Atlanta/Brazzaville – Preventive treatment of neglected tropical diseases (NTD) has saved many lives across Africa. However, obstacles persist as these diseases often affect impoverished communities in rural areas, conflict zones and hard-to-reach regions. These diseases are also almost absent from the global health agenda. Dr Paul Emerson, Director of the Atlanta-based International Trachoma Initiative, discusses ways to improve treatment and apply lessons for effective prevention and control.

What are the major impediments to treatment of neglected tropical diseases?

In the control of neglected tropical diseases context is everything, meaning that each country faces different challenges. Several of the diseases targeted for control or elimination with an emphasis on preventive chemotherapy such as lymphatic filariasis, soil transmitted helminthiasis, and trachoma have seen tremendous progress in disease reduction during the last decade. For these diseases, the challenge is to focus implementation activities, human resources, and donated medicines to those people still at risk of morbidity from the diseases and to recategorize formerly endemic areas into surveillance. Populations who have been marginalized, overlooked, or who are affected by war must be deliberately targeted with services to ensure no one is left behind. For other less common, but equally important, NTDs such as leprosy and yaws there is a need to implement and monitor village wide prophylaxis or treatment in affected areas and carefully monitor disease reduction. For these diseases, availability of implementation funds and donated resources are an impediment to progress, which may be overcome with demonstrated progress in targeted countries.

What strategies can governments adopt to administer effective treatment of NTDs?

Government-led NTD programmes have shown remarkable resilience during the last two years while the world has been affected by the pandemic. The dedication of health ministry personnel to deliver the programmes, and the eager uptake by affected communities underlines the effectiveness of the current strategies. Of course, there are always opportunities for improvement. Efficiencies can be made by targeting donated medicine to those who need it, co-administering medicine for NTD’s in some circumstances, and looking for other areas of integration for example offering deworming tablets to women at risk of hookworm and Trichuris during their antenatal visits. Other disease elimination and control programmes can learn and get inspiration from the community engagement and ownership of NTD programmes.

What lessons can be applied for better and sustainable control of NTDs?

As programmes become mature and the diseases are disappearing the districts that are left are those that do not respond in the same positive way as those in which the disease has gone. National programmes and their partners need to understand that different strategies may be needed at the end of their programmes than were needed at the beginning or during the scale up phases. All programme managers and partners should remember the lessons of humility and listen to the story that is being told when they track data and monitor progress. The data do not lie. If a disease appears to be coming back, or the speed of decline is slowing, mother nature is telling us something. It’s time for a deep dive on the specific context of that area to find out what is really happening.

Beyond treatment, what are some of the key measures to accelerate elimination?

Preventive chemotherapy with donated medicines has reached over a billion people in the last decade and really does form the cornerstone of several NTD control and elimination programmes. However, donated medicine alone is not the only answer to disease elimination. People must want to take the medicine and participate in the other aspects of the programmes. Community members make informed decisions about their family’s health and well-being on an almost daily basis. Building trust so that the benefits of active participation in drug distribution programmes, hygiene promotion, vector and source reduction is an inexpensive and vital way of increasing impact. Other ministries and departments with responsibility for providing access to water and sanitation should be partners in NTD elimination. Residual NTD transmission usually takes place in the least developed communities and districts, meaning that the presence of these diseases can be used as a marker of poverty and help water and sanitation agencies target their efforts to these areas.