Neglected tropical diseases (NTDs) are a diverse group of 21 infectious diseases that affect 1.65 billion people around the world and can disable, disfigure, and be fatal. Credit: Shutterstock.

By Thoko Elphick-Pooley
HOVE, United Kingdom, Aug 14 2024 (IPS)

Over the last ten years, I have been privileged to witness incredible progress in the fight against neglected tropical diseases (NTDs) – a journey marked by unwavering dedication, resilience, and hope.

This group of twenty-one diseases affects 1.65 billion people around the world and can disable, disfigure, and be fatal. But despite significant global obstacles, including the COVID-19 pandemic, supply chain disruptions due to the conflict in Russia and the Ukraine, and severe weather events, our collective efforts fighting NTDs have transformed the lives of millions.

As I step down from my role as Executive Director of Uniting to Combat NTDs, I am filled with a profound sense of pride and reflection. From the inclusion of NTDs in the health-related Sustainable Development Goals to the endorsement by Heads of States of the Continental Framework on NTDs and the Common Africa Position, important global and regional frameworks now exist to guide collective action and efforts.

Supporting countries on the pathway to eliminating NTDs by 2030 and helping 49 additional countries achieve elimination goals will be a smart investment for IDA21, delivering tangible and far-reaching impact

From global leaders endorsing the historic Kigali Declaration on NTDs alongside the 26th CHOGM Summit in 2022 to the Reaching the Last Mile Forum held at the 28th United Nations Climate Change Summit in 2023, we have witnessed countries standing shoulder to shoulder with donors, companies, organisations and civil society to pledge commitments to end NTDs.

These concrete actions have illuminated a path toward a future where NTDs no longer wreak havoc on the lives of vulnerable communities around the world.

The impact we have seen is real and substantial. Fifty-one countries have now eliminated at least one NTD.

Sleeping sickness, for instance, has been eliminated as a public health problem in seven countries, with Chad being the latest to achieve this milestone this year. Lymphatic filariasis has been eliminated in nineteen countries, with the Lao People’s Democratic Republic becoming the most recent to eliminate the disease as a public health threat in 2023. And progress has had a ripple effect, with some countries eliminating multiple NTDs.

In 2022, Togo became the first country in the world to eliminate four NTDs (guinea worm, lymphatic filariasis, trachoma, and sleeping sickness) while Benin and Ghana have eliminated three NTDs each, leading to recognition at an ECOWAS Heads of State Summit in 2013.

Meanwhile, 843 million people received treatment for an NTD in the year 2022 alone, powered by one of the most successful private public partnerships in the history of global health, with over 17 billion treatments for NTDs donated by the pharmaceutical industry between 2012 and 2023.

These successes have been built on years of shared experiences in NTD prevention, control, and elimination efforts.

Thoko Elphick-Pooley

The human impact of this work is the most important measure of our success. Reflecting on this journey, I recall the faces of countless individuals whose lives have been touched by this work.

The children who can now attend school, the families who can now work and thrive, the communities that are no longer shackled by preventable diseases. These stories of transformation are the heartbeat of our mission and the fuel that has driven us forward.

Yet, as we celebrate these incredible milestones, we must also take stock of the critical steps needed to ensure this progress continues. We stand at a pivotal moment, where the gains we have made must be solidified and expanded.

To do so, NTD programmes are in desperate need of sustainable, long-term financing and strengthened political commitment. One critical way to respond to this need is to prioritise disease elimination as a flagship initiative for 21st replenishment of the World Bank’s International Development Association (IDA21), which provides grants and financing to the world’s poorest countries.

This includes establishing a dedicated funding stream under IDA21’s Health Track. Doing so would ensure sustained progress against these diseases and will help the World Bank achieve its mandate to alleviate poverty, boost economic growth, and improve living conditions for millions of people on a livable planet.

With only 15% of the Sustainable Development Goals on track, the urgency to demonstrate impact at scale has never been greater.

Supporting countries on the pathway to eliminating NTDs by 2030 and helping 49 additional countries achieve elimination goals will be a smart investment for IDA21, delivering tangible and far-reaching impact. This is not just a health imperative; it is a moral and economic one.

Our journey is far from over. The path ahead requires sustained political will, continued resource mobilisation, and unwavering commitment.

We have the knowledge, the tools, and the momentum. Now is the time to harness these and push forward with renewed vigor. Let it be said, decades from now, that we did not waver in our fight. Let it be said that we left the world a healthier place, free from the scourge of neglected tropical diseases.

Thoko Elphick-Pooley is the outgoing Executive Director of Uniting to Combat Neglected Tropical Diseases.

