“Addressing NTDs improves productivity and contribute to broader economic growth and prosperity of countries”
– says Dr Neeraj Mistry, Managing Director, Global Network for Neglected Tropical Diseases in an exclusive interview with ANA’s Musah Ibrahim Musah in Berlin, Germany. The interview was conducted at last year’s World Health Summit in Berlin. Excerpts follow:
MISTRY: The Global Network for Neglected Tropical Diseases was started in 2006, and this was when a whole lot of organisations who were working individually on a specific neglected tropical disease got together and they said how can we create a platform to represent all these neglected diseases? Before, it was done by each organisation tackling one disease and, what we found is that there are ways of actually addressing these diseases together. So, they created the Global Network and said this organisation or platform will be the collective representation for many diseases and many organisations that will advocate for NTD control and then also look at fund-raising to help support NTD programmes.
What are the diseases you deal with?
The diseases we deal with, Neglected Tropical Diseases, is about 17 different diseases that fall under this umbrella. We have primarily focused on the seven commonest diseases which account for over 95 percent of all NTD infections. These diseases are the three worm infections, the two blinding infections, which is trachoma and river blindness or onchocerciasis and then we deal with lymphatic filariasis which is also known as elephanthiasis and schistosomiasis which is also known as bilharzia in Africa. So, those are the seven commonest we deal with, but we are not prescriptive, so governments developing policies on NTDs can include those diseases that are priorities in their countries. And the importance of this is that it’s an African-led agenda, or an Asian and Latin American-led agenda; governments are determining what their priorities are in terms of the burden of disease. NTDs affect close to a billion and a half people around the world and this is the poorest of the poor people, the bottom billion, so to speak, and this people live on less than a dollar 25 a day often in very remote and rural locations, with poor access to water, sanitation, hygiene etc.
To what extent would you say the impact of NTD on the poor is, socially and economically?
In very severe conditions or infections with NTDs, they can sometimes cause death, but generally, NTDs or the diseases we deal with don’t often cause death. What they do cause is they cause disability. They are debilitating and they are also disfiguring. What happens is that one of the common features, for example, is anaemia that all the NTDs result in, and there is a general lethargy that people experience. So children often don’t go to school or even if they go to school, they can’t concentrate on their studies and similarly, mothers are unable to take care of their children and their families or tend to their households, and generally people are not able to be as productive in the workforce compared to when they are healthy. So, it often falls under the radar, this impact that it has, because it’s a morbidity issue; it is a quality of life issue rather than people dying. What we have found is that when we address these diseases, school attendance increases, cognitive development in children increases, and also worker productivity improves and that contributes to broader economic growth and prosperity of countries.
What, in your opinion, are the benefits, of NTD control on the poor in the developing world?
To a large extent what this would enable people to do is be more productive in the workforce and it would enable children to go to school and improve in the cognitive development and hence output. We have a study that actually followed children for 20 years and it followed children who were de-wormed when they were young and those that weren’t de-wormed. And in adulthood, those that were de-wormed were more economically productive by a significant amount and also had high levels of education.
Treatment costs of medication of the seven most common NTDs of less than 50 cent per person per year, sounds incredibly low.
Absolutely. All the drugs that we require for NTD control, most of the drugs are actually provided for free by the pharmaceutical companies. They have made huge commitments to donate these drugs and this has been happening for many years now. And in fact the more mature programmes are coming up on 25 years and these are in the hundreds of millions in fact some of the companies are donating a billion doses of these medications and they have committed for the long haul to donate these drugs to help support NTD control. So, when we look at the figure of about 50 cent, and that’s an aggregation of many different figures from different programmes, it’s the cost of actually delivering these drugs, the distribution, the logistics, the mapping of where these drugs are needed and the monitoring and evaluation. So, to ensure that these drug donations are actually fulfilled by distributing it and ensuring that they get to the mouths of the patients. The intervention that we do for this is something called the mass drug administration. And so in communities where we see these drugs are prevalent, there might be one two three up to seven of these diseases, NGO partners on the ground working with governments go into these communities and treat every one for the diseases that they have. And what happens is we get rid of the parasites from the individual which means that we avoid the eggs of the parasite going in to the system and what happens overtime is we can actually break what we call the transmission cycle and eliminate some of these diseases and many countries are on the path to elimination. So, there is actually end in sight with some of these diseases. I think the overall impact also that we need to consider is that all successful countries, that is countries that are economically prosperous have a significant growing middle class population and what NTD control will do is to lift people out of poverty by making them healthier and being able to take care of themselves and move them from the lower income core group to that middle class group. So, overall it contributes to the stability and progress of the society.
