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Home , Deworming, Elephantiasis, Schistosomiasis

PROGRESS SHEET

Significant progress towards the elimination and eradication of neglected tropical diseases has been made in the last decade. Development of public-private partnerships, drug donations from major pharmaceutical companies, increased country and international agency commitment, and effective intervention strategies have led to dramatic declines in rates of from these debilitating diseases.

Over the last five years, neglected tropical diseases (NTDs)— Elimination Program for the Americas (Merck & Co.), a group of debilitating infectious diseases that contribute to Global Programme to Eliminate Lymphatic extreme —have been the focus of increased attention. (GlaxoSmithKline, Merck & Co.), International Countries, supported by a variety of global initiatives, have Initiative (Pfizer), Children Without (Johnson & made remarkable headway in combating NTDs—including Johnson), and the WHO Program to Eliminate Sleeping diseases such as leprosy, (elephantiasis), Sickness (Bayer, sanofi-aventis) to provide treatment for those (river blindness), schistosomiasis ( ), NTDs. For schistosomiasis control, has been and trachoma—and guinea may be the next disease provided via WHO by Merck KGaA and by MedPharm to the eradicated from the planet. Schistosomiasis Control Initiative. Drugs for leprosy control are provided free by Novartis.

Global Progress This collection of programs and alliances has been successful in bringing together partners to address NTDs, but there The prospects for reducing the enormous burden caused are others who also provide support to national programs by NTDs have changed dramatically in just the past few fighting these diseases. years, in part due to the growing recognition of the linkages between the fight against these debilitating diseases and The spearheads efforts with the Centers for progress towards the United Nations Millennium Disease Control (CDC), WHO, and UNICEF to eradicate guinea Development Goals (MDGs). worm disease. This disease has been eliminated in all but six countries, and cases have been reduced by more than 99 The remarkable efforts of public-private partnerships under percent. The final battle to find and contain the last cases in the leadership of the World Health Organization (WHO)— the hardest-to-reach parts of the world is under way. which include the pharmaceutical industry, academic and research institutions, donors, nongovernmental organizations, Bilateral development agencies also contribute, including the and local communities—have revolutionized the treatment U.S. Agency for International Development (USAID) Neglected and control of many diseases. For example, when the Control Program, which was established in Mectizan Donation Program was launched by Merck & Co. Inc. 2006 to reduce the burden of NTDs. USAID expanded efforts in 1987, collaboration between the public and private sectors in 2008, launching the Neglected Tropical Diseases Initiative in addressing challenges was uncommon. The which committed $350 million (2009–2013) to deliver program was initially established to oversee the donation of integrated NTD treatment to 300 million people in Africa, their drug Mectizan® (also known as ) “for as long Asia, and Latin America.1 as needed” to treat onchocerciasis, and was expanded to An improved understanding of the relationship between include lymphatic filariasis in 1998. Programs such as this one NTDs and extreme poverty has prompted other new initiatives. make it financially possible to provide the annual or biannual In addition to the MDGs, there are many international and drug doses required for treatment of these diseases to the regional goals which help spur action to improve health. millions of people at risk. For example, in 2001, WHO adopted a resolution to reduce Since then, pharmaceutical companies have donated billions by deworming 75 percent of all of doses of drugs to programs such as the African Program at-risk school-age children by 2010—the largest public health for Onchocerciasis Control and the Onchocerciasis program ever attempted. WHO’s Global Plan to Combat

OCTOBER 2009 1 PROGRESS against neglected tropical diseases

NTDs has as its goal the prevention, access to and created the control, elimination, or eradication possibility of controlling some diseases GUINEA WORM of NTDs, particularly the elimination to the point of elimination: or eradication of a targeted group of ERADICATION • Distribution of drugs to an entire diseases by 2015. PROGRESS 2 population, known as mass drug Declines in total number Promoting even greater awareness and administration (MDA), has allowed of cases since 1989 coordination is the Global Network for countries to significantly control 900 ( CASES OF NUMBER Neglected Tropical Diseases, an alliance onchocerciasis, lymphatic filariasis, 800 of international organizations working schistosomiasis, trachoma, and soil- 700 to control and eliminate NTDs by 2020, transmitted worms.5 An integrated 600 which launched in 2006. approach using a combination of four drugs can treat multiple 500

