by Julie Jacobson, MD, DTM&H, FASTMH
Immediate Past President
Several years ago, when I was working in Ethiopia, I met a woman who was awaiting surgery to treat a
disease called trachoma from causing her to lose her sight. Trachoma is a bacterial infection once common in the U.S. and still common in low-resource countries that is the world’s leading cause of infection-related blindness. Repeated infections build up scars inside the eyelid that, over time, turn the eyelashes inward producing debilitating pain, visual impairment and, eventually, irreversible blindness. Once it has progressed to a certain point, the only way to stop or at least limit the damage is to surgically repair the damaged eyelid.
The woman I spoke with had seven children; two of her children, aged 7 and 9, already required surgery to protect their sight. Poor access to basic antibiotics to treat the infection left her now in need of advanced health care that was very limited where she lived; she considered herself fortunate to now have access. Many millions of people at risk of trachoma lack this option. That’s the bad news. The good news is that today, fewer and fewer people need this surgery. Over the last two decades, there has been a global effort to conduct mass drug treatment campaigns with the antibiotic azithromycin that have achieved a stunning reduction in the number of people at risk of blindness from trachoma--
from 1.5 billion to 137 million.
At a time when it can seem like we are still struggling to gain the upper hand against just one disease, COVID-19, it’s worth reflecting on the progress we have achieved through long-term bipartisan support in the United States (a rarity these days) and public-private partnerships to fight trachoma, along with a host of other neglected tropical diseases. This Sunday is World NTD Day. Here in the United States, it’s an occasion to highlight the collaborative efforts involving, among others, the
U.S. Agency for International Development (USAID),
the National Institutes of Health and the
Centers for Disease Control and Prevention, and several non-profits and pharmaceutical firms that are putting many NTDs on the path to elimination.
NTDs pose a grave threat to the health, lives, and livelihoods some 1 billion people. They often carry names that are hard to pronounce. But their consequences are brutally easy to understand.
That includes
lymphatic filariasis, which produces painful, disfiguring swelling known as elephantiasis. There’s
onchocerciasis, also known as River Blindness, which is caused by a parasite transmitted by the bite of black flies causing blindness.
Schistosomiasis is a disease caused by a parasitic worm that lives in the body, damaging the urinary and genital tract or intestines, causing organ damage and increasing the risk of HIV in women and girls. Long-term infections with
soil-transmitted helminths, another parasitic worm, can cause significant cognitive and developmental problems in children that have lifelong issues, especially for women and girls and their children that continue to suffer the consequences.
We can be proud of the impressive progress made against each of these NTDs and several others as well. For example, USAID’s support for mass drug treatment with medicines that include albendazole and ivermectin has helped eliminate the risk of lymphatic filariasis for 280 million people. (While not effective against COVID, ivermectin is important for treating a number of NTDs.) USAID also has joined the World Health Organization (WHO) and NGO’s like The
Carter Center to support mass drug treatment campaigns that have
all but eliminated River Blindness in the Americas and
achieved major progress toward doing the same in sub-Saharan Africa.
Meanwhile, NIH’s National Institute of Allergy and Infectious Diseases (NIAID) is supporting public-private partnerships that are identifying new drugs for
sleeping sickness, which is fatal if not treated, and
Chagas disease, a life-threatening parasitic infection endemic through much of the Americas, from the southern United States to Argentina and Chile, that is spread by insects known as kissing bugs. Chagas disease has also been reported in dogs across U.S. southern states. Contracting the infection is dangerous to humans (and their canine companions) because mild or asymptomatic infections can produce potentially deadly heart problems years later and transmitted unknowingly from infected mothers to their unborn child. The
U.S. Centers for Disease Control and Prevention estimates that more than 300,000 persons with Chagas infection live in the United States.
In pure financial terms, the return on the U.S. investment in NTDs has been substantial. USAID estimates that over the last 15 years, just over $1 billion has leveraged $27.5 billion in donated medicines from pharmaceutical companies. This is an incredible leveraging of resources with a huge return in healthier and more resilient communities around the world. These programs have reached 1.4 billion people in 33 countries with treatment and helped
10 countries completely eliminate at least one NTD.
This year will mark the tenth anniversary of the
London Declaration on NTDs. It was a decisive moment when leaders from governments around the world, philanthropy, non-profit, and the pharmaceutical industry, forged an alliance to work as one to eliminate this long-neglected health burden. The London Declaration is now followed by the
Kigali Declaration as a sign of the growing global commitment to end the impact of NTDs holding people and communities back from their potential. The Kigali Declaration, just launched and signed by global leaders around the world, is the start of the 100% Committed campaign aimed at ending NTDs and achieving the WHO’s ambitious target of 100 countries eliminating an NTD by 2030.
As a physician dedicated to serving the underserved, I take enormous pride in our joint commitment to aiding billions of people at risk of NTDs. Our partnerships and innovation are making a major difference, showing us what is possible when working together across borders and specialties. On World NTD Day, let’s celebrate our achievements and now look to the new roadmap to 2030 and the Kigali Declaration to build on and expand our global partnership around NTDs. It is an exciting time to look for new opportunities—and there are many—for additional funding and innovation to accelerate progress toward that Holy Grail of infectious disease fighters: elimination and eradication. Now is not the time to rest on our laurels but instead to go further together.
Julie Jacobson, MD, is managing partner for the global health non-profit Bridges to Development. She served as president of the American Society of Tropical Medicine and Hygiene (ASTMH) in 2021 and has worked at the CDC and the Bill & Melinda Gates Foundation.