Dr Monique Wasunna: “Health is the keystone we need to move.”

Dr Wasunna is a physician and an infectious disease and tropical medicine specialist from Nairobi, Kenya. She joined the Drugs for Neglected Diseases initiative (DNDi) in 2003 and is the Director of the DNDi Africa Regional Office.
Dr Wasunna leads DNDi’s activities in Eastern Africa. She is a founding member and former Chair of the Leishmaniasis East Africa Platform (LEAP), which promotes clinical research for Leishmaniasis and capacity building in the region.

What is DNDi and how did it come into being?
The Drugs for Neglected Diseases initiative (DNDi) is a non- profit, patient-centered drug research and development organization that was founded in 2003. In 1999, Médecins Sans Frontières (MSF) was awarded with the Nobel Peace Prize and dedicated part of their prize money to the development of treatments for Neglected Tropical Diseases (NTDs), since there were hardly any affordable medicines that they could use to treat patients in their field work. As a consequence, MSF came together with other founding partners, and created DNDi: The Drugs for Neglected Diseases initiative.
Today, we have regional offices in New Delhi, Nairobi, Cape Town, Kinshasa, New York, Tokyo, Kuala Lumpur, and Rio de Janeiro, which collaborate closely with our headquarters in Geneva.

What has been the mission of DNDi’s work and how has it developed over time?
Our mission is to work for the poorest and most vulnerable people in the world, who are dying because drugs for NTDs are either unavailable or unaffordable.
In 1999, the lack of treatment for neglected diseases could be traced back to a lack of pharmaceutical companies investing in costly drug development for patients that were too poor to be considered “a profitable market”.
If a disease counts as a Neglected Tropical Disease (NTD) as defined by the World Health Organization (WHO), and DNDi decided to focus on the most neglected among them: Leishmaniasis, Sleeping Sickness, and Chagas Disease. In addition to that, we worked on Malaria, which was still a huge problem in 2003. Today, however, Malaria is dedicated a lot of funding for research and development.

DNDi works in collaborations and across sectors. Why do you consider this approach so crucial for your success?
Partnerships are incredibly decisive for creating easier lives for the poorest of the poor who do not have a voice in public discourse.
When DNDi was founded in 2003, we created our own platform for Leishmaniasis together with stakeholders from Kenya, Uganda, Ethiopia and Sudan: Experts in Leishmaniasis, doctors, representatives from health ministries – anyone who wanted to contribute with their ideas – came together to discuss the conditions for sustainable Leishmaniasis treatment with affected communities.
While the original treatment was administered as injections for 30 days, the clinical trial carried out by DNDi/LEAP and partners reduced it to two injections daily for a duration of only 17 days. As a result, the length of time spent in hospital was reduced and hospital costs could be saved. After reviewing the data from the LEAP clinical trial, WHO accepted the trial results and recommended this new form of treatment to the Eastern African region as the first-line treatment for kala-azar or visceral Leishmaniasis. Subsequently, these countries added the treatment to their Essential Medicines Lists and changed the kala-azar National Treatment Guidelines.

Another example is the Human African Trypanosomiasis (HAT) platform created by partners in HAT endemic countries in Africa, DNDi, and our regional office in the Democratic Republic of Congo (DRC). HAT is similar to LEAP, but whereas the latter was created by DNDi, the HAT Platform includes over 20 individual institutions with their own networking programs.
In November 2018, Fexinidazole, the first all-oral drug for both stages of Sleeping Sickness developed by DNDi, was clinically approved. The HAT platform used Fexinidazole in many countries, whereupon the drug was recommended by the European Medicines Agency and officially registered as a treatment for Sleeping Sickness in DRC. This far-reaching impact would not have been possible if DNDi had not had the foresight to create platforms and partnerships right from the beginning.

How do you see Germany’s political engagement for fighting NTDs?
Federal Chancellor Angela Merkel has proven to be a big supporter of fighting NTDs. She introduced the issue both the G7 and G20, and has consistently retained commitment to tackling NTDs, most recently through initiating the SDG 3 Action Plan, together with Ghana and Norway. In addition, Germany is the first European country who has created a national initiative for Global Health. This interministerial initiative is currently drafting a White Paper on Germany’s Global Health strategy. Moreover, Germany has established a cross-party Parliamentary Sub-Committee on Global Health.

Yet, I would like to see more direct cooperation with the health ministries of affected countries. Some countries, such as Kenya, are running NTD national programs that align all the relevant stakeholders, so an overview already exists that development agencies could profit from.
Moreover, we have to change the mindset of our leaders: Health is a human right! DNDi can do the research and development, and deliver innovation to patients, but the ministries of health need to improve the facilities, including laboratories, so that we can conduct trials properly and without interruptions. Without innovation, Universal Health Coverage will not be achieved.

From your point of view, what is the biggest Global Health challenge the world is facing at the moment?
For me personally, the most important thing is that we leave no one behind. Eliminating NTDs, for instance, requires effective treatments, diagnostic tools, and education, which are dramatically lacking in remote communities. Diseases like Chagas are silent killers: People infected with the disease might not look or feel sick, until they suddenly collapse because of cardiac problems. We talk about neglected diseases, but it is the neglected people left behind that we have to focus on.

The recent Global Fund replenishment was a big step into right direction. With $US 14 billion, we should empower countries by asking them to create specific and timely agendas, and to define the key priorities for the health of their populations.
Investing in health creates the kind of prosperous economies that enable people to remain in their home countries. Global challenges always appear as chain effects, and health is the keystone we need to move.
Last but not least, partnerships are key. We have achieved a lot since DNDi was created because we opened doors to others and they opened their doors to us. We need everyone to contribute, to listen, and to learn.

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