Neglected tropical diseases can be "brought to their knees"
Dr Margaret Chan
Director-General of the World Health Organization
Colleagues in public health, representatives of the pharmaceutical industry, ladies and gentlemen,
Welcome to Geneva, and our thanks to all of you for coming. This is a room full of technical expertise, practical experience, good will, generosity and, frankly, power.
We are here to launch a report, and we are here to seize an opportunity. The two go together.
The 17 diseases covered in the report are not a natural or a uniform group of disorders. They differ significantly in their causes, pathologies, and clinical features, though some have a shared geographical distribution and tend to co-exist.
What brings these diseases together is our collective failure as an international community to do a better job of reducing poverty and addressing the diseases that are bred by poverty.
The neglected tropical diseases form a group because of one shared feature: all occur almost exclusively among very poor people living in tropical parts of the world. All thrive in impoverished settings, where housing is often substandard, safe water and sanitation are scarce, environments are filthy, and insects and other vectors are abundant.
Together, these diseases blind, maim, disfigure, disable, and otherwise impair the lives of an estimated 1.2 billion people. Less visibly, they damage internal organs, cause anaemia, retard the growth of children, impair cognitive development, and compromise pregnancy outcomes.
The significant damage to health is frequently compounded by the misery of stigma and social exclusion, especially for women and girls. In many societies, this is a fate worse than death.
The disease burden has been easy to ignore, as it affects people with little political voice and low visibility on national and international agendas. The immense suffering caused by these diseases is often endured in silence, accepted as an inevitable consequence of being poor.
These diseases anchor large numbers of people in poverty. This is poverty passed from one generation to the next in a painful chain of illness, misery, blunted capacity, and lost productivity.
Working together, an international community of partners is now breaking that chain.
Let us think about what this means.
Many of the neglected tropical diseases are ancient diseases, having caused misery throughout much of recorded human history. What has been achieved in just the past ten years, and what can be achieved in the next five to ten years, needs to be viewed against this historical perspective.
Many of these diseases gradually disappeared from large parts of the world as societies developed and standards of living and hygiene improved.
Today, instead of waiting for these diseases to gradually vanish, a community of partners is deliberately vanquishing them. Some of the recent progress, viewed against such a long and notorious history, is stunning.
Ladies and gentlemen,
As I said, we are here to launch a report, and we are here to seize an opportunity. The two go together.
The report is authoritative, but this is not a comprehensive text. The information is selective, concise, and to the point. The report is a practical tool, but this is not a detailed guide to case detection, prevention, or treatment.
Working to overcome the global impact of neglected tropical diseases sets out a big-picture strategic approach, with a vision.
What the report does, basically, is this. It tells us all we need to know to accelerate control, to seize the opportunity, to bring these diseases to their knees.
The opportunity is immense, and at the heart of the broader drive, guided by the Millennium Development Goals, to pursue health as a poverty-reduction strategy.
The opportunity is well-defined. For the first time, the report profiles 17 neglected tropical diseases according to a common format. The emphasis is firmly placed on technical knowledge and practical experiences that help define opportunities and refine strategies for prevention and control.
This kind of information is useful for partners at the international level, but also for health officials in endemic countries seeking to refine national strategies. Trends are clearly indicated, as are needs, whether for new diagnostics and drugs, better reporting systems, or larger supplies of existing drugs.
The report provides a catalogue of human misery and its geographical distribution, but it also sets out a solid body of evidence suggesting that victory is in sight for several of these diseases. In fact, if we keep doing the right things better, and on a larger scale, some of these diseases could be eliminated by 2015, and others by 2020.
Decades of experience tell us that health initiatives survive long enough to deliver sustainable results only when they are nationally owned and aligned with national priorities and capacities. Self-reliance is realized only when programmes are delivered in ways that strengthen existing infrastructures, systems, and capacities.
Some of the biggest leaps forward have already come from simplification, consolidation, streamlining, and integration. In this sense, the fact that several neglected tropical diseases frequently co-exist has been a strategic advantage.
Breakthroughs came with evidence that a single drug is effective against multiple diseases, that a set of deworming drugs can be safely administered together, and that simple delivery channels can be used to distribute multiple interventions.
Preventive chemotherapy has an approach, and an appeal, akin to childhood immunization. This is population-wide prevention, protecting everyone at risk, with no need for costly screening.
But mass drug administration differs from childhood immunization in one important way. For many of the neglected tropical diseases, an end is in sight.
Addressing these diseases as a group has unquestionably facilitated greater operational efficiency and brought impressive results, but it has another advantage as well.
Success is contagious. When progress for one of these diseases sparks optimism, this can-do attitude spreads to other diseases.
African sleeping sickness, an especially difficult and challenging killer, provides a good example. The drugs are old, dangerous, and cumbersome. The treatment protocol is complicated.
Yet despite these challenges, intensified case-finding and management, supported by generous donations from industry, brought a drop in new cases of around 60% in less than ten years.
When guinea-worm disease is eradicated, this will be the first disease kicked out of its human host, not by a powerful vaccine, but by health education and behaviour change.
As I said, success is contagious. As an added bonus, the drive to combat this group of diseases is revitalizing the field of vector control and bringing greater attention to the role of veterinary public health.
Ladies and gentlemen,
Dr Savioli with give you further examples, say more about the report, and talk about the importance of partnerships.
The success we are seeing is the composite result of multiple contributions, from money and donated drugs, to research, to hands-on work in the field, to the experiences and insights of health officials in endemic countries.
These diseases are dreaded by affected populations, and the demand for treatment is growing. The status of these diseases is rising on national and international health agendas.
The momentum to accelerate control is growing. Let me repeat my advice: keep things lean, nimble, and simple, even as we strive to do more, on a larger scale.
The report will take us a long way towards that goal.
I have a second piece of advice: continue to innovate. We need better diagnostics and medicines, especially for the protozoal diseases. But we also need ingenious low-tech innovations that help streamline operational demands and stretch resources and drugs even further.
I have a final comment. There have been many boosts to progress, contributed by many, but drug donations, I believe, deserve special mention.
When the goal is to reach very large numbers of very poor people, no drug price, however low, is affordable.
I can think of no other group of diseases that has attracted drug donations on such a scale, and with such open-ended commitments as we have seen for the neglected tropical diseases.
For many of these diseases, drug donations have been the true turning point in terms of prospects for control and eventual elimination.
Thanks to these donations, the poorest of the poor are receiving the best-quality medicines on offer. I extend my heartfelt thanks to the pharmaceutical industry, and to all the other partners represented in this room.
This is a thank you on behalf of the millions of children who are growing up free from the risk of blindness, deformities, and disfigurement, the millions who are freed from threats to their physical and mental development, the men who can support their families, and the women who can marry, have children, and lead normal social lives.
The report on Working to overcome the global impact of neglected tropical diseases documents this kind of progress. And it shows us how to do the right things better, and on an even larger scale.
This is a big blow to some ancient diseases, a big blow to the seemingly endless grip of poverty, and a big triumph for the power of partnerships.