The Schistosomiasis Control Initiative (SCI) Professor Alan Fenwick

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1 The Schistosomiasis Control Initiative (SCI) Professor Alan Fenwick Department of Infectious Disease Epidemiology School of Public Health Imperial College (St Mary s campus)

2 Established in 2002 SCI assists countries with implementation of control of Neglected Tropical Diseases; Mapping, training, research, surveillance and monitoring (Partnering and working with WHO, and African Governments)

3 DID YOU KNOW. Over ONE BILLION people worldwide one in six of the human population Live on < 1 or $2/day And one in six suffer from parasite infections which afflict the poorest people disabling and disfiguring them promoting the cycle of poverty and disease Imperial College London Property of the Global Network

4 The Neglected Tropical Diseases Protozoan Infections Helminth Infections Human African Trypanosomiasis (HAT) Chagas Disease Leishmaniasis Bacterial Infections Buruli Ulcer Leprosy Trachoma Imperial College London Ascariasis Hookworm Infection Trichuriasis Schistosomiasis Lymphatic Filariasis Onchocerciasis Dracunculiasis Neurocysticercosis Hydatid disease

5 S.mansoni and S. haematobium eggs and the adult worms

6 Transmission Imperial College London

7 The first target To eliminate urinary and genital schistosomiasis Imperial College London

8 And the extreme morbidity due to Schistosoma mansoni Imperial College London

9 First priority is treating children At school and school aged Imperial College London

10 Treating school children is easy through school health programmes

11 And adults at high risk are offered treat

12 Number of Treatments (millions) SCI started with funding from Bill and Melinda Gates Ministries of Health and Education in 6 countries with SCI support delivered over 43 million cumulative Schistosomiasis treatments and over 100 million albendazole (purchased) /3 2003/4 2004/5 2005/6 2006/7 43 m 26 m m /3 3 m 2003/4 2004/5 SCI Treatment Years 2005/6 2006/7

13 DFID funded plan Population (millions) School age Children (millions) Population at risk (millions) Total 6 year Treatments (millions) Cote d'ivoire Liberia Malawi United Rep. of Tanzania Zambia Uganda Niger Country Mozambique Totals Estimated Cost delivered 11 pence Total Tablets (million)

14 PR and fund raising SCI ORGANOGRAM Director of Monitoring and Evaluation Senior Biostatistician Director Managing Director Programme Manager UGA (Niger, Mozambique) Programme Manager (Yemen and Ethiopia) ICOSA Manager ICOSA M and E Liverpool CNTD Sub-Contract 3 Programme Managers DFID (8 Countries) Finance Officer Africa Capacity Building Liaison Africa country coordinators Long and Short Term Technical Assistants RESEARCH UNIT Finance Manager Programme Manager (Rwanda, Burundi, Senegal) Health Economist Mathematical Modeller Office Manager IMPLEMENTATION UNIT FINANCE AND ADMINISTRATION UNIT

15 By 2012 Ministries of Health and Education have implemented control with SCI assistance Plus Yemen with World Bank funds Burkina Faso Niger Mali Uganda Liberia and Cote D Ivoire SCI Supported countries - 3 in collaboration with Liverpool CNTD Burundi and Rwand a Tanzania Zamb ia Malawi and Mozambique

16 Global NTD coverage Nigeria CC and DFID Mauritania and Senegal Mali Burkina Faso And Yemen With World Bank funds Niger Nigeria Ethiopia Ghana Cote D Ivoire and Liberia Cameroon Uganda DRC Burundi and Rwanda Planned expansion into DRC, Ethiopia Senegal and Zimbabwe Kenya (CIFF) Tanzania Zambia Malawi and Mozambique Implemented by the countries supported by WHO, USAID grantees, NGO s, With financial support from the Gates Foundation SCI and CNTD Liverpool USAID/NTD, Geneva Global and DFID, UK

17 Global coverage of preventive chemotherapy Population requiring Preventative Chemotherapy

18 The pharmaceutical industry has increased its contribution to global health Merck & Co Inc will donate Mectizan for as long as needed for both onchocerciasis and filariasis in Africa GlaxoSmithKline have already donated almost 2 billion tablets of albendazole for lymphatic filariasis and will continue until elimination is achieved In October 2010 GSK committed an additional 400 million tablets a year for 5 years to deworm school aged children Johnson & Johnson has for several years donated up to 50 million tablets mebendazole per year for intestinal worms This has been increased to 200 million tablets per year

19 Pfizer originally committed to provide 120 million doses of azithromycin for trachoma In 2009 alone they donated 50 million they will continue until targeted elimination by 2020 Novartis is continuing their commitment to MDT for leprosy EISAI In October 2010, EISAI committed to provide 2 billion tablets of DEC for LF which is used with albendazole outside of Africa In 2007, E. Merck initially committed to 20 million tablets praziquantel per year This will increase incrementally to reach 250 million tabs/year by 2016

20 The US Government Launched in 2006 by USAID The Neglected Tropical Diseases Cooperative Agreement - Initially $100 million, and in 2010 a new commitment of $450 million ENVISION

21 The British Government 50 million over 5 years for NTD control announced in 2008

22 Other donors The World Bank The END FUND (Geneva Global and Legatum) Childrens Investment Fund Foundation (CIFF) The Bill and Melinda Gates Foundation Global Network for NTD control (END7)

23 Ethiopia is ready to start up Population of approximately 84 million people Split into 9 regions and 2 City Councils Decentralized system Approx 30,000 primary schools S. mansoni and S. haematobium both present STH widespread LF and Trachoma Mapping, PCD in SNNPR Mulptiple donors interested

24 Mapping older data suggests the need Soil transmitted helminths Schistosomiasis

25 Five-year national plans supported by WHO launch in May 2013

26 Population of just 169,000

27 Water sanitation and treatment Zanzibar on the East of Africa has about 2 million and plenty of schistosomiasis We are trying to eliminate it there so why not on Sao Tome Little is known about how prevalent the infection is but it would be expected in rural farmers A comprehensive approach should work

28 January 30th 2012 Bill Gates personally convened a meeting on January 30th to focus on NTDs 13 CEO s of Pharmaceutical companies Ministers of Health from developing countries The DG of WHO, Dr Margaret Chan, The Minister of DFID The World Bank Many other dignitaries This led to pledges for NTD control plus the London Declaration which was signed by most people present

29 An SCI initiative - hydrocele surgery BEFORE To operate costs <$100 and the queue in Niger alone is over 8,000 men waiting for the treatment Imperial College London

30 Post operation a smily face Imperial College London

31 Please visit Alan Fenwick Thank you