What Are Neglected Tropical Diseases And Why Should Their Elimination Be Prioritised?

While ensuring good health and wellbeing of citizens is one of the key responsibilities of governments, there are some diseases that require the urgent attention of policymakers, and follow-through with credible action on the ground. One such group of afflictions is Neglected Tropical Diseases (NTDs), which are the bane of tropical areas.

Worse still, these diseases afflict poor people, mostly women and children. The government of India has taken note and eliminative measures are following. For instance, on February 10, 2023, the Ministry of Health and Family Welfare, Government of India launched a Biannual Mass Drug Administration (MDA) round in Mission Mode for Filariasis, an NTD, in 10 states. Bihar, Jharkhand, UP, MP, West Bengal, Karnataka, Odisha, Madhya Pradesh, Chhattisgarh, and Maharashtra are rolling out MDA in a single phase for the first time and the aim is to increase uptake of anti-filarial drugs in high-burden areas.

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In an interview with Indiatimes.com, Dr. Bhupendra Tripathi, Country Lead for Elimination Programs (Neglected Tropical Diseases), for the Bill & Melinda Gates Foundation, India, shares perspective on why eliminating NTDs should be an urgent priority for India as our country chases faster attainment of Sustainable Development Goals.

Q.1 What are neglected tropical diseases? Why should their elimination be prioritised?

NTDs are a group of debilitating infectious diseases that hold back the world's poorest communities from reaching their full potential. NTDs can shatter the lives of those they infect, causing severe disability, illness and sometimes death if left untreated. Because NTDs affect the poorest communities, health systems need to design adequate safety nets, to ensure no one is left behind. Eliminating NTDs is crucial as the control and elimination of these diseases also contribute to other Sustainable Development Goal ambitions, including those on poverty (SDG 1), education (SDG 4), gender equality (SDG 5), clean water and sanitation (SDG 6), decent work and economic growth (SDG 8) and inequalities (SDG 10).

Q.2 What is your assessment of India's progress in eliminating neglected tropical diseases?

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Historically, India has shown that it has the capacity and capability to overcome major public health challenges. India was once regarded as one of the most challenging landscapes to eradicate polio. Yet in 2011, the country reported its last case. Yaws, another disease of the underprivileged and marginalized, was eliminated from the Indian shores in 2016. With the right actions, smart investments, and resolute and concerted efforts from the highest levels of governance, India can write off Lymphatic Filariasis (LF) and Kala Azar.

India has the world's largest absolute burden of at least 10 major NTDs, that include hookworm, dengue, lymphatic filariasis, leprosy, visceral leishmaniasis. However, despite this, India has made progress and is committed to new goals that will drive progress until 2030 against NTDs. This is possible because our leaders are fully committed to building a healthier & stronger India.

However, India must absorb global learnings and approaches through strengthened social mobilization and IEC/BCC activities that leverage a skilled and sensitized workforce and robust campaigning. Further, as evidenced by the polio elimination drive, social mobilization and communication activities hold the key to end diseases like LF.

Q.3 How many people are susceptible to contracting neglected tropical diseases world over, and what is the threat level in India?

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The WHO South-East Asia Region bears the second highest burden of NTDs globally and has recognized seven NTDs, including Lymphatic Filariasis (LF) that are of public health importance in the region. Countries in the South-East Asia region contribute to 63% of the global LF burden. India ranks first in incidence of Neglected Tropical Disease (NTDs) and leads the world in terms of the total number of cases for each of the major NTDs, as defined by the World Health Organization (WHO). India also bears LF burden with the at-risk population having increased from 37 crore in 2005 to 63 crore in 2018. Close to 43 crore people in India require preventive medicines to stay protected from Lymphatic Filariasis.

Q.4 When will India be able to eliminate Kala Azar? What are the challenges you see in the path to achieving this?

Over the years, India has made tremendous progress towards eliminating Kala-Azar. There has been a significant decline in disease burden from the peak of 80,000 cases in 1992 to 1964 cases reported in 2020. Further, the number of PKDL cases has also significantly reduced with only 617 cases recorded in 2020 as compared to 1657 in 2016. Only 1 out of 633 VL endemic blocks was above the elimination threshold in 2022. This is a major achievement of Govt. of India.

Kala-Azar was prioritized globally when India, Bangladesh, and Nepal, signed a trilateral Memorandum of Understanding to eliminate the disease in 2005. The target for elimination was the reduction of annual Kala-Azar incidence below 1/10,000 people at sub-districts level in India by the year 2015; a deadline that was later reset to 2020, then 2021 because of the pandemic so India is poised to eliminate this disease by 2023.

However, there are some challenges. Kala-Azar patients experience significant delay in diagnosis and treatment initiation resulting in poor health seeking behavior and late-stage presentation at health facilities. Patients prefer to seek care from private practitioners who may have little to no training on the disease, resulting in delays in access to proper and complete treatment. Active case detection (ACD) leads to early diagnosis of suspect cases and can result in a reduction in transmission time.

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Second issue is regarding timely identification and treatment of PKDL (post kala-azar dermal leishmaniasis) cases at the village level. Since they can also contribute for the transmission of parasite, we need to sensitize the health teams and community regarding this disease. It may also get confused with Leprosy in the field.

Finally, the greatest risk is of complacency which may seep-in once we achieve the target of VL elimination as a public health problem in the country. The disease may rebound if the guards are lowered down.

Q.5 India has a high burden of Lymphatic Filariasis. What are we doing to reduce this?

Lymphatic Filariasis (LF) is endemic in nine countries in the South-East Asia region, including India. The region is home to six crores of the 12-crore people globally estimated to be infected with LF. Mass Drug Administration (MDA) is the globally accepted approach through which medicines are administered to the entire eligible population of an endemic region at a regular interval, irrespective of the individual infection status in the community. MDA involves an annual dose of a combination of Diethylcarbamazine citrate (DEC) and Albendazole (two-drug regime administered for a period of 5 years) or Ivermectin, DEC and Albendazole (three-drug regime or IDA administered for a period of 2-3 years) administered to the entire at-risk population in any endemic region.

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However, to further ramp up elimination, the Ministry of Health and Family Welfare, Government of India has launched a Biannual Mass Drug Administration (MDA) round in Mission Mode for Filariasis in 10 states on Feb 10. Bihar, Jharkhand, UP, MP, West Bengal, Karnataka, Odisha, Madhya Pradesh, Chhattisgarh, and Maharashtra are rolling out MDA in a single phase for the first time and the aim is to increase uptake of anti-filarial drugs in high-burden areas.

There is a strong commitment from the Government of India towards reaching the target of elimination as a public health problem by 2027. Ministry of Health is working closely with ministries of Education, Women and Child Development, Panchayati Raj Institute, National Rural Livelihoods Mission, Sports & Youth affairs etc. to ensure high consumption of MDA drugs. Development partners, Rotary, Medical Colleges, and other associations/organizations are supporting Government of India for this endeavour.