Drug Donations Research Articles

Eliminating Lymphatic Filariasis

Among infections closely associated with poverty, lymphatic filariasis (LF) is a study in contrasts. It is both a consequence of and a contributor to poverty. Although rarely fatal, it is recognized as a leading global cause of lifelong disability as well as significant personal, social, and economic burdens coincident with disease. Infection is often considerably more prevalent in communities than the number of cases of overt pathology for which LF is best known (lymphedema, elephantiasis, and hydrocele). With an estimated 120 million to 130 million affected persons in 83 countries and 1.25 billion persons living in areas at risk, in some countries LF may be expanding its range, whereas in others, with economic development, it has disappeared with little if any targeted intervention. The transmission cycle is relatively inefficient, yet an association with pockets of deepest poverty remains tenacious. Thanks to scientific advances in diagnostic tools, and particularly in control strategies focused on large-scale drug donation and mass drug distribution programs, scientists and policy makers now consider LF eliminable. Together with new approaches for morbidity control, a hopeful tone surrounds a disease problem that as recently as two decades ago could easily have been categorized as among the most neglected of neglected diseases. Continued progress toward global LF elimination will require solutions to potential obstacles in the most challenging--that is, the poorest--endemic settings. This chapter reviews progress toward LF elimination and some of the remaining challenges from a perspective in Haiti, the only least developed country of the Americas.

Neglected tropical diseases: Need for sensitization of medical students

The neglected tropical diseases are a set of thirteen disabling conditions that are among the most common chronic infections in the developing countries like India. About 350 million people are already disabled or severely impaired due to them. Over 3 billion children, women and men are at risk worldwide. These neglected tropical diseases lead to long term disability and the resultant poverty. Seven most prevalent and neglected tropical diseases are ascariasis, trichuriasis, hookworm infection, schistosomiasis, lymphatic filariasis, trachoma and onchocerciasis. Together, these diseases are responsible for billions of infections in the developing world and more than six million deaths per year.[1] Population mostly affected from these diseases are the poorest people in the tropical and subtropical areas of the world. Increased awareness of public as well as the political will are needed to reduce the negative impact of neglected tropical diseases on the health and the social and economic wellbeing of affected communities.[2] These neglected tropical diseases, have been recently, identified as ‘targets of opportunity’ by WHO and US Centers for Disease Control and Prevention, in an effort to improve global health, while creating more vigorous economies and a better quality of life in some of the world's poorest countries. These diseases are targets of opportunity because through the expanded use of mass drug administration as well as targeted treatments, we now have the opportunity to control or even eliminate some of the most important neglected tropical diseases in terms of prevalence and disease burden.[3] Strategies to control these diseases are based on surveillance, early diagnosis and treatment, vector control in most of these infections, mass drug administration and patient education. The use of mass drug administration for the control of neglected tropical diseases or preventive chemotherapy was first started in China. Prolonged and targeted use of diethylcarbamazine resulted in the elimination of lymphatic filariasis and widespread use of praziquantel, in control of schistosomiasis in that country. This has promoted the concept of international partnership to control or eliminate these infections. Such partnerships are being formed by pharmaceutical companies mainly through donation of drugs for mass administration. Such comprehensive programmes can be executed in India also. Lymphatic filariasis (LF) is the second most common vector borne parasitic disease after malaria, found in over 80 tropical and subtropical countries. According to WHO, it is the second most common cause of long term disability after mental illness. One third of people infected with LF live in India.[4] So, a global programme to eliminate LF was launched in 2000. This programme largely depends on mass administration of diethylcarbamazine with or without ivermectin or albendazole. Studies show that integration of vector control with the mass drug administration sustains this programme in a better way and decreases the time required to eliminate LF.[5] Though it is a region-based disease but with the advancement in the connectivity through railways or road the specific boundaries cannot be drawn. Hence, teaching of diseases like LF should not be region based but exhaustive knowledge about these diseases should be given an utmost priority. In India, where a large number of people are poor, uneducated and underprivileged it should be considered a moral obligation of medical fraternity to address the problems of the poor. The problem needs to be addressed during the formative years in MBBS curriculum. The domain does not belong to Community Medicine alone but an equal importance should be given in Pharmacology training also in a more comprehensive manner. Several steps can be taken to sensitize the medical students in this regard as follows: An appropriate stress must be given to the National Health Programmes right at the beginning of the Pharmacology teaching. Students must be educated about the seven neglected tropical diseases and their management in details. They should be apprised of the fact that if these diseases are tackled at an early stage, some major complications can be avoided. The students should know the importance of keeping in mind the cost of the drugs while prescribing for these diseases. These topics must be given as much importance as the diseases of CNS, CVS, GIT and Respiratory System and should be taken up by the senior faculty.

