Beyond the Pledge: The Five Shifts Needed to Eliminate Neglected Tropical Diseases

Neglected tropical diseases (NTDs) affect more than 1.6 billion people, mostly in low- and middle-income countries. NTDs cause significant morbidity and mortality, as well as social and economic impacts, especially among the poorest and most marginalized populations.

Recently, a coalition of global health partners pledged over $777 million to fight NTDs. This is an incredible progress, as it demonstrates the commitment and solidarity of the international community to tackle these diseases. However, fighting NTDs requires a new approach that addresses the root causes of these diseases, such as poverty, inequality, and lack of access to basic services.

The following shifts need to happen in order to end NTDs by 2030 as part of the Sustainable Development Goals.

1. Proactive public health response beyond meds distribution

While access to medical supplies remains essential, we should remember the need to hire, train, and deploy clinicians and community health workers who can diagnose, treat, and prevent NTDs. The World Health Organization (WHO) predicted a global shortage of 18 million health workers, especially in rural and remote areas where NTDs are prevalent.

Moreover, we need to strengthen the health systems and infrastructure that support the delivery of quality and affordable health care for all. This includes improving the supply chain, surveillance and monitoring, and referral mechanisms. Effective frameworks like Partners In Health’s “five S’s” model, including staff, stuff, space, systems, and social support, should be adopted to accelerate the pace toward the elimination of NTDs. ?

2. Communities should drive the design and implementation of public health solutions

One of the fundamental principles of the NTD roadmap 2021-2030 is to put people at the center of the NTD response. This means that the affected communities should be involved in planning, implementing, evaluating, and improving the NTD interventions. They should also be empowered to demand their rights to health and to hold the duty-bearers accountable.

Furthermore, the communities should be encouraged to co-create and co-innovate solutions tailored to their local contexts and needs. An increased support for paid community health workers is a promising step in acknowledging the importance of community-driven interventions. By virtue of their proximity to children and families at risk, teachers and other community leaders are well-placed to transfer knowledge, skills, and necessary tools to prevent and tackle NTDs. An extended community health workforce should redefine the role of community leaders and provide them with the necessary resources. Innovative approaches such as Move Up Global’s Knot Framework could facilitate strong linkages between education and health systems.

3. Fostering systems integration

Vertical programming, which focuses on specific diseases or interventions, does not lead to where we need to be. Instead, we need to adopt a holistic and integrated approach that addresses the determinants of health and the consequences of NTDs. This means that we must coordinate and collaborate across different sectors and stakeholders, such as education, water and sanitation, nutrition, agriculture, environment, social protection, and human rights.

For instance, safe water and sanitation can reduce the transmission and morbidity of NTDs such as schistosomiasis, soil-transmitted helminths, and trachoma. The impact of climate change should not be underestimated. Fortunately, the major partners are vocal about the effect of climate change on the increased burden of NTDs. This should be a call to an integrated response.

4. Reimagining funding and global health philanthropy

We need to recognize that the pledge of $777 million is just a drop in the ocean. Considering the five shifts mentioned above, we need to mobilize more resources and re-imagine the global health financing mechanisms.

One way to do this is to leverage the power and potential of global health philanthropy, which has been instrumental in advancing the NTD agenda in the past two decades. For example, the Bill & Melinda Gates Foundation, the Children’s Investment Fund, the END Fund, and the Helmsley Trust have contributed significantly to the research, innovation, advocacy, and implementation of NTD programs. More funders are needed to make a meaningful difference in this fight to break the cycle of poverty and diseases.

5. Leveraging advances in diagnostics and treatment

We need to take advantage of the scientific and technological advances that have been made in diagnostics and treatment of NTDs. For example, molecular diagnostics techniques, such as polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), can enable rapid, accurate, and cost-effective detection of NTD pathogens, especially in resource-poor settings.

Similarly, new drugs and vaccines can offer more effective and safer options for treating and preventing NTDs, as well as reducing the risk of drug resistance. These innovations complement the existing mass drug administration (MDA) campaigns and potentially reduce the need for repeated treatments.

NTDs are not only a health problem but also a social justice issue. They reflect and reinforce the inequalities and injustices that plague our world. Therefore, ending NTDs is a moral imperative and a strategic investment for a more equitable and prosperous future for all.

To achieve this vision, we must adopt a new approach beyond distributing deworming medications. We need to adapt our public health response, engage the communities, integrate the systems, mobilize the funding, and leverage the advances in diagnostics and treatment. We must work together across sectors and boundaries to ensure no one is left behind in the fight against NTDs.

We have the knowledge, the tools, and the opportunity to make history. Let us seize this moment and make it happen.