diseases at once.6 400 thousands Innovation and 300 • Community-directed treatment Scientific Advances 200 is a sustainable and cost-effective Development of innovative strategies 100 method of MDA, which was ) for the delivery of existing drugs and 0 developed by African researchers methods to encourage behavior change 1989 1995 2001 2007 for the distribution of ivermectin have allowed for continued progress in to treat onchocerciasis (river Source: World Health Organization controlling NTDs globally. blindness). This strategy empowers Significant efforts have been made communities to take responsibility to prevent trachoma using the SAFE for drug distribution and has costs, particularly by identifying Strategy, which was introduced delivered hundreds of millions of where the diseases overlap. by WHO in 1996. The strategy uses drug doses, as well as other health National research programs, WHO surgery to correct eyelid defects that interventions, often to populations and other international agencies, lead to blindness, antibiotics to treat with little access to health services.7 active infections, face washing, and and foundations are supporting • To assist in implementing interventions, research and development for “tool- environmental improvement (by researchers have developed rapid deficient” diseases, where existing providing clean water and ) mapping techniques which allow drugs are inappropriate or diagnostic to prevent transmission of the bacteria for targeting of drug distribution and surveillance tools inadequate. that cause trachoma.4 programs and facilitate planning for Innovative nonprofit product New strategies for distributing drugs more integrated approaches. This development partnerships have to infected populations have increased enhances efficiency and reduces also emerged to fill the gaps.

What are neglected tropical diseases? More than 1 billion people—one-sixth of The following diseases are responsible for • Soil-transmitted helminth infections: the world’s population—suffer from one or 90 percent of the global NTD burden.3 , (roundworm) and more NTDs, which can cause disfigurement, (whipworm) are parasites • Lymphatic filariasis (elephantiasis) is disability, and even death. that are ingested in contaminated food a mosquito-borne parasitic infection. or water, or in the case of hookworm, NTDs are called neglected because People with the disease can suffer from exposure of the skin (often the feet) to they have been largely wiped out in the disfigurement and permanent disabilities larvae in contaminated soil. Infection can developed world and persist only in the where limbs or other parts of the body cause and , as well as poorest, most marginalized communities are grotesquely swollen or enlarged. and conflict zones. They thrive in places other more serious and/or fatal problems. • Onchocerciasis (river blindness) is a with unsafe water, poor sanitation, and • Trachoma is a bacterial eye infection, parasitic worm disease spread by the limited access to basic health care. which, if left untreated, leads to bite of infected black flies that causes irreversible and painful visual impairment The primary listing of NTDs includes 13 blindness and skin lesions. parasitic and bacterial tropical infections. and blindness. It is the world’s leading Each disease manifests differently but • Schistosomiasis (snail fever) is a parasitic cause of infectious blindness. worm disease transmitted by freshwater frequently impacts the same populations, The other NTDs which complete the hindering economic development, causing . It causes the highest mortality list of 13 are guinea worm disease, chronic disability, and impairing childhood among the NTDs, but can be treated by , , human development. As a result, NTDs cause billions drug therapy, which reduces the severity (sleeping sickness), of dollars in lost wages, keeping those at risk of lesions that result in chronic and life- Buruli ulcer, and leprosy. of infection trapped in a . threatening disease.

OCTOBER 2009 2 PROGRESS against neglected tropical diseases

Results South Korea, Solomon Islands, Sri Lanka, past two decades. has also made Programs to treat and control NTDs are Suriname, Thailand, and Trinidad and substantial progress, reducing cases , some of the most cost-effective in public Tobago.12 13 Since 2000, the Global from 11 million in 1950 to less than Program to Eliminate Lymphatic health, with remarkable rates of return 1 million in early 2000. Filariasis has helped to deliver 1.9 from annual treatments with donated Trachoma has been reduced from billion treatments to individuals living products or other interventions.8 As a 149 million cases in 1997 to 60 in 48 of the 83 filariasis-endemic result of dedicated partnerships and million cases in 2008 thanks to the countries. In 2007 alone, over 546 increased global efforts, millions of implementation of the SAFE strategy; million people were treated. lives have been saved or improved by Oman, Morocco, and Mexico have preventing disability and disfigurement. Onchocerciasis (river blindness) has eliminated blinding trachoma using been eliminated in Colombia, and this strategy. Another 15 countries are Guinea worm disease is on the studies at sites in Senegal and Mali have verge of being the second disease in making strides towards elimination. demonstrated that elimination using human history (after smallpox) to be ivermectin alone is feasible in Africa as eradicated. One of the most remarkable well. , A program launched in 1974 Moving Forward global health success stories, it will 14 15 that used insecticides to kill infected While the prospects for reducing the be eradicated without the use of black flies eliminated the disease as burden caused by these diseases have vaccines or drugs. In 1986, there 9 a public health problem in 10 West changed dramatically, challenges still were an estimated 3.5 million cases in African countries, benefiting 60 million remain. With a comparatively modest, 20 countries. Since then, cases have people. In other regions of Africa, drug time-limited financial push, many of declined by 99.7 percent. Less than treatment is used instead to control these diseases can be controlled or 5,000 cases of guinea worm have been blindness and skin disease. Community- even eliminated. reported in the last year, with cases , directed distribution of ivermectin confined to six African countries.10 11 reached more than 54 million people in Integrate control and elimination The number of new leprosy cases per 16 countries in 2007. It is estimated that efforts with other programs year has also fallen dramatically, and by 2010, the sight of 800,000 people Traditionally, partnerships and the disease remains a public health will have been saved.16 programs have been devoted to the problem in only seven of the more Prevalence and intensity of infection control or elimination of a single than 100 countries where it used to of schistosomiasis (snail fever) have neglected disease; however, people be endemic. Since 1985, 14.5 million been significantly reduced in , can be infected with more than one people have been cured. Burkina Faso, Mali, Niger, Tanzania, and NTD simultaneously. Since the donated Lymphatic filariasis (elephantiasis) Cambodia. Prevalence in has drugs are effective against several of has been successfully controlled or been reduced from around 20 percent these infections, major health gains as eliminated in China, Costa Rica, Egypt, to less than 1 to 2 percent over the well as administrative efficiencies are

