After Malaria, What is the World's Deadliest Parasitic Disease?

By Brian Lowther

There is a parasitic disease that kills about 500,000 people worldwide every year called black fever. That makes it the second most deadly parasitic disease in the world after malaria. Actually the medical name for this disease is visceral leishmaniasis (VL). But in India, where it is rampant among the poorest of the poor, it is called kala-azar, or black fever. If you get black fever you die a slow agonizing death as the parasite destroys your liver, spleen and bone marrow.

But here is the crazy thing: black fever is curable. All you need is an antibiotic called Amphotericin B.

So what’s the problem?

Amphotericin B is expensive. The people who need it most would have to work for an entire lifetime to afford it. If you put this in equivalent terms, this medication would cost the average American (making a  $40,000 per year salary) $1.7 million.

Enter Victoria Hale. She had an interesting mix of expertise that allowed her to see a solution to this problem. First she was a pharmaceutical scientist. Second she was a veteran of both the biotechnology industry and the FDA.

Her solution: create an effective and safe drug and distribute it for free.

To do this, there were three steps.

  1. Create the drug. The pharmaceutical industry could easily do this, but research and development is very costly.
  2. Make sure the drug is effective and safe. Again the pharmaceutical industry could do this but their clinical trials are a very expensive and lengthy process.
  3. Distribute the drug to the people that need it.This is where the pharmaceutical industry couldn’t offer much help. For a pharmaceutical to get involved they’d have to believe that they could sell the drug at a high enough price to cover their overhead and produce a profit for their shareholders. This certainly wasn’t the case with black fever. But there was another option available: the Public Health model. This model is built to distribute drugs to the people who need it, but it doesn’t create the drug, or make sure the drug is safe and effective.

Hale’s genius was to launch a not-for-profit pharmaceutical company that would use the strengths of pharmaceuticals and the public health model and eliminate the weaknesses. Thus she launched the Institute for OneWorld Health in 2000 at the age of forty.

Instead of creating a new drug, Hale knew from her experience at the FDA that many promising drugs became abandoned because they were unprofitable. So she and her colleagues at IOWH searched for an abandoned medication that might work. Before long they found an antibiotic called Paromomycin, which originally came on the market in 1961 but was discontinued fifteen years later because it wasn’t profitable.

Next she got the drug tested and approved with funding from philanthropic foundations. Then she turned to governments to facilitate the distribution.

“Because the cost is a mere $10 per patient for a full course of treatment, the government of India was able to cover the entire cost for its citizens. IOWH is lobbying the other countries with large numbers of black fever sufferers to follow suit.”
The Opposable Mind: Winning Through Integrative Thinking By Roger L. Martin

I’m convinced that there is a group of believers out there who will be inspired by Victoria Hale and will pool their resources and resolve to eradicate black fever. Maybe they’ll follow her example to develop a vaccine. Because while Hale’s astounding work is absolutely crucial in alleviating the suffering caused by black fever, it won’t place black fever in the archives of human disease. For that to occur the immune systems of every susceptible person on earth must be able to destroy the parasite. For that to occur a vaccine is necessary. Currently there is no vaccine for black fever.

Posted on April 19, 2012 and filed under First 30.