WHO - World Health Organization Regional Office for South-East Asia

01/30/2022 | Press release | Distributed by Public on 01/28/2022 18:22

Prioritizing the ‘neglected’: A peek into WHO South-East Asia Region’s efforts to end the NTD scourge

New Delhi, 30 January 2022: Home to a quarter of the global population, the World Health Organization's South-East Asia Region bears a substantial burden of the Neglected Tropical Diseases (NTDs). Identifying elimination of NTDs as a flagship priority in 2014, the Region has been making concerted and sustained efforts to end trachoma, lymphatic filariasis, visceral leishmaniasis, yaws and leprosy.

"Neglected, as the name suggests, these diseases afflict those 'left out' in every sense. Marred by these debilitating diseases and their associated stigma and socio-economic consequences, the sufferings caused are unimaginable. Prioritizing elimination of such diseases was an obvious decision," says Dr Poonam Khetrapal Singh, who announced elimination of NTDs as a flagship as she assumed office as the Regional Director eight years ago.

The NTDs targeted for elimination - trachoma was endemic in three countries; lymphatic filariasis was endemic in nine countries; visceral leishmaniasis or Kala Azar was being reported from 5 countries, leprosy from all 11 countries and yaws in three countries of the Region.

The years that followed witnessed focused and accelerated efforts by Member countries and tremendous progress. India was declared yaws-free in 2016. Maldives and Sri Lanka eliminated lymphatic filariasis as a public health problem in 2016 and Thailand achieved the same in 2017.

The Region introduced the more effective mass drug administration (MDA) regimen with triple drug (IDA) to fast-track elimination of lymphatic filariasis. India introduced IDA in selected district in 2018 and expanded to more districts a year later. Timor-Leste introduced IDA throughout the country.

Nepal achieved elimination of trachoma as public health problem in 2018. Myanmar followed suit in 2020.

By 2020 end, 98% of implementation units in Bangladesh, India and Nepal had achieved the epidemiological threshold of elimination of Kala Azar as a public health problem.

The Region which bears the highest burden of global leprosy cases, reduced visible disability due to leprosy by 40% between 2016 and 2019, a key indicator of the global leprosy strategy. In the last five years, Bhutan, DPR Korea and Maldives have reported less than 25 new leprosy cases annually. Maldives is implementing its "zero leprosy" plan while Timor-Leste has developed a new National Leprosy strategic plan to move towards "zero leprosy".

The action on the ground resulted from the strong political commitment, reiterated time and again. While in 2014 the Health Ministers from Bangladesh, Bhutan, India, Nepal and Thailand signed a Memorandum of Understanding to collaborate to eliminate Visceral Leishmaniasis from their countries, in 2017 all countries in the Region adopted a 'Call for Action' to eradicate, eliminate and control NTDs.

With the Regional focus in 2019 to Sustain, Accelerate and Innovate for the flagship priorities, many initiatives were planned for 2020 to achieve key milestones. Bangladesh was to conduct the final transmission assessment survey (TAS) to be eligible for validation of LF elimination as a public health problem. Myanmar and Timor-Leste have planned to undertake pre-TAS and TAS in all remaining LF endemic districts that would enable them take decision to stop MDA or narrow it down to few districts. India was planned to start the pre-validation survey for elimination of trachoma as a public health problem. Indonesia was to introduce IDA in select districts with a plan to expand in a phased manner.

However, all community-based activities for NTDs were impacted in all countries in view of the pandemic. Repurposing and task-shifting of NTD staff to COVID-19 response led to gaps in NTD programmes while countries also diverted all funds to COVID-19 response.

But soon countries began prioritizing resumption of essential health services along with pandemic response. Despite initial set back, preventive chemotherapy against NTDs reached 462 million people throughout the Region in 2020. Bangladesh implemented TAS, Timor-Leste pre-TAS/TAS and Indonesia introduced IDA in selected districts.

