Maldives and Sri Lanka have eliminated lymphatic filariasis. Their stunning success must inspire action across the South-East Asia Region.
Neglected tropical diseases have no place in today’s world. As the name suggests, their persistence is the outcome of inattention and omission, and their burden the harbinger of poverty and stigma.
It is of immense joy, therefore, that Maldives and Sri Lanka have now eliminated lymphatic filariasis, a painful and disfiguring disease transmitted by mosquitos. Vulnerable communities in both countries need no longer fear the swollen extremities, disability and mental anguish caused by the disease, which is more commonly known as elephantiasis.
The same does not apply to the rest of the WHO South-East Asia Region. Lymphatic filariasis remains endemic to seven of the Region’s 11 countries, while the Region accounts for around half of the 120 million global cases of infection.
Maldives’ and Sri Lanka’s success demonstrates that the burden can be lifted.
Despite its unique geography and scattered population, Maldives was the first in the Region to be certified as having eliminated the disease as a public health problem. To do so it sustained a mass drug administration campaign that provided at-risk communities several rounds of preventive drugs annually. This occurred alongside mosquito control efforts, as well as a greater emphasis on case identification and treatment. A robust surveillance system, meanwhile, monitored progress and provided authorities the information to better target their interventions.
Commendably, Maldives also developed a plan to provide disability prevention services to ease the suffering of more than 200 people that remain chronically affected by the disease. Since 2008 not a single new case of the disease has been reported across the country’s entire archipelago of nearly 2000 islands.
Sri Lanka, too, has demonstrated how key strategies can be deployed to tackle lymphatic filariasis. After the country launched its most recent elimination program in 2002, mosquito control efforts were scaled up; case finding and treatment were intensified; surveillance was strengthened; and a mass drug administration campaign was rolled out. The combination of strategies proved remarkably successful: Surveys conducted in 2008 and 2011 among school children in endemic districts confirmed the country’s progress, culminating in the recent WHO certification of the country’s ‘filariasis-free’ status.
The technical ability both countries demonstrated in their campaigns is laudable. But it is only half the story. Of equal importance is the political will and commitment shown by health authorities and political leaders at the highest levels. Though lymphatic filariasis is slated for global elimination by 2020, both Maldives and Sri Lanka were able to achieve and certify their filariasis-free status four years before the deadline. This is a remarkable feat, and demonstrates how firm resolve can make real change possible.
Countries across the Region should take note. Though progress against lymphatic filariasis and other neglected tropical diseases (NTDs) has been steady, it must be scaled-up to protect vulnerable communities and meet global targets. Conveniently, the strategies central to tackling lymphatic filariasis can help address other problems.
Mass drug administration campaigns can be employed to target soil transmitted helminthiasis, trachoma and schistosomiasis, for example. Mosquito and other vector control measures can help diminish the transmission of kala-azar, dengue and Japanese encephalitis. And a greater emphasis on case finding can also hone-in on remaining cases of leprosy and yaws. Better surveillance systems will inform and guide all of these efforts.
Importantly, advances in the battle against lymphatic filariasis and other NTDs must be driven by the principles underpinning the Sustainable Development Goals. Goal 3 outlines the need to “Ensure healthy lives and promote wellbeing for all at all ages,” with a special emphasis on leaving no one behind. Given that lymphatic filariasis and other NTDs are often the product of marginalization and inadequate access to services, a focus on equity and access will be critical to progress. It is no coincidence that Maldives and Sri Lanka both have well-developed health systems with high levels of coverage.
To be sure, the certification of Maldives and Sri Lanka as having eliminated lymphatic filariasis should be relished. The health of vulnerable communities in their respective countries will be enhanced, while efforts to tackle other NTDs can be reinforced. But unless other countries in the Region emulate their drive and success, an opportunity will be lost.
All countries must learn from Maldives’ and Sri Lanka’s achievements and fortify resolve accordingly. All countries must prove that lymphatic filariasis and other NTDs have no place in today’s South-East Asia Region.