Dr Tedros Adhanom Ghebreyesus Director-General World Health Organization

Dr Tedros Adhanom Ghebreyesus
Director-General

World Health Organization

The story of neglected tropical diseases (NTDs) is one of great progress and remaining challenges. Five years ago, the world committed itself to control, eliminate or eradicate 10 NTDs by 2020. Since then, tremendous success stories have been received from around the world.

If we are serious about universal health coverage, we must intensify our efforts and our commitment to control, eliminate or eradicate these diseases by 2020.

When the London Declaration on Neglected Tropical Diseases was signed in 2012 by a diverse group of partners, one sentiment was universal:

With a collaborative global effort, we can defeat these debilitating diseases of poverty and underdevelopment.

Five years later, this strong partnership has now reached over a billion people in a single year, making remarkable strides towards achieving the WHO goals for the control, elimination and eradication of 10 NTDs.

‘Thanks to this partnership, these neglected diseases are now getting the attention they deserve so fewer people have to suffer from these treatable conditions. There have been many successes in the past 5 years, but the job is not done yet. We have set ambitious targets for 2020 that require the continued commitment of pharmaceutical companies, donor and recipient governments, and frontline health workers to ensure drugs are available and delivered to the hardest to reach people.’

Bill Gates, Bill & Melinda Gates Foundation


Global public-private partnerships are improving a billion lives

1 billion people received treatment for
at least one NTD in 2016
sightsavers_41986610596 Record-breaking drug
donation programme
400 million people no longer
require treatment
Untitled-1Individuals requiring intervention (bn)0.00.51.01.52.0201620152014201320122011

NTD programmes are a gateway to universal health coverage

The unequalled reach of the NTD programme can provide a gateway to universal health coverage and shared prosperity.

The unequalled reach of the NTD programme can provide a gateway to universal health coverage and shared prosperity. NTD programmes reach some of the world’s poorest communities, and the creative strategies tailored for challenging, complex settings can provide a gateway to UHC.

They provide high-quality treatment and community-based care in remote rural areas never before reached by health systems, by training health workers and empowering health facilities with scant resources to reach more people more effectively.

The essence of UHC is ensuring that everyone has access to high-quality essential health care without suffering financial hardship. Population coverage is key to the UHC journey. NTD programs can open access to populations that are some of the most challenging to reach.


Join us on the journey to defeat NTDs

The vision of a future free of NTDs is built on our successes, applying the lessons learnt and continually seeking additional tools, strategies and partners to help continue progress and address further challenges.

Our collective action and partnerships have proven that we can achieve outcomes that were only envisioned a few short years ago.

However, the path to NTD elimination and universal treatment remains steep. The barriers in reaching the underserved are still high and will require financial resources, political commitment, new tools and other innovations.

We must continue to innovate in both programmes and tools and continue the strong partnership we have built. We share successes and set-backs, and together we will get the job done.


Progress, year after year

Here are some of the numbers that give us much
reason to celebrate:

Human African trypanosomiasis 2,184 cases reported in 2016.
Down from 10,000 cases in 2009
Trachoma 5 countries have eliminated trachoma as a public health problem since 2012
Lymphatic filariasis 544 million people no longer require treatment for LF. A drop of 39% Guinea worm disease Only 26 cases reported so far in 2017. A drop from 3 million, 30 years ago Onchocerciasis 4 countries in the Americas have eliminated onchocerciasis since 2012
NTDs and UHC

Ending neglected tropical diseases – a gateway to universal health coverage

A best buy in global health

Over 1 billion people treated in 2016, millions of health workers and community volunteers trained and services provided to people who are frequently far from a health facility. The unequalled reach of the NTD programme can provide a gateway to universal health coverage and shared prosperity.


A best buy in global health

1 billion

people in over 130 countries were reached with treatment for at least one NTD. Reaching both men and women equitably in poor, rural communities.


Primary healthcare: an army of community health workers powering the NTD programme

>1 million

of community drug distributors, surgeons, nurses and government health officials have been trained by NTD programmes


Financial protection: generous drug donation reduces out of pocket health expenditure

$17 billion

worth of medicine donated by our industry partners, making it one of the most cost-effective programmes in public health


Population coverage: protecting the last billion

The NTD programme has a global population coverage target of 80%, which is aligned with the UHC target for quality essential health care. In 2016, 62% of the population in need of NTD treatment received it, closing in on the 80% target.


