Neglected tropical diseases from their origins to today: impacts of policy, funding and the COVID-19 pandemic

Abstract

Neglected Tropical Diseases (NTDs) are a group of 20 bacterial, viral, and parasitic diseases as defined by the World Health Organization that affect approximately a billion of the world’s poorest people, each year. Infection with one or more NTDs serves to keep people locked in poverty through the cost of treatment(s), from loss of productivity, and can result in lifelong symptoms, disfigurement, disability or death. These diseases are contracted from the bites of infected insects or animals, from contaminated water sources or foods and from poor hygiene and sanitation practices. The formation of the NTDs, as a group of infections, was a product of the Millennium Development Goals; the term coined in the early 2000s to delineate these diseases from the well-funded and well supported HIV/AIDs, malaria and tuberculosis for which there was significant advocacy. NTDs are neglected in terms of advocacy, funding (research, development and control) and global policy and media attention.

To better understand the current status of the NTDs, a number of mixed methods studies were undertaken within the body of work comprising this PhD, including: 1) an assessment of the current aetiology of NTDs, including symptoms, diagnostics, treatments and their global burden as defined by the Global Burden of Disease Study; 2) an evaluation on the effectiveness of community health education as a cost effective and long-lasting intervention geared towards behavioural changes as NTD control; 3) a review of the research and development funding of NTDs; 4) a scoping review of the impact that the global pandemic of COVID-19 has had on NTDs and lastly, 5) a case study to explore the impacts of COVID-19 on NTDs within Zambia, focussing on the opinions of local experts; policy makers, researchers, and international organizations working on NTDs in the country.

While the full implications of long-term effects of COVID-19 on the NTDs remains to be validated, the evidence presented in this thesis shows that control and treatment of NTDs was globally and universally affected by COVID-19, setting back years and in some cases, decades of progress towards control and elimination of these diseases. Interventions for disease control were delayed or cancelled and there is a resultant shortage of funds to complete NTD interventions as planned.

A significant and major hurdle to funding for NTDs is a lack of transparency in reporting of funding for NTDs from 2007 to 2023, from all agencies involved pre- and post- emergence of COVID-19. The NTDs routinely receive a fraction of the financial support required for their elimination as a public health problem and the funds vary annually making long term planning for control programs difficult. Without knowledge of the funds allocated and actual spend on NTD interventions and control programs, it is difficult to argue for increased budget allocation for the NTDs. Financing for NTDs needs to be adequate and consistent to reach and maintain the World Health Organization’s goals of eliminating NTDs by 2030.

Transparency on the side of donor governments providing foreign aid and recipient governments investing aid, to show how much funding is being provided and how those funds are allocated and utilized is essential. Increased transparency and long-term planning for NTDs would aid the global community to meet the targets in place for many of these conditions by 2030.

While advocacy is critical for resourcing for NTD research and development funding and for control activity the importance of community health education to NTDs, but specifically neglected zoonotic diseases (NZD) and their control program cannot be overstated. Giving communities educational programming adapted to their cultural practices, providing information about prevention, treatment, and hygiene can increase uptake of intervention programs and reduce the burden of NZDs and make interventions more cost effective. When introduced through schools using age-appropriate materials, there is greater potential for long term behavioural changes also reducing the burden of NZDs.

The case study in Zambia provides a unique look into the challenges of COVID-19 on the policy makers, researchers, governmental employees and international organizations working with NTDs before and after COVID-19. There are an infinite number of ways to divide funding to improve health, and there are no perfect answers on how to prioritize the elimination of NTDs.