Seventh anniversary of London Declaration on Neglected Tropical Diseases, January 30 2019

It is traditional when marking the anniversary of a public policy commitment to look back over the years and tick off a series of achievements with statistics.

On the seventh anniversary of the London Declaration on Neglected Tropical Diseases (NTDs), which took place on January 30th 2012, we could do just that. After all, it was one of the most ambitious public private health partnerships ever announced and was formed to help over a billion and half people – one in five on the planet – affected by NTDs.

But how about looking from another perspective for a change? How about going back in history and, from that vantage point, looking forward? How about reminding ourselves of our vision back then – a vision that some dismissed as an impossible dream?

The London Declaration on Neglected Tropical Diseases, signed by a huge variety of communities, governments, pharmaceutical companies, international organisations and activists, said, in essence, that we would:

• Sustain and extend programmes to fight ten key neglected tropical diseases, mobilising drugs where necessary.
• Seek the next generation of treatments for NTDs.
• Enhance collaboration in the fight against NTDs at national and international levels.
• Provide regular updates on the progress in reaching goals and identifying gaps.

“Ten years ago, before the London Declaration and before the wider partnership against NTDs was formed”, said Professor Gail Davey, a global health epidemiologist and longtime activist on NTDs;

“we could only dream about things we take for granted today”.

Professor Davey has a list of things she knows barely existed ten years ago, but which do today:

“Over the years, the sum has been much greater than the parts”, she said;

“But the parts which fulfilled the dream are still pretty impressive. They include: much more visibility for NTDs on the agendas of donor governments; a Guinness World Record for drug distribution which has been part of a once unthinkable level of pharmaceutical company donations; and regular, consistent eliminations of diseases around the world”.

And, not to forget the impact of all this on individuals, Gail Davey underlined that; “vulnerable communities have been reached time after time with health interventions for NTDs that for many people are their first ever formal health care.”

As a reminder, the London Declaration prioritised ten NTDs. Within the ten, the first group of five, by far the most common, are those diseases which can be treated through mass drug treatment – blinding trachoma, bilharzia (also known as schistosomiasis), elephantiasis (lymphatic filariasis), river blindness (onchocerciasis) and intestinal worms (soil-transmitted helminths).

The other five, where treatments involve other forms of patient care, are Chagas disease, Guinea worm disease, sleeping sickness, leprosy and kala-azar (visceral leishmaniasis).

The acknowledgement that NTD interventions can reach the poorest and most vulnerable communities in a unique way was a key reason for including NTDs in the broader UN Sustainable Development Goals (SDGs).

Tackling NTDs, which affect 1.6 billion people, is of course a valid goal in itself. But the data, infrastructure, and personnel required to reach NTD-prevalent communities in some of the world’s most remote locations, also lend themselves to helping achieve other development goals.

In other words, if a community volunteer or a doctor can reach remote location X with an NTD intervention, then there is perhaps no excuse for governments or aid agencies not to follow up with other services – whether they be in the health sphere or in pursuit of other development aims.

For this reason, and with the momentum of the London Declaration at its heels, NTDs were incorporated into United Nations Sustainable Development Goal (SDG) commitments. The UN wording adopted in September 2015 was to “by 2030, end the epidemics of AIDs, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.

The past seven years, since the London Declaration, have also encouraged other international actors to take up the NTD cause. In December 2014, African countries signed the Addis Ababa Commitment on NTDs, committing to increase domestic investment in the fight against NTDs, work towards NTD elimination and use NTD work to strengthen their overall health systems.

As with the recognition from the UN with regard to SDGs, African nations (where some 40% of the worldwide NTD burden is) had recognised that NTD infrastructure such as medical care and drug distribution channels could contribute to the ultimate goal of Universal Health Coverage.

But in the end no article looking back over the seven years since the London Declaration can be complete without quoting a few of the amazing statistics we can deploy.

The first Big Number is that the total of people receiving treatment, for at least one of the NTDs amenable to mass drug treatment (also known as preventive chemotherapy), has gone up, year on year, from 730 million people reached in 2011 to 1.03 billion in 2017.

The 1.03 billion figure also represented a higher proportion of those in need of treatment who were receiving it compared with 2011. To be precise, the global “coverage”, as clinicians say, of those in need of treatment for NTDs was 37% in 2011 but grew to 65% in 2017.

There has also been progress in the elimination of NTDs – with “elimination” being defined by the World Health Organization (WHO) as bringing the disease burden down to a point where it is no longer a significant public health problem. Up to 2011, the elimination of an NTD had been confirmed in 13 countries. Since the London Declaration in 2012, NTD elimination has been confirmed in 28 countries.

Of the diseases which are not amenable to drug treatment but require other forms of patient care, Guinea worm disease has come the closest to being eradicated completely. By the end of 2018, only 28 new cases were reported. But although this figure is tantalisingly low compared with the over 3 million cases thirty years ago, the “final mile” towards eradication has now been complicated by the disease being found in animals – including domestic dogs.

And, finally, what summary of the past seven years could be complete without mention of our Guinness World Record? The judges of the popular website (and hardback annual so longed for in childrens’ Christmas stockings!) recorded that the NTD community had in one 24 hour period distributed 207,169,292 does of drugs to seven distribution sites around the world.

This achievement was recognised with a Guinness World Record  certificate awarded on January 30 2017 for the most medication donated in 24 hours.

This feat could not have been reached without the generous donation of NTD treatment drugs, for free, by international pharmaceutical companies. Since the London Declaration on NTDs, the pharmaceutical industry has committed to supply over $17 billion worth of drugs for free.

In large part due to these donations, NTD interventions only cost an average of 50 US Cents to deliver per treatment. Given that successfully treating someone for NTDs can greatly increase their educational achievements, or extend their productive working life, this cost of 50 US cents makes it one of the very best buys in public health.

However, we should also sound a note of caution. The number of people worldwide still in need of treatment for at least one NTD is still 1.6 billion – that’s the equivalent of more than the entire population of China.

This shows that much more investment is needed in the fight against NTDs – from donor countries but also from the governments of countries where the diseases are endemic.

So although there is much to celebrate on this anniversary – and the situation today could indeed only have been dreamed of back in 2011 – there is still considerable work to do.