Figure 1: Comparison of 2016 coverage for PC NTDs with the WHO NTD target and the UHC coverage target (over 1 billion people reached with PC in 2016)

coverage_rates_web2016 PC coverage dataWHO NTD targetUHC coverage target2001030405060Coverage (%)708090100SCHSTHLFTrachomaOnchoGlobal
Industry

Record-breaking commitment of the pharmaceutical industry

Five years ago, the pharmaceutical industry joined the global health community in committing itself to supporting the ambitious goal of eliminating or controlling 10 neglected tropical diseases (NTDs) by 2020. Since then, the pharmaceutical industry has made substantial progress in living up to the commitments of the London Declaration.

1.8 billion treatments donated by the pharmaceutical
industry in 2016
sightsavers_41986610596 207,169,292 doses donated in 24 hours for a Guinness
World Record

A breakthrough in LF elimination!
Merck announces an expanded donation in support of new treatment

A breakthrough in LF elimination! Merck announces an expanded donation in support of new treatment

A new treatment, co-administering ivermectin, DEC, and albendazole (IDA), has shown to be superior to standard two drug approaches. This finding was so striking that an expert group convened and developed a pathway to rapidly evaluate the safety of this approach in MDA programs for LF. Now over 10,000 people across 4 countries have been treated, demonstrating safety. After thorough review, WHO recommends IDA to accelerate LF elimination.

In response, Merck announced an expansion of the MECTIZAN® Donation Program (MDP) to reach up to an additional 100 million people per year through 2025. IDA use should be targeted to achieve LF elimination with high coverage and compliance, strengthening monitoring and evaluation to demonstrate impact. Countries eligible for the donation (currently using DEC and albendazole) could decrease MDA rounds and achieve elimination more rapidly, releasing communities from risk, and resources, both human and financial, to target additional health and development challenges.

‘LF is on the short list of diseases that are targeted for elimination in the World Health Organization’s Roadmap on Neglected Tropical Diseases,’ said Kenneth C. Frazier, chairman and chief executive officer, Merck. ‘With the evidence put forward in the WHO’s new guidelines, we’re expanding the MECTIZAN® Donation Program to bring improved health and hope to millions of people as we work toward the day when LF is no longer a threat.’

The number of new donors that have joined to support NTD programmes in recent years is encouraging. It proves that evidence of impact is a tremendous motivation for investors. But, additional funding partners are still needed, as hundreds of millions of people still need treatment.

WHO estimates that an additional $300 to $400 million in global investment will be required each year through 2020 to reach the remaining 500 million people in need of treatment.

Collectively, private donors, national governments and bilaterals could create a movement that would dramatically transform the socio-economic prospects of the affected countries through one of the most cost-effective global health programmes.

$812 million was pledged by donors at the NTD Summit
to end NTDs over the next 5 to 7 years
$100 million per year provided by USAID over the
last 4 years

Gulf states intensify the fight against NTDs

Over the past 5 years, leadership of donors from the Middle East and Gulf states has continued to grow.

A breakthrough in LF elimination! Merck announces an expanded donation in support of new treatment
Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi
Mr. Abdulwahab Al-Bader, Director-General of Kuwait Fund for Arab Economic Development
Mr. Abdulwahab Al-Bader, Director-General of Kuwait Fund for Arab Economic Development
$100 million fund to support elimination of river blindness and lymphatic
filariasis in African and Middle Eastern countries.
$4 million to support the WHO AFRO region’s Expanded Special
Project for Elimination of NTDs (ESPEN)

Non-governmental organizations are uniquely placed to reach the world’s least-served populations and therefore play a critical role in working with governments towards achieving universal health coverage.

The NTD NGO Network (NNN) represents nearly 80 NGOs. The network provides a global forum for NGOs that are contributing to the control, elimination and management of NTDs.


BESTwBSTBehaviour changeSocial inclusion and equityTreatment and careEnvironmentE

BEST framework

In 2016, the NTD NGO Network launched the BEST framework, as platform for action and engagement, developed to support the SDG goals of reaching the hardest to reach and ensuring that no one is left behind.

The framework recognises that action to combat NTDs is situated within the wider context of the environment and the economic and social dimensions of sustainable development The BEST framework provides a platform for engagement and embeds NTD elimination in national development and progress towards UHC.

Advances and innovations in research empower national programmes in the fight against NTDs, making it possible to treat more people faster. Since the London Declaration in 2012, multinational collaboration has led to advances in the delivery and monitoring of treatment and has streamlined programmes so that they can detect multiple diseases at once.