Optimizing in‐kind drug donations for Tanzania—a case study

A questionnaire survey (QS) among stakeholders in Tanzania had shown that in-kind drug donations (DDs) are important to boost the drug supply system. Major problems were their insufficient quantity for sustainable treatment and the discrepancy between the needs of the recipients and the donors' supply. Objectives in this study were to discuss these findings and to learn from key informants (KIs) how to improve the DD process. Data were collected through KI interviews in 2001/2002.A 30% gap in drug supply has to be bridged by DDs. KIs confirmed the importance of the World Health Organisation and Tanzanian DD guidelines as a tool for good donation practice and emphasized the role of the government in their implementation. They requested that donors meet the recipient country's regulatory requirements. In contrast to QS respondents, KIs did not view DD quality as a minor problem, and proposed that DD quality should be adapted to the national quality assurance procedures. DD processes could be improved through (a) effective implementation of DD guidelines as an aid for decision-making and for quality assurance, (b) availability of data to improve communication between donors and recipients, (c) transparency between recipients and donors and (d) clearly defined accountability.

In-Kind Drug Donations for Tanzania

Tanzania, a country with low access to essential drugs, receives substantial drug donations (DDs) as in-kind gifts. To support the ongoing health sector reform and to promote a good donation practice, stakeholders' and recipients' views on the appropriateness and acceptability of DDs are of particular interest. The objectives were to collect information on the situation of in-kind DDs in Tanzania, to assess the characteristics of the DD system in Tanzania and to collect stakeholders' and recipients' views on problematic areas in DD processes including all strategies of drug donation. Using a qualitative approach, data were collected through validated postal questionnaires in Swahili and English, which were sent out in June 2001 countrywide to stakeholders of all sectors and levels of decision-making involved in healthcare in Tanzania. Of 1,383 mailed questionnaires, 496 were returned, of which 411 (30%) were eligible for analysis. All respondents perceived in-kind DDs as an important resource to assure drug availability in a context of poverty. Half of the respondents were recipients of in-kind DDs. On average, an estimated 27% of the recipients' drug supply was covered through DDs. The main problem for recipients of all sectors involved in healthcare was the insufficient quantity of DDs for sustainable treatment. Representatives of the public sector asked for more transparency in the DD processes. NGOs and religious facilities with better developed structures raised problems such as shipment fees, insufficient infrastructure and training. Recipients suggested that optimizing communication would have the greatest impact on improving the DD processes. In Tanzania, DDs were highly accepted by recipients and stakeholders. The primary concern of DD recipients was less the quality of drugs, although quality assurance remained an ongoing concern, than the discrepancy between the recipients' needs and the donors' supply. DDs often failed to cover priority needs. Suggestions of recipients for DD process optimization corresponded fully with the principles of the Tanzanian and the World Health Organization (WHO) guidelines for DDs, with the call for better implementation of the guidelines among donors and recipients.

Pragmatic Principles of Pharmaceutical Donation

Drug donations to medically underserved areas should abide by principles of pharmaceutical donation such as those formulated by the WHO. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Waterborne Infectious Diseases—Could They Be Consigned to History?

The development of water resources, particularly in Africa, has changed the face of the continent, opening up land for agriculture, providing electric power, encouraging settlements adjacent to water bodies, and bringing prosperity to poor people. Unfortunately, the created or altered water bodies provide ideal conditions for the transmission of waterborne diseases and a favorable habitat for intermediate hosts of tropical parasitic infections that cause disease and suffering. The recent progress in control of these waterborne and vector-borne diseases, such as guinea worm, schistosomiasis, lymphatic filariasis, and onchocerciasis, suggests that many of them could be controlled effectively by 2015, which is the target for reaching the Millennium Development Goals. Donations of safe and effective drugs by several pharmaceutical companies, funds for delivering these donated drugs from foundations and bilateral donors, and effective global health partnerships should make these diseases history.

