Human African trypanosomiasis (HAT), also known as sleeping sickness, has been one of the major diseases of mankind. After it was brought close to elimination in the 1960s, the disease surged significantly by the end of the 20th century. Over the past decade and through joint efforts by countries, WHO and partners, HAT’s incidence has been reduced by over 90%.
Success in controlling the disease, coupled with unprecedented political will, led WHO to publish its Roadmap on Neglected Tropical Diseases in 2012 to control / eliminate / eradicate 17 diseases including the elimination of HAT as a public-health problem by 2020. The Sixty-sixth World Health Assembly in 2013 endorsed the objectives of the Roadmap (WHA66.12), providing an international mandate to work towards elimination.
Rhodesiense HAT(r-HAT) is a zoonotic disease in which wildlife and domestic animals are the main reservoirs and play a central role in maintaining transmission to humans by the bite of infected tsetse flies. The zoonotic nature of this disease makes its elimination especially challenging. However, the elimination of r-HAT as public-health problem (defined as less than 1 case/10 000 people at risk) is achievable. The first WHO stakeholders’ meeting on r-HAT (Geneva, 20–22 October 2014) supported the Roadmap’s goal of achieving and sustaining the elimination of r-HAT as a public-health problem by 2020.
The stakeholders urged the scaling up and maintenance of health system capacities for diagnosis and treatment in r-HAT transmission areas, quantification of infection risk in humans and animals, and vector control. Especially important is the establishment in endemic countries of national coordination bodies including all sectors involved in r-HAT transmission and its impact (i.e. human and animal health, wildlife and tourism) to bring together and synergize efforts.
The zoonotic component of r-HAT, as well as its negative impact on various sectors of the economy – mainly livestock, agriculture and tourism – calls for a larger multisectoral approach. In this context, WHO has a crucial role in supporting endemic countries in the diagnosis, treatment and development of policies to monitor the disease trends.
The WHO network for HAT elimination was launched in March 2014 by stakeholders involved in gambiense HAT. Participants in the r-HAT meeting declared their interest in joining the network to advance the fight against the disease by accelerating biomedical research, expanding the scientific knowledge base, implementing cost-effective vector control, improving diagnosis and clinical care, and enhancing the efficacy of medical and veterinary public-health measures for the control and monitoring of the disease.
The stakeholders appealed to the international community and r-HAT endemic countries to give their full commitment, political support and essential resources to achieve and sustain this goal.
Institutions and organizations represented at the stakeholders meeting on r-HAT elimination having adopted this declaration:
Institutions from r-HAT endemic countries:
- Kenya Agricultural and Livestock Research Organization (KALRO)
- Ministry of Health, Malawi
- Ministry of Health and Social Welfare, United Republic of Tanzania
- National Sleeping Sickness Control Program (NSSP), Uganda
- Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU)
- Makerere University, Kampala, Uganda
- Ministry of Health, Zambia
- Copperbelt University, School of Medicine, Zambia
- Zambia Wildlife Authority (ZAWA)
International organizations:
- African Union Commission (AU) / Pan African Tsetse and Trypanosomiasis Eradication Campaign (PATTEC)
- Food and Agriculture Organization of the United Nations (FAO)
- International Atomic Energy Agency (IAEA)
- Programme Against African Trypanosomosis (PAAT)
- Word Health Organization Strategic and Technical Advisory Group on Neglected Tropical Diseases (WHO NTD STAG)
- World Health Organization (WHO)
Scientific institutions:
- Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), Montpellier, France
- International Centre of Insect Physiology and Ecology (ICIPE), Nairobi, Kenya
- Edinburgh Global Health Academy. University Edinburgh, U.K.
- Institut de Recherche pour le Développement (IRD), Montpellier, France
- Institute of Infection and Global Health, University of Liverpool, U.K.
- Interdepartmental Research Centre for Neglected Diseases, Institute of Tropical Medicine, Antwerp, Belgium
- Liverpool School of Tropical Medicine (LSTM), Liverpool, U.K.
- Scotland’s Rural College (SRUC), U.K.
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa.
- Spatial Ecology & Epidemiology Group (SEEG), University of Oxford, U.K.
- Swiss Tropical and Public Health Institute (STPHI), Basel, Switzerland
- University of Glasgow, Glasgow Centre for International Development, U.K.
- University of Southampton, U.K.
Foundations and NGOs involved in HAT:
- Drugs for Neglected Diseases Initiative (DNDi)
- Foundation for Innovative New Diagnostics (FIND)
Donors:
- Bayer HealthCare
- Sanofi
- Ceva Santé Animale
- Vestergaard Frandsen SA
- Social Finance Ltd
- Merial