Reaching elimination of neglected tropical diseases: Challenges, lessons, and next steps

Neglected tropical diseases (NTDs) are a diverse group of mostly poverty-related health conditions prioritized by the World Health Organization (WHO) for control or elimination. NTDs cause illness, disability, social stigma, and sometimes death, with significant economic impacts on developing economies and the communities within them. The WHO NTD Roadmap has targeted two NTDs for eradication (dracunculiasis and yaws) and eight for elimination as a public health problem by 2030 by reducing morbidity and mortality to below agreed thresholds for each: Chagas disease, human African trypanosomiasis, visceral leishmaniasis, lymphatic filariasis, rabies, schistosomiasis, soil-transmitted helminths, and trachoma.

Substantial efforts have been made by governments of affected countries and their partners to strengthen national disease control programmes, and to develop and evaluate new tools for the prevention, diagnosis, and treatment of these diseases. Global initiatives have sought to raise funds, commitments, and momentum. These efforts have seen important successes for some NTDs, including human African trypanosomiasis, visceral leishmaniasis, schistosomiasis, lymphatic filariasis, and trachoma, while others, such as rabies, are lagging behind 2030 targets.

Approaching elimination of any disease brings a new set of practical last-mile challenges, and reaching elimination brings the need to sustain success. We do not yet have all the tools required for the prevention or simplified diagnosis and treatment of all diseases slated for elimination as a public health problem. In addition, history has shown that as diseases approach elimination, funding and political commitment drop off. As disease burdens fall, so do clinical expertise, community awareness, and relevant health-seeking behaviour. Case-finding becomes more expensive as diseases become less common, and disease surveillance becomes patchy in the absence of sustained funding. Simplified test and treat programmes may be required to ensure prompt diagnosis and treatment of cases, but these are not possible where the needed diagnostic and therapeutic tools do not yet exist.

Many NTDs also face external challenges such as consequences arising from climate change, conflict, disruption due to outbreaks of other diseases or even pandemics, emerging zoonotic and environmental health threats, as well as continued socio-economic inequalities that have a direct impact on access to healthcare services, adequate housing, safe water, and sanitation.

As we approach 2030, what are the essential lessons learned from national and regional successes so far, what tools and innovations are still needed, and what are we missing in the push to accelerate the elimination of target NTDs as public health problems?