Perspective of Tropical Diseases Symposium

Rationale

The Symposium was part of the 6th International Advisory Broad (IAB) meeting. It was held on February 14th , 2003 at the Siam City Hotel, Bangkok , Thailand. Fifty-five participants attended the symposium included experts in Tropical Diseases whom brought out a discussion forums on recent advances in the field. Significantly, the symposium served as a means to update any knowledge through interactions with local investigators. In addition, presentations by T-2 grantees on dengue, malaria, tuberculosis and helminthes infections was delivered this was an extraordinary opportunity for researchers to interact and set up valuable collaborations. More importantly, the knowledge, ideas and concepts that was gained via the symposium will certainly help the IAB members to facilitate their decision making in identifying the future direction of the T-2 Programme.

Summary of Keynote Lectures

The Drugs for Neglected Drseases Initiative (DNDi)
Lecturer: Prof. James Orbinski

As an introduction, he emphasized on the creation of new initiatives and focused on developing new drugs, diagnostics, and new vaccines for neglected diseases. Importantly, there should be establishments of clear collaborations with various organizations, including T-2, in order to move forward together in the pursuit of drug diagnostics and vaccines for neglected diseases. He elaborated on the history, objectives, operating systems, issues, and activities of the "Doctors Without Borders" organization or also known as MSF (Medicins Sans Frontiers). It is an emergency relief organization that deals with direct prevision of emergency medical humanitarian assistance especially in war Zones, epidemics, and places facing famine or long-term health crisis around the world. It is politically and operationally independent because the major funding comes from private citizens donations from all over the world. This contribution is a result from public demand and responsibility. Citizens and patients themselves in order to governmental response.

Dr. Orbinski's lecture basically emphasizes on the answers to the following questions:
- What are neglected diseases?
- Why is MSF interested in it?
- What is the origin of the drug for neglected diseases division?
- Who are the founding partners of DNDi?
- How do DNDi achieve its goals and obtain funds to cover its costs over 10 years?

The discussion for Dr. Orbinski's lecture include questions concerning how MSF and DNDi achieve its objectives in providing easier access to medical treatments for most poor people in developing countries.

It was also informed by Dr. Orbinski and Professor Dyann Wirth that there are calls for short, medium, and long term research projects that focuses on Leishmaniasis, African sleeping sickness, Chagas disease and so on. The DNDi would also fund some projects that Thai researchers would be proposing. Significant amounts of resources are available and the proposals will be reviewed be external panel independent of DNDi.

Future of Antimalarial Chemotherapy
Lecturer: Prof. N. J. White

The main objectives of this lecture include discussion on the attempts to control malaria, treatment to uncomplicated as well as severe malaria, and the 'rollback malaria initiative'.
A reasonably high percentage of child mortality is caused by malaria. Antimalarial resistance is perhaps the main cause of this mortality rate, especially in African. There are two approaches to malaria control: to attack the mosquito and to attack the parasite. Two major effective weapons discovered 50 years ago are DDT and chloroquine. Professor White stressed that insecticides and environmental management are equally important. When bed nets were deployed, the mortality rate decreased by 60%. However, the implementation and uptake of this 'effective tool' is poor although it has been promoted.

There is a serious concern in most countries that have national recommendation for malaria treatment. These drugs are either partially or completely ineffective. Resistance has eaten into most of the drugs' efficacy, including antifols and chloroquine that was once considered the most effective drug. Due to extreme poverty in certain countries, these 'failing drugs' continued to be use sinces newer and effective drugs are unaffordable. The only efficient way to 'rollback malaria' is to provide patients with effective drug treatment or have the government and organization to help them to afford the drugs.

It was addressed that it takes a very long time to develop antimalarial drugs. Thus, drugs are identified. There is much interest in the modification of existing drugs and the combination of more than one compound.
Concerning the development of new antimalarial drugs, Professor White stressed on the need for a drug that allows short course treatment but not rapidly eliminated to delay the emergence of resistances. In order to delay the emergence of resistance and preserve effective drugs, combination therapy is the solution. The co-formulation of artesunate amodiaquine and artesunate mafloquine is an example of combinational therapy used to obtain good cure rates in malarial patients. Artesunate derivatives are also found to be effective in reducing mortality of severe malaria and have no resistance.

Aside from aspects of manufacture, pricing, and making the prescribed regimen understanable, there must be surveillance for drug resistance and drug quality. Since there is an epidemic of fake drugs, there is a necessity to ensure quality assured antimalarial drugs. These 'fake drugs' are well developed because they are largely employed by international pharmaceutical industry to protect the products. This is a serious issues and such an act should be criminalized.

Furthermore, the manufacture of drugs in countries like China, are not in GMP facilities. The manufacturing process is so easy while there is no manufacturing patent on the drugs possible. Drugs like pyronaridine, lumefantrine, and piperaquine have non-GLP standard toxicity evaluation and induce certain symptoms. The stability test has also been done but not done with GLP assay. However, GMP in China will be unified in year 2005. All factories that don't conform to international GMP will be closed down.
Professor White further explained some of the perspectives of MMV toward artemisinin combination therapy. There is a need to engage big pharmas that are interested in initiatives but cannot direct. Thus, it is important to have a transparent strategic process of developing strategy and in deciding on priorities.

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