A meeting in the Togolese capital Lomé has discussed the urgent need to find new ways to address the growing problem of fake and substandard drugs.

Fake products continue to sell well in developing countries because they are cheap. Some of the most widely faked drugs are antibiotics and antimalarials. Many contain low (but ineffective) doses of the active ingredient, and exposure of the disease-causing organisms to such low doses encourages the development of resistant strains.

Delegates at the meeting agreed on the need for a united public-private front to overcome people’s resistance to health warnings and to dismantle increasingly sophisticated trafficking networks.

The event was organized by Leem, a body representing French pharmaceutical companies, and brought together government health officials from francophone African countries. A report on the meeting from IRIN News also includes links to other recent IRIN stories on the issue of fake drugs.

Coinciding with the publication of a major TropIKA.net article on mHealth (the use of mobile phones in health care), the journal Health Affairs has published an interesting contribution on the topic that focuses on one example of mHealth in action - Mexico’s VidaNET (LifeNET) system which sends text messages and e-mail to patients, reminding them to take their anti-HIV drugs, keep their doctors’ appointments, and stay up to date on their lab tests. (This article is freely available online.)

The latest issue of Health Affairs is devoted to the wider topic of eHealth - the use of modern information and communications technology to transform health and health care. The other articles - on a range of potentially interesting eHealth topics - are, however, only available in full to the journal’s paying subscribers.

Reference
1. Lester Feder J (2010). Cell-Phone Medicine Brings Care To Patients In Developing Nations. Health Affairs; 29(2):259-263.

“The current state of country health information systems are inadequate and fail to meet the needs of decision-makers globally, nationally and locally.” This was the conclusion of delegates to the Global Health Information Forum held in Bangkok in January.

The meeting ended with the publication of a call to action that stressed the need for: transparency, good governance, adequate investment, capacity building, harmonization and integration, and planning for the future.

The Bangkok call to action follows a recent statement on health information systems from WHO, the World Bank, the Global Fund, UNICEF, UNAIDS, UNFPA, GAVI and the Bill & Melinda Gates Foundation that called for “new ways of working and a more systematic approach by all partners … to better monitor and evaluate progress and performance” [1].

Reference
1. Chan M, Kazatchkine M, Lob-Levyt J, Obaid T, Schweizer J, et al. (2010). Meeting the Demand for Results and Accountability: A Call for Action on Health Data from Eight Global Health Agencies. PLoS Med 7(1): e1000223.

A leading market research company forecasts that global market for malaria vaccines will reach $1.05 billion by 2017. The predictions are based on likely sales of products that are currently in the pipeline, including GlaxoSmithKline’s Mosquiri (RTS,S), which continues to be investigated in several large scale Phase III trials in Africa. Mosquirix is at a more advanced stage than any other malaria vaccine but is expected to produce protection rates of only around 50%.

More information available from MarketWire.

A new vaccine to protect against tuberculosis is urgently needed. Nowhere is the need greater than for HIV-infected people, who face very high risks of developing TB. A clinical trial in Tanzania has found that a new TB vaccine reduced TB infection rates by 39% amongst 2,000 HIV-infected patients.

The seven-year trial - a collaboration between Dartmouth Medical School, USA and Muhimbili Medical School, Dar es Salaam - employed a whole cell vaccine of the organism Mycobacterium vaccae, closely related to M. tuberculosis the disease agent responsible for TB. Patients in the trial had already received the standard BCG vaccination for TB.

The trial - known as the DarDar Study (Dartmouth-Dar es Salaam) - has already created considerable interest. The next steps are to improve manufacturing methods to support the production of the larger quantities of the vaccine needed for further studies and subsequent clinical use. Development work on manufacturing will be conducted by the Aeras Global TB Vaccine Foundation in Maryland, USA, in conjunction with the London-based manufacturer, Immodulon Therapeutics.

Reference
1. von Reyn CF, Mtei L, Arbeit RD, Waddell R, Cole B, Mackenzie T, Matee M, Bakari M, Tvaroha S, Adams LV, Horsburgh CR, Pallangyo K; the DarDar Study Group (2010). Prevention of tuberculosis in Bacille Calmette-Guérin-primed, HIV-infected adults boosted with an inactivated whole-cell mycobacterial vaccine. AIDS; 2010 Jan 28. [Epub ahead of print]

The Internet allows open discussion to take place on a huge range of topics, including the implementation of programmes to control the infectious diseases of poverty. The excellent Topnaman blog on malaria presents a discussion of an article [1] in the Bulletin of WHO that criticised some aspects of the President’s Malaria Initiative’s (PMI) work in Angola. The intervention in question was the use of indoor residual spraying (IRS) of insecticide.

