This Podcast Will Kill You - Special Episode: Human African Trypanosomiasis & Drug Development

Episode Date: February 15, 2022

Our episode last week ended on a hopeful note, a rare occurrence for this podcast, and it was due in large part to the incredible decline in reported cases of human African trypanosomiasis (HAT) over the past decade. In this bonus episode, we explore one of the major reasons behind this drop in HAT: the new medication fexinidazole, developed through a partnership between the Drugs for Neglected Diseases initiative (DNDi), a non-profit organization dedicated to developing new treatments for neglected diseases and Sanofi, a French healthcare company. We are thrilled to be joined by two researchers from DNDi, Dr. Nathalie Strub-Wourgaft and Dr. Wilfried Mutombo Kalonji, who share their insights into the challenges associated with bringing a medication all the way from its development stage, to testing it in the field, and finally ensuring that access is provided for those who need it most. We also chat about how this treatment works, the impact that COVID-19 has had on screening efforts for sleeping sickness, the lessons learned from fexinidazole’s development, and so much more. Tune in wherever you get your podcasts! And when you’re finished with the ep, check out this beautiful video from DNDi chronicling the story of fexinidazole: A doctor’s dream: A pill for sleeping sickness. See omnystudio.com/listener for privacy information.

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to another bonus episode, our second, in our mini series of content, exploring in more depth the topics we covered the previous week. As we always say on the podcast, A, we're not experts, and B, we can't cover absolutely everything about a disease or a topic in our regular episodes. And those two things probably aren't going to change. But we can talk to actual experts in the subject we covered the previous week and get to explore some aspects of that topic in more detail than we did in our regular season episode. In our first bonus episode, I followed up our hepatitis B episode with a conversation with Dr. Sherry Cohen about the stigma and discrimination that people living with hepatitis B often

face and how it impacts their lives. This week, I'm very excited to chat with Dr. Wilfried Motombo-Kolonji and Dr. Natalie Strobore Gafft from the Drugs for Neglected Diseases Initiative about human African tropanosomyasis. In particular, I wanted to learn more about the development of fexaminozae. a new drug to treat this disease, one that is much safer and easier to use than those that have been historically available. How was this drug discovered? What are some of the challenges in making sure people who need it have access to it? And what impact has it had on control efforts? These are just some of the questions I want to explore in this bonus episode.

If you haven't listened to our human African tropanasomiasis episode yet, you may want to do so before you listen to this bonus episode, because there's just so much to that story, and it'll probably help give a bit of context for this interview. But either way, I'll give a quick overview before we begin. Human African trapanosomyasis, also known as hat, HAT, or sleeping sickness, is a neglected tropical disease caused by two subspecies of tripanosome parasites, one of which, tripanosoma brucei Gambience is much more common than the other, tripanasoma brusiae rhodesiance. These parasites, which are transmitted through the bite of a setzy fly, have been infecting humans for thousands of years and cause a disease that is considered fatal without treatment. Over the past 50 years or so,

there have been substantial global and national efforts to reduce the prevalence of human African tropanasomyasis, and we've made a great deal of progress towards elimination. For instance, from 2009 to 2020, the number of recorded cases dropped from just under 10,000 to 663, which is absolutely amazing. But still, these parasites persist in 36 countries in sub-Saharan Africa, with some countries carrying a disproportionate burden of disease, such as the Democratic Republic of Congo. where 70% of cases reported over the past 10 years have occurred. Control and elimination efforts for human African trupanosomiasis face many different challenges.

