Neglected tropical diseases: becoming less neglected.

Neglected tropical diseases (NTDs) cover a wide range of infections that predominantly aff ect the poorest and most vulnerable individuals. Neglected, but not unknown, these diseases are preventable and treatable. They threaten the lives of more than 1 billion people worldwide, including half a billion children. To take the “neglected“ out of NTDs, public and private partners— including drug companies, donors, and governments— committed to what is now referred to as the 2012 London Declaration to control, eliminate, or eradicate by 2020 ten NTDs (lymphatic fi lariasis, trachoma, soil-transmitted helminths, onchocerciasis, schistosomiaisis, leprosy, guinea worm, visceral leishmaniasis, Chagas disease, and human African trypanosomiasis). The promises made were to ensure the supply of drugs, to advance research and development, to enhance collaboration and coordination at national and international levels, to enable adequate funding, and to monitor programmes. Honouring their pledge to provide regular updates, on April 2, 2014, global health leaders gathered at the Institut Pasteur in Paris for the release of Uniting to Combat NTDs: Delivering on Promises and Driving Progress, a report assessing gains and setbacks towards reaching the 2020 NTD goals. With about 1·35 billion treatments donated in 2013, a 35% increase since 2011, pharmaceutical companies met 100% of requests for drugs. The number of countries requesting and receiving NTD drug donations increased from 37 in 2011 to 55 in 2012. Clinical trials are underway for a new oral drug for human African trypanosomiasis, and a paediatric formulation of praziquantel for schistosomiasis is also under development. Drug companies have supported these goals by opening their compound libraries, and the Drugs for Neglected Disease initiative is screening more than 7000 compounds. More than 70 countries have now developed national NTD plans. Brazil, with the largest NTD burden in the Americas, included NTD programmes in its Without Extreme Poverty plan and launched a school-based strategy combining deworming and leprosy screening. Colombia became the fi rst country in the world to eliminate onchocerciasis. Despite impressive progress, the fi ght is far from over. Only 36% of people in need of NTD drugs worldwide received what they needed. Several indicators are not yet on target to achieve the 2020 goal to control NTDs. Worryingly, coverage is low for schistosomiasis; in 2012, only 31 of 52 endemic countries implemented treatment programmes. Confl icts in countries such as South Sudan are also aff ecting programme performance. Partnerships with the pharmaceutical industry have been and remain crucial. But drugs are only eff ective when they reach the people who need them, so more eff ort is needed to increase scale-up and timely delivery in many countries. Other key challenges identifi ed in the report that must be addressed include fi nancial resources to support programme implementation from public, private, and domestic sources; and increased collaboration across key health sectors—sanitation, education, and nutrition. We emphasise two additional challenges. One is highlighted in the report—namely “there has been no systematic eff ort to support these goals with quantitative modeling to ensure that the various strategies being implemented can be expected to achieve them”. A new NTD modelling consortium has been created and its future role will be crucial. Also, the Stakeholders Working Group includes representatives of organisations that signed the London Declaration—that is, the group is not independent. The accountability arrangements to monitor and review NTD programme progress need to be made more robust. Looking ahead the focus must be on long-term sustainability and continued equity in NTD control, including expansion of NTDs tackled beyond the selected ten. Putting in place coherent and sustainable health and social protection systems is also key. This can only be achieved by countries committing to universal health coverage and anchoring NTDs in the post-2015 sustainable development goals (SDGs). Access to NTD control interventions and increasing their impact on reducing chronic disability must top the agenda. If NTDs are to be an SDG sub-goal, which targets and indicators will be needed? For such a disparate group of diseases, can a single indicator be agreed upon, especially one that goes beyond mortality and captures the burden of disability caused by NTDs? Unfortunately, there was too little time for discussions in Paris last week to refi ne targets and indicators to assess access and impact of NTD control as part of any future SDGs. To be sure, political and fi nancial commitments need to be strengthened much more if the London Declaration and the WHO Roadmap are to be fulfi lled. ■ The Lancet For the 2012 London Declaration see http://unitingtocombatntds. org/resource/london-declaration