Q&A: The key to fighting NTDs in Africa

Mass drug administration programs have been critical in fighting soil-transmitted helminthiases and other neglected tropical diseases, but COVID-19 has jeopardized their progress, according to Carol Karutu, vice president of programs at the END Fund, a private philanthropic initiative working to combat the five most common NTDs in sub-Saharan Africa.

Parasitic worms that are spread via eggs in human feces are the cause of soil-transmitted helminthiases, or STHs. Usually found in areas with lower levels of sanitation, they contaminate the soil and reach individuals as they work the land, eat unwashed vegetables, or drink contaminated water.

STHs affect 1.5 billion people globally, according to the World Health Organization. Across Ethiopia, Rwanda, Zimbabwe, and Kenya alone, more than 40 million children are infected. Livelihoods, education, and the economy can see secondary effects when people don’t receive the necessary deworming medication, Karutu said.

That’s why countries run campaigns for mass drug administration, or MDA, enabling the delivery of essential medicines to all members of a specific at-risk population. School-age children are often the target group for STH efforts.

“[MDA programs] are critical because the prevalence of the worms in the soil is quite high, so you find [them in the] environments where these children live, where the adults live,” Karutu said.

Such programs often rely on medicine donations from pharmaceutical companies such as Johnson & Johnson. Since 2006, the company has donated 2 billion doses of mebendazole — which treats STHs — to WHO for rollout through MDA initiatives like those run by the END Fund, with an emphasis on reaching school-age children with a new chewable formulation of the medicine.

Speaking to Devex, Karutu discussed the importance of MDA and drug donations, the impact of COVID-19 on these initiatives, and what the future holds for tackling STHs and other NTDs.

This conversation has been edited for length and clarity.

What impact do STHs have on children and other populations?

Intestinal worms cause malnutrition, they cause anemia, they stunt [growth and cause] impaired cognitive development, and usually — based on the fact that somebody is quite malnourished — they could be susceptible to other diseases.

In addition to that, these soil-transmitted intestinal worms are responsible for significant morbidity. And in adults, they hamper the ability to work. They also adversely impact children’s school attendance and, as a result, they also create a knock-on effect on countries’ economies.

How key are mass drug administration programs to tackling STHs and other NTDs?

For the past 10 years … MDA programs [have been] very critical. … For now, because these worms are everywhere in the environment, MDA becomes the best way to deliver that treatment to those who need it. Obviously in the future — and that’s what we would like — is [to] get more treatments [to] reduce the infections or the intestinal worms within the soil or within the environment. Then, MDA [will] become less important. But right now, it is extremely critical.

Why are drug donation programs — like that for mebendazole from J&J — so important to the work you do?

What it means is, as we plan our programs, we are already assured that we have the drugs that we need to treat the populations. As we fundraise, we are fundraising for the delivery costs. It brings generally the cost of treatment down to almost 50 cents per child, and that makes treatment [through] … MDAs a very good buy in public health.

In addition, it really helps governments because … they are planning their annual budgets, which includes health. [This means] they don’t have to put in the dollars themselves. They can say, “Well, for this amount, we already have the drugs, and we already know that our MDA will take place.” So in a lot of ways, it also complements … [health ministry] budgets in the countries where we work.

How has COVID-19 impacted such programs?

With the closure of schools, it meant that the platform that we always used to deliver MDA was no longer available to us. It meant that we had to think very quickly and very innovatively because we didn’t want interruption of the MDA schedules. … That was the opportunity that COVID-19 offered. We had to think innovatively and see how to deliver MDA within the community [instead].

Obviously, the school platform remains the most viable … and it makes it a lot cheaper to deliver. … But there is also an advantage to doing it in the community, because then you are able to [reach] adults who don’t have kids in school. They are also learning about STH because … they are curious to know what’s going on, and that’s an opportunity for us to pass on more information about the prevention of STH.

The END Fund’s Deworming Innovation Fund, launched in 2020, “aims to accelerate progress in tackling worming infections” by leveraging drug donations and coordinating with governments and partners to deliver deworming treatment in four countries through 2025. What has the fund’s impact been thus far?

It seeks to work toward interruption of transmission of STH in four African countries: Kenya, Rwanda, Zimbabwe, and Ethiopia. It's a forward-looking, innovative partnership where a couple of donors came together in supporting — through the END Fund — the implementation of the deworming.

So far, we’ve done innovative things, including geospatial mapping in Kenya, Ethiopia, and Rwanda. We are currently executing the same in Zimbabwe. Once we have these results, we are hoping to work with the governments to revise treatment strategies because … we’ve been treating at a much broader level. … Once we get more granular, we can know where the infection really is, and that’s where we target.

Why is it so important for the global community to continue investing in STHs and other NTDs?

NTDs [are] truly neglected … and they impact 1.7 billion people globally every year. … The people that are impacted by NTDs are the poorest of the poor, so their voice is really not amplified enough. And if we, the international community, and also governments don’t support the poorest of the poor, then how do they come out of poverty?

Children, if they have STH — their learning, their schooling is impacted, and that means even their future. Studies have shown that children that are dewormed, in the future, earn more and also spend more in terms of consumption, [so] it does help the economy as well. By simply continuing to treat and support NTD programs, we are also helping low-income countries come out of poverty.

Why is the Kigali Declaration on NTDs so critical to future progress in NTD elimination?

We have the London Declaration that sought to achieve the WHO’s 2020 goals, and now we have the Kigali Declaration to take us through 2030. The reason for that is that the WHO developed a 2030 road map really looking at elimination and control of NTDs. … The road map in itself is a technical document, but the declaration is more [about] political will to achieve these targets.

When you think, “How will 2030 look?” you have to be able to start visualizing it now. That declaration in itself gives us that political piece to bring to the table as we think about elimination and control of NTDs, because we cannot … eliminate and control without the support of country governments.