Ray Collins on strategic attempts to tackle neglected tropical diseases
Neglected tropical diseases (NTDs) are the most common infections amongst the world’s poorest communities, but receive little attention in the media. While not always fatal, their impact on individuals and communities can be devastating. They fall disproportionally upon the world’s poorest and most vulnerable, and result in people being unable to work – affecting their quality of life and that of their families. It is estimated that more than one billion people are affected by NTDs, including roughly 800 million children; and they are a serious impediment to economic development in many nations.
There is no doubt that the coming together of the global health community last January a year ago, to plan a new way forward in achieving a world free of these devastating ailments, was an historic occasion. The London Declaration committed an unparalleled group of partners to the control or elimination of 10 NTDs in line with targets set by the World Health Organization (WHO). It marked the beginning of a new and coordinated effort and in the year since its launch has seen the lives of millions improving. But it will need more resources and political will from all governments if it is to achieve WHO’s 2020 goals.
The 10 NTDs targeted for control, elimination or eradication are:
• Blinding trachoma
• Chagas disease
• Guinea worm disease
• Human African trypanosomiasis (sleeping sickness)
• Lymphatic filariasis (LF or elephantiasis)
• Leprosy
• Onchocerciasis (river blindness)
• Schistosomiasis (snail fever or bilharzia)
• Soil-transmitted helminthiasis (STH or intestinal worms)
• Visceral leishmaniasis (kala azar)
The control and elimination of these diseases is feasible through mass drug administration (MDA). This includes the mass dispensation of inexpensive, available medication, but failure to also address the underlying causes will make the task almost impossible. And the Barriers and risks to achieving the WHO targets include conflicts and the consequent movement of people; population growth; vector or intermediate host control; resistance to medicines and pesticides; expectations overtaking science; inadequate support for research; and climate change.
We still have a world where some 780 million people are without adequate sanitation and safe drinking water. 40% of those without access to improved water sources live in sub-Saharan Africa where many of the NTD are prevalent. The biggest challenge is in India where more than half of the Country’s population (625 million) are without basic toilet facilities.
So an integrated approach is essential if we are to meet the WHO targets. There are other risks to promoting MDA, including the undermining of already fragile and overstretched health-care systems and difficulties with relying on volunteers to assist with distribution in targeted communities.
However, schemes like the Bangladesh’s Ministry of Health and Family “Little Doctors” programme are shining examples of how education on public health and drugs can work effectively together. The programme teaches students from upper grades to assist teachers with deworming days. The Little Doctors also share hygiene and other health messages with their classmates and families, to help prevent re-infection. In partnership with Children Without Worms, the program currently provides twice-yearly treatments to 24 million school-age children annually.
To ensure the London Declaration is delivered we need clear government strategies on improving access to clean water and improved sanitation, and a focus on building health care capacity and improving public health and education.
Lord Ray Collins of Highbury is Shadow Minister for International Development in the Lords, and also a member of the Shadow Health team
Published 30th January 2013
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