There is Still Hope: NTD Elimination Efforts Confront COVID-19 Impact

The coronavirus pandemic has impacted many non-COVID diseases and health conditions. Among these are neglected tropical diseases (NTDs), a group of communicable diseases caused by viruses, parasites, and bacteria. NTDs affect an estimated 1 billion people in 149 countries.

Efforts to control and eliminate these diseases center on health campaigns like mass drug administrations (MDAs) and other community activities that test, treat, and protect large numbers of people where the diseases are endemic. With the onset of the pandemic, the World Health Organization (WHO) recommended that countries pause campaigns to prevent the spread of COVID-19. While fighting the pandemic remains the highest priority, it raised the risk of uncontrolled NTDs spreading and slowing progress toward the global goal of eliminating the NTD epidemic by 2030, requiring countries to balance both needs.

The Task Force’s Mectizan® Donation Program (MDP) has continued to supply medicines for the elimination of river blindness (onchocerciasis) and lymphatic filariasis (LF) as requested by countries “while inviting them to observe WHO safety guidance,”  said Yao Sodahlon, MD, Director of MDP. “With the implementation of COVID-19 protocols to ensure safety for health workers and participant communities, we anticipate MDAs will become more expensive, and countries are worried about the effect of the economic downturn on funding for public health interventions outside of COVID-19.”

However, there is cause for some optimism. A few countries have already resumed MDAs due to new WHO guidance on how to conduct risk assessments for resuming health campaigns. Taking into consideration country-specific needs and protocols, each country will be completing these assessments and resuming MDAs at their own pace.

In the meantime, The Task Force and NTD partners have been tracking the impact of pausing MDA efforts and other health interventions. Across the six NTDs The Task Force works to eliminate, recent data shows that elimination goals will not be greatly impacted as long as all MDAs are resumed by 2021.

The Task Force’s International Trachoma Initiative (ITI) and other trachoma experts have conducted disease modeling to analyze the impact of trachoma program disruption. According to ITI Senior Data Analyst Kristen Renneker, MPH, research shows that most delayed or skipped MDAs this year can be mitigated by implementing an extra MDA in 2021, although high-transmission areas will need special attention. This would result in no substantial increase in cases of trachoma, a painful NTD that affects the eyes and is the world’s leading infectious cause of blindness. 

MDP has seen similar predictions for river blindness – a disease spread by blackfly bites, causing intense itching, disfiguring dermatitis, and eye lesions that can lead to blindness – and LF – a parasitic NTD transmitted through the bites of mosquitoes that can lead to severe swelling of the extremities.

“We are not expecting a significant increase in new LF or river blindness cases as a result of stopping treatment during the COVID-19 pandemic as long as MDAs resume no later than early next year,” said Sodahlon.

MDP oversees Merck & Co., Inc.’s donation of Mectizan® for the elimination of river blindness and LF across 43 countries, such as Venezuela, Mali, and Papua New Guinea.

For trachoma, ITI manages Pfizer Inc’s donation of azithromycin across 40 endemic countries, including Yemen, Colombia, and Ethiopia. ITI Program Director Paul Emerson, PhD, notes that COVID-19 has affected both the ability to implement programs and to acquire new data, but he is undeterred by the challenges.

“Our program has a very robust system that allows us to manage an ever-changing environment with meticulously managed data, so we can assess the impact very accurately and act accordingly to minimize it as much as possible,” he said. “Our commitment to the elimination of trachoma is unwavering. We will get countries the medicine they need when they think it is safe to resume activities.”

Other NTDs are seeing varying impact 

Lockdowns have also impeded treatment and access to care for persons affected by leprosy, a nerve-damaging infection. The Task Force’s Global Partnership for Zero Leprosy launched three emergency working groups to respond to these challenges and prepare for long-term impact following the pandemic.

The Task Force’s Children Without Worms (CWW) program manages an NTD Supply Chain Forum, which has identified significant supply chain issues for the distribution of NTD medicines during COVID-19.

Multilateral approaches like the Forum are key to mitigating global, public health crises by being able to rapidly adapt existing and new platforms and mechanisms for response. Since the start of the pandemic, CWW has held two emergency Forum meetings to help countries manage challenges like medicine stockouts and expirations so that they can resume distribution as soon as possible.

The Task Force’s NTD Support Center facilitates more than 100 operational research projects. Due to restrictions, visits to research sites are currently paused, but the NTD Support Center continues to research new tools and techniques for the control and elimination of NTDs, including working with the WHO, implementing partners, and social scientists to develop an evaluation protocol to help countries monitor the resumption of health campaigns.

NTD tools and resources used for pandemic response

Collectively, NTD programs seek to improve millions of lives and save billions of dollars worth of economic productivity. Although activities have been disrupted by COVID-19, the NTD infrastructure in endemic countries is helping with COVID-19 surveillance and contact tracing.

“While the challenges have been immense for the world in general and in terms of NTD elimination efforts, this pandemic has shown us what a strong disease elimination effort can do,” said MDP’s Deputy Director Rand Carpenter, DVM. “Having these programs helps build the capacity of a country’s health system, allowing them to respond better to other public health issues like the COVID-19 pandemic. It is an example of why investing in countries and partnering with them to solve major health challenges is so important.”

Emerson of ITI echoed this sentiment.

“The real challenges are the unknowns of this pandemic,” he said. “But because we’re used to dealing with an at-scale problem and ensuring that people aren’t left behind, the NTD community has very transferable skills for responding to other large-scale health issues like COVID-19. It is feasible to address NTDs and COVID-19 together.”

Header photo: Active COVID-19 surveillance in Mozambique. Photo courtesy of Mozambique FELTP.

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