The core of the criticisms made is that intervention areas were selected on the basis of reported clinical diagnoses of malaria, unsupported by laboratory findings, and that this led to expensive control efforts taking place in areas where they were not necessary.

Published on the blog are a response from PMI to the original Bulletin article, followed by a comment on this from one of the article’s authors, Bill Jobin.

PMI say that the work conducted in a low-transmission area provided “experience and confidence” to enable subsequent activities in higher transmission areas. But Bill Jobin argues the case for programmes that are based on data from microscopic diagnoses in appropriate sentinel populations. “Then we will know what the problem really is, and where to put our efforts”, says Jobin.

Reference
1. Somandjinga M, Lluberas M, Jobin WR (2009). Difficulties in organizing first indoor spray programme against malaria in Angola under the President’s Malaria Initiative. Bull World Health; 87(11):871-874.

A US doctor working in Cape Town, South Africa says that TB infection rates of children are “at the highest levels ever recorded since the onset of TB chemotherapy in the middle of the last century”. He calls for more research to develop new ways of treating the disease.

Dr Robin Wood is Director of the Desmond Tutu HIV Centre at the University of Cape Town. In a blog in the Huffington Post he speaks of the high TB rates his research team have identified during a clinical trial: “By the time children enter school at age 5, 20 percent are already infected with TB. By the time they reach the age of sexual maturity, 13 years, 50 percent are infected. And between the ages of 24 and 28 - the years of peak prevalence of HIV - 80 percent are infected”. Also serious is the growing number of cases of drug-resistant forms of TB.

He contrasts current funding for TB with efforts being made against H1N1 and expresses concern that the global economic crisis could lead to cuts in research budgets. He want to see “increased research of all the stages of TB development”.

In the good old days, most cases of malaria responded to chloroquine (CQ) treatment and there was a high level of public awareness as to the name of this drug. However, as an editorial in the Tanzanian online newspaper ThisDay points out, in this era of CQ resistance, very few people have a clear idea of what drug they or their children need when they suspect they have malaria.

Referring to a 2008 study [1] the article stresses that a high proportion of the antimalarials on sale in Africa are likely to be ineffective. The situation is confusing and people need guidance. ThisDay says, “There is need for the government to make an aggressive effort to remove all inappropriate and ineffective drugs (most of which are counterfeit products) from the shelves, while at the same time we look into the way of bringing down the costs of other effective drugs”. Governments also need to provide more information to assist the public in their efforts to choose effective drugs from the range of products now available to them.

Reference
1. Bate R, Coticelli P, Tren R, Attaran A (2008) Antimalarial Drug Quality in the Most Severely Malarious Parts of Africa – A Six Country Study. PLoS ONE 3(5): e2132.

Research aimed at developing new treatments for the infectious diseases of poverty (IDPs) has generally been of very little interest to the pharmaceutical industry. The people with these diseases are, by definition, poor and would be unable to afford expensive new drugs. Hence there is no profit to be made.

However, the economies of some of some countries with high rates of IDP incidence are now growing rapidly. China is a case in point. Tuberculosis is the country’s number one infectious cause of death, claiming some 160,000 lives annually. China has the world’s second highest number of TB cases, after India.

But thanks to its economic success China can now pay for TB drugs. A study by the market research group ResearchAndMarkets says that China’s demand for TB drugs has grown at a fast pace in the past decade. It predicts that, in the next five years, both production and demand will continue to grow. The study examines China’s economic trends, investment environment, industry development, supply and demand, industry capacity, industry structure, marketing channels and major industry participants. (Unfortunately the full report is only available for a very high fee - around $6,000.)

What impact will economic growth in IDP-endemic countries have on the research priorities of the pharmaceutical industry? Certainly countries that have both IDPs and money become a more interesting prospect. Many countries with growing economies are, for example, afflicted by dengue fever and by malaria. Will industry come to regard these as more attractive areas for research than previously?

Some of the highest rates of infectious diseases, however, are in Africa where economies are still struggling. The profit motive for addressing their disease burden is still lacking.

A report in Business News says that drug giant Novartis has had no success in trying to raise funds from the public and philanthropic sectors to to finance development of drugs against neglected illnesses including dracunculiasis (guinea-worm disease), malaria and tuberculosis.

Novartis wants to raise about $1 billion annually for 10 years to create a fund that companies and institutions could draw on to develop treatments for diseases that get little drug-development interest because they wouldn’t be profitable. The US and European governments, the Bill & Melinda Gates Foundation and the Wellcome Trust have all apparently been approached without success.

Paul Herrling, head of Novartis corporate research says, “It’s two years I’ve been working on this thing, and I don’t have a cent”.