For instance, these vector-borne parasites have a super complex ecology. Diagnosis of the disease can be quite tricky, and there are many logistical difficulties in providing care to those who need it. Funding for research or drug discovery is always a challenge, and for decades, the only available treatments were either arsenic-based with toxic side effects. These drugs are called Arcebal or Malaropral, or extremely complicated to administer. These last points have changed in the past few years with the discovery and approval of fexinidazole, which is an oral treatment effective for both the first and second stages of Gambiencee,

human African tropanosomyasis. This drug was developed through a collaboration, between the French healthcare company, Sanofi, and the Drugs of Neglected Diseases Initiative, and I am super thrilled that I get to speak with not one but two amazing scientists at DNDDI about this exciting new development and what it means for the global elimination of human African tripanasomyasis. Dr. Motombo-Kolonji and Dr. Strub-Borgaft have both been involved in many different aspects of human African tripanasimiasis control efforts, from regional fieldwork to clinical trials and from drug research and development to forming industrial partnerships to bring

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Currently, I'm coordinating our local R&D team. And we are working currently on three diseases, human African transomeres, funereal disease and COVID. So I'm coordinating all our R&D projects. My name is Natalie Struvoghaft. I'm a medical doctor by training. I've been with the NDI since 2009.

And I've been leading the NTD R&D activities and started the... the Fexidazole program in 2009 until it came to access to patients in 2018. Thank you so much for taking the time to chat about DNDDI and Fexenidazole. So I wonder if you could start off by telling me how did you both get involved with DNDDI? What brought you to this type of work? My first time to hear from D&I was in 2006. I was working as a doctor in a remote village.

So I hear that D&DI was preparing a project of clinical trial on heart, human African hypnosis. So I was interested because I was treating those patients. And so I was a war of issue we had with this disease. And then I applied. and I was selected to be a local PI principal investigator for one of clinical studies. So it's since 2006 that was my first contact and then after I continued, I was an investigator in another clinical trial that was coordinated field and then after from 2012 I started working

as a coordinating investigator of a vaccine azole project and since 2016, I'm full staff of the NDI. As for me, it's a bit different. I've been working before in the pharmaceutical industry and in some biotechs. And in fact, in 2003, when the NDI was launched, I was informed via friends. And I kept watching the DNDDI website for interest because I've always, was being interested in doing something that adds value to, you know, public health. And once I saw a position that was open for a clinical development director, and I called them and I said, this is me, this is me. And they were at the end of the process. So they accepted to receive my CV. I went through interviews and I got the position. And that's how I came with the NDI and I'm still there.

Wonderful. So today we'll mostly be chatting about human African tropanasomyasis, but DNDDI is involved in control efforts for many other neglected diseases. So can you talk briefly about the general missions of DNDDI and what type of work the initiative does? So, you know, in fact, yes, the NTI was founded in 2003, after MSF Doctors Without Borders received their Peace Nobel Prize. And some people at MSF, in fact, doctors who were working in the field, were facing terrible dilemma where they couldn't treat patients who they were trying to take care of because they didn't have the proper tools, the proper treatments. And so they started looking a little bit more, and it was very clear that there were a range of patients or diseases that were totally neglected by the efforts of the industry because they were targeting diseases and all populations that had no economic power and for which there would never be what was expected to be needed, i.e. return of investment. So they developed the model, and at that time, there were a few other. that started developing what was called product development partnerships, looking at ways of developing treatment options that would be responding to the needs of those that are neglected by this industry.

And that's how the NGI decided to focus initially on developing a combination of four treatment for malaria, fix those combinations. That was aligned with what the WHA was. asking for at that time, but also focus on some specific diseases where there was both a need, some partners, and a hope for short, medium, and long-term response. And that's how a few diseases were selected from the list of neglected tropical diseases, which included mostly kinetoclastic related diseases, so parasitic diseases, including sleeping sickness, jagas, and Leschmaniasis.

And then we expanded every three, four years, we had a revision of the strategic plan. And based on needs and opportunities, we expanded to oncoceraciasis, to pediatric HIV, which might come as a surprise, but very neglected in sub-Saharan Africa. And also hepatitis C.

And then mycitoma, also extremely neglected. And then in 2020, we started, as Wilfrid mentioned, to engage into COVID response, but COVID response for low and middle-income countries. The global efforts towards elimination of human African tropanasomyasis, they've been amazingly successful over the past 10 years. For instance, I saw that only 663 cases were reported in 2020, which is a drop of over 300 from the year before.