Excerpt:

A case of advanced liver pathology (hepatomegaly) due to schistosomiasis in a 5-year-old. Prof Takafira Mduluza

By External Source
Mar 14 2022 (IPS)

Neglected tropical diseases is an umbrella term used to describe a group of 20 infectious diseases. These diseases affect over 1.7 billion people. They can disable, debilitate and even kill. The world’s most vulnerable and poorest are most affected.

In the past, the diseases in this group have been overlooked internationally and poorly funded domestically: hence the “neglected” in the name. Some common neglected tropical diseases are Buruli Ulcer, Dengue Fever and Hansen’s disease (also known as leprosy).

There are already tools to prevent and treat these diseases. They include drugs, vector control, veterinary public health interventions and provision of safe water and toilets.

In the past 10 years there have been significant global efforts to control neglected tropical diseases. In 2012, pharmaceutical companies, donors, endemic countries and non government organisations came together to sign the London Declaration on Neglected Tropical Diseases. Together, they committed to control, eliminate or eradicate ten of these diseases by 2020 and improve the lives of over a billion people.

Support from the signatories ranged from donation of the essential medicines to financing the delivery and distribution of the drugs, research, and funding for sanitation and safe water. These concerted global efforts have yielded successes and are grounds for optimism.

To date, 600 million people no longer require treatment for neglected tropical diseases. Cases of some of these diseases, such as leprosy, sleeping sickness and Guinea worm disease, are at an all-time low. Forty-four countries have eliminated at least one neglected tropical disease as a public health concern. Most recently the Gambia and Saudi Arabia eliminated trachoma, a bacterial infection which causes blindness.

However, this progress is now at real risk of reversal as a result of the COVID-19 pandemic. Drug programmes have been interrupted, health budgets re-prioritised and aid cut.

As I have previously highlighted, interrupting control programmes could lead to rebound infections and disease. These could be worse than the original levels. This is now an imminent reality for neglected tropical diseases if control programmes do not resume quickly enough.

Interrupted disease control

One of the most important tools to use against neglected tropical diseases is national mass drug administration. This involves treating every member of a population, regardless of their infection status, because treatment is cheaper than diagnosis and the drugs are safe.

Typically the national treatment programmes are annual events conducted in schools or health centres. It takes time, effort and money to plan and implement these programmes. And it’s critical to maintain momentum. Every dollar spent on these programmes yields a significant return on investment. This is why neglected tropical disease control has been termed a “best buy” in development.

The pandemic has affected neglected tropical disease control in three ways.

First, mass drug administration was stopped or interrupted by the lockdown and social distancing policies. And disruptions in global trade and transportation affected supply chains. A recent World Health Organisation survey indicated that, as of early 2021, disruptions in neglected tropical disease control programmes occurred in 44% of countries.

Second, national governments in neglected tropical disease endemic countries have low health budgets. Changing priorities during and after COVID-19 has meant that the resources allocated to neglected tropical diseases may be shifted to other diseases and health services.

Third, a significant amount of funding for neglected tropical disease control programmes comes from international development partners and foreign governments.

Post-COVID-19 economic contraction in their economies and shifts in funding priorities are threatening the gains made in controlling neglected tropical diseases. For example, the UK recently withdrew over £150 million of funding to neglected tropical disease programmes as part of cuts to the country’s aid budget.

This wiped out a third of donor funding for tackling neglected tropical diseases, with an impact on treatments to 250 million people and as many as 180,000 surgeries to prevent disabilities.

Long term consequences

Continued neglect of these diseases has dire consequences. Those affected continue to suffer the devastating diseases, associated health inequities and cycles of poverty. The effects of these diseases are pervasive and wide-ranging.

As long as neglected tropical diseases are a huge burden on health systems in endemic countries, these countries will continue to haemorrhage resources, finances and lives to these diseases. This will further weaken their health systems, compromising their ability for timely surveillance, detection and containment of the next epidemic.

From the Global Health Security Agenda, we know that weakened health systems anywhere in the world compromise health security globally. Local health security is the foundation for global health security, as COVID-19 has amply demonstrated.

The opportunity to put global attention back on neglected tropical diseases will come later this year when the London Declaration is superseded by the Kigali Declaration. This high-level political declaration, led by Rwanda and Nigeria, aims to mobilise political will and secure commitments to achieve Sustainable Development Goals targets for these diseases.

It is important to remember that controlling neglected tropical diseases is in the best interest of all countries – those where the diseases are endemic and those where they are not.