Challenges and what is next?

Sustained political commitment and advocacy is critical for continued prioritization and accelerated action to eliminate NTDs the ongoing pandemic.

A robust primary care network is paramount - to reach everyone, everywhere - both in the last-mile and post-elimination stages, to support surveillance and response, morbidity management and disability prevention, and psychosocial care.

Strong multisectoral cooperation, beyond the health sector, is critical to improve sanitation, community environment and housing, vector control, water and sanitation, animal health etc which remain critical to contain NTDs.

New and better treatment and diagnostics are needed to accelerate NTD elimination.

As programmatic needs and demand evolve, countries need to review and analyse programmatic areas and, where appropriate, devise innovative solutions to enhance programme efficiency and reach. Scientists, policy makers, and health professionals must come together to understand programmatic gap, share knowledge and technology, and identify innovative solutions.

Global World Neglected Tropical Diseases Day

The Global World Neglected Tropical Diseases Day being observed on 30 January 2022 is an opportunity to draw attention and seek action to rid the world of the diseases that should no longer be affecting anyone, anywhere, said Dr Poonam Khetrapal Singh.

The first World NTD Day was celebrated informally in 2020. Last year in January, the new NTD road map was launched giving a global push to this cause.

NTDs in WHO South-East Asia Region

NTDs are a diverse group of diseases that are most common in tropical and subtropical regions. Proliferated in underdeveloped settings, these mostly occur among people who have little or no access to adequate health care, clean water, sanitation, housing, education and information.

Lymphatic filariasis (LF) : Commonly known as elephantiasis, Lymphatic filariasisoccurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood causing hidden damage to the lymphatic system. It can lead to abnormal enlargement of body parts, causing pain, severe disability and social stigma.

WHO Global Programme to Eliminate Lymphatic Filariasis, launched in 2000, has two principal aims - 1) To stop the spread of infection through annual mass drug administration (MDA) and 2) To alleviate the suffering caused by LF through universal access to morbidity management and disability prevention.

Maldives, Sri Lanka and Thailand are among the first few countries to eliminate LF as a public health problem. India, Indonesia and Timor-Leste have successfully rolled out the triple drug therapy, which is among the two priorities to accelerate elimination of LF.

Visceral leishmaniasis (VL) or Kala-azar: The leishmaniases are a group of diseases caused by protozoan parasites transmitted to humans by insect vector - the bite of an infected female phlebotomine sandfly. In the Region, Kala-azar is the main form of the disease with India, Bangladesh and Nepal being the most -affected. Sporadic cases have also been reported in Bhutan, Sri Lanka and Thailand. Over the past seven years, new cases of VL have reduced by 95% and 98% of implementation units in the Region achieved the target for elimination as a public health problem.

Since 2017, Bangladesh has sustained less than one case of VL per 10, 000 population in all implementing units.

Trachoma:A leading infectious cause of blindness worldwide, Trachoma elimination strategy is summarised by the acronym "SAFE", which means Surgery for advanced disease, Antibiotics to clear C. trachomatis infection, Facial cleanliness, and Environmental improvement to reduce transmission.

In the Region, Trachoma is known to be endemic in India, Myanmar, and Nepal. Through sustained efforts to implement SAFE strategy with support of WHO and other partners, Nepal achieved elimination of trachoma as a public health problem in 2018, followed by Myanmar in 2020. India is currently undertaking a nationwide pre-validation surveillance.

Leprosy: Leprosy is a chronic infectious disease caused by a type of bacterium. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early stages can prevent disability.

Yaws: Yaws is a chronic skin infection characterized by noncancerous lumps and ulcers. About 75-80% of people affected by yaws are children under 15 years of age. Poverty, low socio-economic conditions, and poor personal hygiene facilitate the spread of yaws. A recent disease burden assessment in the remaining endemic countries - Indonesia and Timor-Leste - indicates that eradication of Yaws is feasible.