From Chagas to leprosy: patients with neglected diseases, among the most widely affected by the pandemic

 

Experts warned during a Symposium on this group of preventable diseases affecting low-income people worldwide. In Argentina, Chagas is the prevalent disease.

The so called Neglected Tropical Diseases (NTDs) are a group of 20 infections, including Chagas, leishmaniasis, leprosy and soil-transmitted helminthiasis, which affect 1,700 million people in the world. These diseases are present mostly in populations that are under the most vulnerable conditions, of low income and limited access to health care services.

Chagas disease is the most emblematic NTD in Argentina. This pathology affects about 8 million people in the world, of which 1.2 million are women of childbearing age. Every year about 9,000 babies are born with the disease. In our country, estimates indicate that more than 7 million people are at risk of becoming infected with Chagas disease and that 1.6 million of people are infected.

Leprosy, leishmaniasis, intestinal parasites and hydatid disease are also included in the list of neglected diseases in Argentina.

During the XX Symposium on Neglected Diseases that was held online from last Monday until yesterday, international experts called on governments and the civil society to align efforts to reduce the impact of neglected diseases.

By the end of 2020, the 73rd World Health Assembly of the World Health Organization (WHO) supported the creation of a new “Road Map” for the next decade. Based on the first edition of the document, published in 2012, the multilateral health institution established targets for 2030 that include the elimination of at least one neglected tropical disease in 100 countries and the 90% reduction in the number of people requiring medical interventions against those diseases.

According to international data, in the last decades, important progress has been made in the fight against neglected tropical diseases: 42 countries or regions have eliminated at least one of these diseases. However, a significant portion of the population still remains excluded from this revolution.

“With the new WHO Road Map, we have a great responsibility and the opportunity of aligning efforts to develop new health tools and implement measures that allow us to make progress in the NTD agenda and eliminate or control the diseases that have such an impact on our populations”, stated Marcelo Abril, chief executive officer of Mundo Sano Foundation.

Although those affected by NTDs have been at a particular disadvantage by the health crisis caused by COVID 19, Abril considered that it is an opportunity for countries to transform the situation into a lesson learned and “to move on to speed up the developments that can give a solution to neglected tropical diseases, which have been a challenge to global health since time immemorial and cause suffering to the most vulnerable populations in the world”.

Within the frame of the Road Map, the proposal for Chagas disease, the parasitic infection that causes the highest number of deaths in Latin America, includes the achievement of interruption of vertical, congenital, organ transplantation and blood transmission routes in 15 countries by 2030. In turn, another goal is to eliminate visceral leishmaniasis as a public health problem in up to 64 countries over the next decade.

Silvia Gold, president of Mundo Sano Foundation, also highlighted that the COVID-19 pandemic has affected all the people in the world and, especially in low- and middle-income countries, it has increased the invisibility of people affected by diseases that might be completely avoided, treated and eliminated.

“In this context of general sanitary crisis, a question that is often overlooked is the impact of diseases that we already called neglected in the “old normal”, those that are left behind in public health priorities because the affected people, who belong to vulnerable social groups, lack political influence: the most widely known in Argentina is Chagas disease”, she said.

However, she seemed hopeful because “out of the crisis arises great hope”. To build “the new normal’, the global health community and its partners will have to promote new strategies that give an account of the situation created by COVID-19. In this context, the Road Map developed by the WHO for the 2020-2030 period defines a working line that I consider appropriate: shifting from the vertical approaches specific of a disease to horizontal strategies, which ultimately implies strengthening the primary care system”, she said.

The lecturers at the Symposium that ended yesterday mentioned the overarching targets for the Road Map 2030 of the World Health Organization (WHO), which aim to a 90% reduction of the number of people that require treatment for NTDs. In this context, 100 countries would succeed in eliminating at least one and eradicating two NTDs.

Public health experts consider that a disease has been eliminated when it is no longer present in a given country or territory, whereas, technically, it is eradicated when it has been completely eliminated.

Michael Reich, Professor Emeritus of the International Health Policy Harvard T.H. Chan School of Public Health, was present at the symposium, which was closed today. The expert, who obtained his Ph.D in Political Sciences, his B.A. in Molecular Biophysics and Biochemistry, and his M.A. in East Asian Studies at Yale University, gave a lecture about Universal health coverage with quality caring service”.

“It is essential to work in order to ensure quality standards in health care, especially in primary health care. This is still a big problem in low- and medium-income countries”.

The expert indicated that “improving the quality while expanding access to health” has also important effects on NTDs. We are not interested only in expanding access to treatment; we consider that those efforts should also be used as an opportunity to improve health care quality”.

The symposium, organized by Mundo Sano Foundation, was a virtual space for reflection and analysis about the real situation of those diseases, and gathered renowned international experts and more than 1000 participants.

During the three days, the Symposium addressed the real situation of neglected tropical diseases (NTDs) from the perspective of international cooperation and research at the benefit of health, within the frame of the Road Map for Tropical Diseases established by the WHO for the 2021-2030 decade.

The Symposium was opened by Marcelo Abril, chief executive director of Mundo Sano Foundation, who stressed that “the current COVID-19 crisis has shown the importance of not neglecting the NTDs, those diseases that affect more than 1,500 million people, mainly vulnerable populations living in areas with insufficient or no access to quality health care services, clean water and sanitation”.

On the other hand, Doctor Mwele Ntuli Malecela, director of the Department of Control of Neglected Tropical Diseases at the WHO, referred to the new WHO Road Map 2021-2030. “It is a high-level strategic document, but also a tool that will allow us to align efforts of stakeholders for the next decade. The new road map is focused on the search of specific and measurable targets and in the promotion of cross-cutting approaches”.

Malacela also stated that “the overarching targets for 2030 are focused on 90% fewer people requiring treatments against NTDs, 75% fewer NTD-related disability-adjusted life years, and 100 countries having eliminated at least one of these diseases”.

She also referred to the cross-cutting targets, which are strongly related to the Sustainable Development Goals (SDGs), even when some of these targets are not included in the SDGs, such as achieving 75% increase in integrated coverage of diseases; 90% of the countries being integrated in the NTD international strategic plan; 100% access to water, hygiene and sanitation; and 75% fewer deaths caused by vector-borne diseases.

Malacela stressed that “all the WHO initiatives will be focused on the areas and communities that most need the intervention and will reflect the needs on the ground and of countries, rather than reflecting political decisions made from a distance”.

Julie Jacobson, current president of the American Society of Tropical Medicine and Hygiene (ASTMH), stated that “to meet the targets of the new Road Map we cannot rely only on the programs of these diseases, but we need advances in health care systems, access to water, sanitation, as well as work in animal health, i.e., have overarching and cross-cutting approaches”.

Jacobson also stressed that the achievement of the targets set in the Road Map 2030 for NTDs is “a unique opportunity to change the lives of more than 1,500 million people that suffer from neglected diseases, and to do so, we need a cross-sector approach, many members in many places participating to solve these health challenges”.

In turn, Mirta Roses, Director Emeritus of the Pan American Health Organization (PAHO) and WHO, referred to leprosy, one of the most overlooked among neglected diseases, and the current possibilities to achieve its elimination by 2030.

“Today, the global strategy has 4 pillars: implement the integrated “zero leprosy” road map in all endemic countries, scale up prevention of leprosy alongside active case detection, manage leprosy and prevent new complications, and combat stigma and ensure that human rights are respected”, said Roses.

Roses also highlighted that, in the case of Argentina, the key points to eliminate Leprosy are “political support and reinforcement of the National Programme and provincial networks, and funding and alliances with social, business and education sectors”.

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