English - Global Alliance to Eliminate Lymphatic Filariasis

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REPORT OF THE 6 TH GAELF MEETING, JUNE 2010 Goals Scored: Health Impact Achieved Dr Eric Ottesen presented the results of an analysis of the health impact of the LF elimination programme during its first 8 years (2000-2007) [3]. The analysis includes health improvements directly related to reduced transmission of LF and those “beyond-LF.” The latter benefits, primarily resulting from the broad antiparasitic effectiveness of albendazole and ivermectin, include decreased intestinal worm infections in children; reduced hookworm-related disease in women of child-bearing age; and relief of debilitating skin diseases. Data for this assessment came from the scientific literature on mechanisms of disease and from existing data on drug efficacy, MDA coverage, and the age and gender distribution of populations in filariasisendemic countries. The results suggest that the LF elimination effort is having a huge impact, with some 16.1 million persons receiving direct LF benefits (6.6 million newborns protected and disease progression halted in 9.5 million). These benefits result in 32 million disability-adjusted life years (DALYs) averted. An estimated 146 million persons are estimated to have received “beyond- LF” benefits during the first 8 years of the programme, including 56.6 million children treated for intestinal worms, 44.5 million women of childbearing age treated for STHs, and 45 million persons receiving relief of debilitating skin diseases. Dr Ottesen noted the many challenges and opportunities that remain to better quantify the health benefits of LF elimination. Goals Scored: Economic Impact Mr Brian Chu reviewed the economic benefits of the first 8 years of the GPELF. These benefits are experienced by persons with LF infection, who are protected from progression of disease; by individuals in affected communities who are protected from acquiring infection (and subsequent disease); and by the public health systems in filariasis-endemic areas. The analysis is based on the direct and indirect costs averted as a result of preventing hydrocele, lymphoedema and ADL. Based on the available knowledge of these diseases and the health impact analysis presented by Dr Ottesen, the programme’s economic benefit to date is conservatively estimated at $24 billion. The analysis suggests that 78% of benefits are related to chronic disease, compared to 22% for acute disease, and that the vast majority of benefits ($20.2 billion) have been achieved in Asia (SEAR) [4]. Mr Chu cautioned that the “beyond-LF” benefits are hard to quantify, and therefore were not included in the model. If 100% of the at-risk population were covered under MDA, the model estimates that economic benefit would reach $55 billion. The largest economic gaps (economic benefits yet to be realized) are in the African region. In conclusion, Mr Chu noted that the GPELF is an excellent investment in global health, with impressive economic rates of return. The success of the GPELF, measured in economic terms, is a strong affirmation of the value of investing global health resources in targeting the NTDs. 24
REPORT OF THE 6 TH GAELF MEETING, JUNE 2010 Goals Scored: In Partnership Dr Adrian Hopkins, Director of the Mectizan Donation Program, spoke on the crucial role of partnerships in LF elimination. He defined partnership as a relationship between individuals or groups of people, characterized by mutual cooperation and responsibility, for the achievement of a specified goal. Partnerships develop and evolve fruitfully if several conditions are met, including commitment to common goals; clarity on the role of each partner; and having established ways to resolve conflict – which is inevitable. Dr Hopkins noted that the GAELF involves a “remarkable mix of partners,” bringing together Ministries of Health and Finance with various multilateral and bilateral donors and NGDOs. For example, drug donation programmes have provided funding for mapping, morbidity management, MDA implementation, monitoring, and operational research. Corporate philanthropy has provided funding for both research and programme implementation. And NGDOs previously dedicated only to eye care have joined the fight against LF (and other NTDs). Dr Hopkins highlighted several examples of partnership and collaboration between Merck & Co., Inc. and GSK. They have worked to develop a joint drug application form, coordinate drug approval and delivery, and support a joint technical advisory committee. Partnership among NGDOs has been extraordinarily important to the GPELF. In 2004, the NGDO LF network was formed and in 2009 it joined with other groups to create the NGDO NTD network (www.ntdngdonetwork.org). Dr Hopkins pointed out that the challenges ahead will require new partnerships. It will be important to maintain the interest and commitment of existing partners; put greater priority on morbidity management; and implement effective post-MDA surveillance, which may not be as interesting to donors as MDA, but which is needed if we are to reach our goal. Lessons Learned Mr Andy Wright, Director of the LF Elimination Programme at GSK, began his talk by noting that, when the GAELF was established, it resolved to “learn by doing.” He then highlighted some of the lessons that have been learned during the last 10 years. MDA. The current two-drug treatment strategy has reduced the prevalence of microfilaremia to
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English - Global Alliance to Eliminate Lymphatic Filariasis

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