Visceral Leishmaniasis is characterised by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia.
NewVision Reporter
Journalist @NewVision

People in the remote region of Karamoja in North Eastern Uganda are the most affected by the deadly tropical disease Visceral Leishmaniasis (VL).

Also known as Kala-azar, the disease which is one of the neglected tropical diseases is caused by a bite of an infected sand fly.  If left untreated, the disease is 100% fatal and can lead to death. “Kala-azar is the deadliest parasitic killer after malaria,” health experts say.

Luckily, decades of efforts have greatly reduced the number of cases, but a perfect storm of factors is threatening to undermine this progress, representatives from Doctors Without Borders, say.

“First, the COVID pandemic led to an acute shortage of AmBisome injections that are used to treat VL patients.”

“AmBisome is used to cure the victims of the post-COVID “black fungus” disease; global demand has greatly increased but generic manufacturers are struggling to provide enough doses… and Gilead’s new manufacturing plant for AmBisome has been repurposed to produce remdesivir instead,” the doctors reveal.

Also, UK drastic aid cuts this year have led to the termination of a crucial programme that included funding to purchase life-saving VL drugs. “No other funders have stepped in yet and mortality will inevitably increase.” 

“The only manufacturer of “IT-leish”, the only rapid test with enough sensitivity to diagnose VL in East Africa, announced it will discontinue production.”

Representatives from Doctors Without Borders were joined by the Drugs for Neglected Diseases Initiative (DNDi) and other partners in raising the alarm about the dire situation. They have also published an open letter in the British Medical Journal

Visceral Leishmaniasis referred to as the disease of poverty affects 90 000 people every year, particularly among the poorest communities in nearly 70 countries.

There is concern thousands of cases may go undetected in East Africa as a result of Bio-Rad Laboratories’ planned discontinuation of production of the only effective rapid test.

“In East Africa, existing diagnostics and treatments are not as effective and progress has been more fragile. Around 11 000 cases were reported in 2019 and the true burden is likely to be far higher due to under-reporting,”

“Without immediate action, these multiple threats will impede efforts to achieve both the WHO neglected tropical diseases road map for Visceral Leishmaniasis by 2030 and Sustainable Development Goal 3.3.”

The Sustainable Development Goal 3.3 aims by 2030 to end epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, combat hepatitis, water borne diseases and communicable diseases.

“We encourage an independent analysis to evaluate the impact of UK’s funding cuts, including on Visceral Leishmaniasis control,” Doctors Without Borders say.

Other donors and endemic countries should now prioritise Visceral Leishmaniasis funding. And Bio-Rad must reconsider or delay its decision to cease production of IT-Leish and alternative solutions must be sought to maintain access to this product, recommends Doctors Without Borders.

Equally Gilead must prioritise manufacturing of AmBisome, and Generic manufacturers of quality-assured L-AmB must also prioritise production to better secure the global supply.

“We have two alternatives: finally eliminate this devastating disease by prioritising diagnostics, treatments and putting patients first, or to put thousands of lives from the most vulnerable and neglected populations at stake, undermining decades of progress.” 

“The UK government, Bio-Rad and Gilead must honour their commitments: the alternatives are rarely so stark,” Doctors Without Borders say.

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