Geneva - Two important conferences convene this month that will decide the future of patients suffering from neglected diseases in the poorer countries of the world: The Ministerial Summit on Health Research, November 16-20 in Mexico City, and the Dutch Government / WHO "Priority Medicines for the Citizens of Europe and the World" meeting, November 18 in The Hague. The lives of neglected patients hang in the balance.

Will they be promised life in the form of new drugs or be left to suffer their fate? Ten years ago, the world spent US$30 billion on health research of which under10 per cent was spent on 90 per cent of the world's health problems – a disparity known as the "10/90 gap". Today global spend on health research has more than tripled to under US$106 billion, yet the amount allocated to the R&D for drugs to treat 90 per cent of the global disease burden has risen by a mere US$0.3-0.5 billion to around US$3.5 billion, mainly due to contributions from private foundations, governments, and charities. The 10/90 gap does not just persist - in percentage terms it shows alarming growth over the last decade.

Patients continue to suffer from neglected diseases such as tuberculosis, malaria, leishmaniasis and human African trypanosomiasis (sleeping sickness), and continue to be treated with old, ineffective, and sometimes toxic drugs. The pipeline of drugs for neglected diseases is virtually empty.

From 1975 to 1999 of the 1393 new drugs marketed only 13, or a mere one per cent, were for tropical diseases. This imbalance is unacceptable in the second millennium. The Drugs for Neglected Diseases Initiative is working to help restore the balance. Its current portfolio of projects targets the most neglected diseases, such as sleeping sickness, leishmaniasis, and Chagas disease.

Old drugs to treat leishmaniasis

Today, the leishmaniases are endemic in 88 countries including those in Latin America. An estimated 350 million people are at risk. It has been estimated that 12 million people are affected by this group of diseases with around 1.5 to 2 million new cases occurring annually; and this number is rising. Pentavalent antimony, the most widely prescribed drug to treat Leishmania patients, was discovered a century ago, has serious side effects, requires prolonged course of treatment and is losing its efficacy in some regions due to increasing parasite resistance. Although newer treatments exist, they are not optimal due to development of resistance, problems of toxicity, high price and difficulty in administration. Co-infection with HIV poses an additional challenge.

"For leishmaniasis, for example, we have four projects currently researching novel compounds that could kill the parasite that causes this deadly disease. Another project is investigating possible combinations of existing anti-leishmanial drugs. In addition, we are launching clinical trials of the anti-leishmanial drug paromomycin for registration in Africa," said DNDi's Executive Director Bernard Pecoul. "If we are to achieve our aim to bring new, field-adapted treatments to neglected patients, we will need increased commitment from governments and industry."

The traditional system of drug research and development has proved inadequate for neglected diseases. These diseases are causing increasing mortality and morbidity in the poorer countries of the world; but as they have little commercial value and promise no returns on investment, the research and development of new medicines for these neglected diseases has little or no priority. DNDi believes that the responsibility for public health lies at the door of governments.

The technical and financial support of affluent governments, access to the industry's cutting-edge R&D facilities, as well as the support of scientists in the field of infectious tropical diseases will be essential if drug development projects are to progress through the pipeline and new drugs see the light of day.

The lives of millions suffering from neglected diseases depend on the deliberations and conclusions of the Mexico summit and the Hague meeting. DNDi urges governments to seriously consider the following:

• Invest more in neglected diseases including sustained support for initiatives involved in developing affordable, effective, field-adapted drugs for diseases that fall outside the realm of market forces. This should also be accompanied by the transfer of technology to disease-endemic regions.
• Encourage the translation of existing basic research into molecules that can be tested in patients.
• Strengthen existing capacities in neglected disease endemic regions to facilitate clinical trials.
• Secure the market for, and thus the use of, new medicines.
• Encourage industry to be more engaged in neglected diseases and to find innovative ways to share their enormous resources, expertise, laboratories, and compound databases. "Access to the technological expertise and research facilities of industry is crucial but without the solid support of governments we will not be able to push our drug development projects through the pipeline," said Bernard Pecoul.