A new roadmap for neglected tropical diseases

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The Kigali Declaration on Neglected Tropical Diseases (NTDs) launched in Rwanda aims to mobilize political will and secure commitments to tackle NTDs, to achieve the targets set for Sustainable Development Goal (SDG) 3 and the World Health Organization’s NTD Roadmap (2021-2030). NTDs are a diverse group of 20 diseases affecting 1.7 billion people, mostly in impoverished communities in tropical areas, especially in Africa. They compromise early child development, reproductive and sexual health and quality of life, as well as economic development.

This declaration is the world’s largest public-private partnership and is critical for progressing the health and development agenda in affected countries and strengthening global health security. As long as NTDs continue to burden national health systems, countries’ contributions to global surveillance and control of new and emerging pathogens will be undermined.

People affected by NTDs have already benefited from the 2012 London Declaration on NTDs, a predecessor of the Kigali Declaration which saw global partners committing to controlling, eliminating or eradicating 10 diseases by 2020, thus improving the lives of more than a billion people with 46 countries having eliminated at least one of these diseases.

The road ahead for NTDS is paved with good intentions and optimism. But we need to do more considering the fact that the global response to COVID-19 disrupted NTD control programs in 44 countries. In addition, the withdrawal of over £150 million of NTD funding by the UK, as part of that country’s aid budget cuts, wiped out a third of NTD donor funding, affecting treatments to 250 million people and at least 180,000 surgical operations to prevent disabilities.

Country ownership and prevention is key to resilience

There are actions that African countries must take to build resilience in NTD control programmes. A significant feature of the Kigali declaration is endemic country ownership of the NTD control agenda, with leadership coming from Rwanda and Nigeria. Local ownership allows affected countries to manage all stages of NTD control. This starts with increasing local financing of control programmes for self-sufficiency and investment in public health interventions that work, such as safe water and sanitation. At the same time, countries must invest in research for local solutions and innovations to reduce the need for treatments. Local funding will ensure that affected countries are driving the research prioritisation agenda for their own needs.

NTDs can be viewed as diseases of neglected people. Current programmes focus disproportionately on treatment through drugs or surgery, rather than prevention and disease management when prevention and treatment have failed. People with NTD-related disfigurement or blindness caused by leprosy, elephantiasis, yaws, trachoma or onchocerciasis are the most neglected of all, and health services must engage with them better. Affected countries urgently need to lead through investing in, and implementing home-grown frugal innovations and approaches to address patient needs. Only affordable, and accessible healthcare packages for case management will make a meaningful difference to them.

The declaration’s major goal is to ensure people affected by NTDs, particularly women and girls, persons with disabilities, minority and underrepresented groups are at the centre of NTD programmes and decision-making processes. This is easier said than done, because very few countries currently have structures in place to effectively engage with these groups. We recently showed that non-compliance for toilet use in rural African women was related to their need for safe spaces away from the homestead. This underlined the need for co-creation of solutions with affected communities. Local leadership is critical for delivering locally acceptable and relevant NTD interventions. The Kigali declaration has kicked off the journey to the inclusive engagement of all concerned.