INTEGRATED Approaches to Disease Elimination

 

The novel coronavirus pandemic has demanded an unprecedented, coordinated global response, which has culminated in increased global funding, and more importantly, increased attention to healthcare. But whilst efforts to produce and rollout effective diagnostics, therapeutics and vaccines in record time are being widely acclaimed, there is a danger that this focus on COVID-19 threatens to derail decades of progress in the control and elimination of preventable infectious diseases, including malaria, polio and Neglected Tropical Diseases (NTDs).

To put this into context, research shows that since the start of the pandemic, more diagnostic tests have been developed for COVID-19 than for all 20 NTDs in the last 100 years. Current indications also suggest that NTD funding is being further reduced due to shrinking economies and reductions in international assistance, or the diversion of existing funding towards control of the pandemic.

This is potentially catastrophic for the 1 billion plus individuals currently affected by NTDs globally who have, and will continue to be left behind if we fail to act.

To avoid further resources being diverted away from preventable disease of poverty, we need to adopt a more integrated approach to disease control and elimination that cuts across multiple diseases, rather than focusing on each disease individually. Identifying the synergies between infectious diseases, including COVID-19, is key to achieving a more integrated healthcare system.

Failing to do so may result in severe consequences. Take the Ebola outbreak in West Africa, nearly seven years ago, which devastated communities and placed excessive pressure on health systems. Guinea, where the first ever case of the virus in the region was reported, witnessed over 11,000 deaths in two years. As resources were channelled to tackling this new disease, cases of malaria over this period effectively tripled; in 2014, an estimated 74,000 cases of malaria went untreated in Guinea because clinics and health centres were shut as a consequence of the Ebola outbreak.

Not only was there a significant impact on treatment, but prevention efforts were constrained, too. According to the World Health Organization (WHO), “a 10% disruption in access to effective antimalarial treatment in sub-Saharan Africa could lead to 19,000 additional deaths in the region.” This comes amidst a funding shortfall of nearly half of the desired $5.6bn to tackle malaria globally.

We stand to suffer a similar fate due to COVID-induced disruptions to global healthcare efforts, but on an amplified scale, across multiple geographies. This impact was already felt as early as April 2020, when Pakistan, one of two countries still struggling to eradicate wild poliovirus, suspended its vaccination campaigns due to the pandemic, leading 40 million children to miss out on polio vaccination. While Pakistan has since resumed its Pakistan Polio Eradication programme in July 2020, even temporary suspension to vaccination programmes increases the chances of disease resurgence.

So how can we harness the COVID-19 crisis to create more integrated healthcare systems that address preventable diseases of poverty? The NTD community needs to make a stronger case for ending the neglect. Now is a rare opportunity to do so. The world has seen, first-hand, how the health of individuals is intimately connected across the globe, and how the health of the people and health of the global economy are equally intertwined. Stronger, more integrated health systems will strengthen surveillance, early warning, and pandemic preparedness. We should be seeking resources to tackle NTDs with this in mind.

COVID-19 has also helped raise awareness of the importance of sanitation and hygiene in disease prevention. WHO’s new roadmap for NTDs, 2021-2030, lays out a plan for effective elimination efforts. It cites water, sanitation, and hygiene (WASH) as one of the core strategic interventions in tackling 18 of the 20 NTDs, including lymphatic filariasis, which infected over 56 million people worldwide in 2017. According to the Centers for Disease Prevention and Control (CDC), we can reduce WASH-related NTDs by as much as 78% around the world with better sanitation. The expansion of WASH marks a significant shift for the NTD community as it begins to adopt a more cross-sectoral approach to disease elimination.

There are benefits, too, from adopting a more integrated, cross-disease approach to mass drug administration. Ivermectin, produced by Merck & Co., is a highly effective treatment for the prevention of onchocerciasis, a NTD contracted from a parasitic worm transmitted by black flies, and for lymphatic filariasis, another NTD spread by parasitic worms transmitted by mosquitos. In 1987, Merck & Co. committed to donate Ivermectin free of charge for as long as needed through the Mectizan Donation Programme. There has since been interest in repurposing Ivermectin, and it is now being used to treat certain cases of malaria, for example, and there are even clinical trials to assess its potential use in the fight against COVID-19, although there is little hard evidence of its effectiveness at present.

At the newly formed Global Institute for Disease Elimination (GLIDE), we see the intrinsic value of promoting and adopting multi-sectoral, multi-stakeholder and cross-border approaches to disease elimination. This approach calls for actors across all levels and geographies to engage in ways that facilitate collaboration, address fragmentation, and avoid duplication of effort. It is not always going to be straightforward but if we leverage these opportunities, we are likely to see more impactful, lasting effects with global reach.

Despite its challenges, COVID-19 offers us the opportunity to think more synergistically, so that resources can serve communities suffering from COVID-19 and NTDs. As past outbreaks have shown, deaths from preventable diseases increase dramatically when healthcare systems are overwhelmed and fragmented. This shift to integrating the prevention and treatment of NTDs into routine primary healthcare services brings us one step closer to achieving universal health coverage (UHC), in which no disease, and no person, is left behind.

Simon Bland, CEO of the Global Institute for Disease Elimination (GLIDE), a new global health institute focused on accelerating the elimination of malaria, polio, lymphatic filariasis and onchocerciasis. 

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