How would you rate the commitment of governments to NTD control?
We have been increasingly working with governments around the world and some of our partners in the WHO and the regional offices so for Africa is the Afro Office, the Regional Office of the WHO, in Latin America is with Paho, and in Asia is the Western Pacific and South East Asia offices. These offices have been working with the governments to formulate programmes and plans on NTDs. We would soon have 30 African countries with national integrated plans of NTD controls. So these are formal plans that the government will institute that address up to seven of these neglected diseases. In early November, Kenya will be the first country to actually launch the official plan with their partners on the implementation. The costs of these plans are actually quite low compared to other health and development budgets and yet the return on investment, that is, in the well-being and impact of these programmes, is much greater. So we have seen increase in government commitment for tackling these diseases and this is happening globally.
You are now here at the World Health Summit. How would you rate the Summit so far with regard to NTD control and elimination?
I think in terms of global health summits, and dealing with global health issues, this is one of the first summits that I am seeing, that a general health summit that NTDs are getting increasing attention. And I think as we are challenged in a global economic situation we need to find, or governments are looking to find those interventions that are most cost effective and this is the reason why I think NTDs are getting attention because they are very, very cost effective. The return on investment in terms of impact on populations and quality of life is about the best buy in global health for every dollar that you spent. In addition, we have made critical links between NTDs and HIV, tuberculosis and malaria and these are the three big diseases so to speak. We find that with infections like bilharzia in women there is a three times increase risk of HIV transmission. And so, as part of a comprehensive HIV strategy, one has to actually do NTD control as well. And similarly, people with malaria tend to have anaemia and that anaemia is excercebated with these other parasitic infections as well and the rate of activation of tuberculosis also increases with these worm infections.
So, in a word you are happy with achievements at this summit.
I think we have a long way to go but I think we are moving in the right direction to look at a more comprehensive approach on how all these diseases are related and more importantly than in the response, to look at the common platforms where we can actually consolidate the response. One of the things we are moving forward is the school-based platform and if we have to look at access to populations sometimes the school networks tend to be the widest footprint or broadest distribution in countries. So, if children going to school can receive adequate nutrition, their immunizations, food supplementation but also de-worming and schistosomiasis and other NTDs I think we will be reaching many of the people in populations and even in remote parts. We are also looking at the school-based platforms to see how we can expand that to communities through efforts to, for example bring your siblings to school day or bring your parents to school and access communities like that.
Finally, are you happy with the way NTDs are being tackled in Africa?
I think there has been a lot of success, but we are at a critical point now were we have to scale up. If we don’t scale up we will be continuing the re-infection cycle, and so if we have two villages and we treat one and not the other, the village that we haven’t treated will re-infect the one that we have. So it actually negate our efforts unless we do every one that is affected by this. So I think we are at a critical point of scale up. And there are certain positive developments. One, we have an increase in drug donations from the pharmaceutical companies showing huge commitments, second, we have growing commitment from national governments to actually institute integrated plans for NTDs. The third is we have the emerging signs suggestive that we can eliminate some of these diseases and how these diseases and their intervention can be integrated. That support is being provided by NGOs to countries, as well as the World Health Organisation. So the critical thing we now need to do is to get some international donors as well as national governments partnering to help support the distribution of these drugs.
The Global Network for Neglected Tropical Diseases
The Global Network is an advocacy initiative of the Sabin Vaccine Institute dedicated to raising the awareness, political will, and funding necessary to control and eliminate the most common neglected tropical diseases (NTDs).
The Global Network provides an advocacy platform for the broad NTD community that reaches the attention of policymakers, philanthropists, thought leaders, and the general public. Through that platform, we highlight the work—including implementation, research, advocacy, and policy efforts—of the NTD community at the local, national, and international levels.
The Global Network raises the profile of NTDs and builds support for control and elimination activities through our efforts to educate, advocate, catalyze, and convene. We highlight efforts underway in the field, and we connect global players and afflicted communities to increase access to vital medicines that can lift the world’s poorest people out of poverty.
It collaborate closely with the World Health Organization and other technical agencies, NGOs, donors, and the broader public health community; together we support international organizations, governments, and afflicted communities that work through regional strategies to advocate for and implement NTD control and elimination programmes.