WHO's 2021–30 roadmap for neglected tropical diseases
Authors: Vijay Shankar Balakrishnan
Journal: The Lancet Microbe (2021)

Neglected tropical diseases (NTDs)—such as onchocerciasis, leishmaniasis, and yaws, among others—affect more than a billion people in the poorest, most marginalised communities worldwide. Infected adults are often unable to work. Children miss school. Entire communities become mired in poverty as disabled and disfigured people face stigma and social exclusion, while struggling to afford food and basic services, including health care. Since 2007, WHO has engaged in the control, elimination, and eradication of NTDs. Towards this goal, in 2012, WHO convened member states, foundations, and pharmaceutical companies to make a formal, joint commitment to eliminate at least ten NTDs by the end of 2020 and pooled US$785 million for research and development and intervention programmes for NTDs. Dubbed as the London Declaration, this first roadmap has now come to an end and although its goals were not fully met, some measurable successes were achieved. Among the accomplishments, 500 million people no longer require interventions against NTDs; 40 countries have eliminated at least one NTD, some eliminating multiple NTDs; onchocerciasis (river blindness) has been eliminated in four countries (Colombia, Ecuador, Guatemala, Mexico); and lymphatic filariasis has been eliminated as a public health problem in 16 countries and trachoma in nine. Peter Hotez, Dean for the National School of Tropical Medicine at Baylor College of Medicine (Houston, TX, USA) believes the first roadmap has gone well, not only in terms of treatment scale-up, but also of advocacy and raising awareness. However, he is troubled by the one-shot-one-goal approach used to tackle NTDs, with a lack of multi-modal control-and-prevention programmes such as those implemented to fight diseases such as malaria, tuberculosis, and AIDS. For example, the availability and common use of a drug, praziquantel, to treat people with schistosomiasis has hindered efforts to develop a vaccine against the disease. “Somehow we've gotten to this double standard, where for NTDs the subliminal message is you only get one approach; and I think that that needs to be fixed”, Hotez told The Lancet Microbe. To make things worse, management of COVID-19 has slowed down the progress of NTD control. An estimated additional 88 million people have fallen into extreme poverty globally as a consequence of the pandemic. The redistributing of international funding and other resources for COVID-19 was necessary, but has caused damages that go beyond the interruption of the NTD control programmes. “So now we really need a landscaping document that asks ‘we've had some setback and now how do we recover?'”, said Hotez. Thoko Elphick-Pooley, Head of Uniting to Combat NTDs, shares the sentiment; however, both Hotez and Elphick-Pooley are hopeful that a new WHO-led roadmap will help straighten things out. Indeed, having reviewed the successes and failures of the London Declaration, WHO announced the roadmap for 2021–30 at the virtual session of the 73rd World Health Assembly on Nov 12, 2020, which aims to: achieve a 90% reduction in number of people requiring interventions for NTDs, in line with the Sustainable Development Goals; eliminate at least one NTD in 100 countries; secure a 75% reduction in NTD-related disability-adjusted years; and eradicate two NTDs—dracunculiasis and yaws. “We recognised well before [2020] that we're not going to hit the 2020 target, so it was important for us to look at how we could make sure that we accelerate progress, ensure multisector participation in moving forward, and also ensure that the [member] countries are at the centre of these programs”, said Mwelecele Ntuli Malecela (Department of Control of Neglected Tropical Diseases, WHO, Geneva). The roadmap advocates a shift in strategy that aims to: strengthen primary health-care systems and integrate NTDs into them; work across governmental ministries and departments, such as those managing water resources, sanitation, education, and nutrition, to promote hygiene education and access to safe water nutritional food; and enable countries affected by NTDs to take ownership of their NTD programmes. Ministries and non-governmental organisations worldwide have endorsed this ambitious roadmap. “I am 100% confident that achieving elimination of at least one NTD in 100 countries is absolutely possible”, said Elphick-Pooley. “The strategies are unarguable but two big questions for me are how are we going to integrate the [research and development] agenda for new tools into the implementation step of this roadmap and how are we going to finance it”, adds Hotez. WHO has estimated that its global budget for NTDs is US$86 million for 2020–21, of which over $70 million will be in the form of memoranda of understanding for NTD health products, technical collaboration, or financial donations. WHO has also established a NTD Diagnostic Technical and Advisory Group (DTAG). “The DTAG have made [an] impressive contribution—even during COVID-19—and have produced the first high quality Target Product Profiles (TPPs) for lymphatic filariasis and onchocerciasis”, said Malecela. “We believe the TPPs will guide investments for research and development of identified diagnostics.”