Professor Gail Davey: ‘Act now. Act together. Invest in tackling neglected tropical diseases for health equity and social justice’

30 Jan 2023
Credit: Professor Gail Davey. Caption: Rwandan podoconiosis patients learning self-care for their legs

For World NTD Day, Professor Gail Davey, Trustee and Past President of RSTMH and a medical epidemiologist specialising in skin-related Neglected Tropical Diseases at Brighton and Sussex Medical School, looks at why it is crucial that we act now and together to end NTDs and says that NTD programmes can no longer be considered in isolation from endemic country health systems.

With some surprise, I realise I am nearing my 20-year anniversary of work in Neglected Tropical Diseases (NTDs). Starting in the mid-2000s from a base within Addis Ababa University, Ethiopia, and now from within the NTD hub in the Centre for Global Health Research at Brighton & Sussex Medical School, I’ve spent almost two decades researching into and driving action against some of the most neglected of these conditions. Reflecting on these years, it is clear we need to maintain their energy and urgency to put an end to these diseases. 

Acting now and acting together is crucial: NTD programmes can no longer be considered in isolation from endemic country health systems. These programmes can act as catalysts to stronger, higher quality health systems, through direct health system support in the form of health workforce capacity strengthening or investment in health management information systems. 

Supporting NTD programmes increases health equity in bringing a range of essential services closer to the community. For example, our group’s work with people affected by leprosy, lymphatic Filariasis (LF) or podoconiosis in northern Ethiopia demonstrated the importance of training primary care staff in mental health as part of the care package. NTD programmes may also strengthen provision of surgical care as a component of universal health coverage by, for example, training non-specialist doctors, nurses and technicians in primary care to treat Buruli ulcers and conduct trachomatous trichiasis or LF hydrocele surgery within a package of Emergency and Essential Surgery Care.

And it’s not just health systems, or the health sector. Many NTDs are water-washed, water-based, or water-related, so over the past decade vital collaboration with safe water, sanitation and hygiene (WASH) services has been championed by the World Health Organization (WHO). Similarly, the One Health and Planetary Health approaches across human health, veterinary health, agriculture and environment sectors championed in RSTMH’s Policy Position on NTDs (currently in draft format and available to RSTMH members here) are not only essential to control of many NTDs, but will impact more broadly on disease surveillance and monitoring antimicrobial resistance.

Garnering investment

The NTD community’s approaches to garnering investment need to reflect these changes in emphasis from individual disease programmes to support of universal health coverage. Early appeals for investment focused on the cost of preventive chemotherapy treatment per person within Mass Drug Administration programmes. These eye-catchingly low costs (around US$0.40 per person in simplest terms) secured new funding partners for programmes in many countries. However, as soon became clear, it is the intensive disease management, the vector control and the structural and environmental changes that constitute the real investment challenges.

In the light of this, more nuanced Elimination (or Eradication) Investment Case approaches going beyond traditional efficacy and efficiency measures have been developed and applied to LF, Human African Trypanosomiasis and onchocerciasis. Harnessing the understanding of social justice can enable NTD treatment and prevention as global public goods, with long term and often overlapping health, economic and social impacts. Investment cases can now be made that emphasise the ethical impact of NTD programmes in redressing the highly skewed global burden of disease.

Finally, but most importantly to investment, affected countries have become central to resource mobilisation. The Kigali Declaration commitment to “Unlocking domestic resources, including strengthening public health infrastructure to deliver effective NTD services, complemented by external resources” is being met in many countries. In my sphere of work, a powerful example from 2019 was the Rwandan Government’s commitment of more than one third of the total £617,000 cost of podoconiosis elimination in that country. International donors should take note and recognise how their support can help to bolster and accelerate governments’ actions. 

Competing with other health and development priorities for vital investment is undoubtedly a major challenge for those concerned with NTDs in a world facing climate crisis, disease pandemics and violent conflict. However, potential funders need to understand that the returns on relatively small financial commitments are great and multiple. Diseases can be eliminated and the investment in these actions will benefit wider improvements in societal health, wellbeing and equity. Together we must make these messages heard and convince others to act now and together.