The London Declaration on NTDs

Partnership objectives

To eradicate, eliminate, or control 10 NTDs by 2020, including:

  1. Eradicating Guinea worm disease by 2020.
  2. Eliminating lymphatic filariasis, leprosy, sleeping sickness (human African trypanosomiasis) and blinding trachoma by 2020.
  3. Controling schistosomiasis, soil-transmitted helminthes, Chagas disease, visceral leishmaniasis and river blindness (onchocerciasis) by 2020.

By providing access to existing drugs and accelerating development of new treatments, millions of people can have a better opportunity to succeed in school and lead a more socially and economically productive lives. By providing access to existing drugs and accelerating development of new treatments, millions of people can have a better opportunity to succeed in school and lead a more socially and economically productive lives. Copyright GlaxoSmithKline

What are the health needs and challenges?

Neglected Tropical Diseases (NTDs) are a group of 17 diseases that disproportionally impact those living in poverty. More than 1.4 billion people worldwide are affected by NTDs, including more than 500 million children. The opportunity exists to help millions of people avoid significant debilitation and disability, including malnutrition, disfigurement and social discrimination.

Description of partnership activities and how they address needs and challenges

Many NTDs can be controlled through existing, affordable interventions and tremendous progress has been made in recent years.

Consistent with the London Declaration on Neglected Tropical Diseases (January 2012), the public and private partners will seek by 2020 to help eradicate Guinea worm disease, help eliminate lymphatic filariasis (elephantiasis), leprosy, sleeping sickness (human African trypanosomiasis) and blinding trachoma and river blindness (in Latin America, Yemen and selected countries in Africa), and help control schistosomiasis, soil-transmitted helminthes, Chagas disease (American trypanosomiasis) and visceral leishmaniasis.

To achieve this, original endorsers of the London Declaration, including twelve pharmaceutical companies, the World Health Organization, governments of the United States and United Kingdom, Drugs for Neglected Diseases Initiative, the Bill and Melinda Gates Foundation and the World Bank, among others, work cooperatively to sustain or expand existing drug donation programs to meet demand through 2020. These partners share their expertise and compounds to accelerate research and development of new drugs and provide more than USD 785 million to support R&D efforts and strengthen drug distribution and implementation programs.

The partners also seek to advance R&D for many of these diseases through partnerships and by providing funding to find next-generation treatments and interventions for neglected tropical diseases (NTDs). They enhance collaboration and coordination on NTDs at national and international levels through public and private multilateral organizations to work more efficiently and effectively together. Partners ensure endemic countries have the funding necessary to implement NTD programs that will help achieve these goals, supported by strong and committed health systems at the national level.

These are the five big commitments made in the London Declaration:

  1. Sustain, expand and extend programs that ensure the necessary supply of drugs and other interventions to help eradicate some diseases and to help control others by 2020.
  2. Advance R&D through partnerships and provision of funding to find next-generation treatments and interventions for neglected diseases.
  3. Enhance collaboration and coordination on NTDs at national and international levels through public and private multilateral organizations.
  4. Enable adequate funding with endemic countries to implement NTD programs necessary to achieve these goals, supported by strong and committed health systems at the national level.
  5. Provide technical support, tools and resources to support NTD-endemic countries to evaluate and monitor programs.

By providing access to existing drugs and accelerating development of new treatments, millions of people can have a better opportunity to succeed in school and lead a more socially and economically productive lives.

The partners provide regular updates about their progress in reaching the 2020 goals and identify remaining gaps.

Summary of impact and forward looking information

In 2015, pharmaceutical companies donated an estimated 2.4 billion tablets, enough for 1.5 billion treatments to prevent and treat NTDs – an increase of 11.7% from 2014. An unprecedented 1.1 billion treatments were delivered to 858 million individuals in 2014. Between 2012 and 2014, the number of people who needed treatment decreased by 230 million. Since the London Declaration, there have been over 7.9 billion tablets in pharma donations, which is enough for 5 billion treatments.

