Ending tropical diseases requires a holistic approach -- End Fund CEO

At least 1.6 billion people globally live with at least one tropical disease and while 500,000 die each year from complications. Philanthropists are now calling for robust measures through holistic approaches from governments to end the burden of these NTDS. Sunday Times’ Solomon Asaba caught up with END Fund, Chief Executive Officer, Ellen Agler, during the sidelines of the WEF Africa meeting in Kigali for a discussion on ending NTDS. Below are the excerpts... Neglected tropical diseases are some of the major challenges that people face. What do you think should be done at this stage? NTDS affect over 1.6 billion people globally and while there are a lot of problems in this world that are hard to fix, this is one that has solutions. It is possible to control and eliminate the five most common neglected tropical diseases (NTDs). Government leadership is critical. Most countries that have these diseases have so many people that need to be treated, which means this needs to be a national-led plan incorporated into health ministries as a priority, backed by domestic resources and with governments leading the way. It appears that the danger is more in African countries. In your own assessment which countries are more affected? It is a global problem, but close to 500 million people who need treatment are in Africa. Sub-Saharan Africa bears 40% of the global burden of NTDs, and some of the most complicated cases are here. The largest burden in Africa is in countries with high populations like Nigeria, Ethiopia and the DRC. But if you look at the data, it is a problem in every single country. The 47 countries in the World Health Organization (WHO)’s African Region are all affected by at least one of the five most common NTDs. What is your take on the fact that more supplies are needed yet affordability of drugs remains an issue? Each of these five diseases that we are talking about is actually backed by drug donations. At least five drug companies, such Johnson & Johnson, GlaxoSmithKline, Merck and Merck Serono and so many others, have donation programs to help treat populations. In other words, this is actually a case where it is not the price of drugs that is a barrier since drugs are all free and available. For other things that you need to pay for, such as HIV drugs, malaria drugs, bed nets, the commodity price is a barrier, but here it is not - the barrier is delivery. That still costs money because you need community health workers, teachers, trainings, and etcetera. That is the piece we should look at. Rwanda’s plan is to use drones to deliver medicines in remote areas. What’s your take on this crucial development? Well I think when I first heard the term drone, it seemed like a military thing but that is not the case now. Drones are used for many activities especially in developed countries. This is a new world where we need to embrace technology and it can be used for good or for evil. If I hear that drones are being used to deliver medicines to the poorest and most vulnerable people, I would say that is a very excellent deployment of drones and Rwanda is on the right course. You realize unclean water is a source of most diseases like schistosomiasis/bilharzia. How can this be fixed? I think the long term solution of NTDs is not only in medicines. It has to be in clean water, appropriate sanitation and hygiene practices, as well as all around education and infrastructure. I think in some ways, taking deworming medicines is a short term fix and the long term fix is ensuring that a single person has access to a toilet and clean water and has shoes. I think the two agendas need to work hand in hand and we should do a lot to coordinate with the water and sanitation sectors. What we have seen from other countries is that once you have significant development in the country, neglected diseases go down because there is a close association of NTDS and poverty. Don’t you believe that chances are high for areas with conflicts having more NTDS compared to stable regions? Yes, there is a link between disease, conflict and public health systems. These are some of the things that remain at risk when it comes to war. In places where violence has broken out, like Central African Republic, it is hard to keep up some programs, such as mass drug administration campaigns for NTDs. Although we had been working in Yemen for some years we had to pause the program for some time after the war broke out this past year. Even the Ebola outbreak in Liberia also affected such programs because the NTD program involves going door to door. No one wanted to go door to door during the Ebola epidemic. So whether it is a pandemic or epidemic, or whether there is war, it really affects the eradication of these diseases. The target is to at least save 50 billion dollars spent on NTDS by 2030 but the question remains what is the best intervention? NTDS are affecting more people but receiving less than 1 per cent of global health financing. We are trying to advocate for both the international community and countries to prioritize these diseases because the impact on health, education and the economy is immense. This is what we need high on the agenda. One of the interventions includes preventative chemotherapy. How realistic is this for African nations? It is a technical term, but it is just taking medicines. What is done is studying a map and finding out who is at risk. This may involve going to each school and finding out how prevalent certain NTDs are in the population, but then you treat everybody in the community, whether they have worms or not, because the medicines are safe and easy to take and being donated for free. That way you reach everyone in the community since it is more expensive if you go person to person taking stool samples or finding out how many eggs of worms they have. That is why de-worming is important every six months or one year for kids. How do you intend to integrate mapping in fighting NTDS? More sophisticated mapping is taking place in more countries than ever before, including in hard-to-reach areas and places that have conflicts. After a few years of treatment, we should go back and remap to see if the disease prevalence is going down. It is great because there is so much data and you can see where the prevalence went up or down, including in Rwanda. You can monitor progress and that is what we are looking for across districts and villages.

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Ending tropical diseases requires a holistic approach -- End Fund CEO