An estimated 1.6 billion people globally are at risk of neglected tropical diseases (NTDs), a group of parasitic, viral, bacterial, fungal, and non–communicable diseases that disproportionately affect people living in poverty in tropical climates. Though preventable and treatable, these 21 diseases have devastating health, economic, and social impacts on affected communities, and very limited resources are available to fight them.
Dr. Abdel Direny, PATH's Senior Manager for NTD surveillance, is part of the team that is working to combat these debilitating diseases. In this edition of PATH NTD Perspectives, Abdel reflects on his work to help countries beat NTDs—and make sure they stay beaten.
What challenges in the fight against NTDs is your team working to address?
A: The World Health Organization (WHO) includes 21 NTDs in its 2030 road map to prevent, control, eliminate or eradicate disease. More than 40 countries will have eliminated at least one of these diseases and be in their post–verification or validation phase in the next three years, including four for onchocerciasis, 17 for lymphatic filariasis (LF), and 33 for trachoma.
Given that disease-specific funding is likely to decrease after a country attains elimination of an NTD, the period just before presents a critical window to identify and invest in sustainable post-elimination surveillance. We’re working to help national NTD programs identify and plan integrated approaches to NTD surveillance in post-elimination settings, with an initial focus on onchocerciasis and LF, to ensure that surveillance efforts can be sustained if resources are withdrawn.
Why would it be important to continue surveillance of a NTD after the WHO has verified or validated that it was eliminated?
A: To eliminate a disease, it takes time and costs a lot of money and energy. After eliminating an NTD, it’s important to put in place a surveillance plan to detect any signal of resurgence of the disease, provide information on potential causes of resurgence, and to treat any cases that may emerge. Without a good surveillance plan, the disease might come back and the fight for elimination will never end.
What is your team doing to help improve sustainability of post–verification/validation surveillance of NTDs?
A: Under the leadership of the WHO and with funding from the Bill and Melinda Gates Foundation, PATH is developing an integrated post–validation/verification surveillance planning toolkit for NTDs to help program managers identify resources and stakeholders existing in their country to monitor for re–emergence after elimination of NTDs.
Using inputs from national NTD programs, the toolkit will provide a step–by–step process to help national NTD programs assess what surveillance platforms currently exist in their country that could be leveraged or extended to monitor for resurgence of eliminated NTDs.
Our work to develop this toolkit prioritizes country ownership of the planning process, ensuring the toolkit is user–friendly and effective through human–centered design, creating a toolkit that is flexible and adaptable to different NTDs and contexts, and thoughtfully integrating gender equity and social inclusion.
The first stage of this work is already available online.
Looking to the future, what do you think will be most critical to achieving the targets outlined in the WHO 2030 road map for NTDs?
A: Integrated intervention between partners supporting NTD activities is key. We all know that mass drug administration alone will not eliminate NTDs. It should be associated with other interventions such as water, sanitation and hygiene (“WASH”) and vector control. However, these programs are still working in silos—that makes the elimination of NTDs more challenging.
It will also be important to strengthen domestic funding for NTDs to complement field activities that donor organizations will not be able to support, such as morbidity management and disability prevention (MMDP), and extended mass drug administration (MDA) to reach required coverage.
What inspires you in your daily work? Why is this work important to you?
A: As a medical doctor and a public health expert, it’s imperative for me to play my role—small as it might be—to eliminate these horrible diseases and consequently to improve education levels and reduce poverty.
I feel a small amount of pride when I hear that a country that I have supported in NTD elimination has reached or is about to reach that goal. As long as these diseases are still endemic in so many countries, I feel like I have more work to do. The fight against NTDs—I will be always involved in it.