Francisca Mutapi, Professor in Global Health Infection and Immunity. and co-Director of the Global Health Academy, University of Edinburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Over 600 million people in Africa require treatment for an NTD, making up 35% of the global burden. Credit: Uniting to Combat NTDs

By Thoko Elphick-Pooley
HOVE, United Kingdom, Jun 11 2021 (IPS)

As world leaders come together in the UK for the G7, the global response to COVID-19 and how we can build a better defence system against infection is at the forefront of discussions.  Whilst we applaud the incredible global efforts in tackling COVID-19 and support calls for vaccines to be shared equitably across the world, we also urge G7 leaders not to abandon efforts to tackle existing epidemics such as neglected tropical diseases (NTDs), HIV/AIDs, malaria, TB and polio.

The gains that have been made fighting these diseases must not be lost or we risk disease resurgence that will be even more costly to address, which could lead to a disastrous disease epidemic with mass consequences.

Diseases like blinding trachoma, leprosy, intestinal worms, Guinea worm disease and elephantiasis; they blind, disable, and can even be fatal. These diseases are preventable and treatable, yet they still affect 1.7 billion people around the world

As demonstrated by COVID-19, health crises don’t pop up overnight. They are a consequence of systemic underinvestment in global health, lack of strong disease surveillance systems capable of detecting disease outbreaks, global data sharing protocols, weak health systems compounded by a lack of pandemic preparedness backed by sustainable financing for global health.

COVID-19 has shown us that it doesn’t matter whether you are a low, medium or high-income country. If you lack the essential medical supplies, lives will be lost. If you have a critical gap in health workforce and infrastructure, other essential health services will suffer as resources get diverted to fighting a pandemic. Moreover, diseases do not respect borders.

This is why we must not abandon efforts to tackle existing epidemics. Take neglected tropical diseases (NTDs), for instance, coined as such because of persistent neglect. NTDs is the collective name for a group of 20 infectious diseases and conditions. Diseases like blinding trachoma, leprosy, intestinal worms, Guinea worm disease and elephantiasis. They blind, disable, and can even be fatal. These diseases are preventable and treatable, yet they still affect 1.7 billion people around the world. They are a chronic epidemic that rarely make it to the top of anyone’s agenda. They affect the most vulnerable communities in low-resource settings, primarily in Africa. 

Over 600 million people in Africa require treatment for an NTD, making up 35% of the global burden. Across the continent, 12 countries are on track to eliminate an NTD in the next three years – an extraordinary feat based on years of necessary action.

Vulnerable African communities currently face a triple burden; the pandemic has had a devastating impact on health services; cuts to NTD treatments will make them more vulnerable to tropical diseases, and the prospect of these individuals receiving a COVID-19 vaccine before 2023 is highly unlikely. This triple threat makes some communities in Africa more vulnerable to future outbreaks and increases the risk of disease resurgence, undermining efforts to improve global health security. 

It is in the interest of all the G7 countries to sustain investments that directly underpin our safety, security and economic success – and to help shape a recovery plan that promotes the health and prosperity of individuals globally. Only then will we be able to prepare for and tackle future outbreaks of deadly infections.

We welcome the focus of world leaders on One Health, which is a collaborative effort to achieve health for people, animals and the environment at the local, national and global level. We urge G7 leaders to go a step further, beyond focusing on zoonotic diseases and antimicrobial resistance, which simply isn’t enough to truly build pandemic preparedness.

Future health threats could develop from different origins, patterns, nature or impact. All aspects of One Health must be included if we are to improve global health security, including tackling other diseases, such as NTDs.

This will be a win-win for people and countries everywhere. Investments in NTDs have been a success story with 43 countries having eliminated at least one NTD, including 17 in Africa and 600 million people no longer requiring treatment for them. But the UK government’s recent exit from supporting NTD programmes, particularly during a pandemic, undermines years of progress and will deeply impact millions of Africans.

Now, 184 million tablets in 25 African countries are at high risk of expiring in 2021 and 2022 due to the funding cuts. By failing to place tackling NTDs and disease epidemics at the forefront of the global health security agenda, we risk our children’s lives and their future. Poverty will increase and access to education will be impacted. COVID-19 has shown the entire world how highly connected we are and now it is time for disease control to be dealt with collectively.

Thoko Elphick-Pooley is Executive Director of Uniting to Combat Neglected Tropical Diseases

Credit: UN

By Ifeanyi Nsofor and Adaeze Oreh
ABUJA, Mar 30 2020 (IPS)

As COVID-19 surges globally and leaves fear and panic in its wake, global efforts are underway to find a cure. Yet, the same level of response is lacking for several other infectious diseases that kill millions annually. These kinds of neglected tropical diseases (NTDs) are a broad group of communicable diseases which affect more than two billion people and cost developing economies billions of dollars every year.

