Let’s Move the Agenda from Control to Elimination of NTDs

By Prof Louis Albert Tchuem Tchuenté, Pamela Bongkiyung & Prof Russell Stothard

Who has the perfect answer to controlling or eliminating a disease? It gets more difficult when simply using medication does not guarantee no re-infection. In the case of Schistosomiasis and Soil-transmitted Helminthiasis, in the agenda of elimination one wonders if what we need are more parasitologists in the affected areas or getting the current ones to be more publicly engaged in educating the population?

Prof. Louis-Albert Tchuem Tchuenté who has been working on schisto control for over three decades emphasises the control of Schisto as many other NTDs is a long-term combat. That means a lot of investment and capacity building at all levels. It also needs to have the involvement of many actors and stakeholders. It is difficult for a single organisation or a single group to interrupt the transmission of this disease. That is why intersectoral cooperation, partnership and involvement of stakeholders at all levels is very important. Policy makers, scientists, community health workers, health personnel staff, teachers and all category of the population need to be involved in this fight.

Training of parasitologists is very important because in the African setting more needs to be done. It is vital to optimise and adapt the strategy according to the different transmission setting. The same strategy cannot be deployed as it will not have the same impact. That is why for example in Cameroon, when you compare the current distribution of Schistosomiasis to what was done 25 – 30 years ago; there is a significant decrease in some areas. We have examples where transmission has been interrupted, we have many examples where prevalence has been lowered to more than 80 – 90 percent in some of the localities.

But we still have some challenges where the dynamics vary.  The disease prevalence is reducing but variances remain due to the existence of conditions that allow for the transmission cycle to continue. That is why moving from control to elimination requires integration is intensified. Part of this requires increasing capacity building by training more students, investment, health education, change in behaviour and increase awareness of the population. It is a huge challenge.

The Sustainable Development Goals (SDG) has as one of its key point a call for countries to invest more for the control and elimination of Neglected Tropical Diseases (NTDs). Therefore, for the transmission of schistosomiasis to be interrupted there is a need for countries to invest more for the elimination of this disease. When more is invested, this means that we also should invest in equipment, in sanitation, in access to water and change of the environment or that you improve the hygiene.

Prof. Tchuem Tchuenté said: “Granted, the control of schistosomiasis is very challenging, it is a long-term commitment which is feasible. At this stage, there are tools and strategies in place to interrupt the transmission of schistosomiasis; what we need now mainly in Africa is that we must change our approach to become more ambitious. We must move completely from control to elimination. This shift in paradigm should be clearly effective and endorsed by all African countries.”

He believes that when we keep the word ‘control’, we can be satisfied with morbidity control and therefore control morbidity forever. If the agenda shifts to elimination, then the momentum and the target aligns with that shift. Lymphatic Filariasis (LF) programmes have used this approach. The LF programme’s target for years has been elimination and this makes us put a lot of effort into its elimination.

There is a tendency to become complacent when you reduce a disease to the level where it no longer constitutes a health problem. This is when we need to be most careful as you could miss when the disease makes a come-back again. But if you have a target for elimination, this means additional or further efforts to interrupt the transmission and then to move to the surveillance phase. Japan is one of the good examples. In the 1960s, there were some areas in Japan where the prevalence of schistosomiasis was higher than in most parts of Africa. But they decided and launched a ‘zero parasite’ campaign. From the beginning, it was not about control but zero parasites; meaning elimination. In less than 20 years Japan has eliminated schistosomiasis. China started with control but then rapidly moved to the elimination phase. Now their objective is to eliminate everywhere in China.

The COUNTDOWN project is in a key position to contribute to this agenda. Our research aims to increase acceptability, affordability, accessibility and availability of Neglected Tropical Diseases solutions. Our multidisciplinary approach is investigating efficient methods to cost-effectively upscale mass drug administration programmes, thereby moving the agenda closer to elimination.

With this word elimination, you must put the necessary efforts and investment to interrupt transmission. In Africa, the time is right to think about this and to shift completely from control to elimination. It is not easy as this will require a lot of investment. We need to raise momentum and commitment from the government, including investment. That is what the SDG is about; as espoused in one of its goals –  for countries to invest more for the elimination of NTDs!

