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OPINION: Neglected tropical diseases are the landmines of global health

They are 20 disparate diseases that, like mines, unduly affect the world’s poorest people. Now there’s a plan to eradicate them by 2030

By Albert Picado and John H Amuasi for The Guardian

In January the World Health Organization launched a new strategy for eradicating neglected tropical diseases, boldly setting targets to eliminate 20 of them by 2030.

But what are neglected tropical diseases (NTDs)? There is no easy answer. The concept was first proposed in the early 2000s to bring to light a group of diseases that disproportionately affect poor people yet, despite their collective impact, do not attract as much attention as diseases such as HIV/Aids, malaria or tuberculosis.

The common denominator of poverty and the dearth of prevention efforts is largely what binds these diseases together, even though they may be extremely disparate in presentation and approaches to solutions – snakebite v schistosomiasis, for example. Currently, the WHO identifies 20 NTDs and the differences between them make it difficult to talk about them all together.

How can we succinctly describe 20 different conditions that are caused by parasites, bacteria, viruses, fungi and toxins? How can we summarise complex transmission cycles involving multiple vectors – mosquitoes, sandflies or dogs? And routes – oral, , through the skin or congenital? How can we explain in a simple way the diversity of control strategies, including mass drug-administration campaigns, multiple vector-control tools, active screening of cases, dog vaccinations and facilitating the use of footwear? Most vitally, how can we illustrate the devastating impact that NTDs have on individuals and communities across Africa, Latin America and Asia?

And how can we explain to funders, governments, researchers, aid organisations and the public why we should invest money, time and effort to control and eliminate them?

Here’s an analogy that might help.

Neglected tropical diseases are the landmines of global health. Landmines have been described as “indiscriminate weapons of mass destruction in slow motion” and are well known thanks to movies and international awareness campaigns.

Landmines are designed to incapacitate, injure or kill their victims, and especially affect poor rural communities, where people are trying to make a living through activities that place them in direct contact with the ground, expose them to the elements and ultimately to pathogens, vectors and animal reservoirs; such as herding, farming or collecting water.

Landmine survivors often suffer permanent disability, with physical, mental, socialand economic consequences. Landmines have a dire impact on victims’ caregivers, families and communities. Children are often the victims of landmines and women and girls are more likely to give up their jobs or drop out of school to take care of the injured. As Michelle Bachelet, the UN high commissioner for human rights, said at the 2019 mine ban convention: “Landmines continue to kill, burn and damage limbs and other body parts in horrific ways. They cause lifelong impairments, including visual and auditory impairments. They destroy livelihoods […] and even impede national economic recovery.”

Similar language can be used to describe the impact of NTDs. Though medically diverse, NTDs can slowly kill, blind, disfigure and debilitate their victims. They cause untold suffering to victims and caregivers in the poorest communities and contribute to perpetuating a cycle of disease, stigma and poverty.

Collectively, NTDs killed more than 80,000 people and caused the loss of more than 18m disability-adjusted life years (a measure of the burden of disease burden, expressed as the years lost to ill health, disability or early death) in 2019 alone. Unfortunately, these staggering figures, which are grossly underestimated, still do not get NTDs the kind of attention they deserve.

The 1997 mine ban treaty represents an international commitment and responsibility to eliminate landmines around the world. The roadmap for NTDs sets a similar goal – to “control and eliminate the NTDs by 2030”.

Nonetheless, the resources allocated to help people suffering from NTDs remain scarce. Despite recent successes (for example, 33 countries have eliminated at least one NTD since 2012) and communication efforts (30 January has been declared World NTD Day), we have largely turned a blind eye to these conditions.

A clear and powerful message on the terrible impact that NTDs have on individuals and communities would help to raise awareness and engender the required international commitment to control and eliminate these “slow-motion, indiscriminate weapons of mass destruction” by 2030.

  • Albert Picado is senior scientific officer for the Foundation for Innovative New Diagnostics in Switzerland. John H Amuasi is executive director of the African Research Network for Neglected Tropical Diseases in Ghana

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