Competition for multi-million pound grants to tackle debilitating parasitic diseases in the developing world means that serious concerns about whether current drug programmes actually work are being side-lined says Professor Tim Allen in a letter published in The Lancet.
Professor Allen, Professor in Development Anthropology, and Dr Melissa Parker, Director of CRIMA (Centre for Research in International Medical Anthropology) at Brunel University, write that mass drug administration programmes (MDAs) – such as those supported by the UK Government – are often designed without taking into account local political, economic and social issues.
Young mother bathes her infant on the shoreline of Lake Victoria unwittingly exposing her to parasitical infection. Credit: Russell Stothard
They explain that sending vital drugs for neglected tropical diseases (NTDs), such as bilharzia and elephantiasis, to countries that need them, does not necessarily mean that affected communities in Africa will actually be treated.
Their research in East Africa shows that current systems of distribution may work quite well in one village, but largely fail in the next. Re-infection of those treated is very likely.
Communicating with communities about the reasons for the mass drug programmes has not been made a priority. This allows rumours and local conspiracy theories which question the real purposes of free drug administration to flourish in some locations.
In 2008 there were protests in Tanzania by parents who were convinced that tablets that were being given out in schools for bilharzia had been sent to poison their children.
Professor Allen says: "There is a growing tendency for those promoting mass drug administration programmes to overlook evidence concerning how effective they really are.
"Responding to complex health problems requires a richly textured understanding of the lives of the people being targeted. We need a better approach that combines the expertise of scientists with social scientists.
"Closing off debate and critical analysis of what is actually happening on the ground is profoundly unhelpful. There is also a need to complement and support sustainable national systems."
Allen and Parker point out that large internationally funded drug distribution programmes can weaken already over-stretched health-care systems.
Dr Parker says: "For mass drug administration programmes to be more effective, there has to be flexibility in the system to move away from a 'one size, fits all' approach and to adapt to local realities. "
Professor Allen and Dr Parker also draw attention to medical research which indicates that the long term effects of mass treatment and the combinations of medication to treat multiple infections require much better surveillance and monitoring, particularly when given to already weak and malnourished people.
On January 21 2012 the UK Department for International Development announced that it was boosting its support to £245 million, a five-fold increase, for programmes to combat neglected tropical diseases (NTDs).
Professor Allen said: "Providing free and subsidised drugs creates a window of opportunity to make a massive difference. But the availability of tablets is not enough – dealing with these diseases will involve a number of factors, not least of which will be behavioural change."
Dr Parker adds: "We are obviously in favour of treating people for debilitating parasitic diseases. We are also not against mass drug administration programmes so long as they are implemented effectively and monitored appropriately. However, in their current form, they will not, as some are claiming, make poverty history."
Edwin Michael, Professor of Disease Epidemiology at the University of Notre Dame said: "Parasite management is complex and approaches that do not take account of this may lead to unforeseen 'surprises'. We don't know, for example, how parasites from one species will react when another species is removed from the system, or how the drugs used in NTD programmes might impact on allergies and autoimmune diseases in people or the effectiveness of routine vaccinations.
"A strong commitment to the development and use of statistically sound monitoring plans, tracking the effects of different management strategies on the ground, together with a multi-disciplinary biosocial approach to their design and assessment are fundamentally needed, if the promises of NTD control initiatives are to be met and sustained."
Around 800 million people suffer from neglected tropical diseases. These include elephantiasis (Lymphatic Filariasis) which causes extreme swelling of the limbs or other parts of the body and bilharzia (schistosomiasis) which can result in life-threatening damage to the urinary system and liver and bladder and bowel cancers.
LSE has today launched an online public lecture by Professor Allen called 'Parasites - enemy of the poor' where he discusses these issues and shows the devastating impact these diseases can have on people.
The lecture is the first of LSE's 'Burning Issues' lectures – a short series of interactive talks designed with a public audience in mind. Two lectures will follow with Professor Emily Jackson tackling the issue of assisting dying in the 'Right to Die' and Professor Conor Gearty asking what human rights are in 'The DNA of Human Rights'.
The Burning Issue Lectures are supported by the LSE Annual Fund and Cato Stonex.
Posted: Monday 30 January 2012