To find out more about our research visit our websites:

http://www.countdownonntds.org

http://countdowncameroon.org/

Follow our activities via our Twitter accounts:

@NTDCOUNTDOWN  @NTDGHCOUNTDOWN  @COUNTDOWNNTDCAM  @COUNTDOWNLR  @COUNTDOWNNG

 

 

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China and Africa Join Forces in fight to Eliminate Schistosomiasis

by Prof Louis-Albert Tchuem Tchuenté, Pamela Bongkiyung, Prof Russell Stothard

In the fight against Neglected Tropical Diseases (NTDs), it has become obvious that learning from other countries’ successes will help many others to control and eliminate these diseases. This is how the China-Africa meeting and collaboration came about in 2012.

Whilst on a visit to the Liverpool School of Tropical Medicine, we caught up with Prof. Louis-Albert Tchuem Tchuenté regarding the China-Africa Meeting on Schistosomiasis Elimination and Training Course on Malacology, organised in Cameroon from the 24 – 28 October 2016.

Prof. Louis-Albert Tchuem-Tchuenté is an NTD Ambassador for Liverpool School of Tropical Medicine. He also heads the Centre for Schistosomiasis & Parasitology in Cameroon and is a professor of parasitology. He lectures at the University of Yaoundé I and is Country Director for the COUNTDOWN project in Cameroon. His expertise in Schistosomiasis and Soil-Transmitted Helminthiasis spans over 30 years. He is Cameroon’s National Coordinator for the control of Schistosomiasis and Intestinal Worms.

Discussions with Prof. Louis-Albert revealed that this China-Africa meeting started a long time ago. Given that China has a vast amount of experience in Schisto control and has successfully eliminated Schisto in many of their provinces; many African countries still struggling with schisto can learn from the Chinese experience. Very few areas have Schisto in China and Schisto has been eliminated as a public health problem there. The highest prevalence is probably 1-2 percent and the plan now is to interrupt the transmission everywhere.

According to Prof. Louis-Albert, China invested a lot on their elimination agenda including treatment, environmental modification and snail control. Most of the schistosomiasis cases in China are zoonotic because they have a lot of animals who act as reservoir hosts. That is why they have invested a lot of money to modify the environment so that the animals do not maintain the parasite life-cycle.

One of the highest components of this is the snail control. Schistosomiasis has two main hosts: vertebrate hosts (including human beings and animals) and the snails. In the transmission, you have both factors that make this happen. The snails are in the water and if you don’t change the environment, the snails remain present. Even if you reduce the transmission, then at some stage it just needs one person who is infected to defecate or urinate into the environment, to rebuild the transmission cycle. That is why it is very important to control the snails. The Chinese have done so successfully and have vast experience in snail control.

Based on this, it became important for African countries to benefit from the Chinese experience. That is why the World Health Organisation(WHO), together with the Chinese government, decided to have this China-Africa cooperation, for the elimination of schistosomiasis in Africa.

This began at the governmental level between China, WHO and the governments in Africa. The agenda was further discussed at the China-Health Ministerial Forum that reviews valuable health development issues. During the 2013 Minister’s Forum held in Beijing, an agreement was reached on this partnership and the initiative approved. This move was necessary to progress granted things take time at the government level. That is why the China team, WHO and African governments decided to start an institutional-based cooperation. This initiative was developed to sustain a China – Africa Cooperation for Schistosomiasis Elimination.

China has several provinces that are endemic for schistosomiasis and it was important to link these provinces to different African countries depending on the relationship they have. That is why in the first phase, ten countries were selected in Africa and were linked with different provinces in China.

The first meeting to set-up the institution-based cooperation was launched in 2015, in Malawi. The meeting launched the initiative and the memorandum of understanding between the partners. The memorandum was signed between different African institutions and Chinese institutions for research. The meeting in Cameroon was the second meeting and it was focused on snail and malacology training. Another component of the training was using mollusciciding to control the snails. The Chinese team and ten countries participated in the meeting in Cameroon.

The rationale for collaboration is clear as it fosters relationships between various actors and allows in-depth knowledge of what works in practice. This knowledge gets refined for better use through creating more cost-effective solutions which are sustainable in the long term for NTD control and elimination.

To continue this cross-sharing of knowledge, COUNTDOWN will be at the upcoming British Society of Parasitology Autumn Symposium taking place on 28th September 2017 taking place at The Linnean Society in London. This session will focus on ‘The Multidisciplinarity of Parasitology: Host-Parasite Evolution and Control in an Ever-Changing World’.