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Neglected tropical diseases (NTDs) are ancient diseases of poverty that impose a devastating human, social and economic burden on more than 1 billion people worldwide, predominantly in tropical and subtropical areas among the most vulnerable, marginalized populations.
Since WHO’s first road map for the prevention and control of NTDs (Accelerating work to overcome the global impact of neglected tropical diseases) was published in 2012, substantial progress has been made. Today, 600 million fewer people require interventions against several NTDs than in 2010, and 42 countries, territories and areas have eliminated at least one disease.
Dracunculiasis is on the verge of eradication, with 54 human cases reported in four countries in 2019; lymphatic filariasis and trachoma have been eliminated as public health problems in 17 and 10 countries, respectively; onchocerciasis has been eliminated in four countries in the Region of the Americas; the annual number of cases of human African trypanosomiasis has fallen from more than 7000 in 2012 to fewer than 1000 in 2019, halving the original target of 2000 cases by 2020; and the number of new leprosy cases reported globally has continued to decline since 2010 at an average of 1% per year after most endemic countries achieved elimination as a public health problem, defined as less than one case on treatment per 10 000 population.
Progress against NTDs has alleviated the human and economic burden they impose on the world’s most disadvantaged communities.
Over the past nine years, it has demonstrated the effectiveness of aligning the work of Member States with that of diverse partners. Two important facts have emerged, namely the recognition that:
(i) interventions to prevent and control NTD are one of the “best buys” in global public health, yielding an estimated net benefit to affected individuals of about US$ 25 per US$ 1 invested in preventive chemotherapy; and
(ii) NTDs are important tracers for identifying disparities in progress towards both universal health coverage and equitable access to high-quality health services.
Despite the substantial progress that has been made since 2010, many of the targets set for 2020 in the earlier road map were not met. The new road map identifies critical gaps and the actions required to reach the targets set for 2030, established through global consultation. Experience from the past decade shows that further multisectoral action is required for all 20 diseases and disease groups, particularly in diagnostics, monitoring and evaluation, access and logistics, and advocacy and funding. Ambitious, impact-oriented targets are required to achieve the Sustainable Development Goals (SDGs) and accelerate control and elimination.
Concerted action in multiple dimensions and agile responses to challenges will be necessary to achieve the targets. The recognition, for example, of Dracunculus medinensis infection in mammals other than human beings shows how challenges to eradication can manifest in the last stages – the last mile – of eradication. Circumstances such as epidemics, political instability, migration, the consequences of climate change and antimicrobial resistance increase the complexity of the situation and will require additional action.
Targets and strategies for the next decade
The road map for 2021–2030 sets global targets and milestones to prevent, control, eliminate and eradicate 20 diseases and disease groups. It also sets cross-cutting targets aligned with both WHO’s Thirteenth General Programme of Work, 2019–2023 and the SDGs, with strategies for achieving the targets during the next decade.
The new road map was prepared by extensive global consultation. This process involved regional workshops with managers of national NTD prevention and control programmes, meetings with stakeholders in NTDs and related areas of work, country workshops with stakeholders in NTDs and related areas of work, input from disease experts, disease modellers, donors and partners obtained through more than 100 bilateral interviews and consideration of more than 300 responses from three rounds of online consultations. The document therefore reflects the perspectives of Member States and a wide range of stakeholders.
The road map also describes the integrated approaches needed to achieve these targets through cross-cutting activities that intersect multiple diseases. It is built on three pillars that will support global efforts to control, eliminate and eradicate neglected tropical diseases:
Pillar 1. Accelerate programmatic action
Pillar 2. Intensify cross-cutting approaches
Pillar 3. Change operating models and culture to facilitate country ownership.
Pursuant to decision EB146(9) of the Executive Board at its 146th session in February 2020, the proposed road map is being submitted to the Seventy-third World Health Assembly for consideration.
Integrating and mainstreaming approaches
Continued programmatic action is called for, particularly in targeted areas where serious gaps exist across multiple diseases. Adequately structured operational and implementation investigations, including community-based and applied research, are also essential for building a solid foundation on which effective NTD interventions can be designed and delivered.
More radical change is needed for approaches to be integrated and mainstreamed into national health systems and for coordination of actions across sectors. Such cross-cutting concepts are not new; they are outlined in various existing NTD plans, but their operationalization has been problematic in some instances.
The road map aims to renew momentum through its proposed concrete actions within integrated platforms for delivery of interventions, and thereby to improve the cost–effectiveness, coverage and geographical reach of programmes. Strengthening the capacity of national health systems will ensure delivery of interventions through existing infrastructures, improve the sustainability and efficiency of interventions and ensure that patients have equitable access to all aspects of treatment, care and support. Close coordination and multisectoral action within and beyond the health sector, encompassing not only vector control, water and sanitation, animal and environmental health and health education, but also, for instance, education and disability, will maximize synergies.
Delivering results, achieving impact
Countries are both the drivers and the beneficiaries of progress towards the 2030 NTD targets. National and local governments must therefore lead work to define agendas and realize their objectives, with financing partly or fully from domestic funds. Countries must integrate and prioritize prevention and control of endemic NTDs in national health plans and dedicate a corresponding line item in national health budgets. Multisectoral action must be fostered and planned well in advance at ministerial and higher levels in order to build the high-level political will required to support NTD plans.
As countries define their national NTD plans, the support of partners will be essential for filling gaps, strengthening capacity and enabling targets to be achieved. Deliberate efforts are needed to engage the community, especially, young people, in processes that support national NTD programme implementation, follow-up and review.
Given the shift to cross-cutting approaches, structures and ways of working may have to be adapted accordingly, for example by making funding streams more flexible and reporting structures less cumbersome.
Much work will be required during the next decade to reach the at least 1.74 billion people who still require interventions against NTDs. These diseases of poverty must be overcome in order to attain the SDGs and ensure universal health coverage. The road map sets out global targets and actions to align and re-focus the work of stakeholders during the next decade. It encourages all parties to evaluate the efficiency and effectiveness of their contributions and approaches and seeks to foster greater collaboration and openness in order to lessen and remove the profound global burden of NTDs.