Beyond 2020: A discussion on Neglected Tropical Diseases at the Bill and Melinda Gates Foundation, London

By Russell Stothard Liverpool School of Tropical Medicine

I was fortunate today to be invited to attend this discussion arranged by the strategic policy group within Bill and Melinda Gates Foundation. I was representing COUNTDOWN, along with my two colleagues Lorenzo Savioli and David Molyneux. This meeting followed on from the launch of the World Health Organisation’s 3rd Report on Neglected Tropical Diseases.

The WHO’s report is today’s foremost Neglected Tropical Disease (NTD) policy document. It reviews progress towards control and elimination of several diseases and calls for increased financial support and mobilisation of resources within the health system to secure progress towards control and elimination targets up to 2020.

Today’s meeting addressed a different agenda – tomorrow’s health policies. More specifically, those that take us towards 2030 and address the Sustainable Development Goals (SDGs). It is without doubt that this coming year is very important within the global health policy arena and we hope to see a fruitful marriage between the WHO’s report and the soon-to-be-released 17 SDGs. Dove-tailing these two projections and policies, however, is complex and brought to my mind the often quoted Yogi Berra who once said “The future ain’t what it used to be”.

The meeting’s objectives were introduced by Don Bundy, who has recently joined the Bill and Melinda Gates Foundation from the World Bank. These were then elaborated by Richard Horton, the editor of the Lancet, who went on to expertly chair the meeting and drew out many observations, questions and answers from the 40 or so delegates.

We were joined by video link to the WHO-AFRO offices in Democratic Republic of Congo and to the newly installed regional director Matshidiso Moeti. She confirmed her strong commitment to the control and elimination of NTDs within the Africa region and was supported in local discussions by Julie Jacobson from the Gates Foundation and by Ifeoma Anagbogu, Federal Ministry of Health, Nigeria. Both Julie and Ifeoma were visiting Brazzaville and it is by good fortune that I will meet with Ifeoma next week in Abuja. Once there we will discuss future activities of COUNTDOWN within her country, being able to quickly follow-up on many of the points being raised today.

How will the SDGs take NTDs into account?

I must admit I am not very familiar with the SDGs and their 169 associated targets but I am more aware of the Millennium Development Goals (MDGs), especially how ‘other diseases’ in MDG 6 made scant reference to NTDs. As introduced by Dominic Haslam of Sightsavers, it is clear that NTDs are now specifically mentioned in SDGs as part of promoting universal healthy lives and fostering general well-being.

As the SDGs are currently being formulated, as well as development of indicators to record and track progress, Christopher Fitzpatrick, WHO outlined the current NTD-specific indicator. This will attempt to encapsulate progress in control and elimination of NTDs by 2030 within a simple metric. Obviously this metric will be quite complicated in its calculation and will be discussed at length but it will help to unify efforts within the international health agenda to highlight activities against NTD across the world.

During discussions, it was felt that the NTD community should be proud to have achieved so much in the past decade. This ranged from forming equitable public-private-partnerships to the mobilisation of the pharmaceutical sector to donate millions of tablets of essential medicines to national NTD control programmes. Indeed, NTD programmes are cost-effective and are addressing very real health inequities in many impoverished regions of the world.

Addressing present and future hurdles

As might be expected, such large-scale deployment of medicines at the coal-face of control, which often operates outside the final level of primary health care infrastructure, has some unique challenges. Foremost, is the realisation that even with donated medicine there still needs to be considerable financial outlay and manpower to cover costs and delivery of medications to affected communities.

Moreover, developing methods to sustain this and promote the equitable administration of drugs to those in need with regard to age, gender and marginalisation is not trivial. Although these issues were not specifically addressed during the presentations, they were raised during discussions and how inter-sectoral dialogue between, health, education and water/sanitation was needed. The latter might consider using NTDs as ‘tracers’ of progress toward this end.

We should not lose sight of the efforts needed to achieve WHO 2020 targets. During the meeting it became increasingly clear that placing NTDs explicitly within the SDGs, with an associated specific indicator, is a tremendously important step. To conclude I therefore very warmly congratulate those philanthropic organisations and individual NTD advocates who have taken us to this point with a clearer vision towards 2030.

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