Most people, when asked to think about deadly and debilitative diseases rife in the developing world, would jump immediately to Malaria. This would be a logical conclusion, as of course Malaria is an infamous killer, and is responsible for about 450,000 deaths a year. AIDS and Tuberculosis should not be forgotten, but it is parasitic worms and other mosquito-borne diseases, which often get overlooked, thus preventing neglected tropical diseases (NTDs) from receiving the time and funding that could eradicate them completely.
The concept of NTDs was established in the aftermath of the Millennium Development Goals. They are a group of parasitic and bacterial diseases that cause substantial illness for over one billion of the world’s poorest people. They are unfamiliar diseases to most, including names such as Elephantitis, River Blindness, Snail Fever, Trachoma and Hookworm. Thriving in communities that lack access to health services, adequate sanitation and clean water, NTDs impair physical and cognitive development, contribute to mother and child illness and death, and make it difficult to farm or make a living. They trap individuals, families and whole communities in a cycle of poverty and disease, as well as costing developing economies billions of dollars a year.
Given that these diseases are so prevalent and are publicly acknowledged to be exceptionally damaging, many people would be surprised to know that we already have the necessary tools to control and eliminate the seven most common NTDs by the end of this decade. It costs just $0.50 per person to treat and protect against these diseases for up to one year through a ‘rapid impact package’ of mass drug administration (MDA). However, implementing a disease prevention and treatment programme on a global scale comes with its fair share of challenges.
In 2011, the World Health Organisation (WHO) launched a plan to combat NTDs when the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases and its partners adopted a roadmap for control, elimination and eradication of NTDs. Its six recommended strategies (preventative chemotherapy, intensified disease management, vector and intermediate host control, veterinary public health at the human-animal interface, provision of safe water, and sanitation and hygiene) were determined as the WHO believed that until these situations improve, many NTDs and other communicable diseases will not be eliminated, and certainly not eradicated.
Over the next few years, several new key global health policies began to emerge. In 2012, the London Declaration for Neglected Tropical Diseases was set up for controlling and eliminating 10 of the 17 NTDs by 2020. Not only did it strive to ensure necessary medication availability, but also the promotion of research and development for “next-generation treatments and inventions”.
National programmes of NTD control and elimination were soon underway in at least 20 developing countries, made possible through financial support from the British (£248 million) and American governments ($100 million per year), the Bill and Melinda Gates Foundation Ending Neglected Tropical Diseases (END) Fund ($363 million), as well as the thirteen London Declaration multinational pharmaceutical partner signatories supplying the medications.
Pill donations by the pharmaceutical industry mean that additional expenses are largely limited to transporting and delivering medication within endemic countries, mobilising the public to accept the treatments, training community health workers, and conducting monitoring and evaluation activities. Despite assistance from a number of additional donor organisations however, there continues to be a funding gap that leaves millions of people at risk of contracting these diseases.
In 2012, the Rio+20 conference in Brazil (also known as Earth Summit 2012) developed a new set of Sustainable Development Goals (SDGs), addressing important environmental issues not covered by the MDGs. In the same year, the UN Secretary-General announced the formulation of a UN Sustainable Development Solutions Network (SDSN) to mobilize scientific and technical support of the SDGs.
In May 2013, the 66th World Health Assembly (WHA) adopted resolution WHA66.12 which urged member states to begin to take ownership of NTD programmes (particularly those affecting their own countries, such as in South America and China), to intensify and integrate measures and plan investments to improve the health and social wellbeing of affected populations. Particularly relevant here, is the concept of ‘blue marble’ health. It recognises that NTDs are prevalent wherever poverty occurs, including emerging market economies, and not just in the world’s most devastated nations. Member states need to provide “sufficient and predictable” funding and recognise the importance of expanding research and development in order to incorporate NTDs into the new framework of the SDGs.
The most recent success occurred in October this year, when the Inter-agency and Expert Group on the Sustainable Development Goals (IAEG-SDG) approved the inclusion of an indicator for NTDs during a meeting in Bangkok. This indicator had been requested by the WHO, and was supported by the Global Network for Neglected Tropical Diseases. It will act to provide a clear benchmark to measure global progress in combating NTDs over the next 15 years. Target 3.3 of the SDGs reads: “by 2030, end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases.” With this set target, there will be more incentives for programmatic and political support for treatment programs, and will increase our chances of reaching these goals.
It is clear that despite our best efforts thus far, more needs to be done in order to eradicate NTDs. New advances are being made every year, including through international non-profit organisations such as the Global Health Innovative Technology Fund (GHIT Fund). Set up by the Japanese government, a group of Japan’s leading pharmaceutical companies and the Bill and Melinda Gates Foundation, and working in partnership with the Welcome Trust, it invests in the discovery and development of new health technologies such as drugs, vaccines, and diagnostics. It will support the development of new tools to tackle infectious diseases that devastate the world’s poorest people. As well as this, support for campaigns such as the END Campaign, can continue to raise public awareness of these diseases, and raise funds. Our governments working in cooperation with multilateral institutions, businesses and not-for-profit organisations do have the real possibility of fulfilling the SDG commitment to eradicating NTDs for good before 2013.
Bronwyn Rae-Le Bourn, MA Medical Law and Ethics