Source: merck.com
Interviews
Merck & Co. ** CDC
For this website we interviewed two experts involved in the eradication campaign of lymphatic filariasis. We thank them for their support and efforts in this important endeavor.
Ken Gustavsen
Manager, Global Product Donations
Merck & Co., Inc.
Tel: (+1) 908 - 423 - 3088
Fax: (+1) 908 - 423 - 1987
e-mail: ken_gustavsen@merck.com
Visit www.mectizan.com
The global fight to eliminate lymphatic filariasis has a great advantage in that safe and effective medicines exist to combat the disease. As you probably know already, in most countries in Africa the recommended treatment is one annual dose of Merck's donated drug Mectizan, co-administered with albendazole, a drug donated by GlaxoSmithKline. In other areas in Africa and the rest of the world, the treatment strategy consists of the drug diethylcarbamizine (DEC) and albendazole. The reason for the two approaches is that DEC has some unfavorable side effects in countries where another disease, river blindness, also exists. Therefore, Mectizan is used instead of DEC in those areas, as Mectizan is also donated by Merck to combat river blindness.
1. What do you see as the biggest barrier/challenge to the eradication of lymphatic filariasis? Why?
So, since the medicines exist and are easily available, one of the biggest challenges is for affected countries to have a healthcare infrastructure developed enough to deliver the drugs and monitor and track the progress of the intervention. And to do that, they need sufficient physical infrastructure -- roads, clinics, etc; as well as human infrastructure -- doctors, nurses, public health professionals and community volunteers. For both of those needs, funding in the national healthcare budget towards LF is necessary, placing a priority on eliminating the disease, in recognition of the health and socioeconomic burden it places on the affected populations.
2. What role do you think the United States should play in the campaign to eradicate filariasis?
The United States can play a role by encouraging governments of affected countries to place a high priority on infectious disease programs.
3. Sources indicate that eradication can be accomplished by the year 2020. How realistic do you think this is?
With the medicines available, if existing programs can scale up to reach all the required populations and new programs can begin in all affected countries -- and can sustained for long enough -- then elimination by 2020 is a real possibility.
4. What can students such as ourselves do to help with this campaign?
Students can increase the level of awareness of LF amongst their peers, colleagues, families and friends so the world knows that this challenge is out there. By studying public health and then working in a related field, students can become front-line participants in the fight to eliminate this disease.
5. How do you instill confidence in mass drug treatment programs (such as India), where the public distrusts government authorities?
If a public health program is well managed and
engages in social mobilization and thorough community advocacy programs in
anticipation of the treatment program -- educating everyone about the disease,
the treatment, and the resultant benefits -- the program will be a success.
The success of the LF program in more than 40 countries is testament to that
model.
Dr. David Addiss
Centers for Disease Control and Prevention
Division of Parasitic Diseases
Mailstop F-22, Building 102, 4770 Bufford Highway N.E.
Atlanta, GA 30341-3724 USA
tel: +1 (770) 488 7760
fax: +1 (770) 488 7761
e-mail: dga1@cdc.gov
1. What do you see as the biggest barrier/challenge to the
eradication of lymphatic filariasis? Why?
A lack of funding. Gates fundation has been one of major funders. They've
shifted a little bit in what they wanted to funded. Originally they wanted
to fund programs, but now want to fund technical innovations instead. In South
Pacific barrier is great distances, remote places. In Africa, it's competition
for other programs. Most fudning from public health is addressing TB, AIDS,
Malaria and other dieseases that actually kill people. As a result, diseases
that don't cause death but cause a lot of disability are neglected. Althugh
Merck donates free drugs, but the delivery drugs costs money, too.
2. What role do you think the United States should play in the campaign to
eradicate filariasis?
U.S. has played an important role so far. For many years, NIH and CDC has
been doing a lot of reserach on the basic biology and effect on immune system
of filiarisis. Technical assistence, research, Agency for iNternational Development
has committed treatment for elephantitis that will be put into programs in
Africa/India. I think U.S. can still play a much greater role by seeing the
huge impact and role that the "major donor" countries can play in
raising awareness of some of these more "neglected" diseases. The
World Bank has not really pushed these donor countries to do more either.
The U.S. can also provide moral leadership and say "eliminating some
of these diseases should be a priority for us." U.S. should also push
for more funding.
3. Compared to other types of filariasis, how prominent is lymphatic filariasis and why have all global efforts been targeted towards lymphatic? Is it worthwhile to also focus on other types of filariasis?
Part of problem you're facing is that filariasis is often used as a synonym for lymphatic filariasis. "Loa loa" and "river blindness" (onchocerciasis) and a bunch of other human filariasis that can also be categorized under "filariasis." But in terms of global distribution and amount of disability that it causes in other countries, lymphatic is much greater global health problem than the others. But a single intervention can be active against filariasis as well as intestinal worms because people in those places (like Africa) are oftentimes infected wtih both.
4. Sources indicate that eradication can be accomplished by the year 2020.
How realistic do you think this is?
I don't think it's going to happen by then, given the current status of funding
and attentiont that it has. I think technically, it's possible, but that it
may be more difficult than we initially thought. Actually it's "elimination
as a public health problem" by 2020, but ther is no proper definition
of what is a "public health problem." (the WHO never provided one).It's
more of a political statement and goal and a call to arms rather than something
that can be realistically accomplished. On the other hand, I don't think it's
wrong either to set a date, if only to get people to move in the right direction.
5. What can students such as ourselves do to help with this campaign?
Raising awareness is really important. I think
it's great that you're studying about this. Even if your exposure to this
material from your class interests you in public health or tropical medicine,
I think that's relaly wonderful. this field really needs more young people.
I think the website is a great idea, because very few people have even heard
of this disease. I wonder if even within stanford there is a way to raise
more awareness about it...STanford is a very influential community with a
lot of resources, research money, etc.
6. How do you instill confidence in mass drug treatment programs (such
as in India), where the public distrusts government authorities?
That's a BIG challenge and really the crux of the problem. There are people
to this day who believe putting fluoride or iodine in your water is a communist
plot. And there are people against vaccinations as well. Mass treatment programs
against lymphatic filiarisis is in some ways similar to those. In many countries
you may get 40-60% of people taking the drugs every year, but the same 30-40%
of people are also not taking the drugs every year, and these people can serve
as a reservoir for the disease. we need to find out more about these people,
why is it that they aren't taking the drugs, and what to do about it.
But it does really boil down to trust. The coverage is much lower when the relationship between the distributors and thos receiving the meds is not good. It's important to work very carefully with the communities, really listening to them and responding to their concerns is the best thing to do.
