All posts by Deborah Elson

Connecting the Dots: Greater Integration between WASH and NTDs

 

Photo by Esther Havens

Photo by Esther Havens

Over the past month, we’ve heard many times from the neglected tropical disease (NTD) and water, sanitation and hygiene (WASH) communities about the importance of cross-sector collaboration (see here and here). Momentum has especially been building, though, in the past two weeks.

Just last week, as the part of events recognizing the second anniversary of the London Declaration, we celebrated new commitments from WaterAid and Dubai Cares that will advance integrated deworming and WASH interventions.

This week, the Global Network and partners gathered with the former President of Ghana and Global Network’s NTD Special Envoy, H.E. John Kufuor – who also serves as Chair of the Sanitation and Water for All (SWA) Partnership – to discuss the cost-effective and sustainable strategies our sectors and private industry can take.

Another important conversation also occurred this week: “Why water and toilets matter in foreign aid,” hosted by WaterAid at the National Press Club. Barbara Frost, chief executive of WaterAid UK; Henry Northover, head of policy at WaterAid UK; and Lisa Schechtman, director of policy and advocacy at WaterAid America spoke about how WASH can advance many U.S. interests. WaterAid also invited Dr. Neeraj Mistry, Global Network’s managing director, to weigh in about the health implications of poor WASH circumstances.

Lisa observed that there’s been increasing “recognition that development component isn’t just good for moral authority but that it helps bolster defense and diplomacy components.” The 2012 National Intelligence Estimate on Global Water Security emphasizes that water can be a tool of conflict or peace and makes the connection that poverty reduction – through WASH – can increase security.

Similarly, the U.S. Center for Disease Control and other collaborators published a Global Health Security Agenda in February to thwart risk of infectious diseases.

Barbara then stressed the impact that WASH has on “women’s health, girls’ lives, empowerment and what it means for their healthy development.” For instance, in many vulnerable communities, “girls drop out of school because they are carrying water or because there aren’t adequate toilets when they go through puberty.”

In the same way, NTDs disproportionately impact females. When END7 campaign ambassador Abhishek Bachchan visited a lymphatic filariasis clinic in Orissa State, India, he heard from women about how the stigma and misinformation associated with the disease prevented their daughters from getting married and participating equally in society. Women and girls with a certain form of schistosomiasis, one of the most common NTDs, are also three times more likely to contact HIV.

Henry, who noted that “dirty water is the vector for so many of the diseases that you see under the microscope,” also reflected on global challenges in the WASH community. Most importantly was that some serious challenges on how aid is targeted.

Global health is a fraction of one percent of the federal $1.012 trillion budget – and the budget for NTDs is even smaller. But this tiny amount has a huge impact, which is why the Global Network is urging the public to encourage key members of Congress to protect funding for this critical program.

Then Neeraj emphasized, “this is not an either or measure – we have to do both [WASH and NTDs] to have a significant and sustainable impact on many of these diseases.” While WASH and NTDs “may seem like disparate thematic issues in the development agenda, we are looking at similar thematic platforms” to make positive changes, in schools or during child health weeks.

Ultimately, we will not stop the transmission of NTDs without clean water, improved sanitation, and better hygiene practices, and even with good water, we need to distribute treatments to protect against disease. The Global Network looks forward to continuing its support as collaboration and dialogue between both sectors grows.

Experts Weigh In On Successes, Challenges with Tackling NTDs

 

Microscope

Photo by Esther Havens

 

Sabin Vaccine Institute president Dr. Peter Hotez and many of our neglected tropical disease (NTD) partners contributed to a comprehensive report in Infectious Disease News on efforts to control and eliminate NTDs by 2020.

“NTDs require more recognition, resources to be controlled,” by Emily Shafer, details the activities currently underway and provides a frank assessment of the challenges we must overcome. Experts remarked on a number of priorities, including: carrying out advocacy, conducting mass drug administration, encouraging greater investments from current and potential donor governments, integrating NTDs in existing development interventions and building up endemic countries’ infrastructure to deliver treatments.

Here are some of the highlights:

On donor government funding:

“According to [Dr. Peter] Hotez, with the exception of the U.S. and British governments, there has not been widespread funding provided by other G-20 countries for NTD control or elimination. However, this may change in the coming years, and now some G-20 countries are supporting research and development efforts for NTDs.”

On the importance of strengthening capacity:

“We need to take advantage of the large donations to distribute free and safe medications to distribute to the poorest of the poor. … We need to develop the infrastructure to deliver the medicine, along with health education and community engagement, so that everyone is on board with the process.” – Dr. Frank O. Richards, director of the River Blindness, Lymphatic Filariasis, Schistosomiasis and Malaria Programs at the Carter Center

On NTD integration:

“Bed nets don’t only prevent malaria, they will also help eliminate lymphatic filariasis. We’re trying to get people to take a more holistic view of the way health care interventions are delivered to local communities.” – Dr. James Kazura, director of the Center for Global Health and Diseases and professor of international health, medicine and pathology at Case Western Reserve University

On our end goal:

“If the drug donations continue and we continue reaching out to people and delivering treatments, then the net results will be that the diseases disappear.” – Dr. Alan Fenwick, professor of tropical parasitology at Imperial College London

For the full article, click here.

