by Peter J. Hotez and Neeraj Mistry
The German Bundestag has an opportunity to make unprecedented commitments toward the treatment and prevention of the world’s most common poverty-related diseases — a group of debilitating infections known as the neglected tropical diseases (NTDs). They include ancient scourges linked to poverty such as elephantiasis, river blindness, blinding trachoma, schistosomiasis, roundworm, whipworm and hookworm. Today, these NTDs are among the most common afflictions of the poor, and almost every person living in abject poverty suffers from at least one NTD. New research has shown that these NTDs, because of their long-standing effects on the mental and physical health of children and adults but especially girls and women, now rank among the most important reasons why people cannot escape poverty in the “global south,” including Africa and the Middle East, Asia and Latin America.
For more than 150 years, German science has provided leadership in tropical medicine that makes it possible today to discuss the eventual global elimination of the NTDs. Theodor Bilharz discovered the cause of schistosomiasis (also known as bilharziasis) while working in Egypt in the 1850s; Otto Henry Wucherer conducted studies in Brazil in the 1860s that helped discover Wuchereria bancrofti
Then, in 2005, the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) and the World Health Organization organized a landmark conference in Berlin to integrate the control and elimination of the most common NTDs by combining mass treatments for these diseases in a simple “rapid impact package” of medicines. Today those low-cost (less than one Euro per person annually) packages have reached at least 450 million people. As a result, we are now seeing major reductions in the global prevalence of elephantiasis, river blindness and blinding trachoma. Thus, a decade following that historic Berlin meeting, we have the opportunity to eliminate at least these three NTDs.
The Berlin conference also promoted the importance of research and development so that today new interventions are underway including a human hookworm vaccine now in clinical trials in Gabon through a European HOOKVAC Consortium that includes both the Sabin Vaccine Institute’s product development partnership and the Institut für Tropenmedizin, Universitätsklinikum Tübingen. In the 19th century, both Bilharz and Wucherer trained in Tübingen.
The German Bundestag now has a significant opportunity to build on these successes. New legislation to support non-profit product development partnerships to produce new drugs, diagnostics, and vaccines could create a new generation of ground breaking technologies for the world’s poverty related diseases. In parallel, Germany can join the governments of the United States and United Kingdom in supporting the delivery of low-cost rapid impact packages, now recognized as one of the most cost effective global health interventions known.
Earlier this year, Chancellor Angela Merkel also delivered a historic address to the World Health Assembly about the important role the Group of 7 (G7) nations could have in eliminating NTDs. Her call to the G7 to take on NTDs can now be backed with time-sensitive action. The German Bundestag should reassert its historic commitment to these diseases, in the research and development space and for mass treatment. In so doing, Germany can lead efforts to finish the job it began more than a century ago.
Peter Hotez, M.D., Ph.D., is president of the
Neeraj Mistry, M.D., M.P.H., is managing director of the
In September, the Global Network for Neglected Tropical Diseases (Global Network) and the Sabin Vaccine Institute traveled to Berlin to meet with Members of Parliament, German NGO partners and the media to inspire action on the promises to combat neglected tropical diseases (NTDs), made during the G7 Summit held in Germany this summer.
The Global Network, which is committed to seeing the end of NTDs — a group of 17 diverse diseases with distinct characteristics that thrive mainly among the poorest and most marginalized populations — works with partners around the world toward achieving this mission. The momentum to combat these debilitating and disfiguring diseases continues to grow and, during the G7 Summit at Schloss Elmau in June, Germany elevated the profile of NTDs by making “neglected and poverty-related diseases” a key topic for discussion.
