Lack of new drugs for tropical disease should not be accepted

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7254.179/a (Published 15 July 2000) Cite this as: BMJ 2000;321:179
  1. Michael Schull, president, Médecins Sans Frontières/Doctors Without Borders (Canada) (mjs{at}ices.on.ca)
  1. Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Center, University of Toronto, Canada M4N 3M5

    EDITOR—In their overview of recent advances in the treatment of common tropical infections Murray et al note the dramatic resurgence of African trypanosomiasis, which claims tens of thousands of lives annually in sub-Saharan Africa.1 They also describe the toxicity and increasing resistance associated with current drug regimens.

    In their discussion of newer drugs to fight trypanosomiasis they remark that more effective drugs exist, though they are more costly and of limited availability. Instead of calling for increased availability of these agents, however, they conclude that “new drug development … is impossible for commercial reasons; priority should [therefore] be given to improving the use of old drugs.”

    Médecins Sans Frontières/Doctors Without Borders rejects this view. Instead of accepting the profit driven logic of modern pharmaceutical multinationals, doctors should be calling for the development of new drugs. One new drug, eflornithine—originally developed as an anticancer agent—has been shown to be effective against African trypanosomiasis, with far less toxicity than other drugs.2 It is the only effective agent against resistant trypanosomiasis, which has a prevalence of up to 20% in parts of Uganda.2 The pharmaceutical company that developed it, however, refuses to market it for commercial reasons.

    The pharmaceutical industry has done much in the fight against tropical disease,2 yet more recently it seems to have abandoned the battlefield. From 1975 to 1997 only 1% of new drugs put on the market were aimed specifically at tropical disease.2 Yet the scale of this public health emergency raises other questions: how long would Western governments stand by if drug companies refused to market a safe and effective treatment for a disease killing thousands of its citizens every year? Why are those governments now doing nothing while thousands of Africans die?

    Doctors have a long tradition of advocacy and action in the face of public health emergencies; we must not abandon this in the face of cold, profit driven “logic” and government inaction. Those who believe in an unfettered pharmaceutical free market must acknowledge that the only freedom it offers to those with ignored tropical diseases is the freedom to die without effective treatment.


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