That's an incredible drop in cases, and it shows that real progress is being made. What do you think are the biggest factors contributing to this decline in human African trapanasamyasis cases? First, it was the diagnostic. That was very, very difficult. And the second and very big challenge was the treatment, because the treatment we used to use was Arsobal with arsenic and that treatment was toxic and less effective was losing its effectiveness. And I think the great moment was when D&A was involved with all his partner and when we changed

the treatment. The first great step was to change to switch from the Arsobal to net the combination of of neuroticotinox and a fluoronitin. This was the first quick step we did. By this changing of treatment, we had a very effective drug and less toxic. And so we have very, very few relapse

and even people who was very comfortable to receive this treatment. This was, I think, for me, a very critical moment. And we have involved in the DNA and this partner, we are still working on the best way to ease the treatment, and now we are on oral treatment. So all this was very important and very critical step toward the elimination.

Yeah, so maybe I think we should also recognize the efforts from the, I mean, this is what Wilfrid mentioned, but under the umbrella of national sleeping sickness control programs and and collaboration with many partners, which I think under, you know, also the leadership of the WHO, all of this, there was a momentum and a push to consolidate to have joined efforts on diagnostic and treatment.

A lot of training activities performed via the national programs. And since Wilfrid was also part of the national programs, maybe that's why he's being modest. But I think we should recognize that the organization, at the country level was also absolutely crucial in making this a reality. So you have both been working in this field for a number of years and have had this opportunity to witness this drop in cases firsthand.

So how do you feel that this field has changed since you first became involved? I did my medical training in Kasai province. So this was one of endemic areas of a sleeping sickness. So even during my training, I was seeing how those patients were treat with melasoprol. And when I became a medical doctor, I was in charge of managing those patients in my small village where I was walking. And, you know, I was receiving those patients. And the only drug we had at that time was melasopor. This was a terrible drug.

I even lost two of my patients. It was a sad, very bad experience. You know, when we were treating passion with Al-Sobar, it was stressful, not only for health worker, but, you know, even for fashion, family, so. But since we have those new drug things change, you know, we have even health workers are more comfortable, more confident. This is a great change. And I think the key point is also that.

people are less afraid of going for treatment, but maybe also with time, they will also be less stigmatized because, you know, less mystery is surrounding this disease. They can, with vaccine, as all patients can be treated. In the village, there's nothing magic about, you know, the treatment patients come. And some of our colleagues used to say the success will be one day when you consider sleeping sickness as any other infection. It has been, you know, impacted by a lot of stigma that this stigma, I think, may decrease with getting a treatment that looks like any other treatments. It's tablets. There's nothing, no specific requirements regarding, you know, its use, protection of activities you shouldn't be doing when you take the drug and a lot of things which make it really more normal.

And that's really important because what we need is patients to be treated, what we have observed. is that patients have come, sometimes come very late for treatment, because treatment before meant going to hospital, which meant not being able to work, which meant maybe having an economic impact on the family, which meant also that the family had to accompany patients at the hospital, pay for fees. I mean, a lot of things which are impacting the quality of life

and the acceptability of treatment. So it's a huge change. One of the things that I wanted to ask about was the COVID-19 pandemic. How has this had an impact on control efforts? Do you think that we'll see another decline in reported cases of human African tropanasomyasis from 2021 or has the pandemic impacted control efforts? So sure, yes, the pandemic has an impact on control efforts. You know, most of the national program works with what we call it.

mobile team and those mobile team work 12 months. Every 12 month they spend more than 20 days or more than 15 days going from a village to another during the screening of population. So it's not easy for them to go from a village to another village due to COVID restriction. And since we have this COVID problem, you know, they are not able to have 12 months of work. This is a other problem. And you know, we work with many partners, many founding partners with COVID, their impact too. So the national program, you know, receive not the entire money for their activities. So this is the second impact. And another impact, you know, if I go, for instance, in the field of another neglected disease, like philateral disease, they do what we call mass drug administration.

