Can partnerships and pooled funding drive NTD elimination?

Neglected tropical diseases, or NTDs, are a group of 21 preventable and treatable conditions affecting over one billion people primarily in impoverished communities furthest from access to health care services. Despite their prominence, they remain largely overlooked by donors — often sidelined in endemic countries where more immediate or higher-profile health priorities take precedence.

The World Health Organization’s first road map on NTDs, released in 2012, laid out ambitious targets for 2020. Most were not met. A revised strategy for 2021-2030 now aims for a 90% reduction in people needing interventions and the elimination of at least one NTD in 100 countries by 2030. But achieving this will require sustained, coordinated investment.

At a Devex roundtable hosted on the sidelines of the 78th World Health Assembly and sponsored by the END Fund — a private philanthropic initiative focused on NTD elimination — global health leaders explored how better-aligned funding strategies and stronger partnerships with national health systems could help unlock the resources needed to reach elimination goals.

These were the key takeaways:

1. Country leadership is essential, but needs more support

While country ownership remains central to eliminating NTDs, speakers emphasized that leadership alone is not enough. “We can’t talk about government-led programs without discussing the key things they want out of it,” said Dr. Sultani Matendechero, senior deputy director at Kenya’s Ministry of Health. There was broad agreement that national leadership must be matched with deeper investment in advocacy, policy support, and sustainable financing to ensure health priorities are not only heard but also funded and implemented.

Kenya — which successfully eliminated Guinea worm disease in 2018 and interrupted the transmission of onchocerciasis, or river blindness, and human African trypanosomiasis, or sleeping sickness — was cited as a model for how strong partnerships and government alignment can drive results. But concerns remain about long-term sustainability, particularly as external funding declines and countries are expected to shoulder more of the burden. “We need to now bring to center stage how we can start having financial sustainability,” Dr. Matendechero urged. Another participant pointed to the lack of a dedicated global financing mechanism: “We don’t have global funds for NTDs like we do for AIDS.”

The role of the World Health Organization was also a point of discussion. With increasingly limited resources, speakers stressed the importance of WHO supporting — rather than “duplicating or replicating” — country-led efforts, calling for complementary strategies that strengthen existing systems.

Despite these challenges, there was a hint of cautious optimism. One participant described NTD programs as “one of the few activities that we have funded and engaged with where I honestly believe there is full country ownership — real country leadership and expertise, and tremendous clarity around an elimination agenda.” The aggregation of private philanthropic and corporate capital, combined with strong local leadership, has created a solid foundation, they said — but one that still needs continued support.

2. Integration into national health systems is key

Sustainable elimination requires NTD programs to be integrated into broader health systems, as opposed to being adjacent to them. While donor-led initiatives have succeeded in rapidly expanding treatment access and reducing disease burden, these models fall short when it comes to long-term sustainability.

Speaking to Devex after the event, Claus Runge, chief health equity officer at Bayer, stressed that “NTD care should be primary care — then you remove the N from the NTD.” He argued that for diseases with high prevalence, regular screening must be part of basic health services before exploring new financing models. “It needs to be ingrained into the basics,” he said.

Speakers also emphasized how Togo, for example, became the first country to eliminate four NTDs by 2023 thanks to strong government leadership and a deliberate strategy to integrate NTD work into its health infrastructure.

Following the roundtable, a senior representative from the Gates Foundation highlighted the importance of pharmaceutical companies’ drug donation programs in this context: They “form the bedrock upon which the low-cost, high-impact we’ve seen to date has been built. These partners remain central to how countries will achieve their elimination targets.”

However, many countries remain locked in short-term funding cycles that undermine systems development. “Many of us, particularly donors, sort of set up these parallel systems. We’re responsible for these very cool schemes of funding,” said one speaker, adding, however, that “when we come to a country and we say …‘This is the issue that needs to be fixed,’ the country will say, ‘Well, this isn't my priority.’”

Going forward, the emphasis must be on aligning investment with country-identified priorities and strengthening the foundation of public health delivery.

3. Pooled funding is helping de-risk innovation

NTDs struggle to attract commercial investment due to limited market incentives, but pooled philanthropic funding is beginning to shift that. By aggregating capital and sharing risk, this model allows funders to collectively back new approaches that individual donors might otherwise avoid.

As one speaker said, “Innovation is how we remove neglect from the activity,” explaining how the key has been shared funding structures. “Aggregating private capital allows you to sustain multicountry, national-scale programs over a sustained period of time — and that’s literally the only way to get to elimination.”

Another speaker credited the Reaching the Last Mile Fund — a 10-year, multidonor initiative launched in 2017 by the United Arab Emirates and the Gates Foundation and managed by the END fund — with helping drive progress on NTDs through targeted investments and strong government coordination. Milestones such as Niger becoming the first African country to eliminate river blindness were seen as a direct result of this approach.

Still, collaboration at scale brings challenges, particularly around governance and implementation. “There are a lot of growing pains around governance and what works,” a speaker noted. “While we are aligned on the mission and have brought in the money, there are also disagreements about how we achieve the mission.”

Some donors are still attached to legacy approaches, hence why speakers also emphasized the importance of making sure that countries have a meaningful voice in how programs are implemented. “We didn’t want to enforce an implementing partner on a country when that partnership didn’t work,” one speaker from the END Fund said. “And frankly, that was not easy — because it’s easy to just keep doing what you’re doing and expect the same results.”

4. New headwinds are reshaping disease patterns and responses

Speakers raised the emergence of new threats such as climate change, which is shifting how and where NTDs spread, leading to new outbreaks in areas previously unaffected — and an even greater urgency to eliminate these diseases.

“We are seeing sleeping sickness coming back to Ethiopia,” noted Vanina Laurent-Ledru, director general of Foundation S – The Sanofi Collective, stressing that “we cannot continue working the old way” amid shifting conditions.

To respond effectively, speakers emphasized the need to recognize the interaction between climate change and the spread of NTDs — work that the END Fund is already advancing in partnership with WHO. This will require investing in research to understand how environmental shifts — from climate pressures to population movement — are affecting both the diseases themselves and the implementation of NTD programs.

Speaking to Devex after the event, Jeremy Knox, head of policy for infectious disease at Wellcome, noted that philanthropy also has a unique role to play: He noted how philanthropy can tackle “more difficult research questions” and invest in “early-stage product development where there is a higher risk and a much higher level of uncertainty.” This role, he said, will be critical for addressing emerging threats like drug resistance and climate change that could derail elimination efforts.