WHO-based tropical disease research programme to focus on emerging diseases

The World Health Organization (WHO) based Special Programme for Research and Training in Tropical Diseases (TDR) has adopted a new strategy for strengthening and expanding research to prevent and control 'infectious diseases of poverty.'

The strategy builds on the programme’s 30-year record of developing new drugs, delivery strategies and enhancing research capacity in countries where parasitic tropical diseases are endemic. The new plan addresses some of the emerging disease challenges facing developing countries, such as TB-HIV co-infection.

Over the coming decade, TDR will focus on addressing key bottlenecks in getting health care treatments to poor and remote populations, and fostering research and policy leadership in countries where these diseases create significant health problems.

"If we want better health to work as a poverty reduction strategy, we must reach the poor. This is the acid test, and this is where we are failing," said WHO Director General Dr Margaret Chan, speaking Tuesday at the opening session of the TDR Joint Coordinating Board. "I am very glad to see TDR move into this new territory."

The Board on Thursday approved the new ten-year strategy and vision. The Board includes the four TDR cosponsors - UNDP, UNICEF, the World Bank and WHO - as well as 30 representatives of governments of developed and developing countries. The vision calls on TDR, one of the major UN-based programmes dedicated to health research in the developing world, to "foster an effective global research effort on infectious disease of poverty in which disease endemic countries play a pivotal role."

Over the past three decades, TDR has sponsored research that paved the way for the control of leprosy, onchocerciasis (river blindness), Chagas disease, lymphatic filariasis and visceral leishmaniasis. These five neglected tropical diseases, which previously killed or disabled millions of people every year, are now targeted for global or regional elimination, "largely as a result of tools and strategies developed through TDR-coordinated activities," noted Dr Chan.

TDR also initiated and sponsored the first large-scale field trials of insecticide-impregnated bednets in the mid 1990s, demonstrating their life-saving value in malaria control.

Under the new strategy, TDR's field research experience and networks will be harnessed to address one of the biggest challenges faced by the global health community: access to primary health treatments for poor people. Implementation research -- that is, research to investigate how best to use health tools and drugs more effectively in communities and health systems -- has traditionally been a key element in TDR's work.

In the mid-1990s, for instance, TDR created a model for community-directed treatment with ivermectin for onchocerciasis that causes river blindness. This delivery system has become the backbone for control strategies in remote, rural African communities where there are no doctors or healthcare centres. Community-directed treatment systems now cover some 60 million Africans, nearly one-sixth of the continent’s population. The onchocerciasis control effort has been described as "one of the most triumphant public health campaigns ever waged in the developing world" (UNESCO, 2005).

Now, TDR is supporting African scientists to explore how community-directed systems could be used to deliver other essential primary health care interventions that are still underutilized -- such as insecticide-treated bednets, home-based malaria treatment, TB diagnosis and treatment, and Vitamin A supplements.

"TDR-supported research has made a difference because of a long-term commitment from countries and donors to research as a critical factor in disease control," said Dr Robert Ridley, Director of TDR. "Together with experts around the world, particularly those from disease-endemic countries, we identify key disease control problems or gaps that research needs to address. We sponsor that research in partnerships, leading to evidence-based solutions that can be taken up by health ministries, global health agencies and disease-control officials."

Research on how to implement is critical to WHO's broader goal of improving access to critical health-saving medications and tools. "TDR's experience offers some of the best models for doing that -- and in the long term, investment in that kind of research saves time and money," said new JCB chairman Dr Rolf Korte.

Moving beyond expert-only arenas, the new strategy will involve broad-based groupings of stakeholders to evaluate and propose new research directions for particular diseases and thematic areas. A new web-based knowledge management platform, TropIKA.net, is being developed with several partners, along with a new publications series on trends and developments in tropical diseases.

Examples of other new activities include research to define how and when treatment should begin for people with TB/HIV co-infections, and developing and identifying reliable, rapid diagnostic tests for diseases such as TB and syphilis, particularly for use in remote communities.

TDR also is establishing and expanding broad networks of drug discovery with public and industry partners to accelerate the screening and identification of potential new and innovative drug leads for diseases such as malaria, which receive insufficient focus from private sector R&D.

The former WHO Director-General Dr Halfdan Mahler, who helped lead the creation of the programme in the 1970s, said: "As WHO prepares to write the history of its first 60 years, any chapter on tropical diseases would highlight the immense contribution of TDR to WHO's control strategies."