By Esther Nakkazi
Almost 200 million doses of medicines used for the treatment of Neglected Tropical Diseases (NTDs) in Africa are at risk of expiring and not getting to the communities that need them due to the UK government’s sudden withdrawal of £150 million in funding.
Lifesaving drugs including praziquantel, used for the prevention and treatment of bilharzia, a debilitating condition that affects the urinary and intestinal system, will have to be destroyed as countries lack the funds to help with distribution of the drugs.
Praziquantel drugs from Merck are donated freely in partnership with the UK Government. The UK Government funds programme delivery (via ASCEND) to get them to the communities that need them across 24 countries in Africa.
The World Health Organisation (WHO) has joined many other agencies in warning about the impact of the cut to foreign aid this year.
In total, close to 13 billion drugs have been donated due to commitments made at the London declaration in 2012 (over one billion in the last year). In addition, other companies such as Bayer and Sanofi have been providing financial resources so that WHO can provide technical support to the countries.
In a submission to the International Development Committee – which is conducting an inquiry into the future of UK aid – the WHO said the cuts would leave millions of the world’s poorest people at risk from NTDs.
These include elephantiasis, trachoma and Guinea Worm and are among 20 disease groups that mainly affect people in the poorest countries. They are preventable but without treatment the WHO said they “kill, blind, disfigure and maim”.
“The urgent priority is to try and plug the funding gap created by the UK Government’s exit and to get these donated medicines to the people that need them before they expire,” said Executive Director at Uniting to Combat Neglected Tropical Diseases, Thoko Elphick-Pooley.
In April the British government announced that it will slash its funding to tackle the world’s most NTDs by 90 % – a cut of £150m, reducing funding this year from £167m to just £17m.
In Zambia alone, the country is now racing to administer 4 million doses of praziquantel that expire at the end of June amid a third wave of COVID-19. The drugs could treat 1.7 million children, said Elphick-Pooley.
Out of the 26 countries affected by the UK aid cuts, 24 are in Africa. The five most affected African countries include the Democratic Republic of Congo, Malawi, Mozambique, Tanzania and Zambia – which are set to lose a total of $126 million in funding for the treatment for NTDs.
African countries, including Mozambique, Ghana, Ethiopia, Liberia and Sierra Leone also stand to lose out.
“We are calling on countries affected by these diseases to step up and fund a larger proportion of the NTD programme themselves, to prioritise NTD interventions in their bilateral engagement with donor countries, and to speak about the impact of this aid cut on their populations,” said Elphick-Pooley.
He said the withdrawal of UK funding will necessitate a campaign to mobilise approximately £150 million annually to “ensure that populations requiring interventions against NTDs continue to receive them and we can stay on course towards the goal of a 90% reduction of the numbers of people requiring an NTD intervention by 2030”.
NTDs are a group of infectious diseases that greatly affect especially poor communities and include diseases such as intestinal worms, elephantiasis, bilharzia, blinding trachoma, river blindness, Guinea worm disease, visceral leishmaniasis and leprosy.
About 1.7 billion people worldwide are affected by NTDs and at least 40% of the global burden of the NTDs is in the African continent. NTDs affect over 600 million people in Africa and disproportionately impacts young people.
In East Africa the aid cuts will mean exiting from supporting interventions against visceral leishmaniasis – a fatal disease which causes swelling of the spleen and liver, 50% of the global burden of which is in the East Africa region.
Many of the NTD treatment drugs which will expire due to UK aid cuts would have been used to prevent parasitic worms in children which cause numerous health issues such as anaemia, reproductive organ damage, stunting, kidney damage, and increased risk of HIV in women to name just a few.
Parasitic worms not only prevent children from attending school, but also reduce their ability to learn and negatively affect their future earning potential. They also prevent adults from going to work which traps individuals and whole communities in poverty cycles.
Similarly, diseases like Guinea worm, blinding trachoma and elephantiasis could cause unnecessary setbacks for the poorest communities in Africa.
