Activities of the DNTDs
Rethinking the Global Health Architecture: Neglected tropical diseases and malaria can be tackled together
+ + GHHG - Working Group Week 2021
Berlin, 24.3.2021 - Malaria and neglected tropical diseases can be tackled together, the participants of the webinar “Integrated and cross-sectoral interventions: Example Neglected Tropical Diseases and Malaria” which took place within the Actionweek of the Global Health Hub Germany. International experts had met in the run-up to the Kigali Summit on Malaria and NTDs, scheduled for June, to find out how both diseases - NTDs and malaria - can be tackled together and how this can lead to a paradigm shift in health policy.
Dr Mwelecele Ntuli Malecela, Director, Department of Control of Neglected Tropical Diseases, World Health Organization (WHO) advocated for reformulating the global health architecture and breaking down vertical health financing and allowing endemic countries more flexibility in spending as part of their greater responsibility for programmes. Dr Aimable Mbituyumuremyi, Division Manager for Malaria and NTD Programmes, Government of Rwanda explained that in his country both diseases, which represent the greatest burden of disease, were already being worked on together in one division in the Ministry of Health. He described the coordination and collaboration of the different levels of work at government, district and community levels. Richard Allan, CEO, MENTOR Initiative explained that poor populations could often benefit from joint control structures and activities of malaria and NTDs. He said that community health workers, who should be further trained and equipped with innovative digital tools, can make better diagnoses and share important data, are crucial in the fight against both diseases. Dr Daniel Eibach, Senior Health Officer One Health, from the German Federal Ministry for Economic Cooperation and Development (BMZ) underlined Germany's efforts to integrate the One Health approach in the fight against NTDs and made the case that despite all the necessary interventions in the COVID-19 epidemic, neither malaria nor NTDs should be forgotten. Dr Lutz Hegemann, Group Head, Corporate Affairs and Global Health, Novartis Institutes for BioMedical Research pointed out that pharmaceutical companies continue to support partnerships to fight both diseases. A request from the audience underlined the importance of incorporating local knowledge and decolonising innovation. The event was moderated by Dr. Dr. Carsten Köhler, Director of the Competence Centre Tropical Medicine Baden-Württemberg, Institute for Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital, Eberhard-Karls-University Tübingen and Prof. Dr. Achim Hörauf, Director of the Institute for Med. Microbiology, Immunology and Parasitology at the University Hospital Bonn, speaker of the DNTD and coordinator of the GHHG working group.
Neglected tropical diseases and their significance for Europe - Chagas disease a little-noticed tropical disease
++ Kick off the week of action against neglected tropical diseases
Berlin, 25.01.2021 - To kick off the week of action against neglected tropical diseases, the German network under the patronage of Georg Kippels MdB, organised a webtalk on Chagas disease.
Thomas Jacobs, group leader at the Bernhard-Nocht-Institute for Tropical Medicine Hamburg (BNITM), regretted that the fight against Chagas disease was not receiving any attention. Much more resources - from research to access to medicines - were needed to contain the disease. In Europe in particular, the issue is ignored, even though the disease is spreading rapidly through migration. In Spain, it is estimated that between 48,000 and 90,000 people are infected. In Hamburg alone, where his institute is active, it is estimated that 200 to 1000 people are affected.
Dr Simone Kann, Chagas expert from the Medical Mission Institute in Würzburg, described the activities in Colombia, how important hygiene concepts, the fight against local intermediate hosts but also prevention among the rural population are. The insidious thing about Chagas disease is that it is often not visible for many years. The Mission Medical Institute has therefore developed a PCR-test that can be used to measure the pathogen load.
Ulrich Madeja, Head of NTD Program at Bayer pointed out the important cooperation of drug manufacturers with WHO, especially in the context of developing and implementing a regional action plan with partners under the leadership of WHO/PAHO. He stressed that most Chaga-sufferers do not have access to health systems. It is a disease of the poor.
Eric Chatelain, Head of Drug Discovery, DNDi stressed the importance of working with good studies that show the effectiveness of drugs. It is also important to develop new drugs that are better tolerated.
Prof Achim Hörauf, DNTDs spokesperson and Director of the Institute for Medical Microbiology, Immunology and Parasitology at the University Hospital in Bonn, summarised that one must be realistic and assume that the pathogens cannot be eradicated. The Corona virus has made it very clear how dynamic infectious diseases are. He therefore pleaded once again that national and international funds in this area should not be reduced, but rather increased, if we want to be prepared to combat infectious diseases in the coming decades. He emphasised that the fight against Chagas disease can only be successful if poverty is combated.
Two thirds of all new infectious diseases originate from animals. 60-70% of all new infectious diseases occurring in humans originate from animals: Chagas disease also has a zoonotic reservoir. It is one of the 20 neglected tropical diseases that the World Health Organisation (WHO) has put on its list with the aim of eliminating them. There is no vaccination against Chagas disease. According to WHO estimates, about 6 to 7 million people are infected worldwide, with the majority living in Latin America (about 4.6 million), followed by the USA with over 300,000 and Europe with about 80,000 infected people.
