Togo had reason to celebrate in 2022 when it became the first country in the world to eliminate four neglected tropical diseases. The West African nation was free of Guinea worm disease in 2011, lymphatic filariasis in 2017, sleeping sickness in 2020, and trachoma disease last year.
These diseases are spread in different ways. Guinea worm disease, for example, is a waterborne disease while sleeping sickness is transmitted by the tsetse fly.
They are just a few of a host of neglected tropical diseases, which often affect poor communities and which are exacerbated by instability, climate change, and poor living conditions. Each year, 1.7 billion people are affected by these diseases. They cause great pain, stigma, disability – and sometimes death.
Togo achieved its milestone through a combination of measures. These included door-to-door public drug administration, training of health workers, sustained financial support and strong political support.
Other African countries also made significant progress in tackling neglected tropical diseases by 2022. Benin, Rwanda and Uganda succeeded in eliminating sleeping sickness. Malawi eliminated trachoma and the Democratic Republic of Congo (DRC) eliminated Guinea worm disease.
On another continent, in India, Prime Minister Narendra Modi hailed his country’s success in eradicating smallpox, polio and guinea worm disease, while expressing confidence that it could “soon” eliminate another neglected tropical disease, visceral leishmaniasis.
All of this means there are plenty of reasons to celebrate. But the global health community cannot rest on its laurels. These diseases are still present in some areas.
Many of these disease-carrying insects do not respect borders—so no one is safe unless everyone is. The COVID-19 pandemic severely disrupted control programs, delaying the achievement of elimination goals for some diseases for years. Some countries are also struggling to combat neglected tropical diseases due to instability and conflict that hamper control efforts or have large remote areas that are difficult to reach.
Adequate funding is needed for drug distribution, training of health care workers, and awareness raising. Funding for research and development is also important, so that promising innovations emerging from African laboratories and clinical trial sites can reach doctors and patients.
One of the challenges facing many neglected tropical diseases is the lack of adequate treatment. Existing medications are often not effective enough or are difficult to administer, such as regular injections that require hospitalization. Some treatments are very painful. Others are completely toxic. For some diseases, such as a fungal infection called mycetoma, which is endemic in Sudan, there are no effective treatments – amputation is often the only option.
Because these diseases affect poor communities and little profit can be made from developing new drugs, they have historically been neglected by conventional medicine research.
But the abundant good news of the past year has given me hope. 2022 was an incredible year for visceral leishmaniasis, which is endemic in East Africa and is my area of expertise as a physician and specialist in infectious diseases and tropical medicine.
Read more: Innovation – and research – key to beating neglected tropical diseases in Africa
This disease is fatal if not treated. It is the deadliest parasite killer after malaria. People infected with visceral leishmaniasis suffer from fever, weight loss and acute fatigue. Many are unable to work, which means a loss of income for their families.
But in September 2022, a shorter, more effective new treatment was announced. Developed with several partners, including Médecins Sans Frontières, this treatment partially eliminates the need for daily injections.
In June, the World Health Organization also recommended improved treatment, especially for people co-infected with HIV and visceral leishmaniasis. It gives hope to thousands of patients – mostly young seasonal migrant workers – who respond poorly to standard treatment.
Promising results for a new, one-dose drug for sleeping sickness were also announced last year following clinical studies by Congolese and Guinean researchers in the DRC and Guinea. This new drug would be a significant improvement over existing drugs and could open the door to permanently eradicating the disease. This is a remarkable achievement. I still remember when the only medicine available to my fellow doctors in the DRC was an arsenic derivative so toxic it killed 5% of their patients.
Cooperation and partnership
However, research and development efforts alone are not enough. Collaboration and partnership are key. These are not just buzzwords: past successes in tackling neglected tropical diseases are based on close partnerships between national health authorities, international donors, medical research institutes, universities and industry.
The new treatments I mentioned above were all developed because of such alliances. I am the director of the East Africa office of the Drugs for Neglected Diseases Initiative, a global non-profit medical research organization, which has played an active role in all of these research and development collaborations.
The good news is that new partnerships are forming. In 2022, we established LeishAccess, a regional collaboration working to promote access to visceral leishmaniasis treatments in East Africa and remove barriers that prevent half of patients from accessing the life-saving drugs they need.
All these advances give me hope. These extraordinary efforts will eventually pay off. I am convinced that in the not too distant future, people will stop dying from leishmaniasis, and will be safely cured thanks to simple oral medications.
Many gaps remain, with millions of people still suffering from curable diseases. And neglected tropical diseases that have been slowly disappearing can suddenly return with a vengeance fueled by conflict, economic crisis, rising poverty, or climate change.
But if sustained investment is combined with African political leadership and scientific excellence, there is good reason to hope for the elimination of neglected tropical diseases on the continent.