Francisca Mutapi

Neglected tropical diseases are an umbrella term used to describe a group of 20 infectious diseases. These diseases affect more than 1.7 billion people.

They can disable, debilitate and even kill. The most vulnerable and the poorest in the world are the most affected.

In the past, diseases in this group have been neglected internationally and poorly funded nationally: hence the “neglected” in the name.

Some common neglected tropical diseases are Buruli ulcer, dengue, and Hansen’s disease (also known as leprosy).

Tools already exist to prevent and treat these diseases. They include drugs, vector control, veterinary public health interventions, and the provision of clean water and toilets.

Over the past 10 years, significant efforts have been made globally to control neglected tropical diseases.

In 2012, pharmaceutical companies, donors, endemic countries and non-governmental organizations came together to sign the London Declaration on Neglected Tropical Diseases.

Together, they pledged to control, eliminate or eradicate ten of these diseases by 2020 and improve the lives of over a billion people.

Support from signatories ranged from donating essential drugs to funding the delivery and distribution of drugs, research and financing sanitation and clean water.

These concerted global efforts have borne fruit and give cause for optimism.

To date, 600 million people no longer need treatment for neglected tropical diseases.

Cases of some of these diseases, such as leprosy, sleeping sickness and Guinea worm disease, are at their lowest.

Forty-four countries have eliminated at least one neglected tropical disease as a public health problem.

More recently, Gambia and Saudi Arabia have eliminated trachoma, a bacterial infection that causes blindness.

However, this progress is now in danger of being reversed due to the Covid-19 pandemic. Drug programs have been cut, health budgets have been redefined and aid has been cut.

As I have already pointed out, the interruption of control programs could lead to a rebound in infections and diseases.

These could be worse than the original levels.

This is now a looming reality for neglected tropical diseases if control programs do not resume soon enough.

Disease control interrupted

National mass drug administration is one of the most important tools to be used against neglected tropical diseases.

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, national treatment programs are annual events held in schools or health centers.

It takes time, effort and money to plan and implement these programs.

And it’s essential to keep the momentum going. Every dollar spent on these programs generates a significant return on investment. This is why the fight against neglected tropical diseases has been called development’s “best buy”.

The pandemic has affected the fight against neglected tropical diseases in three ways.

First, mass drug administration has been stopped or halted by lockdown and social distancing policies. And disruptions to global trade and transportation have affected supply chains.

A recent World Health Organization survey indicated that at the start of 2021, disruptions in neglected tropical disease control programs occurred in 44% of countries.

Second, national governments in countries endemic for neglected tropical diseases have low health budgets.

Changing priorities during and after Covid-19 mean that resources allocated to neglected tropical diseases may be redirected to other diseases and health services.

Third, a significant portion of funding for neglected tropical disease programs comes from international development partners and foreign governments.

Post-Covid-19 economic contraction in their economies and shifts in funding priorities threaten gains made in the fight against neglected tropical diseases.

For example, the UK recently withdrew more than £150m of funding to neglected tropical disease programs as part of cuts to the country’s aid budget.

This wiped out a third of donor funding to fight neglected tropical diseases, impacting treatments for 250 million people and up to 180,000 surgeries to prevent disabilities.

Long term consequences

Continued neglect of these diseases has disastrous consequences.

Those affected continue to suffer from devastating diseases, associated health inequities and cycles of poverty. The effects of these diseases are pervasive and widespread.

As long as neglected tropical diseases represent an enormous burden on the health systems of endemic countries, these countries will continue to sacrifice resources, finances and lives to these diseases.

This will further weaken their health systems, compromising their ability to timely monitor, detect and contain the next outbreak.

From the Global Health Security Agenda, we know that weakened health systems around the world undermine global health security. Local health security is the foundation of global health security, as Covid-19 has amply demonstrated.

The opportunity to bring global attention back to neglected tropical diseases will present itself later this year when the London Declaration is replaced by the Kigali Declaration.

This high-level political declaration, led by Rwanda and Nigeria, aims to mobilize political will and secure commitments to achieve the Sustainable Development Goals for these diseases.

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

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