On Wednesday 19th, 2017, the heavy weights in international health initiatives and international relations, were joined by pharmaceutical companies, country representatives and NGOs to celebrate 10 years of multi-stakeholder collaboration as well as the 5th anniversary of the World Health Organization's roadmap on NTDs and the London Declaration that was signed in 2012.
A recap for everyone unfamiliar with the London Declaration, in 2012, inspired by the WHO roadmap for implementation, outlining targets for control, elimination or eradication for 17 (now 18) neglected tropical diseases, leaders of prominent global health and development organisations as well as partners from the pharmaceutical industry met in London. They pledged to unite in their efforts to achieve the WHO targets by 2020 with regards to 10 of the 17 NTDs. “These collective promises of support where formalized into the London Declaration on NTDs, and it is around this Declaration that the coalition of partners called Uniting to Combat NTDs was created.“ Uniting to Combat NTDs features these 10 NTDs as they allowed for immediate support to be provided since 5 diseases can be controlled by means of mass drug administration, meaning large-scale population treatment with safe and effective medicines without diagnosis, and the other 5 can be controlled by innovative and intensified disease management (IDM). IDM refers to individual diagnosis and treatment, surgery where needed as well as care and rehabilitation of infected individuals.
The room was beaming with energy and excitement as the morning session was opened by words by WHO DG Dr Margaret Chan, former United Nations Secretary-General Kofi Annan and Bill Gates. Dr Margaret Chan rightly captured what many felt “it is too rare that all stakeholders sit together in one room and listen to each other”.
While somewhat sceptical by the dense programme we were handed out, James Chau, WHO Goodwill Ambassador for Sustainable Development Goals and Health, used his TV moderation experience to lead us skilfully through the three “chapters” of this session, “collaborate, accelerate, eliminate”.
An important feature of all three chapters were announcements of promises and commitments by countries and pharma companies to either continue or increase their donations and contributions to the fight against NTDs. For example, Lord Bates, representing Rt. Hon Priti Patel, Secretary of State for International Development, UK, repeated the UK’s promise of a GBP 360 million donation over the next five years, and Haruo Naito, CEO of Eisei announced during the session that his company would continue his drug donation of DEC (diethylcarbamazine) to treat lymphatic filariasis beyond 2020 and until elimination. Bill Gates promised $ 345 million over the next five years, $ 42 million of which would go towards the elimination of Guinea Worm. Belgium also seemed inspired by this energy and officially joined this cooperative movement and committed € 25 million over the next five years to fight sleeping sickness. All these promises can be summarised by Merck’s attitude “we want to finish our job and leave no one behind”.
The importance of collaboration in the fight against NTDs was very apparent. The German ambassador Antje Leendertse highlighted the importance of improved international cooperation, Prof Lima, President of the Oswaldo Cruz Foundation emphasised the role of academic work and partnerships in the efforts against NTDs and the Sanofi Executive Vice President Medical Affairs considers there to be three pillars for pharmaceutical companies and their involvement:
- Treatment and vector control
- Drug development activities
- Financial contributions, e.g. for mobile distribution systems.
Any of the aforementioned examples of collaboration should not take place alone but in “trustful relationships”.
This idea of trustful relationships and togetherness was also what carried this meeting forward, as if the entire group was riding on a wave of optimism by the opportunities and possibilities represented in this room.
Important messages that came up during the next two chapters of accelerate and eliminate were the role of health systems and health systems strengthening as well as the importance of working with endemic countries in such a way that they can stand on their own feet, raise domestic funding, establish health care workers and health coverage for their people (Dr. Moeti, WHO AFRO).
An important, if maybe a little quiet contribution, was made by Dr Eloit, DG World Organisation for Animal Health, who said that we needed to assess whether the right resources are allocated to animal health, given that animals play an important role in the transmission of many NTDs, and with One Health being an increasingly important concept, we cannot overlook animals as part of the ecosystem we work in.
In closing this morning session, Dr Margaret Chan raised her ask to Argentina, host of the next G20 rounds in 2018 to put health on the agenda.
In realisation that this was the last big international summit / conference before the World Health assembly in May when she will be replaced by the next DG, the room said goodbye in standing ovation to Dr Margaret Chan who had put NTDs on the WHO’s agenda during her two terms.
In the afternoon, the energy had waned somewhat, maybe it left the room with Dr Margaret Chan, Kofi Annan and Bill Gates who had moved on to other meetings. But nevertheless, important contributions were made and the room was still filled with committed people central to the fight against NTDs.
Health systems continued to feature as being central in the “changing NTD landscape” and “the era of UHC and SDGs”, our guiding sections in the afternoon. The link between health systems, universal health coverage (UHC) and SDGs is undeniable and was thus rightly emphasised as having to be a priority. However, as also pointed out by Dr Fareed Mirza, Head Healthcare and Outcomes Research, Novartis Foundation for Sustainable Development, priorities also need to be set within health system strengthening. Otherwise, precious resources may not be allocated efficiently.
This session was useful in that it highlighted additional aspects that are part of the SDGs and must become more central to any health activities. Dr Fitzpatrick from the WHO for example stressed that environment and nutrition need to be considered more.
A very interesting field was raised by Dr Nick Hamon, CEO Innovative Vector Control Consortium, who highlighted the interplay between vector control, healthy cities and urban planning, as well as food security and health. In particular when considering the already mentioned One Health concept, accounting for vectors, animals and sustainable agricultural businesses is very important. This also means that additional partners in the agricultural businesses should be sought.
And on a similar line of reminding us of gaps in our considerations so far, Dr Zakaria from the International Organisation of Migration raised the question of whether UHC really was that universal. Given the refugee and migration movements everyone is talking about, is health coverage really extended to migrants and refugees? NTDs are a central problem to these population groups. Migration in general is understood as a major factor in the introduction and re-introduction of NTDs, however, this situation is made even more difficult to control and prevent when refugees set camp in living situations without adequate sanitation and hygiene facilities, where poverty is rampant and proximity to other households facilitates the easy spread of diseases. Extending health system coverage and treatments to migrants and refugees is thus extremely important to care for those affected as well as to contain the further spread of these diseases.
Finally, after many mentions of very grand and sometimes maybe somewhat abstract contributions, Simon Bush of Sightsavers, an NGO so central in the fight against NTDs, in particular blinding trachoma, reminded us to focus again on practicalities, such as project management, data management and data analysis. We need to consider and act on the data collected in order to amend the projects we plan and envision if we really want to move closer to elimination.
It was an interesting and inspiring meeting, a get together of so many partners that do too rarely come together in this constellation. We are excited to see real outcomes of today’s exchanges.
We would like to end this post by sharing the following words by Jimmy Carter, a lighthouse in the fight for global health, to inspire us to continue with our interest and work in global health, “we must not be complacent, we must be persistent. We must translate our compassion into action”.
Scientific publication
- Hélène Carabin, Andrea S. Winkler and Pierre Dorny: Taenia solium cysticercosis and taeniosis: Achievements from the past 10 years and the way forward. PLOS April 2017
Neglected Tropical Diseases in the media
- The Guardian: WHO director general says significant strides have been made in fight against sleeping sickness, elephantiasis and other neglected tropical diseases
- CNN: Winning the war against ancient diseases
- Reuters: Gates backs Big Pharma push to wipe out tropical diseases
- BBC News: 'Phenomenal' progress in fighting tropical diseases