About a billion people in the world – one-sixth of all humans on the planet – are shaved by so-called "neglected doctors": diseases that the pharmaceutical industry is not afraid to investigate, according to the World Health Organization (WHO).
The reason? "They are related to poverty, I do not have much interest in the market because I do not give a lucrative return," explains Sinval Brandão, researcher at Fiocruz and president of the Brazilian Tropical Medicine Society (SBMT).
WHO classifies 17 pathologies as negligent tropical diseases. They are different from each other, but the fate of us is mainly related to low income or misery, in poor places and in developing countries.
Some of the pathologies are known for centuries, says Ethel Maciel, epidemiologist at the Federal University of the Holy Spirit (UFES).
Several of them have already had to study at school: had, leprosy, Chagas disease, schistosomiasis, sleep sickness, trachoma, oncocercosis, lymphatic filariasis, among others.
For many of us living in large urban centers in the First World, there is the impression (mistake) that they are the dozens of the past, which were eradicated. Afinal, in vast parts of the world in which the conditions of life and hygiene improved, they are no longer a problem.
But they continue to be present, concentrated in poor regions of the world, in remote rural areas, in favelas and urban areas without sanitation – inclusive (and in great quantity) in Brazil.
"Brazil was responsible for 70% of deaths in the world due to Chagas disease in 2017; it contributed 93% of the new cases of hansenyia and 96% of cases of visceral leishmaniasis from the continent, just to name a few examples," says Jardel Katz, research and development manager of the DNDI (Initiative Medications for Neglected Diseases).
If so many people are troubled, why are not you talking about more things? They are silent, I say to WHO, "because the people are afraid or at risk they fear little political voice."
"The more we call attention is when we leave the low-income circuit and the poor places in which I am usually endemic and we are dealing with the middle class, rich neighborhoods," says Ethel Maciel. "This is the case of dengue, for example."
Some entities consider a larger group of diseases in the negligence list. The G-Finder project mentions 33 diseases in its annual report on neglected diseases, including tuberculosis and malaria in the list. The project is organized by the Policy Cures Research center, dedicated to finding ways to promote advances in the health of the poorest people in the world, and sponsored by the foundation Bill & Melinda Gates.
According to Jardel Katz, of DNDI, all 33 women considered G-Finder hair are present in Brazil, to a greater or lesser extent depending on the region.
In 2008, the Ministry of Health defined seven neglected diseases as a priority in the country, based on its impact on Brazil: dengue, Chagas disease, leishmaniasis, hanseniasis, malaria, schistosomiasis and tuberculosis.
The problem is that, just in an area that is dependent on public investment, government spending as a research and development we are falling. According to a recent G-Finder report, the 42-year government has cut 42 percent to investigate neglected cases between 2016 and 2017.
In the absence of interest in the pharmaceutical industry, as these are some of the oldest treatments, such as limitations, low efficacy and adverse reactions, explains Jadel Katz.
One of the main treatments for leishmaniasis, for example, is done as a substance called antimoniate, which kills the protozoa that causes the infection.
"It is a treatment that is more than a hundred years old and it is a lot of toxic. The patient enters the treatment and may have a heart and kidney problem," explains the epidemiologist Guilherme Werneck, a doctor in public health at Harvard and a professor at the Rio de Janeiro State University (Uerj).
"There is another remission, the liposomal Amphotericin B, but it's a lot of face and it's also quite toxic," says Werneck.
Ethel Maciel explains that difficulty is not only for treatments, but also for prevention and diagnosis.
"In the fight against dengue, the way of fighting the vector (the mosquito transmitter of the virus) is the same since the 1980s in most parts of the country," she said. In the case of dengue, there is no specific remedies available and there is hardly a vaccine, which has low efficacy.
Search and development
"For these diseases, it is the public asset that finances more research, and this makes important discoveries. But for questions of innovation and treatment, partnership as private initiative is essential," says Werneck.
That is because, explains Jadel Katz, when there is talk of advances in the area of general health, public universities and institutions usually do most of the basic research searches (studying the causing agents and how to fight them).
The study on the breeding and application of remedies, just like those, ends up being a private initiative, which is more concerned with the style and structure of economic interests. "They take more care of this stage where there are regulatory issues, clinical tests, which require patients' participation, money," says Katz.
However, it is a third stage of manufacturing, which demands a production infrastructure.
In the case of neglected diseases, however, practically all the research and development is made public hair or by lucrative institutions, mainly foreign.
