“Some diseases do not need innovation but simply modest funding and a little imagination in order to distribute drugs to those in need" - Prof. Alan Fenwick, Imperial College London (Financial Times, 2006)
Neglected tropical diseases (NTDs) refer to a group of largely worm-based infections which represent one of the largest global economic and health burdens, affecting over 1.4 billion people across the world. NTDs are painful, disfigure and disable, and can lead to both blindness and death. The hundreds of millions who are infected are often unable to work or attend school, which prohibits them from being productive members of society and perpetuates the endless cycle of poverty and disease.
An article in the Financial Times in June 2006, led Legatum to meet with Prof. Fenwick at Imperial College in London, and a subsequent commitment to delivering low-cost treatments which can mitigate the effects of these horrific diseases.
Strategy
Legatum’s strategy has been two-pronged. First, by facilitating the launch of The Global Network for Neglected Tropical Diseases, concerned parties have been brought together to co-ordinate their work. Secondly, Legatum’s funding has launched innovative, country-focused programmes with a uniquely integrated approach to disease prevention that includes governments, the pharmaceutical industry and local partners. By applying its value-seeking, investor's approach to NTD initiatives, Legatum has facilitated the launch of the world's first integrated large-scale, multi-year, country-wide NTD study and associated follow-up program, treating millions of afflicted people.
Burundi and Rwanda
After reviewing proposals with the Global Network, Legatum chose to focus on Rwanda and Burundi as the first countries to receive funding. Successful pilot projects such as these have been effective in demonstrating that nation-wide interventions can be both affordable and effective for millions of people.
Burundi was selected due to its size and a longstanding history of development projects within the country; and Rwanda also because of its size, but particularly because of a belief in the political leadership of the country and the fact that Legatum had previously supported a number of social entrepreneurs active in a variety of development sectors across the country. In 2007 and 2008, Legatum granted a total of USD 5.3 million for NTD projects in both Rwanda and Burundi and in 2009 will provide an additional USD 2.9 million. Legatum's total funding of almost USD 9 million for leading NTD initiatives in both countries will directly impact more than 18 million lives.
Impact
It is exciting and compelling to learn that, despite being a scourge afflicting over one billion people, NTDs can be effectively and permanently treated through a couple of simple interventions per year, for a mere $1 per person. After sustained community intervention for approximately four years, NTDs can be eradicated, completely. Eradicating NTDs is the most high-impact, cost-effective, wide-scale, life-changing medical investment available on the planet – we already have "the $4 cure".
Neglected No More?
Of course, the human infestation of worms does not readily invite enthusiastic media coverage, concert-causes or public support. These diseases are now unfamiliar in the developed world, particularly since the Rockefeller Foundation launched a successful program in 1909 which eradicated the hookworm from the USA. Today we may be more familiar with "fashionable" diseases like HIV/AIDS and malaria, yet the scale of human misery caused by NTDs remains in a class of its own.
As Rockefeller demonstrated in early 20th Century America, the scourge of worms can be permanently eradicated. By working together, we collectively have the means and unique opportunity to permanently rid people of these overlooked diseases, and benefit entire communities and nations for generations to come.
Mother and Child Health Week in Burundi and Rwanda
In June 2008, Legatum supported Burundi's National NTD Control Programme and National Programme for Onchocerciasis Control, in organising the first of two national Mother and Child Health Weeks for 2008 (Semaine Santé Mère et Enfant - SSME). In previous years, the SSME delivered immunizations and micronutrient supplements to all preschool children (1-5 years old) and pregnant women, nationally. But this year, treatments against NTDs were added to the "Health package" in order to highlight the importance of deworming in the effort to mitigate the negative social and economic impacts of NTDs. At the launch, staff handed out albendazole and praziquantel - drugs to treat soil-transmitted helminths and schistosomiasis, respectively - to the community members present. So far, 502,447 individuals have been treated with praziquantel in 2007 and 596,820 in 2008. In addition, 823,438 individuals were dewormed using albendazole in 2007 and 3,623,128 in 2008.
During the "Mother and Child Health Week" in Rwanda, the NTD team carried out a de-worming campaign targeting pre-school, school aged children and mothers. A total of 3,785,263 people were de-wormed within one week:
- Pre-school children (1-5 years) : 1,133,704
- School children (5-16 years) : 3,159,502
- Post-partum mothers (6 weeks after delivery) : 46,463
The target population for the schistosomiasis treatment was children aged 5 to 16 years and a total of 107,028 children were de-wormed with praziquantel. The treatment was administered by school teachers and community health workers.
Integrated Drug Distribution
The Burundi NTD team also closely worked with the National Programme for Onchocerciasis Control and the African Program for Onchocerciasis Control and their respective networks of community drug administrators. The NTD program trained volunteers to incorporate albendazole and praziquantel into their distribution of ivermectin for Onchocerciaisis treatment. Overall, this project reached over 800,000 people and is the beginning of further opportunity to leverage integrated delivery of medication.
Education Campaigns
To improve community awareness of NTD's, it is essential to provide educational material during these drug distribution campaigns. In both Rwanda and Burundi, the development of educational material was a key outcome and distributed in combination with radio shows, a documentary film and a local television show to increase awareness of NTD's in these countries.