A new three-drug combination could pave the way for tackling the lymphatic filariasis (LF) scourge in India. The Union Health Ministry will administer the combination, including Ivermectin, a new drug that has been introduced in the therapy.
Ivermectin is manufactured by the US-based pharma giant Merck in a pilot project.
Target States
The pilot rollout of the new three-drug administration protocol – Ivermectin, Diethyl Carbamazine and Albandazole – will be initiated in five States; Uttar Pradesh, Bihar, Jharkhand, Karnataka and Maharashtra.
The rollout will see a mass drug administration (MDA) campaign in endemic districts as half of India's population is susceptible to LF infection. Scientists say that preventive consumption of the drug will cease the scourge from blowing up.
The case for three-drug combo is being made after India failed to control LF with the two-drug combo of Diethyl Carbamzine and Albandazole. “In Karnataka, even after several rounds of giving the two-drug combo, people were still infected,” a State health official said.
Merck has the capacity to supply 100 million doses of Ivermectin annually to India. It will mostly be donated. LF is spread by mosquitoes and close to half the population of India (65 crore people) are susceptible to parasitic worm burden in the body.
Disease risk
“Nearly four to 11 per cent of those who have the infection will go on to develop painful conditions such as like an elephant foot or swelling in the private parts,” said NK Ganguly, reputed microbiologist and former director general of the Indian Council of Medical Research.
Yet to be published data from global trials for testing safety and efficacy of the three-drug combo, conducted by Bill and Melinda Gates Foundation (BMGF), have shown promising results in infected population, said Julie Jacobson from BMGF. “The majority of those who were administered the three-drug combo were cured of the infection,” Jacobson told BusinessLine .
Up to 21 States and Union Territories, that include 256 districts, are reeling under a high burden of LF. In 2017, as many as 8,62,815 patients across India developed lymphoedema, swelling in arms and legs due to late detection of LF. Bihar alone had 25 per cent of these cases, up to 2,16,666 patients. Other high burden States are Jharkhand, Uttar Pradesh, Odisha and West Bengal.
Challenges
“Resistance of masses when it comes to 'Night Blood Survey,' where a field person collects blood samples between 10 pm and 2 am in susceptible populations as also issues in decentralizing drug supply have created obstacles in the programme,” said Nupur Roy, Additional Director, National Vector Borne Disease Control Programme (NVBDCP).
Also, there are issues of lack of human resources. In Bihar, for example, of 1,221 sanctioned public health posts to tackle LF, 779 are lying vacant, said RK Yadav, a State health official at NVBDCP.
India has repeatedly missed deadlines to eliminate lymphatic filariasis, last one being in 2017. In 2002, National Health Police set a goal for wiping off LF in India by 2015, which was further extended to 2017. India has now extended the deadline to 2020, Union Health Minister JP Nadda said in New Delhi on Wednesday.