The city of Berlin has a unique historical connection to NTDs; it was in Berlin 10 years ago that scientists, the German government and implementing partners first came together and coined the term “NTDs,” an important milestone in defining a collective response against these diseases. Germany is also home to the Institute for Tropical Medicine at the University of Tübingen where two 19th
During this most recent visit to Berlin, the Global Network’s Dr. Maria Elena Bottazzi, participated in one-on-one meetings with Members of the German Bundestag, discussing short- and long-term goals surrounding disease elimination. Globally, nearly 1.4 billion people, including more than 500 million children, are at risk from NTDs and require treatment. Medicines are generously donated by pharmaceutical industry partners, however, the value of the donated drugs is not enough to combat NTDs if the funding falls short to ensure their delivery to communities who need them most.
It is fitting that a decade after pivotal meetings in Berlin created the term “NTDs,” the focus is once again on Germany. The G7 Leaders’ Declaration, published at the culmination of the summit, offers hopeful news for communities across Africa, Southeast Asia and in Latin America and the Caribbean, most marginalized by NTDs by promising to “invest in the prevention and control of NTDs in order to achieve 2020 elimination goals.”
An immediate increase in financing for NTD treatment and prevention programs is essential to build on the progress achieved so far. Opportunities to eliminate elephantiasis, river blindness and trachoma are nearly within our grasp. Countries worldwide, including the G7 nations, can play an important leadership role by helping to close this annual funding gap of US $220 million. If we fail to act now, not only will we reverse many milestones achieved, but one in six people across the world will continue to suffer unnecessarily from NTDs, held hostage in a cycle of perpetual poverty and inequality. Moreover, failure to act now will undermine the efforts of the G7 to demonstrate their accountability and effectiveness as a group.
We certainly applaud the German government for her bold steps taken on behalf of NTDs this year, and we will be watching this week on October 8th and 9th as the G7 ministers for health and research meet once again in Berlin to discuss next steps.
In advance of every G7 summit, the national science academies of the G7 countries prepare policy statements on the priority issues identified by the G7 host country. This year, the national science academies delivered statements on neglected tropical diseases, antibiotic resistance, and the future of the ocean.
In the statement on NTDs, they note that progress on NTDs “would be a major step towards alleviating poverty.”
NTDs affect the world’s poorest people and place an economic burden on low and middle-income countries. The academies called on G7 leaders to support efforts to reach WHO control and elimination targets by 2020:
In principle, NTDs are preventable, treatable, controllable and some even eradicable. Moreover, most interventions against NTDs are highly cost-effective. To make progress toward preventing, controlling and eliminating NTDs, the G7 Academies of Sciences call for: (1) increasing efforts to empower and build capacity in affected countries to deal with these diseases, (2) intensifying research on NTDs, (3) developing and delivering affordable and accessible treatments, and (4) NTDs to be fully accounted for in the Sustainable Development Goals.
Much more needs to be done with a much greater urgency to reach the 2020 targets for all major NTDs. The specificity of diseases as well as the likely adverse impacts of severe climate events, risks of conflicts, increasing mobility/migration, and political instability need to be taken into account when developing strategies for tackling the NTD challenges. NTDs should be fully accounted for in the Sustainable Development Goals.
Chancellor Angela Merkel, who carries the G7 Presidency this year, invited representatives of the national science academies to a G7 dialogue forum to share their scientific expertise in advance of the 2015 G7 Summit, to be held in June in Schloss Elmau, Bavaria. The event was hosted by Leopoldina, the German National Academy of Science.
In his London Declaration in 2012. Professor Molyneux is a Sabin partner and professor at the Liverpool School of Tropical Medicine where NTDs are a major focus of research. In his speech, he highlighted the need for increased aid to combat NTDs only 0.6% of overseas development assistance is allocated to NTDs.
Professor Molyneux said that policy makers must be convinced that NTDs are the markers of poverty, that control of these diseases reflect the capacity of health systems to ensure healthier communities and by default reduce the burden of poverty. He argued that addressing the “chronic pandemic of NTDs” requires capacity at all levels across the broad spectrum of health sciences.
After receiving the statement from the academies, Chancellor Merkel responded with a call to strengthen the WHO’s ability to combat disease. “I will attend the World Health Assembly in May, and neglected tropical diseases are on the agenda this year. This will hopefully help to encourage Member States to persevere in the fight against these terrible diseases, especially since simple treatments and measures are often enough to prevent them.”