“The UK pulling out at this time, from what has been a successful global health partnership, not only undermines hard fought gains, but looks to weaken the very partnerships the UK is seeking to forge with African countries,” said the Head of SADC Youth Task Force on neglected tropical diseases, Maximillian Godwin.
The WHO recently launched a sustainable framework for action against NTDs 2021-2030 to help Member States, stakeholders and partners to align their strategies on identifying sustainable pathways towards the WHO road map 2030 targets endorsed by the 73rd World Health Assembly in November 2020.
Member countries also renewed commitment to reaching the global NTD targets by re-focusing their work for the next decade and adding new cross-cutting targets that are more aligned with the Sustainable Development Goals.
The focus of the framework entailed protecting the progress achieved and, at the same time, expanding the scope to cover all 20 diseases and disease groups towards the eradication, elimination and control of NTDs.
“We are supporting the ongoing country, regional and international engagement and advocacy efforts in the delivery of the WHO’s roadmap on NTDs. We are also committed to contributing innovative ideas, skills and talents in the fight against NTDs. We must ensure that future generations of Africans are not held back – we must act now so that we can live up to our full potential,” a statement from the youth said.
The WHO in the framework had warned countries against dependence on external funding sources which increases the uncertainty of funding for NTD interventions, and urged countries that receive external funding to have ongoing discussions with donors to understand their financing plans and commitments.
Various organisations including Uniting to Combat Neglected Tropical Diseases which represents (100+ organisations working on NTDs) have also written an open letter to Prime Minister Boris Johnson urging him to maintain at least 50% of this year’s budget to NTDs and commit to previous funding levels in 2022.
The open letter was sent in partnership major funding agencies including the Bill & Melinda Gates Foundation, Drugs for Neglected Diseases Initiative (DNDi), FIND, Global Citizen, Liverpool School of Tropical Medicine, London School of Hygiene and Tropical Medicine, Médecins Sans Frontières/Doctors Without Borders, Mundo Sano, RSTMH, SDGs Promise Japan, and The End Fund.
Reversing gains made so far:
SADC Youth, representing an estimated 207 million youth in 16 countries in Africa, said they want the UK to reconsider the decision to exit NTD programs entirely, and instead look to protect a proportion of the funding this year, with a view to coming back when the economic situation improves.
This would save lives at a time when COVID-19 has shown just how critical collaboration is and it is just the right and ethical thing to do,” they said committing to holding leaders accountable, making sure that they are deliver on their health promises by working in partnership with local communities, other African governments and international donors.
A lot of progress has so far been made especially towards research and development of new treatments for NTDs.
Across Africa, 43 countries have eliminated at least one NTD according to DNDi data. A further 12 countries were expected to be on track to eliminate an NTD in the next three years – but this incredible progress could be undone.
“We mustn’t jeopardise years of hard-fought progress toward eliminating NTDs in several countries, and risk seeing possible disease resurgence in areas once free of these devastating diseases,” said Elphick-Pooley.
According to data from the DNDi, currently, less than 0.5% of the 88,000 drugs in the global innovation pipeline target NTDs even though these diseases represent more than 10% of the global disease burden.
Dr. Monique Wasunna the director DNDi said that the few treatments that exist for DNDi could be toxic, with a low cure rate and efficacy with minimal options available to access but the organization was working to increase patient-friendly treatments by 2028.
The UK Government had previously promised to deliver 251 million NTDs treatments and support 180,000 disability-preventing surgeries. Pharmaceutical companies had already freely donated the medicine to provide these treatments.
“Funding to tackle NTDs is one of the best investments in global health. In a world where we are fighting to find solutions to new challenges, Africa’s experience shows that NTDs are solvable problems. Tackling NTDs is a shared responsibility – each partner must do their part to ensure that young African are not left behind,” said Godwin.
In February 2020, youth from around the world gathered in Dar es Salaam, Tanzania to launch Youth Combating Neglected Tropical Diseases (NTDs) – a global movement of young people committed to be a generation free of NTDs.
This was swiftly followed by the establishment of a Youth Task Force within the Southern African Youth Forum (SAYoF) who are dedicated to fighting NTDs across the Southern African Development Community region.