The challenges of disease elimination – the example of visceral leishmaniasis

Piero Olliaro

Progress towards the elimination of a neglected tropical disease from a country can sometimes be a curse. It’s easily interpreted that there is no longer any need to address the health problem, and limited resources are redirected to the next priority.

This is the challenge countries in the Indian subcontinent are currently facing. In 2005, the governments of India, Nepal, and Bangladesh, in collaboration with World Health Organization (WHO) and later joined by Bhutan and Thailand, developed a strategic framework to eliminate visceral leishmaniasis as a public health problem (Kala-azar Elimination Programme). Since then, there have been significant decreases in morbidity and mortality, and the elimination target is being reached.

Visceral leishmaniasis treatment in Bangladesh
Visceral leishmaniasis treatment in Bangladesh
Credit: WHO/TDR/Andy Craggs

Countries are now faced with making these achievements last and preventing a resurgence of the disease. Approaches that have been successful in the attack phase may not be appropriate or sustainable in the maintenance phase.

It may be time to reconsider a different target – to reduce transmission, not just reduce the number of total cases. There are a number of other important changes that should be considered – such as new types of treatments and the impact a vaccine could have.

This is the analysis and conclusion of control programme officials and researchers from Bangladesh, India and Nepal along with international experts. They have been working together for a decade, with TDR support, to design and conduct research to test interventions to curb visceral leishmaniasis, and translate findings into policy. They are now appealing for additional attention from endemic country governments and investments by the international community. This is what is needed so that recent advancements are sustainable, visceral leishmaniasis can sustainably be eliminated, and transmission reaches zero.


For more information, please contact Piero Olliaro

This editorial is excerpted from an article published in PLOS Neglected Diseases written by Piero L. Olliaro, Tushar A. K. M. Shamsuzzaman, Baburam Marasini, A. C. Dhariwal, Ahmed Be-Nazir, Dinesh Mondal, Megha Raj Banjara, Pradeep Das, Shyam Sundar, Suman Rijal, Byron Arana, Jorge Alvar, Daniel Argaw, Rosanna W. Peeling, Axel Kroeger and Greg Matlashewski.

  • Read the full article:
    Investments in Research and Surveillance Are Needed to Go Beyond Elimination and Stop Transmission of Leishmania in the Indian Subcontinent