The WHO Southeast Asia region is healthier than ever. Polio has been vanquished. Maternal and neonatal tetanus has been eliminated. And after decades of struggle, the HIV, TB, and malaria epidemics have been halted and reversed. They will be ended altogether in coming years.
Amid these stunning achievements, region-wide progress against neglected tropical diseases (NTDs) stands out. As the name suggests, NTDs -- including leprosy, trachoma, lymphatic filariasis, and kala-azar -- take their most severe toll on the poor and marginalized, communities whose political influence is limited and health needs often overlooked.
High-level political buy-in has changed that dynamic, and with it the NTD burden. India is now yaws-free. Maldives, Sri Lanka, and Thailand have eliminated lymphatic filariasis as a public health problem. Nepal is in the process of validating the elimination of trachoma as a public health problem and maintained the elimination target for kala-azar for more than three consecutive years.
By the end of 2017, 100% of sub-districts in Bangladesh and 90% of blocks in India had done the same. As a whole, the region remains responsible for the world’s largest preventive chemotherapy campaign.
Progress must continue. Though the region has eliminated leprosy as a public health problem, the disease continues to circulate among vulnerable communities, accounting for more than 60% of leprosy-caused grade 2 disabilities worldwide.
And though several member countries have eliminated lymphatic filariasis, its burden continues to haunt communities in remote and hard-to-reach areas elsewhere.
Region-wide, 53% of all people require mass drug administration to stay free of the disfiguring disease. Importantly, no member country can be complacent -- one of the 20 NTDs is endemic to each of them.
Nevertheless, in line with the region’s Flagship Priority Areas, we are almost there: On a number of diseases and in a range of locations we have entered the last mile and are confronting associated challenges. Though each NTD has its own clinical, environmental, and biosocial components, the core principles of our strategy -- outlined in WHO’s roadmap to overcome the impact of NTDs -- are critical to success, and should be marshaled to decisive effect.
First, national ownership and buy-in must continue, and where necessary be fortified. The ongoing strength of national NTD programs is crucial to maintaining momentum and overcoming persistent difficulties, whether related to the depth and quality of surveillance or the stubborn endurance of stigma and discrimination.
Stable domestic funding for national programs is central to this outcome, as is high-level focus on key targets and accelerated progress. Region-wide, country-level commitment to addressing NTDs has for many years been impressive, and was demonstrated once again in the 2017 Jakarta Call for Action -- a document explicit in affirming high-level political resolve.
Second, as progress continues, member countries must ensure programming is both dynamic and flexible. That means pursuing large-scale campaigns such as mass drug administration where appropriate, but also (and at the same time) strengthening NTD-related services at the primary level to secure long-term gains. It also means working creatively across sectors: Agro-engineers, for example, have much to offer in the battle against schistosomiasis.
Ensuring all communities everywhere are free of NTDs means ensuring all communities have access to health services and the benefits they provide
Where appropriate, they should be sought out and engaged. Similarly, vector control programs can have immediate and substantial impact on disease transmission in NTD-affected areas.
That potential must be actively pursued and harnessed by programs at the local level. To promote the dynamism and flexibility needed, however, it is imperative that donor funding becomes more supple, accommodating and responsive to local needs.
Finally, member countries should invest in and take full advantage of innovations in research and technology. The effective use of rapid diagnostics, for example, can facilitate swift and accurate diagnosis of a range of NTDs, at the same time as helping health workers reach large and often underserved populations.
That will not only increase treatment (and in the case of leprosy and lymphatic filariasis, forestall deformity and disability), but will also decrease disease transmission. As part of efforts to use technology more effectively, IT infrastructure should be integrated with existing surveillance systems, allowing program managers to gather, analyze, and act on real-time data and course-correct as and where necessary.
Perhaps most significantly, stake-holders across sectors must appreciate the significance the battle against NTDs has within the sustainable development agenda and our quest to leave no one behind.
Ensuring all communities everywhere are free of NTDs means ensuring all communities have access to health services and the benefits they provide. Though universal health coverage is a good in itself, it is one that is transformative in scope, empowering communities to fully engage in and take advantage of the social and economic opportunities that define our age.
That is, in essence, the promise of sustainable development, and the realization of a more just and equitable world.
It is for this reason that achieving our NTD-related goals is so critically important. It is for this reason that ending neglected tropical diseases really would be the greatest gift of all.
Dr Poonam Khetrapal Singh is WHO Regional Director.