The Americas is One Step Closer to Eliminating Onchocerciasis

 

Less than a year after Colombia eliminated onchocerciasis from its borders, its neighboring country, Venezuela, is making similar strides in the fight against neglected tropical diseases (NTDs). Earlier this month, we were excited to hear that Venezuela interrupted transmission of onchocerciasis in its last remaining focus area of the country – meaning Venezuela is well on its way to being certified for eliminating this painful and disfiguring disease.

Onchocerciasis is the world’s fourth leading cause of preventable blindness. As one of the seven most common NTDs, onchocerciasis primarily affects poor populations living along rivers. Infection occurs when black flies carrying the filarial parasitic worm Onchocerca volvulus bite humans. After the larvae enter the body, develop into adult worms, and eventually die, the disease progresses to cause severe skin rashes and depigmentation, visual impairment and blindness. Control efforts in the both the Latin American and African regions are focused on eliminating this NTD as a public health concern.

If you can recall, six countries in the region of the Americas were previously endemic to onchocerciasis: Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela. Through the concerted efforts of the ministries of health of the endemic countries and the local communities, the Onchocerciasis Elimination Program for the Americas (OEPA), the Carter Center, the Pan American Health Organization (PAHO), and Merck & Co., 11 out of the 13 foci had achieved control of this NTD by 2013. The two remaining foci are found in the border region between Venezuela and Brazil, specifically in the migrant Yanomami indigenous community.

Francisco Armada, Venezuela’s Minister of Health, announced the interruption of transmission on World Health Day last week. The People’s Ministry of Health of Venezuela (MPPS) and the PAHO country office will now begin the three-year surveillance stage. If no new cases are found during the three years, Venezuela can begin the process for certifying the elimination of onchocerciasis. Minister Armada also reaffirmed the government’s commitment to Brazil to continue working together to reach the joint goal of onchocerciasis elimination in the region.

Colombia was the first country in the Americas to receive verification of the elimination of this NTD from the World Health Organization (WHO). Ecuador has completed the three-year surveillance phase and Guatemala and Mexico are close to completing it – after this phase, they will be able to request verification of elimination from WHO. The progress demonstrated in the Latin American and Carribbean region is encouraging.

We congratulate Venezuela on this success and look forward to following the country’s – and the region’s – progress towards onchocerciasis elimination!

Health Care Workforce Shortage=Failure to Meet MDGs

 

Health workers in Honduras

Health workers in Honduras. Photo by Olivier Asselin

Did you know 83 countries do not have enough health workers to meet the World Health Organization’s minimum standard to provide basic health services (No Health Without a Workforce, 2013)? The importance of the health workforce cannot be overstated and without concrete efforts from the international community to strengthen the frontline community of health workers, the Millennium Development Goals (MDGs) and those health goals being outlined for the Post-2015 United Nations Development Agenda, will not be met.

Congressional Briefing Highlight

 Recently, I attended a congressional briefing led by International Medical Corps (IMC) and Management Sciences for Health (MSH) in cooperation with Representative Jaime Herrera Beutler and Dibba F. Edwads and Representative Kristi Noem and Doris O. Matsui. The briefing, titled,“Saving Women’s and Children’s Lives; Strengthening the Health Workforce in Fragile Countries” discussed the needs of the frontline health workers today and highlighted a few examples of programs addressing these gaps successfully.

Saving Mothers, Giving Life, was one program highlighted as a model of best practice.  The program is currently operating in Uganda (a fragile state) and Zambia, and is focused on maternal and child health.  Saving Mothers, Giving Life pays special attention to the needs of individual health care providers by offering training and mentoring services to improve contact with patients and grow the workforce of community health workers in these cities.  The program also focused on the health facilities themselves, working to improve access to health services overall.  By focusing on the health workforce and the health workplace, this program has seen a 30% reduction in maternal mortality in both countries. The multitude of public and private partnerships involved has also been an innovative piece to the model of this program design worth noting.  A few other “best practice models” were highlighted at this briefing, including examples from other fragile states (ie: Sudan, Afghanistan and Pakistan), but the resounding message from all examples was clear: the importance of individual health workers’ needs and the need for infrastructure to support their endeavors improves health outcomes for the community.

Multi-Talented Workforce Easily Overworked

Health workers are a huge asset to improving population health and they often are trained to care for a multitude of ailments (ie: maternal child health care workers can offer services for nutrition needs, routine immunizations, malaria, HIV/AIDs, TB, and neglected tropical diseases (NTDs) and NTD health workers distributing mass drug administration pills can also distribute malaria nets and vitamin A supplements).  While this integration of health services provided by the health workforce is ideal, often times the health workforce becomes overburdened, or worse, burnt-out. A contributing factor to the overburdening of the health workforce is the chronic health workers shortage. It will be no surprise when the MDGs are not met given the current health workforce shortage, an estimated 4.2 million health workers, with 1.5 million needed in Africa alone. However, looking ahead to the UN Post-Development Agenda, increasing the health workforce significantly will be imperative to success.

Health workers are the backbone of a healthy society and without them, health goals of the international community will not be reached.  While World Health Workers Week has come and gone acknowledging the backbone of a health society should be a constant effort.

Follow #healthworkerscount @MSHHealthImpact @IMC_Worldwide and @USAIDGH for more on this topic.

Strengthening Supply Chains for NTDs through Partnerships

 

Have you ever been curious about how the medicine to treat neglected tropical diseases (NTDs) reaches communities across the world? A new video from GlaxoSmithKline (GSK) explains how establishing key partnerships and implementing evidence-based supply chain methods enables us to prevent and treat those that are suffering from NTDs across the globe.