COUNTRY SPOTLIGHT: Elimination of Lymphatic Filariasis in Egypt

Lymphatic filariasis (LF) has been The large-scale intervention five years.23 Egypt was able to affecting people in Egypt for included identifying infections, achieve high compliance in MDA hundreds of years. The country treating the whole population primarily due to its effective EGYPT experienced a resurgence of annually using MDA, and outreach services and innovative the disease in the 1970s, when monitoring infection rates. social mobilization methods, prevalence rose to 40 percent in which included announcements After identifying the filariasis- certain areas. , Since then, Egypt in mosques, television clips, and 21 22 endemic areas, teams comprised has made substantial progress comic books for children. of physicians, nurses, and other in dramatically decreasing the health workers were tasked The implementation of this prevalence of the parasite which with informing the population intervention has led to a infection, Egypt has been causes the disease, becoming about drug safety, possible significant decline in parasite conducting a post-surveillance one of the first filariasis-endemic adverse reactions, and the prevalence rates and an absence intervention and expects to countries in the world to eliminate importance of eliminating of transmission. The study announce results in 2010. Egypt’s LF as a public health problem. LF. Beginning in 2000, these intervention demonstrated that story exemplifies that committed Egypt’s success stemmed from teams visited every household five rounds of MDA with high national efforts, public-private the novel approach of treating the and administered coverage rates may be able to international cooperation, and entire infected population at the and diethylcarbamazine (DEC) eliminate lymphatic filariasis.24 community involvement can lead to onset, rather than the traditional tablets to 2.5 million people in To confirm that LF has been elimination of a disfiguring disease. method of gradually scaling up 181 Egyptian localities, over a eliminated, and to detect any over a number of years. two-week period every year for early signs of resurgence of

OCTOBER 2009 3 PROGRESS against neglected tropical diseases achieved by coordinating efforts to Investments are needed in many programs. New antihelminthic (anti- address several diseases at once. One areas, including: worm) drugs are needed to keep study estimated that, if programs were ahead of potential resistance and • Diagnostics and treatment for several combined, drugs could be delivered at shorten the duration of interventions.6 NTDs, including human African a cost savings of 26 to 47 percent. 17 trypanosomiasis (sleeping sickness), Increase global financing to Further benefits could be gained by , Chagas disease, control and eliminate NTDs including NTD control efforts in and Buruli ulcer need to be improved. An estimated $2–3 billion will be needed and HIV/AIDS programs. Investing • In some worm diseases, a drug which over the next five years to control and in NTD control also promotes and 20 kills adult worms would pave the way eliminate NTDs. The funding gap improves the efficiency and coverage to more rapid elimination and could for drugs alone is an estimated $222 of immunizations, vitamin A and bed lead to eradication. million (from 2008 to 2012).3 Additional net distribution, and maternal child funds are needed to cover drug delivery , health programs.18 19 • Tools to quickly and inexpensively costs, social mobilization, training, and identify whether a disease has monitoring and evaluation. U.S. funding reentered a population need to Invest in research and development is expected to increase, and the United be developed for programs in the for drugs, diagnostics, and Kingdom has committed £50 million surveillance tools elimination phase. over the next five years to fight NTDs.1 Although there have been advances in • Monitoring drug efficacy is essential Overall, however, the funds committed drug development, essential medicines because of the potential development represent only a fraction of what is to treat many NTDs are too expensive, of drug resistance—especially given needed for global control of the seven highly toxic, or becoming less effective. the huge scale of mass-treatment major diseases.3

