by Chloé Eward HBA MPH

Neglected tropical diseases, or NTDs, are a group of diseases of public health importance in many countries across Africa, Asia and the Americas. Their continued presence in some of the world’s most remote and poorest communities, represents long-standing global health inequities. Success in overcoming neglected tropical diseases has been suggested as a tracer of equity in access to health services and progress towards universal health coverage, given that these diseases affect the world’s most underserved communities.

Cross-sectoral partnerships and networks are increasingly highlighted as the way forward to control and eliminate these diseases by 2030. Traditionally, NTD control and elimination programs have worked in silos, focused mostly on medical and pharmaceutical interventions. However, integrating mass-treatment focused medical approaches with the causes and social effects of NTDs, is now the focus of global plans to control and eliminate NTDs by 2030. Cross-cutting components of One Health, vector control, water, sanitation and hygiene (WASH), disease management, disability, inclusion, and gender equity are central to the success and sustainability of NTD programs. In Canada, recent survey research has demonstrated the opportunities for non-government organizations (NGOs) to collaborate and count their efforts in contributing to the global NTD control and elimination goals.

The big picture

Neglected tropical diseases are a group of 20 communicable diseases caused primarily by an infection with a parasite or bacteria or virus. They are often diseases that Canadians would consider ‘diseases of old’ like leprosy or diseases that are easily cured with modern medicines, like intestinal worms. NTDs prevail in countries where basic resources, like access to clean water and sanitation are not always available. NTDs are noted as diseases of the poor, where they are a symptom of disadvantage. Approximately 1.7 billion people are affected by one or more NTD, the majority of cases in low- and middle-income countries. Populations who are frequently in contact with common vectors such as contaminated food & water, mosquitoes, and black flies are most at risk of contracting a NTD like lymphatic filariasis, schistosomiasis, or soil-transmitted helminths. Many NTDs are transmitted by zoonoses, where animals or their excrements carry the disease. An infection with a NTD can often lead to disability and, as a result, the inability to receive a quality education, work a regular job, or contribute to the community. Although they are less known in comparison to other widespread infectious and chronic diseases like malaria, HIV and tuberculosis, NTDs pose a large economic, physical, and emotional health burden on communities around the world.

Controlling or eliminating NTDs is one of the targets of the United Nations’ Sustainable Development Goals (SDGs) and is the focus of many Canadian global health organizations and NGOs. However, the work of Canadian NGOs in global health is not always considered or counted as work towards the NTD-specific SDG goal. For example, some of these organizations may be running programs that include de-worming initiatives as part of child health and nutrition, without acknowledging that intervention is also working to eliminate NTDs.

What does NTD research and advocacy look like in Canada?

Although Canada has a record of involvement in NTD research since the 1950s, Canadian NGOs’ involvement in advocacy and the development of activities to control NTDs is only moderately known.

In June 2020, the Canadian Network for NTDs surveyed Canadian NGOs to assess the activities and engagement of global health organizations in NTDs, count Canada’s contribution to this collaborative area of global health and signify their contributions towards the SDGs. Our findings suggest that Canadian NGOs’ knowledge about NTDs and the NTD control and elimination targets could be improved, but there are Canadian-sponsored programs which are contributing to the global health goals.

Surveying Canadian NGOs: what did we find out?

A virtual survey of 22 closed and open answer questions was sent to approximately 170 contacts from 89 Canadian NGOs in French and English. We received 22 anonymized responses to the survey.

While almost all (91%) of our respondents had heard of neglected tropical diseases before receiving the survey, only 33% percent rated their own knowledge of NTDs as ‘high’ or ‘very high’, with the remainder only considering their knowledge ‘neutral’, ‘low’ or ‘very low’. Of the 20 diseases that the World Health Organization classifies as NTDs, our respondents had heard of some of the more historically well-known diseases like rabies (89% of respondents had heard of this disease), dengue (89%), leprosy (84%) and scabies (79%), but diseases with a high disease burden globally, were less well-known including soil-transmitted helminthiasis (58% of respondents had heard of this disease), leishmaniasis (42%), schistosomiasis (53%) and food-borne trematodiasis (23%).

Positively, almost half of respondents said that their organization carried out activities related to one or more NTDs in low- or middle-income countries within the last five years, with a significant number reporting activities that complemented NTD interventions, like school-based health programs, health literacy programs, mass drug administration programs, WASH activities, training for community health workers or supervision of community health workers. Interestingly, no respondents identified that they provided deworming programs at school or deworming programs for pregnant women, and only two respondents (11%) said that their organization carried out deworming programs in the community. Preventative deworming is a key treatment or intervention for soil-transmitted helminths and schistosomiasis, two diseases with a very high global burden estimated through disability-adjusted life years (DALYs).

The surveyed Canadians working in global health NGOs highlighted they are indeed a global-operating group of organizations, with programs operating across every region of the world. Most programs were recorded in occurring in Eastern, Middle, Western, and Southern Africa as South and South-eastern Asia, where NTD prevalence is high. This survey highlights the opportunities for those working in global health in Canada to increase their knowledge of NTDs and integrate NTD actions into their existing programs. Many of these Canadian NGOs work in areas where millions of dollars of drug donations are provided to address NTDs through the Ministry of Health and the WHO.

Where to next?

Our survey has highlighted that although many Canadian global health professionals have heard of NTDs, there is much more we can do together to make further progress in beating NTDs and achieving the global control and elimination goals by 2030.

Research conducted by CNNTD in 2020 highlighted that Canadian researchers across the country have contributed significantly to the evidence base of all 20 NTDs in the global scientific literature. As work to support the WHO NTD road map 2021-2030 rolls out globally, the Canadian research community, in collaboration with its partners, and in solidarity with people living in vulnerable circumstances in endemic regions worldwide, is well positioned to meet future research challenges so that the goal of eliminating the disease burden attributable to NTDs can be achieved. With a diverse base of programming across NTD-endemic regions, Canadian NGOs can be an equal integral part of the global NTD and public health community, representing Canadian leadership on the global stage.

The effects of COVID-19 demonstrate that integrated action on NTDs is more important than ever. A focus on NTDs in health programming is important in helping everyone build back better from COVID-19. Although the management of NTD projects is deeply rooted in the targets of the various all-inclusive SDGs, creating partnerships for the goals (goal 17) may be the greatest importance in their management. Multi-sectoral collaboration amongst different stakeholders around the world can both beat NTDs and strengthen health systems. It is vital for Canadian NGOs to embrace our commonalities and common goals and work together in partnership for better health for all, which includes addressing NTDs.

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Chloé Eward undertook her MPH practicum at CNNTD over summer 2020. She’s passionate about public health and global heath and currently works as a Health Planner at Entité 2 de planification des services de santé en français / French Language Health Planning Entity.