How COVID has affected the control of neglected tropical diseases

Neglected tropical diseases is an umbrella term used to describe a group of 20 infectious diseases. These diseases affect over 1.7 billion people. They can disable, debilitate and even kill. The world’s most vulnerable and poorest are most affected. In the past, the diseases in this group have been overlooked internationally and poorly funded domestically: hence the “neglected” in the name. Some common neglected tropical diseases are Buruli Ulcer, Dengue Fever and Hansen’s disease (also known as leprosy).

There are already tools to prevent and treat these diseases. They include drugs, vector control, veterinary public health interventions and provision of safe water and toilets.

In the past 10 years there have been significant global efforts to control neglected tropical diseases. In 2012, pharmaceutical companies, donors, endemic countries and non government organisations came together to sign the London Declaration on Neglected Tropical Diseases. Together, they committed to control, eliminate or eradicate ten of these diseases by 2020 and improve the lives of over a billion people. Support from the signatories ranged from donation of the essential medicines to financing the delivery and distribution of the drugs, research, and funding for sanitation and safe water. These concerted global efforts have yielded successes and are grounds for optimism.

To date, 600 million people no longer require treatment for neglected tropical diseases. Cases of some of these diseases, such as leprosy, sleeping sickness and Guinea worm disease, are at an all-time low. Forty-four countries have eliminated at least one neglected tropical disease as a public health concern. Most recently the Gambia and Saudi Arabia eliminated trachoma, a bacterial infection which causes blindness.

However, this progress is now at real risk of reversal as a result of the COVID-19 pandemic. Drug programmes have been interrupted, health budgets re-prioritised and aid cut.

As I have previously highlighted, interrupting control programmes could lead to rebound infections and disease. These could be worse than the original levels. This is now an imminent reality for neglected tropical diseases if control programmes do not resume quickly enough.

Interrupted disease control

One of the most important tools to use against neglected tropical diseases is national mass drug administration. 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 the national treatment programmes are annual events conducted in schools or health centres. It takes time, effort and money to plan and implement these programmes. And it’s critical to maintain momentum. Every dollar spent on these programmes yields a significant return on investment. This is why neglected tropical disease control has been termed a “best buy” in development.

The pandemic has affected neglected tropical disease control in three ways.

First, mass drug administration was stopped or interrupted by the lockdown and social distancing policies. And disruptions in global trade and transportation affected supply chains. A recent World Health Organisation survey indicated that, as of early 2021, disruptions in neglected tropical disease control programmes occurred in 44% of countries.

Second, national governments in neglected tropical disease endemic countries have low health budgets. Changing priorities during and after COVID-19 has meant that the resources allocated to neglected tropical diseases may be shifted to other diseases and health services.

Third, a significant amount of funding for neglected tropical disease control programmes comes from international development partners and foreign governments. Post-COVID-19 economic contraction in their economies and shifts in funding priorities are threatening the gains made in controlling neglected tropical diseases. For example, the UK recently withdrew over £150 million of funding to neglected tropical disease programmes as part of cuts to the country’s aid budget. This wiped out a third of donor funding for tackling neglected tropical diseases, with an impact on treatments to 250 million people and as many as 180,000 surgeries to prevent disabilities.

Long term consequences

Continued neglect of these diseases has dire consequences. Those affected continue to suffer the devastating diseases, associated health inequities and cycles of poverty. The effects of these diseases are pervasive and wide-ranging.

As long as neglected tropical diseases are a huge burden on health systems in endemic countries, these countries will continue to haemorrhage resources, finances and lives to these diseases. This will further weaken their health systems, compromising their ability for timely surveillance, detection and containment of the next epidemic. From the Global Health Security Agenda, we know that weakened health systems anywhere in the world compromise health security globally. Local health security is the foundation for global health security, as COVID-19 has amply demonstrated.

The opportunity to put global attention back on neglected tropical diseases will come later this year when the London Declaration is superseded by the Kigali Declaration. This high-level political declaration, led by Rwanda and Nigeria, aims to mobilise political will and secure commitments to achieve Sustainable Development Goals targets for these diseases.

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