This presentation was given by Prof David Molyneux at the British Society of Parasitology Autumn Symposium, held at the Linnean Society in London on 28th September 2017. http://bsp.uk.net/2016/10/04/bsp-autumn-symposium-2017/

1. Addressing neglected parasitic diseases:
Moving towards the development agenda
amidst change : partnerships, networks and
global health policies
David Molyneux, Laura Dean, Russell Stothard, Tosin Adekeye, Sally
Theobald
Liverpool School of Tropical Medicine

2. … … … … … …
Goal 3:
Ensure healthy lives & promote well-being for all at all ages
A 2030 agenda: The sustainable development goals (SDGs)

4. The dichotomy

6. Evidence for the Anthropocene epoch

7. Climate and Conflict
Meta analysis of studies since 1950 - for each one standard deviation (1σ) change in
climate toward warmer temperatures or more extreme rainfall, the frequency of interpersonal
violence rises 4% and the frequency of intergroup conflict rises 14% (Hsiang et al Science 2013)

9. bb

11. CHANGES
WATER
RESOURC
ES
AGRICULT
URAL
DEVELOP
MENT
HABITAT
CHANGE
LEISHMANIASIS
AFRICAN TRYPANOSOMIASIS
CHAGAS DISEASE
DENGUE
YELLOW FEVER
MALARIA
GUINEA WORM
SCHISTOSOMIASIS
LYMPHATIC FILARIASIS
ONCHOCERCIASIS
MINING
IRRIGATION
FARMING
MICRODAMS
FIRES
DEFORESTATION
REAFFORESTATION
MIGRATION
URBANIZA
TION

12. The new bottom billion
• The "bottom billion"
were people living in the
poorest countries
(fragile and failed states)
• The "new bottom
billion" are the poorest
people living in middle-
income countries
From "diseases of the
poor" to diseases of
the bottom 40%?

13. • Stigma and
discrimination
• Physical and sexual
abuse
• Restrictions on political
and civil rights
• Unable to participate fully
in society
• Unable to access
essential health and
social care
• Barriers to education and
employment
• Experience disability and
premature death

15. Systematic review: FGS widespread but under-reported
COUNTDOWN implementation research

16. Sanofi Aventis
Support for drugs for
sleeping sickness,
leishmaniasis treatment
Merck & Co Inc
“Mectizan for as long as
needed” for onchocerciasis
and filariasis in Africa
GlaxoSmithKline
Albendazole for lymphatic
filariasis at least to 2020 and
for deworming
Pfizer
Azithromycin for
trachoma 120 million
doses
Novartis
Continuing commitment
to MDT for leprosy;
tricladbendazole for fascioliasis
Johnson & Johnson
Mebendazole for intestinal
worms
Merck Serono
Donation of 250 m tablets
annually of praziquantel
(100 m treatments)
Eisai
Provision of DEC for filariasis
Gilead
Ambisome for visceral
leishmaniasis

17. Global Alliance for the Elimination of Lymphatic Filariasis

18. A-WOL Industry
Collaborations

19. Control Reduction of disease incidence, prevalence, morbidity or mortality to a
locally acceptable level as a result of deliberate efforts; continued
intervention
Elimination of disease Reduction to zero of the incidence of a specified disease in a defined
geographical area as a result of deliberate efforts; continued intervention
measures are required
Elimination of infection Reduction to zero of the incidence of infection caused by a specified
agent in a defined geographical area as a result of deliberate efforts;
continued measures to prevent the re-establishment of transmission are
required
Eradication Permanent reduction to zero of the worldwide incidence of infection
caused by a specific agent as a result of deliberate efforts; intervention
measures are no longer needed
Extinction The specific infectious agent on longer exists in nature or the laboratory

20. Importance of knowing the local transmission biology
The need for a more sensitive human diagnostic is obvious i.e. CAA

22. Aedes aegytpi-
The ancient
threat
• Dengue
• Chikungunya
• Zika
• Yellow fever
Plus Aedes
albopictus

23. Cell phones

24. Individuals missed for treatment are on the periphery of
the village social network
Profiles of missed individuals for
pzq, alb, & ivm
• Minority tribes
• Minority religion (Muslim)
• Low social status
• Poor home quality
• No home latrine
Chami et al. 2016 Clinical Infectious Diseases
Chami et al. 2017 Social Science & Medicine
Common factor?
• On periphery of village
social network, i.e. in
households with few
friendship ties
Illustrative example of full
friendship network in a rural
Ugandan village

25. The SDGs or Global Goals

26. Africa Population in
sub Sahara circa 800
million in 2016
• By 2030 50% will live
in cities
• Projected Population
circa 4 Billion by 2050
• Decline in crop yields
by 2050 projected to
be circa 20-50 %
• High levels water
stress in North Africa
• Circa 30% increase in
thermal stress

27. NTDs and the post 2015 agenda
• See NTDs through lens of poverty, equity and gender, human
rights, universal access to essential medicines-markers of poverty
index
• Innovation-progress dependent on non- technical innovation
• Time scale to new product development is decades-low
expectations for any magic bullet
• Importance of advocacy and linking to other diseases-malaria, HIV,
polio
• Economic case-best buy, numbers treated, essential drugs,
universal health coverage
• Expected the unexpected-always surprises

29. The Changing Global Landscape of NTDs
The Health System
Leadership and Governance; Financing; Health Workforce; Medical Products and
Technologies; Information and Research; Service Delivery
Communities
Biological and Technological Political Social and Environmental
+ Creation of new drugs and
diagnostics
- Emergence of resistance
- Need for vector control
+ NTD Brand, Partnerships, Drug
Donation, Advocacy
- Intersectoral Complexities
+/- Changing Disease Distribution
- Global Shocks/Natural
Disasters
- Emergent Infections (Ebola/Zika)
+ Improved Pharmacovigilance
+ Innovative community
solutions for drug delivery
- Loss of vector control capacity
- SAEs, Side Effects, Rejection of
MDA
+ Committed health workforce
dedicated to community change
- Lack of appropriate
remuneration/recognition for
health workforce
+ Wide Reach of MDA
- Limited consideration of
patient voice, equity, mental
health
- Violence and Disease Exposure
Multi-directionalCapacityStrengthening