The risk of infection with neglected tropical diseases increases in Europe, particularly through the transmission of parasites from latently infected mothers to their unborn children or through blood supplies contaminated with Chagas pathogens.
One problem in fighting Chagas disease is that the infectious disease is usually not diagnosed in time because the symptoms are very unspecific at the beginning (symptoms like a cold). Without diagnosis or treatment, however, Chagas can lead to serious health complications, such as heart disease, some of which result in death.
Background on German activities in the field of Chagas
At the Bernhard-Nocht-Institute for Tropical Medicine in Hamburg, researchers are working on a study to find out more about the disease in Germany. They are dedicated to screening, research, prevention and education about Chagas disease. As part of this study, people of Latin American origin living in Germany will be informed about the disease. If necessary, the study participants can receive free diagnosis and treatment at the BNITM. The project also advocates for a change in the prevention policy of this disease for Latin American people.
The Medical Mission Institute Würzburg runs a large project against Chaga disease in rural areas of Colombia. The programme follows the "One Health Approach" and consists of three pillars: the medical part (disease screening, observed therapy, therapy success and patient follow-up), the surveillance part (screening for the transmitting insects, spray campaigns, programme initiations) and the education part (about Chagas, infectious diseases, hygiene, etc.). In addition, co-infections and other newly spreading infectious diseases (e.g. gastrointestinal infections, leishmaniasis, etc.) are also addressed. The overall system in which the disease develops and spreads is considered. It is about the connections between agriculture, veterinary medicine, human medicine and nutrition.
The German pharmaceutical company Bayer, for example, has been supporting the WHO in its fight against Chagas disease since 2004, with 1 million free tablets of Lampit (nifurtimox) per year and an additional 300,000 € per year for logistics and distribution.
The Institute of Medical Microbiology, Immunology and Parasitology at the University of Bonn is working with the Drugs for Neglected Disease Initiative (DNDi, Geneva) to develop the drug fexinidazole against Chagas disease, which was already approved for sleeping sickness in 2018.
++ Interview with Prof. Dr KH Martin Kollmann
Berlin, 21 January 2021 - WHO will present the new Roadmap on NTDs 2030, which was adopted by the World Health Assembly at the end of last year, to the public. The new thing about this roadmap in particular is the integrative, multi-sectoral approach and the emphasis on the responsibility of countries where the neglected tropical diseases are endemic.
Prof. Dr. KH Martin Kollmann, founding and honorary member of the DNTDs, expert on neglected tropical diseases at the Christoffel Blind Mission (CBM) and CBM ophthalmologist explains what changes the new WHO NTD Roadmap entails. He has lived in Kenya with his family since 1994.
1st QUESTION: The new WHO NTD Roadmap is being presented to a broad public worldwide, what is new?
Prof. Dr. KH Martin Kollmann: “First of all, the new WHO-NTD Roadmap 2030 builds on the successes of an extraordinary multi-actor partnership. With the experience of decades of collaboration, e.g., in river blindness and trachoma control, this coalition of country programmes, implementing partners, research institutions, the pharmaceutical sector and communities affected by the burden of disease set common goals in 2012 with the "London Declaration" on the road to global control and elimination of NTDs.
As a result, by 2020, 42 countries have already eliminated one or more of the 20 tropical diseases defined by the WHO as neglected tropical diseases (NTDs). These impressive advances have been helped not least by substantial and long-standing drug donations from research-based pharmaceutical companies, as well as innovative approaches by civil society aid organisations. However, many interventions in the past have focused mainly on individual diseases and have paid too little attention to interactions, overlapping disease burdens and joint intervention options. It has already been shown that NTD-interventions also have systemic effects, such as the administration of antibiotics in trachoma treatment, which also have an effect against other infections and can thus reduce disease-related mortality overall, especially among children.
Integrated into the UN Sustainable Development Goals (SDGs), the WHO is now making a remarkable course correction with the new Roadmap 2030. This paradigm shift aims to better coordinate and bring together established and new NTD-partnerships to achieve the ambitious goals.
The emphasis on community-centred approaches is rightly central to this: people affected by NTDs must be systematically and from the outset actively and inclusively involved in the planning, implementation and evaluation of programmes.
This goes hand in hand with a shift in focus towards more holistic and intersectoral programmes. For example, the WHO-Roadmap explicitly highlights the importance of deepening collaboration with the WASH sector, as well as the need to strengthen One-Health-approaches.”
2nd QUESTION: What are the roles of old and new partners in implementing the strategy?
Prof. Dr. KH Martin Kollmann: “The new NTD-Roadmap 2030 builds on past successes and existing partnerships. These include, for example, disease-specific coalitions with their technical and programmatic expertise, as well as various drug donation programmes supported by the pharmaceutical sector.
