Paying attention to neglected diseases.

Tropical diseases are drug development's poorest relations. Until recently, these diseases have been so ignored that "people even refer to them as neglected neglected diseases," says Charles Gardner, associate director for health equity with the Rockefeller Foundation, which funds a number of initiatives focused on diseases of the poor. In July 2003, a new international collaboration was launched to reinvigorate research and development on treatments for tropical diseases.

The Drugs for Neglected Diseases Initiative (DNDi) was spearheaded by the volunteer medical group Medecins Sans Frontieres (MSF) and five other partners: France's Institut Pasteur, the Malaysian Ministry of Health, Brazil's Oswaldo Cruz Foundation, the Kenya Medical Research Institute, and the Indian Council of Medical Research. The nonprofit initiative was designed to revitalize drug development as a public responsibility rather than a strictly market-driven enterprise.

Governments and the pharmaceutical industry are pitching in, with some already providing money (the European Union) and expertise (Merck & Company and Novartis Pharmaceuticals). DNDi's operations, headquartered in Geneva, will be distributed throughout the developing and developed world, with the goal of supporting a budding collaboration on health care research and application between developed and developing nations.

DNDi is in the process of building a portfolio that will contain a balanced mix of short-, medium-, and long-term projects targeting neglected diseases. DNDi's initial drug development efforts are aimed at chloroquine-resistant malaria, human African trypanosomiasis (sleeping sickness), visceral leishmaniasis (also called kala-azar), and Chagas disease. According to the World Health Organization, malaria affects more than one-third of the world's population and kills more than 1 million children each year. Sleeping sickness afflicts half a million people and threatens more than 60 million in sub-Saharan Africa. Worldwide, about 12 million people suffer from visceral leishmaniasis, and 200 million are at risk of contracting it. Chagas disease afflicts an estimated 18 million in Latin America and threatens about a quarter of the region's population. All of these diseases are transmitted by biting insects. Chagas disease is also transmitted congenitally and through transfusion with infected blood.

Tropical diseases can be very difficult to treat, says Martin John Rogers, a program officer with the Parasitology and International Programs Branch of the National Institute of Allergy and Infectious Diseases, because of the disease progression within human beings. Initial symptoms are often nonexistent, minor, or nonspecific, and by the onset of severe symptoms--sometimes decades after infection--the disease is so far advanced that treatment is either futile or possibly fatal in itself. Moreover, drug delivery techniques and treatment regimens are often impractical in rural and/or impoverished areas, and patients may need to travel great distances, leaving their families and lands untended, to reach the nearest health center. DNDi hopes to investigate and develop less toxic, more effective, and more practical treatments adapted to patient needs.

The global burden of neglected diseases has increased, some say, because pharmaceutical companies are loath to spend money on unprofitable drugs. Furthermore, the first wave of tropical medicine was driven by the self-interest of colonial powers, according to Mohammed Hassar, director of the Institut Pasteur du Maroc in Casablanca. "The health of soldiers, the colonists, and the local population was vital for the success of the colonization," Hassar says. But when colonial powers withdrew, they also took their money, medical expertise, and concern about local conditions. In the post-colonial world, the countries where neglected diseases have made a comeback must pick up the slack. "I believe DNDi is a good start," says Hassar.

Early reactions from researchers are encouraging. By July 2003, when DNDi was established as a foundation, it had received 71 project proposals from its first call for letters of interest from the scientific community. Early next year, work will commence on selected projects. Says DNDi spokesperson Jaya Banerji, "The organization is still in the process of building its portfolio of drug research and development projects and will soon be issuing a second call for proposals aimed at its target diseases." The success of these projects depends on the collaboration of scientists across the world and will enable DNDi to achieve its vision of improving the quality of life and health of people suffering from diseases neglected diseases in poorer countries.