Why do neglected tropical diseases suffer low priority?
Harare – Neglected tropical diseases affect millions of people across Africa, yet the efforts to eliminate them and alleviate the suffering they cause receive little national attention. Professor Nicholas Midzi, an expert in preventive chemotherapy of neglected tropical diseases and the Director of Zimbabwe’s National Institute of Health Research, analyses factors contributing to low priority to these diseases and how to reverse the trend.
What leads to low priority of neglected tropical diseases?
Neglected tropical diseases are referred as such because they mostly linger on the lower rungs of the global health agenda. Even today with the focus on ensuring universal health coverage, programmes on neglected tropical diseases receive limited resources and are almost ignored by global funding agencies. This is despite that these diseases affect more than 1 billion people globally and have devastating socioeconomic impacts on the affected communities.
With already inadequate health workers in many African countries, implementing health programmes in areas in which neglected tropical diseases flourish – often rural, hard-to-reach or conflict-hit regions – is a great challenge. Implementing large-scale projects for clean water and sanitation in rural areas is impeded by the general prohibitive costs of construction materials and costs of experts such as water, sanitation and hygiene infrastructure engineers.
Countries also face competing health priorities, including tackling outbreaks, pandemics such as COVID-19 and natural disasters. While these are critical and require swift response, they redirect national resources away from neglected tropical diseases, leaving vulnerable populations further exposed to the debilitating impacts of these diseases.
Infections due to neglected tropical diseases – except rabies and snakebites – are less acute in that most of them cause less case fatality rates. High priority and high national health responses that trigger government budget allocation is given to disease with high case fatality rates – diseases that can rapidly cripple key sectors such as tourism and ravage the economy.
What is the impact of such low priority to neglected tropical diseases?
Low prioritization of neglected tropical diseases means that fewer people, if any, receive the health care and support they need. Diseases such as elephantiasis and blinding due to trachoma result in lifelong disability and significantly impair livelihoods as those affected have reduced capacity to carry out economic activities.
Many of the neglected tropical diseases are chronic in nature, meaning that complications and morbidities become apparent many years after infection. For example, elephantiasis or hydrocele due to lymphatic filariasis and trichiasis, a complication of blinding trachoma, are observed mainly in adults even when the disease was acquired earlier in life. The resultant dependence of the affected individuals weighs heavily on household economies and in already marginalized communities the socioeconomic impact is significant.
What are the major impediments to eliminating neglected tropical diseases?
In most developing countries, neglected tropical diseases control programmes are solely or largely sustained by development partners, yet the elimination of neglected tropical diseases requires substantial investment, which means countries need to own and sustain the response strategies. Lack of national ownership is a huge impediment to elimination.
Poor coverage when implementing mass drug administration programmes also hampers effective response to neglected tropical diseases. If mass drug administration coverages are lower than the stipulated critical coverage and worse if they are disrupted, as is the common experience in many endemic countries, then elimination efforts are jeopardized.
Lack of well-constituted mass drug administration programmes with trained experts at both national and subnational levels hampers the comprehensive implementation of elimination programmes in many endemic countries. There is need for an audit in endemic countries to establish if they have established steering committees that regularly plan and monitor elimination programmes. Many countries could be having only a single neglected tropical disease programme manager and when they leave service the programme stalls.