Activities of the DNTDs
A signal for more cooperation: 50 days before the Kigali Summit against malaria and neglected tropical diseases
++ Joint event of Friends of the Global Fund Europe and the DNTDs
Berlin, 04.05.2021 - In the run-up to the Kigali Summit on Malaria and NTDs and on the occasion of World Malaria Day, Friends of the Global Fund Europe together with the German Network against Neglected Tropical Diseases organised a joint discussion event.
Heidemarie Wieczorek-Zeul, former Minister for Economic Cooperation and Development, Vice-President of Friends of the Global Fund Europe welcomed the opportunity of the Kigali Summit in June to discuss integrated solutions to combat infectious diseases. Financial commitment and political will are needed to fight these diseases. But at the beginning of everything is attention. That is why an event like this is important.
Olivia Ngou, Impact Santé Afrique and network CS4ME (Civil Society for Malaria Elimination), described the work of community health services in the fight against malaria and NTDs. The scope of work was becoming more and more ambitious, from diagnosis to treatment. Unfortunately, the staff are often not t integrated into the state structures of the public health services.
For Prof. Dr. Achim Hörauf, spokesperson of the DNTDs, Director of the Institute for Medical Microbiology, Immunology and Parasitology at the University Hospital of Bonn, new programmes of digitalisation offer the possibility to tackle NTDs and malaria control faster and more effectively together. Also, the just-released UN Aids 5-year plan (2021-2026) points to the links between HIV and female genital schistosomiasis (FGS) and proposes treatment in integrated health services.
Dianne Stewart, Donor Relations Department, GFATM supported the thesis that in the future the integrated, one-health approach would lead the way. The Global Fund is on the way to achieving this.
Birgit Pickel, Head of Division at the Federal Ministry for Economic Cooperation and Development, underlined the importance of integrating the One Health approach in the Global Fund against HIV/AIDS, TB and Malaria and how closely it is linked to the fight against neglected tropical diseases. In the future, intersectoral approaches must be taken into account, and her ministry is increasingly involved in the area of WASH. But also, the cooperation of human and veterinary medicine, with the finance ministers and the representatives of civil society are groundbreaking pioneering.
Dr Claude Oeuvray, Program Lead: Malaria Integrated Health Solution at Merck Group took a look at the use of different drugs that can be used in the fight against neglected tropical diseases and malaria. With ivermectin, an insect bite becomes a lethal risk for the malaria mosquito. At the same time, the drug is used in the treatment of neglected tropical diseases such as river blindness and elephantiasis (lymphatic filariasis).
Dr. Aimable Mbituyumuremyi, Rwanda Biomedical Center, Ministry of Health described that in his country, control strategies are coordinated in the national plans. This leads to savings in financial resources for vector control and in the deployment of personnel.
A short survey showed that a small majority of participants think that Momentum Covid offers an opportunity to improve health systems in middle- and low-income countries. A vote that was echoed by the speakers.
Discussion on Malaria and NTDs in the run-up to the Kigali Summit
++ Government of Rhineland-Palatinate for more awareness in the fight against neglected tropical diseases
Berlin/Mainz - 29.04.2021. At a joint event organised by the Rwanda Department of the Rhineland-Palatinate State Government and the DNTDs on the occasion of the Kigali Summit on Malaria and NTDs in June 2021, NTDs were the focus of discussions.
Prof. Dr. Achim Hörauf, speaker of the DNTDs, Director of the Institute for Medical Microbiology, Immunology and Parasitology at the University Hospital Bonn (IMMIP) explained some disease patterns of NTDs and placed the Kigali Summit in the context of the numerous activities in the field of global health policy.
Uta Elisabeth Düll, a doctor in Rwanda, spoke about the great efforts of the Rwandan government to maintain the NTD programmes despite the COVID-19 pandemic. She reported on the well-coordinated health infrastructure at different levels - through community health workers, health posts and district hospitals. A health insurance scheme for everyone, she said, provides the population with good health care.
"The state government of Rhineland-Palatinate has been supporting a country partnership with Rwanda for more than 40 years, which focuses on schools, hospitals and water supply," said Carola Stein, Head of Division for the partner country Rwanda in the Rhineland-Palatinate Ministry of the Interior and Sport. The partnership approach is important. The exchange is not a one-way street. Rwanda is ahead of Germany in the implementation of the Sustainable Development Goals 2030, for example, and one can learn from this.
Johannes Waltz, Head of Merck Schistosomiasis Elimination, Program and Global Schistosomiasis Alliance (GSA) affirmed Rwanda's pioneering role in the fight against neglected tropical diseases, especially schistosomiasis. The prospect of elimination is realistic, he said. Therefore, Merck has agreed on additional drug donations with the Rwandan government in order to get closer to the goal. However, integrated use is important, i.e. education, prevention, WASH and hygiene measures must be combined with the use of medicines.
Burkard Kömm, Managing Director, DAHW Deutsche Lepra- und Tuberkulosehilfe e.V. (German Leprosy and Tuberculosis Relief Association), described the trauma suffered by many women and men who have schistosomiasis, leprosy or elephantiasis. Often superstition and ignorance lead to the exclusion of the sick and traditional healers are then the first port of call. DAHW therefore has programmes with social workers to find these people and to convince them to accept help from modern medicine.
Ottmar von Holtz, Member of the German Parliament, member of the Parliamentary Advisory Council against Neglected Tropical Diseases and for the Strengthening of Health Systems underlined the possibilities of the parliamentarians to raise the issue of neglected tropical diseases in different committees such as the Subcommittee on Health in German parliament. He promised they will continue to put pressure on the federal government to further promote the fight against NTDs.
There were also numerous questions from the audience. Among other things, the announced cuts by the British government were intensively discussed. It is planned to reduce public development funding from 0.7 per cent to 0.5 per cent. The effects would also be dramatic for programmes of neglected tropical diseases, because millions of donated medicines would no longer reach the sick people on the ground.
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.”