A new dawn: One pill conquers sleeping sickness

The small, dusty village of Bagata feels a familiar chill each time the sun dips below the horizon, but it is not merely the evening air. It is the creeping shadow of Ndoki, “sleeping sickness”, a silent assassin that has haunted generations.

For Mama Adisa, the fear became a brutal reality when her vibrant 14-year-old grandson, Kito, began to change. His boundless energy drained away, replaced by a lethargy that deepened with each passing day. The playful twinkle in his eyes faded into a vacant stare.

 “He would fall asleep unexpectedly, sometimes even mid-sentence,” his mother narrates, adding that the tremors began soon after, violent shakes that wracked his small frame.  Adisa recognised the signs. She had seen Ndoki claim too many victims, slowly stealing loved ones until they slept forever.

“We prayed. We tried traditional medicines. But the disease, it always won. The doctors in the past, they had needles, and the medicine made people sicker before they got better. Sometimes, it killed them too.”

Kito’s diagnosis confirmed their worst fears: Trypanosoma brucei gambiense, the most common form of human African trypanosomiasis, or sleeping sickness. But this time, hope arrived not with a painful injection, but with a promise. A single, small tablet.

Today, Kito’s energy is fully restored. His story, once a testament to despair, is now a beacon of monumental triumph. He is among the first to benefit from Acoziborole Winthrop, a groundbreaking new treatment that is poised to change the face of public health in Africa.

 The World Health Organisation (WHO) officially validated Kenya as having eliminated Human African Trypanosomiasis (HAT), or sleeping sickness, as a public health problem in August 2025. This makes Kenya the tenth country to achieve this milestone. This elimination was the result of consistent control activities over many years, including strengthening surveillance in 12 health facilities across six historically endemic counties, equipping them with diagnostic tools, and training personnel. Kenya also actively monitors tsetse flies and animal trypanosomiasis. 

But the Democratic Republic of the Congo (DRC), which accounts for more than 70 per cent of all reported sleeping sickness cases in sub-Saharan Africa, is yet to achieve this ground-breaking milestone. However, the European Medicines Agency (Ema) has issued a positive opinion for Acoziborole Winthrop, a new three-tablet, single-dose oral treatment for Trypanosoma brucei gambiense. This development, a collaborative effort by DNDi (Drugs for Neglected Diseases initiative) and Sanofi, aims to simplify treatment and support the WHO goal of eliminating the disease by 2030.

On February 27, 2026, the EMA’s Committee for Medicinal Products for Human Use (CHMP) recommended acoziborole for treating both early and advanced stages of gambiense sleeping sickness in adults and adolescents aged 12 and above, weighing at least 40 kilograms.

This endorsement, part of the EU-M4all procedure for high-priority medicines, confirms the treatment meets EU standards. It is expected to expedite regulatory approval in endemic countries, starting with the DRC, and will inform revisions to the WHO sleeping sickness treatment guidelines.

Two decades ago, advanced-stage patients relied on an arsenic-based injection that carried a five percent mortality risk. While lethal if untreated, the arsenic regimen was often the only available option.

Over time, DNDi and Sanofi, in partnership with endemic nations, introduced improved treatments. These included the NECT (nifurtimox-eflornithine combination therapy) injectable in 2009, and fexinidazole, the first oral treatment requiring a 10-day course, in 2018. Acoziborole is the outcome of this sustained research and development, providing a more streamlined approach.

 “The development of acoziborole and today’s positive scientific opinion is a victory for Africa-led science,” declared Dr. Erick Miaka, Director of the DRC’s national sleeping sickness control programme.

He highlighted the pivotal role of “African doctors and researchers who conducted cutting-edge pharmaceutical research in some of the most remote and difficult-to-reach areas on the continent.” According to him, this isn’t just medicine developed for Africa; it’s medicine developed with Africa.

These therapeutic advancements have markedly reduced disease incidence. In 1998, approximately 40,000 cases of gambiense sleeping sickness were reported, with an estimated 300,000 undiagnosed. By 2024, reported cases had decreased to under 600. The simplified, one-day oral treatment is expected to further accelerate this decline.