The article quotes the director of the Southern Sudan Guinea Worm Eradication Program, Makoy Samuel who says: “There’s no way we can succeed in interrupting transmission of Guinea worm disease without taking into account the movements of the cattle, and thus of villagers, between their permanent locations and the cattle camps”.

The campaign to eradicate Guinea worm began in 1986, when there were an estimated 3.5 million cases of the disease in 20 countries in Africa and Asia. Last year there were 3,190 cases in just four countries, all of them in Africa: Sudan, Ghana, Mali, and Ethiopia. The US Carter Center continues to play the leading role in the campaign: http://www.cartercenter.org/health/guinea_worm/index.html

Writing in PLoS Neglected Tropical Diseases, Peter Hotez, President of the Sabin Vaccine Institute and Distinguished Research Professor of The George Washington University Medical Center, and Bernard Pecoul, Executive Director of Drugs for Neglected Diseases initiative (DNDi), outline in eight points why the global community should increase financial support for NTD control and elimination efforts and research and development.

The manifesto states that:

·      All NTDs are “tool ready” with cost-efficient and effective interventions that could be implemented now, even if for some diseases such tools are far from being perfect or complete.

·      At the same time that NTDs are tool ready they are also tool deficient, signifying that the tools are incomplete, or inadequate, to sustain elimination efforts.

·      NTDs have received little attention from the international community during the past ten years despite their large disease burden.

·      Increasing evidence indicates an association between NTD prevalence and conflict and violation of human rights.

·      NTDs can be particularly destabilizing and disrupt agricultural productivity and food security. Many poor societies with high NTD burdens have been recently engaged in a civil or international conflict or are currently at war.

·      Sustained involvement by the WHO and other international health agencies is crucial for current and future NTD control and elimination efforts.

·      Nothing is more important to the success of global NTD control than the involvement of communities themselves and disease-endemic countries’ health ministries.

·      Achievement of Millennium Development Goal 8 (”develop a global partnership for development”) will rest with stakeholders — health ministries, affected communities, public–private partnerships, large and small non-governmental organizations, etc. — establishing a well-functioning international strategy for NTD control.

While acknowledging that policymakers are “slowly beginning to appreciate the importance of NTDs” — evidenced by the creation of a new department of Neglected Tropical Diseases at the World Health Organization; TDR’s 10-year strategic plan; and the identification, by NIH’s Francis Collins, of neglected diseases as a research priority, among other developments — Hotez and Pecoul argue that the challenge of NTDs calls for a manifesto — “a public declaration of motives by a government or by a person or group regarded as having some public importance.”

Moreover, they add, by doing more to tackle NTDs, the global health community can make progress toward Millennium Development Goals.

“[NTD control] activities have facilitated the delivery of additional interventions such as insecticide-treated bed nets, antimalarial drugs, micronutrients, and childhood immunizations,” they write.

The authors urge scientists working on NTDs to increase collaboration and identify funding opportunities and cost-efficient interventions.

“By highlighting important challenges in the fight against NTDs, this ‘manifesto’ calls on the global community for urgent, renewed, and innovative efforts.”

Reference
1. Spiegel JM, Dharamsi S, Wasan KM, Yassi A, Singer B, et al. (2010) Which New Approaches to Tackling Neglected Tropical Diseases Show Promise? PLoS Med 7(5): e1000255. Available from: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000255

Kristof focuses the column on a village in southern Sudan, one of the few remaining places the disease still exists. “In recent decades, the world has learned that fighting poverty is harder than it looks,” he writes. “But the Guinea worm campaign underscores that a determined effort, with local people playing a central role, can overcome a scourge that has plagued humanity for thousands of years.”

According to WHO, Guinea worm is endemic in only three other countries – Ethiopia, Mali and Ghana – and that as the eradication campaign nears the final mile, heightened surveillance is crucial to containing the last cases and interrupting transmission.

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”.

It is necessary for at least three years to pass without notification of a case before WHO will certify a country as being guinea worm free. As recently reported on TropIKA.net, over a year has gone by since a case was seen in Nigeria. Neighbouring Niger is in a similar position. WHO considers that both nations have interrupted transmission and it is hoped that they are well on the way towards elimination of the disease.

Ethiopia, Ghana, Mali and Sudan are the four remaining ountries where transmission has yet to be interrupted.

Further details are available in a WHO press note.

The US Carter Center which has been at the heart of guinea worm eradication efforts says there have been no known cases since November 2008. According to the Center, the last person to have had the disease (a villager in the southeast of the country) has become a “minor celebrity”.

Two more years must pass without further cases before Nigeria is officially accredited as being free of the disease. Nevertheless, the achievement of the eradication efforts, which began in 1988, have been nothing short of astonishing. According to 1987 figures, there were 650,000 guinea worm cases in some 6,000 villages across Nigeria.

Nigeria joins 15 other countries that have rid themselves of Guinea worm disease since 1986. It is estimated that in 2009, fewer than 3,500 cases of the disease remain in four African countries: Ethiopia, Ghana, Mali and Sudan. It has hard to believe that just 20 years ago the total number of cases worldwide was approaching three million.

In Ghana there have been calls for opinion leaders to support community-based surveillance volunteers who are a key part of the plan to eradicate the disease there by 2014 - see Ghana News Agency report.

A recent report on Afrika.com notes that it is now six years since Uganda had any cases; WHO’s country director there has handed over an official certificate saying the coutry is guinea worm free.

Eradication was first claimed in 2006 but then new cases were found. However, a report on the Next website quotes Gowon as saying, “Available records have shown that there is zero case of the spread of the disease in Nigeria, though more than 650,000 guinea worm cases were discovered across the country in 1987.”

The Yakubu Gowon Centre has worked with the US Carter Center in efforts to eradicate the disease in Nigeria.

Speaking on National Guinea Worm Day, former Head of State, General Yakubu Gowon, said, “By the end of this year, we will have been one year free of reported cases, which leaves us with the challenges of achieving three years of active and intensive surveillance before certification by WHO [as a country that has eliminated the disease].” The progress made underscored the importance of an effective and efficient surveillance system. General Gowon said, “Unless this is given high priority, we stand the risk of re-infection and a reversal of all the gains so far made”.

Minister of Health Professor Babatunde Oshotimehin, explained that the fight against guinea worm in Nigeria began in 1988, when there were 650,623 reported cases of the disease in 5,978 villages across the country. Last year’s 38 cases were confined to one area of the country and that outbreak appears to have been contained. Read the full story in Vanguard Online.

A Voice of America report from a couple of months previously also makes interesting viewing.

Nevertheless, the most comprehensive TV coverage of the infectious diseases of poverty remains that from the BBC’s Survival series - see our article here on TropIKA.net.