The COVID-19 pandemic has shown that despite robust health indicators, exposure to even one infected host can restart the chain of transmission. It also reaffirmed that Neglected Tropical Diseases (NTDs)—a set of about 20 diseases that occur primarily in tropical environments and disproportionately affect poor and marginalized populations—are a critical challenge. The World Health Organization (WHO) estimates that more than 1.7 billion people worldwide require treatment for at least one NTD per year, and that NTDs contribute to nearly 19 million disability-adjusted years (DALY), or one percent of the global disease burden.
In January 2021, the WHO set an ambitious roadmap: to ‘prevent, control, eliminate, or eradicate’ NTDs by 2030. The objectives set out to achieve include:
- Reducing the number of people requiring treatment for NTDs by 90 percent
- Eliminating at least one NTD in a minimum of 100 countries
- Eradicating two diseases: dracunculiasis and yaws
Of the 20 NTDs recognized by the WHO, 11 are prevalent in India. This includes Lymphatic Filariasis (LF), Visceral Leishmaniasis, also known as Kala Azar (KA), leprosy, dengue, and rabies. India bears up to 40 percent of the global burden of both KA and LF, and is working toward eliminating both diseases, in line with Sustainable Development Goals.
According to recent data, LF is more prevalent than KA and is endemic in more than 270 districts across 20 states and union territories. However, KA, although less prevalent, poses a higher risk, as it can be fatal when left untreated. The disease is currently endemic in 54 districts across four states.
Both KA and LF affect rural and urban poor - communities and groups of people who lack adequate access to healthcare resources, diagnostics, treatment, and voice.
LF ELIMINATION
The Bill & Melinda Gates Foundation is focused on partnering closely with central and state governments to accelerate the elimination of LF. We support their twin-pillar approach, which combines control of transmission through mass-drug administration (MDA) and the eventual cessation of MDA, along with subsidized care for morbidity management and disability prevention.
Through our partners, we also support the delivery of preventive drugs to those at risk. This involves distribution of two drugs (Diethylcarbamazine (DEC) and Albendazole (DA)). It also involves the administration of Ivermectin with DEC and Albendazole (IDA) to help reach the WHO-prescribed criteria for elimination of LF as a public health problem.
On-the-ground innovation plays a significant role in achieving these goals. This includes the introduction and use of finger marking for all those in an endemic community who have already taken the prescribed dose of medication to ensure an accurate record of MDA. It also includes a meticulous two-step process to screen for the presence of LF.
An improved surveillance system for identifying and treating patients on time is another focus area. The Foundation also partners with organizations centered around providing support to patients disfigured by LF. One way is by enabling the training of physicians at the district hospital level itself. This helps provide care closer to home and eliminates any inconvenience to patients from having to travel long distances to access good quality healthcare in big cities.
These efforts are bearing fruit. Until a few years ago, the majority of people in high burden areas were not willing to take drugs for treatment. However, thanks to sustained efforts by the government and our partners, as of 2022 nearly 70 percent of affected people were estimated to be taking the treatment in nearly 80 percent of affected areas. Going forward, achieving 100 percent MDA coverage remains a priority.
KA ELIMINATION
The Foundation also supports government efforts to eliminate KA and Post Kala Azar Dermal Leishmaniasis or PKDL. India is well on its way to eliminating KA as a public health problem and significantly reducing the PKDL case load. Thanks to sustained efforts toward its elimination, KA remains a concern in only a few blocks across four states across the country.
Out of four endemic states—Bihar, Jharkhand, Uttar Pradesh (UP), and West Bengal (WB)—two states, UP and WB, have achieved elimination and are reporting cases well below the stipulated threshold of infection.
Bihar and Jharkhand are also making significant strides towards reporting lower infection rates and inching closer toward the elimination goal.
India's ability to successfully meet its goal to eliminate KA requires continued and sustained efforts. In the case of LF, there must be renewed focus on targeting migratory urban populations from endemic areas, who may be asymptomatic, but pose a considerable risk of transmitting infection.
The measures India has taken in roping in local resources, people, and innovations to eliminate KA will also empower it to eliminate LF. Adopting evidence-based practices, including early diagnosis and complete treatment, advocacy for behavior change management, thorough and continuous surveillance, supervision, and evaluation, along with government leadership, has created an enabling environment towards successful elimination of these diseases.
