This is where the pathogen lurks: Schistosomiasis is caused by a parasitic worm of the genus Schistosoma, which lives in standing water
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EMD intends to expand its commitment to the fight against schistosomiasis tenfold. This means increasing its annual donation to 250 million tablets in the medium term. Distribution in endemic African countries in cooperation with the World Health Organization (WHO) calls for sophisticated logistics.
Good logistics help to protect health. That has been the personal experience of about 21 million African schoolchildren who have been treated with the drug Cesol® 600 as part of the EMD Praziquantel Donation Program since 2008.
The drug, which contains the active ingredient praziquantel, is produced by EMD in Mexico. To date, the company has donated up to 25 million of these tablets annually to programs for combating the tropical disease schistosomiasis. In the medium term, EMD will increase its donation tenfold to 250 million tablets a year. According to the World Health Organization (WHO), the increase will help to close the supply gap for praziquantel.
“It's a tremendous logistical challenge.“
Head of Public Affairs
Together with WHO and the national health ministries of endemic countries, the pharmaceutical and chemical company is also making sure that the tablets reach their destinations promptly. Several thousand kilometers lie between Mexico and the 14 African countries that have benefited from the program so far. "It's a huge logistical challenge to order , produce, transport,, and distribute the drug to schoolchildren on schedule," says Frank Gotthardt, Head of Public Affairs at EMD and the project manager of this donation program. That's why a sophisticated logistics chain has ensured a smooth process from the very start of the program.
"The interface for all the transports is WHO, which has representative offices in all of the participating countries," Gotthardt continues. That's the procedure for a typical delivery to Nigeria, for example. In consultation with the Nigerian Federal Ministry of Health, WHO ordered 1.8 million tablets for the region surrounding the city of Jos in central Nigeria in early January 2012.
The EMD plant in Mexico subsequently ramped up production, and at the end of January the necessary documents were sent to WHO, together with a request to approve shipment to Nigeria. In February, WHO negotiated the air transport of the tablets from Mexico to Nigeria, where they arrived in early March at the airport of the country's capital city, Abuja. From there they were transported by truck to Jos, where they were centrally stored and then taken by the project workers by car to the individual dispensaries, which are generally schools or local health centers.
This complex but clearly organized structure will be more important than ever in the future, when 250 million tablets of Cesol® 600 will be distributed per year as the fight against schistosomiasis is expanded to other countries.
Ethiopia and Zimbabwe were included in the program for the first time in 2012. The careful planning and organization of the distribution of praziquantel is also due to medical considerations, because the purpose of the program is not only to treat people who are already ill but also to practice preventive therapy to keep schistosomiasis from spreading.
That's how the program's organizers plan to curb the transmission of the pathogen. This plan will work only if a certain minimum of all people living in a region are treated at the same time. "If we treat 75 percent of the vulnerable group with this drug at a certain point in time, this will have a long-term effect on the transmission of the pathogen in the region. That will of course benefit the whole society," explains Dr. Lester Chitsulo from WHO's Department of Control of Neglected Tropical Diseases in Geneva, Switzerland. He uses as his example the schoolchildren the program is focusing on.
Fighting schistosomiasis: EMD is planning to expand its praziquantel donation program. According to the WHO, the increase will help close the supply gap for praziquantel
Parallel to providing treatment with praziquantel, EMD has financed the publication of a comic booklet in collaboration with WHO to create awareness among schoolchildren about schistosomiasis - its background and the risk harbored by standing water, where the pathogen usually lurks.
Schistosomiasis is caused by a parasitic worm of the genus schistosoma, whose larvae live in water and penetrate human skin when they come into contact with it. Inside the human body, the larvae develop into mature parasitic worms whose eggs are excreted from the body via urine and feces.
The worms are also called paired blood flukes because after insemination the female lives in a fold of the male's abdomen. When the eggs come into contact with fresh water, ciliary larvae hatch from them, infest snails, and develop further inside the snails' bodies into larvae that once again infect human beings. Schistosoma worms initially attack a human host's liver, and from there they spread to other organs such as the bladder, the intestines, the lungs, and the brain. Chronic inflammation is the most common result.
The effects of an infection are especially serious for children, because schistosomiasis leads to anemia, retards growth, and limits the ability to learn. An estimated 200 million people in Africa suffer from schistosomiasis, and approximately 200,000 of them die every year. However, this disease can be effectively combated with praziquantel. A single dose already helps patients over the long term, according to Chitsulo. He adds that people who are members of groups at risk should basically be treated with this drug once a year.
EMD is forging ahead in the fight against schistosomiasis. "This is one of our lighthouse projects within the context of our sense of social responsibility. As a pharmaceutical company we bear a special responsibility for giving people in the developing countries access to certain drugs," says Gotthardt.
He adds that this is why the company will not only donate 250 million tablets annually in the coming years but is also looking for ways to make the active ingredient praziquantel available to children up to five years of age. Accordingly, the pharmaceutical experts are developing a new formulation based on a different method of administering the drug that is also suitable for infants. A great deal of know-how from EMD has already gone into the formulation and packaging of the drug. The tablets have been developed in such a way that they remain stable even in the hot and humid climate of the countries for which they are destined.
The tablets are delivered in large 1,000-unit special packs with a desiccant. Each package contains a tape measure to check the children's height so that the right dosage of the drug can be determined for each child's body size. Details of this kind are part of the intelligent logistics that are being used by EMD and its partners to combat schistosomiasis. EMD's long-term goal is to eliminate this tropical disease in Africa.
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