Globally, kala azar is the second largest parasitic killer after malaria. In India, Bihar is the epicentre of kala azar, home to, as per the state Kala Azar Task Force, over 1,00,000 patients.

Kala azar is eminently preventable and curable. The parasite that transmits the disease is the sandfly. An extensive and effective vector control programme can go a long way in preventing transmission of the disease.

In terms of those who already have the disease, treatment can be provided in India. The problem is that the drugs authorised by the public health system to treat the majority of patients either take very long in terms of the period of treatment or are toxic or very expensive. Patented by an Indian company, an emulsion of amphotericin B offers a single-day, single-course treatment. It has been in the market for five years now, but is not part of the public health system.

The problem and the solution have been identified, what is missing is a road-map.

The model for kala azar eradication is a cross-sectoral public-private partnership (PPP). This is not an option but a necessity. Introducing and deploying a new public health innovation cannot just be the responsibility of a government. A host of other players, from multilateral agencies to private players — not-for-profits as well as commercial entities — have to get involved.

A quicker, more efficacious drug for kala azar is a quest being pursued by more than one consortium. The Bill and Melinda Gates Foundation and the Drugs for Neglected Diseases Initiative (DNDi) are both supporting separate projects for developing and clinically testing cheaper and shorter treatment kala azar drugs. To some degree, this would amount to reinventing the wheel. Bharat Serum’s single-day treatment, based on an emulsion of amphotericin B, is already available.

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