Kavita Singh, Indian scientist: “The patterns of dengue and other diseases are altered by climate change. “Before we didn’t have so many cases or so many deaths.”

Diseases know no borders, neglected ailments do not always affect people thousands of miles away, and calling them “neglected” should not mean that they disappear from the agenda of those who have the money and the power to transform the priorities of society. global health. With this message, Indian scientist Kavita Singh, director for South Asia at the Drugs for Neglected Diseases Initiative (DNDi), has arrived in Oviedo, receiving the Princess of Asturias Award for International Cooperation this Friday. The entity has been recognized for its work in the research and development of new “affordable and easy-to-use” treatments for those who suffer from any of these 20 ailments, a total of 1,000 million people in the world, according to the World Health Organization. (WHO).

On the list of these diseases, most of them registered in impoverished places in tropical areas, are visceral leishmaniasis, a parasitic disease, and dengue, transmitted by a mosquito, which occupy part of the work of this 54-year-old woman. Singh celebrates small victories in these 20 years of DNDi’s journey, but she prefers to focus on what remains to be done. “Our work will only be complete when a patient from a town lost in a tropical country can have a diagnosis and access to the best medicine that exists for their illness, without having to make a long trip,” he emphasizes in this interview, conducted by telephone. .

Ask. Neglected disease is not synonymous with distant disease.

Q. Can you give an example of the impact of climate change on the evolution of these diseases?

R. For example, patterns of dengue and other diseases are altered by climate change. Before we did not have so many cases or so many deaths in our South Asian region. In Bangladesh there have been more than 1,000 deaths from dengue this year. These are figures that we have not seen in decades. The same happens in Sri Lanka or Pakistan, where there are thousands of infected. Health systems collapse due to the high number of patients and we inevitably lose patients.

Treatments for neglected diseases benefit everyone, not just the region that suffers from them today.

Kavita Singh, DNDI

Q. The DNDi has just formed a Global Alliance against Dengue, with institutions from several countries such as India, Thailand, Malaysia and Brazil, to precisely accelerate the research and implementation of a treatment against this disease in the next five years. Is it also an example of the effectiveness of South-South cooperation?

R. The knowledge, experience and years of work in the fight against dengue are in the Southern countries because that is where the majority of patients are, so the trials must take place in these countries. It is not that we want to leave out the Northern countries, but it is an initiative to work together, advance faster and achieve a true treatment against this disease, because for now it does not exist. We only limit ourselves to mitigating the pain and symptoms of the sick. We must not forget that today dengue occurs mainly in tropical countries, but with climate change, the vector may change and the presence of the disease may also change.

Most of these neglected diseases attack already impoverished communities and make them even poorer. It’s a hellish cycle

R. Each disease is different. There are some that are now controlled and removed from the list of public health problems. Others have treatment, but it does not reach the population, and there are others in which the best treatment does not yet exist, as occurs in Chagas disease, for example. In the case of sleeping sickness, DNDi has done incredible work with a drug that cannot yet be applied to all forms of the disease. Most of these 20 neglected diseases attack already impoverished communities and make them even poorer. It’s a hellish cycle. Therefore, our work will only be complete when a patient from a remote town in a tropical country can have a diagnosis and access to the best medication that exists for her illness without having to travel a long way.

Women are disadvantaged when it comes to accessing medicines and they do not have it as easy as men, in many cases.

Q. Right now, what are India’s biggest challenges in fighting these neglected diseases?

R. We always talk about the region, because diseases and vectors do not know borders. Over the past 20 years, we have made great progress in the treatment of visceral leishmaniasis, also known as kala random. Before we had three treatments, we did a study to compare their effectiveness and we saw that a single dose of a medication, liposomal Amphotericin B, showed very high effectiveness and should be the first option. This recommendation was included in the national programs and has transformed the panorama and, above all, has reduced the number of deaths. In India, for example, there were 18,000 deaths per year in 1990 and now there are around 800. This disease has complications and years later, there are patients who develop another variant, called Postkala-azar Dermal Leishmaniasis (PKDL, for its acronym in English). ), which causes serious skin lesions. At this time, a clinical trial has been completed and we are closer to implementing a simpler treatment without side effects. Reducing this disease and treating it early also implies stopping the social marginalization suffered by those affected, especially children and women.

R. From a strictly medical point of view, no, but women are hampered when it comes to accessing medications and they do not have it as easy as men, in many cases. Furthermore, they are more afraid of making their illness public, due to the weight of the societies in which they live. For example, if a girl or woman has skin lesions, it is not so easy for them to leave their homes and ask for treatment. That is why, for us, education is almost as important as the adoption of effective treatments.