Working in partnership with a group of philanthropists and the U.K. Department for International Development has “allowed for a new way of doing business” in the fight to eliminate neglected tropical diseases, according to USAID’s head of NTDs.
The term NTDs refers to a group of illnesses that affect the poorest communities in the world, killing approximately 150,000 people every year, and disabling 1.6 billion. But given the relatively low death toll compared to other global killer diseases, they tend to be overlooked by donors.
The real impact of these diseases are felt long term through stunting, malnutrition, disability, and pain and suffering, which can perpetuate cycles of poverty as children miss school and adults are unable to work.
Earlier this year, the U.S. Agency for International Development marked 10 years of work on NTDs and launched a new five-year strategy to eliminate trachoma, the world's leading cause of preventable blindness, and lymphatic filariasis, a painful and disfiguring parasitic infection transmitted by mosquitoes.
This means 1.3 billion more treatments have been carried out which have prevented more than 585 million people from needing treatment for NTDs.
The good news is that many of these diseases can be eliminated with improved sanitation, preventive treatments, and mass drug distribution campaigns, and USAID, working with its partners, has committed to an ambitious new strategy to achieve this.
Devex spoke to Emily Wainwright, head of NTDs at USAID, to find out more about the new strategy and what the agency has learned from the past 10 years of NTD programming.
Why are neglected tropical diseases important?
NTDs are diseases which haven’t drawn a lot of attention from donors in the past because the emphasis isn’t on mortality reduction, instead it’s about reducing disabilities caused by blindness, or illnesses which contribute to poor cognitive development and stunting and poor attendance in school.
USAID’s health program places an emphasis on reducing mortality for women and children around world. But now as we are seeing under-5 mortality rates decline, this presents us with an opportunity to move from focusing just on surviving, to helping people thrive. The NTD portfolio really gives USAID the opportunity to complement its mortality reduction work with investing in the chance to help children thrive and fully grow.
How did USAID start working in this space?
Ten years ago when USAID first started working on NTDs, this was all pretty new. There were drugs out there to treat NTDs and they were being donated by the pharmaceutical companies, but nobody was taking up the offer to distribute them. Fortunately, a group of very determined scientists brought this to the attention of the U.S. Congress and we started with a $15 million budget across five countries.
The first year was a test and we delivered 36 million treatments to people in need and we were able to demonstrate that NTDs were a good focus. In 2009, Congress increased the budget and we now spend $100 million a year on NTDs across 31 countries, and provide 300 million treatments every year.
We continue to leverage far more than we spend through donated drugs — currently every $1 we spend brings in $26 in donated drugs. We have also calculated it costs 63 cents to treat a person, which represents extremely good value for money.
Partnership was essential to the success of this work and this included investments from DfID, and the Queen Elizabeth Diamond Jubilee Trust. Over the past 10 years, pharmaceutical companies have given more than $11 billion worth of drugs free of charge to the countries where USAID supports mass treatment campaigns. These companies include Eisai, GlaxoSmithKline, Johnson & Johnson, Merck & Co., Merck Serono and Pfizer.
What does the next five-year strategy look like?
We recently announced a new five-year strategy to help eliminate and control NTDs, aiming to provide 1.3 billion treatments and leverage $6 billion in donated drugs in order to prevent more than 585 million people from contracting NTDs.
Trachoma, lymphatic filariasis, onchocerciasis, soil-transmitted helminths and schistosomiasis are the main NTDs being targeted and the aim is to ensure that by 2020, 400 million people no longer need treatment for lymphatic filariasis, and 186 million do not require treatment for trachoma.
Moving forward we continue to work closely with DfID, who are the second largest NTD donor after us in terms of program implementation. We are also working with the third largest NTD donor, the END Fund, which is a private initiative supported by a number of philanthropists and high networth individuals.
These partnerships have really allowed for a new way of doing business. Working with DfID has enabled us to expand our reach and spread across 30 countries and we have been able to fill the gaps in each others’ portfolios such as expanding geographic coverage across a country and filling treatment gaps to ensure all five diseases are covered.
Working with private philanthropy has brought flexibility and greater resources to our work. Where in the past agencies like USAID were the major ones investing in the space, philanthropists are now stepping in to fill the gap and I’ve been very impressed by how thoughtful and well-informed a partner the END Fund has been. This is a great example of private philanthropy working well and being coordinated with foreign assistance.
Philanthropists are also able to play a role in expanding diseases treated — at USAID we would like to focus on eliminating diseases you can treat and turn off, so we can provide support to more countries.
The END Fund has been willing to step in and work with governments to set up programs for diseases with a longer treatment time line. For example, deworming requires a 20-year effort of repeated treatments and sanitation and hygiene programs to stop people getting reinfected. Partnering with the END Fund has enabled us to focus on the elimination stage knowing the philanthropic funds can take on the longer-term programming.
What more needs to be done?
Our program has grown up enough and demonstrated its value and it’s become clear that we have developed a powerful tool or platform for reaching the poorest of the poor. So now we are starting to think about how we can draw attention to the opportunity these large community distribution platforms offer and not just turn the programs off once they reach their goals, but instead see if we can use them to reach people with other life enhancing interventions.
We will be raising this with country governments who may not fully appreciate that they have a program which reaches the most disempowered communities and which can be used in a more consistent way within other health service programs.
What are the lessons learned?
Some of the key lessons learned from USAID’s past 10 years treating NTDs, and which have informed our new strategy, are around the power of the private sector. When the private sector really gets behind something they can be a very powerful partner in achieving global public health goals.
The hallmark of our success has been integrated treatment — many countries used to conduct separate treatment campaigns for each disease, but now USAID combines treatments so that children in schools receive preventive treatment for both schistosomiasis and soil transmitted helminths at once. In community distributions programs we can provide treatment for lymphatic filariasis, onchocerciasis and soil transmitted helminths at the same time. This has enabled us to roll out treatment much faster to more people and get quicker results.
Finally, the work has taught us that you can never have enough political commitment and leadership from national programs, and it’s all about partnership any way you look at it.
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