“The most important thing is that these diseases affect the poorest of the poor. And one thing that brings votes is lifting people out of the cycle of poverty.” 

Dr. Mwele Malecela, WHO NTD Director

Neglected tropical diseases (NTDs) are a set of viral, parasitic, and bacterial diseases that affect about 2 billion people globally. They are a diverse group of diseases that disproportionately affect low-income populations in developing regions of Africa, Asia, and the Americas. In developed settings, NTDs are often overshadowed by other public health programs such as malaria and HIV/AIDS.

There are many different classifications for neglected tropical diseases, however, the most common and reliable classifications are by the World Health Organization (WHO) and the Centre for Disease Control and Prevention (CDC).  Factors like climate change, zoonosis, poor sanitation, and access to clean and safe water are consistently linked with NTDs. 

While preventive measures exist for several NTDs, accessibility barriers make it difficult for those most in need to access them. Preventive measures such as clean water, sanitation, and hygiene are more readily available in high-income countries and are not universally available in low-and-middle-income countries, where the disease burden is greatest.      

This article provides an overview of NTDs, its global impact on impoverished populations, and calls to action to renew efforts to “end the neglect”, as a way towards sustainable development.

Global burden of Neglected Tropical Diseases

Combined, neglected tropical diseases (NTDs) affect about 2 billion people globally (Engels & Zhou, 2020). Low-and-middle income countries (LMICs), particularly in sub-Saharan Africa, South Asia, and Southeast Asia are more impacted by the effects of these neglected tropical diseases.

According to the WHO, over 40% of the NTD burden lies within sub-Saharan Africa impacting over 600 million people (WHO, 2021).

These diseases also impact communities in the Americas, with a large disease burden in Latin America and the Caribbean. Though anyone can be affected by NTDs, the highest burden of disease is felt among the world’s poorest communities.

Why neglected?

NTDs contribute to the local burden of disease, but individually, none of them represent a global priority in terms of the number of people affected or disability-adjusted life years (DALYs). Though NTDs can perpetuate cycles of poverty, they tend to do this by causing disability and disfigurement, rather than mortality (Engels & Zhou, 2020).

Because NTDs do not lead to high rates of mortality, many global programs focus on the “killer diseases”, such as HIV/AIDS, tuberculosis (TB), and malaria, since these diseases often lead to greater years of life lost. As a result, NTDs and those living with the conditions continue to be left behind – neglected.

Another reason for the neglect is that NTDs disproportionately affect the world’s poorest communities. According to The First Annual Report on the London Declaration on NTDs, assuming current funding continues and based on preliminary estimates, there is a US$3 billion funding gap for program implementation through 2020. However, we know that even current funding sources are insecure, as highlighted by the recent UK aid cuts which directly affected neglected tropical disease programs.

With the help of public-private partnerships and global public health campaigns, there has been an encouraging rise in not only awareness of NTDs, but in global initiatives aimed at eliminating these diseases altogether. One such program is the 2021-2030 Roadmap to End the Neglect for Sustainable Development, developed by the WHO.

The Impact of Covid-19 in the fight against NTDs

As we fight COVID-19, we must also not forget the fight against NTDs, along with other diseases like malaria and TB, which poses a serious threat in the public and community health.

Some interventions like hand washing and general personal hygiene must continue to be  prioritized as they have proved to be effective in preventing spread of disease both COVID-19  and many Neglected tropical diseases.  

We have witnessed some funds for NTDs being reduced, which is likely to significantly impact global agendas like the sustainable development goals (SDGs) and universal health coverage (UHC). These setbacks in the fight against NTDs could lead to the intensification of poverty.

Stakeholders in global health are strongly encourage to continue the fight against COVID-19, in parallel with the fight against NTDs, to realize an equitable and sustainable approach to UHC and SDG #3: Better Health for All.

Desired situation and way forward to fight against NTDs

“It is remarkable that more than 40 countries have achieved WHO’s elimination target for at least one NTD.”

Dr. Rebecca Martin, Director, CDC Center for Global Health.

Every human being desires a better life, free from diseases like NTDs, which can lead to stigma and underproduction.

In 2020, the WHO launched a Roadmap for Neglected Diseases 2021-2030 with the purpose of ending the neglect to attain sustainable development. It is true that with diseases, sustainable development is difficult to achieve due to the vicious cycle of poor health and poverty.

There are valuable lessons from some countries which have managed to beat some NTDs. For example, China eliminated Schistosomiasis during the millennium development goals (MDGs) era through a multi-disciplinary integrated strategy (Liu et al., 2017).   

As a global public health advocate, I am calling on governments and stakeholders to strengthen political will and replenish funding sources to fight NTDs and end the neglect. 

Innovative approaches to disease surveillance, data collection, and management, as well as interventions supporting ongoing monitoring and evaluation, are also crucial in ensuring that the goal to “end the neglect” is achieved. Furthermore, research and development should be well-financed. Consistent capacity-building sessions among community healthcare workers and scientists are needed to properly intervene against NTDs. 

Massive screening and drug administration should also not be ceased, and more resources should be mobilized to strengthen these programs, in order to reach everyone, everywhere, effectively, and equitably. Access to clean and safe water is also an inevitable measure that must be prioritized in the fight to beat NTDs. 

Finally, community outreach initiatives to raise awareness and promote knowledge surrounding control, prevention, and elimination of NTDs should be strengthened. This will ensure that communities are equipped with the necessary tools for everyone, everywhere, to effectively participate in the fight against NTDs.

Future Outlook

The years 2021-2030 are being marked as a decade of hope for the fight against NTDs. Governments, civil society organizations, international organizations, and individual stakeholders are stepping up to support the fight against NTDs.

The benefits of this work will impact communities for generations to come. We must continue the fight until we have achieved our target of zero NTDs, globally. Will you join us?