Symposium Neglected Tropical Diseases

The Symposium focussed on consolidating global, regional and national efforts to strengthen the measurement of NCD prevention policies, programmes, research and laws, with a view to defining measurable NCD prevention targets in the years ahead. During the meeting, we will discuss the global situation of NCDs, evidence-based practices, and prevention policies targeted towards the developing countries. Speakers will include international experts in the field of NCDs.

By organizing the symposium, we aimed to understand the current situation of the NCD public health programmes, describe the future policy and research directions, promote exchange of ideas and encourage scientific debate and foster networking, partnerships and opportunities among experts from different fields.

Topics and Speakers:

• Global Approaches to Neglected Tropical Diseases - Dr. Olaf Horstick, Institute of Public Health, University of Heidelberg, Germany He started the talk by clarifying the concept of NTDs and highlighting that there were different classifications of neglected tropical diseases. He said we however, could all agree that NTDs affected neglected populations mostly in tropics/subtropics, are related to and create poverty and there is currently low spending on research development and control. He mentioned that approaches to NTDs currently comprised of a three-pronged approach (broader coverage with rapid-impact interventions, strengthened vector control & improved surveillance). It was stressed that seven NTDs could be controlled or eliminated through low-cost rapid impact packages of essential medicines, many of which are now donated by multinational pharmaceutical companies. He shared experiences with NTD control approaches for Chagas, Dengue, Guinea worm and Onchocerciasis. This highlighted the differences is control approaches based on the situational context and the biology of the diseases. He concluded by sharing the targets and milestones for control of NTDs.

• South – North Collaborations - Prof. Dr. Michael Hoelscher, Ludwig-Maximilians-Universität München, Munich, Germany Prof. Dr. Michael Hoelscher revisited the history of tropical medicine as dating back to the colonial era when tropical medicine was primarily oriented to preserve health of the colonists; medicine for the native workforce concentrated on the need to keep them active producers. Afterwards he shared insights on what the roles of the ‘North’ and ‘South’ were in international research cooperation. He stressed that it is important for southern researchers to define, fund and conduct their own research agenda. However, he pointed out the fact that many southern researchers are confronted with obstacles such as poor funding, inadequate infrastructure and lack of scientific know-how, and little influence on the international scientific agenda. He gave an example of a successful collaboration, The NIMR- Mbeya Medical Research Programme in Tanzania. This is a collaboration between the University of Munich, Tanzania Ministry of Health and the Walter Reed Army Institute of Research.

• Experience from Ethiopia - Prof. Berhanu Erko, Aklilu Lema Institute of Pathobiology, Addis Ababa University, Ethiopia Prof Erko gave an overview on NTDs in Ethiopia, the prospects for program integration and highlighted the new National Master Plan for NTDs adopted in 2013. Achievements so far recorded in NTD control in Ethiopia include the integrated mapping of Malaria and Trachoma, as well as Schistosomiasis and soil-transmitted helminths. There is also combined treatment of Lymphatic filariasis with ivermectin and albendazole in Onchocerciasis endemic areas. The country target is to have established a sustainable integrated national NTDs control programme to by 2015, capable of achieving the goals of individual vertical programmes. The key strategies to achieving these he said were mass drug administration, case detection, transmission control, as well as good WASH (water, sanitation and hygiene) programmes.

• Experience from Tanzania - Dr. Mwelecele Malecela, Director, National Institute for Medical Research, Tanzania Dr Malecela began with a brief history of NTDs, highlighting that the 66th World Health Assembly adopted a resolution on NTDs in 2013. She then went on to describe the linkage between the three types of interventions for NTDS: mass drug administration (MDA); integrated vector management; and water, sanitation, hygiene. She retraced the history of the NTD programme in Tanzania from inception in 1997 when it was majorly dependent on vertical control programmes, to now where there is an integrated NTD control programme in 15 regions (97 districts) of Tanzania. Key control interventions in Tanzania’s NTD programme include MDA campaigns at least once a year, health promotion, education, advocacy, WASH, surgical interventions and vector control. Landmark achievements of the Tanzania NTD Programme are the inclusion of NTDs in the Ministry of Health budget; the development of integrated data registers and an NTD database which allows integrated analysis of real time data; and the interruption of transmission for Onchocerciasis, Trachoma and Lymphatic filariasis in some previously high-burden areas. She noted that among the lessons learnt from Tanzania with respect to NTD programmes, community engagement and multi-sectoral planning were essential to programme success.