Endnotes 1. USAID NTD Initiative, “About the NTD Initiative,” 10. The Carter Center, “Guinea Worm Eradication 18. B.G. Blackburn, A. Eigege and H. Gotau, et http://www.neglecteddiseases.gov/about/index Program,” 2009, http://www.cartercenter.org/ al., “Successful Integration of Insecticide- .html (accessed September 20, 2009). health/guinea_worm/index.html (accessed Treated Bed Net Distribution with Mass Drug September 23, 2009). Administration in Central Nigeria,” American 2. WHO, Global Plan to Combat Neglected Tropical Journal of & Hygiene 75 (2006): Diseases 2008–2015, 2007, http://whqlibdoc 11. WHO, “Monthly Report on Cases, 650–55. .who.int/hq/2007/WHO_CDS_NTD_2007.3_eng January–April 2009,” Weekly Epidemiological .pdf (accessed September 18, 2009). Record 84 (2009): 212. 19. Special Programme for Research and Training in Tropical Diseases, Community-Directed 3. P. Hotez, et al., “Rescuing the Bottom Billion 12. E.A. Ottesen, et al., “The Global Program to Interventions for Major Health Problems in Africa: Through Control of Neglected Tropical Eliminate Lymphatic Filariasis: Health Impact A Multi-Country Study (Geneva: WHO, 2008). Diseases,” Lancet 373 (2009): 1570–5. After 8 Years,” PLoS Neglected Tropical Diseases 2 (2008): e317. 20. White House Press Office, “Fact Sheet: Fighting 4. S. Polak, et al., “Mapping the Global Distribution Neglected Tropical Diseases Around the World,” of Trachoma,” Bulletin of the World Health 13. M. Bockarie and D. H. Molyneux, “The End of Press Release, 2008. Organization 83 (2005): 913–919. Lymphatic Filariasis?” British Medical Journal 338 (2009): b1686. 21. D.H. Molyneux, “Elimination of Transmission of 5. P. Hotez, et al., “Control of Neglected Tropical Lymphatic Filariasis in Egypt,” Lancet 367 (2006): Diseases,” The New England Journal of Medicine 14. The Carter Center, “Onchocerciasis Elimination 966–968. 357 (2007): 1018–1027. Program of the Americas,” 2009, http://www .cartercenter.org/health/river_blindness/oepa. 22. R.M.R. Ramzy, et al., “Effect of Yearly Mass Drug 6. D.H. Molyneux, P. Hotez and A. Fenwick, html (accessed September 24, 2009). Administration with Diethylcarbamazine and “‘Rapid-Impact Interventions’: How a Policy Albendazole on Bancroftian Filariais in Egypt: a of Integrated Control for Africa’s Neglected 15. L. Diawara, et al., “Feasibility of Onchocerciasis Comprehensive Assessment,” Lancet 367 (2006): Tropical Diseases Could Benefit the Poor,” PLoS Elimination with Ivermectin Treatment in 992–99. Medicine 2 (2005): e336. Endemic Foci in Africa: First Evidence from Studies in Mali and Senegal,” PLoS Neglected 23. Global Alliance to Eliminate Lymphatic Filariasis, 7. WHO, “How Community-Directed Treatment Tropical Diseases 3 (2009): e497. The Global Elimination of Lymphatic Filariasis: The with Ivermectin (CDTI) Began,” http://www.who Story of Egypt (Geneva: WHO, 2003). .int/apoc/cdti/history/en/index.html (accessed 16. WHO, “African Program for Onchocerciasis September 18, 2009). Control (APOC): About Us,” http://www.who.int/ 24. Global Alliance to Eliminate Lymphatic Filariasis, apoc/about/en/ (accessed September 22, 2009). “10 Years of Progress Towards Elimination: 8. D.H. Molyneux, “‘Neglected’ Diseases but Success in a Changing Policy Environment,” Unrecognised Successes—Challenges and 17. M.A. Brady, P.J. Hooper and E.A. Ottesen, http://www.filariasis.org/documents/ Opportunities for Infectious Disease Control,” “Projected Benefits from Integrating NTD GAELF5reportEnglishWeb.pdf (accessed Lancet 364 (2004): 380–383. Programs in Sub-Saharan Africa,” TRENDS in September 30, 2009). Parasitology 22 (2006): 285–291. 9. C. Paddock, “Guinea Worm Eradication Almost Complete Says Jimmy Carter,” 2008, http://www .medicalnewstoday.com/articles/132147.php. (accessed September 15, 2009).

The Living Proof Project is a multimedia initiative intended to highlight successes of U.S.-funded global health initiatives. Millions of lives have already been transformed and saved with effective, affordable solutions. We have the knowledge, innovative technologies and proven tools to do much more. The content for this progress sheet was developed by the Global Health Group at the University of California, San Francisco and SEEK Development in Berlin. It is also available online at www.livingproofproject.org.

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