Celebrating the Second Annual World NTD Day: A Q&A with Katey Owen

January 30 is the second annual World NTD Day, a day to raise global awareness of neglected tropical diseases, which are often overlooked but affect 1.7 billion people each year. We spoke to Katey Owen, director of the foundation’s Neglected Tropical Diseases team, about how COVID-19 has hampered the fight against NTDs, what our partners are doing to overcome these challenges, and what the NTD landscape will look like in 2021 and beyond.

COVID-19 has shown how quickly science and medical advancements can move when there is political will. In less than a year, the first COVID-19 vaccine started rolling out. Then you have NTDs, which are ancient parasitic diseases—even Biblical diseases, like leprosy—that still affect 1.7 billion people each year. But since they impact only the poorest communities, they receive fractional amounts of global health investment.

While NTDs do not usually kill, they cause pain and disabilities, keeping children out of school and adults from earning a living. In other words, in areas where economic development is most needed, NTDs trap communities in cycles of poverty.

At the foundation, we believe that ending the suffering caused by these preventable and treatable diseases is both a moral imperative and a chance to maximize human and economic potential.

While many organizations have been dedicated to fighting NTDs for decades, in 2012 there was an important shift: the London Declaration on Neglected Tropical Diseases.

The declaration was the first time that partners from many sectors—from nonprofits and pharmaceutical companies to governments and the World Health Organization—united behind a concerted effort to beat NTDs. This moment, whose anniversary is marked by World NTD Day each year, ushered in an era of unprecedented commitment, collaboration, and progress.

Since 2011, the number of people reached with NTD treatments has increased almost 40%—to nearly 1.2 billion people in 2019. The number of people at risk of NTDs has also fallen by 300 million since 2011. Since 2012, 33 countries have eliminated at least one NTD.

The pace of these gains is in large part driven by the strong multi-sectoral collaboration that sets the NTD community apart.

Innovative partnerships between pharmaceutical companies; donor governments such as the U.K., U.S., and UAE; philanthropic partners like the END Fund and Sightsavers; the World Health Organization (WHO); and, of course, endemic country governments enable the delivery of 1.7 billion NTD treatments annually. A large portion of these treatments are generously donated by industry partners—in fact, more than 11.5 billion treatments have been donated since 2012.

Without such partnerships, we would not see such impressive NTD R&D initiatives that are helping to fill treatment and diagnostic gaps needed for the last mile.

One inspiring example is India’s progress against an NTD called visceral leishmaniasis (VL), which the country is aiming to eliminate by 2021. There has been a 76% decrease in VL cases in the past five years, with only 2,031 cases reported in 2020. Even amid COVID-19, India was able to safely deliver critical services under the VL elimination program.

Another example from India is its commitment to the elimination of lymphatic filariasis (LF). India was among the first countries in Southeast Asia to adopt the WHO-approved Triple Drug Therapy (IDA) to accelerate the pace of LF elimination. Since December 2018, the country has successfully reached 57 million people with IDA, which is one of the largest scale-up stories in the world. India’s resilience in innovating with locally relevant solutions to deliver LF treatment during COVID-19 is a benchmark for the global NTD community.

As with many disease elimination efforts, NTD programs were temporarily paused at WHO’s recommendation from April to July 2020. While this was necessary to prevent the spread of COVID-19, many people were left without access to needed NTD treatment.

Fortunately, the NTD community is not new to challenges and disruptions—delivering treatments to the most remote, underserved communities with often limited resources is our specialty—and NTD partners have once again risen to the challenge.

Where programs are resuming, health workers and communities are taking steps against COVID-19. In Guinea, partners like USAID’s Act to End NTDs, Helen Keller International, and FHI 360 worked with the Ministry of Health to adapt mass drug administration (MDA) campaigns to be safer. In addition to rigorous mask-wearing and hand washing, health workers went house to house instead of gathering the community in one fixed location, as before. Ultimately, they delivered 20 million treatments to 4.4 million people.

Countries also need reliable tools to help them decide how and where to resume NTD activities. USAID’s Act to End NTDs and WHO AFRO’s ESPEN published guides to help countries do exactly this, and ESPEN and the NTD Modelling Consortium developed a modeling tool that analyzes how much delay programs can tolerate before seeing a negative impact.

Last but not least, as soon as COVID-19 emerged, NTD partners mobilized to support the pandemic response as well. The END Fund launched a COVID-19 emergency fund to help implement communications campaigns about sanitation and hygiene to prevent COVID-19 and NTDs alike. Government partners like FCDO’s ASCEND program have helped support 11 countries’ COVID-19 responses, including with mass media behavior change campaigns, health worker training, and supplies.

The good news is that modeling of COVID-related delays to NTD programs has shown that setbacks are not inevitable. For some NTDs, intensified catch-up strategies and additional rounds of MDA can help prevent progress from rolling back. Data also show which NTDs are most likely to resurge the quickest, such as trachoma and schistosomiasis, and in which types of settings, such as places where programs are in earlier stages pre-COVID and where residual infection rates are higher.

But our window of opportunity won’t last forever. We need to act decisively and rely on data to target limited resources where they’re needed most as NTD programs resume.

The strain COVID-19 has placed on health systems and economies—in both endemic and donor countries—means we must adapt existing approaches so they stretch resources further—for example, by delivering treatment for more than one NTD and other disease areas together. We must also prioritize investing in systems that will sustain and pay for themselves long-term.

On January 28, WHO launched a new roadmap to guide the global NTD effort for the next decade. This strategy aims to put people at the center and to accelerate progress by making NTD programs more effective and efficient.

While we have made impressive gains in recent years, many of the goals for 2020 from the previous roadmap were not reached, which makes embracing the new roadmap’s shifts even more critical if we want to achieve the 2030 targets.

One such shift is a focus on systemic solutions that leverage the entire health system, not just disease-specific approaches.

To address long-term resource constraints, we will also need to optimize NTD interventions by identifying new tools that can help deliver NTD programs in quicker, smarter, and more impactful ways, such as adopting microplanning tools used in polio and routine immunization campaigns.

Investment in NTD R&D is also urgently needed. Compared to other disease areas, particularly those that affect high-income countries, NTDs receive far less funding for research, despite key gaps. For example, for some NTDs we don’t have diagnostics sensitive enough to identify when MDA can be stopped. For other NTDs, existing treatments can’t kill the adult parasite, so many rounds of MDA are required to break the transmission cycle.

This June, NTD partners will come together at the Kigali Summit on Malaria and NTDs to repledge their commitment to addressing these diseases and to achieving the goals laid out in the WHO NTD roadmap for 2030. If we can maintain commitment, embrace new ways of working together, and push for innovative approaches that more effectively utilize available resources, I am confident that we will protect hard-fought gains against COVID-19’s disruptions and beat NTDs for good.