Novel Financing Model for Neglected Tropical Diseases: Development Impact Bonds Applied to Sleeping Sickness and Rabies Control

Abstract

'Jakob Zinsstag'] Sleeping sickness, or human African trypanosomiasis (HAT), epitomises the concept of a “neglected tropical disease” [1]. The history of HAT reads like a Hollywood parody of Homeric pestilence. Both the chronic and acute forms of HAT are exclusively confined to sub-Saharan Africa, where they affect the poorest of the rural poor-thriving in weak health systems and conflict zones-and where they have been responsible for massive historic epidemics [2]. Both forms of the disease are invariably fatal if not treated, but available therapies are difficult to administer, highly toxic, and increasingly pose problems of drug resistance [3]. Diagnostics are complex, and the procedures needed to sanction the more toxic treatments are difficult, painful, and dangerous, resulting in massive underreporting [4, 5]. The cunning ability of the causative parasites to evade the immune system has made a mockery of attempts to develop vaccines, and any continued protestations of a vaccine breakthrough on a meaningful timescale are, at best, wishful thinking [6]. Finally, the hope of control through targeting the disease vector, the tsetse fly, has (for the most part) eluded cost-effective, sustainable, large-scale delivery [7]. In the face of such challenges, the talk of effective disease control-elimination even-may at best be thought misplaced optimism and at worst detracting limited resources from a focus on further research to develop better tools for the future. However, disease elimination is a stated aim of the World Health Organization, and the moral imperative must be to deploy control tools to save lives now [8]. Successes arising from a small number of well-run programmes give confidence that even with existing tools, as limited as they may be, effective control-and in some areas elimination-is a realistic target [9]. The main challenge to realising these benefits is securing the necessary financing to enable appropriately designed interventions to be sustainably delivered at scale immediately [10].