Lassa Fever is an example and is endemic in Nigeria and other West African countries such as Benin, Ghana, Guinea, Liberia, Mali and Sierra Leone. At present, it kills about 17.8 percent of those infected in Nigeria. In 2020 alone, there have been nearly 4,000 suspected Lassa fever cases and more than 160 deaths.

First reported in 1969, there is still no viable vaccine to prevent it. An acute viral haemorrhagic illness that is similar to Ebola, the infection could last anywhere from two days to twenty-one days and is spread to humans through contact with food or household items that have been contaminated with rodent urine or faeces or from person-to-person.

Given the drive from the global north for a safe and effective vaccine and treatment for COVID-19, it is evident that for as long as diseases like tuberculosis, Lassa fever, as well as others like trachoma and sleeping sickness are limited to poor and marginalised populations, persistent underfunding will continue

Tuberculosis is another neglected disease. According to the World Health Organization, about 10 million people globally were infected with tuberculosis in 2018 including over one million children. India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa accounted for two thirds of all TB cases.

In same year, more than one and a half million people infected died, and over 200,000 of these deaths were recorded in children. What is most astonishing is that for decades TB has been both treatable and preventable. In fact, for the millions across the world living with TB, they are especially susceptible to COVID-19 with a likelihood of millions of deaths. This, according to Médecins Sans Frontières would be a “second tragedy”.

Collectively, while NTDs can lead to complications such as heart and kidney failure, visual impairment, seizures and in several cases death, they do not enjoy the attention of the global health community.

Perhaps because they are often limited to populations that are poor, live in remote locations and lack adequate sanitation. Recent scientific breakthroughs have led to the roll-out of effective drugs for diseases such as sleeping sickness and lymphatic filariasis with new rapid tests for sleeping sickness and leishmaniasis. However, these conditions have not attracted enough domestic and international donor support.

In contrast, between first report of COVID-19 in December 2019 and the first week in March 2020, more than eight billion US dollars has been raised for relief and response efforts worldwide and that figure is steadily rising.

A quick online search for mentions on COVID-19 research yielded over 3.6 billion results in less than half a second, whereas research on Lassa fever yielded only 1.2 million results. Given the global concern and commitment to advancing research, it is estimated that by the end of 2020 there could be a viable vaccine and effective treatment to protect the world and treat this infection; the race to the finish line is now a global competition and major biotechnology companies and the countries behind them all want in.

Given the drive from the global north for a safe and effective vaccine and treatment for COVID-19, it is evident that for as long as diseases like tuberculosis, Lassa fever, as well as others like trachoma and sleeping sickness are limited to poor and marginalised populations, persistent underfunding will continue.

This means that viable vaccines will remain a pipe dream and effective tests and treatments where they exist will not be made widely available and, in enough quantities, to wipe out these diseases.

In light of this reality, these are the steps that must be taken to address these neglected diseases.

First, developing countries that bear the greatest burden of these “neglected diseases” must develop local financing mechanism for healthcare. For too long, these countries have been passive recipients of donor assistance from western countries.

This aid is almost always conditional and tied to certain disease areas. These developing countries as a matter of priority need to shore up domestic finances to make effective interventions against these conditions widely available.

For example, in 2016, about 44 percent of current health expenditures in Africa was financed through domestic government funds and 37 percent from out-of-pocket payments creating significant burdens on African households with no appreciable improvements in healthcare delivery.

Second, countries in the global south must actively develop their research capabilities. A near-total reliance on research from the global north will continue to leave massive gaps in healthcare delivery simply because research is always driven from a perception of need and priority.

For as long as many of these diseases continue to be domiciled in developing countries in sub-Saharan Africa, Asia and Latin America, these continents must become the hubs of research into these conditions.

Third, corporate organisations in developing countries must begin to fund healthcare and health research. Already the private sector in Nigeria is partnering in the response to COVID-19. For instance, the United Bank for Africa is supporting African governments with $14 million for the outbreak response.

Other Nigerian private businesses have also joined in. However, these corporations should also fund epidemic preparedness because it is more cost-effective to prevent a disease outbreak. When pandemics such as COVID-19 happen, their returns on investments suffer.

As the push for decolonising global health continues, governments and the private sector in developing countries must also show leadership and fund the health of their people. It is the ethical and common-sense thing to do.

Dr Adaeze Oreh is a family physician, Senior Health Policy Adviser with Nigeria’s Federal Ministry of Health and Fellow of the West African College of Physicians.  She is also a Senior New Voices Fellow for Global Health with the Aspen Institute.

Dr. Ifeanyi M. Nsofor, is a medical doctor, a graduate of the Liverpool School of Tropical Medicine, the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch. He is a Senior Atlantic Fellow for Health Equity at George Washington University, a Senior New Voices Fellow at the Aspen Institute and a 2006 International Ford Fellow.