Thus, one of the largest public health programs in the world owes its success to a drug donation program on a truly global scale. The generous contributions of pharmaceutical partners ensure that preventive chemotherapy programs for NTDs are highly cost-effective, ranking them as one of the best buys in global development.

Furthermore, the number of people who needed treatment for lymphatic filariasis (LF) decreased by 230 million between 2012 and 2014. Thanks to the Global Trachoma Mapping Project (GTMP) there have been examinations of over 2.6 million people in 29 countries, representing a total of 224 million people. 18 of 73 countries endemic for LF and 8 of 58 countries endemic for trachoma have stopped mass drug administration (MDA) and are under post-MDA surveillance; an additional 22 countries are on track to achieve elimination of LF as a public health problem by 2020. Four of six endemic countries in the Americas have met the 2015 target of elimination of onchocerciasis, the disease remaining only in hard-to-reach Yanomami communities on the border between Brazil and Venezuela. The program in Africa is the only program to successfully achieve its coverage target.

Merck doubled its donation from 100 million tablets in 2015 to 200 million in 2016. To date, more than 100 million patients have been treated, consisting primarily of children. Merck and Astellas are part of a public-private partnership to help develop an effective pediatric formulation of praziquantel to treat children under six years old, an age group which accounts for around 10% of the global population infected or at risk for schistosomiasis.

Through participation in the London Declaration Bristol-Myers Squibb extended the reach of its R&D efforts into NTDs, providing access to proprietary compound libraries to third parties, including Drugs for Neglected Diseases initiative (DNDi), to help develop potential new medicines for targeted NTDs. BMS further extended its collaboration with DNDi on Chagas and Leishmaniasis and to identify potential clinical stage compounds with activity against helminthes. Furthermore, at the Institut Pasteur Korea, thousands of compounds from the Bristol-Myers Squibb library were screened and over 100 compounds were identified with potential activity against Chagas Disease and Visceral Leishmaniasis. Initial screening at the University of Dundee identified 119 compounds with potential activity against Visceral Leishmaniasis.

In 2014 Bayer and the Drugs for Neglected Diseases initiative (DNDi) started a product development partnership on the active ingredient emodepside to develop a new oral drug to treat river blindness. Emodepside originates from the Japanese pharmaceutical company Astellas and has been developed by Bayer’s Animal Health division for veterinary use. The compound has been found to be effective in killing adult worms in pre-clinical studies, thus showing potential as a new ‘macrofilaricidal’ drug for the treatment of patients with river blindness. A current Bayer study  on the compound nifurtimox is to develop an appropriate, weight-adjusted dosing for newborn babies and children. The study, which involves pediatric patients including newborn babies, also aims to provide evidence for a shorter treatment duration. 

Sanofi contributes to the fight against neglected tropical diseases, particularly within the scope of a long-term partnership with the WHO. Launched in 2001 with a program focused on sleeping sickness, their partnership was extended to include Leishmaniasis, Buruli ulcer, yaws and Chagas disease. Since then, over 27 million people living in endemic areas in sub-Saharna Africa have been screened for sleeping sickness, and more than 175,000 people have received free treatment.  In partnership with the Drugs for Neglected Diseases initiative (DNDi), Sanofi is working to develop a new oral treatment and Novartis is engaged in drug discovery to identify improved oral treatment that could support disease elimination efforts.

Bayer develops a new formulation of nifurtimox to allow weight-adjusted doses in children of all age groups suffering from Chagas disease. The study in pediatric patients including newborn babies also aims to provide evidence for shorter treatment duration.

