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 infection 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 Filariasis extreme poverty—have been the focus of increased attention. (GlaxoSmithKline, Merck & Co.), International Trachoma Countries, supported by a variety of global initiatives, have Initiative (Pfizer), Children Without Worms (Johnson & made remarkable headway in combating NTDs—including Johnson), and the WHO Program to Eliminate Sleeping diseases such as leprosy, lymphatic filariasis (elephantiasis), Sickness (Bayer, sanofi-aventis) to provide treatment for those onchocerciasis (river blindness), schistosomiasis (snail fever), NTDs. For schistosomiasis control, praziquantel has been and trachoma—and guinea worm 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 Carter Center spearheads efforts with theCenters 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 Tropical Disease 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 global health 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 ivermectin) “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 parasitic worm infections 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 medications 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 NUMBER OF CASES ( 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 sanitation) 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 Hookworm, Ascariasis (roundworm) and more NTDs, which can cause disfigurement, Trichuriasis (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 anemia and malnutrition, 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 snails. 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 leishmaniasis, Chagas disease, human development. As a result, NTDs cause billions drug therapy, which reduces the severity African trypanosomiasis (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 cycle of poverty. threatening disease. OCTOBER 2009 2 PROGRESS aGainst neglEcted tropical diseases Results South Korea, Solomon Islands, Sri Lanka, past two decades. China has also made Programs