Children, largely forgotten in research against neglected tropical diseases

A report from the World Health Organization (WHO), published on November 7, is alarmed by the shortcomings in research and development to treat neglected tropical diseases (NTDs) in children. “These diseases are generally neglected, and children are even more affected by this lack of investment”Martina Penazzato advances, co-author of the report and technical director of the Global Accelerator for Pediatric Formulations Network (GAP-f), a network of non-governmental organizations (NGOs) and research institutes, coordinated by WHO, which aims to accelerate the development of treatments for children. A scientific study already warned in 2019: less than half of the drugs available for NTDs then had authorization and information for pediatric use.

NTDs affect poor populations, mainly in Africa, but also in Asia and Latin America. The WHO lists 21. Some particularly affect children. The latter represent, for example, half of the cases of visceral leishmaniasis, a parasitic disease transmitted by small insects, sandflies, which is fatal when untreated.

The WHO has identified, for the first time in 2023, seven pediatric drugs whose development is a priority for five NTDs: bilharzia, African trypanosomiasis, scabies, onchocerciasis or “river blindness”, and visceral leishmaniasis.

For the pharmaceutical industry, the commercial interest in developing pediatric drugs for NTDs is low. The proportion of children affected is sometimes unknown, because they are less well diagnosed than adults. And the little patients can find themselves scattered in different countries. “Clinical trials on children cost more because you often have to do several groups of different ages”adds Michelle Childs, advocacy officer for Drugs for Neglected Diseases Initiative (DNDi).

Bitterness must be reduced

NGOs like DNDi, based in Switzerland, or Medicines Development for Global Health, in Australia, are taking over. “They often conduct research that manufacturers do not do”observe Martina Penazzato. “Children are not little adults. The way their body metabolizes treatments is different”explains Michelle Childs.

“A medicine must not only be safe and effective. In the case of children, it must also be easy to administer”recalls Martina Penazzato. According to the report, 70% of those indicated for NTDs, included in the WHO list of essential medicines for children, are not available in suitable formulations. Tablets are easier to transport than syrups and tolerate tropical temperatures better. But the little ones can’t swallow them.

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