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Neglected tropical diseases affect the poorest people ... neglected people

THERE'S a telling quote on the website of Dr Stuart Smith's organisation, Developing World Health.

"A scientist who is also a human being," it says, "cannot rest while knowledge which might reduce suffering rests on the shelf."

The words were uttered by Dr Albert Sabin, a Polish-born medical scientist who was responsible for the oral live virus polio vaccine.

Sabin died 20 years ago this month and today an institute in Washington DC which bears his name seeks to reduce needless human suffering from vaccine-preventable and neglected tropical diseases.

On the other side of the Atlantic, from an office at Stirling University's Innovation Park, Dr Smith is carrying on work in a similar vein.

The neglected tropical diseases (NTDs) targeted by the charity – which include Leishmaniasis, African Trypanosomiasis (sleeping sickness), Chagas disease and dengue fever – are still-powerful adversaries across the world's developing countries, affecting 3.2 million people every year and killing 150,000 people, many of them children. NTDs in general, says the World Health Organisation, "blight the lives of a billion people worldwide and threaten the health of millions more".

Much has already been done to try to eradicate them. Developing World Health, for its part, hopes to develop two 'highly promising' pharmaceutical products for use against the four NTDs it has targeted. It also has co-launched a 50p appeal – this being the sum that will give a child an entire year's treatment against the seven most common NTDs such as hookworm, whipworm and schistosomiasis.

Dr Smith's efforts took him to London recently, and a top-level meeting, the London Declaration on Neglected Tropical Diseases.

For decades, partners including pharmaceutical companies, donors, endemic countries and non-government organisations have been contributing technical knowledge, drugs, research, funding and other resources to treat and prevent NTDs among the world's poorest populations.

The landmark London meeting included the Bill and Melinda Gates Foundation, governments, NGOs, multilateral organisations and the private sector, all uniting to help consign the diseases to history. The Bill and Melinda Gates Foundation promised to inject $363 million (£231m) over five years to boost programmes for the control of these diseases; the UK's Department for International Development committed £195m until 2015.

"It was quite an historic and unusual meeting," Dr Smith says. "It was a great privilege to be there. Inspired by the World Health Organization's 2020 Roadmap on NTDs, we believe there is a tremendous opportunity to control or eliminate at least ten of these devastating diseases by the end of the decade."

It was the first time there had been a unified collection of leading pharmaceutical companies, pledging free donation of medicines for mass drug administration, and a WHO commitment to try to eradicate many NTDs in sub-Saharan Africa by 2020. The fact that it sent over its Director General, Dr Margaret Chan, spoke volumes to its involvement.

"What Gates has done as a philanthropist is extraordinary," Dr Smith adds. "He has a great passion and interest in infectious diseases, in polio and eradication, and is showing an increasing interest in NTDs."

As a young man, Dr Smith did a PhD in schistosomiasis, a parasite-borne disease also known as Bilharzia, or snail fever. "No-one can pronounce it," he says, half-seriously, though TV newsreaders had to learn how to get their tongues round it when Prince William, then an under-graduate at St Andrews, contracted the condition from parasitic flatworms while on African safari a decade ago. The parasite becomes an adult worm, taking up residence in the bowel, intestine or liver, depending on its species.

Dr Smith also worked in drug research and development at Schering Agrochemicals, in Cambridge, in both its animal and public health divisions. Later, as area manager for East and South Africa, he found himself in such countries as Kenya, Zambia and Uganda. "I've seen some of these diseases at first hand, and they're pretty traumatic to see" he says.

He has worked in the cancer field for the last 22 years; it's only recently that he has returned to tropical diseases, or, as he puts it, "re-discovered what I used to do for my PhD and subsequently in the field. I've been using my pharmaceutical knowledge and skills to move this whole project forward."

Does he think the West ignored such diseases in the past, because they were occurring in continents such as Africa?

"Absolutely. The very term 'neglected tropical disease' stems from the fact that they affect more than a billion people, one in seven on the globe, but they really affect the poorest of the poor. They've been neglected because they affect neglected people, the kind of people who really have no ability to pay for medicines, though that is changing.

"Pharmaceutical companies have been relatively slow in terms of addressing new treatments, though the ones involved in the London meeting have been supplying free drugs mainly through mass drug administration.

"It's all credit to them that they've done that. The pharma industry often gets a bit of a bashing, but these companies have donated millions of tablets free. A classic example is Merck & Co Inc, which has been donating Mectizan, a treatment for river blindness, for many years and will continue doing so until river blindness is eliminated."

He's optimistic that the WHO target of 2020 is largely achievable. "There's a good probability that, if not elimination, we will at least make a major impact on some of these diseases." He cites as an example lymphatic filariasis – elephantiasis, which causes a huge swelling of limbs.

"Through co-ordinated drug delivery in schools, I think we can between now and 2020 make a massive impact on these diseases.

"But some of the other diseases are going to be more difficult. African sleeping sickness is a very rural disease, extremely complex and difficult to treat. Leishmaniasis is another prevalent disease – an NTD that Ben Fogle contracted a few years ago. [The TV presenter came into contact with the bug, which is transmitted by the bite of the female sandfly, while filming Extreme Dreams for the BBC in the Peruvian jungle].

"Leishmaniasis is going to be much more of a challenge: it's very widespread. There's visceral leishmaniasis, which affects the internal organs has a high mortality rate, and cutaneous leishmaniasis, which causes sores on the skin. A lot of troops in Iraq and Afghanistan have contracted the cutaneous form and is actually on the increase. It's easier to treat [than the visceral variety] but it can be very disfiguring."

Dr Smith is also interested in the revealing link between NTDs and HIV/Aids. Many Aids specialists have long wondered why the disease is so prevalent in Africa. The reason, it turns out, is not necessarily down to sexual promiscuity and unprotected sex across the continent.

"Recent studies show there is as much promiscuity in parts of the western world, south-east Asia and South America, but we can't explain the 10-fold, 20-fold increase in Africa, just based on sex."

It has emerged that young, sexually active women with genito-urinary schistosomiasis are three times more likely to contract HIV. "We believe there's a very strong link between co-infection with NTDs and an increased risk of getting HIV. That's a very important area and one we hope to be raising awareness of. We've discussed this with Jack McConnell and will present this at the All Parties Parliamentary Group for Malawi and Zambia in June."

The charity has achieved much in its four years and it has been boosted by Dundee-born actor Brian Cox agreeing to act as its ambassador. Next month, Cox will act as Grand Master at the annual Tartan Week in New York. Dr Smith was on hand in Edinburgh recently to watch Cox being fitted for a bespoke tweed kilt which he will wear at the Parade on 5th Avenue and also at a DWH charity event called Scotland Unfiltered.

A stylish kilt, worn with panache by an internationally famous Scot on one of the biggest stages in America? The charity's profile is about to get a little higher.

www.developingworldhealth.org

dr stuart smith, expert in tropical diseases

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