Research to support the elimination of visceral leishmaniasis: Business Plan 2008-2013
Visceral Leishmaniasis (VL) is a fatal disease with an estimated incidence of 500,000 cases per year. Of those, 60% occur in the Indian subcontinent (India, Bangladesh and Nepal) mainly amongst the poorest population groups living in rural areas. Diagnosis and treatment of VL has always been very difficult, but the recent developments of new drugs (e.g. miltefosine - first oral drug for VL - ambisome and paromomycin) and diagnostics (rK39 - rapid diagnostic test for VL) has created a major new opportunity for improved control or even elimination of VL. Given the unique epidemiological features of the disease in the Indian sub-continent, namely (i) human beings are the only reservoir (ii) there is only one vector species which is amenable to control and (iii) the geographical distribution is limited, the elimination of VL is truly a realistic possibility. Furthermore, there is political commitment at the highest level with the Ministers of Health of Bangladesh, India and Nepal signing a Memorandum of Understanding at the World Health Assembly in 2005 for joint efforts to eliminate VL from the Indian Subcontinent by the year 2015. The elimination initiative has been facilitated by WHO as a whole and notably through its South East Asian Regional Office and has attracted the interest of several donors. However, to achieve elimination, major hurdles will have to be overcome and research is needed to further improve intervention tools and provide evidence on cost-effective and appropriate implementation strategies.