Neglected tropical diseases

Neglected tropical diseases (NTDs) are a diverse group of 20 conditions¹ that are mainly prevalent in tropical areas, where they mostly affect more than 1 billion people who live mostly impoverished communities.  They are caused by a variety of pathogens including viruses, bacteria, parasites, fungi and toxins. These diseases cause devastating health, social and economic consequences to more than one billion people. The epidemiology of NTDs is complex and often related to environmental conditions. Many of them are vector-borne, have animal reservoirs and are associated with complex life cycles. All these factors make their public-health control challenging.

They are ‘neglected’ because they are almost absent from the global health agenda. Even today, when the focus is on Universal Health Coverage, NTDs have very limited resources and are almost ignored by global funding agencies. NTDs are diseases of neglected populations that perpetuate a cycle of poor educational outcomes and limited professional opportunities and are associated with stigma and social exclusion.

NTDs flourish mainly in rural areas, in conflict zones and hard-to reach-regions. They thrive in areas where access to clean water and sanitation is scarce – worsened by climate change. Furthermore, NTDs tend to      affect regions without quality healthcare, leaving poor populations vulnerable to these often debilitating diseases and newly emerging threats.

Addressing NTDs requires cross-sectoral approaches that span from bringing medicines to the ‘end of the road’ - thus making “universal health coverage” (UHC) a reality, to relieving the associated mental health burden, to tackling fundamental human rights issues.

WHO’s road map for 2021-2030 sets out ambitious targets in tackling many of these diseases in an integrated manner. The road map targets are aligned with those of the Sustainable Development Goals. Ensuring that essential services reach all who need them is at the heart of efforts to respond to NTDs. 

Despite the difficulties inherent in their public-health control, WHO envisages ambitious targets for NTDs, including control, elimination as a public health problem, elimination of transmission and global eradication.

Over the past decade, WHO has progressively harmonized public health approaches against NTDs and fostered integration of disease control efforts in endemic areas, moving away from vertical programmes and strengthening cross-cutting interventions that are best poised to impact on diseases that often overlap geographically and affect the same population groups.

WHO has supported the global community by developing a comprehensive set of normative guidance to support the planning, financing, implementation, monitoring and evaluation of NTD interventions from global to community level. World Health Assembly resolution 66.12 (2013) reflects the commitment of WHO’s Member States to address the burden of NTDs. While the first NTD road map (2012–2020) delineated milestones and targets, the new roadmap for 2021–2030 sets out actions to drive progress towards a world free of NTDs by 2030.

The notion of equity and primary health care is woven into the fabric of the global NTD agenda. NTD programmes mostly serve marginalized communities and prioritize the needs of the most disadvantaged groups of people that must be explicitly considered. NTD programmes are closely aligned with UHC targets and are considered important steps on the path towards achieving UHC by 2030.

Much progress has been made over the past decade. Compared with 2010,  almost 500 million people are no longer at risk of disease/disability from NTDs today; 43 countries have eliminated at least one NTD; more than 1 billion people were treated for at least one NTD from 2015 through to 2019.

Despite the ongoing SARS-CoV-2 pandemic, the NTD road map aims to leave no one behind. It moves from vertical disease programs to cross-cutting approaches, with shared goals and disease-specific targets, through smarter investments to improve health and wellbeing by 2030. The road map works to reduce poverty by addressing the burden of disease due to NTDs and works to support the achievement of UHC and poverty reduction. The road map provides opportunities to evaluate, assess and adjust programmatic actions as and when needed over the next decade, by setting clear targets and milestones.

Another distinct feature is to drive greater ownership by national and local governments, including communities.

The overarching 2030 global targets are:

• reduce by 90% the number of people requiring treatment for NTDs
• at least 100 countries to have eliminated at least one NTD
• eradicate two diseases (dracunculiasis and yaws)
• reduce by 75% the disability-adjusted life years (DALYs) related to NTD

NTDs have the greatest relevance for SDG 3 (the health goal). Interventions against NTDs directly contribute to the achievement of the Sustainable Development Goal 3.3: “end the epidemics of...neglected tropical diseases”, and are measured by SDG indicator 3.3.5: “number of people requiring interventions against neglected tropical diseases” NTD activities also contribute indirectly to many others SDGs (1, 2, 4, 5, 8, 10 and 17), while progress towards some SDGs (6, 9, 11, 13) is critical to tackle NTDs.

WHO is optimistic, although significant challenges remain. Some of these can include consequences arising from climate change, conflict, emerging zoonotic and environmental health threats, as well as continued socio-economic inequalities that have a direct impact on access to healthcare services, adequate housing, safe water, and sanitation. Also, most recently, disruption to health services caused by the COVID-19 pandemic has added a further burden.

Nevertheless, the WHO road map offers all the tools required to overcome these and any future challenges. It is built on delivering health services in an integrated, cross-sectoral manner, it moves away from the vertical, disease-centered approach to being people-focused, and is adaptable to different contexts and scenarios.