Across Kenya, Sudan, and Ethiopia, frail and feverish patients are being taken to emergency clinics by their stressed families, blasted by a parasitic executioner. It may seem like malaria, yet these patients are indeed affected by a lesser-known parasitic illness, visceral leishmaniasis, also known as kala-azar.
Kala-azar is the second deadliest parasitic killer in the world after malaria. The World Health Organization (WHO) estimates that 50,000 to 90,000 people globally are infected each year. Without treatment, it is almost always fatal.
Many years of efforts by health ministries, specialists, and medical organizations have led to significant advances in controlling the disease. Better treatments have been developed, and the number of cases has been dramatically reduced in some parts of the world, particularly in South Asia.
In Kenya, there was significant progress in 2021, "the first in many years during which an annual outbreak of kala-azar did not occur," said Dr. Sultani Matendechero, head of the neglected tropical diseases division of the Ministry of Health in Kenya. However, to maintain this progress, access to diagnostic test kits and effective treatments must continue.
This is now under threat. Kala-azar, already one of the most neglected diseases globally, is at risk of becoming even more neglected.
To raise awareness, the health ministries of Ethiopia, Kenya, Sudan, and South Sudan, Doctors Without Borders (MSF), and the Drugs for Neglected Diseases Initiative recently issued a call to action in an op-ed in the BMJ journal.
"We wrote the editorial to highlight that the system of diagnostics and treatment that saved Mary's life and countless others is under serious threat," they explained.
This is due to a perfect storm of indirect effects of the Covid-19 pandemic, withdrawal by pharmaceutical companies, and significant donor budget cuts. Combined, these are putting countless lives at risk across Eastern Africa in countries where the disease is endemic.
First, kala-azar control progress is compromised by a severe shortage of a key "second-line" drug given to patients when the standard treatment fails. Known as AmBisome, this anti-parasitic treatment is used for vulnerable kala-azar patients such as pregnant women or severe cases. Recently, it has also been used in India to treat the deadly "black fungus" disease seen in Covid-19 patients.
Faced with increased global demand, generic manufacturers have not been able to produce enough doses.
Simultaneously, the US pharmaceutical giant Gilead repurposed its AmBisome factory to produce a broad-spectrum antiviral called remdesivir. While this has not yet affected supplies in Eastern Africa, specialists in Ethiopia, Sudan, and South Sudan, where the kala-azar peak season is about to begin, are expressing deep concerns.
A second threat comes from the drastic cuts announced in November to the United Kingdom’s foreign aid budget. These cuts have already led to the end of a major neglected tropical diseases program, which included funding for the purchase of a life-saving kala-azar drug.
Unless other donors step in soon, thousands could die.
Another major concern is diagnostics. The American diagnostics company Bio-Rad announced that in 2022 it will stop producing the "IT-leish" rapid test. This is the only test with high enough sensitivity to detect kala-azar in Eastern Africa.
Without adequate diagnostics, many kala-azar cases will go undetected.
Bio-Rad argues that it is too expensive to comply with new European requirements for rapid tests such as IT-leish. However, the consequences will be catastrophic if a solution is not found to transfer these technologies and manufacture the tests on the African continent.
"We urge the global community not to turn away from this deadly disease and the people it affects. Life-saving funding and access to the best diagnostics and treatments are absolutely critical for tackling the disease," wrote Dr. Mousab Siddig Elhag, a tropical disease consultant from the Ministry of Health in Sudan, a country with one of the highest burdens of kala-azar in the world.
He recently urged the international community not to turn away from this deadly disease.
Kala-azar pandemics are exacerbated by climate, co-infections like HIV, and population displacement, such as large refugee movements during conflict.
For example, shortly after the start of the 2013 civil war in South Sudan, MSF observed a "significant outbreak" of kala-azar in the Lankien region – the number of patients treated by MSF doubled within a year.
A similar outbreak is now feared in Ethiopia, where the devastating Tigray civil conflict is causing hunger, displacing millions, obstructing aid, and leaving 400,000 people facing famine-like conditions according to the UN. The closure of clinics is affecting kala-azar programs.
Thousands of lives are at risk. We need to act now. Donors and kala-azar endemic countries must step up. The industry must prioritize kala-azar treatment and diagnostic production. The outcome of another course of action will be nothing short of a humanitarian disaster.
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