The Kigali Declaration on neglected tropical diseases and the new societal outlook

Tropical diseases have historically been ignored by conventional medicine because they primarily affect impoverished communities
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On 23 June 2022, Rwanda hosted the Kigali Summit on Malaria and Neglected Tropical Diseases (NTDs) during CHOGM 2022. The resulting Kigali Declaration on NTDs was an endorsement of an existing World Health Organization (WHO) road map: Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases, which was adopted in 2021. The WHO road map and this endorsement are a significant development for Africa. Here’s why.

NTDs are a group of 20 preventable diseases that, for the most part, are vector-borne (transmitted by a vector such as mosquitoes, fleas, ticks, etc.) and are, to a large extent, prevalent in tropical areas. NTDS were termed the diseases of inequity and poverty in the recent Kigali Declaration because the socio-economic and environmental conditions in which they fester are characterized by poverty and insalubrity. To make matters worse, climate conditions in tropical areas favour the proliferation of vectors. However, as countries put in place the infrastructural development of their cities and improve their health systems, these diseases slowly disappear.

Since 2012, WHO sets a road map for every decade to eradicate NTDs. For instance, the 2012-2020 road map was endorsed by the London Declaration on Neglected Tropical Diseases, an initiative from different stakeholders that occurred in January 2012 and had the goal of eradicating or preventing the transmission of 10 of the 20 NTDs by 2020. In the same vein, the Kigali Declaration reaffirms the global commitment to WHO’s new 2021-2030 road map. At the core of the road map are two main approaches: country ownership and partnership. In other words, it’s an opportunity for the African countries (who are the most affected) to take ownership of addressing the challenge of NTDs while partnering with local, regional and international organizations, as well as private actors.

Africa’s ownership is key because tropical diseases, known to ravage neighbourhoods, are a thorn in the flesh of the Global South. They have historically been ignored by conventional medicine because they primarily affect impoverished communities. The neglect of tropical diseases is apparent through the underfunding of programmes aimed at eradicating them. Unsurprisingly, the focus of conventional medicine has often been on the so-called ‘global’ and ‘conventional’ diseases. The “global” label usually means that diseases that primarily affect the Global South receive little to no attention when it comes to funding, research and production of vaccines and drugs.

Worst still, the allocated budget to the health sector in most African countries is insufficient if the objectives are to regulate, prevent, and treat NTDs. This explains why funding from global organizations and high-income countries is still needed in the affected regions. Indeed, the implementation of policies and programmes meant to eradicate NTDs must be undertaken at the national level. And since funds are imperative to reach any form of achievement in this regard, governments usually partner with regional bodies and international health organizations.

For all these reasons, the Kigali Declaration is an important political engagement that will attract more visibility and, therefore, more pledges and investments from both public and private sectors. These might in turn benefit regional academic institutions in specific research projects and the development of management approaches. Many of the private organizations involved in the healthcare sector, such as pharmaceutical companies have already started to pledge to the new endorsement. For instance, Novartis has pledged $250 million in tropical disease research over the next five years. Most notably, the African Union had also made a commitment a few months before CHOGM 2022 to prioritise NTDs by including them in the “Agenda 2063, The Africa We Want” vision.

It is worth noting that NTDs fall into Sustainable Development Goal 3: Good health and well-being,which is intrinsically linked with many other SDGs. In fact, NTDs not only prolong the poverty in individual families whose meagre resources are diverted to healthcare spending, but they also have human resources costs on the country. These are real people living in extreme poverty for generations due to circumstances that can be eliminated and prevented with functioning socio-economic systems.

Despite the challenges related to funding, climate and poverty, there have been significant strides since 2012 with 47 countries eradicating at least one NTD, and 600 million people no longer requiring treatment. For instance, diseases such as human trypanosomiasis are now rare. In another instance, Elflein published that from 2013 to 2020 the mass medication administration for lymphatic filariasis (or elephantiasis), which was once required for about 316 million people who resided in affected regions, is now no longer essential due to very low transmission. Hopefully, more can be achieved with adequate political leadership.

The 21st century has definitely reshaped the way we conceive and organize our lives, with healthcare proving to be a pivotal factor in modern societies. We have realized that, oftentimes, if not always, individual health outcomes mostly depend on the quality of life of the collective. Healthcare is also omnipresent in every high-level discussion such as during the CHOGM summit recently held in Kigali. Hence, the zeal that Africa has demonstrated in participating and taking the lead in these global discussions gives hope that more emphasis will be put by multilateral organisations on issues that primarily affect the Global South in general and the continent in particular. This might in turn help future generations from all over the world to think with a bigger perspective in mind.

* NTDs include Buruli ulcer, Chagas disease, dengue fever and chikungunya, dracunculiasis (Guinea worm disease), echinococcosis, foodborne trematodiases, human African trypanosomiasis (sleeping sickness) also known as “mouche tsé-tsé” in some African countries, leishmaniasis, leprosy (Hansen’s disease), lymphatic filariasis, mycetoma, chromoblastomycosis and other deep mycoses, onchocerciasis (river blindness), rabies, scabies and other ectoparasitoses, schistosomiasis, soil-transmitted helminthiases, snakebite envenoming, taeniasis/cysticercosis, trachoma, and yaws and other endemic treponematoses.

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