A Thirsty World

The search for fresh water—to drink, to bathe in, to irrigate crops—is a problem as old as civilization. Across the ages, cities have thrived where the supply is abundant and collapsed in the face of drought. Remarkably, despite the technological progress characterizing the modern era and the fact that most of Earth's surface is covered by oceans, the availability of fresh water remains a pressing concern throughout the world. In this special section, we highlight some of the diverse contemporary scientific and engineering projects dedicated to obtaining and maintaining freshwater resources. We begin with a Review by Oki and Kanae (p. [1068][1]) on current understanding of the natural water cycle, and in particular the role of climate change in determining freshwater abundance. A related Review in this week's issue by Peterson et al. (p. [1061][2]) focuses more specifically on the Arctic region. Even in regions of abundant fresh water, contamination and disease can disable local communities. Schwarzenbach et al. (p. 1072) present a Review of chemical contamination problems. They note that although effective strategies have been implemented to remediate large-scale pollutants, a substantial amount of work looms ahead to cope with the numerous different compounds that are present at lower concentrations. In particular, collaborative efforts among chemists, geologists, and toxicologists are increasingly important to characterize the complex interactions of these compounds in the environment. Fenwick's Perspective (p. [1077][3]) follows with an optimistic view of the ongoing effort to combat waterborne diseases accompanying development programs in Africa, highlighting the role of drug donations from the pharmaceutical industry. It may seem strange to many people that modern societies cannot fulfill their water needs simply by purifying ocean water. Tal offers a Perspective (p. [1081][4]) about the multipronged strategy—of which desalination is an increasing component—that Israel has adopted to procure fresh water in an arid environment. Bohannon highlights the resource issues specific to the Gaza region in an accompanying News story (p. 1085). Another News story by Service (p. 1088) focuses more broadly on current developments in desalination technology. Additionally, two related stories by Stone and Jia (p. 1034) and Bagla (p. 1036) in the magazine's News Focus section describe large-scale engineering efforts in China and India to supply fresh water across extensive geographical areas. Inevitably, water resource management is a political problem as well as a scientific one (see the related Editorial by Kennedy and Hans on on p. 1019). It is clear that ensuring adequate supply will necessitate continuing collaborations across a great range of disciplines. The approaches described here offer a measure of hope for the future. [1]: /lookup/doi/10.1126/science.1128845 [2]: /lookup/doi/10.1126/science.1122593 [3]: /lookup/doi/10.1126/science.1127184 [4]: /lookup/doi/10.1126/science.1126011

Response from Savioli and Colleagues from the Department of Neglected Tropical Diseases, World Health Organization

Response from Savioli and Colleagues from the Department of Neglected Tropical Diseases, World Health Organization

A blueprint for success: integration of neglected tropical disease control programmes

The rapid expansion of chemotherapy-based control programmes for neglected tropical diseases has been catalysed by funding from the Bill and Melinda Gates Foundation, donations of several drugs from pharmaceutical manufacturers, and the reduced price of the drug praziquantel. Focussing on lymphatic filariasis, schistosomiasis and soil-transmitted helminthiasis, we review here the progress made to date with the implementation and integration of large-scale control programmes. Unresolved issues include a means for rapid identification of communities at highest risk of co-morbidity, cost-effective approaches for integrating the technical interventions into setting-specific packages, and determination of the most appropriate and sustainable delivery systems.

Corporate social responsibility strategies aimed at the developing world: perspectives from bioscience companies in the industrialised world

Bioscience companies have started to implement Corporate Social Responsibility (CSR) mechanisms aimed at the developing world because many companies feel they have a moral responsibility to give back to society instead of only focusing on profits. This research team went to the source and interviewed over 100 managers and executives of bioscience companies to uncover what ethical issues they face and what mechanisms they are using to address these issues. This paper reports on six CSR mechanisms that the companies studied are using to address global health problems in the developing world: (1) Drug Donation Programmes, (2) Pricing Strategies, (3) Building Local Health Capacity, (4) Public–Private Partnerships (PPPs), (5) Benefit Sharing and (6) Charitable Foundations. Each mechanism is described in detail with examples from the companies studied followed by a preliminary analysis of some cautions that should be considered before each mechanism is implemented. These empirically based mechanisms offer ideas and models from which other companies can learn.

New initiatives against Africa's worms

Since 1999, the funding available for the control of diseases of poverty (neglected diseases) has increased mainly due to leverage resulting from donations by the Bill and Melinda Gates Foundation and loans from the World Bank. Many countries have embarked on control programmes on a national scale due to drug donations by pharmaceutical companies through vertical programmes. The Schistosomiasis Control Initiative has expanded its operations to cover six countries in sub-Saharan Africa, but overlap of treatments between different vertical programmes is now a reality, and so care is needed to ensure that too many different drugs are not given together. Dialogue between programme managers has increased, and integration of some programmes may offer chances of synergy.

Uganda is learning from its Global Fund grant suspension

When in Kampala Victor Bampoe East Africa portfolio manager for the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM) works in an office with panoramic views of the downtown area of Ugandas capital city. In mid- November this area was thronged with riot police and dotted with cars torched by crowds protesting at Ugandan President Yoweri Kaguta Musevenis decision to jail his principal political opponent. Yet when Bampoe was recently asked how he was coping with the ongoing unrest he was momentarily confused about whether the question referred to the political protests or the Global Fund. Indeed the decision by the Geneva-based GFATM secretariat to suspend Ugandas five grants--totalling US$367 million--sent shock waves through a country whose robust response to AIDS is a point of national pride. At a meeting during the 11-week suspension one finance ministry staffer said: "This almost brought the country down." While this is more than a slight hyperbole the suspension did tarnish Ugandas reputation for AIDS programmes in sub-Saharan Africa. So the lifting of the suspension on Nov 10 was welcomed as an opportunity for the country to restore its reputation. (excerpt)

Onchocerciasis control and elimination: coming of age in resource-constrained health systems

During the past three decades, onchocerciasis control has been successful in reducing blindness and skin disease in Africa and the Americas. In this article, I review the control and elimination of Onchocerca volvulus as a public health problem. The success of onchocerciasis control has been the result of secure financing, generous drug donation, effective partnership between stakeholders, and focused operational and implementation research. The future challenges are to ensure sustainability of existing programmes and to increase the level of integration with other health interventions in resource-deficient health systems.

