October 1, 1998
When the World Health Organization (WHO) needed a specialist to help it distribute a drug donated by a giant pharmaceutical company to eliminate a debilitating tropical disease, it called on Barnett Cline to help. Cline, professor of tropical medicine in the School of Public Health and Tropical Medicine, recently became a member of a WHO review group that will advise the organization on how to administer and manage a global program to eliminate lymphatic filariasis.
The program was formed in response to SmithKline Beecham's donation of albendazole, a drug known to be effective in treating lymphatic filariasis. This parasitic disease causes elephantiasis, a dramatic swelling of limbs and other body parts, and currently affects more than 120 million people in 73 countries.
One-third of the people infected with the disease live in India, one-third live in Africa and the remainder reside in Southeast Asia, the Pacific and in the Americas. About one billion people are at risk of infection. The nature of lymphatic filariasis poses interesting challenges to administering the program, Cline says.
"Most of the people infected with filariasis have asymptomatic infections. They don't know they're infected," Cline says. "One of the challenges of this program is health education. The challenge is to motivate people to get treated for something they don't know they have."
Even infected individuals with an asymptomatic form of the disease can pass it on to others, Cline says. Tiny, thread-like worms cause lymphatic filariasis when they lodge in the lymphatic system, the network of nodes and vessels that maintain the delicate fluid balance between the tissues and blood and are an essential component of the immune system.
Mosquitoes transmit the disease when they bite infected humans, pick up the minute worm larvae that circulate in the blood and then bite another individual.
"The idea here is to treat a large portion of the population with the drug, which has two benefits," Cline says. "One is to cure or reduce the infection and the other is to reduce transmission so that there will be fewer or no new cases over time. Another important benefit is that albendazole kills virtually all common worms including intestinal worms."
The drug regimen needed to interrupt the parasite's life cycle in all people in infected areas--one dose yearly for about five years--may require more than one billion doses of albendazole. WHO estimates that it will take approximately 20 years to eliminate the disease.
Cline, who has more than 30 years of experience in the control of tropical diseases, says drug donation programs benefit the pharmaceutical corporations, too.
"It has long been recognized in the pharmaceutical industry that drugs for so-called tropical diseases are rarely profitable in the tropics," Cline says. "Corporations recognize that to give the drug away to people who can't afford it is a good idea. It presents an image of a corporation who cares."
Cline and the four other members of the WHO review group are currently devising an application process for countries that will participate in the program.
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