While the programme had a strong impact in terms of the number of communities that met the criteria for stopping MDA, the overall score was yellow, because 22 countries are not anticipated to achieve the 2020 goal unless they adopt new strategies. MDA coverage was extended from 40% in 2011 to 58% in 2016; thus, the programme must find ways to reach all the affected populations with MDA, morbidity management and disability prevention. The move from early research to WHO recommendations was completed in record time, which will accelerate progress towards elimination; this was due to the strong partnership of many stakeholders and WHO. Success in 2018 will depend on scaling up administration of both ivermectin, diethylcarbamazine and albendazole (IDA) and twice yearly albendazole where loaisis is also endemic. Additional support is still needed for research on diagnostics and methods for post-validation surveillance.
Overall, the onchocerciasis programme was scored yellow to reflect the transition from a strong disease control programme to an elimination programme with significant areas of uncertainty. A new strategy will be required to confirm whether treatment is needed, how to treat onchocerciasis in areas co-endemic for loaisis and how to determine when communities can stop interventions. Despite the good progress, more guidance should be given to countries during this transition, and guideline development should be accelerated, including on coordinating activities with those for lymphatic filariasis. Mapping must be completed, and funding is urgently required to strengthen programme capacity and launch interventions.
The schistosomiasis programme is still scored an overall red because, although elimination remains the stated target, there has been no significant, measurable progress. Despite this score, impressive progress has been made towards controlling morbidity, with the scaling up of treatment of school-aged children with donated praziquantel. A focus on morbidity control and better measures of progress towards this target would more accurately reflect the progress made in the programme. More research is urgently required on more effectively controlling morbidity, with the eventual goal of contributing to the elimination of schistosomiasis. Further studies should be conducted on behaviour change, therapies, vector control and WASH and on new tools that the programme will require to move from control to elimination.
As the programme is showing steady progress and improvement overall and is on track to achieve the 2020 target, it was scored green. A major milestone was initiation of deworming in all high-burden countries. WHO recently revised the programme guidelines to include women of reproductive age among those who should be treated, and the soil-transmitted helminths community is collaborating to meet this operational challenge and to ensure that the guidance for each phase of the programme is more accessible. The drug supply has been scaled up, in keeping with the demand of the growing programme. Research on these diseases was scored yellow because the current portfolio does not include any drugs or methods that would significantly accelerate progress towards achieving the targets.
The programme has grown significantly and performed well; however, it was scored yellow overall because the roadmap targets for 2020 will probably take longer to achieve. The exceptional growth is due to strong collaboration among all partners on critical strategic projects, such as global disease mapping, funding for interventions, preparation of surveillance guidelines, an action plan for global elimination and donor coordination on Africa. The remaining challenges are to identify funding in order to reach all the communities that require interventions, to ensure funding for assessing impact and to solve important research questions.
On the fourth scorecard, the programme for Chagas disease was scored red, mainly due to lack of data and unclear indicators for following progress. This year, better data were available and there was more discussion on the significance of the data, with collaboration between WHO and the Chagas disease community. Overall therefore, the programme was scored yellow. Impressive progress has been made in Latin American countries in which the disease is endemic, with prevention of transmission from bites of the vector and promising steps towards preventing transmission from blood transfusions. Continued engagement with the Chagas disease community and WHO will provide a better picture of progress made and the challenges to moving forward.
Guinea worm disease
The Guinea worm disease programme was scored yellow. Good progress was made towards the new 2020 elimination goal, but cases are still occurring in Chad, a new potential outbreak began in Ethiopia, and cases continue to be found in dogs. This year the number of dog infections fell by 20% between January and September 2017 compared with the same period in 2016. Good progress was made in Mali and South Sudan, with no cases reported. Programme support remains strong, with sustained funding for the campaign and good collaboration among stakeholders on cross-border issues and research. Insecurity and population displacement remain significant challenges. The robust research programme has yet to find how dogs are infected. The overall score of yellow reflects continued progress towards zero human cases in Mali and South Sudan; however, cases persist in Chad, with no improvement over the past few years. Animal infections and lack of security are unpredictable external challenges that will have to be overcome for the final stage of the programme.
Human African trypanosomiasis
Overall, the programme was scored green, in light of the likelihood of meeting the 2020 goal of fewer than 2,000 cases globally. The targets for coverage, impact and drug supply are all on track and were scored green. Programme support and research were scored yellow. It will be critical to maintain stakeholder momentum, introduce and consider new tools, even as case numbers continue to fall, in order to avoid the very real possibility of recrudescence. This tragic scenario has already occurred once, when the disease re-emerged in the 1980s after near-elimination in the 1960s. Activities must be integrated into peripheral health facilities and country health systems during the next few years. Diagnostic and treatment options that are easier to use are required to support the transition and to ensure that elimination is sustainable.
Overall, the leprosy programme was scored yellow. A slight increase in the number of new cases was seen between 2015 and 2016, which was however, attributed to intensified active case detection. The score was based primarily on the persistent occurrence of new cases and continued detection of new patients, including children, who already have disabilities caused by leprosy, indicating late detection. The new global strategy 2016–2020, supplemented by operational guidelines and a robust monitoring and evaluation framework, will provide solid guidance to countries and better coordination among partners for a strategic approach to reduce incidence, will result from the ‘global partnership towards zero leprosy’.
Overall, the programme was scored green because of continued, strong progress towards the WHO targets for elimination on the Indian subcontinent, with an increasing number of districts declaring elimination. There has been a sustained decrease in the number of cases reported globally, and the global case fatality rate is on target, although there is some concern that the fatality rate may be underestimated because of attribution of deaths to other acute causes. WHO has significantly improved data management during the past 5 years, but more resources for data collection and management at national level would enable the system to achieve its potential, particularly with regard to data on active screening. Research is required urgently on vector control, the role of asymptomatic and post-kala-azar dermal leishmaniasis in sustained transmission, diagnostic tools that are easier to use and treatment that is easier to administer. The requests for AmBisome® were met, and this aspect was scored green. Gilead Sciences signed a new 5-year agreement for drug donation and funding for better diagnosis and treatment in late 2016.