A Médecins Sans Frontières nurse prepares a single dose of LAmB, an intravenous infusion administered over a short period of 2–3 hours. Photo by Matthew Smeal
Opinion article |

BMJ Global Health: Control of visceral leishmaniasis in East Africa: fragile progress, new threats

Photo by Matthew Smeal
A Médecins Sans Frontières nurse prepares a single dose of LAmB, an intravenous infusion administered over a short period of 2–3 hours. Photo by Matthew Smeal

In this commentary article in BMJ Global Health, authors from MSF, DNDi, and the Ministries of Health of Sudan, South Sudan, Kenya and Ethiopia highlight that though progress has been made in reducing the global burden of visceral leishmaniasis (VL; also known as 'kala azar'), a neglected disease that is fatal if untreated, threats to this progress are on the horizon:

  1. Recently announced cuts to the overseas aid budget of the UK, the leading donor of the global leishmaniasis response, could lead to the premature end of a flagship neglected tropical diseases (NTDs) programme, which includes VL control. 

  1. US diagnostics company Bio-Rad announced it will discontinue production next year of IT-Leish, the only rapid diagnostic test with high enough sensitivity for VL in East Africa, which could result in thousands of cases going undetected in this high-burden part of the world.

  1. The global supply of AmBisome (liposomal amphotericin B), produced by US pharmaceutical company Gilead Sciences and the first-line treatment for many people with VL, has been heavily impacted by COVID-19, with a shortage looming. 

The authors call on the UK government, Bio-Rad and Gilead to honour their commitments to avoid undermining decades of progress on VL, offering a 5-point action plan:

  1. Funding of lifesaving VL treatment and tests should be continued by the UK government. 

  1. Other donors and endemic countries should now prioritise VL funding. 

  1. Bio-Rad must reconsider or delay its decision to cease production of IT-Leish VL test. 

  1. Gilead must prioritise manufacturing of AmBisome. 

  1. Generic manufacturers of liposomal amphotericin B must boost production. 

Quotes from the authors:

  • As one of the countries with the highest burden of visceral leishmaniasis, we urge the international community not to turn away from this fatal illness and the people it affects. Lifesaving funding and access to the best tests and medicines are absolutely critical for tackling this neglected disease.” - Dr Mousab Siddig Elhag, Neglected Tropical Diseases Advisor, Ministry of Health, Sudan 

  • 2021 is the first in many years during which an annual outbreak of visceral leishmaniasis, typical for the first and second quarter of the year, did not occur in Kenya. This celebrated milestone came in the wake of partnerships towards increased testing and treatment. To sustain these gains, availability of effective diagnostic test kits and access to efficacious treatment must be maintained.” - Dr Sultani Matendechero, Head, Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Kenya

  • Too many people continue to die from the neglected disease visceral leishmaniasis, despite effective tests and treatments. Prioritising access to these medical tools would save lives. We call on the UK government and the companies Bio-Rad and Gilead to continue to ensure lifesaving access to visceral leishmaniasis medical tools for people at risk throughout East Africa.” - Dr Elin Hoffmann Dahl, Infectious Diseases Medical Advisor, MSF Access Campaign