They can do it. You know, last week I was visiting some remote areas, and there the Maslow administration was not done due to this COVID issue, due to this restriction of movement, and due to the decrease of finance, so this COVID will have a great impact. And we must be aware of this. I was wondering if you could talk a little bit more about the stigma surrounding human African tropanasomyasis.

Yes. As you know, it's a chronic disease. The first step is what we call an melampathic step. The second stage, it's neurological stage. And at that stage, you know, can become like a foolish, you know, more sleepy and so on. We've trouble with the fever and so on. And for those who suffer from sleeping sickness, this was a very great stigma. That was one of the factor that could avoid some people to come to receive the treatment.

But now, sleeping sickness are more and more accept and are being humanized. You know, now things are changing. In our episode on human African tropanasomyasis, we touched briefly on fexinidazole, which is this oral medication recently developed to treat this disease. Can you tell us a bit more about this drug, starting with how exactly it works? We haven't fully elucidated the mechanism of action of vaccine edazole, but we know it interacts with the enzyme material of the parasite that is responsible for the disease. So in essence, it kills it. How effective is it for Gambiencée?

So it's really effective. So we did a study, a very robust study in comparison. with the NECT, which is the standard of care mentioned earlier by Wilfried. And we showed that it was non-inferior to it, which was the statistical hypothesis, within a limit of 13%, which means that in essence it is almost as equivalent as NECT, with slightly lower efficacy, but within a range that is considered as really what the physicians wanted and what the regulators accept. So it's very important because it means that with an oral treatment, you can replace an injectable treatment and something else, a combination of an injectable

and an oral treatment. But I think something we haven't yet mentioned is that to administer the standard of care, which is next, you need to have patients being hospitalized. But before that, they need to go through a lumber puncture to verify if they are eligible to this complex but very effective treatment combining an infusion and a neural treatment or if they can stay with an intramuscular treatment which is simpler to use but still to get this standard of care they need this lumber puncture the lumber punctures are painful some of us who have had lumber punctures in the past we have access to anesthesia, but that's not the case when you do lumbar puncture to test patients for treatment allocation. You have headaches post-lumber puncture, and that's also one of the factors that made

sometimes patients want to avoid being tested just for the sake of not having to go through this lumbar puncture. Now, with FACC2, you don't systematically need a lumbar puncture. You may need it if patients are experiencing severe neurological symptoms where maybe they would benefit more. from this standard of care treatment. But otherwise, once a patient has been tested with the parasite, that patient provided he doesn't have very severe symptoms, can get oral treatment immediately. It has also shown us that it has really high efficacy in stage one,

meaning those patients were not severe. And it's also as efficacious in children, which is very important as well, because otherwise those small kids would require the lumbar puncture if they are in the advanced stage and would require the infusion, the combination of infusions and oral treatment. So overall, it is almost the same as the standard of care, but it's oral and doesn't need the lumbar puncture. That's wonderful, yeah. And I'd love to hear more about the story of this drug's discovery. How was it selected as a potential candidate for a

sleeping sickness medication? And then what happened after that? So that came from the year, well, the way we worked at the NDI and it was our predecessor, so El Sorelli and Bernadette Burdine, who evaluated drugs of the class, nitroemidazol class, because they were known to have a potential for this disease and looked at a library of, I think, of almost 700 drugs and started looking at the potential for those drugs. Faxidazole came out. It had been developed earlier on. by predecessor of Sanofi and put on shelves before it came to clinical stage just for probably, you know, strategic reasons, nothing else.

So it was identified back from the shelves. And then as the value chain of clinical development evolved, meaning looking at in vitro testing on parasite labs, going to animals to test the efficacy of the drug in animals, infected, by the parasites, we selected at the end, Fexineidesol as a clinical candidate, at which point we also signed a contract agreement with Sanofi and then started engaging in the standard phase one healthy volunteer study followed by the very large study in Africa that was co-led by Wilfried and Dr. Comde in the Diorth.

