Yesterday the World Health Organization launched a new road map to prevent, control, eliminate and eradicate a set of 20 neglected tropical diseases, by 2030. The new road map “Ending the neglect to attain the Sustainable Development Goals” is the culmination of an extensive consultative process involving a diversity of stakeholders, partners and disease experts across the globe.
The draft road map went through several iterations until finally being submitted to the Seventy-third World Health Assembly in May 2020. Due to the pandemic, the WHA moved to virtual meetings predominantly concerned with Covid-19, and the NTD road map was finally endorsed by the WHA in November 2020. Keen to get stuck into the work as soon as possible, the official launch of the road map was set for the 28th of January 2021, ahead of World NTD Day on the 30th of Jan (see last year’s Bugbitten post for the first World NTD Day).
The burden of Neglected Tropical Diseases and achievements since 2012
Neglected Tropical Diseases are a diverse set of 20 conditions, caused by parasites, bacteria, viruses, fungi, and toxins, affecting around 1.7 billion people worldwide. Predominantly affecting people living in deprived, underserved, and disenfranchised communities, NTDs succeed through our failure to correct inequities. NTDs both thrive in areas of poverty and strengthen the causal roots of poverty, by stunting child development, robbing productivity, reducing quality of life and causing irreversible damage, disability and stigma.
“Their impact is felt more often than not by the very people who are least equipped to bear the burden of suffering and disability, not to mention the profound social and economic burdens of disease.” Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control of NTDs explains in this article.
Huge progress has been made since the launch of the WHO roadmap for 2020 and the 2012 London Declaration where organizations, governments, research institutes and pharmaceutical companies pledged to work together to control and eliminate at least 10 NTDs. Today around 500 million fewer people are at risk of NTDs and 42 countries have eliminated at least one NTD. As an example, read about the gains made to fight one group of NTDs, Soil-transmitted helminths, in this recent Bugbitten blog.
Whilst this has come on the back of huge efforts and commitment, the world is experiencing new challenges that have revealed, now more than ever, the devastating impact of inequities in health. To ensure no one is left behind and that we #EndTheNeglect, a new approach is needed.
Paradigm shifts to accelerate progress to the Sustainable Development Goals
The open consultative approach by the WHO revealed the need for fundamental shifts in strategies and three crucial shifts underpin the new road map:
- Accelerate programmatic action; Moving from measuring process to measuring impact, thereby increasing accountability, evidence-based programmatic decisions and data-driven responses.
- Intensify cross-cutting approaches; Moving from vertical, top-down programmes to horizontal, cross-cutting programming – combining efforts and involving people and partners across sectors and disciplines to build integrated, holistic approaches, and importantly keeping patients at the centre of these interventions.
- Change operating models and culture to facilitate country-ownership; Moving away from partner-led to country-driven and country-owned programming meaning that interventions will reflect the needs on the ground and will align with the global health agenda.
The WHO NTD Road map 2021-2030 has set the following overarching targets:
- reduce by 90% the number of people requiring treatment for NTDs
- at least 100 countries to have eliminated at least one NTD
- eradicate two diseases (dracunculiasis and yaws)
- reduce by 75% the disability-adjusted life years (DALYs) related to NTD
On top of this, the road map also lists 10 cross-cutting targets and disease-specific targets for the 20 NTDs. The road map’s Sustainability Framework was released yesterday with the launch and the WHO are developing the following to accompany and support the road map: a Monitoring and Evaluation Framework and an Investment case; a research and development blueprint and an updated global strategy on water, sanitation and hygiene (WASH) and NTDs.
Innovation and Research
“Focusing on country-driven solutions is critical to achieving the NTD road map 2030 targets. Investing in developing new tools & innovations in the delivery of NTD related services can help us #EndTheNeglect & #BeatNTDs ” said Dr Katey Owen, Director of NTDs at the Bill and Melinda Gates Foundation, giving the example of onchocerciasis “We still don’t have a drug for the adult worms of this ancient disease, onchocerciasis, or a better diagnostic than the archaic skin-snip.”
Yesterday’s launch highlighted the critical role research and innovation play to bridge the gaps between where we are now and where we want to be by 2030 (Check out this special issue on NTDs). Key research areas raised in the road map and in the launch are:
- Epidemiology and pathology of these NTDs and how the diseases and interventions interact with the wider social, environmental and demographic context
- Social-anthropological research to move to a patient-centred approach and improve NTD interventions
- Diagnostics that are accessible in low-resource settings, quality assured and appropriate for disease programme targets (control, elimination, surveillance) and at point-of-need (e.g. useable at community level, in peripheral healthcare services etc)
- Effective and efficient treatment strategies and interventions that prevent and treat NTDs, manage cases and provide rehabilitation and care. These interventions need to use platforms that access the hardest-to-reach
- Mapping protocols and monitoring and evaluation strategies with strong data collection, management and analysis to enable evidence-based decisions.
- Development and use of innovative technologies such as GIS, satellite imaging, artificial intelligence and low-cost technologies
- Cross-sectoral strategies working with the Water, Sanitation and Hygiene Sector; One Health approach for human and veterinary disease elimination, vector management and environmental health; a thorough understanding of the impact of climate change on NTDs and NTD services to sustain the gains made
“Looking for catalysts to improve south-south and north-south collaborations …we need an integrated approach to overcome perennial barriers of language, geography and disease”. Dr John Amuasi, Director of the African Research Network for NTDs
Strengthening research capacity within and across endemic countries is vital to reach the NTD 2030 road map targets. Dr John Amuasi, Director of the African Research Network for NTDs highlighted the crucial work being done to build robust African research capacity. Dr Amuasi also highlighted the need to understand the impact of the COVID-19 pandemic on NTDs at the biomedical level and at the public health level. “We need to seek to understand more about the impact of COVID-19 on NTDs, both for people affected by NTDs and for future program action. This knowledge is vitally important for the success of the NTD road map”.
A particular inspiring statement was given by Gerald Chirinda, founder of Future Africa Forum and Youth Combating NTDs. “Young people are innovators” he said as he described how youth groups, and early career researchers & professionals are working on a variety of innovations from local language information sharing using mobiles, last mile delivery of health products and services, and innovative diagnostics, to drive change in their communities.
The road map is now launched. It is is a guide, a vision and a call to action, to end the neglect and beat NTDs.