In this article, Sumaiyah Moolla interviews Professor Alan Fenwick of Imperial College London about his work leading the Schistosomiasis Control Initiative, which delivers cures to diseases afflicting a huge proportion of the severely poor globally. Read more of our Impact Interviews.
Malaria, tuberculosis, HIV/AIDS – all are highly ‘visible’ diseases, well-known on a global scale. Lesser known are a set of parasitic and bacterial infections, referred to collectively as neglected tropical diseases (NTDs), which afflict over one billion persons worldwide.
NTDs are found almost exclusively in the poorest and most deprived regions of the world, where residents face unsafe water, poor sanitation and limited access to basic healthcare. The afflictions form part of a vicious cycle, in which ill health resulting from NTDs helps to anchor millions of people in long-term destitution. Some 500 million people – two-thirds of Africa’s total population – suffer from two or more NTDs and require regular treatment.
The Schistosomiasis Control Initiative (SCI) works with ministries of health in numerous countries to develop, fund and implement in-country control programmes. It aims to manage and eventually eliminate the seven most prevalent NTDs from sub-Saharan Africa, including schistosomiasis (bilharzia), river blindness, roundworm and hookworm infection, and elephantiasis.
Since its inception, the initiative has successfully treated scores of millions of patients in Africa, often dramatically reducing the proportion of those afflicted by NTDs. In Uganda, for example, fewer than three percent of school-age children now suffer from schistosomiasis, compared to more than 26 percent before SCI’s campaign there. We spoke to SCI Director Professor Alan Fenwick about the origins of this tremendously effective impact effort, and the challenges he and his team have overcome and continue to face in reaching those who need treatment.
Q: What motivated you to want to undertake an impact intervention such as this?
A: My motivation was that I had worked in several African countries where I had visited many schools and seen children desperate to learn, and yet I was aware that they all suffered from parasitic infections which hampered their development and affected their health. I also knew that two drugs – praziquantel for schistosomiasis and albendazole for intestinal worms – were available and inexpensive (US 8 cents and US 2 cents respectively in 2002). I therefore wanted to fill the gap – offer as many children as possible access to these drugs and set up ministry of health and education facilities for delivering the drugs on an annual basis. If we could achieve this and monitor the impact, there would be many publications to be written on the results at a never-before-reached scale.
Q: How were you able to launch the initiative?
A: I applied to the Bill and Melinda Gates Foundation in 2001 when I heard about the money available for tropical diseases. I pointed out to the foundation just how many people (200 million) were infected with schistosomiasis (a parasitic disease) and that a drug was available at a reasonable cost. When the foundation agreed to fund the work, I approached Sir Roy Anderson (a leading British expert on epidemiology), who agreed to chair the SCI Board and sponsored me into Imperial College.
Q: What would you say are your most significant successes in the project?
A: The fact that 15 countries now have SCI supported intervention programmes and that we can claim credit for assisting delivery of over 95 million praziquantel treatments and well over 100 million deworming treatments. Most countries now have an NTD master plan which donors have bought into.
Q: What were the most significant challenges you faced in the early days of the project?
A: After receiving funding, the first tasks were to select the countries to benefit from the funding and then to agree memoranda of understanding with the countries’ ministries of health. Then we had to get the ministries to prepare proposals. I convened a technical committee to scrutinise 12 proposals and selected six countries: three in East Africa and three in West Africa. The next challenge was to obtain good quality praziquantel (used to treat infections caused by parasites) at a reasonable price.
Q: What are the most significant current challenges?
A: The current challenges are several and all different. The first is governance: so many African countries seem to have a tendency for civil unrest, which always disrupts health programmes. The second is how to hand over ownership of the programmes to the countries and yet ensure that there is good accountability of donated funds. The third is the expansion into problematic countries, because in order to retain credibility, we have to be reaching out to assist the Democratic Republic of Congo, Nigeria and Ethiopia – all of which present massive challenges.
Q: What do you see as the key to actually making an impact? How do you go about trying to influence policy, and otherwise make it possible for a project such as yours to make a positive difference?
A: We won over and received fantastic support from the World Health Organization. I am passionate in delivering a simple message: 200 million people are suffering from an infection which can be safely and effectively treated for just US 50 cents per person per year. All we need is the drugs and the political will combined with the expertise and logistics to ensure timely delivery.
Q: What would you say to those people – whether they be administrators, academics or others – who say that academics should focus on research, not seek to make direct interventions on specific issues?
A: Mostly they are right, but having an academic institution behind me has helped enormously to give me credibility when approaching governments. Academic research is important, but so is implementation of the results. Research had found the two drugs mentioned above, but no one was delivering them, so we filled the needed gap.
Q: What advice would you offer to an academic who wants to make a more direct contribution?
A: Provided that the project offers something unique, think hard about the mechanism of funding and the home – whether to remain as I did in an academic institution or establish an independent non-governmental organisation; both have advantages and disadvantages.
Q: If you could have done something differently at any point in the project, what would it have been?
A: When I was offered funding from Legatum and Geneva Global, I routed it through the Global Network for Neglected Tropical Diseases, because I felt that the network had something special to offer. The network does offer advocacy now, but that particular funding suffered from too many layers of bureaucracy and I should not have introduced that extra layer, because it proved to be top heavy. I think I lost a bit of management credibility with that decision.
Q: Next steps for SCI?
A: Our project has achieved a lot in terms of saving millions of lives and improving the health of millions more. Now SCI needs to switch from morbidity control to elimination. To achieve this we need to introduce clean water and better hygiene and sanitation in the areas where we offer treatment.