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The Americas, at the forefront in the fight for the elimination of neglected diseases

 

Eliminating leprosy, Chagas disease, dengue… The XX Symposium on Neglected Diseases, about twenty illnesses affecting more than one thousand people, insists on fostering the new WHO road map for their eradication or control by 2030

The XX Symposium on Neglected Diseases (NTDs), organized by Mundo Sano Foundation, was opened in Buenos Aires on November 2, and was held online. It was focused on the targets of the new road map for NTDs approved by all members of the World Health Organization (WHO).

The elimination or eradication of some of these diseases is on the horizon. Actually, it is already a fact in some cases, as in Argentina and Paraguay, where malaria has been eliminated, with El Salvador being the last country to join this list in 2021. These cases make the Americas the spearhead. “They are proof that elimination targets can be achieved by 2030″, stated Julie Jacobson, president of the American Society of Tropical Medicine and Hygiene (ASTMH), in one of the first speeches of the symposium.

Previously, Mwele Malecela, director of the department for the Control of Neglected Tropical Diseases of the WHO, highlighted the most important targets set in the  new road map (2021-2030):  90% fewer people requiring interventions against one or some NTDs and up to 75% increase of integrated treatment coverage, the same percentage as that of deaths due to vector-borne diseases that is intended to be reduced.

One of the purposes of road maps is to foster actions that have a real impact, even if the goal set may not be met. For this reason, during the period covered by the previous road map (2012 to 2019), we know that “more than 1,000 million people were treated for at least one NTD and 40 countries eliminated one of those diseases”. This is how Malecela highlighted it. Moreover, she showed that elimination and eradication are close by giving examples such as sleeping sickness (very close to its end), trachoma (reduced by 74%), and lymphatic filariasis, which was eliminated in 16 countries.

“At present, the targets are even more ambitious and include a change in mentality”, said Malecela with respect to the new road map 2021-2030. Basically, this is translated into three fundamental shifts. First, there is a shift from measuring the implementation process to measuring the real impact of health care programs on the ground. Second, there is a shift from a vertical to a horizontal approach, which implies more collaborative work across the different sectors of the health care system, as well as education and development sectors. The third and last shift is related to the ownership and commitment to carry out the plan. In this new decade, countries affected by the NTDs are expected to assume greater leadership and responsibility, getting more involved in the generation and search of resources.

Bottlenecks

Both Jacobson and Malecela described the bottlenecks encountered during the process of elaboration of this road map, in which hundreds of experts from countries around the world have been involved. First it is necessary to advance in the access to and adaptation of the diagnostic methods. Without this, neglect will increase. But it is also necessary to make major adjustments to the strategies and delivery of health care services, as well as to the search of new funding sources.

Jacobson showed a heat map that illustrates the advances at these three points. “Going from red (which represents a precarious situation) to green (the optimum situation) will require integration and sustainability efforts, and we are already working on that with the affected countries”, she said.

The integrated approach helps to think of the responses to health needs as something much broader that starts, for instance, with access to quality water and sanitation. This is still lacking in vulnerable populations, more than 1,500 million people that are affected by the NTDs, as Marcelo Abril, chief executive officer of Mundo Sano Foundation, recalled in the opening remarks at the symposium.

Of all the bottlenecks analysed, COVID-19 was the unexpected one. As Abril recalled, the pandemic showed that “the response capacity of the countries (at the global and national levels) was insufficient. They weren’t ready”. But he also highlighted that scientific development has proved to be efficient, fast and adapted to respond to huge challenges. At the same time, the need to “overcome inequities through collaboration to make access to health possible for all” has been made evident, which is directly related to neglected diseases.

Nonetheless, although the COVID-19 has reversed progress on health programs of all other diseases, “the countries have not withdrawn their support to the road map launched on January 28 2021″, the WHO director of NTD, Mwele Malecela, stated earlier.

From London to Kigali

Road maps are a useful tool to attract support from diverse sectors. In her intervention, Jacobson, from the ASTMH, recalled that when the first road map was launched, in 2012, several public-private organizations signed the  London Declaration, in which they committed to support the WHO efforts to eliminate 10 of the 20 NTDs. This year, work is underway to develop a new declaration, which was promoted within the frame of the summit on malaria and other NTDs in Kigali, capital city of Rwanda, and that will include important commitments from countries and all the sectors related to these diseases.

Jacobson showed an excerpt of the declaration: “We have a unique opportunity to change the lives of 1,700 million people suffering from neglected diseases. These can be prevented and treated”. And she encouraged everyone to participate, from any sector, not just the health sector, to achieve elimination, eradication or control of NTDs in 2030.

Furthermore, Jacobson presented the work of Mundo Sano as an example of the model that the road map seeks for integrated health care of several neglected diseases. The foundation, which started in Argentina, is one of the most important organizations in the combat against Chagas, a disease that has now become a little more visible thanks to the alliance of different organizations. This year, a new program involving endemic and non-endemic countries to control mother-to-child transmission, called Not a single baby with Chagas disease, will also be launched; this program was approved in the last Ibero-American Summit.

Besides the lectures addressing updates on other diseases such as leprosy and helminthiasis, the symposium, which ends on November 4, hosts a virtual exhibition of some 70 studies about different topics related to NTDs, as indicated by Victoria Periago from Mundo Sano.

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