• Experience from Italy - Prof. Alessandro Bartoloni, Director of Post-Graduate School of Infectious Diseases, University of Florence, Italy Professor Bartoloni began by giving a brief background of Italy. He explained that in Italy, NTDs were mostly imported, found mostly in migrants (from Africa and Latin America) and travelers. However, some autochthonous cases occur. He presented historical data on NTD cases from medical practice in Florence, Italy. They consistently showed an increasing trend from the 1980s to date, globalization and global warming being the key drivers of this trend. He emphasized that particular attention should to be given to NTDs which have other modes of transmission (transplancental, transfusion, transplantation and laboratory accident) as well as infections which develop from asymptomatic to chronic disease over a long period of time. Importantly, he stated that recommendations on Chagas control measures to implement across the European Union were elaborated in the project for controlling Chagas among migrants and this project recommended that Chagas must be considered in legislation regarding safety of blood transfusions and organ donation. He noted that many developing countries had implemented these policies. However, most European countries have not implemented these policies. He concluded by stating that more attention be paid to educating European doctors who are not experienced in detecting clinical cases of NTDs in adopted children, migrants, and people who return from endemic areas.

• Research and Funding - Prof. Harald Noedl, Head, Experimental Tropical Medicine Unit, University of Vienna, Austria He began by saying NTDs could be almost called “poverty diseases”, excluding the big three (Malaria, HIV, TB). He stated that the big advantage to getting funding and attention for the big three was that HIV and TB occur also in the North. He pointed out that NTDs could affect the North as well as shown in the example from Italy, stressing this is as an important point when advocating for more money for research and funding in NTDs. He added that if adequate funding for the provision of adequate treatment and research was not provided, NTDs would continue to be imported into developed countries in the European Union. He said NTDs were at least as important as Tuberculosis and Malaria. He highlighted several challenges in research and funding for NTDs which include the underestimation of the true burden of NTDs; the heterogeneity of the diseases which constitute the NTD group; and the disproportionate amount of drug and vaccine development for NTDs. He concluded by emphasizing the need for sustained efforts and funding to raise the level of attention to NTDs and maintain control efforts.

• Implementation of NTD policies & progress towards elimination by 2020 - Prof. Alan Fenwick, Schistosomiasis Control Initiative, Imperial College, United Kingdom Prof. Fenwick stated that 20 years ago, most drugs were available for treatment of helminths, but only one was reaching Africa. He added that the picture is better now in terms of treatment doses given out yearly for NTD control - these largely coming from donations from multinational pharmaceutical companies. He said concerted efforts to control NTDs could speed up progress with the Millennium Development Goals as five of the eight goals were impacted by NTDs. He reiterated that for many infections we have medicines that only need to be given once a year and that the drugs need to be donated because people can’t afford to buy them. He said the main policy implemented for NTD control has been mass drug administration. He reported that the dose pole had been a useful tool for the determination of dosages (dosage based on weight for height). He discussed Onchocerciasis, Shistosomiasis, Trachoma, Lymphatic filariasis and soil-transmitted helminths as NTDs treatable with mass drug administration. He said the 4-5 different drugs could be distributed for treatment yearly at very little cost. He added that with most of the multinational pharmaceutical companies donating drugs, the funding required is to be spent on delivering the drug to the affected populations. He however stated that although mass drug administration was important, there was also need for socioeconomic development, improved water and sanitation, and that Africa still has a long way to go to achieving all these. He acknowledged the contributions of non-governmental organizations to mass drug administration campaigns. He highlighted that targets for NTDs had changed from treatment to elimination, and that the next step in NTD control implementation was reducing the burden of NTDs in the three big African countries. He added however, that there is currently available only a quarter of the funds required to achieve this.

• Getting NTDs back on the Global Agenda - Dr. Olaf Horstick, Institute of Public Health, University of Heidelberg, Germany Dr. Horstick in his second talk posed a question about whether NTDs needed to get back on the agenda or rather be mainstreamed into national agenda. He said experience from the WHO Special Programme for Research and Training in Tropical Diseases (TDR) had shown capacity building in countries was important and that implementation research and strategies were lacking. He raised issues about existing evidence for NTD control measures and the best approach to measure them. He was of the opinion that research in NTDs needs appropriate funding and that funding must go to affected countries who should also decide how the funds are utilized. While discussing NTDs in the context of the MDGs and the current post-MDG agenda, he said the MDGs were orientated towards reduction of poverty, but the post-MDG agenda has refocused into ensuring healthy and sustainable living and includes the importance of NTDs as they relate to poverty and ecological environments. He emphasized that although health system building and strengthening were important, it would take long term planning to achieve in many countries. As such, in some specific cases vertical programs are the only solutions at the moment. He emphasized the increasing role of public-private partnership models for funding NTDs but was of the opinion they should be run and led by the countries affected.

Panel Discussion

An interactive panel discussion was conducted where various issues were raised, including the role of PPPs, vector control, budgets to sustain NTD programmes, teaching of NTDs in tertiary institutions, community response to NTD programmes, campaigns to encourage populations to purchase drugs individually once a year, role of international non-governmental organizations and possible complications in those co-infected with HIV. Good exchange between the panel and participants was achieved. Interactive Quizzes Two interactive quiz sessions were held as part of the programme. These included a selection of multiple choice questions on the epidemiology, causes, diagnosis, and control of various NTDs. Feedback from the symposium evaluation forms indicated that participants greatly enjoyed these quiz sessions.