"It is an area that is extremely dependent on public investment," explains Sinval Brandão.
Even more than the public and academy invested in research, the advancement is much harder to the infrastructure of the industry, mainly in the creation of treatments and the manufacturing of remedies.
In Brazil, public institutions such as the Farmanguinhos remedies laboratories of Fiocruz, let's face it, but they are still few and we can not afford a level of production comparable to private initiative.
"Oh, what is not a pure business, you need to have development alternatives," says Katz. "Trace partners to discuss, both in the governmental and basic sciences, how much an industrial partner thinks. It is necessary to have different partners, who dominate different stages of production."
It remains in the investment
In Brazil, there is a great deal of concern about the shortage of government investments in these cases.
According to G-Finder's report on investing in research and development (P & D) in neglected cases, investment in Brazil has fallen sharply in recent years – despite having grown in the world, where it hit its biggest peak in 2017.
According to the survey, published last week, the total investment in the area in Brazil was R $ 29 million in 2017, 42% less than in 2016, which pulled Brazil from the list of twelve largest global financiers.
"We are sensibly aware of this reduction in the budget cuts," says Sinval Brandão, from the SBMT. "The reduction in investment, which has been felt in recent years, in 2017 and 2018 has been much higher, interrupting projects and closing laboratories."
According to the report, between 2016 and 2017 the decline in public funding was the result of the spending expense set by the government, which caused cuts of two financing agencies: the National Bank for Social Development (BNDES), which has a reduction of R $ 15 million in the investment; and the Fundación de Amparo a Pesquisa of the State of São Paulo (Fapesp), which cut R $ 14 million.
"This general reduction is extremely significant in an area that has little interest in private settlers," says Brandão.
This pharmaceutically affected all neglected pathologies considered to be priorities in the Ministry of Health in Brazil.
The investment you've searched for malaria fell 15%. For leishmaniasis, the reduction of words was 63%. For tuberculosis, the cut was 45%.
For Chagas disease – a problem for which Brazil was, during five years, the second largest research funder – the cut was 74%.
Only two things had an increase in investment. Uma of them was dengue, which grew 41%.
The other was schistosomal, which has a considerable increase, from R $ 500 thousand in 2016 to R $ 2.8 million in 2017 – a 460% increase. According to the Ministry of Health, about 1.5 million people will live in areas at risk of contracting the disease.
What does the government say?
When the expenditure count was approved, in 2016, the government repeatedly said that the limit in the budget would not affect the areas of health and education – several advocates of the measure would have said affirmation, including the ministers Henrique Meirelles (who was in the Ministry of Farming) and Dyogo Oliveira (Planning).
Questioned by BBC News Brazil, the Ministry of Planning said that it would be best to pronounce the subject matter is the Ministry of Health. "The money you want to pay for the order. It's up to you to decide where and how to spend," says the pasta, I note.
The Ministry of Health says that its Department of Science and Technology (Decit) does not make any cuts in neglected cases and that we continue investigations by means of parcerias such as government agencies such as CNPq and Finep, rather than responding to cuts made by financial agencies.
The ministry also affirms that Brazil has "a high burden of non-transmissible doctors, along with transmissible and neglected diseases."
"This makes the resources for searching for different sources of knowledge. Regarding specifically neglected issues, we can make allocations of higher or lower resources for specific diseases based on specific needs. For example, in 2016 and 2017, as the emergency in Zika, there was higher investment in mosquito-related searches Aedes aegypti. "
The paste highlights data from the G-Finder report that we appeal to the Decit as one of the largest research funders related to the vector control of the mosquito in 2017. It goes without saying that other areas of the Ministry of Health and the Federal Government "finance investigations and are not contemplated in the report, "but I did not specify which ones, for which drugs and how much was invested.
However, the ministry highlighted a list of actions to combat neglected doctors that do not involve research and development (and that is not in the G-Finder report), such as "annual extras over $ 10 million to intensify the actions of control of malaria in the States as the largest case register ".
"As far as it was concerned, the Ministry of Health conducts annually a campaign to alert the population about signs of the diseases, stimulate the search for health services and mobilize health professionals in the search of cases, favoring the early diagnosis, timely treatment and prevention of the incapacities ", I say pasta, I notice.
The article also highlighted the National Plan for Fim of Tuberculosis as a Public Health Problem, launched last year, and the "Joint Action as the state and municipal health secretaries in the control of the Leishmania", along with the diagnosis and free treatment offered at SUS for the diseases.
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