Healthy Skepticism Library item: 18689

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Publication type: Journal Article

Shetty A
Bernard Pécoul: championing the cause of neglected diseases
The Lancet 2010 Aug 28; 376:(9742):677
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61324-4/fulltext

Abstract:

Scientists don’t tend to set much store by superstition. Even so, for Bernard Pécoul, then at Médicins Sans Frontières (MSF), the fact that a key meeting to set up the Drugs for Neglected Diseases initiatives (DNDi) happened on the same day that MSF won the 1999 Nobel Peace Prize seemed like a good omen. MSF committed the prize money to finding solutions for neglected diseases, a cause that Pécoul took up with a passion.
Pécoul and MSF have a long history together. After a medical degree from the University of Clermont Ferrand in France, during which he worked in Africa, and a Master of Public Health from Tulane University in the USA, he spent 5 years working as a physician on MSF field projects in Latin America and Asia. But he says he “was left with a lot of questions on how to improve the efficacy of the operations”. So, in 1987, Pécoul’s response was to co-found Epicentre, MSF’s centre for epidemiological research. In the early stages especially, says Pécoul, the fledgling unit was strongly guided by the US Centers for Disease Prevention and Control (CDC).
By the early 1990s, Pécoul was executive director of MSF-France and based in Paris, when he started to realise that scientific progress in developed countries often did not translate to health benefits in developing nations. During an outbreak of shigellosis that devastated Burundi, Rwanda, and the Democratic Republic of Congo, Pécoul was appalled to discover that all MSF had to treat patients were ineffective antibiotics. Even worse, a class of drugs called quinolones that were known to be effective against shigellosis was not available in developing countries. “It was really a shock that we were still using bad drugs at a time that new antibiotics were available in the North”, he says. The fight to make those drugs available would spark one of MSF’s most high-profile and successful campaigns, the Campaign for Access to Essential Medicines. Pécoul also realised, however, that sometimes there were simply no drugs at all because of the dearth of research and development (R&D) for neglected diseases. This understanding-and the drive to change the global paradigm-led Pécoul to set up DNDi in 2003.
DNDi works by acting as a key facilitator, liaising between governments, academic groups, and drug companies. So far, it has had much success. Its R&D pipeline has potential treatments for leishmaniasis, African trypanosomiasis or sleeping sickness, and Chagas disease. The organisation is well on track to fulfilling its goal of creating between six and eight new treatments for neglected diseases by 2014. Already, it has three new treatments available: two antimalarial combination drugs, artesunate-amodiaquine and artesunate-mefloquine, and nifurtimox-eflornithine (NECT), the first new treatment against sleeping sickness in 25 years. Pécoul is confident that three more will be ready in the next year or so. Identifying drug candidates can mean completing the development of drugs that have been abandoned. It can also mean devising new uses for existing drugs, and DNDi’s latest venture is an agreement signed last month with the TB Alliance to explore the promise that nitroimidazoles hold for neglected diseases, such as Chagas disease and visceral leishmaniasis.
Although DNDi has strong supporters in both global health and government, Pécoul admits that “a core problem has been the difficulty in attracting sustainable long-term commitments from key players, particularly national governments. R&D cannot thrive on 1-year long commitments”. Sustainability is a keyword in DNDi’s lexicon, and Pécoul emphasises the importance of “long-term relationships with research groups in disease-endemic nations”. In some ways, DNDi’s end game is for them to become redundant-ie, when there is enough political will and funding for neglected disease R&D to be taken more seriously. In the mid-term, however, there is much to do. For example, Pécoul describes how DNDi has facilitated technology transfer between South-South partners in India and Brazil for the development of a non-patented drug for malaria. DNDi can facilitate this kind of licensing agreement allowing innovative partnerships.
Pécoul is not given to deep self-analysis. Ask him why he was so drawn to working in developing countries and he simply says he has always found it “interesting”. Yet it is evident that the needs of the most underprivileged patients are close to his heart. For instance, he is clearly angry when he talks about the absence of a US national plan to deal with Chagas disease. Although the disease is mainly a problem in regions such as Latin America, migration to North America means that according to the CDC, about 300 000 people in the USA are infected. There is only one specialised centre to treat Chagas patients in Los Angeles. But because these people tend to be poor, illegal immigrants, their problems don’t feature in the public health plan. MSF’s Nathan Ford, who worked with Pécoul on the Access campaign, says that “Bernard’s major contribution was to ensure that the urgency of patients’ needs was always at the centre of the discussion, that whatever was being discussed would result in practical benefits for patients”. Ford neatly sums up why Pécoul has such an impact on global health: “It is typical of Bernard’s commitment to practical solutions that while others might have satisfied themselves by calling for a paradigm shift in an editorial, he created an institute.”