ASTMH Roundup

 

astmha

 

For those of us in the neglected tropical disease (NTD) community, Washington, DC was an exciting place to be recently. World renowned experts gathered in the nation’s capitol at the American Society for Tropical Medicine and Hygiene’s annual meeting, sharing their latest findings and innovations that have the potential to make a direct impact on the improvement of people’s health and financial well-being.

The Global Network attended many of the sessions, ranging from how to integrate NTD treatments with water, sanitation, and hygiene programs and assessing progress in the fight against lymphatic filariasis to mapping NTDs. Here are just some of the highlights:

Women and Out-of-School Children in Determining the Success of NTD Programs: Next steps include investing in gender-sensitive education, recognizing guidelines on how to treat pregnant women, collecting better data, engaging women from the onset, and integrating various interventions to reach out-of-school children, including mass drug administration (MDA) for NTDs, polio vaccines and vitamin A.

Fred L. Soper Lecture: Dr. Frank Richards, director of the River Blindness Program, Lymphatic Filariasis Elimination Program, Schistosomiasis Control Program and Malaria Control Program at the Carter Center, celebrated the achievements of the Carter Center’s Onchocerciasis Elimination Program for the Americas (OEPA). OEPA has led an aggressive onchocerciasis elimination program, contributing to Colombia’sverification from the World Health Organization (WHO) that it successfully eliminated onchocerciasis; Colombia was the first country in the world to achieve this milestone. Dr. Richards noted the important elements that have made OEPA successful, including being data-driven and having prolonged political will, and he encouraged African nations to consider the twice a year treatment for onchocerciasis to help meet global elimination targets.

The Global Health Funding Landscape: Who and What You Need to Know and Why: Research and development (R&D) funding for NTDs has generally increased due to increased investments from the pharmaceutical industry, while public funding has largely remained steady. To help increase investments, communicating NTD research to the public and making NTDs relevant and important issues to local communities in the US are essential. Engaging scientists in advocacy work can also help make a difference because they can share first-hand experiences to policymakers.

The Critical Role of Water, Sanitation and Hygiene in Controlling Neglected Tropical Diseases: Improvements in sanitation has a substantial impact on trachoma. There is also a strong association between a lack of wearing shoes and hookworm infections. Randomized controlled trials and development strategies for high prevalence areas will help further assess the linkages and inform future efforts.

The Global Program to Eliminate Lymphatic Filariasis: Where Are We Now?: Global progress has been made in lymphatic filariasis (LF) elimination thanks to mass drug administration and unified international policies to address the disease. Morbidity management and disability prevention programs are also critical undertakings; while 27 countries have these programs in place, there is a need to scale up programs to reach everyone who has morbidity (40 million people).  To continue sustainable progress, there will need to be better integration of NTD control and elimination activities in primary health care settings.

Thanks to ASTMH and all of the presenters for engaging, interesting conference!

Calling All Collaborators to Eliminate Intestinal Worms in Children

 

Pictured from left to right: John A. Jufuor, President of the Republic of Ghana (2001-2009) and Global Network NTD Special Envoy; Bill Lin, director of Worldwide Corporate Contributions at Johnson & Johnson; Dr. Lorenzo Savioli, director of the Department of NTDs at WHO; Kathy Spahn, President and CEO of Helen Keller International (HKI); and Richard Besser, chief health and medical editor at ABC News

Pictured from left to right: John A. Kufuor, President of the Republic of Ghana (2001-2009) and Global Network NTD Special Envoy; Bill Lin, director of Worldwide Corporate Contributions at Johnson & Johnson; Dr. Lorenzo Savioli, director of the Department of NTDs at WHO; Kathy Spahn, President and CEO of Helen Keller International (HKI); and Dr. Richard Besser, chief health and medical editor at ABC News

“What we want to do is produce quality of life for the people.” – H.E. John A. Kufuor, President of the Republic of Ghana (2001-2009) and Global Network NTD Special Envoy

We have been anxiously awaiting the United Nations General Assembly’s (UNGA) sixty-eighth kick-off session, “The Post-2015 Development Agenda: Setting the Stage.” Neglected Tropical Diseases (NTDs) have impeded critical breakthroughs in development efforts for too long – plaguing one in six people globally, including half a billion children. While we have the medicine, which costs just 50 cents per person per year, we must garner greater attention, collaboration and political will to see the end of horrible suffering in the world’s most neglected communities.

We are certainly hopeful.

