The Lancet. 2010; 276 August 28
www.thelancet.com
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Bernard Pecoul: championing the cause of neglected diseases
Scientists don't tend to set much store by superstition. Even so, for
Bernard Pecoul, then at Medicins Sans Frontieres (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 Pecoul took up with a passion.
Pecoul 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 fi eld 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, Pecoul's response
was to co-found Epicentre, MSF's centre for epidemiological research. In
the early stages especially, says Pecoul, the fledgling unit was strongly
guided by the US Centers for Disease Prevention and Control (CDC).
By the early 1990s, Pecoul 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, Pecoul 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. Pecoul 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 Pecoul 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. Pecoul 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,
Pecoul 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 commitment'. Sustainability
is a keyword in DNDi's lexicon, and Pecoul emphasises the importance of
'longterm 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, Pecoul 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.
Pecoul 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 Pecoul 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 Pecoul 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'.
Priya Shetty
priya4876@googlemail.com