The historical lack of funding for human African tropanasomyasis and all other neglected tropical diseases, it has meant that drugs are slow to be developed and once available, there are many logistical challenges that prevent access by people who need them. So can you talk about how important it is to form industrial partnerships to connect drug development with setting up infrastructure for actually administering those drugs? Having a disease that has priority for public health that is on the WHO list of diseases that need to have, you know, solution is one way of attracting funders together with an organization that can bring elements to show it can deliver, which was something we did with the development of Azac, which in fact we had done also with Sanofi. On the other hand, Sanofi, as part of their global corporate responsibility activity or access to drug engagement for a long time, had been supporting the WHO financially. Therefore, it was kind of a natural partner for us to go with Sanofi to engage into this partnership where we would be doing the development and looking for funds to do that, which we got from public funding as well.

as private funding, them doing the manufacturing and distribution together with the WHO via a donation of vaccine diesel to countries via WHO. So it's a bit complex and I think for each disease, it's different and it's clear that we have to continue to promote the need to fund research for neglected tropical diseases. But there is a kind of move to public health interest in doing that, although still not as much as we have seen for TB, malaria, and HIV. So I want to take a quick pause here. And then when we get back, I want to dive deeper into the story of fexinidazole,

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Welcome back, everyone. So I was wondering if you could talk about what went into the clinical trials to test the safety and efficacy of this drug, and what were some of the biggest challenges in conducting these trials? This is a good question. To conduct the clinical trial, you need to go where patients are. And those patients are living in remote areas. As you may know, our health facilities in remote areas are in very bad state. So the first challenge, we have many challenges. First, we need to improve those health facilities, patient wards, laboratory, sanitation,

all those things and even to put clean waters and electricity by generator and to provide internet connection because this is very important in clinical trial. We need to train people because health worker working in those remote areas was not very used to clinical trial. So we need to trend them on GCP, good clinical practice, on protocol, on how to manage the clinical trial, how to manage the adverse events, serious adverse events. So we need to train people on this. And we need to set up a good way to reach those sites because we have local team, we have national, international team. So we need to set up a very safe way to reach those remote areas by using safe boat, safe car and so on. Even to set up to all those

accommodation because when people go there to work, they need after the working day to have an acceptable accommodation. So we need to set up all this. And again, working on those population, you know, most of them will not, would not be able to read or to be involved or to, you know, to go in the clinical trial, you need to give your, you need to sign an informed consent and form. So how to make this at that level for those people who could not read? So we set up image boxes to explain them clearly what is the clinical trial. So while they were giving the agreement, there was a war of what is it. So we need to follow all this and we set up all this. And again, you know, because we are in clinical trial, we need to provide food to those

a person, but we were giving food to all heart patients, not only for those who were involved in clinical trial. So we set up all this, and then after we start with a clinical trial and with many supervision, many follow-up. So we work with the national program and with GNDI and all our partners with TPH that was doing the monitoring. So when I joined and I was coming from the very, very, well equipped

clinical research networks in Europe or the US and I came to the NDI and here we were with a new chemical entity we had the basic standard package for phase one very good and then we had to

start this phase two study where for the first time you start treating patients a very far away and with little access I would say to information of what was going to happen to patients at the site level. And as Wilfrid said, we had to do it where

patients are. And with the only people who know how to treat those patients and who are also physicians that work in very remote areas. So we had to do things that I had not thought before I would need to do, which is set up internet connections, come with more, you know, bring some equipment that was not there, find ways of doing lab tests in a way that would not bring something artificial and then leaving that was not the artist. So we had to think with many people and it was a collective effort of how can we bring the best science in the conditions where we were. And in addition to everything that Wilfrid said, we had to think about this and bring what we thought were the best sustainable solutions. We, we had to.

had to do electrocaryngograms. So we took those devices that allow us to have a direct connection in France with what was happening in the middle of the DRC in one patient, et cetera. So it was quite a bit of a stretched effort. But I have to say with so much enthusiasm from everyone, everywhere, we were all so excited to make it happen. So I think we did something really nice that could serve as a, as a model for future research and that also brought a lot of experience to all of us.

