There is a group of diseases you don’t hear much about but that has a terrible impact on more than 1 billion people around the world – that’s one sixth of the world’s population. The World Health Organization (WHO) has classified 13 of these as neglected tropical diseases (NTDs) and they include such dreaded illnesses as elephantiasis, leprosy, blinding trachoma, and intestinal worms. Together, NTDs have a disproportionately large impact on poor and rural populations, causing severe illness, disfigurement, and disability. They also perpetuate poverty by reducing people’s ability to work and children’s intellectual and physical development.
A young woman is measured for height to determine her proper treatment dosage for lymphatic filariasis and soil-transmitted helminthes during a mass drug administration in Sierra Leone. Photo credit: Michel Pacque/USAID
Until recently, many countries were treating NTDs through separate, uncoordinated programs. However, pilot studies suggest that it is possible to integrate programs to control and treat seven of these diseases together by providing safe and effective drug treatments once or twice a year to all people in an affected community. This approach, which has been endorsed by WHO and is called mass drug administration (MDA), targets large, at-risk populations, rather than individuals, since NTDs tend to occur together in the same geographic area. Pilot studies of MDAs of the seven targeted NTDs resulted in significant reductions of illness and transmission of these diseases and indicated that, though there were major challenges, integrating control programs was possible and could result in cost savings and efficiencies. However, it was not clear if integrated programs could be scaled up to the national level.
Fortunately, an opportunity arose to find out whether such programs could be successful. In 2006, an act of Congress authorized funding of national integrated NTD control programs in 15 countries over a five year period and USAID launched its NTD program that September. The NTD Program focuses on integrated control of the seven NTDs that can be treated through MDA: elephantiasis, (referred to by scientists as lymphatic filariasis), schistosomiasis (also known as bilharzia), trachoma, onchocerciasis (river blindness), and three soil-transmitted helminthes (worms): roundworm, hookworm, and whipworm. USAID’s NTD Program is one of the first global efforts to integrate existing disease-specific treatment programs to control these diseases.
A recent article in the American Journal of Tropical Medicine and Hygiene reviews the first three years of USAID’s NTD Program, during that time MDA programs had been implemented in seven countries (Burkina Faso, Ghana, Haiti, Mali, Niger, Sierra Leone, and Uganda) and the program was scaling up in five other countries. Working with its prime contractor, RTI International, and in coordination with national NTD programs, USAID has provided funds to support the launch and scale up of integrated NTD programs. Through these programs, nearly 16 million people were treated during the first year; the number treated rose to 55 million people by the third year, proving the feasibility of the integrated approach. USAID’s NTD Program was able to treat millions of people by tapping into existing networks, including ministries of health, schools, non-governmental organizations, which together provide the program with greater efficiency and long-term sustainability as well as strengthen the capacity of national programs.
Remarkably, most of the drugs distributed to treat all these people – 222 million treatments during the first three years – were provided through public-private partnerships between the national NTD programs and major drug donors: GlaxoSmithKline; Johnson & Johnson; Merck & Co., Inc.; and Pfizer. The estimated value of the drugs donated during the first three years totaled more than $1.4 billion.
The article points out that, while there continues to be technical and political challenges, USAID’s NTD Program exceeded expectations during its first three years, demonstrating the feasibility and cost effectiveness of scaling up integrated NTD program to the national level. It is now clear that with proper support, integrated NTD control programs, following WHO guidelines, can be implemented in other countries, relieving the terrible burden of these diseases for millions of people around the world.