Dr. Stephen Robinson works as a Pharmaceutical Development Director at the Drugs for Neglected Diseases initiative (DNDi), offering life-changing treatment to the world’s most neglected patients. DNDi is an international nonprofit founded in 2003 to target NTDs. The organization has developed 14 treatments for six NTDs over the past 23 years, including treatments for deadly diseases such as river blindness and parasitic worms.

In his interview with The Borgen Project, he covers the work of two drugs manufactured by DNDi: Zoliflodacin and Acoziborole.

Manufacturing Zoliflodacin

Zoliflodacin is a drug manufactured for sexually transmitted diseases (STDs), mainly gonorrhea. STDs have the highest prevalence in low- and middle-income countries and are also more likely to impact women and young people. Their global impact has made the prevention and management of STIs a high priority for the WHO, making a nonprofit such as DNDi very useful and integral to the health of those with STIs, especially in underserved areas. 

In the interview, Robinson mentions the challenges in the manufacturing of Zoliflodacin. This included determining what the final product would actually be, as the idea, which came to him in 2017, was still in its early stages. Overall, Zoliflodacin became a 3 g dose per day and recently received FDA approval, meaning it can now help thousands in low-income areas suffering from STIs. 

Another issue Robinson faced in the production of Zoliflodacin was the synthesis design of the molecules. This meant that the way the drug’s molecules interacted was hard to scale up for global rollout. To overcome this, Robinson and his team had to invent a different process to produce the drug with the same quality.

The success of Zoliflodacin’s production means that treating gonorrhea has become much simpler. Another sign of success in the drug’s development was that more than 90% of participants in clinical trials reported positive effects.

Manufacturing Acoziborole

Acoziborole is a drug that has very recently received positive feedback from the European Medicines Agency as a single-dose treatment for the most common form of sleeping sickness. Starting with symptoms similar to a cold, sleeping sickness can then affect a person’s brain and central nervous system. It is caused by a tsetse fly bite.

Robinson interestingly points out the use of the element boron in Acoziborole, which gives the drug a very long half-life. A half-life is the amount of time it takes a drug to lose half of its concentration in the body. This is important to recognize so that professionals can continue to understand the impact of the drug, especially since it is so new. 

The main challenge faced by Robinson is the urgency of the drug’s development. Sleeping sickness is a severe disease, so the drug needs to consistently be of high quality and mass-produced to help those in need.

Challenges Overcome

In the interview, Robinson also focuses on broader issues he and the nonprofit have faced and overcome. One of these issues was the need to appear profitable. As many NTDs have the greatest impact on low-income countries with the highest poverty rates, Robinson had to ensure that defeating them would also benefit higher-income countries. With more than 40 countries and 200 partners involved in DNDi’s cause, it is evident that the elimination of NTDs has been seen as beneficial for everyone.

Another challenge within drug production is quality control. It is vital that every drug administered is made to a high standard. To overcome this, Robinson explains that every stage of the manufacturing process is subject to quality control, whether it involves the people working within drug production, the materials used, the facilities available or the equipment at hand. Ensuring quality control is traceable is also integral to maintaining high quality at every step of the process.

For the Future

Overall, the work of Robinson and DNDi is integral to efforts to eliminate NTDs. Already, DNDi has been massively influential in countries such as Thailand, Tanzania and Sudan. This work, especially the production of these drugs, is so important because it has the potential to positively impact the lives of millions living in the world’s poorest areas.

– Caitlin Cooper

Caitlin is based in Aberdeen, Scotland and focuses on Global Health and Politics for The Borgen Project.

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