By Thoko Elphick-Pooley, Executive Director, Uniting to Combat Neglected Tropical Diseases
When five-year-old Msto Pushen from western Kenya fell ill, his family didn’t know what was wrong with him. He lost over a third of his weight, his stomach ballooned, and he was so weak he couldn’t stand. He was suffering from a disease called visceral leishmaniasis (VL), also known as kala-azar, one of the deadliest parasitic diseases after malaria. If left untreated, kala-azar has a 95 percent fatality rate.
Transmitted through sandfly bites, it is characterised by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. Most cases occur in Brazil, East Africa and in India. An estimated 50,000 to 90,000 new cases of kala-azar occur worldwide annually. In 2020, more than 90 percent of new cases reported to WHO occurred in 10 countries, six of these in East Africa: Ethiopia, Eritrea, Kenya, Somalia, South Sudan, and Sudan. For the fourth consecutive year, East Africa has the highest burden of kala-azar in the world.
Kala-azar is a neglected tropical disease (NTD), an umbrella term used to describe a group of 20 diseases that cause immeasurable suffering. Affecting over 1.7 billion people worldwide, with around 35 percent of the burden in Africa, these diseases trap affected individuals and communities in cycles of poverty.
But there is hope. Unlike some other health investments, action against neglected tropical diseases delivers measurable wins for people, communities, and countries. What’s more, incredible progress has been made against NTDs. Some 46 countries have eliminated at least one NTD, including 19 in Africa, and 600 million people globally no longer require treatment for them.
Just in September this year, Malawi became the latest country to celebrate the elimination of trachoma, a bacterial infection of the eye that causes excruciating pain and can lead to blindness.
Likewise, the East African Community (EAC) is on the cusp of eliminating Guinea worm disease (a parasitic illness which can result in painful blisters and worms emerging through the skin) with just a handful of cases reported in South Sudan. A final example is African sleeping sickness, a disease that can cause death if left untreated. This disease once decimated large populations in Africa, with close to as many as 40,000 cases per year in the late 1990s. Today, there are fewer than 1,000 reported cases globally each year. Yet, around 70 percent of these reported cases occurred in the Democratic Republic of the Congo, presenting an opportunity to eliminate the disease from Africa.
However, there is still more work to be done before East Africa is free from NTDs.
First, we need political leadership and country ownership. Without countries embracing international and regional targets for NTD eradication, elimination and control, translating these into national strategies and then delivering on these, progress would not have been possible. It’s essential that countries continue to lead on and take ownership of ending NTDs if we are to carry on seeing results at scale. And crucially, we need African leadership and African-led solutions. An example of this is the Continental Framework (CF) and Common Africa Position (CAP) on NTDs endorsed by Member States of the African Union. The CF’s vision is to free Africa of all NTDs by 2030. For this to come alive, we need effective implementation at the sub-regional and country level. The East African community could, and must play a key role in tackling diseases that affect the region, such as the further control of kala-azar.
Second, we need adequate and sustainable funding. In April 2021, the UK (the main funder of life-saving drugs for kala-azar in East Africa) pulled all funding as part of sweeping aid cuts. At the time, the WHO warned this could result in 20,000-30,000 more deaths from kala-azar. No country has stepped up yet to plug the gaping hole left by the UK funding cuts. This is a devastating blow to disease management in East Africa. For the estimated 10,000 cases of kala-azar in East Africa, it would only cost $1 million for the first-line medicines and diagnostics needed per year.
Third, we need African-led innovation and local production. We are over-reliant on international single source suppliers for both drugs and diagnostics. This poses a risk when one supplier pulls out from manufacturing. In 2022, the American diagnostics company, Bio-Rad, will discontinue production of a rapid test which is the only test with high enough sensitivity to detect kala-azar in Eastern Africa. Without adequate diagnostics, tens of thousands of kala-azar cases in East Africa will go undetected.
Thankfully, Global Access Diagnostics (GADx), a signatory of the Kigali Declaration on NTDs, will be stepping in to produce these essential diagnostics tests. What if EAC could develop and sustain local manufacturing or pool procurement to access drugs and diagnostics for the region?
The case for action is clear. Tens of thousands of lives are at risk. Removing the threat of these diseases is not only life-changing for individuals and communities, but also delivers significant benefits across the region. Investing in NTD elimination programmes creates a ripple effect in society. It leads to better education, health, and employment outcomes, and transforms lives and communities. It helps to reduce gender inequity and stigma.
NTD programmes also strengthen health systems by increasing access to hard-to-reach people by trained community health workers who provide a first line of primary healthcare. Both are vital for achieving universal health coverage. When we have stronger health systems, deadly diseases have less room for manoeuvre and our populations and economies become more resilient.
Intelligent investment upfront can save billions of dollars down the road. Deworming school children increases school attendance and can raise their future earning potential by 20 percent.
The United States Agency for International Development estimates that for every US$1 spent on NTD programmes, US$26 in donated medicines are given through partnerships with pharmaceutical companies.
That is why we are calling on Heads of State in East Africa to endorse the Kigali Declaration on Neglected Tropical Diseases – a high-level, political declaration to mobilise political will and secure commitments against NTDs – and commit to its delivery.
We have seen incredible leadership from Africa (Botswana, Djibouti, Ethiopia, Malawi, Nigeria, Rwanda, United Republic of Tanzania, and Uganda) and elsewhere (Belgium, Canada, Germany, Japan, Papua New Guinea, Switzerland, Timor-Leste, UAE, USA and Vanuatu), all who have signed the Kigali Declaration. We welcome Heads of State in East Africa to join them and be 100 percent committed to ending NTDs.
Ending NTDs within our lifetime is possible. Beating kala-azar is possible. A generation of Africans free from NTDs is in reach. But it requires African leadership, African-led solutions, and sustainable financing.
No-one should continue to suffer from preventable and treatable diseases. Let’s act now and act together. Let’s invest in neglected tropical diseases. Join us in committing to build a healthier, happier future in East Africa and beyond.
For more information about how to endorse the Kigali Declaration on NTDs, visit https://unitingtocombatntds.org/kigali-declaration/