New WHO road map for NTD recovery post COVID-19
Authors: Tim Jesudason
Journal: The Lancet Infectious Diseases (2020)

The publication of a new WHO road map to reduce the burden of neglected tropical diseases highlights the importance of strengthening health systems. Tim Jesudason reports. In April 2020, WHO published a draft 2021–2030 road map for neglected tropical diseases (NTDs), which is expected to guide countries towards the achievement of Sustainable Development Goal target 3.3 on NTDs. Speaking at a virtual event hosted by WHO on June 16, 2020, Mwele Malecela, Director of WHO's Department for the Control of NTDs, presented the new road map to a global audience of government representatives and NTD stakeholders. The new road map, titled “Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021-2030”, contains three fundamental shifts for NTD programmes, which will be critical to sustain progress for NTDs. These include: a transition from process-orientated programmes to impact-oriented programmes with a clear focus on monitoring and evaluation processes to improve performance and measure results; a focus on multi-sectoral and holistic programmes that address cross-cutting development issues; and strong country ownership with domestic financing. The draft road map for 2021–2030 was developed through global consultation of WHO Member States and NTD stakeholders. The document sets ambitious global targets and milestones to prevent, control, eliminate, or eradicate all 20 NTDs. Significant progress has been made to reduce the burden of NTDs since the first WHO NTD road map. 500 million fewer people require interventions against NTDs than in 2010 and 40 countries have been validated by WHO for eliminating at least one NTD. Great advance have been seen for individual diseases too. Dracunculiasis (guinea worm) is on the verge of eradication, with 53 human cases reported in four countries in 2019; lymphatic filariasis and trachoma have been eliminated as public health problems in 16 and nine countries respectively; and the number of new leprosy cases reported globally has continued to decline at 2–3% per year after most endemic countries reached the goal of eliminating leprosy as a public health problem in 2010. To sustain the unprecedented progress towards NTDs since the first road map, it will be critical to strengthen national health systems to ensure the delivery of interventions through existing infrastructure. Countries should improve the sustainability of programmes through improved access to water, sanitation and hygiene and ensure that patients have equitable access to all aspects of prevention, treatment, care and support. This will require national and local governments to define and deliver an agenda, financed partly or fully from domestic funds. The importance of integration was also emphasised by Matshidiso Moeti, WHO Regional Director for Africa, who urged countries to do more to achieve synergies across health systems and highlighted the need for countries to include NTDs as part of essential health packages linked to targets for universal health coverage. “We cannot afford the usual siloed approach” Moeti said. “We can do a lot of work to integrate around people and around similar interventions for other diseases. For example, if we need to do vector control, we can do that together with malaria programmes and put together our resources and capacities as it is very often the same communities who are affected by both diseases”. Throughout the event, panellists, including Ren Minghui, WHO's Assistant Director General of Malaria, Tuberculosis and NTDs, recognised the implications of COVID-19 for NTDs. “COVID-19 poses a major threat to the continuity of essential services, including those for preventing and managing the full range NTDs” Minghui said. “[The road map] proposes a new model of operation, setting out a bright future. Its importance is even more relevant as we deal with the pandemic. The road map seeks to promote resilience, health system strengthening, equity and country ownership.” Agreeing on this point, Malecela said, “the road map with its clear shift promoting resilience, integration, multisectoral action, and equity, serves as our path to recovery. We have a chance as a community to build back better and leave no one behind”. COVID-19 has caused significant disruption to NTD programmes. In April 2020, WHO issued interim guidance for NTD programmes, recommending the postponement of all community outreach campaigns, including mass drug administration, community-based surveys, and active case finding for NTDs. Despite the schallenges presented by COVID-19, the pandemic has demonstrated the importance resilient health systems that reach the most remote and vulnerable communities, which lies at the heart of the new NTD road map. Through multi-sectoral actions and holistic programmes that are embedded into strong national health systems, countries have an opportunity to truly leave no one behind for NTDs and ensure they are prepared to tackle the next global health challenge post COVID-19.