The number of people requiring treatment for Neglected Tropical Diseases (NTDs) decreased from 2.19 to 1.65 billion between 2010 and 2021 – an impressive 25 percent decline. However, interlinked challenges, including the COVID pandemic and, now, accelerating patterns of climate change are putting this progress at risk. We World NTD Daywe need to recognize these emerging challenges and look to more integrated approaches.
The impressive 25 percent decrease in the number of people requiring treatment for NTDs and the mounting number of countries that have eliminated at least one NTD are testimony to the progress being made to stamp out some of the world’s most deadly and debilitating diseases – which strike mostly at communities in developing countries and at people living in poverty.
According to the World Health Organization (WHO)47 countries have eliminated at least one NTD since 2010, and NTD programs have performed better in the past year than in 2021.
But while this progress is admirable, it is too slow for millions of people still living with, or at risk of infection from these 20 viral, parasitic and bacterial diseases considered NTDs which range from river blindness to leprosy, rabies and more, and continue to defy national and global elimination plans in many parts of the world today.
Storm clouds on the horizon
Moreover, new challenges like the COVID-19 pandemic and climate change are putting recent progress at risk, threatening to reverse the tremendous gains that have been made over the last few years.
During the pandemic, services for NTDs were the second most frequently disrupted set of health systems services. Looking ahead, changing temperature and rainfall patterns will exacerbate poverty and displace people, and climate change will influence the emergence and re-emergence of multiple NTDs in higher latitudes and altitudes and pose a major risk for communities.
This year’s World NTD Day is an opportunity to revitalize the way we tackle NTDs to not only maintain the progress we achieved so far, but to catalyze better, more efficient, bolder strategies for elimination in the future – harnessing the power of collective action.
The climate threat
This is especially crucial in addressing the added challenges that climate change poses.
NTDs are highly influenced by temperature, rainfall, humidity, and other climatic changes, and even small fluctuations can greatly increase transmission and spread, with potentially devastating effects. Climate change is thus threatening the re-emergence of NTDs in many parts of the world and will likely result in negative health outcomes and disruptions to healthcare systems.
The threat to progress expands beyond NTDs to other infectious diseases. For malaria alone, study show that climate change could lead to an additional 60,000 malaria deaths per year between 2030 and 2050.
Despite the risks, the world is paying little attention to the climate-health nexus and the impact it could have on the resurgence of NTDs and their transmission.
Up until now, approaches to address health and climate emergencies have remained largely separate, perhaps partly due to the lack of knowledge and guidance surrounding the health impact of climate change.
The current literature on the intersection between climate and health is also insufficient to guide policy development. This is why countries, world leaders, and all stakeholders involved should prioritize research in this area. By exploring new and under-explored areas of the interface between climate and infectious disease, we can start to tackle the challenge and protect the gains and accelerate progress towards elimination.
Removing NTDs from the disease control silo
Fulfilling the goal of elimination begins by taking NTDs prevention and control out of isolation and adopting a more integrated approach. At the Global Institute for Disease Elimination (GLIDE) we see the intrinsic value of promoting and adopting cross-disease, cross-border, multi-stakeholder and multi-sector, approaches to innovatively and effectively control, eliminate, and eradicate NTDs.
For this to work in global health, we must make way for more integrated healthcare systems that address preventable infectious diseases of poverty.
The COVID-19 pandemic has exposed the pre-existing cracks in our healthcare systems, spotlighting the dangerous link between NTDs, other communicable diseases, and health emergencies. It has also reinforced the need to address health issues in a more holistic manner. HAS stronger, more systems-wide approach to health will strengthen surveillance, early warning, and pandemic preparedness.
Mainstreaming NTDs within health systems and primary health care services, and promoting country ownership and accountability is an effective jumping off point, according to WHO’s NTD road map 2021-2023. In fact, this will contribute to sustainable and efficient NTD prevention and control, yielding better health outcomes and program management, and cost-effective solutions. But we must understand the economics of neglected diseases and elimination better in order to develop and refine investment cases in a more holistic way, using the health system and packages of essential health care as an important entry point to this mainstreaming.
Water, sanitation and hygiene as a starting point
Another starting point is to consider cross-sector coordination such as with water, sanitation, and hygiene (WASH) for disease prevention. WHO’s roadmap lays out a plan for effective elimination efforts, citing WASH as one of the key interventions in tackling 18 of the 20 NTDs. Improved access to clean water and sanitation can reduce the transmission of many NTDs, such as schistosomiasis, trachoma and guinea worm which, according to the Centers for DIsease Control and Prevention (CDC)is caused by the parasite Dracunculus medinensis and contracted when people do not have access to safe water for drinking.
There is no vaccine or medicine available against guinea worm. However, eradication is being achieved by implementing WASH-related preventive measures. These include filtering drinking water to remove the water fleas that carry the parasite, providing improved water sources and preventing infected individuals from wading or swimming in drinking-water sources. The measures – supplemented by active surveillance and case containment, vector control and provision of improved water sources – have led to great progress toward eliminating guinea worm, with the number of human cases annually falling from 3.5 million in the mid-1980s to just 13 cases in 2022, poising it to become the second disease in human history that could be eradicated altogether, according to a report last week by the Carter Center.
Breaking down silos
The elimination of NTDs is feasible, but we need new approaches.
The upcoming 28th Conference of the Parties (COP28) to the United Nations Framework Convention on Climate Change (UNFCCC), hosted by the United Arab Emirates (UAE) between 30 November and 12 December 2023will be an opportunity for world leaders to both recognize and commit to addressing the health impacts of climate change.
Tea World Health Assembly’s NTD roadmap 2021-2030, meanwhile, emphasizes the importance of integrating NTD programs and establishing links with other sectors such as education, nutrition, WASH, animal, and environmental health. We also must increase spending on NTD control and elimination, strengthening the case for investment.
There is an intimate connection between the health of individuals and the interlinked, cross-boundary events across the globe.
Recognizing this, we need an approach that engages all sectors and geographies in ways that facilitate collaboration, stimulate innovation and continued investment and, finally, by staying committed to delivering a world free of NTDs.
Simon Bland is the CEO of the Global Institute for Disease Elimination (GLIDE), based in the United Arab Emirates (UAE) and focused on accelerating the elimination of four preventable infectious diseases – malaria, polio, lymphatic filariasis, and river blindness – by 2030 and beyond. Founded in 2019 as the result of a collaboration between UAE President, His Highness Sheikh Mohamed bin Zayed Al Nahyan, and the Bill & Melinda Gates Foundation, GLIDE works to elevate awareness and engagement, advance elimination strategies, and foster and scale innovation for disease elimination and eradication.
Image Credits: DNDi, Oxfam East Africa, Deep Knowledge Group.
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