Written by Nirmal Kumar Ganguly
As we grapple with the magnitude of changes brought by the Covid-19 pandemic, we must also consider its impact on other health emergencies. Disease outbreaks usually result in single-minded efforts to stem the tide, distracting from other public health issues in the process. The 2014-16 Ebola outbreak resulted in the loss of an additional 10,600 West African lives due to HIV, TB and malaria. Now, as health services, resources and attention are diverted to the fight against Covid-19, experts have warned that the pandemic will indirectly exact a secondary toll. This could be particularly catastrophic when it comes to programmes to combat Neglected Tropical Diseases (NTDs).
NTDs such as dengue, lymphatic filariasis and visceral leishmaniasis (Kala-Azar) afflict 1 billion people worldwide, and yet, are not prioritised in the public health narrative in many parts of the world. India bears the largest burden of NTDs in the world, accounting for 40 per cent of the global lymphatic filariasis disease burden and almost a quarter of the world’s visceral leishmaniasis cases.
In recent years, the government has made concerted efforts to address the nation’s NTD burden, especially visceral leishmaniasis and lymphatic filariasis which were slated to be eliminated by 2020 and 2021 respectively. However, the onset of the pandemic and the consequent lockdowns have led to the postponement of activities crucial to achieving the target — these include measures like Mass Drug Administration (MDA) for lymphatic filariasis prevention in endemic districts and Indoor Residual Spraying (IRS) to control the breeding of sandflies that transmit visceral leishmaniasis. While state governments are now resuming these activities, social distancing requirements make their implementation challenging as MDA and IRS activities are human resource intensive and require interpersonal contact.
In the current situation, we must adapt, integrate, optimise and accelerate existing strategies. Most importantly, we need to minimise the risk of COVID-19 transmission by equipping field staff with Personal Protective Equipment (PPEs), handwashing stations and training to ensure social distancing during field activities. There is growing evidence that wearing masks can reduce transmission of the virus by as much as 50 per cent. Our field health staff must be mandated to wear masks.
We can no longer afford to implement public health programmes in silos. In NTD endemic districts, interventions to eliminate NTDs, malaria and HIV are often aimed at the same target population. Thus, the limited programmatic and financial resources must be optimised to deliver healthcare services in an integrated manner. Furthermore, greater flexibility in decision-making at the district level would allow for refining the integrated approach based on available resources, disease profiles and the unique needs of a community.
Another approach would be to leverage technological solutions. Telemedicine consultations are being made available to people suffering from NTDs in areas that are hard to reach. Integrated messaging on NTDs and Covid-19 through radio announcements, SMS and WhatsApp need to be enhanced along with traditional mobilisation efforts to bolster community acceptance of critical vector control activities. Covid-19 has highlighted the need for creating a repository of best practices that can spur local innovative responses to the challenges posed by the pandemic and ensure safe delivery of NTD programmes.
The World Health Organisations new roadmap on NTDs espouses a people-centric approach — it is based on the principles of partnership and strengthening the health system. As the pandemic is here to stay, the strategies outlined in the roadmap for measuring impact, creating linkages with other programmes and ensuring continued and greater domestic funding must be implemented if we are to keep our promise to end NTDs like lymphatic filariasis and visceral leishmaniasis.
Like Covid-19, NTDs too push people into economic despair. Achieving the elimination of these diseases will be critical to reducing poverty and ultimately, driving our economic growth.
The writer is Former Director General, Indian Council of Medical Research
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