Why eliminating NTDs would have far-reaching socio-economic impacts

World leaders, philanthropists, and representatives of civil society organisations at the ‘Reaching the Last Mile Forum’ at COP28 in Dubai, UAE, in 2023.

Photo credit: ALMA

By Pauline Kairu

The effort to eliminate Neglected Tropical Diseases (NTDs) should not be narrowly viewed as solely eradicating diseases. Instead, it should be recognised as a critical step towards promoting a more equitable society, human capital development, and gender equity. This is the view of the Executive Secretary of the African Leaders Malaria Alliance, Joy Phumaphi.

NTDs not only present a formidable public health challenge, but also persistently impact marginalised communities, sustaining poverty. Often, this disproportionately affects women and exacerbate gender disparities, besides restricting economic prospects among affected communities.

“These are diseases which have been with us for a long time and are caused primarily by lifestyles and by our interaction with the environment. They are mainly prevalent among impoverished communities in tropical areas, although some have a much larger geographical distribution where people interact with the environment in such a way that they can't protect themselves, or don't have the right type of shelter, are exposed to poor sanitation, or use water that is contaminated, etc,” says Phumaphi.

According to her, “NTDs impose a significant economic burden on communities, particularly on households. This includes the loss of household income due to out-of-pocket health expenses and wages forgone as a result of illness, sometimes leading to permanent disability. The economic cost is estimated to be at least $33 billion per year. So it is a huge loss. Overall, the benefit of ending NTDs for affected individuals or communities in terms of affected out-of-pocket health expenditure and lost productivity exceeds $342 billion from 2015 to 2030.”

Phumaphi stresses the significance of nations incorporating necessary funds in their budgets to combat NTDs, and effectively channelling resources to NTD programmes. She highlights the importance of global partnerships in mobilising resources for collective efforts against these diseases.

Already, in a historic move, partners committed a ground-breaking $777 million at the 2023 Reaching the Last Mile (RLM) Forum, a global health initiative led by His Highness Sheikh Mohamed Bin Zayed Al Nahyan.

Committed during the UN Climate Change Conference (COP28), the funds aim to combat NTDs, benefiting 1.6 billion people globally. The initiative focuses on addressing the impact of climate change on NTDs, supporting research and innovation, and strengthening health systems.

Pledges like these are crucial in closing the funding gap for the WHO road map targets, which aim to eliminate at least one NTD in 100 countries, and reduce by 90 percent the number of people needing treatment for NTDs, by 2030.

On January 30, the world marks the World NTD Day. This year marks the fourth of such commemoration, which has been held under the theme, “Unite. Act. Eliminate”. The day is set aside to help raise awareness on NTDs, to celebrate milestones, highlight gaps, and call for unity in the response to the fight against NTDs.

“We must collaborate and partner with civil society, with communities, with young people, with patient associations, with service providers, and with partners, to fight against these diseases,” Phumaphi stresses.

NTDs include Buruli ulcer, Chagas disease, dengue and chikungunya, dracunculiasis, echinococcosis, foodborne trematodiases, human African trypanosomiasis, and leishmaniasis. Others are leprosy; lymphatic filariasis; mycetoma, chromoblastomycosis and other deep mycoses; noma; onchocerciasis; rabies; scabies and other ectoparasitoses; schistosomiasis; soil-transmitted helminthiases; snakebite envenoming; taeniasis/cysticercosis; trachoma; and yaws.

WHO estimates that NTDs affect more than one billion people, while the number of those requiring NTD interventions, both preventive and curative, is 1.6 billion.

“The commemorative events serve as a reminder that we must all act effectively, collectively, together; assess country commitments, and appreciate what resources we have, the technical assistance we need, and work in solidarity to enhance all these so that they can meet our target of elimination,” says Phumaphi.

She says that as global climate changes, NTDs are expected to be highly impacted due to their prevalence among vulnerable populations in countries facing significant environmental changes in the coming decades.

A recent WHO communiqué notes that there is growing evidence that climate change is affecting behaviour shifts, and the range and intensity of diseases like lymphatic filariasis and dengue. The global health organisation urges adoption of strategies to preserve health gains and investments in this rapidly evolving climate landscape, identifying opportunities for integrated approaches, such as with malaria.

Besides, according to Phumaphi, certain NTDs have a social gender impact as they disproportionately affect women. She notes that the current surge in flooding, attributed to climate change, also exacerbates the prevalence of schistosomiasis, posing a significant threat to women. The explanation lies in the proliferation of snails, which are carriers of the disease, in areas with abundant standing water.

“The fact that women and girls perform most of the water collection globally places them at an elevated risk of contracting schistosomiasis, especially in endemic regions,” Phumaphi observes, adding: “An estimated 56 million women are believed to be afflicted with female genital schistosomiasis, heightening their susceptibility to HIV and organ damage.”

She adds further that women are two to four times more likely to develop trichiasis (trachoma), mostly found in children, than men. This is due to their role as caregivers. If a child or a man is infected, the woman is often the caregiver, heightening her risk of exposure.  

In the case of children, NTDs disrupt the educational process, impede cognitive development, and curtail opportunities. It's important to recognise that compromised cognitive development not only affects learning but also hinders an individual’s potential later in life. Consequently, the overall well-being of this individual is compromised. Research indicates that this phenomenon contributes to over 57 million disability-adjusted life years worldwide.

Highlighting the crucial significance of eradicating NTDs to achieve equity, Phumaphi emphasises the potential positive outcomes for women and girls if this burden is alleviated. She points out that interventions such as preventative chemotherapy, as estimated by WHO, can generate a net benefit of $25 for every dollar invested, demonstrating a significant return on investment in the fight against NTDs.

“The singular act of eliminating NTDS in economically disadvantaged nations has the power to greatly enhance development and foster substantial growth. Contrary to popular belief that infrastructure projects drive progress, the elimination of these diseases alone can lead to significant poverty reduction. This includes poverty mitigation, promotion of inclusive education, advancement of gender equality, reduction of disparities, development of human capital, and stimulation of economic growth,” says Ms Phumaphi.

One of the tactics being considered in the elimination of NTDs is the “One Health” approach, which recognises the interconnectedness of human, environmental, and animal health in the face of changing climates. This holistic approach, emphasising links in surveillance across animal health, environmental health, and human health sectors, is believed will effectively mitigate disease transmission risks, optimise resources, and promote sustainable outcomes through a unified system, enabling early detection, efficient communication, and intervention, among experts across these fields.

Phumaphi emphasises the importance of incorporating NTDs into primary healthcare that encompass prevention, control, treatment, and disability management. She highlights the role of political decisions in ensuring NTDs are given the necessary attention.

According to her, investing in NTDs within primary healthcare systems is most cost-effective and pivotal for robust outcomes. Moreover, doing so establishes the groundwork for universal health coverage.

NTD programmes enhance health systems, extending access to remote populations and training community health workers, a key aspect of primary healthcare. Emphasising community trust in tackling NTDs, Phumaphi adds that early detection and intervention, which is often supported by free drug donation programmes, will contribute to NTD elimination.

She notes that efforts to eliminate NTDs require addressing these underlying social determinants of health, including improving access to clean water and sanitation facilities, strengthening healthcare systems, and fostering community engagement.