Towards a world without sleeping sickness

Monday 31 January is the national day for the elimination of sleeping sickness in the DRC. The Institute of Tropical Medicine (ITM) in Antwerp has been working for years on neglected tropical diseases (NTDs), including sleeping sickness. The World Health Organization’s (WHO) NTD road map aims to eliminate the transmission between humans and tsetse flies by 2030. Belgium and the Bill and Melinda Gates Foundation made a commitment to this end. Together with its Congolese partners, ITM has the ambition to eradicate sleeping sickness from the world by then.

For more than 100 years, ITM has put its scientific expertise at the service of the fight against the deadly sleeping sickness. After a very low number of cases in the 1960s, sleeping sickness made a comeback in the Democratic Republic of Congo (DRC). When foreign aid was temporarily suspended, the number of cases rose to a peak of over 26,000 reported cases in 1998. The WHO estimated that the actual number was ten times higher. In response, Belgium again took the lead in the fight against sleeping sickness, assisted by the Bill and Melinda Gates Foundation.

From disease control to disease elimination

In 2020, the objective of bringing sleeping sickness under control as a public health problem was achieved. This means that in endemic regions today, less than one in ten thousand of the population is infected with sleeping sickness. Since then, ITM and its Congolese partners have a new challenge: by 2030, to interrupt the transmission between humans and tsetse flies, the insect that transmits the disease. This challenge amounts to the elimination of sleeping sickness, an ambition that has only been achieved for a few diseases, such as smallpox.

To succeed, a more targeted approach is needed, adapted to the context. This approach focuses on old outbreaks and hard-to-reach areas. In addition to mobile teams, diagnosis and treatment in primary care also play a role: patients are tested for sleeping sickness during their visits to local health care providers.

New drug for sleeping sickness

2024 will be a turning point in the treatment of sleeping sickness. The new drug acoziborole is expected to be available by then. One treatment dose is sufficient and there are few side effects. If the current safety studies confirm that acoziborole is so safe that it can even be given when sleeping sickness is suspected, without further diagnostics, this leads to a major switch from undertreatment to overtreatment. The drug would bring us a whole step closer to eradicating sleeping sickness.

Even without acoziborole, the ultimate goal of ridding the DR Congo of sleeping sickness is achievable, but it will take more time and resources.

Neglected diseases in the spotlight

Neglected diseases, such as sleeping sickness, leishmaniasis, dengue and chikungunya, are a group of 20 conditions which occur mainly in developing countries. The diseases are overshadowed by the big three: HIV/AIDS, malaria and tuberculosis. However, a billion people are at risk for neglected diseases, especially those living in poverty and poor hygienic conditions. At ITM, neglected diseases are high on the agenda. ITM conducts clinical, epidemiological and biomedical research activities to fight these diseases.