Big pharma on board for Africa mission

For most of his working life, Simon Bush, Sightsavers Director of Advocacy and African Alliances, has lived in Africa, where he has helped bring worldwide awareness to so called "neglected' tropical diseases.

There are about 17 such diseases, mainly bacterial or worm based, and they affect some 1.4 billion people worldwide. We’ve come to know the names of some of these diseases through very public campaigns in recent years – river blindness or trachoma, for instance – but still today, one sixth of the world’s population are affected by these conditions.

The good news is that through early intervention and advances in pharmaceuticals, many of these conditions can be eradicated fully. Sightsavers has set itself the task of eradicating river blindness by 2020, and tomorrow Bush travels to Ireland to launch this global campaign. Big pharma, so often criticised for not doing enough to make products available to those who can't afford them in areas of the developing world, has been working with agencies such as Sightsavers in tackling neglected tropical diseases since the 1980s.

The result of that work is showing that some of these diseases are being eradicated, particularly in urban areas. "It started in 1987 with a drug called Mectizan, and the chairman of the company that developed it, Merck, said they would donate it to as many people for as long at is needed." Bush explains. "The president of the company probably went above his board at the time, and early on in his career did the same thing I did and went to villages in Africa and saw the impact of these diseases on communities. Over 25 years later, we are seeing about 90 million treatments a year and the company are still providing this medicine for free."

Bush says the success of that programme has led him to change some of his views of how large pharmaceutical companies can interact with the developing world. Eradicating certain diseases though is not simply a matter of getting medicines donated with little or no cost– the challenge remains in how to distribute these drugs effectively and turn the tide on neglected diseases. “We have learned so much in the last two decades about distribution,” Bush says. “You need to train volunteers in communities to work out whom to give them to. Some medicines will have exclusions such as young children, and often we deal with communities who sadly are too poor to distribute a donated drug. Local knowledge will tell you what is the best day to distribute, maybe on market day, and not when farmers have to be in their fields. Sometimes, for example, we create a community event around it and then maybe begin to use those days to introduce other health related programmes.”

The sense that Africa is a rising continent has been around for several years, and while Bush says he has seen positive developments in some countries, the rate of change is not yet widespread. In a general sense, urban areas are moving ahead of rural ones, and this further inequality is worrying.

"I see fantastic developments in cities for example. I see new roads and buildings and banks, and Africa is selling commodities like coffee, cocoa and oil. But to some extent, I do wonder about the person on the street and if their situation has improved. Often when you leave the city limits, you get into communities that have diseases that are so preventable they shouldn't exist. River blindness should have been gotten rid of years ago, through good economic development, access to clean water and so on," he says. The success of the river blindness programme, has led Sightsavers to believe it can fully eradicate the disease before the end of the decade. Several years ago, the agency recognised that not alone was the drug they were distributing treating the illness, but it was also effectively eradicating the disease in some areas. "Year on year we thought we were just controlling river blindness," Bush says. "A few years ago, scientific evidence in Mali and in Nigeria showed that if you use the drug to treat persons on a regular basis every year, you break the transmission of the disease. In effect, we now believe we can eliminate this disease and the blinding effect of it."

Having worked in Africa for a quarter of a century, does Bush ever become sanitised to the inequalities and daily struggles many Africans face? “It does still get to me. Sometimes it is a feeling of anger when I go to some communities and see how these people are struggling to live and support families and trying to give their kids what they may not have had. When I’m visiting hospital and projects, I’ve never yet met a lazy health worker. I have met people not managed well and who don’t have the tools to do their jobs. Africans are incredibly resilient and they suffer terribly from everything the world throws at them. Their resilience and sense of pride are their most incredible traits.”

A limited number of tickets are available to the public for Simon Bush's talk in Dublin at the Education and Conference Centre, Royal Victoria Eye and Ear Hospital, on Thursday at 9.30am. Email rcronin@sightsavers.ie for more information. See sightsavers.ie