Winning the war against neglected tropical diseases
MANILA, 15 July 2013 - Together with its Member States and partners, the World Health Organization (WHO) continues to make progress against neglected tropical diseases (NTDs) such as leprosy and yaws in the Western Pacific Region. However, there are pockets in the Region where some of these afflictions continue to take a high toll on the poor. This is according to the latest WHO report—Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases—which charts progress in controlling, eliminating and eradicating these ancient illnesses.
"Tropical diseases are diseases of poverty and neglect," says WHO Regional Director for the Western Pacific Dr Shin Young-soo. "They afflict the most vulnerable people in society in 28 countries and areas in our Region. Although they are usually not fatal, they are distressing and create lasting disability and stigma. We are determined to despatch these diseases to where they belong—in the history books."
International experts, partners and national programme managers will gather in the WHO Regional Office for the Western Pacific for two key meetings on NTDs—the Western Pacific Region Programme Managers Meeting on Neglected Tropical Diseases from 16 to 18 July 2013, and the Western Pacific Regional Programme Review Group on Lymphatic Filariasis and Other Neglected Tropical Diseases on 19 July 2013. Both meetings aim to review the progress of integrated approaches in NTD control or elimination and explore new opportunities, as well as provide specific recommendations for each endemic country to address key challenges regarding NTDs.
During the Sixty-sixth World Health Assembly in Geneva in May 2013, a resolution on all 17 NTDs was adopted. Among other measures, the resolution urges Member States to:
ensure country ownership of prevention, control, elimination and eradication programmes;
expand and implement interventions and advocate for predictable, long-term international financing for activities related to control and capacity strengthening;
integrate control programmes into primary health-care services and existing programmes; ensure optimal programme management and implementation; and
achieve and maintain universal access to interventions and reach targets set out in the WHO global road map to 2020 on neglected tropical diseases.
The resolution also calls on WHO to sustain its leadership in the fight against NTDs; develop and update evidence-based norms, standards, policies, guidelines and strategies; monitor progress, and support Member States in strengthening human resource capacity for prevention and diagnosis, including vector control and veterinary public health. Many Member States highlighted intensifying efforts to tackle dengue.
WHO promotes five public health strategies to control, eliminate and eradicate NTDs: preventive chemotherapy; innovative and intensified disease management; vector control and pesticide management; safe drinking water, basic sanitation and hygiene services and education; and veterinary public health services.
In September 2012, WHO developed the Regional Action Plan for Neglected Tropical Diseases in the Western Pacific (2012–2016), to help countries in the Region to control or eliminate NTDs and link the WHO global road map with national plans of action. The five-year plan focuses on seven key diseases: lymphatic filariasis (LF), schistosomiasis, blinding trachoma, leprosy, yaws, soil-transmitted helminthiases (STH) and foodborne trematodiases (FBT).
Three countries in the Region—China, the Republic of Korea and Solomon Islands—have already eliminated LF. Countries and areas still endemic for LF in the Region aim to eliminate the disease before 2020. Brunei Darussalam, Fiji, French Polynesia, Kiribati, the Lao People’s Democratic Republic, Malaysia, the Philippines and Tuvalu are currently implementing preventive chemotherapy. American Samoa, Cambodia, Cook Islands, the Marshall Islands, Tonga and Viet Nam have entered the post-mass-drug-administration surveillance phase, which usually happens five years after the completion of five to six rounds of mass drug administration. Palau, Niue, Vanuatu and Wallis and Futuna are now preparing to submit the dossiers for verification of elimination of LF.
Schistosomiasis is endemic in Cambodia, China, the Lao People's Democratic Republic and the Philippines. The Western Pacific Region has successfully controlled Schistosoma japonicum, and elimination as a public health problem will be achieved by 2016. Incidences of schistosomiasis have been significantly reduced in Cambodia, the Lao People’s Democratic Republic and the Philippines, but treatment campaigns will need to continue.
Slated for global elimination by 2020, blinding trachoma is suspected or known to be endemic in parts of Australia, Cambodia, China, Fiji, Kiribati, the Lao People's Democratic Republic, Nauru, Papua New Guinea, Solomon Islands, Vanuatu and Viet Nam. Elimination of this disease has been set by the Lao People's Democratic Republic and Viet Nam in 2015, by China in 2016, and by Australia and Solomon Islands in 2020.
During 2010–2011, the number of new cases of leprosy declined from 1324 to 1144 in China, and from 2041 to 1818 in the Philippines. Kiribati, the Marshall Islands and the Federated States of Micronesia have not yet eliminated leprosy. An Action Framework for Leprosy Control and Elimination for the Pacific Island Countries was prepared in 2011, which focuses on integrating leprosy services into general health services, intensifying early case detection through contract tracing and mass screening, and strengthening rehabilitation services.
Yaws is mostly endemic in poor populations in remote areas of Papua New Guinea, Solomon Islands and Vanuatu. While mass treatment campaigns in the 1950s using penicillin injections significantly reduced the number of people with yaws, the disease has been resurgent due to incomplete initial intervention coverage. With the availability of an oral drug for mass chemotherapy and new monitoring tools, achieving global eradication is possible by 2020.
Preventive chemotherapy for soil-transmitted helminthiases is required in 15 countries and areas in the Region. In 2011, 8.1 million out of an estimated 22.3 million school-aged children at risk were dewormed in 12 countries and areas: American Samoa, Cambodia, Fiji, French Polynesia, Kiribati, the Lao People’s Democratic Republic, the Marshall Islands, Papua New Guinea, the Philippines, Tuvalu, Vanuatu and Viet Nam. Cambodia, Fiji, Kiribati and Tuvalu achieved the WHO global target of deworming of 75% of school-aged children.
Similar activities for women of childbearing age need to be scaled up in Cambodia, Fiji, Papua New Guinea and Viet Nam and need to begin in the other endemic countries.
Six countries in the Region are endemic for foodborne trematodiases: Cambodia, China, the Lao People’s Democratic Republic, the Philippines, the Republic of Korea and Viet Nam. In Cambodia, mapping continues to identify areas where foodborne trematodes are transmitted. At least 600 000 people in Cambodia are infected with opisthorchiasis. Pilot control interventions based on WHO's recommendations are planned.
Medicines such as praziquantel and triclabendazole are available through donations to the endemic countries. In the Lao People's Democratic Republic, preventive chemotherapy with praziquantel started in 2007; in 2011, approximately 325 000 adults and children out of an estimated 2.6 million people at risk were treated. In Viet Nam, preventive chemotherapy with praziquantel started in 2006. In 2011, more than 128 000 people were treated for clonorchiasis as part of a campaign targeted to people in high-risk communities. In the Republic of Korea, approximately 4000 people were treated for clonorchiasis in clinical settings in 2011.
“The achievements so far are both measurable and encouraging,” says Dr Shin. “We have momentum on our side. But we must not relax our efforts when success is so close. History would not forgive us.”