How to keep fighting neglected tropical diseases during a pandemic

As the COVID-19 pandemic continues to spread across the globe, we must not lose sight of other health challenges facing healthcare systems, particularly neglected tropical diseases (NTDs) which affect the poorest populations.

NTDs continue to impact more than one billion people globally and add heavy social and economic costs to developing economies. The ongoing COVID-19 pandemic might further exacerbate the burden of NTDs, with the risk of reverting control and eliminating the progress achieved to-date.

There is also an imperative to keep NTDs among our health priorities as the effects of these diseases continue to grimly affect their victims, causing serious physical disfigurations, deformities, social stigma and long-term negative consequences. These diseases can perpetuate the cycle of poverty through impediments to education outcomes and obstructing employment prospects.

NTD interventions largely hinge on community efforts; however, the public health measures put in place to reduce the transmission of COVID-19 – such as lockdowns and physical distancing – have made it difficult for healthcare workers to implement NTD programmes in many endemic countries. The World Health Organization (WHO) has issued guidelines that recommend postponing high-risk activities, but which also call for continued implementation of essential NTD prevention and treatment services – a challenge for many countries.

Furthermore, there have been disruptions to essential supplies, medications and vaccines – the latter increasing long-term consequences among children. These disruptions in supply chains have affected NTD programmes such as mass drug administration (MDA) and other high-impact campaigns. An additional potential impact is that NTD infections can result in immunosuppressed individuals, who are then at higher risk of contracting COVID-19.

The impact of COVID-19 on NTD programmes can be alleviated by following these key strategies:

1. Leverage existing NTD health education and interventions

COVID-19 has amplified socio-economic inequalities, with a higher infection rate among poor communities who can struggle to maintain public health measures such as frequent hand-washing without adequate water, sanitation and hygiene (WASH) infrastructure. Similarly, a lack of WASH services in poor communities is among the root causes of NTD infections.

An important aspect of NTD programmes has been health education and interventions around WASH, which can be leveraged to provide support to COVID-19-related preventive measures. The expansion of these interventions – such as messaging on hand washing, availability of soaps or sanitizers – would not only benefit the COVID-19 response, but also lead to NTD transmission control, with an added impact on other WASH-related diseases.

2. A coordinated multi-stakeholder approach with local ownership

An important multi-stakeholder approach to tackling NTDs was established through the WHO's London Declaration, which resulted in the formation of the Uniting to Combat NTDs, a partnership between development organizations, NGOs, pharmaceutical companies and donors, as well as countries with incidences of NTDs who seek to support the WHO's aim to eradicate NTDs by 2030.

This multi-stakeholder approach has been particularly effective as it ensures local ownership of priorities and responsive allocations of resources. Within the current context and post-COVID-19, there is an essential role for national and sub-national coordination of activities, to ensure targets for health priorities are maintained while a new normal is established.

Further, a platform or community of partners working in NTDs and WASH programmes can be quickly mobilized to work alongside national-level coordination mechanisms such as a COVID-19 task force – particularly in surveillance and communication.

3. Fully engaging a powerful set of collaborators

In a recent online event on how youth advocates can contribute to achieving the targets set out in the 2030 NTD roadmap, the WHO's Director-General, Tedros Adhanom Ghebreyesus, acknowledged the significance of intergenerational partnerships in addressing NTDs: “As young leaders, […] [y]our insights, innovation and ideas are essential for addressing diseases of poverty and achieving our shared vision of an NTD‐free generation,” he stated.

As countries grapple with ways to maintain progress towards eliminating NTDs, while addressing the ongoing COVID-19 pandemic, there is an opportunity to fully engage young people, who represent a growing strength that can be leveraged in reshaping current programmes and responses.

Initiatives like Youth Combating NTDs recognize and champion the role of youth in combating NTDs. This youth platform centres youth as strategic actors and advisors at both the grassroots and high levels. Another initiative is 'End the Neglect', a campaign that seeks to raise awareness and prompt positive action on eliminating NTDs.

In such unprecedented times, the insight, innovation and engagement of young people in response to COVID-19 is a reminder that the proposed way forward of fully engaging young people in combating NTDs is a strategic approach that can be leveraged in the COVID-19 pandemic response.

The progress made in eliminating NTDs remains at risk if COVID-19 measures in place do not reinforce NTD programmes and essential services. The burden of NTDs will continue to increase, particularly among vulnerable communities. Maintaining a focus on addressing these high-burden and underreported diseases will ensure that endemic countries are better prepared to confront the ongoing COVID-19 and any future health challenges.