The World Health Organization (WHO) has called on the various alliances working to eliminate specific neglected tropical diseases (NTDs) to come together to better support countries in their efforts to overcome these conditions that affect mostly poor populations.
“The time has come now for all the alliances to come together and talk about an NTD elimination alliance or network,” said Dr Soumya Swaminathan, WHO Deputy Director-General for Programmes. “This will [...] help us to create a louder voice[ ..] and [..] support countries' efforts better [...] because cross-cutting efforts will be more helpful”.
Addressing participants at the 10th meeting of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF) in New Delhi, India through a video-recorded message, Dr Swaminathan said that WHO would be happy to convene the various alliances and facilitate discussions on how to unite to address the issue.
“Similarly, within countries at national level, within the Ministry, we need to break the silos across health programmes to ensure efficiency and to make sure we are sharing the benefits across the programmes,” added Dr Swaminathan.
WHO has initiated a transformation process that is changing the way in which the Organization functions. By better shaping policy outcomes and their delivery, WHO aims to achieve the “triple billion” over the next five years by providing 1 billion more people with universal health coverage, keeping 1 billion more people safe from health emergencies, and promoting health and well-being for 1 billion more people.
India’s new strategy to eliminate lymphatic filariasis
During the opening of the 3-day meeting, the Minister of Health and Family Welfare of the Government of India, Mr Jagat Prakash Nadda, announced the country’s new strategy to accelerate elimination, adding that India is committed to interrupting transmission.
“With the concerted efforts of Government, state governments and development partners, 100 districts out of a total of 256 endemic districts have achieved the elimination target and stopped mass drug administration (MDA) after successful validation by Transmission Assessment Surveys, and are now under post-MDA surveillance,” added Mr Nadda.
India is committed also to integrating the activities of different departments in order to mobilize communities, and welcomes newer initiatives and research to accelerate its elimination campaign.
WHO recommends a combination of ivermectin, diethylcarbamazine citrate and albendazole as an alternative regimen1 (known as IDA) to accelerate the global elimination of lymphatic filariasis.
The Minister of State for Health and Family Welfare, Mr Ashwini Kumar Choubey, spoke of the need to create awareness and address the causes of non-compliance in at-risk populations receiving large-scale treatment for the disease.
Prizes were awarded to 11 countries2 that have been validated by WHO for having eliminated this debilitating disease as a public health problem.
Global progress achieved despite challenges
From 2000 to 2016, an estimated 6.7 billion treatments were delivered to more than 850 million people at least once in 66 countries, thereby reducing transmission in many areas, the number of people requiring MDA to 499 million (by 36%) and the prevalence of infection below elimination thresholds.
The overall economic benefit of the programme in 2000–2007 is conservatively estimated at US$ 24 billion.
Besides the 11 countries which have been validated by WHO, an additional nine countries claim to have successfully implemented WHO’s recommended strategies and stopped large-scale treatment. These countries are now conducting surveillance to demonstrate that elimination has been achieved.
10th GAELF meeting
The theme of the meeting – Celebrating progress towards elimination: voices from the field on overcoming programme challenges – brings together country programme managers, governmental agencies, representatives of foundations, nongovernmental organizations and pharmaceutical companies as well as research organizations.
In 2002, India hosted the second meeting. This tenth meeting, convened from 13 to 15 June, is being held in collaboration with the National Vector Borne Disease Control Programme and the Ministry of Health and Family Welfare of the Government of India.
The disease
Lymphatic filariasis is caused by infection with parasitic worms living in the lymphatic system. The infection impairs the lymphatic system triggering abnormal enlargement of body parts, causing pain, severe disability and social stigmatization. The larval stages of the parasite (microfilariae) circulate in the blood and are transmitted from person to person by mosquitoes.
Manifestation of the disease after infection takes time and can result in an altered lymphatic system, causing abnormal enlargement of body parts, and leading to severe disability and social stigmatization of those affected.
Almost 856 million people in 52 countries worldwide are threatened by the disease and require preventive treatment to stop its spread. Regular MDA reduces the density of microfilariae in the bloodstream and prevents the spread of parasites to mosquitoes.
MDA can interrupt the transmission cycle when conducted annually for 4–6 years with effective coverage of the total population at risk.
The causative parasites of lymphatic filariasis are transmitted by four main types of mosquitoes: Culex, Mansonia, Anopheles and Aedes.
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1 Evidence from recent research studies has demonstrated that adding ivermectin to the currently recommended combination of diethylcarbamazine citrate (DEC) plus albendazole clears microfilariae more efficiently from the blood than the two-drug regimen, and is equally safe.
2 WHO has validated 11 countries: Cambodia, Cook Islands, Egypt, Maldives, Marshall Islands, Niue, Sri Lanka, Thailand, Togo, Tonga and Vanuatu.