In order to help the world combat VL, we need to ensure that paromomycin is put into use as one important component of a broad package of diagnosis, treatment, and prevention efforts targeting every aspect of the disease.

In 2005, we provided significant additional funding to iOWH to launch a pilot program in India that will help identify how to deliver paromomycin in the world’s poorest rural settings. As part of this pilot program, some patients will receive paromomycin in government-run district hospitals and clinics. But, in a break from established tradition in India, many others will receive it through non-governmental organizations, such as the Bihar-based Janani network. 

The Janani network was started in 1996 as a set of franchisees selling condoms and oral contraceptives in small shops in Bihar and Jharkhand—two of India’s poorest states. Today, thanks in great measure to outside support from the David and Lucille Packard Foundation, Janani franchisees are building more than 40,000 shops and 57,000 rural health centers—nearly one per village. We believe that making VL diagnosis and treatment available through Janani and other non-governmental clinics will be an effective way to expand access in a setting where public-health services are extremely weak. 

We are also working with other grantees to help develop the next generation of VL drugs.  Paromomycin is highly effective today, but it is not a silver bullet. There is a small but real chance that the parasite will develop resistance to the drug. Therefore, the wisest public-health strategy is to combine paromomycin with other new drugs—just as doctors do with drugs for malaria, TB, and HIV/AIDS. We have already made one grant, to the University of North Carolina, to work on a new oral drug for VL. A vaccine for VL that would provide a lifetime of immunity would be an even more powerful weapon, and we have made a grant for this purpose to the Infectious Disease Research Institute.