It was fitting that in the height of UNGA meetings, the Global Network, Johnson & Johnson, Children Without Worms, The Task Force for Global Health and the World Health Organization (WHO) co-hosted a conversation to identify innovative ways we can eliminate soil-transmitted helminth (STH) infections – one of the key diseases undercutting many Millennium Development Goals (MDGs).

“Business as usual” simply wouldn’t do! So, our event, “Innovate & Integrate: Multi-sectoral Approaches for Eliminating Intestinal Worms in Children,” set out to explore how and why organizations in the fields of NTDs; water, sanitation, and hygiene (WASH); nutrition; maternal and child health; and education can collaborate on this issue to ensure lasting advancements.

 

Bill Lin presents on NTDs and WASH

Bill Lin presents on NTDs and WASH

, director of Worldwide Corporate Contributions at Johnson & Johnson, opened with his experience growing up in a rural area outside of Hong Kong. Forever imprinted on him was the constant chanting of “wash your hands” and “don’t put your hands in your mouth.” “You [couldn’t] get clean water just by flipping a faucet.” Bill explained.

Bleak living conditions then and now have caused the perpetual transmission of intestinal worms. Therefore, we must not only distribute medicines to control STH infections but also work with partners to stop them from spreading. “There is a clear need for the education [and] health sectors to work together” to encourage behavioral changes.

, chief health and medical editor at ABC News then asked tough questions to our panelists: H.E. John A. Kufur, former president of the Republic of Ghana (2001-2009); Dr. Lorenzo Savioli, director of the Department of NTDs at WHO; and Ms. Kathy Spahn, President and CEO of Helen Keller International (HKI).

Recognizing that we were talking about “a disease that isn’t killing a lot of people” during a “busy week in New York,” Dr. Besser asked Dr. Savioli, “why does [STH] deserve attention?”

Optimistically, Dr. Lorenzo responded, “We can do something about it. We are eradicating guinea worm, we have the drugs to treat intestinal helminths … we can really interrupt transmission. We can make a difference with the tools we have in our hands.”

President Kufuor chimed in, “our goal is to seek solutions.” Speaking from his experiences in making NTD and WASH advancements as President of Ghana, including tremendous strides in the effort to eliminate guinea worm, President Kufuor noted that behavior change was critical, including “show[ing]  [people] how to boil water.” President Kufuor also stressed that the successes he oversaw were due to implementing policies that educated the public and provided infrastructure, and knowing when to “seek international help.”

Dr. Besser then asked Kathy, “Why does HKI think this is an important problem to tackle?”

Kathy answered that STH infections are “incredibly disabling” and threaten worker productivity, children’s attendance in school and the ability of children to achieve. We’re “really talking about the posterity of the country unless these diseases are tackled,” Kathy said.

Dr. Besser then asked President Kufuor about the widespread impact of intestinal worms. President Kufuor stated, “Worms prevent kids from getting full benefits. … The economy isn’t well when people have worms. … We tackle the problem from the source.”

President Kufuor also touched on a devastating consequence of STH infections: the impact on pregnant women and their babies: “Even with mothers, if they do not look after themselves well with what they eat, what they drink, then the fetus will not mature the way it should.”

Addressing the economic impact, Dr. Besser asked Dr. Savioli, “What evidence is there that these type of control efforts make a difference?” Dr. Savioli recognized that there is huge economic growth occurring in Africa, and that “those countries doing best in the African continent with NTDs are the ones that are doing better economically.”

Asking Kathy about whether it’s “idealistic to think that you can accomplish cross-sector integration,” Dr. Besser said, “Can it happen?” To which Kathy responded, “Nothing can happen unless you work cross-sectorally.”

Wrapping up the interviews, Dr. Besser asked, “If the MDGs don’t list NTDs, what does that mean?”

Dr. Savioli noted, “We need to put pressure to make sure that happens” and that, thanks to “a unique relationship between international organizations, NGOs, endemic states and the private sector,” we have a “historically unique” opportunity “in the history of public health.”

Kathy shared that we need to go beyond the drugs, giving the example of HKI’s partnership with Johnson & Johnson to develop curriculums in education – hand washing, face washing – in Cambodia to realize tremendous successes.

It’s no wonder that after the interviews and audience Q&A, Dr. Besser said, he has “about 50 more questions [he] would love to ask” and that we’re “fortunate to have such different perspectives on this problem.” STH is different in that the solution is known, and that “it’s a problem of will and resources to implement the solution,” Dr. Besser concluded.

In his closing remarks, Dr. Savioli stated, “We have the scientific evidence that when you treat people regularly, the morbidity goes down.” However, “countries have to be at the center of it” because “countries that have done well have performed better” in economic, health and other development markers.

“You deprive the country if you don’t do it,” Kathy closed.

Thanks to all for such an engaging, thought-provoking event! We look forward to seeing how cross-sectoral collaborationcan make a difference in STH control and elimination in children.