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S<br />
90<br />
SAFETY AND<br />
EFFECTIVENESS<br />
TRUMP COST<br />
The principle that NTDs must be fought in the present<br />
with the tools available has a corollary: when a new<br />
and better tool comes along, it is used, regardless<br />
of cost. It is commonplace in the business and government<br />
worlds to choose cost-effective approaches<br />
to problems but, in matters of health, the operating<br />
principles are different. Early in the campaign against<br />
NTDs, WHO and its partners established a set of<br />
non-negotiable priorities:<br />
→ use of quality-assured drugs<br />
→ it would use the most effective drugs<br />
→ it would use the safest drugs<br />
→ treatment would be administered<br />
by highly skilled personnel.<br />
Melarsoprol was a brutal medication that for years<br />
offered the best results in treating advanced sleeping<br />
sickness. Eflornithine, a less toxic and more effective<br />
drug, has now replaced it. It is more expensive, but it<br />
is the best treatment available. The pharmaceutical<br />
firm donating the drug has agreed to this approach<br />
for ethical reasons and because it offers the greatest<br />
chance of eliminating the disease.<br />
Similarly, better and sometimes more costly<br />
treatments – such as AmBisome – are progressively<br />
replacing the drugs formerly employed against various<br />
strains of leishmaniasis. Also, combinations of medications<br />
– such as NECT, against sleeping sickness – that<br />
have shown the best results are now routinely administered.<br />
In addition, benznidazole is now guaranteed<br />
to be available as an alternative to nifurtimox in geographical<br />
areas where it best serves to treat Chagas<br />
disease.<br />
In some cases, money can be saved at the same<br />
time as treatment is improved. Rifampicin and streptomycin<br />
were major breakthroughs in the early cure<br />
of Buruli ulcer infections (and halted damage during<br />
later stages of the disease). These antibiotics have<br />
become the much-preferred alternative to invasive<br />
surgery and lengthy hospital stays. Ease of use in the<br />
field is another area of improvement.
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