Course Code: Health 601

Course Title: Epidemiology

Course Instructor: Mr. Sauvik Ghosh chowdhury Academic Task No. 1 sickness in Africa Date of Allotment: 2/9/13 Academic Task Title: Sanofi Aventis: Fighting sleeping

Date of submission: 16/9/13

Students Roll no: A08 Students Reg. no: 11203968 Evaluation Parameters: (Parameters on which student is to be evaluated- To be mentioned by students as specified at the time of assigning the task by the instructor)

Learning Outcomes: A brief idea about sleeping sickness, its causes, factors for spreading it and its control. How Sanofi Aventis and WHO tackle to control Sleeping sickness?

Declaration: I declare that this Assignment is my individual work. I have not copied it from any other students work or from any other source except where due acknowledgement is made explicitly in the text, nor has any part been written for me by any other person. Students Signature:

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INTRODUCT ION Sanofi-aventis is the largest pharmaceutical company in Europe and the fourth largest in the world with a presence in 88 countries headquartered in Paris, France. The guiding principle of sanofi-aventis business activity is, discovering and developing innovative and well-tailored treatments and making them available to doctors and their patients. In 2001 Sanofi-Aventis began a partnership with the World Health Organization (WHO) to fight sleeping sickness and other neglected diseases affecting the world s poorest populations. Initial discussions with the WHO highlighted that a simple drug donation was not enough. The setting up of this department was in fulfilment of sanofi-aventis corporate strategy, an integral part of which was based on the principle that healthcare is a right and a right that all should enjoy. Only combined actiondrug donation, subsidies to fund distribution programmes and new research and development to improve treatments and diagnosticscould create a reasonable chance to bring sleeping sickness back under control. Over the first five years, 36 African countries benefited from the partnership. Nearly 110,000 lives have been saved. The case examines the special challenges and opportunities facing the partnership and the innovative ways that it has remained viable. Above all, it demonstrates the unique leadership role that a private firm like Sanofi Aventis can play by applying its talents and resources. In October of 2006, Sanofi-Aventis and the WHO renewed their collaboration with a new agreement covering an extended range of neglected tropical diseases and an additional commitment of US$25 million over the next five years. This case examines the special challenges and opportunities faced by this partnership and the innovative ways in which the partnership has been kept strong and sustainable. It also discusses some of the challenges faced by this programme in delivering effective healthcare to the rural poor, because many live in remote parts of Africa.

WHAT IS SLEEPING SICKNESS? Sleeping sickness, also called "human African trypanosomiasis", is a widespread tropical disease that can be fatal if not treated. It is spread by the bite of an infected tsetse fly ( Glossina Genus), a species native to the African continent. Sixty million people who live mainly in rural parts of East, West and Central Africa are at risk of contracting sleeping sickness. CAUSES Sleeping sickness is caused by two germs, Trypanosoma brucei rhodesiense and Trypanosomoa brucei gambiense . The more severe form of the illness is caused by T. rhodesiense . Tsetse flies carry the infection. When an infected fly bites you, the infection spreads through your blood. Risk factors include living in parts of Africa where the disease is found and being bitten by tsetse flies. The disease is very rare in the United States, and is only found in travelers who have visited or lived in Africa.

SYMPTOMS General symptoms include: Anxiety Drowsiness during the day Fever Headache Insomnia at night Mood changes Sleepiness (may be uncontrollable) Sweating Swollen lymph nodes all over the body Swollen, red, painful nodule at site of fly bite Weakness

TREATMENT Medications used to treat this disorder include: Eflornithine (for T. gambiense only) Melarsoprol Pentamidine Suramin (Antrypol) Some patients may receive combination therapy

SLEEPING SICKNESS PREVALENCE IN AFRICA The diseases flourishes mainly in the impoverished part of rural parts of Western and Central Africa WHO has documented a number of epidemics of sleeping sickness in Africa in the last century: one between 1896 and 1906 in Uganda and the Congo Basin, one in 1920, and the most recent one in 1970. The re-emergence of the disease from the 1970s, after almost disappearing in the 1960s (it was reduced to less than one case in 10,000), was due to a relaxation of surveillance and control efforts. By 1998, almost 40,000 cases were reported with an estimated 300,000 to 500,000 undiagnosed and untreated cases. In the Democratic Republic of the Congo (DRC), Angola and Southern Sudan, sleeping sickness prevalence reached about 50 percent in some areas, making it endemic in these countries. Subsequently, in these areas sleeping sickness became the first or second greatest cause of mortality. NEGATIVE REPERCUSSION OF SLEEPING SICKNESS DUE TO POOR SOCIO ECONOMIC CONDITION IN AFRICAN COUNTRIES This disease affects the people who are marginally poor in living standard who depend mainly on land for livelihood. The disease can therefore perpetuate the poverty-disease cycle, because it affects people mainly in the productive age group. Children affected by sleeping sickness are likely to delay their mental development even after successful treatment of the disease. This negatively impact the education and consequently their future livelihoods

