COVID-19 pandemic drains resources for neglected diseases

The enormous diversion of funding to COVID-19 research and management since 2020 has drained capacity for studies and treatment for neglected tropical diseases (NTDs).

The pandemic has had a huge toll on diagnostic reach and treatment options for NTDs — a diverse group of conditions of bacterial, viral, parasitic, fungal and noncommunicable origin. The World Health Organisation estimates that more than 1.7 billion people, mostly in low and middle-income countries, require interventions for at least one NTD every year.

The latest G-FINDER annual report 2021 that tracked investments in global health for the year 2020 shows that funding for medical research on neglected diseases dropped significantly to $328 million in 2020 — a 6% decrease from 2019, and the fourth year of funding decline.

While R&D for some NTDs is performed by a few large organisations, many of the neglected diseases are almost completely reliant on just one or two ongoing funders.

Snakebites kill between 81,000 to 138,000 people every year globally, and cause many amputations and other permanent disabilities. Of the estimated 50,000 to 90,000 new worldwide cases annually of Visceral leishmaniasis (VL), or kala-azar, only 25% to 45% are reported to WHO. Fifty countries, or around 859 million people, are threatened by lymphatic filariasis or elephantiasis, which requires preventive chemotherapy to stop the spread of the parasitic infection.

Kavita Singh, director of Drugs for Neglected Diseases Initiative (DNDi), South Asia, says that low funding has impeded the development of new tools or optimised treatments. “Many public donors have not renewed multi-year commitments to NTD research and development, though some have provided bridge funding to sustain activities. The uncertainty is a huge concern.”

Singh says that in spite of the focus on universal health coverage, “NTDs have very limited resources and are almost ignored by global funding agencies”. For the pharmaceutical industry, work on diagnosis and treatment does not bring sufficient returns, so very few new options have been launched for NTDs in recent years.

“They are neglected because they mostly affect poor communities and do not receive as much attention,” says Y K Gupta, principal advisor, India Strategy Development, Global Antibiotics Research and Development Partnership (GARDP).

Lalit Kant, former head of Epidemiology and Communicable Diseases division at the Indian Council of Medical Research ICMR) advocates inclusion of NTDs in healthcare systems under a single nodal agency for research. “NTDs must be an integral part of health systems. Multiple organisations work in parallel and the result is fragmented,” he says.

Besides disrupting community-based interventions, the pandemic has caused delays in diagnosis, and halted monitoring and evaluation measures, including surveillance and surveys.

A Bill and Melinda Gates Foundation report found that some NTDs are treated using annual mass drug administration campaigns (MDAs), which many countries are postponing for fear that healthcare workers could spread COVID-19. For some, this delay may not pose a serious problem, because catching up is relatively easy. However, for more contagious NTDs like trachoma, schistosomiasis, and VL, delayed MDAs are likely to cause surges in infection.

The slide in funding is expected to slow progress made in the last decade to tackle NTDs. Compared with 2010, almost 500 million fewer people are at risk of disease or disability from NTDs today, according to WHO, and 43 countries have eliminated at least one NTD. More than 1 billion received treatment for at least one NTD between 2015 and 2019.

N K Ganguly, former director general of the Indian Council of Medical Research, pointed to the development of miltefosine , and liposomal amphotericin for kala-azar. The combinations, designed by DNDi — including paromomycin with miltefosine, and miltefosine with Amphotericin B — were developed to reduce drug resistance.

Ganguly said Bangladesh eliminated leishmaniasis and Nepal was nearing that goal. In the Indian state of Bihar, infection rates had significantly declined, but it was concerning that incidence had started moving towards non-endemic areas. Partnerships behind the elimination programme were drained of funds and could not work during the pandemic. The trial of three new vaccines, and integrated vector control, were also thwarted.

Gupta said that the kala-azar elimination project in Bihar, Jharkhand, Uttar Pradesh and West Bengal was in its last phase. “Diagnostic and treatment services are now available at public health centres”, he said, adding that India was also moving towards filaria elimination via the annual mass drug administration through triple drug therapy of IDA (ivermectin, diethylcarbamazine and albendazole) for five years or more.

In positive developments, Kant said, fexinidazole and combination therapy of nifurtimox-eflornithine have raised hope for the elimination of Human African Trypanosomiasis (sleeping sickness). A recent global count of cases of guinea-worm disease has been the lowest ever recorded. “These figures give us hope for elimination of other NTDs, but funds remain a major concern,” Kant said.