Budget cuts hamper efforts to eliminate neglected tropical diseases

Fatma Kabole cried when she learned that the British government was withdrawing its support for the fight against lymphatic filariasis, one of the most pernicious diseases in the world. The cuts, announced this spring, undermined her plan in Zanzibar – as well as the expectations and goodwill she had spent months developing.

“It was so unethical,” she says. “I couldn’t believe they first gave us hope and then told us to return the remaining funds. I couldn’t stop thinking about the images of a young man who had come to thank us for our work.

As a program director at the island’s health ministry, Kabole had begun to see progress against lymphatic filariasis, a parasitic infection transmitted by mosquitoes. Also known as elephantiasis, it causes deeply stigmatizing disability and disfigurement, including swelling of the scrotum or legs in more than 36 million people worldwide.

Kabole’s job was to reduce local prejudices and the shame felt by more than 3,500 people with severe forms of the disease – by encouraging them to contact a team of social and health workers for support; give advice on hygiene and surgery; and expanding a program to prevent re-transmission.

Elephantiasis is one of 20 neglected tropical diseases that together affect more than one billion people © Haziq Qadri / Barcroft Media via Getty Images

Aid cuts have been a blow and have exacerbated existing disruptions to similar programs caused by coronavirus infections and the reallocation of health workers and volunteers to fight the pandemic.

Elephantiasis and 19 other “neglected tropical diseases” affecting over 1 billion people have gained increased attention in recent years, inspiring an ambitious World Health Organization “road map” to eliminate disease. ‘by 2030.

At the heart of efforts to control these NTDs are ‘mass drug administration’, or MMD, programs whereby local community health workers and volunteers distribute cheap or low-dose drugs to large numbers. people at risk. It acts almost like a vaccine, protecting them from contracting, developing and transmitting diseases.

The MDA approach has appealed to government donors, philanthropists, and fundraising charities because it offers great value for money and uses the funding to reassure drug companies that all donated drugs can be distributed effectively.

“One dollar invested generates $ 26 in drug donations,” says Thoko Elphick-Pooley, director of Uniting to Combat NTDs, an advocacy group. The wider benefits of better schooling for children and their future economic contribution are even greater.

The UK Department for International Development initially championed the approach, bolstering the country’s reputation as a world leader in delivering a range of high-impact, low-cost interventions. But the program was scrapped this year after being taken over by the Foreign and Commonwealth Office and the UK government slashed its aid budget from 0.7% to 0.5% of gross national income.

As the drugs donated for MDA expire, time is running out for their use – just as the annual peak season for infections is brewing. Without fresh money to support their distribution, pharmaceutical companies are reluctant to donate fresh inventory.

“The crisis has exposed the structural flaws in the system,” says Johannes Waltz, who oversees donations of praziquantel, provided by Merck from Germany, to treat schistosomiasis. He points to particular concerns in Nigeria, the Democratic Republic of the Congo and Zimbabwe. “We can’t assess losses and unrelated inventory in a timely manner,” he explains.

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Several private donors, including End Fund, The Children’s Investment Fund Foundation, Elma Philanthropies and the Bill & Melinda Gates Foundation, have stepped in to temporarily close the UK’s funding gap, totaling around £ 100million. sterling for the current year. But Bill Gates warns: “You never want to position yourself to replace [much larger government donors]. There is no way we can match these cuts.

“The UK government’s decision was devastating,” says Simon Bush, NTDs director at the Sightsavers charity.

“My biggest worry is what is happening now with river blindness and lymphatic filariasis. It feels like entire countries are in danger of being abandoned if we fail to persuade new donors to come forward.

Wendy Harrison, head of the Schistosomiasis Control Initiative tackling another NTD, points out that much of the bridge funding is earmarked for drug delivery programs and will not cover the broader efforts the UK had supported to integrate them more closely into initiatives to strengthen health. and sanitation systems.

Some financial support may arrive too late to prevent further decline, she adds. “We have a significant risk ahead for programs especially in Niger and Liberia,” says Harrison. “We are now waiting to find out what donors will support and where the gaps lie. It is incredibly frustrating.

Aid cuts may prompt affected countries to increase their own funding for the most neglected populations. But Harrison warns: “Covid’s response has severely depleted health systems. Countries have multiple calls on their time and resources and it seems like they have mobilized as many resources as possible. “

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About Natalee Broderick

Natalee Broderick

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