Could COVID-19 pandemic have led to less focus on other diseases?

By The Inspirer reporter.

There is almost one year and a half since the Covid-19 pandemic started to hit the World, countries invested much towards preventing it and treating the infected people. A question is that this pandemic has led to less focus on other diseases that are also remain burdens for nations.

Our reporter conducted a detailed interview with Dr. Eugene Ruberanziza, Senior Technical Adviser at the END Fund to get his views about the pandemic and its linkage to other infectious diseases.

1. We have had the Covid-19 pandemic around for about 1 year and a half. Much focus from medics, and resources from governments have been aimed towards it. Hasn’t this in some way led to less focus on other diseases, and thus given these diseases room to be on the rise?

The END Fund works on neglected tropical diseases (NTDs) – a group of parasitic, viral, and bacterial infections that affect more than 1.7 billion people, with 40% of the global burden in Africa alone. They include diseases such as intestinal worms, bilharzia, trachoma, and many more. The current pandemic caused a redshift in the manner in which we talk about NTDs. It created an opportunity to build on the NTD platform and emphasise the connection between water, sanitation and hygiene (WASH) and NTDs because improved WASH conditions reduce the susceptibility of getting NTDs. Through our COVID-19 Response Fund, we worked with 17 organizations in 22 countries to target millions of people with COVID-19 prevention interventions. These organizations work on public awareness, hygiene, prevention, and food security. The communities that the END Fund serves are often extremely vulnerable and are therefore likely to be more impacted by COVID-19. We leveraged our network and resources to continue to help protect these communities by providing them with soap and installing community / household handwashing stations and tying this support into existing NTD programming where possible.

2. What more linkages are there between pandemics and infectious disease threats?

Communities that lack adequate access to WASH programs and services are vulnerable to pandemics and infectious disease threats including NTDs. Therefore, improving access to these resources will make a lasting impact on reducing the spread of pandemics as well as NTDs. Safe drinking water, basic sanitation, and hygiene services are key interventions that combat NTDs. Improved WASH conditions can reduce the burden of trachoma by 27%. Sanitation alone can reduce bilharzia (schistosomiasis) by as much as 77%.

3. Which countries have been more affected by this crisis (pandemic situation giving rise to the increase of infectious diseases)?

The impact of this crisis on NTDs is pervasive. In a recent survey of 135 countries, the World Health Organization highlights that 44% of countries reported delays to NTD services.

4. Which infectious diseases can be singled out in this crisis, and what has the burden been like, statistically?

It is difficult to single out specific NTDs in this crisis. However, it is worth noting that public health research shows that certain groups of individuals are disproportionately affected by the NTD burden. For example, women and girls who have female genital schistosomiasis are 3 – 4 times more likely to become infected with HIV. Furthermore, they are 4 times more likely to develop trichiasis, risking blindness. 80% of the economic burden falls on women when members of their households have blinding trachoma.

5. What do nations have to learn from this? And what can be done?

Government investments must complement the ongoing efforts and ensure long term sustainability. Firstly, governments can prioritize NTDs on the national agenda by channeling in-country resources for disease surveillance, mass drug administration campaigns, and community mobilization efforts. This would promote country ownership in disease elimination and position endemic countries to deliver tangible results at scale. Secondly, national governments can establish country coordination mechanisms that work to incorporate WASH goals into national development plans. This includes coordinating with other sectors and clarifying stakeholder roles within and beyond health on NTD-related interventions. Lastly, governments can identify and invest in research and development in order to improve service delivery.

6. Rwanda, in Central Africa is one of the countries with a health system that is trying, but not yet there. What can you say about the handling of the pandemic here, connecting it with the gaps that might have been created regarding other diseases as much attention was being given to Covid-19?

The pandemic is having a negative impact on the entire health system. Although the provision of care services has continued in all health facilities and in the community with some adaptations, lockdowns and movement restrictions may have delayed seeking care and resulted in complications of the disease. For example, one round of mass deworming treatment for children was delayed by 4 months due to lockdown. Different programs have followed WHO guidelines to help maintain essential health services during the COVID-19 pandemic.

7. What is END FUND view of the fight of NTDs during this pandemic period?

We must scale up efforts geared towards ending NTDs and champion collaborative philanthropy. In April, The U.K. Foreign, Commonwealth & Department Office (FCDO) announced that it was cutting its aid for NTD programs. Without this funding, 250 million NTD treatments will not be delivered. 180,000 life-changing, disability-preventing surgeries will be stopped. The withdrawal of UK funding threatens years of hard-fought progress toward eliminating NTDs in several countries, and increases the possibility of disease resurgence in areas once free of them. So far, we know that the cuts will preclude the elimination of several NTDs including guinea worms, visceral leishmaniasis, river blindness, trachoma, and more. Secondly, hundreds of millions of NTD treatments already delivered to countries are now at risk of expiring as the distribution funds to deliver them to those that need them the most are no longer available. This would be a travesty, not least because companies like Merck and Johnson & Johnson, among many others, generously donate these medicines. Efforts being made to strengthen health systems – and enable pandemic preparedness – will be set back in several countries. The global NTD sector is most definitely in a crisis as a result of the FCDO’s decision, and we know that this decision will affect the lives and livelihoods of hundreds of millions of people. Despite the challenge, we are encouraged by the number and diversity of voices who have spoken out against these cuts and the END Fund is supporting a growing African NTD Leadership Initiative, led by pioneers from the public and private sectors to more effectively drive local responses to the challenges that NTDs cause. It is a time when private philanthropy can also do more, both to mitigate this immediate crisis and support a new approach to NTD funding that can offer a more sustainable, locally owned solution. 

8. What has been your achievement in the fight against NTDs in Rwanda from the time you began focusing on the country?

For more than ten years, the END Fund has worked with the Government of Rwanda (GoR) on nationwide mapping of NTDs and deworming of children. At the beginning, our joint aim was to regularly treat all preschool and school age children. Once this was successfully in place, we set our goals higher to eliminate these diseases in all age groups so that children would not miss school because of sickness and NTDs would not prevent adults from fully engaging in their socio-economic activities. In addition, the END Fund has contributed to the GoR’s efforts to build the capacity of health professionals for making the country free of NTDs. This includes the integrated cascade training on NTDs and Malaria which reached 42,000 community health workers in 2018.

9. What measures have you undertaken to safeguard the gains you have made in the fight against NTDs to go down the drain during this unpredictable period of COVID 19?

The END Fund has championed public health messages such as those approved by the WHO on washing hands with clean water and soap where possible. These public health messages cause individuals to change their behavior in order to reduce their risk of getting an NTD. We are also pushing for greater collaboration at the national, regional, and continental level. These collaborations give rise to a more seamless and coordinated proactive response during a public health crisis. As a response to the ongoing crisis, the END Fund hosted an urgent convening in June to discuss how African leaders, in particular, can galvanize a groundswell of action to respond to the need on the continent. This was an opportunity for African leadership to chart a more sustainable way forward in this new chapter of ending preventable diseases and building resilient health systems.