ABU DHABI — Abu Dhabi’s crown prince and the Bill & Melinda Gates Foundation on Wednesday launched a $100 million fund to eliminate river blindness and lymphatic filariasis from key countries in Africa and the Middle East.
Reaching the Last Mile Fund is a 10-year facility that will be hosted at the END Fund, a multi-donor platform focused on neglected tropical diseases. Crown Prince Sheikh Mohammed bin Zayed Al Nahyan will contribute $20 million to the fund, and the Gates Foundation will add up to $20 million. This confluence of influential backing then hopes to “kickstart a rally of donors” to the fund, said Maha Barakat, board member of the Roll Back Malaria Partnership.
The fund builds upon and expands the role that Abu Dhabi has carved out in combating preventable disease. The country’s crown prince has donated $250 million of his own wealth toward combatting polio, malaria, guinea worm, and other NTDs since 2010, Barakat told Devex. Meanwhile, the crown prince’s convening power — the UAE is a key ally of many affected countries, as well as traditional donors — has galvanized attention and funding.
Along with the fund, announced at the Reaching the Last Mile Summit in Abu Dhabi on Wednesday, the Crown Prince and Gates Foundation also announced the creation of a disease elimination institute to translate data and technological advances into policy.
The fund focuses on river blindness and lymphatic filariasis, two diseases where experts believe eradication is within sight. The aim of the fund will be to take this advantageous starting point and fund the implementation of programs to surveil, treat, and then ultimately eradicate the two diseases.
“It is possible,” said Barakat. “The last few decades have shown that what wouldn’t have been possible, is possible.”
River blindness today is endemic in 29 countries, while LF is present in 53. Both diseases take a heavy toll on infected individuals and their surrounding communities. Patients often find it difficult or impossible to work, or are surrounded by negative stigma.
Drugs used to combat the two parasitic diseases overlap — but until now, that synergy has rarely been taken advantage of. Advocates hope that the joint fund will finally bring two siloed public health communities together. “It makes so much sense to work together, but they haven’t,” said Frank Richards, director for the Carter Center’s River Blindness Elimination, Lymphatic Filariasis Elimination, and Schistosomiasis Control Programs. “Why they haven’t is multifactorial, but now is a time when they should.”
The first factor that sets the stage for eradication is the donation by Merck of key drug Ivermectin, which primarily treats river blindness, but has an impact on LF as well. GlaxoSmithKline plc, meanwhile, is donating Albendazole, a de-worming agent. The World Health Organization in September certified a treatment regime using those drugs that requires just one to two years, down from five to seven years with the previous combination therapy.
NTDs “have rarely had the interest, resources, and energy, and now we’ve had a sustained shift in that, both through the generosity of some of the big pharmaceutical companies and the donations they are making,” Gates Foundation Chief Strategy Officer Mark Suzman told Devex.
“But you still need implementation resources to get to that last mile.” Reaching the Last Mile Fund, he said, will “help bring in the human resources that are needed to administer these campaigns out in the field.”
Affected countries themselves are also prioritizing NTDs — a vital component to effective eradication. Four countries in Latin America, for example, have recently been certified by the World Health Organization as having eliminated the disease. Others are looking to that example.
“These are not a small projects; these are huge campaigns, and huge parts of [affected countries] health systems need to be mobilized,” said Ellen Agler, CEO of the END Fund, told Devex. “There is no way to do that without a national plan.”
The END Fund model will aim to fill in gaps, plug holes, and give the added push needed to move from disease control to eradication. Its setup as a multi-donor fund allows for the flexibility to tailor specific programs for individual countries, as well as to partner and coordinate with large donors such as the U.S. Agency for International Development and the U.K. Department for International Development, Agler said.
Specifically, the fund could support interventions such as technical assistance, implementation programs by international NGOs, or even health ministry budgets or initiatives. It will work in “demonstrating success in last mile countries, scaling up activities in difficult settings, and providing ongoing support for last mile elimination efforts,” according to the Crown Prince’s Court.
The fund will have its eyes both on immediate gains and the long fight ahead. Both are important to combat NTDs, Dean G. Sienko, vice president for health programs at the Carter Center, told Devex.
“As we make progress and demonstrate proof of concept — that indeed this can be done — that spurs others to continue with the effort,” he said.
One anticipated gap, for example, is in the laboratory capacity to surveil river blindness. The Gates Foundation has separately committed to mapping river blindness prevalence. Monitoring the disease, however, will require ongoing efforts that are both laborious and technical. River blindness is transmitted by the black fly, a vector that will need to be monitored in addition to human patients. Catching enough flies today requires someone to stand in the water with their pant leg rolled up and wait for a fly to land, Agler said. Those specimens then need to make it to labs, staffed by specialized technicians.
Few countries have enough lab capabilities, and expanding these systems could benefit other diseases, in addition to river blindness, she said.
In addition to the technical pieces falling into place, global health has seen a crucial mentality shift that now makes this fund possible, partners told Devex. Polio’s near-eradication — and recent progress in particular — has demonstrated what’s possible, they said. The UAE has deepened its engagement with each subsequent initiative, for guinea worm, polio, malaria, and now NTDs.
“It’s been an interesting journey with UAE in terms of their own deepening engagement of the issues,” Suzman told Devex. “As each partnership has delivered more results, it helps lay the groundwork for the next.”
Architects of the new fund say that the UAE’s role goes beyond funding, to active participation and political influence. In combatting polio, for example, the UAE helped galvanize and even administer vaccinations in Pakistan’s rural Federally Administered Tribal Areas, a longtime stronghold of the disease that had resisted previous campaigns.
In river blindness and LF, the UAE could leverage its political role. Transmitted by vectors that know no borders, the diseases cannot be eradicated without cross-border collaboration, at times between countries that are otherwise at odds. It may be crucial to have a mutual ally at the table who can “use health as a bridge to peace,” Agler said.
Getting toward eradication “takes the commitment of tens of thousands of community health workers, but also at the highest level of global health,” she said. “I think that’s where having the crown prince’s engagement to bring a level of credibility and convening power and a level of attention to these diseases — that gives all of us a sense of real hope and optimism that we can achieve.”