Starting over? A critical moment in the struggle against neglected tropical diseases

Margriet den Boer, Kala Azar Advisor, MSF Manson Unit; and Julien Potet, Neglected Tropical Disease Policy Advisor, MSF Access Campaign

As COVID retreats — for the moment at least — in many places around the world, a space is opening up for urgent attention to be given once more to other global health challenges.

The pandemic has dealt a blow to quite a few ongoing ‘success stories’ in tackling diseases that impact people in countries where MSF works — for instance people living with HIV, TB, and other devastating infections. This is sadly also the case for people affected by the group of conditions that are often overlooked and are therefore known as Neglected Tropical Diseases (NTDs).

Dr. Ernest Nshimiyimana, MSF medical team leader, examines people in the ward for kala azar co-infections at the Abdurafi MSF health centre in Ethiopia. © Susanne Doettling

After nearly two decades where we’ve had some success in preventing, diagnosing and treating people with these diseases, along with a track record in developing new and better diagnostic tests and treatments, the story has taken a sudden turn for the worse.

Following the experience of COVID, many donors have pivoted their funding towards initiatives prioritising diseases that have the potential to create global pandemics, a potential that the vast majority of NTDs don’t have, since NTDs are focused on very specific subregions of the world. As a result, funding previously pledged by western donors to combat NTDs is now being reallocated to deal with these other emerging diseases that may hit their own populations directly at some point.

As a case in point, last year the UK government as part of a wider cutback on UK aid, drastically reduced its funding for NTDs in order to prioritise actions against COVID and other emerging infections. This has sent a disastrous signal at a critical moment in the renewed struggle against these diseases, given that the UK was one of the few major donors to fund initiatives to protect people from NTDs. The UK’s deep funding cuts are even more ironic given that the UK played host to the first mass gathering of NTD actors a decade ago in an effort to kickstart the work against NTDs, resulting in the creation of the London Declaration on Neglected Tropical Diseases.

MSF and NTDs

Recently I [Julien Potet] ran a training week for some of our staff in the Central African Republic (CAR) to improve the treatment we can offer to snakebite victims. A great deal of progress was made in helping the team there to know more about the medically important snake species in the country, to learn how to prevent snakebite, and, most importantly, to provide effective treatments against snakebite envenoming in the hospital. It’s enormously encouraging to be able to see the progress made in the team’s skills in just a week or two. But the reality is that it’s a drop in the ocean of the medical needs to combat the horrendous damage and loss that snakebite inflicts on so many communities where MSF works in CAR, Yemen, South Sudan and elsewhere.

We often work in remote areas and are on the frontline of those diseases. We treat thousands of patients a year. That is why we continue to push manufacturers and the pharmaceutical industry for rapid tests and better medication… It’s about people close to our hearts: the most excluded and vulnerable people in need. More than caring about these forgotten diseases, we care about the forgotten people suffering from them.”
Dr Koert Ritmeijer, MSF NTD Coordinator

Beyond our work with communities affected by snakebite, MSF medical teams treat many thousands more patients with NTDs every year, mostly in very remote settings, and witness on a daily basis the suffering caused by a range of other ‘forgotten’ and often fatal NTDs — leishmaniasis, sleeping sickness, noma or Chagas. We participate in research efforts, through clinical trials, to develop safer, shorter and more effective treatments. We also push the pharmaceutical industry for more accurate rapid tests and better medications.

We have been committed to bringing these diseases out of the shadows, into the public eye, and to call loud and clear for more funding and political attention and commitment to end the ‘neglect’ and to invigorate and resource the struggle against these diseases.

Yet today, the gap between the medical needs on the ground and the wherewithal to meet those needs is once again widening. Nowhere is this gap more painfully visible than in the case of people living with visceral leishmaniasis (VL). What’s happened here is emblematic of the issues surrounding all NTDs today. MSF has worked for many years treating people with VL in East Africa and Asia and advocated continually for more support. Our efforts were relatively successful and funding was secured for the continuation of lifesaving treatment programmes. MSF felt confident about the future of these programmes, and we shut down some of our own projects as a result. Then came the bolt from the blue when the main donor behind the new treatment programmes pulled out. From one day to the next, the progress of a decade or so was put in jeopardy.

With limited philanthropic funding to fill the gaps left by the missing international aid funding, country programmes have become much less effective — costing lives. Even funding granted directly to the World Health Organization (WHO) to tackle this disease has been severely reduced. As a result, for the coming year, WHO does not yet have sufficient funds to purchase the diagnostics and medicines needed to support programmes on the ground. The human impact is and will be devastating.

But we cannot and will not give up. We will continue to bear witness to the terrible marginalisation of people at the mercy of these diseases who rarely have a voice or a place at the table to demand change.

With the scene set for a high-level summit of world leaders to discuss malaria and NTDs in Kigali, Rwanda this week, we are now reaching a critical moment in the work to reduce the suffering caused by NTDs, where much progress could be lost forever. But equally, much could be achieved with the necessary injection of funding and coordinated political will. It’s time to act.

MSF has signed the Declaration that will be published in Kigali with the aim of mobilising finances, communities and, above all, political will to end NTDs.

It will take a range of different actors and activities to deliver on the ambition. We need new international donors to step up and finance the implementation of programmes in the field. We need to continue supporting the development of new and better tools to beat NTDs. And in response to repeated shortages of supplies of certain NTD health products in recent years, we need pharmaceutical manufacturers of medicines and diagnostic tests for NTDs to commit now to reliable long-term production and distribution of their products. At country level, the ambitious plans drawn up by many ministries of health in endemic countries must be fully financed and implemented.

So, when the press cameras start rolling in Kigali as the heads of state and other actors arrive in grand style to participate in the summit, we call on them to make real their declared commitments to wiping out NTDs and to demonstrate a genuine and renewed enthusiasm for tackling these diseases that claim so many lives across the developing world. And if countries and donors do indeed step up to those commitments, then this could be the defining moment for the next decade in our efforts to wipe out these diseases that so disproportionately hit the most vulnerable people on the planet.

Read more about MSF’s work on NTDs.

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