Ninety per cent of the world’s annual kala-azar cases occur in five nations – Brazil, Sudan, Bangladesh, Nepal and India. And half of all the world’s cases together occur in Bihar.

Money from the Bill & Melinda Gates Foundation – to which Warren Buffett has contributed some $31 billion – could change that, for India was the country most referred to by Melinda Gates when she gave an insight into the vision of how to spend that money.

“We are going to target areas where we can save the maximum lives. In India and Bangladesh, we can save 200,000 lives a year if we can eradicate kala-azar,” she said at the press conference in New York where Warren Buffett officially announced his decision to give his billions away to charity.

The only drug, said a report in the India Times, which could work against kala-azar is paromomycin, a disused drug patented by an Italian firm some 50 years ago for use against some other infections. But there are very few stocks of the medicine around. Only one small unit in Malta was manufacturing the drug – and even this unit was thinking of closing down.

Kala-azar (black fever), or visceral leishmaniasis as doctors call it, is a deadly parasitic disease transmitted by the bite of female sandflies. The disease is almost always fatal if not treated.

The impact is worst in villages like Harpur Hardi, where women work in summer temperatures of over 40° Celsius, harvesting rice and wheat. Most know someone who has died of the disease; most do not have money for a full course of drugs, costing about Rs 4,000.

Not only are the least-expensive drugs beyond the reach of the poor, many of them become ineffective as the parasite develops into drug-resistant strains.

And since kala-azar – like many diseases afflicting people in Third World countries – almost always strikes the poor, large pharma companies have little incentive to market new drugs that are safe, effective and inexpensive.

It was in such a scenario that Dr Victoria Hale, who left Genentech and started a non-profit pharma company called Institute for OneWorld Health (iOWH), approached the Bill & Melinda Gates Foundation for help in 2001. She had found that paromomycin, a disused drug patented by an Italian firm some 50 years ago for use against some other infections, could work against kala-azar. Backing her claim were tests conducted by a Kenyan physician in the 1980s, which saw all 53 patients cured. Small studies in India had also shown positive results. The iOWH tried to conduct further studies but couldn’t obtain funding.

In May 2002, the foundation approved the first of three grants to finance iOWH studies of the drug, and the largest-ever clinical trial was undertaken with the help of Indian doctors who had been treating the disease for decades. The result was remarkable: 95 per cent of the 667 patients in the trial were cured. Last week, iOWH delivered a dossier of the results to the Drugs Controller-General of India, and hopes to receive approval soon. Clearance will also be sought from US Food & Drugs Administration.

With iOWH’s help, an Indian pharmaceutical firm has developed a safe and efficient process to produce paromomycin at a price of about Rs 500 for a full course.