Sleeping sickness, river blindness… Despite their world day, January 30, NTDs are of little interest to research. However, in the DRC, scientists are developing revolutionary treatments once morest these forgotten infections. Remarkable work, carried out in harsh conditions, which might serve as a model for the whole continent.
© Neil Brandvold-DNDi
A member of a mobile team from the NGO DNDi testing for sleeping sickness in the remote village of Yalikombo.
Few countries have been as stricken by neglected diseases as the Democratic Republic of the Congo. From the deadly waves of sleeping sickness that claimed hundreds of thousands of lives in the early 20th century, to river blindness that still blinds thousands today, the country continues to pay a heavy price for these conditions for which diagnostics, vaccines or treatments often do not exist, or are not suitable – hence their name neglected tropical diseases (NTDs).
During the colonial period, uncontrolled exploitation of the territory contributed to the spread of devastating infections. Today, the establishment of national NTD control programs remains a colossal task, complicated by the immense size of the country, the difficulties of access to certain regions, the fragility of the health system and periods of instability. recurring.
Until two decades ago, the only available treatment for sleeping sickness was injections of an arsenic derivative that killed one in twenty patients.
Sleeping sickness perfectly illustrates this long history of neglected diseases in DR Congo. Also called human African trypanosomiasis (HAT), this dreadful disease is transmitted by a bite from a tsetse fly and causes serious neurological damage, before causing death.
Despite several appalling waves during the 20th century, fueled by colonial exploitation, conflicts and the displacement of populations, very little medical research had been carried out: until two decades ago, the only treatment available consisted of injections of an arsenic derivative that killed one in twenty patients. But the extraordinary determination of researchers and health personnel in the field has made it possible to change everything.
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Pills accessible to all patients
It all started in 2003, when Congolese scientists, in partnership with the initiative Drugs for Neglected Diseases (DNDi) – a medical research NGO – set up a series of clinical trials – also conducted in Guinea and the Central African Republic – which led to the development of revolutionary drugs once morest HAT. First the NECT formulations, in 2009, followed, in 2019, by fexinidazole, a tablet capable of curing all patients in ten days, including those with an advanced stage of the disease.
With the means at hand and limited resources, the country’s scientists have managed to set up clinical trials that meet the strictest international standards.
These simple pills are now accessible to all patients in the region, whether in the Central African Republic, the Republic of Congo, Guinea, Chad and elsewhere.
And researchers are now working on a drug called “acoziborole”: a single dose of this tablet, which is easy to transport and distribute, will be enough to cure patients, especially in the most difficult-to-reach villages. For the first time in its history, the DRC can envisage the pure and simple elimination of the disease. Even better: through these efforts, the country has proven to be a formidable leader in innovation and medical research.
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In a regular context of crisis, with the means at hand and limited resources, in remote areas, villages accessible only by boat or at the end of rutted tracks, its scientists have succeeded in setting up clinical trials that meet international standards. the strictest. Trials comparable in all respects to those conducted in high-income countries. Last year, fexinidazole was registered by the American drug agency, the FDA.
Onchorcerciasis, 217 million people at risk in Africa
These Congolese researchers, doctors and laboratory technicians have thus developed valuable skills, which have made it possible to develop clinical practices adapted to their environment and which have saved countless lives. And they continue to do so.
Their experience is now being used in the context of clinical trials aimed at developing drugs once morest onchorcerciasis. Also called “river blindness”, this neglected disease is caused by worms, parasites that are transmitted by the bites of the black fly that lives along waterways. These parasites reproduce in the body of infected people, causing terrible itching and severe skin lesions, before causing blindness.
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It may be the second leading cause of infectious blindness in the world, yet there is still no drug capable of killing adult worms. The only existing response consists of massive distributions of ivermectin, a drug that only kills juvenile worms, and which must therefore be administered frequently, through massive prevention campaigns. A treatment capable of curing patients already infected is therefore urgent, and the clinical trials that have started in the DRC are a great reason for hope for the 217 million people at risk on the African continent. One of the sites where these trials are taking place was originally set up for studies on sleeping sickness.
Medical Innovation Lab
As the summit of African Heads of State in Kigali, which is scheduled for this year and which will focus on neglected diseases, approaches, the Congolese example might serve as a model for other countries on the continent, which are also struggling with these problems. The key to local success? Partnerships. DRC scientists did not work alone. They have forged close relationships with doctors from other countries, donors, industrialists and international organizations. They also benefited from the strong support of their government. And have established a large regional network of researchers – it is moreover this network which has made it possible to set up Anticov, the largest clinical trial in Africa to identify early treatments for Covid-19.
There is urgency: 1.7 billion people worldwide are affected by neglected diseases, according to WHO
We want to learn from these experiences, so that the Democratic Republic of Congo can become a medical innovation laboratory for all NTDs on the continent. There is urgency: 1.7 billion people worldwide are affected by neglected diseases, according to the World Health Organization. These diseases disproportionately strike already poor communities, fueling a vicious cycle of poverty. Finding drugs once morest NTDs means participating in the economic and social well-being of an entire country.
The Democratic Republic of Congo must therefore continue on this path. It must show leadership and, in cooperation with its partners and neighbours, continue to put medical innovation at the heart of the solutions to the health challenges of the African continent.