Presidential address to the Royal Society of Tropical Medicine and Hygiene
Hi there. Rhona here. Sorry for ther lengthy delay between blog entries. I was carted off to hospital at the weekend which I was not quite expecting and am just catching up with everything now. So will leave it to Lizzie Moore, a medical student from Sheffield to tell you about a stimulating lecture by Professor David Molyneux who gave the presidential address at The Royal Society of Tropical Medicine and Hygiene last week. More later. Rhona 
Last week, Professor David Molyneux made a fascinating and inspiring address as President of Royal Society of Tropical Medicine. The theme was the ‘other diseases’ in MDG 6, and how combating these is a route to poverty reduction. There is a growing body of evidence that goals such as ‘eradicate extreme poverty and hunger’ will not be met until the problems faced by ‘the bottom billion’ are solved.
The talk started with an awesome introduction to Professor Molyneux’s numerous national and international positions, awards and achievements in research. Professor Molyneux then took us on an excellent journey through the history, politics, epidemiology, economics and anthropology of Neglected Diseases. We saw a fabulous depiction of aliens looking upon earth and seeing the world prioritising only the afflictions of HIV/AIDS, Malaria and TB, blind to the Neglected Diseases affecting the poorest and most vulnerable in developing countries, powerless in political voice.
The combined cost of these diseases in DALYs is more than half of that of HIV/AIDS and greater than Malaria. In contrast, Neglected diseases receive a fraction of the funding, despite the fact that their treatment or prevention is predominantly easy and highly cost effective. Given an overlap in geographical distribution, control could also be highly effective in the fight against ‘The Big Three’.
He highlighted success stories of vertical programmes such as the Schistosomiasis Control Initiative. These receive little attention, but have eliminated certain parasitic infections in communities. There is also increasing awareness of the importance of health systems (”Where there are no roads…”), and several major public private partnerships are dedicated to eradication of specific neglected diseases in sub-Saharan Africa. Pharma is playing a role, for example the donation of Albendazole for the treatment of Lymphatic Filariasis by GlaxoSmithKline indefinitely. Although their committment to access to medicines is doubtful given the industry’s recent legal challenges to extend patent monopolies.
One of the main messages was of the efficacy of integrated control initiatives and mass drug administration at low cost (e.g. $0.07 per tablet of Praziquantel for Schistosomiasis). Treatment overlap means that the use of preventative chemotherapy with 4 drugs, ($0.40 per person per year) could control 7 major neglected diseases (compared to near $1000 for HIV/AIDS). Control initiatives are so successful partly because they do not rely on well developed infrastructures, drug delivery can be conducted in the community, following cheap to transport even to landlocked countries, and results are seen very quickly which encourages participation.
Vector control is also extremely effective. Tsetse fly trapping to control Trypanosomiasis was given as an example of a simple measure which near eliminates the vector, compared to the complex, risky and costly process of introducing sterile male flies. rofessor Molyneux argued that we do not need these new expensive technologies, instead we just need proper implementation and funding of existing solutions.
We were also shown a graph of growing trends in bed-net use by pregnant women in sub-Saharan Africa. This looked promising at first glace, yet at closer look, the range spanned only to 35%, and the proportion of untreated nets was high. On the other hand, we still face severe obstacles - mainly for diseases which rely on case finding, e.g. Buruli Ulcer, and others for which treatment is outdated, ineffective, difficult to deliver and downright dangerous. The treatment for Trypanosomiasis for example, is fatal in 5%. This is where the R&D gap is most poignant.
What I found most thought provoking was his breakdown of the 10% of research towards 90% of global disease burden: When practicalities of application are considered, the 90/10 gap becomes more like 99/1. Only 1% of global research was really going on useful, implementable R+D for diseases of the poor. This made me consider the importance of careful policy making in the use of technology and basic scientific research. For example, we know a huge amount about the biology and genetic makeup of vectors such as the Tsetse fly, yet this knowledge is essentially useless until we implement it to actually making a change. This reminded me of UAEM’s vision, that research successes should not be measured financially, but according to impact on global health .
Professor Molyneux also touched on the rate of change in the world of global health. From the emergence of public private partnerships, the work of the Global Fund and initiatives such as Roll Back Malaria, to the growing interest from students and junior doctors.
In conclusion, initiatives need to focus on working in partnership, with an increase in horizontal rather than vertical programmes. Policy makers need to account for associations between the Big Three and Other Diseases, and that more funding needs to go to relevant and applicable research. Professor Molyneux certainly made me think differently about the role of multinational aid agencies, and I’m definitely going to make a few purchases as well (The Bottom Billion by Paul Collier and The White Man’s Burden by William Russell Easterly, to name a couple!) Lizzie Moore, Sheffield
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