Funding in Africa is concentrating too heavily on the "big three"
Klaus Morales

Certain tropical diseases are being unjustly ignored in Africa because
funding is so heavily concentrated on the "big three"
diseases-HIV/AIDS, tuberculosis, and malaria-says a new study by David
Molyneux and colleagues (PLoS Medicine, doi:
10.1371/journal.pmed.0020336).

The neglected tropical diseases, including schistosomiasis,
onchocerciasis, trachoma, lymphatic filariasis, and the
soil-transmitted helminth infections, are responsible for as many as
500 000 deaths a year. But the international health community gives
priority to the big three.

"Instead of 95% of funding being addressed to the big three, give them
90% and we will be able to do a lot of cost effective treatment with
the extra 5%. We don't need research; we just need funds to sustain
the implementation of control programmes, and we urge policy makers
and donors to rethink policies, and address the neglected diseases,"
said Alan Fenwick, professor of tropical parasitology at Imperial
College, London and one of the co-authors of the paper.

These diseases can be effectively treated with a minimum budget,
estimated at $0.40 (£0.23; {euro}0.33) a year. The proposed rapid
impact package includes four drugs-praziquantel, albendazole,
ivermectin, and azithromycin-with the three last being donated by
multinational pharmaceutical companies, the paper says.

"Compared to a minimum of $200 per person per year to treat HIV/AIDS,
$200 to treat a single episode of tuberculosis and $7-10 to treat a
single episode of malaria, the cost of the package would be
negligible. It is equivalent to the costs of 12 condoms for HIV
prevention and a quarter of the price of an antimalarial bednet," the
paper says.

Professor Molyneux, director of the Lymphatic Filariasis Support
Centre at the Liverpool School of Tropical Medicine, added, "For the
big three, transmission would still continue at the present rate. For
example, treating three million people until the end of this year as
stated in the `3 by 5' target for HIV would still leave 90% of HIV
infected individuals untreated and actively transmitting."

There are currently six public-private partnerships working in Africa
linked to specific neglected tropical diseases, each reaching a large
number of people. "Our plan is to bring all of them together to
complete the job we have started, and reach half a billion people
annually for five years. In doing so, we would take morbidity due to
these diseases out of the burden of disease equation for Africa.

"If donors would just get the funding more evenly balanced, we can put
forward this emergency treatment package through these integrated
programmes," said Professor Molyneux.

Implementing these goals, however, might be not as simple as it
sounds. "The final costs of an integrated package may need to include
the costs of drug use monitoring and of developing new tools for
neglected disease control. Additional costs must therefore be
considered in order to promote ongoing research and development for
new neglected diseases control tools," the article says.

http://bmj.bmjjournals.com/cgi/content/full/331/7521/866-a