STEPS TAKEN UP BY BOTH THE PARTNERSHIP Sanofi Aventis initially considered just donating free medicines to the WHO Later a combined action of drug donation, subsidies to fund distribution programme and new research and development to add on the existing measures An innovative mechanism of working together between the Sanofi Aventis and WHO along with distribution linked to NGO (DOCTORS WITHOUT BORDERS/MEDICINES SANS FRONTIERES) The combined workforce works together shaping and implementation of an effective health strategy against sleeping sickness in Africa Evaluate the rhythm of drug delivery processes, the efficiency of treatments, the progress of diagnosis programmes and health worker training modules. This assessment is done every six months with data obtained from the field through WHO missions as well as government agencies. Other signatories (TROPICAL DISEASE RESEARCH), AN ENTITY COMPRISED of representatives from WHO, WORLD BANK, UNDP, UNICEF conducts clinical trials involving new treatment for neglected tropical diseases ROLE OF WHO WHO defines and shape public health strategies to help combat sleeping sickness and other tropical diseases Healthcare personnel are trained in the beneficiary countries Helps in coordination of distributing of therapeutic drugs to patients Strengthen and coordinate control measures, and ensure that field activities are sustained. The existing surveillance system is monitored to strengthen in endemic countries. The three drugs necessary quantities are regularly forecasted and sent to Sanofi Aventis to manufacture to cover the expected patients need accordingly. The quantity of the three medicines are determine which should be sent to which countries and provide Doctors Without Borders the necessary orders of expedition ROLE OF SANOFI AVENT IS All the three drugs (pentamidine, melasorprol and eflornithine) are made available for the treatment of sleeping sickness are made free of charge, distributed in a timely manner and in quantities fixed by WHO according to regular needs forecasts. Manufacturing units of those are transfer to developing countries to help reduce the cost. This has been done for pentamidine and eflornithine, where an Indian subsidiary has been sub-contracted to manufacture these drugs. Funds are provided to allow WHO to strengthen programmes which are aimed at controlling the diseases which includes activities like campaigns for routine screening of populations which are at higher, monitoring the epidemiological progression in infested areas and the training of healthcare personnel. Support WHO/Tropical Disease Research efforts in research and development of new treatments.

RESULT OF THE PROGRAMME Decrease death from sleeping sickness The partnership increased screening from a level of 1.8 million people in 1998 to almost 3.3 million people in 2004 and treatment which reduce sleeping sickness related mortality significantly and nearly 110000 lives have been saved. Number of new cases being reported has also been decreased Increase accessibility and affordability to better healthcare Sanofi Aventis provided free medicines to those affected with diseases about 350000 ampoules of medicines for the treatment of 45000 patients. thus helping in reducing the number of death due to sleeping sickness sustained livelihood This disease has a negative impact towards the livelihood of the people because these people are mostly farmers or pastoralist. This programme offer good health which helps to sustain the livelihoods of a large number of poor people in Africa. Human capital growth Education has been established by the correlation between the health of an individual and the ability to accumulate wealth. Therefore it is necessary to fight against this disease that can potentially affect the human capital by hampering in the education. MAJOR PROBLEM FACED BY THIS PROGRAMME Cost Due to limited resources of poor people a huge investment has to be made for exhaustive screening of the population to identify patients at the early stages and reduce the transmission. Providing the medicine free of cost, delivering and administering them, etc was expensive. Remoteness of diseases prone areas Most of the affected region was very remote, hard to reach the infected individual or those at risk pose a great challenge. In such situation, the patients may die before they are diagnosed or treated Civil strife and conflict Political issues which are confined to the prone areas sometime resulted in the ability to detect the infected people and keep the population at risk. Even some of the migrants can no longer participate in the screening activities Inadequate health personnel and infrastructure African countries lack a good infrastructure and have shortage of health personnel. Neglected diseases People often neglected the diseases though the disease is more visible in the public and political agenda due to low expenditures on public health.

HOW MAJOR CHALLENGES ARE ADDRESSED Financial support for the screening programmes and donation of drugs has help to reduced to cost dramatically. The government in the countries also helps them in utilizing the resources well in fighting against the disease. Healthcare personnel were also trained with the help of training programmes and numbers of personnel were also increased and were able to treat and diagnose the disease. These training programmes are organized every year for nurses and doctors over a three-week period, with the costs paid for under the sanofi-aventis programme The significant raise in the awareness has gain prominence in the political agenda. New research and developments for new diagnostics and treatment options are made. In 2005, an African Union was endorsed which was seen as a final push to control the disease for and bring eradication one step closer to reality.

SUGGESTION More Healthcare organizations should come together to control more other tropical diseases as this develops trust and confidence and are essential for success. This also makes them more flexible in dealing the problems, easy in handling the diseases. Collaboration enhances the visibility of both the organizations aim thereby making it easier to achieve their individual goal or common goal. This collaboration will help the company to be seen as a public health contributor especially in are where no profit is to be expected. This also makes them more strong internally bringing cohesiveness between them as a result they will be able to provide effective cures to illness wherever it can.

FUTURE PROSPECT A replica of the programme can be made to control other tropical diseases Small organization can team up with WHO which provides a good platform for reaching the poorest of the poor CONCLUSION The partnership brought a quite successful result. The partnership which has been extended to tropical diseases can positively impact many lives in developing countries. The time has come to work on the process of eliminating the disease despite the difficulties, obstacles and the threat. Without such approach, there will be stagnation in the control and surveillance like the one occurred in 1960 that ultimately led to the return of the disease. There is no doubt that new tools would facilitate the elimination process and the sustainability of results; thus, funding efforts for HAT control and research must continue based on public health objectives, and no longer on the burden of the disease.