A Moral Imperative: END7 Student Simran Dhunna Urges World Leaders to Prioritize NTDs

END7 has just announced the members of the 2015-2016 Student Advisory Board. Congratulations to all of our new and returning board members, and our sincere thanks to everyone who applied! The Student Advisory Board will mentor other student leaders and advise END7 on student engagement for the entire school year. By contributing their time and expertise to the activities of the Board, representatives play a major role in charting the course of the END7 campaign.

As world leaders prepare to finalize the Sustainable Development Goals (SDGs) this September — and their indicators in March — we asked students to tell us how they would make a case to world leaders to include a goal to control and eliminate neglected tropical diseases. Read END7 Student Advisory Board representative Simran Dhunna’s response below.

Simran Dhunna E7

After the Ebola outbreak in West Africa, the world suddenly became acutely aware of the gaps that exist in global health governance and health systems. The World Health Organization demonstrated that there are deep-rooted structural limitations in its own system of finance and accountability. Furthermore, the infectious disease events of this year, including but not limited to Ebola, have shown the debilitating effects of neglect on populations without access to healthcare. For example, we’ve stood by as civil unrest has continued to exacerbate the spread of NTDs, such as the outbreak of Dengue in Yemen. Within and beyond the 17 diseases that the WHO designates as “Neglected Tropical Diseases,” lies an unfortunate truth: communities and the endemic diseases they suffer from are neglected because they are trapped in a cycle of poverty. Thus, the case I would make to world leaders rests on this principle: neglected diseases do not function in a vacuum. Rather than being an isolated public health issue, NTDs are multifaceted, in that they interact with virtually every aspect of society.

The SDGs, naturally, include an emphasis on poverty and climate change. NTDs encompass both of these topics. Firstly, it has been well established through clinical and academic literature that neglected communities remain generally at the lowest tiers of socioeconomic status. In essence, diseases such as sleeping sickness or lymphatic filariasis disproportionately affect the poor much more than every other socioeconomic class. This is not a coincidence. Individuals who suffer from NTDs have nearly every facet of their lives affected, such that they cannot pursue their most basic goals and aspirations, like an education or sustainable employment. To the world leaders, I would say that NTDs are so interwoven with issues of poverty, that to not include diseases of poverty in our global agenda would be a disservice to the SDG that aims to eliminate poverty. In other words, our strengthened efforts to eliminate NTDs could result in more children going to school, getting a job and having prosperous lives. Removing this massive health burden can be the key to lifting millions of individuals, and neglected communities, out of poverty.

One of the other SDGs concerns itself with climate change. The unique characteristic about neglected tropical diseases is that they profoundly interact with the environment. Many of the NTDs are zoonotic or parasitic/helminthic diseases. Thus, there is an inevitable cause-and-effect relationship between a community’s environment and its state of health. Just as several global health professionals use a ‘One Health’ perspective, it’s essential to recognize the unique animal-human interface that is so inherent in NTDs. Changing climates mean that the ecology and evolution of vectors and other pathogenic organisms is also constantly fluctuating. The migration patterns of mosquitos, for example, could be spreading an outbreak to other areas not equipped to deal with it. We already see the rapid development of certain diseases like MDR-TB, in which organisms are spreading resistance genes at a faster rate due to environmental factors. Moreover, weaknesses in environmental systems, such as sanitation and sewage, lend themselves to further public health concerns. Hence, NTDs are not isolated to one community and one clinical issue – they are affected by the agricultural practices of a given region and the environmental policies that govern whether individuals have access to clean water. The ecology and environment of humans, which is undeniably affected by climate change, is a fundamental contributing aspect of NTDs. Including climate change in the SDGs necessitates that NTDs also be addressed, because one is a central causal factor of the other.

Finally, to the world leaders I say this: having broad goals is admirable, but having achievable goals is necessary. Campaigns like END7 demonstrate the austerity in addressing NTDs: medications that eliminate certain neglected diseases exist. There are simply no systems in place for neglected communities to access them. I would implore the world leaders to consider the feasibility of adding NTDs to the Sustainable Development Goals, because eliminating NTDs can be done through appropriate dissemination and implementation of treatment programs, such as deworming initiatives.

The elimination of NTDs is very much a reality in the future. The problem lies in the lack of existing frameworks to address them: there is limited global commitment to eliminating NTDs, and a lack of incentive to invest R&D into them. What I see is a gap in commitment to a worthwhile cause, one that demands as much attention as any other global health or development issue. Dedicating a Sustainable Development Goal to ending neglected tropical diseases is not only an achievable target – it is a moral imperative for world leaders to act upon.

END7 Student Advisory Board representative Simran Dhunna is a junior studying microbiology and global health at the University of Toronto.

