Neglected Tropical Diseases: Time for a fresh approach

By Sally Theobald, Liverpool School of Tropical Medicine

A pre-Inca piece of pottery featuring a patient with leishmaniasis, an ancient Japanese water colour painting depicting a man with elephantiasis, and a 14th century manuscript of someone with leprosy with a warning bell. LSTM’s newly appointed Senior Professorial Fellow Prof Lorenzo Savioli used these images in his a keynote address to remind us of the long-lived links between poverty and Neglected Tropical Diseases (NTDs).

Sadly the vicious cycle of poverty, social marginalisation and NTDs is still alive and well in 2014. NTDs are among the most common infections of the “bottom billion” – people who live on less than $2 a day. They affect some of the poorest and most marginalized communities in the world.

NTDs can cause chronic, debilitating, disabling, stigmatizing and disfiguring conditions that further exacerbate poverty by limiting the options and livelihoods of infected individuals and their families. Lorenzo explained that the broader social and physical environment shapes risk and vulnerability to NTDs.

Setting goals and meeting targets

Lorenzo outlined the processes and alliances that were behind the Roadmap for implementation on NTDs, which was launched in January 2012. He argued that this has transformed the focus on NTDs from romantic diseases embedded in the post-colonial era to health issues whose elimination requires clear systematic and accountable goals and milestone for action.

There is momentum for change.

The London Declaration (2013) pledged to control or eliminate at least ten of these devastating diseases by the end of the decade. Later in 2013 the 66th World Health Assembly endorsed the Declaration and it was signed by all member states.

NTDs are on the political agenda. It is time to build the relationships, systems, and infrastructure to promote universal health coverage to preventive chemotherapy, diagnosis, and vector management and control.

New alliances and partnerships to tackle NTDs

Movement towards universal health coverage for multiple NTDs requires new alliances and partnerships. It must be underpinned by careful health systems strengthening and an in-depth analysis of the opportunities, challenges and possible unintended consequences from a health systems perspective. It will be important to capture the voices and perspectives of front line health workers and understand the challenges they face in their critical role in addressing NTDs.

Lorenzo is part of the newly formed COUNTDOWN Consortium, which is funded by the UK Department for International Development.

In COUNTDOWN we will use implementation research to produce evidence from multiple contexts on the links between NTDs and poverty and we will work in partnership to promote pro-poor and gender equitable responses. The project provides an opportunity to conduct a health systems analysis that will enable us to better understand the most effective strategies to work with Community Drug Distributers (CDDs) and Community Health Workers. These workers are vital if we are to extend the scaling up of Mass Drug Administration to hard to reach communities and build the resilience of vulnerable and marginalized people affected by NTDs. Multi-sectoral action is necessary to tackle NTDs and in COUNTDOWN we will foster cross sector working, for example with  sanitation, water and agricultural sectors.

Lorenzo was speaking at the Health in Humanitarian Settings Research Symposium. The symposium is run by current and previous Masters students and is supported by ReBUILD.

COUNTDOWN partners include: the Liverpool School of Tropical Medicine (lead), the Cameroon Ministry of Public Health; the Centre for Schistosomiasis and Parasitology (Cameroon); the Liverpool School of Tropical Medicine; Ghana Ministry of Health; FHI 360; Liberia Ministry of Health and Social Welfare; and Pamoja Communications.

To find out more about COUNTDOWN contact Rachael Thomson –

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