Bill Gates: The one-man army vs Neglected Tropical Diseases

On Monday 30th January, Bill Gates yet again proved what a remarkable man he is. Much to the surprise of everyone, it was announced that Bill Gates had somehow managed to persuade the heads of 13 pharmaceutical companies to co-operate in battling neglected tropical diseases (NTDs). This co-operation will include further donation of drugs as well as, amazingly, sharing their compound libraries to help develop new drugs to treat these diseases.

Considering the reputation that pharmaceutical companies have, this is a major victory for Bill Gates, who hopes to help eradicate 10 NTDs. The 10 diseases are:

  1. Sleeping sickness: caused by the Tsetse fly. Leads to disruption in sleep cycle leading to eventual coma and death
  2. Schistosomiasis: caused by a trematode parasite. Can be a risk factor for bladder cancer or cause enlarged liver and spleen which can lead to haemorrhage and death.
  3. Chagas Disease: caused by a parasite carried by the Lyme fly. Chronic stage causes damage to the nervous system, heart and digestive system which may be lethal.
  4. Blinding disease: cause by the bacteria Chlamydia trachomatis. It is the leading cause of infectious blindness in the world.
  5. River blindness: parasitic disease caused by a filarial nematode. May be the cause of up to 1,500 blind people per 100,000 people in endemic areas.
  6. Leprosy: bacterial disease caused by Microbacterium leprae.
  7. Leishmaniasis: caused by the parasite species Leishmania. Causes sores to break out and can cause spleen and liver damage.
  8. Guinea worm: long thin worm that moves down to the lower leg causing intense, burning pain.
  9. Yaws: bacterial disease which causes widespread skin ulcers. The later stages can cause a breakdown of bone and cartilage.
  10. Elephantiasis: caused by another filarial nematode. Causes enlargement of affected areas due to build up of lymph.

A guinea worm being removed

To achieve this aim the Bill and Melinda Gates foundation have set aside $363 million to be used over the next 5 years to help control and hopefully eradicate these diseases. The Department for International Development, USAid and the World Bank have also pledged financial support to help develop treatments for these NTDs.

These initiatives have come as a response to the highly ambitious World Health Organisation (WHO) roadmap. This roadmap sets out a plan to help address underdevelopment due to diseases preventing the education of children. The WHO has set the aim to eradicate a number of these diseases by 2020. While this target would be ideal, it may be unrealistic.

While the co-operation of the major pharmaceutical companies will inevitably pay dividends, it is important to realise the length of time to bring a chemical compound to clinical use. Standard drugs take at least 10 years to be approved for clinical use. Many of the NTDs have no effective drug treatments, so time could be a limiting factor for the WHO’s and Bill Gates’ aims.  Furthermore, with few effective drugs for some of the NTDs, the donations by pharmaceutical companies will have little impact, wasting money that could have been used to develop better treatments for the diseases. Efficacy must be proved for the drugs before a mass donation scheme is implemented.

A second potential problem is the diagnosis of these diseases. Many of the NTDs are not easily diagnosable until late stages, by which time the disease has already inflicted quite severe damage. The implementation of drugs would be of little to no use in these diseases unless progress is made in the development of ways to diagnose the diseases in the early stages.

Another potential flaw is the approach of using drugs to eradicate the NTDs. The use of drugs does not prevent a person from becoming infected with a disease, rather it treats the disease. In fact, the eradication of a number of previously common diseases have shown that drugs are not necessary to eradicate diseases. The most effective way to eradicate a disease is through the successful implementation of a vaccination programme. Smallpox, an extremely lethal virus, has been eradicated since the 1970’s due to a successful vaccination programme. Other diseases such as polio are almost non-existent, though in some underdeveloped countries cases still occur. This approach however has not been neglected by those such as Bill Gates, who is personally trying to implement successful polio vaccination schemes in every country throughout the world. Some of the NTDs could be significantly reduced if a successful treatment was applied to the vectors so that they could no longer carry the disease.

While Bill Gates’ efforts in getting the major pharmaceutical companies to co-operate are highly commendable, it is important to inject a small dose of reality. Any progress could potentially be slow. However even this slow progress is better than none.

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