Dr. Neeraj Mistry speaks at the UN ECOSOC High-Level Political Forum on July 9, 2015.

What Gets Measured Gets Counted

A man is disfigured and shunned by his community. A child is too tired and sick to go to school. A woman is blinded by an infection. These are just some of the effects of neglected tropical diseases (NTDs). There are 1.4 billion of these stories — one for each person whose life is impacted by an NTD.

We can’t tell every one of these stories, so we rely on numbers. 1.4 billion people. More than half a billion children. These numbers are our rallying cry. Statistics tell us where we are improving and where we are failing, and provide a sense of scale for problems too big to comprehend.

Fifteen years ago, the United Nations (UN) established the Millennium Development Goals (MDGs), eight international development goals that brought together the global health and development community to tackle some of mankind’s greatest challenges. The eight narrow targets “helped channel everyone’s energies — and money,” according to NPR’s Nurith Aizenman. Unfortunately, that meant issues without clear targets were left behind. NTDs were listed in the MDGs as “other diseases,” and had no specific indicator. As a result, these diseases, true to their name, have remained neglected.

When the MDGs expire at the end of 2015, they will make way for the Sustainable Development Goals (SDGs), a new set of targets that present a second chance to ensure NTDs receive the attention they deserve. Back in 2000, the process of developing the MDGs was “brilliantly simple,” Mark Malloch-Brown, a member of the original UN team that developed the MDGs, told NPR. But things are very different this time around. With the MDGs far surpassing initial expectations, all eyes are on the SDGs, and the process is far from simple.

Following years of politicking and debate, the UN Summit is expected to adopt the finalized SDGs in September, and the UN Statistical Commission plans to set official indicators in March 2016. At last count, the proposal contained 17 goals and 169 proposed targets. Though critics say the proposal’s broad scope will dilute its effectiveness, these myriad goals will level the playing field, elevating important issues that were ignored by the MDGs.

NTDs are included in Goal 3 of the proposed SDGs, which reads, “by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.” This explicit mention of NTDs is already an improvement over the MDGs, but what does it mean to “end the epidemic”? A clear indicator will be key to rallying support for NTD elimination.

But an initial draft of indicators presented during the March meeting of the UN Statistical Commission failed to include indicators for NTDs. As we have learned from the MDGs, “what gets measured gets counted,” said Global Network Managing Director Dr. Neeraj Mistry in remarks at the UN Economic and Social Council’s High-Level Political Forum earlier this month.

To effectively control and eliminate NTDs will require a coordinated global effort, and finding the right set of indicators will be extremely important. The NTD community strongly recommends:

90 percent reduction in the number of people requiring interventions against NTDs by 2030

Treating NTDs is extremely cost-effective and contributes greatly to the success of broader development goals. With medications already available, NTD elimination is not only possible, it’s within our grasp. And with a clear indicator, we can meet this target within the next 15 years.

Photo: Dr. Neeraj Mistry speaks at the UN ECOSOC High-Level Political Forum on July 9, 2015. 

Top News Stories

 

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Come here every month to see the most important news on NTDs!

1.  Malawi Eliminates Lymphatic Filariasis (LF) Disease – AllAfrica, June 1
2.  Jigawa Trains 650 Health Workers on Neglected Diseases – PM News Nigeria,    June 8
3.  It’s Not Just About Bad Choices – The New York times, June 13
4.  The Planet’s Children and Their Neglected Tropical Diseases– Healio, June 12
5.  WB Backs Tropical Diseases Project in Africa with $121m – Trade Arabia, June   12
6. Cannes Lions 2015: Ogilvy Bags Silver, Medulla Bags Bronze – Campaign India, June 20
7.  Nigeria: Gates Foundation to Boost Primary Healthcare in lagos – AllAfrica, June 20
8.  New Report: Investments in Neglected Tropical Diseases Are One of the Best Buys in Development – Uniting to Combat NTDs, June 24
9.  India’s Next Public Health Victory – Impatient Optimists, June 24
10. Network to Check Tropical Diseases – The Hindu, June 25

Measuring the District Health Sister of Kenema, Sierra Leone to determine the appropriate dosage of NTD medicine for her. Photo: FHI360

Down But Not Out: Sierra Leone’s NTD Program Restarts Activities as the Ebola Threat Subsides

It all started a year and a half ago in Guinea, West Africa, when in December 2013, the country reported several cases of the Ebola Virus Disease (EVD). By March 2014, the outbreak had spread to neighboring Liberia. In May, it reached also Sierra Leone, dealing a huge blow the country’s public health system, including its Neglected Tropical Diseases (NTD) program.