Through the 2012 London Declaration on NTDs, pharmaceutical companies, non-governmental organizations (NGOs), and donor and endemic governments dedicated themselves towards scaling up drug supply to over a billion people suffering from NTDs. In 2013, 1.35 billion low-cost treatments for NTDs were donated to more than 70 endemic countries worldwide.

To build upon the successes realized over the past two years and to meet the NTD control and elimination goals by 2020, new approaches on the methodology of supply chain management for NTDs are needed. To answer this challenge, pharmaceutical industries, NGOs and supply chain experts formed the NTD Supply Chain Forum. The team includes pharmaceutical companies (GSK, Pfizer, Eisai, Merck Serono, J&J, Merck & Co., Inc), NGOs (Children Without Worms, International Trachoma Initiative  Mectizan Donation Program), DHL, JSI, and Bill & Melinda Gates Foundation.

Their goal is to simplify complex logistical, manufacturing, and personnel challenges to streamline the high number of drugs being distributed to rural villages, schools, and clinics in need of NTD treatments.

Already through this partnership, 809 million treatments were donated for lymphatic filariasis, 115 million treatments for onchocerciasis, 276 million treatments for soil transmitted helminthes, 52 million treatments schistosomiasis and 51 million treatments for trachoma.

We encourage you to watch GSK’s video on Supply Chain: A Critical Link in Combating NTDs. For more information about the supply chain progress that is being made for NTDs, please read the Supply Chain section of the recent 2013-2014 report on Delivering on Promises & Driving Progress: The Second Report on Uniting to Combat NTDs.

SMS and eMedicine in the Elimination of NTDs

 

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This blog was originally posted by By Matthew Alexander on POLYGEIA‘s blog *

Just over a fortnight ago, 27th March saw India declared a Polio-free country; it has been over three years since 18 month-old Rukhsar Khatoon was diagnosed with the last case in South-East Asia. The disease left her with mild paralysis in her right leg.

Only three decades ago, 200,000 children per year were left with disabilities due to polio in India, and in 2009 India was still the site of 741 of the world’s 1,604 cases. Now, following the elimination of polio from India, 80% of the world is polio free. [1] The final push will involve mass vaccination of remaining endemic countries: Afghanistan, Niger and Pakistan, but with one-hundred children recently infected in Syria there is a race to prevent new epidemics before the 2018 eradication target. [2]

The Polio virus will not be the first pathogen to be eradicated by human intervention. The Variola virus (the causative agent of smallpox) has been extinct in the wild since 1977, and more recently in 2011, the Rinderpest virus was declared eradicated by the OIE. [3] The successful Smallpox campaign cost $1billion in today’s currency, with two-thirds of the financial burden on the endemic countries; this is in stark contrast to the polio programme with the Post Graduation Education Institute (PGEI) estimating that the next four years will cost $5.5 billion in addition to the billions already invested since the 1980s. Yet there is still a strong economic case for eradication, with returns of $25 billion in as few as two decades when compared to routine immunisation. [4]

So what does polio elimination have to do with Neglected Tropical Diseases (NTDs)? Like the polio virus, many of the pathogens that cause NTDs are eradicable; they cause debilitating symptoms that hinder economic and social activity; they cause much suffering to the afflicted and their families; in total, 1.7 billion people are at risk of developing these diseases. Of the 17 NTDs listed by the WHO, two are set to be eradicated worldwide and 10 have co-ordinated programmes to eliminate the disease from endemic populations, all within the next 10 years. [5]

In 2004, another disease was eliminated from India to a much smaller fanfare; Yaws begins as a cutaneous infection and spreads to cartilage inflicting disfigurement and disability. The causative pathogen, a bacterium of the Treponema pallidum species, is easily treated with a single oral dose of azithromycin and yet Ghana, Papua New Guinea and the Solomon Islands report over 10,000 cases per year. WHO hopes for its eradication by 2020 through a programme of identification of endemic areas and blanket treatment. [5]

The NTD policy team members of Polygeia are working hard to find areas where we can take novel ideas and apply them effectively to real world situations. My personal interests lie in the use of mobile phones and SMS to improve uptake of available testing, counselling and treatment concordance. Much work has been done in HIV and TB treatment with schemes such as WelTel showing promise. Under this programme, HIV positive patients were required to respond to weekly texts from a nurse and then outcomes were compared to a control group receiving standard care. Those receiving texts were 19% less likely to be non-compliant and 16% less likely to show failure of viral suppression. In other words, for every 11 people treated, one would remain well who may otherwise have developed AIDS. [6]   We hope to develop policies that will take successful concepts in eMedicine to the fight against NTDs.

References:

[1] Basu, M.  India beats the odds, beats polio. CNN, 27th March 2014

[2] Whewell ], T. Polio in Syria: An outbreak that threatens the Middle East. BBC, 26th March 2014

[3] Rinderpest Eradication, Bulletin No. 2011-12, OIE, Feb 2011

[4] Economic Case for Eradicating Polio, PGEI, 2013

[5[ Sustaining the drive to overcome the global impact of neglected tropical diseases, WHO, 2013

[6] Yaws fact sheet No. 316, WHO, 2014

[7] Lester R. T. et al, 2010. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet, Vol. 376, Issue 9755

*Polygeia was founded to give students the opportunity to contribute to global health policy. Its core aims are:

  1. Research and disseminate high quality policy papers and follow up on their implementation where possible.
  2. Develop the skills of our researchers through our policy workshops and mentoring programme.
  3. Engage students and others with the global health issues on which we are working.