END7 has just announced the members of the 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.
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.
Nearly 1.8 billion people require treatment for neglected tropical diseases (NTDs). Many of these diseases can be easily prevented or treated, yet only 43 percent of people are receiving the treatment they need for the most common NTDs.
In this time of resource scarcity, our collective commitment to the poorest communities should not wane. Yet, the traditional donor-supported model is not a sustainable solution. Increasingly, the global health and development community has been promoting the concept of country ownership as a critical issue of sustainability for country programs. In order to build programs that will live on past the life of a grant or the passing interest of a donor country, affected nations need independent, self-sustaining systems that are domestically organized and funded. This is not country ownership, but rather country leadership.
This country leadership was solidified when health ministers reaffirmed their commitment to the Addis Ababa Commitment on NTDs at the World Health Assembly (WHA) in Geneva in May. Nearly two dozen African countries signed this declaration in December 2014, pledging to increase domestic investment, promote multi-sector approaches, encourage adoption of data-driven, long-term strategic plans and ensure mutual support of NTD programs and overall health systems.
This Commitment heralds a new development model, where low- and middle-income countries partner together to invest in and lead their own development with support from the global community.
The Addis Commitment exemplifies the partnership required to create a successful health system through political, financial and technical reciprocity between donor countries and endemic countries. While financial assistance is a critical stepping stone on the road to self-sufficiency, the real value comes from building proficiencies and systems that will last long after the money has been spent.
More and more, leaders from endemic and donor countries alike are recognizing the importance of neglected tropical diseases (NTDs). NTDs, the most common diseases of the world’s poor, are on the agenda for this week’s G7 summit in Germany, where leaders from the G7 countries, along with representatives from the European Union and leaders from six African countries, will discuss key issues of economic, foreign, security and development policy.
At the World Health Assembly last month in Geneva, German Chancellor Angela Merkel declared that NTDs will be a top priority for the group, stating, “With relatively little material effort, the suffering of hundreds of millions of people could be combated.” Merkel also stressed the importance of close collaboration with affected countries.
The G7’s support will hopefully result in a much-needed boost to investment in NTD treatment and prevention efforts, and certainly raise the global profile of NTDs. The G7’s influence could be instrumental, as well, in ensuring that specific indicators for NTDs are incorporated into the United Nations post-2015 development framework and the final Sustainable Development Goals.
Established more than 15 years ago, the United Nations Millennium Development Goals (MDGs) set out measurable accomplishments to improve the world by 2015. Despite crippling health effects and evidence that NTDs perpetuate poverty, hunger and poor education outcomes, NTDs were lumped into MDG 6 under “other diseases,” lacking specific indicators to measure success or rally sufficient resources.
As the MDG deadline nears and the Sustainable Development Goals are finalized, an important opportunity presents itself to set clear mileposts for NTDs that were missing from the MDGs, catapult support for NTD programs, and help lift millions of the world’s most neglected people out of poverty. Watch our video to see why this is so important:
A new “worm index” developed by Sabin President Dr. Peter Hotez and Baylor College of Medicine’s Dr. Jennifer Herricks reveals a strong association between neglected tropical diseases (NTDs) and human development.
The index was based on the disease burden of major worm (or helminth) infections: intestinal helminths, lymphatic filariasis and schistosomiasis, which can lead to diarrhea, anemia, disability, disfigurement and even death. Increasing evidence over the last decade links the most common NTDs to significant adverse impacts on both human and economic development.
Hotez and Herricks created the worm index (see map below) using World Health Organization (WHO) data on disease burden for these worm infections in the world’s 25 most populous countries. Countries’ worm indices range from 0-1, with higher indices indicating a higher disease burden.
Hotez and Herricks then compared their worm index to the United Nations Development Programme (UNDP) human development index (HDI), which measures a country’s achievement in education, standard of living and years of life lived in good health.
This side-by-side comparison uncovered a strong negative correlation (see graph below).
It is tempting to conclude from these results that worm infections hold back human development, but it could just as easily be that situations of poverty (poor healthcare infrastructure and lack of access to clean water and sanitation, for example) result in worm infections. “It is possible or even likely that the causes and effects flow in both directions,” the researchers state.
That said, evidence illustrating this relationship abounds. Hotez and Herricks cite studies from Kenya showing that deworming led to improvements in school attendance and participation, and the effects of deworming could still be seen into adulthood—adults who received deworming treatments as children were more productive, both in hours worked and wages earned. Higher wages and more schooling are critical tools for achieving the Sustainable Development Goals (SDGs).
Given the strong associations between helminthic and other NTDs and mental, physical, and economic human development, vulnerable and excluded populations, and HDI, in the coming months and years it may become essential to give due consideration to eliminating helminth infections as a means to achieve SDGs. Of course, poverty, “Water, Sanitation and Hygiene” (WASH), and nutrition play an important role in health outcomes. As we look to reduce poverty and increase WASH and nutrition, we must also focus on chronic diseases such as helminth infections that reinforce the cycle of poverty and malnutrition. Therefore, we suggest that the NTDs need to be an important consideration in any discussion about the SDGs, and helminth control and elimination as proposed by the 2012 London Declaration for NTDs must be embraced by the SDGs and the sustainable development community.
No matter which came first—poverty or worms—the fact is that these infections impact millions of people every day, disabling communities’ workforces and further limiting economic growth where it’s needed most.