Sierra Leone is a poor West African country with poor health indicators. A decade earlier, a twelve-year civil war (1991-2002) had devastated the economy and almost brought the entire health care system to a standstill. Nevertheless, the country made progress in revamping its socio-economic situation after the war, and the outlook appeared optimistic. In the health arena, FHI 360 was in the forefront of assisting Sierra Leone in rebuilding its public health system. Through the USAID-funded END in Africa project, FHI 360 has supported a successful integrated NTD program since 2010 in Sierra Leone that targets 7 NTDs: lymphatic filariasis (LF), schistosomiasis (SCH), trachoma, onchocerciasis (oncho) and three soil-transmitted helminthes (STH).

Shortly after the EVD outbreak began in Sierra Leone, all public health program activities were suspended in the country, including those involving NTDs. Consequently, the NTD Program (NTDP) was unable to provide any mass NTD treatments in Sierra Leone in 2014, as the EVD outbreak had spread to all 14 districts in the country, bringing the country to a virtual stand-still.

Almost an entire year passed before the NTDP was able to resume mass NTD treatments. Even now, three of the country’s 14 districts (the Western Urban, Kambia and Port Loko districts) are still working toward containing the outbreak.[1] However, mass drug administration (MDA) for LF, Oncho, STH and SCH (baseline studies have shown that trachoma is not endemic in Sierra Leone) was successfully resumed in May 2015, on the heels of a recent nationwide malaria MDA and vaccination campaign.

Preparing for Sierra Leone’s 2015 NTD MDA

After a year-long interruption in mass treatment, Sierra Leone’s national NTDP and Helen Keller International (HKI), END in Africa’s sub-grantee in Sierra Leone, carefully planned and carried out many preparatory activities prior to embarking on the country’s 2015 NTD MDA campaign. These included conducting:

  • An NTD stakeholders meeting to plan the resumption of NTD activities in Sierra Leone (February 2015).
  • A national refresher training session for trainers in the Bo district (March 7, 2015).
  • A refresher training for peripheral health unit (PHU) district personnel (March 24 – April 4, 2015).
  • Social mobilization through radio discussions and community meetings in every community targeted for treatment in 12 provincial districts (April 2015).
  • Special advocacy and social mobilization meetings in the 3 districts that failed the last pre-transmission assessment surveys (pre-TAS) for LF conducted in 2013 (Koinadugu, Bombali and Kailahun districts). These meetings targeted paramount, section and village chiefs, people in the community, health workers and community volunteers such as community directed distributors (CDDs).
  • Advocacy and social mobilization meetings led by the district health management teams (DHMTs) under the supervision of the NTDP and partner organizations in all 12 provincial districts (May 2015).
  • Training for the CDDs, led by PHU staff supervised by DHMTs, the NTDP and partner organizations (May 2015).

 

Leading by Example to Regain Trust

As the MDA was getting underway in late May 2015, END in Africa Technical Advisor (TA) Dr. Joseph Koroma visited the community of Komende Luyama in the Kenema district, which was conducting MDA for LF, oncho and STH.

“The MDA in Komende Luyama was just getting started on the day of my visit,” Dr. Koroma said. “Only after Chief Musa Lahai, the village chief, and the village’s two community nurses took the NTD treatment, would the people in the community consent to taking the treatment themselves.” He added that three members of the district health team who had accompanied him to the village, also took the NTD treatment in front of community members to further convince people to take the treatment.

“END in Africa will continue to support HKI and the national NTDP in the process of reestablishing NTD program activities in Sierra Leone, so that the effect of the EVD on NTD control and elimination efforts will be minimal,” he said. While there’s a clear need for special social mobilization in order to convince community members to take the NTD treatment, given the country’s terrible experience with EVD, early indications are that Sierra Leone’s 2015 MDA will ultimately be considered a success.

[1]Sierra Leone cannot be declared EVD-free until every health district in the country has no new cases for at least 42 consecutive days. According to the MOH EVD situation report of June 17, 2015, 11 of Sierra Leone’s 14 health districts have not reported any new EVD cases in the past 42 days or longer. They include: Pujehun and Kailahun, with no new cases for over 6 months; Bonthe and Bo, with no new cases for over 5 months; Kenema, Kono, Tonkolili and Moyamba, with no new cases for over 3 months; and Bombali, Koinadugu and Western Rural, with no new cases in 81, 60 and 55 days, respectively. Three districts still intermittently report new EVD cases (1-3 per day): Western Urban district has gone 18 days without a new case, but Kambia and Port Loko each had 1 new confirmed case during reporting period.

Photo: Measuring the District Health Sister of Kenema, Sierra Leone to determine the appropriate dosage of NTD medicine for her. Credit: FHI360

This blog was originally published on the End Neglected Tropical Diseases in Africa blog.