Confirmatory mapping for lymphatic filariasis

This mapping gives programmes a clearer picture of LF infection than previous methods and prevents needless MDA.

In Ethiopia and United Republic of Tanzania, the tool saved national programmes $9 million by finding that MDA was not required in 52 districts.

Supervisor’s coverage tool

This tool is designed to help programme managers assess the coverage of MDA while it is being implemented.

It has been effective in identifying treatment gaps in Ethiopia and Nigeria - improving the coverage of the programmes.

Understanding the impact of stopping treatment for LF on STH

Stopping treatment for one disease can affect another. Soil-transmitted helminths responds to drugs for LF. As LF treatment scales down, STH infections come increase.

In 2015, WHO published guidelines to help programme staff understand how LF treatment affects STH. By following the guidance, staff can decide whether MDA should be continued to control intestinal worms.

Progress by disease

Lymphatic
filariasis

10 countries

have now eliminated LF as a public health problem

Onchocerciasis

67%

of people in need are covered by preventive chemotherapy

Schistosomiasis

71 million

children covered by schistosomiasis programmes

Soil-transmitted
helminths

531 million

children reached by deworming
programmes

Trachoma

80%

increase in antibiotic coverage since 2014

Chagas
disease

9 countries

have halted vectorial transmission

Guinea worm
disease

98%

decrease in cases from 2011 to 2017

Human African
trypanosomiasis

68%

decrease in cases from 2011 to 2016

Leprosy

65%

of priority countries with a decrease in new leprosy cases compared to 2011

Visceral leishmaniasis

60%

decrease in cases from 2011 to 2016


Scorecard

scorecard_webAchieved or minor delay; or 90–100% of requested treatments shipped Delayed but achievement anticipated; or 80–89% of requested treatments shippedDelayed, additional action required; or 0–79% of requested treatments shipped London Declaration NTDsCoverage and impact milestonesProgram support milestonesDrug requests filledResearchOverall progressPreventive chemotherapy (PC)Lymphatic filariasis22112Onchocerciasis22122Schistosomiasis32133Soil-transmitted helminths11121Trachoma22122Innovative and intensified disease management (IDM)Chagas disease22132Guinea worm disease22not applicable22Human African trypanosomiasis12121Leprosy32122Visceral leishmaniasis12121123

Call to action

Neglected Tropical Disease (NTDs) programmes reached over 1 billion people in a single year. Now, we must beat that record and reach the rest of the 1.5 billion people in need of treatment.

Great progress has also been made in control and elimination: several diseases are at their lowest levels in recorded history and more than a dozen countries have eliminated at least one NTD in the last several years. Nevertheless, as we approach 2020, it is clear that we will not meet all our targets. To build on our progress, we need new tools, new resources, and new approaches.

The next steps should involve the wider community to ensure the access of marginalized populations with NTDs. Universal health coverage (UHC) can become the next step to providing targeted health services for all, including those who are hard-to-reach. We should build on the momentum and use the opportunities created through the NTD platform to ensure no one is left behind.

We call on endemic countries to:

  • increase domestic financial and political commitment to NTDs
  • scale up programmes and reach all those at risk
  • invest domestic resources in fighting NTDs
  • complete and more timely, report programme data disaggregated by age and sex from district level to ensure that no one is left behind
  • incorporate new tools such as new triple-drug therapy for LF and tiny targets for sleeping sickness into national strategies and deploy them widely and rapidly to the field

We call on the World Health Organization to:

  • maintain the momentum in the fight against NTDs as the 2020 WHO roadmap targets approach, and work towards the fulfilment of the Sustainable Development Goals (SDG3) target for NTDs
  • commit itself to goals of the NTD roadmap and to new goals beyond 2020
  • prepare recommendations on how best to transition from donor-supported initiatives to national platforms for UHC

We call on existing and new donor countries including private philanthropy to:

  • invest in NTD elimination. Support for NTD programmes is one of the best buys in development. NTD programmes leverage billions of dollars’ worth of donated drugs, multiplying the impact of every dollar committed. Every dollar invested in NTD control and elimination has an economic return of US$ 27 and $ 42
  • stay the course until these diseases are eliminated, and encourage new donors to join this global effort

We call on programme implementers and NGOs to:

  • work with the health system to strengthen it and ensure that morbidity management does not fall behind treatment as we move boldly ahead
  • document successes as countries achieve their elimination targets and learn, duplicate and scale up best practices while taking time to celebrate progress.

Together, we can reach our goals and build a better, fairer and healthier world.