As the G7 Summit approaches, we hope world leaders heed the national science academies’ call to develop and deliver affordable and accessible treatments for NTDs, and support multilateral efforts to address NTDs as part of the Sustainable Development Goals and the post-2015 development agenda.
By CBM UK
This blog post is part of Global Networks #G7forHealth series, which highlights the current and potential impact of G7 countries on those suffering from neglected tropical diseases.
Hadiya is 9 years old. When CBM community workers met her in her village in Amhara, Ethiopia, her eyes had been itching and watering for three days. It keeps her from being able to see others. She cant see them clearly because of the tears, explained her father Ali. But it wasn’t the first time Hadiya has experienced trachoma and she’s not alone in her village. 6 out of every 10 children in this region of Ethiopia suffer from an active trachoma infection.
Hadiya’s infection was treated with Zithromax, and her family now knows how face washing can help prevent the disease. CBM’s partner, Organisation for Rehabilitation and Development in Amhara (ORDA), has been working with the community to ensure that the village well is protected with the source capped and a retrieval unit fitted so that the water used for drinking and washing stays clean.
These interventions will make a huge difference to Hadiya. Not only will she be free from the itching and pain of the trachoma infection, but she is no longer at risk of losing her sight to the disease. And in a poor community like Hadiya’s the consequences of sight loss can be utterly devastating. Her chances of completing her education would be much reduced – only 1 in 10 children with disabilities in the global south goes to school. She would be at 2-3 times greater risk of violence or abuse. Her access to healthcare and opportunities to earn a livelihood would be far more limited. Like millions of people with disabilities worldwide, she could very easily find herself trapped in a cycle of poverty and disability.
Neglected tropical diseases (NTDs) such as trachoma are caused by poverty, flourishing under conditions characterised by poor housing and sanitation, unsafe water and limited access to basic health care. But by causing disability, they also lead to increased poverty for individuals and communities. This is why we believe investment in the fight against NTDs should be a priority for the world’s leading economies and why CBM UK — alongside 100+ international institutions and experts working on NTDs — is one of the signatories of an open letter to G7 leaders, asking them to sustain their current support for NTD control and elimination as well as to address current gaps.
Tackling disability is vital to ending extreme poverty, and eliminating NTDs like trachoma is a key way to prevent disability – 2.2 million people are visually impaired due to trachoma, and of them 1.2 million are irreversibly blind.
CBM has been working to prevent and treat blinding NTDs such as river blindness (onchocerciasis) and trachoma for over 20 years. CBM UK is currently involved in the Queen Elizabeth Diamond Jubilee Trust’s programme to tackle blinding trachoma in 10 out of 18 Commonwealth countries where trachoma is confirmed or estimated to be endemic.
Within the Trust’s programme, CBM UK is an implementing partner in Kenya, Uganda and Malawi, aiming to eliminate trachoma as a public health problem in each of these countries. This is done by implementing the ‘SAFE’ Strategy which consists of Surgery, Antibiotics, Facial Cleanliness and Environmental Improvements. The programme has recently completed its first year. During this time, CBM has held a number of community outreach camps to conduct trachoma surgery, which is used to treat the more advanced, blinding stage of the disease. The surgery element of the SAFE Strategy is used to address the backlog of trachoma cases, whilst the other elements are aimed at prevention and stopping (re)infection.
Funding programmes like the Trust’s initiative make a crucial contribution to the World Health Organisation’s (WHO) Alliance for the Global Elimination of trachoma by 2020 (GET 2020). The UK and the other G7 members must now ensure that this moment is sustained to permanently eliminate trachoma and other NTDs.
CBM is in international Christian disability and development organisation improving the quality of life of millions of people living with or at risk of disability in some of the world’s poorest communities. CBM UK programmes include a range of NTD programmes and other disability related programmes in Health, Livelihoods and Inclusive Education.