The Drugs for Neglected Diseases initiative (DNDi) takes the BBVA Foundation Frontiers of Knowledge Award in the Development Cooperation category

The BBVA Foundation Frontiers of Knowledge Award in the Development Cooperation category goes in this fifth edition to the Drugs for Neglected Diseases initiative (DNDi) for “developing and delivering new, effective and affordable treatments for poverty related diseases including Chagas disease, sleeping sickness, malaria and leishmaniasis affecting the world’s most vulnerable populations,” according to the award citation. DNDi, in the jury’s judgment, “represents an institutional model of good practice, translating scientific research to development cooperation, through knowledge management and delivery of results to disadvantaged populations suffering from neglected diseases.”

26 February, 2013




Bernard Pécoul, director of DNDi

Informed of the award, DNDi‘s Executive Director Bernard Pécoul expressed his delight “for the organization, but also for those suffering neglected diseases, who are what this initiative is all about.”

“Despite the major progress achieved in global health over the last century, there remains a significant equity gap and many diseases affecting the poorest populations are still neglected,” the citation continues. “This represents shortcomings of market incentives resulting in only 10% of the world research expenditure being spent on diseases that account for 90% of the global health burden. Controlling and eliminating these diseases is a vital component of the strategy to alleviate poverty.”

“A neglected disease is one that affects many people, but whose victims who do not constitute a lucrative market and therefore fail to attract private-sector investment. They are also diseases which kill or which, like sleeping sickness for instance, prevent their young sufferers from working. And this imposes a heavy economic as well as personal burden on families and communities. In places where these conditions are widely prevalent, economic development is seriously impaired,” Bernard Pécoul explains.

It is reckoned that over a billion people – almost one in six of the world’s inhabitants – are infected with one of the 17 diseases listed by the WHO as neglected tropical diseases, and, of this number, 500 million are children. These conditions moreover cause half a million deaths a year. And if we include other poverty related diseases like malaria, the affected population swells to three billion.

The awardee organization is a Product Development Partnership (PDP), a model which, the jury affirms, has proved its effectiveness over the last ten years: “It has successfully worked with academia, industry, NGOs and governments around the world, to develop and implement six new drugs against malaria, Chagas, sleeping sickness, and leishmaniasis. These diseases potentially affect more than 3 billion people. Some of their new products have been registered in more than 30 countries in Africa, Asia and Latin America, and, as an example, over 150 million doses of their antimalarial drugs have already been delivered.”

Drugs for Neglected Diseases is a not-for-profit organization founded in 2003 on the combined initiative of seven public and private institutions: Médecins Sans Frontières/Doctors Without Borders, the Indian Council for Medical Research, the Kenya Medical Research Institute, the Malaysian Ministry of Health, France’s Institut Pasteur, Brazil’s Oswaldo Cruz Foundation (Fiocruz), and the Special Program for Research and Training in Tropical Diseases of the World Health Organization.

A 120-strong team working out of its offices in Switzerland, Brazil, the Democratic Republic of the Congo, Kenya, India, Malaysia, the United States and Japan, coordinate a partnership network of around 600 engaged individuals who liaise with the public and private institutions involved in each project.

Its mission is to discover and develop new treatments for neglected diseases and other poverty related conditions, and to ensure that patients in the most vulnerable countries enjoy equitable access to the results. In view of the circumstances of this target public, the “ideal” treatment should be oral, safe, effective, low cost, and short course. “Diagnosis should be simple,” Pécoul points out, “while the idea that treatments should preferably be oral and short course is so patients do not have to travel for hours or even days to have the drug administered in a hospital center.”

DNDi‘s strategy is to detect the need for a particular treatment, then coordinate and synergize the efforts of public and private partners – including pharmaceutical companies – in its development, production and distribution. Pécoul talks about its relationship with the pharma industry: “We have signed contracts with numerous laboratories, some of them at quite early development stages, and I can say that these relationships have worked well. They know that they’re not going to make a profit, but the projects are supported by the people in their own teams and they are also aware that the countries affected are the market of the future.”

Since it was founded, DNDi has come up with six new treatments for forgotten patients by improving, reformulating or combining existing drugs.

These include two treatments against malaria – ASAQ, developed in partnership with Sanofi, manufactured in Africa and distributed in 32 countries, and ASMQ, based on a technology transferred from Brazil to India; one to combat sleeping sickness – NECT, replacing previous toxic or more expensive treatments; a further two against visceral leishmaniasis – of shorter duration and now being distributed in East Africa and Asia; and a sixth against Chagas disease – a new pediatric dosage form of an existing treatment developed with a public laboratory in Brazil.

Pécoul is especially proud of the new sleeping sickness treatment: “It has meant a huge change. I spent over 20 years with Médecins Sans Frontières, and it was tough walking into a hospital and knowing that the drug in use – an arsenic derivative – was so toxic that it killed 5 percent of the patients it was supposed to cure. But we had no alternative because the disease killed 100 percent.”

The jury stressed that DNDi’s work encompasses the design, evaluation, registration, production and implementation of drugs under the strictest standards of quality and safety, and collaborating with public and private organizations on the ground to ensure a successful delivery.

Pécoul highlights a recent shift in the flow of research. “It used to be that research was generated in the north then applied in the south. But we have now extended our model to enable more interaction between the countries of the south, so they help each other mutually. In the future, this could mean, for instance, that the solution for Chagas patients in Spain comes from Brazil or Argentina.”

DNDi is currently promoting research in two other conditions: filarial parasitic worm diseases and pediatric HIV. It also has 30 projects at different stages of the development pipeline, 11 of which are totally new drug candidates.

“We are working on a one-week oral treatment for sleeping sickness which it seems could also be effective against leishmaniasis and Chagas,” informs the DNDi director. “If things go well, we may one day have a single drug for these three poverty related conditions at far below the current cost.”

DNDi draws its funding in equal measure from public agents – governments and institutions – and the private sector – foundations, NGOs and other organizations. “The situation in Europe is worrying in this respect. That’s why we are seeking to diversify, so if a particular government can no longer help, we have other sources on hand to support our activity.”

International jury

The jury in this category was chaired by Pedro Alonso, Director of the Barcelona Institute for Global Health (ISGlobal) of Hospital Clinic-University of Barcelona, with José García Montalvo, Vice President for Science Policy at Pompeu Fabra University, acting as secretary. Remaining members were Maricela Daniel, Representative in Spain of the United Nations High Commissioner for Refugees (UNHCR); Vicente Larraga, Research Professor in the Center for Biological Research of the Spanish National Research Council (CSIC); and Francisco Pérez, Professor of Economic Analysis at the University of Valencia and Research Director of the Valencian Institute of Economic Research (Ivie).