Integrated Approaches to Disease Elimination

We stand to suffer a similar fate due to COVID-induced disruptions to global healthcare efforts, but on an amplified scale, across multiple geographies. This impact was already felt as early as April 2020, when Pakistan, one of two countries still struggling to eradicate wild poliovirus, suspended its vaccination campaigns due to the pandemic, leading 40 million children to miss out on polio vaccination. While Pakistan has since resumed its Pakistan Polio Eradication programme in July 2020, even temporary suspension to vaccination programmes increases the chances of disease resurgence.

So how can we harness the COVID-19 crisis to create more integrated healthcare systems that address preventable diseases of poverty? The NTD community needs to make a stronger case for ending the neglect. Now is a rare opportunity to do so. The world has seen, first-hand, how the health of individuals is intimately connected across the globe, and how the health of the people and health of the global economy are equally intertwined. Stronger, more integrated health systems will strengthen surveillance, early warning, and pandemic preparedness. We should be seeking resources to tackle NTDs with this in mind.

COVID-19 has also helped raise awareness of the importance of sanitation and hygiene in disease prevention. WHO’s new roadmap for NTDs, 2021-2030, lays out a plan for effective elimination efforts. It cites water, sanitation, and hygiene (WASH) as one of the core strategic interventions in tackling 18 of the 20 NTDs, including lymphatic filariasis, which infected over 56 million people worldwide in 2017. According to the Centers for Disease Prevention and Control (CDC), we can reduce WASH-related NTDs by as much as 78% around the world with better sanitation. The expansion of WASH marks a significant shift for the NTD community as it begins to adopt a more cross-sectoral approach to disease elimination.

There are benefits, too, from adopting a more integrated, cross-disease approach to mass drug administration. Ivermectin, produced by Merck & Co., is a highly effective treatment for the prevention of onchocerciasis, a NTD contracted from a parasitic worm transmitted by black flies, and for lymphatic filariasis, another NTD spread by parasitic worms transmitted by mosquitos. In 1987, Merck & Co. committed to donate Ivermectin free of charge for as long as needed through the Mectizan Donation Programme. There has since been interest in repurposing Ivermectin, and it is now being used to treat certain cases of malaria, for example, and there are even clinical trials to assess its potential use in the fight against COVID-19, although there is little hard evidence of its effectiveness at present.

At the newly formed Global Institute for Disease Elimination (GLIDE), we see the intrinsic value of promoting and adopting multi-sectoral, multi-stakeholder and cross-border approaches to disease elimination. This approach calls for actors across all levels and geographies to engage in ways that facilitate collaboration, address fragmentation, and avoid duplication of effort. It is not always going to be straightforward but if we leverage these opportunities, we are likely to see more impactful, lasting effects with global reach.

Despite its challenges, COVID-19 offers us the opportunity to think more synergistically, so that resources can serve communities suffering from COVID-19 and NTDs. As past outbreaks have shown, deaths from preventable diseases increase dramatically when healthcare systems are overwhelmed and fragmented. This shift to integrating the prevention and treatment of NTDs into routine primary healthcare services brings us one step closer to achieving universal health coverage (UHC), in which no disease, and no person, is left behind.  

Simon Bland, CEO of the Global Institute for Disease Elimination (GLIDE), a new global health institute focused on accelerating the elimination of malaria, polio, lymphatic filariasis and onchocerciasis.