Offline: The “chronic pandemic” that just won't go away

Abstract

“I strongly encourage you to be cynical about the whole Sustainable Development Goal framework.” Dirk Engels is Director of the Department of Control of Neglected Tropical Diseases at WHO. He was speaking the day after a successful launch of the agency's third report on NTDs. The Bill & Melinda Gates Foundation had convened a small group at its new headquarters in London to discuss this disparate collection of 17 diseases, affecting over 1 billion people in 149 countries worldwide. The Foundation sought a vision for NTDs in the coming era of sustainable development. The tone of the conversation was sometimes pessimistic. A “nightmare”, was how one participant described the SDG landscape. But the NTD community should surely not have to worry about SDGs. They have already crafted their own Roadmap—produced by WHO in 2011, endorsed the following year by countries, donors, non-governmental organisations, and pharmaceutical companies in the London Declaration, and backed in 2013 by a tough World Health Assembly Resolution. The latest WHO report describes these extraordinary milestones as “the ‘rags to riches’ story of NTD control”. And the targets are unambiguously clear: eradication of dracunculiasis (in 2015) and yaws (in 2020); global elimination of blinding trachoma, leprosy, human African Trypanosomiasis, and lymphatic filariasis by 2020; regional elimination of selected diseases (eg, rabies and onchocerciasis in Latin America by 2015); and country elimination (eg, onchocerciasis and schistosomiasis from several countries in Africa by 2020). What more could the SDGs offer to such a well-organised international response? The answer, in one word, is money. Currently, about US$200–300 million is given for NTDs annually by donors. In 2014, the NTD community estimated that an additional US$200 million each year would be needed to meet their eradication and elimination targets. But WHO's new report cites further eye-watering figures to underline the funding challenge. Excluding medicines—thanks to generous donations by pharmaceutical companies—the total investment target for 2015–20 is US$18 billion. This massive figure is massive because it includes vector control. WHO's NTD strategy also takes advantage of the momentum behind Universal Health Coverage. Investment in universal coverage against NTDs is estimated to be US$2·1 billion annually for the entire SDG era, 2015–30. But compare these ambitious numbers to the present sobering reality. WHO ruefully notes that, “Commitments for the period 2015–2020 are currently projected at less than US$200 million per year.” Here is the reason why the SDGs are so important. Unless high-level political recognition is given to NTDs by their inclusion in new development goals, the financing to meet WHO's targets is unlikely to materialise. What are the prospects for establishing NTDs as a core element of the SDGs? Dominic Haslam, who leads policy and programmes for Sightsavers, a charity dedicated to eliminating avoidable blindness, was optimistic. NTDs were “well-placed” to be included in the post-2015 framework, he said. Christopher Fitzpatrick, an economist from WHO, pointed out that NTDs were already included in the current draft of the SDGs. Most development experts understood that NTDs were a litmus test for health equity. So what should be the specific SDG target? The target proposed, and supported at the Gates meeting, was a 90% reduction in the number of people requiring prevention of NTDs by 2030. There is no room for complacency. David Molyneux, a tenacious advocate on behalf of NTDs, argued that to strengthen political engagement these diseases should be called what they are—a “chronic pandemic”. But I left this meeting anxious about relying on the SDGs alone as a lever to pump prime funding for neglected tropical diseases. An additional objective should be the identification of a Head of State to be a standard bearer for NTDs. The UN Secretary-General himself should be encouraged to put his name and office behind WHO's Roadmap. And even if NTDs do succeed in winning an SDG target, progress will be slow without independent accountability—a mechanism to monitor and review the promises and commitments made by partners. Without a more nuanced political strategy, the NTD community's hopes of achieving either proper acceptance or new financing may need to be severely curbed.