Opinion: Urgent call for integrated approaches to disease elimination

Today, presidents, philanthropists, community and business leaders meet on the sidelines of the 26th Commonwealth Heads of Government Meeting in Rwanda to host the Kigali Summit on Malaria and Neglected Tropical Diseases. The summit will call on global leaders to reaffirm their commitment to the Kigali Declaration on Neglected Tropical Diseases, which aims to mobilize political will to achieve Sustainable Development Goal 3 — which, among other things, calls for an end to NTDs.

The summit will also reinforce calls for the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria’s investment case with at least $18 billion to fund its next three-year cycle of grants for HIV/AIDS, TB and malaria, pandemic preparedness, and health system strengthening.

The importance of achieving these goals cannot be underestimated. Combined, malaria and NTDs, a group of 20 infectious diseases prevalent across low-income communities in tropical and subtropical areas, affect nearly a quarter of the world’s population. Yet funding to support programs tackling these diseases is far below the level needed to eliminate them within a generation. Limited resources and changing environments have consequently led global health leaders, including the World Health Organization, to advocate for more integrated approaches to tackling these diseases.

Integrated approaches to disease elimination look at efforts to improve coordination, cooperation, collaboration, and synchronization of prevention, treatment, care, support, and surveillance that target multiple diseases, rather than focusing on each disease individually.

When there is a clear rationale for integration between two or more initiatives, such approaches can also facilitate more integration and synergies between priority public health programs and primary health care. Integration can also examine cross-sector relationships in water, sanitation and hygiene, and education, for example. There are several ways in which we can consider an integrated approach to the elimination of malaria and NTDs.

Firstly, malaria and NTDs thrive in areas of poverty, where access to quality health care, clean water, and adequate sanitation is scarce. Consider the geographical overlap: almost 40% of the global burden of NTDs and 95% of malaria cases are found in Africa. Malaria and lymphatic filariasis, for example, are transported by the same vector — the mosquito — so there’s a strong case to make for integrated vector management. Available data shows that the use of treated or untreated bed nets and indoor residual spraying for malaria control concomitantly reduced filarial rates.

We should also be investing more in research and development into new tools like diagnostics, vaccines, and treatments that can target multiple diseases. For example, onchocerciasis and lymphatic filariasis — NTDs prevalent across the global south — are both treated with ivermectin. In Africa, community-wide mass drug administration with ivermectin for onchocerciasis and ivermectin plus albendazole for lymphatic filariasis is the core strategy to reduce transmission.

There is currently a study underway exploring the use of ivermectin as an endectocide to tackle malaria. In some cases, vector control is also used as a complementary intervention strategy. Identifying synergies in treatments and using existing tools and platforms to distribute multiple drugs to target diseases will accelerate the elimination of NTDs which thrive in resource-poor parts of the world.

Eliminating malaria and NTDs will be a major milestone in our efforts to achieve universal health coverage. COVID-19 has shown the critical importance of investing in strong public health systems that can both respond to endemic diseases, such as malaria and NTDs, and build global resilience against future pandemics and other health threats.

The platforms built by malaria and NTD programs have been at the forefront of the COVID-19 response, and the evidence shows that increased investments against these diseases will further strengthen the health systems that will protect humanity against future pandemics. Breaking down silos among health programs can allow for those programs to learn from each other, leverage synergies, and increase the effectiveness and reach of scarce resources.

The benefits of eliminating these infectious diseases go beyond health and will yield economic returns. Not only are malaria and NTDs debilitating to the health of billions of people across the world, but they prevent children from going to school and adults from going to work, costing endemic countries billions of dollars a year and hindering economic growth. The annual direct and indirect costs of malaria in Africa, for example, is estimated to be more than $12 billion, slowing the continent’s economic growth by up to 1.3% per year.

The arguments are clear. That is why, on this historic day, the representatives of the Kigali Summit are calling on endemic and donor countries, civil society, private sector, academia, and nonprofit organizations to work together to ensure global progress against these preventable diseases is not only maintained but is accelerated.

Increasing investment in integrating malaria and NTDs programs, as well as wider health care and cross-sectoral programs, will lead to more efficient use of limited funding, better utilization of data to help those in need, and better delivery of lifesaving tools, which will help end malaria and NTDs within our lifetimes.