Fourth Progress Report on The London Declaration on Neglected Tropical Diseases Released

Last year, pharmaceutical companies donated medicine to treat 1.5 billion people for neglected tropical diseases (NTDs), more than ever before.

The release of the Uniting to Combat Neglected Tropical Diseases scorecard and report today underscores the urgency and the opportunity before us to control and eliminate the most common NTDs. For the first time, the global coverage rate exceeded 50 percent. But progress is not being made across all regions or all diseases. For instance, only 20 percent of the nearly 259 million people at risk of schistosomiasis received medication in 2015.

Four years ago, leaders from 13 pharmaceutical companies, the governments of the United States, United Kingdom and United Arab Emirates, the Bill & Melinda Gates Foundation, the World Bank and other global health organizations pledged new and extended commitments in support of the WHO’s goal to control or eliminate 10 NTDs by 2020. The global effort to control and eliminate NTDs is now one of the largest public health initiatives in history. But the fourth progress report from Uniting to Combat Neglected Tropical Diseases finds that many deadlines have been missed.

Just 40 of 73 countries are now on track to eliminate lymphatic filariasis by 2020, including India. Although India continues to have the most cases of lymphatic filariasis, 87% of endemic districts are now assessing whether they have interrupted transmission and, as a result, can stop mass drug administration.

Dr. P.K. Srivastava, the Joint Director – Nodal officer of India’s Elimination of Lymphatic Filariasis Programme, shares his thoughts on India’s efforts and challenges in a post on our blog. No other government will have a greater influence on whether we reach the 2020 goals.

As we advance toward elimination goals, the challenges will change – mapping and wider use of new diagnostic tests will provide data needed to make more informed decisions. Ensuring that we have a full arsenal of tools including drugs, vaccines and diagnostics to complement existing treatment programs will be critical.

Ending extreme poverty and achieving the Sustainable Development Goals (SDGs) requires controlling and eliminating NTDs. Achieving NTD disease goals is projected to produce up to $184 in improved economic productivity for every dollar invested, helping to bring communities out of poverty (SDG 1). At the same time, strategies for success against NTDs are strongly linked with other development priorities, including universal health coverage (SDG 3) and water and sanitation (SDG 6).

Progress against NTDs over the last four years has accelerated, but not fast enough. As we approach the fifth anniversary of the London Declaration, the 2012 pledge to end NTDs by 2020, we must assist countries to scale up programs to ensure no one is left behind.


Scaling up NTD treatment and prevention: India’s experience scaling up mass drug administration for lymphatic filariasis

by Dr. P.K. Srivastava is the Joint Director – Nodal officer of Elimination of Lymphatic Filariasis Programme, Government of India

Of the more than a billion people in the world affected by NTDs, 34% live in India. This is in large part due to the number of people living in India at risk of being infected with lymphatic filariasis (LF).  India alone is responsible for 42% of the global burden of LF and 16 states and 5 union territories are endemic for the disease. Many factors make LF a challenge to tackle in India.  First, there is the wide geographic spread of endemic areas in a country with one of the largest populations in the world — from the tip of the subcontinent in Kerala to the reaches of the Sundarban mangrove forests in West Bengal. The demographic and climactic diversity is also a challenge — progress in rural areas may be offset by changes in the way urban populations respond to mass drug administration (MDA), MDA schedules may be interrupted by annual cyclones or floods, and subtle changes in the monsoon rains may change vector patterns.

India has a long history of addressing LF, beginning with a pilot project in 1949 that shaped global standards for elimination.  India started administering diethylcarbamazine (DEC) in highly endemic areas in 1955. The lessons from these early years informed the launch of a revised strategy in 1997 when India signed the World Health Assembly resolution to eliminate LF.  Three years later, the then health secretary Mr. Javid Chowdhary was appointed the chairperson of the Global Program to Eliminate LF (GPELF).  Mr. Chowdhary committed to launching a program that covered 40 million people at risk of contracting LF, beginning with 20 million people that year. In 2002, India set 2015 as a target for LF elimination in the National Health Policy.

The current strategy to eliminate LF was launched in 2004. Between 2004 and 2007, the program scaled up to reach 421 million people, achieving 100% geographic coverage, all 250 endemic districts[1]. Coverage rates started out high, at 73% on average across the country, and continued to increase, reaching 83% in 2007 and 88.8% in 2014. India has benefited from drug donations of albendazole, provided for all annual MDAs against LF.

This increase in national average coverage may not seem like much over the course of a decade, but consider the challenges faced: as annual MDAs continue, LF infections become less common, serious complications related to LF, lymphedema and hydrocele, become less visible in the community and young people may be less motivated to participate in the annual MDA.  Rigorous pre-testing prior to undertaking transmission assessment surveys also requires technical human and laboratory resources at the regional and state level- something that can be challenging in the mostly rural areas where the disease has traditionally taken hold.  33 districts have been identified as “hotspot” districts, where microfilaria rates remain high and programs have not been as effective at tackling LF. Still, the scale the program has achieved is remarkable.  This rapid scale would not have been possible without the lessons from earlier pilots, the strong political will demonstrated on national and global platforms, local technical expertise, and the existence of an integrated, multi-level health system.

India’s efforts to scale MDAs and tackle LF have proven successful.  Of the 255 endemic districts, 222 have microfilaria rates below 1%, qualifying them for transmission assessment surveys (TAS).  72 districts have already passed the first round.  Although the 2015 deadline for elimination has passed, it is estimated that a first round of TAS will be underway in all 255 endemic districts by 2017. The fight will not end there. There is more to be done to scale up community based and facility based morbidity management, and surgical options have to be made accessible and affordable for those who can benefit from them.  We will need to continuously monitor the situation to not only ensure success against LF, but also sustain deworming efforts once MDAs for LF end. Fortunately, India’s National Deworming Day initiative will scale up school and community based deworming for children as LF MDAs start to scale down.

Just as getting to this point has been as result of a coordinated effort of technical, political, and community based partners, the road ahead will depend on coordinated monitoring and surveillance, community-based support from civil society, NGOs, and village health workers, accommodations in the health system and political support to see LF elimination to the end.  India’s success impacts the global progress on NTDs and will be a model for other nations, and so we encourage you to check back with us at the end of 2017.

Dr. P.K. Srivastava is the Joint Director – Nodal officer of Elimination of Lymphatic Filariasis Programme, Government of India

[1] The number of endemic districts in now 255, due to geo-political realignment of state and district boundaries.

India Should Not Lose Sight of Programs to Combat Diseases of Poverty

_MG_0672_CopyAn editorial, “To our health,” in The Indian Express, published on March 31, 2016, highlighted an initiative to update India’s public health framework in a time-bound process. The updates, which may be finalized in three months, will bring a new focus to preventing non-communicable diseases and operationalizing plans that have been in development. Programs focused on neglected tropical diseases (NTDs), including lymphatic filariasis and visceral leishmaniasis, are specifically mentioned as opportunities to meet targets set in global frameworks. While this initiative is a positive step, the editors note there are risks to the plan.

As new scourges replace the epidemic killers of old, public health in India has suffered for want of a regime for early detection. However, the government must be aware that a refocus on new disorders draws attention away from programmes against older threats to the poor — filariasis was supposed to be history in 2015, but is still out there.

The Indian Express is one of India’s most widely circulated daily newspapers.