Donated drugs from Pharma companies are essential to achieving the goals of control and elimination of Neglected Tropical Diseases (NTDs). GlaxoSmithKline and Johnson & Johnson founded the NTD Supply Chain Forum (NTDSCF) in October 2012 with the goal of identifying and addressing impediments to NTD drug delivery. The Forum’s over-arching purpose is to streamline and coordinate the provision of donated drugs/supplies for country NTD programs. It is an excellent example of collaboration between companies, the WHO and the Gates Foundation in support of commitments made as part of the London Declaration.

The NTDSCF was initiated by a coalition of NTD drug supply chain partners led by GSK, and currently includes Eisai, Janssen Pharmaceutical Companies of Johnson & Johnson, Pfizer, MSD*, Merck, Sanofi, WHO, the Bill & Melinda Gates Foundation, as well as freight forwarder DHL and supporting NGOs (Children Without Worms, International Trachoma Initiative, Mectizan Donation Program and RTI International).

The Forum initially focused on delivery of NTD drugs from the manufacturer to the endemic countries (the ‘First Mile’) primarily focused on the preventative chemotherapy diseases that rely on MDA where drugs are frequently co-administered. More recently, it expanded its remit to assess possible in-country supply chain management and distribution areas where further support may be required (the ‘Last Mile’).

 

*MSD is known as Merck & Co. within the US and Canada

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Partnership information

Company(ies) AbbVie , Bayer , Bristol-Myers Squibb , Eisai , GlaxoSmithKline , Johnson & Johnson , Merck , MSD , Novartis , Pfizer , Sanofi

Partner(s) BD (Becton Dickinson), Bill and Melinda Gates Foundation, CIFF, Drugs for Neglected Diseases initiative (DNDi), Gilead Sciences, Global Pharmaceutical Relief, Lions Club International, Mundo Sano, UK Department for International Development (DFID), US Agency for International Development (USAID), World Bank, World Health Organization (WHO)

Type of Partner(s) Government, IGOs, NGOs, Other Business, PDPs

Therapeutic Focus Neglected Tropical Diseases

Disease(s) Buruli Ulcer, Chagas Disease, Dengue, Dracunculiasis (Guinea Worm), Human African Trypanosomiasis (Sleeping Sickness), Leishmaniasis, Leprosy, Lymphatic Filariasis, Onchocerciasis (River Blindness), Schistosomiasis, Soil-Transmitted Helminthiasis, Trachoma

Program Type(s) Availability of Treatment - Technology Transfer - Scientific Collaboration and Knowledge Sharing, Health System Infrastructure - Development of Physical Infrastructure, Health System Infrastructure - Training, Prevention Programs - Awareness & Outreach, Prevention Programs - Mass Drug Administrations (MDA), Research & Development - Development of Treatments, Research & Development - Innovative Funding Mechanisms, Research & Development - Pediatric R&D

Targeted Population(s) Children, Marginalised / Indigenous People, Patients in needs of treatment, People with low income, Youth

Region(s) East Asia & Pacific, Latin America & Caribbean, Middle East & North Africa, South Asia, Sub-Saharan Africa

Number of Countries 82

Country(ies) Algeria, Angola, Argentina, Bangladesh, Benin, Bolivia, Botswana, Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, Cape Verde, Central African Republic, Chad, Chile, China, Colombia, Comoros, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Djibouti, Dominican Republic, Ecuador, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Ghana, Guinea, Guinea-Bissau, Guyana, Haiti, Indonesia, Kenya, Lao PDR, Lesotho, Liberia, Libya, Madagascar, Malawi, Malaysia, Mali, Mauritania, Mauritius, Morocco, Mozambique, Myanmar, Namibia, Nepal, Niger, Nigeria, Papua New Guinea, Paraguay, Peru, Philippines, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sri Lanka, Sudan, Suriname, Swaziland, Tanzania, Thailand, The Gambia, Timor-Leste, Togo, Tunisia, Uganda, Uruguay, Venezuela, Vietnam, Zambia, Zimbabwe

Start Date 2012

More information Uniting to Combat NTDs website

Anticipated completion date 2020