Benefit Cuts Force Many To Make Painful Choices

Benefit Cuts Force Many To Make Painful Choices

Satoshi Ōmura: in pursuit of nature's bounty

Professor Satoshi Omura has spent over 40 years searching for bioactive compounds in naturally occurring microorganisms, discovering more than 330 biomedically and commercially significant compounds in the process. The discovery, development and delivery of the drug ivermectin has pioneered the way for subsequent partnerships between the public and private sectors, as well as international collaborations and drug donation programmes. It has involved a variety of ground-breaking steps, providing a curative drug that will help rid Africa and the world of at least one of the most devastating of all human diseases, onchocerciasis. It has also improved the health of pets and livestock around the globe, and encouraged development of a community-based delivery mechanism that could herald a revolution in public health care in Africa.

Unhealthy drug donations

Unhealthy drug donations

Antiretroviral use in Ouagadougou, Burkina Faso.

Burkina Faso has the second highest seroprevalence rate for HIV in West Africa, estimated at 6.5% of the population. Although it is one of the poorest countries in the world, antiretrovirals have been used on an extremely limited basis in Burkina Faso since at least the early 1990s. In this article we will review the evolution of antiretroviral availability in this country, describe the mechanisms by which drugs are being accessed, and review our experience with expanding antiretroviral access through drug donations in community-based settings. Finally, we will discuss some of the implications for future attempts to expand access to treatment for people living with HIV in Africa.

Lymphatic Filariasis (Elephantiasis) Elimination: A public health success and development opportunity

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis, launched following World Health Assembly Resolution 50.29 (WHA 50.29), has been facilitated in its progress by new research findings, drug donations, the availability of diagnostic tools, disability management strategies to help those already suffering and the development of partnerships. The strategy recommended by the World Health Organization of annual treatment with a two-drug combination has proved safe.DiscussionUsing different approaches in several countries the elimination of lymphatic filariasis (LF) has been demonstrated to be feasible during earlier decades. These successes have been largely overlooked. However, the programme progress since 2000 has been remarkable – upscaling rapidly from 2 million treatments in 2000 to approximately 60 million in 2002. Around 34 countries had active programmes at the end of 2002. It is anticipated that there will be further expansion – but this will be dependent on additional resources becoming available. The programme also provides significant opportunities for other disease control programmes to deliver public health benefits on a large scale. Few public health programmes have upscaled so rapidly and so cost-effectively (<$0.03/treatment in some Asian settings) – one country treating 9–10 million people in a day (Sri Lanka). The LF programme is arguably the most effective pro-poor public health programme currently operating which is based on country commitment and partnerships supported by a global programme and alliance. Tables are provided to summarize programme characteristics, the benefits of LF elimination, opportunities for integration with other programmes and relevance to the Millennium Development Goals.SummaryLymphatic filariasis elimination is an "easy-to-do" inexpensive health intervention that provides considerable "beyond filariasis" benefits, exemplifies partnership and is easily evaluated. The success in global health action documented in this paper requires and deserves further support to bring to fruition elimination of lymphatic filariasis as a public health problem and health benefits to poor people. A future free of lymphatic filariasis will reduce poverty and bring better health to poor people, prevent disability, strengthen health systems and build partnerships.

Inappropriate drug donations

Drug donations sent to ‘help’ developing countries can actually do more harm than good. Iris Stehmann explores the reasons why and explains what should be done instead

Affordable access to essential medication in developing countries: conflicts between ethical and economic imperatives.

Recent economic and political advances in developing countries on the African continent and South East Asia are threatened by the rising death and morbidity rates of HIV/AIDS. In the first part of this paper we explain the reasons for the absence of affordable access to essential AIDS medication. In the second part we take a closer look at some of the pivotal frameworks relevant for this situation and undertake an ethical analysis of these frameworks. In the third part we discuss a few of the proposed solutions to the problem and conclude with an argument in support of our preferred course of action. In this article we argue for compulsory licensing of essential AIDS medications in the current conditions of public health emergency. We argue on broadly consequentialist grounds that compulsory licensing is preferable both morally and pragmatically to the alternatives, notably the currently offered price cuts and drug donation schemes.