Something else we did aside of this was when we said, okay, we need to have this study as any study in the world approved by an ethics committee. Well, who's the best position to verify that you're not taking risks for patients, that you're responding to your scientific hypothesis, that what you're doing is well done, makes sense. You're not exposing patients to a risk. And when I joined, the routine way was to have a double ethics committee, one in the north and one in the south.

And it was exactly that. And we said, well, maybe we can do differently. Maybe we can have committees from the south and one committee in the north, discussing this together and finding ways of, you know, consolidating different experience from different areas of the world in a way that would help to have the best review. This is what we did and we published. And it was a learning experience for all of us, from those maybe from less experience ethics

committees in DRC or elsewhere that were taking a huge responsibility in accepting, you know, for the study to be conducted in their patients. but also from the committee in the north who were faced with questions they had never thought about that, you know, made them think a bit differently. Like, you know, funding issues. Our colleagues from Africa were asking, are you sure that you will have the funding to continue? Or they were asking questions about how we explained the study to patients or community issues, things like that, which they had not. ever, you know, really experienced. So a very rich experience. And then once everything was in place, the study was conducted as it would be anywhere else, except that we found again something which,

when you have experience in clinical trials, you wouldn't think is real. We had a follow-up of patients enrolled in the study of 18 months. And, you know, it is not unusual that once patients are receiving a treatment that here was for 10 days, well, they come after, okay, they will come for the follow-up visit at three months, maybe at six months. A few will not come at 12 months. And why the heck would they come at 18 months if they're feeling well? Well, we had three, I think three patients lost to follow up out of over 390 patients. This is outstanding, outstanding and everybody has been so impressed by this. Why did this happen?

Because there was such an effort locally. Not every single patient that was diagnosed and entered in the study was followed. And I think again, Wilfrid can explain how this was done because it was not simple. Yes, you know, clinical trial on heart, we need to keep those patients because the last follow-up was 18 months after receiving the treatment. This was not easy, you know, because when they feel good, they don't come because they are okay, they receive the treatment. The very important moment when we were doing the informed consent form so that they are

a word that they need to come to all the follow-up visit because if you don't come, it's considered failure. But we had their address, even the name of the leader of the leader of the. their village, the name of the head of nurse of the village. So we have a motorbike to follow them, then cell phone number of one of relative, if they have it, all these, we use all this to reach the great majority of patients. And as we were all motivated local team, they are at the national level and at our HQ. So we did this success story. and we succeeded, but it was not easy, but we did it.

Yeah, that's incredible. And I can imagine that, you know, this enormous effort at the national and the local and the international scales, it's probably led to a lot of lessons in terms of, you know, not just how to set up clinical trials and how to reach patients and keep in contact with them. But I wanted to ask, you know, what are the biggest lessons do you think we can take from this story of feccinidazole? And how can we use them to help control efforts for other neglected tropical diseases or just general healthcare infrastructure? Yes. The great relation to my side is, you know, this collaboration, because the D&I succeed to put together the national control program.

