Belgium wants to tuck in sleeping sickness for good

Chris Simoens
30 April 2017
By 2025 the fatal sleeping sickness has to be eradicated. Minister of Development Cooperation De Croo has 25 million euros available for this cause. The Antwerp Institute of Tropical Medicine (ITM) coordinates the programme. Convinced by the expertise of the ITM, Bill Gates adds an additional 25 million euros.

 

The World Health Organisation  (WHO) distinguishes between 18 neglected tropical diseases (NTDs), one of which is sleeping sickness. NTDs mainly affect persons who are living in extreme poverty. So for a long time the pharmaceutical industry showed little interest in developing medicines to treat them.

The London Declaration of 2012 was a turning point. An international coalition – including 13 pharmaceutical companies – committed to fight NTDs. These commitments have been renewed in Geneva in April 2017. That’s where Minister De Croo announced his initiative with regard to sleeping sickness.

Colonial experience

Yet, Belgium has never neglected sleeping sickness. In colonial times our country seriously invested in the eradication of this fatal disease in Congo, the main outbreak of sleeping sickness. This decision followed various severe epidemics between 1896 and 1906,  and in 1920. Belgium nearly succeeded in eradicating sleeping sickness in Congo, on the basis of its well-organized healthcare and calling all Congolese for a compulsory medical examination.   

During the chaos following the independence in 1960 the attention waned. As a consequence, there was a new epidemic outbreak in the seventies. In the eighties a second attempt to check the spread of the disease failed.  In 1994 Belgium renewed its funding in the fight against sleeping sickness, focusing on mobile teams to detect the disease. Indeed, early detection is crucial for a successful control, as this is the way to prevent biting tsetse flies from spreading the disease.

In colonial times our country seriously invested in the eradication of this fatal disease in Congo, the main outbreak of sleeping sickness.

Still 3000 cases

With all-terrain vehicles and scooters, the teams are moving from village to village in order to take blood samples. That way, 2 million people are medically examined per year. And it pays off! Last year, the number of newly reported cases in Congo amounted to only 3000, compared to 25,000 in 1998. Today, the WHO estimates the total number of patients at a maximum of 20,000. Yet, still 65 million people are at risk of contracting the disease.

What’s the sense of investing millions of euros in a disease that is nearly eradicated? Even if there is only one patient left, the tsetse fly can keep on infecting people. ‘Congo faces a massive population growth’ as stated Minister De Croo in Geneva. ‘If we don’t continue until the last case, 50 million people risk infection in the long term.’

If we don’t continue until the last case, 50 million people risk infection in the long term.

Minister Alexander De Croo

Five reasons

The Minister emphasised that more than ever, the stars are aligned to eradicate the disease, taking into account these five reasons:

  • A new rapid testing kit allows new cases to be identified within 15 minutes. The test is similar to a pregnancy test: apply a drop of blood to a control line and wait for a positive or negative result. This is a quite accurate test. The former CATT-test gave more false positives.
  • In the course of 2018 a new tablet will be launched which is much safer than the present injections causing strong side-effects. This new oral treatment can also be administered by non-medical health workers.
  • The tsetse fly can be controlled much more efficiently via special traps: small nets impregnated with insecticide combined with a blue zone that attracts tsetse flies.
  • Digital techniques simplify the control. Digital population data can easily be combined with satellite information on the natural environment. This allows a more targeted approach to identifying the sources of contamination. Another example: you can send a doubtful microscopic image from the jungle to an expert in Antwerp and discuss it with him.
  • Belgium joins forces with the Bill & Melinda Gates Foundation, the Institute for Tropical Medicine, the Belgian Technical Cooperation and partners from the pharmaceutical sector. The initiative is fully supported by the WHO and the Congolese health ministry.

The chances of success to eradicate sleeping sickness by 2025 are relatively high. But there remain blind spots. We do not know as yet how long a parasite can survive undiscovered in a human being before resurging. ‘We must stay alert for at least twenty years after the last case. Moreover it is not clear whether or not the parasite can hide e.g. in an animal species and then return to human beings’ as states professor Marleen Boelaert, sleeping sickness expert at the ITM.

Besides, minister De Croo had already committed an amount of 11.2 million euros to the ITM for 5 years of scientific research into sleeping sickness.

A parasite attacking the skin of its victim
© Center for Disease Control

What is sleeping sickness?

 

  • Sleeping sickness is a deadly tropical disease caused by a single-cell parasite that is transmitted by the tsetse fly. Especially the rural population is affected: farmers, hunters, fishermen and cattle breeders.
  • Sleeping sickness is only found in Africa. The ‘gambiense’ type - representing 98% of the cases – is seen in Western and Central Africa. More than 85% of the new cases affect the DR Congo.
  • For gambiense it can take years before the first symptoms are seen: fever, headache, itching, painful joints and general weakness. In a next phase the parasite penetrates the central nervous system and the brain. This causes confusion, behavioural disorders, sleep disruption and finally a coma, hence the name of the disease. If left untreated, sleeping sickness is always fatal.

 

ITM, pioneer in the field of sleeping sickness

 

The Institute for Tropical Medicine in Antwerp has been working on the fight against sleeping disease since colonial times. By the end of 1970 the institute developed the CATT-test: a diagnostic field and laboratory test. Since then the ITM has produced and distributed millions of tests worldwide. However, the CATT test remained somewhat laborious: you need refrigerated reagents (and thus a jeep and refrigerator) as well as a device with an engine (and thus batteries). Moreover, quite a lot of false positives are produced. In 2014 the ITM succeeded in developing, together with other partners, a much more accurate rapid test which is as simple as a pregnancy test. Within 15 minutes, the diagnosis is available. The test now has to be optimized in order to reduce false positive and negative results.

Although the ITM does not develop medicines, it can rely on a vast network of partners who are active in the tropics. Consequently it can submit new medicines, including the tablet against sleeping sickness, to clinical trials.

Besides, the ITM conducts research into the control of the tsetse fly that spreads the disease. The work in the field is done by Congolese partners, whereas the ITM coordinates and carries out the scientific analyses in cooperation with colleagues in Kinshasa.

At the presentation of the initiative, Bill Gates had words of praise for the ITM: ‘The ITM possesses extensive expertise. It has discovered the right method to reach even the most remote areas.’

Tropical diseases Sleeping sickness Health
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