Stamping out disease

When Mimoungou Haruna’s leg first started swelling, he was concerned. By the time it had swollen to well over twice its normal size, he was justifiably horrified. No longer able to work, he now relies on family and friends to look after him.

The incapacitating symptoms first appeared two decades ago, and Haruna, now 70 years old, had no idea what caused them. He went to the traditional healer, but the swelling continued. The words ‘lymphatic filariasis’ (LF) had never reached his rural corner of Burkina Faso in west Africa. Only when officials from the Ministry of Health visited his village to raise public awareness of the disease did he learn the real cause.

Around 120 million people suffer from LF, which, as in the case of Haruna, can lead to elephantiasis and subsequent grotesque swelling. Over a billion more are at risk of contracting the disease, which is transmitted by mosquitoes. Highest on the danger list are those living in the tropical regions of Africa and South Asia.

The bad news is that there is no known cure for those already infected. The good news, however, is that a major programme is underway to eliminate the disease. This uses two prescription medicines given once a year, for five years, to those living in endemic areas.

One of the required drugs, albendazole, is made by the international pharmaceuticals company GlaxoSmithKline (GSK). Albendazole was originally developed as a de-worming agent for animals, but it was also found to be effective against the parasites that carry LF in humans. When taken with another drug, albendazole was shown to stop the transmission cycle of the LF parasite.

In 1997 the World Health Assembly passed a resolution to eliminate the disease. It chose 2020 as a target date. ‘We were looking for something in keeping with our corporate mission as a health company,’ says Minne Iwamoto, manager of GSK’s LF programme. ‘Eliminating LF was an issue where we could make a difference to millions of people – a tangible difference in some of the world’s poorest communities.’

Soon after the World Health Assembly announcement, GSK began a major donation programme of its drug. That was back in 1998. Almost ten years later, the company has given away 700 million albendazole treatments free of charge. In 2006 alone it donated 155 million tablets, which calculated according to the wholesale average cost was worth around £16million ($32m).

The main beneficiaries of the LF programme are the drug recipients themselves. Each needs treatments over five years, and an estimated 140 million people have been treated so far, a third of whom are children. For communities that complete the five-year programme, the chances of eliminating LF are high.

As well as the health benefits, the programme also means there are fewer people, such as Haruna, who are out of work because of LF. This has the knock-on economic benefit of a more productive workforce for the developing countries involved.

GSK also stands to benefit. Iwamoto points out that enhancing the company’s global reputation and reaffirming its mission statement (‘Do more, feel better, live longer’) represent two clear outcomes from its involvement. The company’s flagship LF programme complements its other disease prevention initiatives, which include fighting the spread of malaria and HIV. With a social spend valued at £302million last year, equivalent to almost four per cent of pre-tax profits, the company donates well above the one per cent of pre-tax profits to which many companies aspire.

But it’s not just GSK’s external reputation that’s at stake. ‘Employees want to work for a company that concerns itself with more than just profit, and the company’s commitment to lymphatic filariasis is good for employee morale,’ says Iwamoto. GSK’s efforts to stamp out LF, in other words, increase its standing in the recruitment market. Socially responsible investors also give greater weight to GSK due to its work on this and other health issues.

Direct financial rewards for the company are less evident. GSK only sells albendazole commercially in a handful of countries. More important is the role that donation programmes play in building an awareness of GSK’s position as a leading manufacturer of medicines and vaccines. Its product list covers everything from cancer and diabetes treatments to polio and whooping cough vaccines.

GSK is not alone in its fight against LF. From the start, the company has always looked for other organizations with whom to partner. Working with the World Health Organisation, GSK was instrumental in creating a worldwide coalition of health ministries, non-profit groups and other corporate partners. Established in 2000, the Global Alliance to Eliminate LF now has more than 120 member organizations, including Merck, another large pharmaceuticals company. In each of the countries involved, the lead is taken by the local ministry of health, with technical and financial assistance provided by the other Alliance members.

Participating in a public-private partnership of this size is not easy, and represents one of the ongoing challenges for GSK, according to Iwamoto. ‘Having a common goal is essential for this kind of partnership to work,’ she says. ‘It’s also key that from the start everyone has a clear idea of what their particular roles and responsibilities are.’

While donating albendazole is GSK’s main contribution to the Alliance, it also uses its global presence and contacts to get more participants and funders on board. In addition, GSK puts approximately £1m a year into the Alliance’s work on the ground. The money supports roll-out and management of the LF programme, through activities such as technical training, advocacy and monitoring.

David Molyneux, director of the LF support centre and professor of tropical health science at Liverpool University’s School of Tropical Medicine, says: ‘GSK has shown the desire to make a large scale public-private partnership like this really work. It’s stuck in through thick and thin and now the public health successes are being demonstrated.’

Although it’s a decade since the fight against LF began, the project is still in its early days. Each participating country must go through at least five years of mass drug administration – a process that only around half a dozen countries have so far completed. In the case of Haruna it’s too late, although the medical assistance he’s received through the programme has stabilized his condition. But for millions of others, there’s real hope that the end of this crippling disease could be close at hand.