And that was very important to have the national control program because they had to give the product profile they need. What was the exact need? that was the first. And to have farmers, of course, and to have WHO, and to have all those stakeholders to put them together working on this project. That is a great lesson to my side. So it's something we can, you know, reduce, use it when to want to tackle a health problem. You need to involve the health worker, the control program, the researcher,

university, WHO, and all those stakeholders. And together, we are strong. So fixinidazole is currently approved to treat the Gambiencea form of human African tripanasomyasis, which is by far the most common form of the disease. But can you talk about how far along we are in the research to determine whether this drug is also effective against tripanosoma, bruciae, Rhodesianzae, the other form of human African intrapanosomiasis. Yes, so we have good news because it took some time, but we managed to get funding from EDCTP. And I think I should mention the other funders for the for the HAD program,

you know, the Gates Foundation, MSF, the UK government, the French government. I just want to mention them because we wouldn't be here without their support. But thanks to EDCTP, we were able to start and finish recruitment in a small study of Paxinidazole at Tb Hodesianz, because based on the same studies that showed the potential for Faxini Dazole to work on T.B. Gambianzi, we had the same information of Tb. Hadesianz. So we've just finished an moment, and I hope that we'll be able to report on this quite soon. But it's fantastic because because here the reference treatment is melaroprol, is still melaroprol, which is this arsenic-based treatment. So if we can show that fexidazole can be an alternative to a drug that is, yes,

very efficacious, but also extremely toxic, that would be incredibly useful. Yes, absolutely. Are there other potential applications for fxinidazole, like for, for instance, instance, other parasitic diseases besides these tripanasomas? So we looked at visceral leshamanases and we conducted a small study in Sudan, which didn't show any efficacy. So here we stopped. And then we looked at chagas and the signal for chagas is not quite clear. So I think we have to wait until we have final results because that could also be one area of interest. Other than that, we've not looked at anything concrete, but it's an anti-parasitic disease. So, you know, it could have other potential use. So I just have one last

question for you. And that is, what do you hope this next year brings in terms of human African tropanosomiasis research or control efforts? I think the great step we make. is to ease the treatment. So we move from melasopor to NET, which is the kind of gold standard, but with NECD, we had many challenges, logistical challenge. But now what we have with FACCNED as all, that can treat both stages, and that is tablet is, you know, easy to send it anywhere, even in those remote areas, and it's very easy to train people to use this. And this is one of a very important contribution to our work toward elimination. I think maybe that he can completely.

No, I think first we'd like to see vaccine need as a rollout and we'd like to see, as I said, the results of vaccine, Hodevianzzi, that's one. And see that numbers continue to go down, not as an artifact of patients not being treated. But I think what I'd like to see is still attention, because we know that what people call the last mile to elimination and sustained elimination or elimination of transmission takes time.

There's another compound in our pipeline, which is hugely promising as well, a single dose treatment. And I think it's just making sure that there is still interest. Job is not done. It's not finished. There are still patients who need treatment. We need to continue the efforts, including to have the commitments. of countries to continue to be engaged in this fight. And in fact, this comes really nicely because in three days,

this will be the third NPD, the second NPD day, but the third human African tripanosomizes day in DRC. So, you know, I think it's hugely important that we do not think that we have finished, but we are encouraged by our successes. And the fact that in a way, you know, if our success in Hatt can, be a kind of reference and enthusiastic hope for others to continue to engage in that area of entities will all be really, we will have double one and fulfilled a bit of our mission. Thank you so much to Dr. Motombo-Kolonji and Dr. Strobore Gaffed for such a fantastic interview.

It is so incredible to hear what a game changer affects in it as all has been for human African trapanasamyasis, and also what this drug's development can teach us about the importance of collaborations among national control programs, healthcare companies, and global nonprofits for the elimination of other neglected tropical diseases. If you want to explore more about Fexanidazol or other projects that DNDI is involved in, check out their website, dndi.org, and I'll also post some links on the page for this episode on our website. Also on our website, Also on our website, you can find all kinds of good stuff, like the sources for all of our episodes, transcripts, quarantini, and placebo-rida recipes, our bookshop.org affiliate account,

links to music by Bloodmobile, links to merch, our Patreon, alcohol-free episodes, and so much more. A big thanks, as always, to Bloodmobile, who provides the music for this and all of our episodes, and thanks to you, listeners, I really hope you like this. this deep dive into human African tropanasomyasis and fexinidazole. And a special thank you as always to our wonderful patrons. We love you and appreciate you.

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