Malaria is killing between one and two million people each year, 90 per cent of them in Africa and more than half of them young children. And visceral leishmaniasis will kill half a million in the developing world if they don‘t receive treatment. These are neglected, seriously disabling or life-threatening diseases that mainly affect people in the poor world, and for which treatment options are inadequate or do not exist. In their own right, they don‘t constitute a valuable enough ‘market‘ to stimulate adequate research and development for new medicines by the pharmaceutical industry. Take sleeping sickness. Civil war and the mass movement of civilians fleeing conflict has led to an epidemic of the disease through Uganda, DR Congo, Angola, Congo Brazzaville and Sudan. Sixty million Africans are at risk from catching this often-fatal disease. Although 45,000 cases of sleeping sickness were reported in 1999, the World Health Organization estimates that the number of people actually affected is 10 times greater. Yet it‘s a disease that most people living in industrialized countries haven‘t heard of. And because it poses no threat to rich-world consumers, there is little incentive to research effective drugs to treat it.
So until very recently the only drug available to patients infected with sleeping sickness was an archaic treatment first made 50 years ago that has a 1-in-20 chance of killing them. This drug – melarsoprol – is a derivative of arsenic. When injected it burns the patient. It can also cause a swelling in the brain leading to convulsions, coma and death. It has placed doctors in an invidious position – they knew the risks of injecting their patients with this caustic poison, yet they had no other option.
Then, in the late 1990s, a new drug emerged which could treat sleeping sickness with none of the painful side-effects. The new drug – eflornithine – has been dubbed the ‘resurrection drug‘ because of its ability to revive even comatose patients. But it did not make it into Africa‘s hospitals: despite its potential to save thousands of lives, eflornithine was pulled off the shelves in 1999 because its production was considered unprofitable. Finally, in 2001, the drug made it to Africa. Why? Because a new use for it was discovered late last year: it suppresses the enzymes that cause facial hair to grow. Now – in a facial-hair cream costing $54 a tube – it is again deemed worthy of manufacture.
The discovery of a cosmetic use for the drug is good news for those at risk of sleeping sickness in Africa. The pharmaceutical companies say they will donate 60,000 vials of free eflornithine to the medical aid organization Médecins Sans Frontières in each of the next three years.
However, people in the Majority World facing death from other neglected diseases will not be so lucky. Drug research and development for diseases there are at a virtual standstill. Of the 1,393 new drugs approved between 1975 and 1999, only 16 (just over 1 per cent) were specifically developed for tropical diseases and tuberculosis (which between them account for 11.4 per cent of the global disease burden). Of the money spent on researching cures for leishmaniasis, more presently goes into the strains which kill dogs in the North than those which kill people in the South.
Médecins Sans Frontières International Council President Morten Rostrup says: ‘Doctors in poor countries are forced to use old and ineffective treatments on their patients who are dying from treatable diseases because profit, not need, is driving the development of new medicines. We have the scientific know-how to right this fatal imbalance, but serious political and financial commitment is lacking.’*Nicolette Jackson* and *Sean Healy*