the form of the antibiotic azithromycin. Surgery can alleviate symptoms, and improved sanitation stops the spread of the disease by reducing the transfer of infected eye-juice. The number of cases worldwide has dropped from 150 million in 1995 to 21 million.
But even after treatment, even once the active infection is gone from the eye, sometimes disease still persists in the follicles. We don’t know why, or whether this will lead to blindness.
Trachoma has been eliminated from several areas, but how long should surveillance continue, and what is the best way to do so? Hopefully this question will become relevant to more and more NTDs. Monitoring infection levels can be expensive and difficult. Simon Brooker, deputy director of the new centre, has written a blog about mapping the spread of diseases within countries using mobile phones and GPS. In Africa, technology development has skipped a generation, and mobile and satellite technology rules over landlines and broadband cables. Trachoma is just one disease using mobile technology to ensure data is accurate, and the techniques can be developed and shared for all neglected tropical diseases.
The ultimate aim of research into NTDs is to make treatment cheaper and more effective.. “These diseases are attracting the attention they deserve,” says Mabey. “Integrated control of NTDs will saves money,” says Mabey. But drug companies do not want to donate drugs forever; eradicating and eliminating disease requires the collaboration encouraged by the London Centre for NTDs.