Ending the neglect – integrating approaches to disease elimination

• Focus on COVID-19 is jeopardising progress on neglected tropical diseases;
• Cross-cutting approach to disease control and elimination is needed;
• Certain drugs have the potential to tackle multiple diseases.

By Simon Bland

A cross-cutting approach is needed to tackle neglected diseases as COVID-19 diverts attention, writes Simon Bland.

Just over a year after the pandemic was declared a public health emergency of international concern by the World Health Organization (WHO), more than 173m doses of the COVID-19 vaccine have been administered across 77 countries. Yet whilst efforts to produce and rollout effective vaccines against COVID-19 are being rightly hailed as a science-based, medical marvel, there are fears that this exclusive focus could derail decades of progress in the fight against Neglected Tropical Diseases (NTDs).

To put this into context, research shows that since the start of the pandemic, more diagnostic tests have been developed for COVID-19 than for all 20 NTDs in the last 100 years. Current indications also suggest that NTD funding is being reduced due to shrinking economies and reductions in international assistance, or the diversion of existing funding towards control of the pandemic. This is potentially catastrophic for the one billion plus individuals currently affected by NTDs globally, who have been, and will continue to be left behind if we fail to act.

“Since the start of the pandemic, more diagnostic tests have been developed for COVID-19 than for all 20 NTDs in the last 100 years,”

- Simon Bland, CEO, Global Institute for Disease Elimination

To avoid more resources being diverted away from NTDs, we need to adopt a more integrated approach to disease control and elimination that cuts across multiple diseases, rather than focusing on each disease individually. Identifying the synergies between infectious diseases, including COVID-19, is key to achieving a more integrated healthcare system.

Connected world

The NTD community needs to make a stronger case for ending the neglect. Now is a rare opportunity to do so. The world has seen, first-hand, how the health of individuals is intimately connected across the globe, and how the health of humans and health of the global economy are equally intertwined. With COVID-19, no one is really safe until, and unless, everyone is safe. Stronger, more integrated health systems will strengthen surveillance, early warning, and pandemic preparedness. We should be seeking resources to tackle NTDs with this in mind.

Moreover, COVID-19 has helped raise awareness of the importance of sanitation and hygiene in disease prevention. WHO’s new roadmap for NTDs, 2021-2030, lays out a plan for effective elimination efforts. It cites water, sanitation, and hygiene (WASH), as one of the core strategic interventions in tackling 18 of the 20 NTDs, including lymphatic filariasis, which infected more than 56 million people worldwide in 2017.

According to the Centers for Disease Prevention and Control (CDC), we can reduce WASH-related NTDs by as much as 78 per cent around the world with better sanitation. The expansion of WASH marks a significant shift for the NTD community as it begins to adopt a more cross-sectoral approach to disease elimination.

Repurposing drugs

There are benefits, too, from adopting a more integrated, cross-disease approach to mass drug administration. Ivermectin, produced by Merck & Co., is a highly effective treatment for the prevention of onchocerciasis, an NTD contracted from a parasitic worm transmitted by black flies, and for lymphatic filariasis, another NTD spread by parasitic worms transmitted by mosquitos.

In 1987, Merck & Co. committed to donate Ivermectin free of charge for as long as needed through the Mectizan Donation Programme. There has since been interest in repurposing Ivermectin, and it is now being used to treat certain cases of malaria, for example, and there are even clinical trials to assess its potential use in the fight against COVID-19, although there is little hard evidence of its effectiveness at present.

At the newly formed Global Institute for Disease Elimination (GLIDE), we see the intrinsic value of promoting and adopting multi-sectoral, multi-stakeholder and cross-border approaches to disease elimination. This approach calls for actors across all levels and geographies to engage in ways that facilitate collaboration, address fragmentation, and avoid duplication of effort. It is not always going to be straightforward but if we leverage these opportunities, we are likely to see more impactful, lasting effects with global reach.

Despite its challenges, COVID-19 offers us the opportunity to think more synergistically, so that resources can serve communities suffering from COVID-19 and NTDs. As past outbreaks have shown, deaths from preventable diseases increase dramatically when healthcare systems are overwhelmed and fragmented. This shift to integrating the prevention and treatment of NTDs into routine primary healthcare services brings us one step closer to achieving universal health coverage (UHC), in which no disease, and no person, is left behind.