Tag Archives: NTDs

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. 

3rd Progress Report on The London Declaration on Neglected Tropical Diseases Released

Uniting to Combat Neglected Tropical Diseases released its third progress report on The London Declaration on Neglected Tropical Diseases on June 25, 2015. Read the full executive summary and report. 

From the Executive Summary

In the course of human history, few public health efforts can match the scale and ambition of the endeavor to rid the world of 10 Neglected Tropical Diseases (NTDs). These efforts have accelerated over the last three years, as a diverse group of players have come together in one of the largest ever public-private partnerships to deliver the funding, drugs, and technical assistance required.

The good news is that we are beginning to see positive results from this collaboration: a growing number of endemic countries are achieving elimination goals, more people are being reached, and there is increasing national ownership of NTD programs. The political and economic gains from NTD investments make a compelling case for further investment both domestically and from donors.

Nonetheless there are challenges that threaten our ability to meet the WHO NTD Roadmap targets. Currently the supply of donated drugs exceeds our ability to reach communities and more needs to be done to scale up programs. If, as a global consortium of partners, we cannot marshal the resources required to deliver donated drugs to the communities in need, more than a billion people will remain at-risk of harm by NTDs. We need to redouble our efforts.

This third report on progress since the 2012 London Declaration on NTDs highlights important accomplishments and learnings, and identifies areas that warrant greater attention. Five principal themes have emerged within the report:

  1. Control and elimination of NTDs provide one of the strongest returns on investment in public health
  2. Leadership among endemic countries has shown a substantial increase
  3. The largest public health drug donation program in the world continues to grow
  4. Coverage is increasing, but the pace is too slow to meet key milestones
  5. National NTD programs are achieving elimination goals

 

As noted in the 2015 G7 Summit communique, “2015 is a milestone year for international cooperation and sustainable development issues”—and, the fight against NTDs is no different. We have the opportunity now, together, to reach many of the goals laid out in the WHO roadmap on NTDs and position the future elimination of these 10 NTDs as an achievable objective for this generation. Those living in extreme poverty around the world are counting on our help. Let’s not keeping them waiting.

Read the full executive summary and report. 

Children at dusk in Malawi

Calling Time on Urogenital Schistosomiasis

I spent many of my teenage years living in Malawi, enjoying swimming in beautiful Lake Malawi. Wind on to age 30, and I was struggling to get pregnant. Eventually, following illness, I was diagnosed with schistosomiasis by a consultant and colleague at the Liverpool School of Tropical Medicine. I was told that I had probably been infected for a while and that it might be affecting my fertility. So I took praziquantel, the only available drug against the parasite, and soon after I was pregnant. Today my first born daughter is 10 years old. Whilst the links between urogenital schistosomiasis, sub-fertility and HIV have become increasingly well-established over my first born daughter’s life time, a combined and robust health systems action that brings together neglected tropical disease, sexual and reproductive health and HIV communities to address and scale up treatment for urogenital schistosomiasis is sadly lacking.

It is 20 years since the Beijing Women’s Conference and the International Conference Population and Development and the sexual and reproductive community have been taking stock on progress, challenges and future priorities. I attended a research agenda setting meeting on sexual and reproductive health, rights and gender at the WHO on 12th and 13th of January, where we discussed how to best decide priorities for action. Scaling up treatment for urogenital schistosomiasis is arguably a win-win.

The global burden of disease

Schistosomiasis is wide spread and there are two forms of disease, intestinal and urogenital. An estimated 600 million people are at risk of being infected and approximately 200-220 million people are living with schistosomiasis in Africa. Of the people infected with urogenital schistosomiasis it is thought that between about 100 and 120 million suffer from urinary and reproductive tract damage, which also impacts directly with HIV co-infection and sub-fertility in general. Typically many adolescent girls and women exhibit several symptoms in their lower genital tract where overt bleeding and unpleasant discharge, general discomfort and pain during sex can lead to low self-esteem, depression and stigma.

Peter Hotez estimates that globally there are between 67-200 million cases of urogenital schistosomiasis among girls and women. Hotez argues that between 20 million and 150 million girls are affected, possibly making it one of the most common gynaecological conditions in sub-Saharan Africa but unfortunately much under-reported. Urogenital schistosomiasis, as in my experience, also affects fertility and it is estimated to reduce a woman’s reproductive health capacity by up to 75%.

The links between urogenital schistosomiasis in women (female genital schistosomiasis) and HIV are well established. Writing in the Lancet, Stoever and colleagues argue that up to 75% of girls and women infected with female genital schistosomiasis develop often irreversible lesions in the vulva, vagina, cervix, and uterus, creating a lasting entry point for HIV and discuss how research in Zimbabwe showed that women with female genital schistosomiasis had a threefold increased risk of having HIV. In a recent review of the evidence Pamela Mbabazi and colleagues argue that “Studies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects”.

Gender, equity and rights

There is remarkable overlap between the maps showing high HIV prevalence in Africa (particularly amongst women and adolescents girls) and those showing cases of female genital schistosomiasis. A complex interplay of biological, social and cultural factors means that young women are particularly vulnerable to HIV in sub-Saharan Africa. Gender norms also shape exposure to urogenital schistosomiasis, with women being particularly responsible for activities involving water in many communities (washing, cleaning, collecting water etc). Drawing on work from Ghana, Vlassoff and Manderson have shown that women interact with water significantly more often than men.

What to do?

Several tens of millions of praziquantel tablets are now donated each year by Merck-KGaA for mass drug administration campaigns as a cost-effective method to protect people from the urogenital schistosomiasis. Hotez argues that by preventing female genital schistosomiasis in sexually active women we have an innovative and timely opportunity to reduce and likely much reduce HIV transmission throughout many rural areas of sub-Saharan Africa.

But in infected communities treatment also needs to start early.

Stoever and colleagues argue that periodic and regular treatment with praziquantel from when children are first infected should prevent the development of genital lesions, which increase HIV risk and cause gynaecological problems. Treatment, however, may need to be started even earlier as the extent and burden of schistosomiasis in pre-school-aged children is being more fully described.

To make progress in this area we need joint action between the HIV, sexual and reproductive health and neglected tropical disease communities. Health workers and communities need more information on the multiple impacts of urogenital schistosomiasis and how it can be treated.

The lack of action to date on urogenital schistosomiasis clearly illustrates the importance of new partnerships and new approaches to scaling up strategies to address neglected tropical diseases. COUNTDOWN, a new initiative in Cameroon, Ghana and Liberia, will be paying close attention to the potential role of close-to-community providers such as drug distributors in providing an interface between communities and health systems.   We will also evaluate how to deliver equitable drug delivery for schistosomiasis through the inclusion of preschool-aged-children, out-of-school-children and adults. The Director of COUNTDOWN is helping to co-organise a meeting in South Africa later in the month where several members of COUNTDOWN will also attend. It brings together world leaders in the field of schistosomiasis, HIV and paediatrics to present on the current state and future direction of research on female genital schistosomiasis.

COUNTDOWN is set to foster and to stimulate others in thinking of innovative ways of prompting a synergistic approach to neglected tropical diseases which crosses sectors and builds strength in national health systems.

If you would like to find out more follow us on Twitter or email Rachael Thompson.

This blog post was writtem by Sally Theobald, COUNTDOWN Consortium & Research in Gender and Ethics: Building stronger health systems (RinGs), and was originally posted on Cross-Talk: A Place to Share New approaches to Neglected Tropical Diseases.

Photo courtesy of Andrew Whalley. Children at Dusk.