Coffee Break with Marcelo Abril. Mundo Sano.

“Pediatric treatment is available and free for those countries with children affected by Chagas disease”.

21 December 2017

He started very early. When the Argentinian biologist Marcelo Abril was only 20 years old he was raising a colony of Kissing Bugs and diagnosing Chagas diseases in the Instituto Nacional de Microbiología. Today, with the personal commitment to get closer to the field for a first-hand knowledge of the affected communities, he is director of Mundo Sano FoundationFrom its headquarters in Buenos Aires, we take a coffee-break to talk about the agreements of Mundo Sano with WHO and PAHO, particularly on care and control of congenital transmission, the providing of pediatric treatment and what it was the most commented news about Chagas this year:  the expectations after Benznidazol was registered in the U.S.

WHO released a collaboration agreement with Mundo Sano. Could you tell us a bit more about this agreement?

We are finishing the last details, but basically it is an agreement to ensure the donation of pediatric treatment of Chagas to all non-endemic countries. At the same time, we will collaborate in the update of data collection about the real dimension of Chagas at global level.

Lack of accuracy on Chagas data is an issue. Why this happens?

The WHO works on data coming from each country. But those data on morbidity, mortality or congenital transmission are very partial and fragmentary. That’s not any surprise because the lack of accuracy on global data reflects the level of how the people affected have been neglected in most of the countries. That’s why Chagas is a neglected disease.

Is there any alternative model to improve data collection and estimates?

Sure. WHO is dealing with some proposals and we are studying the ways to work on it. I think you should consult with doctor Pere Albajar, at the Department of Control of Tropical Neglected Diseases in Geneva, to have more details on that.

We will contact him soon. We take note.  

In addition, we will collaborate with PAHO in the ETMI-PLUS initiative, which included Chagas disease in the regional strategy for the improvement of control of congenital transmission for HIV, syphilis and hepatitis B. It is important because it has to do with providing attention to the people affected in two key moments: pregnancy and delivery. It means a great opportunity to screen mothers and give treatment to children who were born with the infection. It will allow us to screen other relatives and provide a comprehensive approach including vector control in endemic areas. If we are able to implement this strategy successfully in certain locations it will be a pilot case for all the countries affected.

Pediatric treatment in Latin America for free

Mundo Sano Foundation offered to Latin American countries the pediatric treatment for free. However, you haven’t received any order or request at the moment.

We reaffirm our commitment to send pediatric treatments to all the countries in Latin America. Chagas national programs just only need to request it through PAHO or to contact us directly. We invite them to send us their orders. The treatment is for free and it is available for all the countries in need of them.

May they be reluctant because of some lack of knowledge on Chagas pediatric drugs management?   

It is possible, but I am not sure about the reasons. However, we as Mundo Sano can not only deliver the treatments but also provide all the technical support and training needed.

Benznidazol in the US.

The news of this year was the registration of Benznidazole in the United States. What benefits and connotations do this news could bring for the people affected by Chagas disease?

The regulatory agency of the United States, FDA (Foods And Drugs Administration) approved the use of Benznidazole for patients of 2 to 12 years old. This decision was based on the scientific knowledge and evidences about the benefits of the drug. The next step is to get the registration of the treatment for a wider range of age. I would like to highlight the fact that the most stringent regulatory authority has approved this drug. That’s great news in front of some old doubts about how effective it was. The FDA confirms the Benznidazole therapeutic efficacy and its compliance with all security criteria.  

Does it mean that the FDA considers Benznidazole as an effective treatment only for children between 2 and 12 years old?

In fact that age range limitation has to do with the limitations of the Chagas diagnosis itself. This poses again the need to demonstrate with accuracy the cure of a patient treated and encourage Chagas community to continue working on biomarkers to prove the efficacy  of Benznidazole as well as any other new drug in the future.  

As a result of the registration, there is a Priority Review Voucher that the FDA gives to the owner of Benznidazole (Argentinian pharmaceutical group, Chemo). Is it a mechanism to stimulate the access to neglected diseases treatments?

Yes. The FDA provides this voucher to support the access to treatments of neglected diseases when a company registers a drug of one of those diseases for the first time in the US. The voucher is a kind of bonus to speed up the process of registration for any other product. So Chemo (the owner of the voucher) may transfer or sell the voucher to any other group interested in being prioritized by the FDA in a registration process.  

In other words, if I were the owner of another company interested in registering one of my drugs as soon as possible, I could buy that voucher to Chemo.

That’s right. And the commitment signed by Chemo, Mundo Sano and DNDi is to dedicate the 50% of the total amount received after the sale of the voucher to neglected diseases (25% for an access plan on Chagas and 25% for other neglected diseases among which Chagas may be also included)

Are there any figures expected? How much money we are talking about?

The voucher’s owner, Chemo, has not sold it yet. It takes time.

Mundo Sano works to improve neglected diseases treatments.

Finally, let’s talk about Mundo Sano Foundation. You have projects in so different countries as Argentina, Spain and Ethiopia

We were born in Argentina, but our commitment is to work on neglected diseases. From the beginning we mainly focused on vector control but later we started to cover other mosquito-borne diseases and helminthiasis. From Spain we work in partnerships with other institutions as Instituto Carlos III and ISGlobal in some projects in Mozambique and Ethiopia. We are also working in the improvement of new regimes and treatments for helminthiasis as well as for Chagas disease.

And now when we are finishing our coffee, let us ask you a personal question. If you haven’t met the world of Chagas disease, where would Marcelo Abril be working today?

Oh, that’s a difficult question. I don´t know where I would be today because in fact I started very early with this issue. I began as a scientific interested in parasites and vectors and finally I get more passionate about all the challenges we face in these kind of diseases, not only at health level (strictly speaking) but also at development, education and infrastructure level and all the social aspects. It is hard to get out of this world. It is so fascinating.

In may case, I could not be satisfied with monitoring and analyzing the disease only from the lab or from a desk. I need to go out to the field, to talk to the people. My personal commitment is to be in contact with the reality as close as possible. The direct knowledge acquisition is irreplaceable.

Then you are a mix of a lab mouse with a field mouse.

Well, something like that. Yes.