But we need to step up our efforts in many areas if we are to achieve our ambitious goals of stopping all 20 NTDs. We need more drug donations and need to expand distribution structures and accompanying health interventions. And we need increased research and development efforts for additional innovative diagnostics and active ingredients.
Furthermore, to implement the new NTD-Roadmap 2030, it is essential to involve new partners, for example from the WASH (water, sanitation and hygiene) and One-Health-sectors with the important interfaces between people, animals and their shared environment. But we should also deepen partnerships with other health actors, such as the HIV/AIDS, tuberculosis and malaria communities. The links between NTDs, stigma and mental health are also obvious. Systematic treatment is also needed for other diseases caused or exacerbated by NTDs, such as female genital bilharzia, which massively increases the risk of HIV infection for affected women and girls.”
3rd QUESTION: What are the major challenges in the next ten years?
Prof. Dr KH Martin Kollmann: “Crucial to success by 2030 will be how to achieve greater efficiency and sustainability by effectively bringing together what have often been separate, side-by-side programmes; how to create congruence and strengthen local resources by systematically integrating NTD-programmes into general health and development systems; and how to meet the expected "last mile" challenges.
This includes, in particular, finding local answers for countries and regions particularly shaken by poverty and crises, shouldering the increased costs with decreasing numbers of cases, overcoming the presumably decreasing willingness of national governments and international donors to invest with increasing success, and mastering possible problems such as the development of resistance.”
Presentation of the short study: Combating neglected tropical diseases - Financing the activities of German actors in 2020 and beyond
Berlin, November 20, 2020 - Under the patronage of Ottmar von Holtz, Member of the Bundestag, the DNTDs has presented a study that for the first time provides an overview of various measures by German actors from civil society, research, the private sector and the federal government, and their funding in the fight against neglected tropical diseases.
Christian Franz, author of the study by cpc analytics, uses data that he has gained from the membership of the DNTDs to describe a broad spectrum of activities that are in part funded by the German government. It becomes clear that the civil society and private sector actors finance a large part of the fight against NTD from their own resources - in accordance with their mission “leave no one behind”. It is worrying that many projects that are funded by the German government are about to expire. In order to ensure a sustainable fight against the NTDs, the projects would have to be extended or new ones started.
Representatives from the Federal Ministry for Health, Education and Research as well as Economic Cooperation and Development and the Federal Chancellery discussed future developments with members of the DNTDs. All representatives of the ministries - BMBF, BMG, BMZ - emphasized that the fight against NTDs would also play a role in the future and that programs would be continued.
The members of the DNTDs pointed out that the adoption of the WHO Roadmap 2030 (November 12, 2020) will bring about a paradigm shift in the fight against neglected tropical diseases, away from control and towards elimination. This process will require different methods in the future and the need for drugs will increase by 2030. It is important that the fight against NTD is embedded in health programs and that cross-sectoral programs are supported more intensively.
First virtual World Health Summit 2020
Berlin – 26.10.2020 The DNTDs workshop at the first virtual World Health Summit 2020 focused on the COVID 19 crisis and the effects on the measures to eradicate neglected tropical diseases. Dr. Mwele Malecela, WHO, Director of Department of Control of Neglected Tropical Diseases noted that the COVID-19 pandemic has dramatically impacted advances in the eradication of neglected tropical diseases (NTDs). Implementation of NTD programs has been suspended following the initial WHO recommendations, but a differentiated decision-making framework for resumption of mass treatment and other NTD interventions is now in place. This means that the annual mass drug administration cycles have been interrupted, no monitoring and evaluation has been carried out, little to no operational research was implemented, work is slowly resuming. Dr. Johannes Waltz from Merck pointed out that if COVID-19 NTD interventions are disrupted for a longer period of time, the probability is high that the exposure to NTDs will increase again and long-term efforts will be lost. Dr. Irene Ayakaka from DAHW described for the East African region how the NTD community has adapted programs and guidelines, faced the challenges of the COVID-19 pandemic and continued on the path to eradicate NTDs. Makoy Yibi Logara, the NTD program coordinator for the country of South Sudan, emphasized that NTD programs offer unique platforms that reach all communities in their target areas, thus ensuring prevention and treatment, even for those who often do not have access to health care benefit the fight against COVID-19. Constanze Bönig then pointed out, how NTD control programs can be combined with the One Health approach and that the German government is building a new "One Health" focus in the Federal Ministry for Economic Cooperation and Development. Prof. Dr. Achim Hörauf, spokesman for the DNTD and director of the Institute for Medical Microbiology, Immunology and Parasitology at the Bonn University Hospital and Dr. Dr. Carsten Köhler, Director of the Competence Center Tropical Medicine Baden-Württemberg, Institute for Tropical Medicine, Travel Medicine and Human Parasitology, University Hospital, Eberhard-Karls-Universität Tübingen moderated the event.
More information is available here.