9.2 Neglected Tropical Diseases

Key documents

• Neglected tropical diseases Prevention, control, elimination and eradication (EB132/19)
• Report on financial and administrative implications for the Secretariat of resolutions proposed for adoption by the Executive Board or Health Assembly (EB132/19 Add.1)

Note by WHO Secretariat

This Secretariat report outlines the work being done to sustain the drive to overcome the global impact of neglected tropical diseases. As requested by Member States participating in the technical briefing on neglected tropical diseases during the Health Assembly in 2012, a draft resolution has been prepared for consideration by the Board.

PHM's Comments pre-EB

This report on neglected diseases is centred on the first WHO roadmap (2010) and the London Declaration on Neglected Diseases (2012). It recommends five interventions; preventative chemotherapy, intensified case-management, effective vector control, the provision of safe drinking water, basic sanitation and hygiene and involvement of veterinary public health. It also ‘praises’ the pharmaceutical companies for their drug donations.

The draft resolution urges member states to properly manage national programmes, advocate for international financing, to ensure prompt diagnostic testing and treatment, expand preventative chemotherapy and provide safe drinking water, basic sanitation, vector control and public health. It asks partners including the private sector to assist in ensuring funding, harmonise support to countries, ensure universal access to preventative chemotherapy, encourage new initiatives for the development of new medical technologies, and collaborate with WHO to support member states.

It does not provide a clear mechanism to boost much needed R&D for neglected tropical diseases in contrast to the recommendations of the CEWG report that explicitly linked innovation in health R&D with the need for affordable access to the outcomes of innovation.

As a supplement to this draft resolution, the second report of the WHO roadmap was released on the 16th of January 2013. This report emphasises mass treatment and vector control in its report on progress towards seventeen neglected diseases. It also states that the partners in the London Declaration - the multinational pharmaceutical industry, “have been crucial to the successes achieved: they have donated resources, expertise, time and energy to deliver and expand interventions”.

The recent WHO report states that the consequences (and infers causes) of neglected diseases for women and children – referred to as biological, socio-cultural and stigma. What is missing here are the socioeconomic determinants that significantly contribute to the causes of the disease (and the consequences) beyond biology, culture and stigma, including lack of access to sanitation and water, lack of income and employment, and poor housing among others.

The draft resolution explains the challenges to implementation as a lack of expertise in the management of programmes in countries, unavailable and poor quality medicines, and the need to estimate costs to expand programmes. In the recent WHO report, further obstacles to achieving the targets are stated as ‘conflicts, population growth, vector control, resistance to medicines, insufficient capacity for scaling up, inadequate support for research and climate change’.

Again what is missing here is that if member states to not seek to improve socioeconomic conditions, such as access to clean water and sanitation, then the targets will not be addressed.

In fact the 2nd WHO report finds that in 2010, 780 million people did not have and safe drinking-water, and 2.5 billion were without adequate sanitation, which is recognised as a critical determinant of many neglected tropical diseases. Forty per cent of people without access to quality water live in sub-Saharan Africa, where many neglected tropical diseases are prevalent. It also notes that the present indicators used to count water sources do not provide any absolute information on the safety of this water.

However, in this draft resolution, the need for safe drinking water and sanitation appears in one line. The draft resolution should be strengthened to reflect the equal attention to the five much needed much health interventions – in particular the fact that 35% of the world’s population still lack access to basic sanitation.

In addition, vertical programmes create an overlapping of resources and efforts. The draft resolution should recognise the importance to addressing these through a primary health care approach.

As in the recent WHO neglected tropical diseases report and this draft resolution, the private sector is sought as key partners. To what extent should the multinational pharmaceutical industry be considered WHO’s key partner for neglected tropical diseases? This is somewhat counter to the recommendations of the CEWG for a binding member state global convention. 

Report of the discussion

The Executive Board was invited to consider the draft resolution on neglected tropical diseases (NTDs), namely 17 illnesses which are defined by the WHO as a group characterized by their association with poverty and their proliferation in tropical environments where multiple infections in a single individual are common.

The resolution was broadly welcomed by MS with some amendments proposed by Lithuania on behalf of EU, Australia, the Russian Federation and the USA. While acknowledging the importance of technical interventions (among others, USA mentioned the development of a specific vaccine for Chagas Disease) in tackling the burden of these diseases, Croatia, Mexico, Iran and Cameroon - on behalf of the African Region - stressed that those conditions are strictly linked with poverty and environmental factors and are often causes of stigmatization and low educational outcomes in children, challenges that have to be addressed in order to achieve sustainable improvements in the fight against NTDs.

Brazil recalled the need for strengthening health system through a Primary Health Care approach when dealing with these conditions and for linking this resolution with the recommendations made by the Consultative Expert Working Group on Research and Development (CEWG). On the other hand the country welcomed the commitment of WHO, Bill and Melinda Gates Foundation, pharmaceutical companies, NGOs and the academia in fighting the NTDs.

Cameroon, recognizing that an increasing number of partners work on this issue, stressed the importance of a joint action and called upon WHO to coordinate stakeholders and governments at global as well as local level.

After MS, three NGOs took the floor. While the International Federation of Pharmaceutical Manufacturers Association (IFPMA) reaffirmed the commitment of the industries in the fight against NTDs through research activities and drug donations, Medicus Mundi International along with the People’s Health Movement (see the MMI-PHM statement at the following link:

http://www.ghwatch.org/sites/www.ghwatch.org/files/WHO.EB132_NTD.MMI_.statement.pdf) and MSF International, expressed their concerns about the lack of integration with the work done by the CEWG and the technical approach adopted in the resolution. MSF International drew also the attention to the need for pursuing strategies other than donations that allow access to quality-assured affordable drugs.

Considering the amendments made by MS, the Secretariat would prepare a conference report to reopen the discussion on Monday.

Update on Neglected Tropical Disease Resolution

On Saturday 26th January the amended resolution on NTD’s explicitly included the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property and the Consultative Expert Working Group on Research and Development: Financing and Coordination - by Brazil and Cuba – into the preamble and sections ‘calling on WHO partners’ and ‘requests the DG’. It also included textual amendments by the EU, Australia, Russia and the US. In the discussion on Monday the EU sought deletion of the added sections on the CEWG because it thought this was not directly relevant to combating NTDs. This was supported by the US and Australia. Cuba made no objection to this deletion. The resolution was adopted as amended.