Millions deprived of life-saving antifungal medicines
August 11 2016
The world is in the grip of a global crisis that kills the equivalent of the populations of Philadelphia, Kampala or Prague, - around 1.6 million each year. A new report published today in the Journal of Antimicrobial Chemotherapy, documents how many countries do not have life-saving antifungal therapies.
Now GAFFI (The Global Action Fund for Fungal Infections) has published the largest survey ever undertaken from 159 countries and found that a pair of critical antifungal medicines for AIDS patients are not available in over 95 countries. One of these antifungals has been available since the 1950’s and the other since the 1970’s.
Professor David Denning, President of GAFFI and the paper’s lead author says it beggars believe that hundreds of millions of people cannot access the optimal therapy for fungal meningitis and fungal lung infections.“It is doubly tragic,” he says, “that these antifungals have been used since the late 1950’s in the case of amphotericin B. Yet the systems for delivering these drugs to the most needy are still not in place".
“Last year GAFFI called on governments to provide fungal diagnostics and antifungal drugs to all their citizens yet there has been a deafening silence. There is clearly a long way to go, but the tragedy is that every day thousands more people die needlessly while the world turns a blind eye,” he adds.
Dr Glenda Gray, President and CEO of the African Medical Research Council and Professor of Paediatrics, Faculty of Health Sciences, at University of Witwatersrand, says: “In South Africa we are addressing the HIV epidemic squarely on with greatly increased provision of anti-retroviral drugs and expanding testing. Fungal diseases in AIDS have not received the priority they should have, although this is now changing with our national screening program for cryptococcal meningitis. Clearly ensuring antifungal agents are available to all is an key component in reducing deaths and illness across southern Africa".
Lowest daily cost of fluconazole treatment based on 750–800 mg by country in 2016. All prices in US$, converted from local currency as data received from 2013 to 2016
- One of the critical drugs for fungal meningitis (amphotericin B) is not available in 42 countries.
The other key drug for fungal meningitis, flucytosine is not licensed in and is unavailable in 89 of 125 (71.2%) and 95 of 125 (76.0%) countries, respectively, representing an unserved population of 2898 million. The daily price of flucytosine varied from $4.60 to $1409.
Yet both Amphotericin B and flucytosine have been available in Europe and the US for over 40 years. The World Health Organisation recommends they are used together to bring down mortality from 100% to 25%.( Fungal meningitis is the commonest form of meningitis in sub-sarahan Africa because of AIDS).
The 25 year old drug, fluconazole is available in all countries and itraconazole is unavailable in just five countries. However, being available is not enough – cost matters as patients pay for their care in many countries. The daily cost of fluconazole varied from <$1 to $31 and itraconazole from <$1 to $102.
In South Africa, which has the largest AIDS burden in the world and a massive TB problem, itraconazole costs about £11.60 per day – unaffordable for most people there.
Hollywood actor and GAFFI celebrity patron Rupert Everett declared that: ‘We have known for over 25 years that many people with AIDS and cancer die of fungal complications. And death is avoidable with treatment. Why on earth are commonly used antifungal medicines not provided to everyone who needs them?.”
Article published in Journal of Antimicrobial Chemotherapy,
Global access to antifungal therapy and its variable cost, Matthew Kneale; Jennifer S. Bartholomew; Emma Davies; David W. Denning
Journal of Antimicrobial Chemotherapy 2016; doi: 10.1093/jac/dkw325