by David Hendrickx
The colloquium got off to an energetic start this morning with a session on the state of the art of neglected tropical diseases (NTDs) control in Asia. In the opening plenary presentation Professor Jacob John (Christian Medical College, Vellore, India) defined this group of diseases as those for which no health system based intention of control exists. He argued that if certain infectious diseases are currently not under control or no initiatives are in place to move towards control, it is because of a lack of interest and determination on a political level. Professor John therefore urged the colloquium delegates to consider their role in demanding their country’s political actors to address the issue of health and accept the principle that people’s health should be an intrinsic responsibility of the state, especially in the case of the poorest of the poor.
The session’s second keynote speaker, Professor Suman Rijal (BP Koirala Institute for Health Sciences, Dharan, Nepal) illustrated some of the opportunities and key challenges regarding the control of NTDs in Southern Asia. His presentation highlighted the tremendous burden this group of diseases represents for the region, amounting to estimates as high as 14.8 million DALYs. The need for integrated efforts towards NTD control was discussed, stressing that effective interventions need to be multifaceted. This was illustrated by the case of Kala Azar (or visceral leishmaniasis) and the elimination initiative that has been put into place in the Indian subcontinent. This program adopted a two-pronged strategy consisting of early diagnosis and treatment, and integrated vector control.
Throughout the various presentations and discussions the session also put forward a call for moving beyond the vertical programme-based approach to NTD control in Southern Asia. This strategy was considered unrealistic, uneconomical, and potentially damaging to the health system. Instead, it was argued that the health system’s own capacity to monitor and control NTDs should be strengthened. A well-established disease surveillance system is essential for developing such an integrated strategy for the control of NTDs, although it was argued that the value of such a system is wholly dependent on the ability to effectively translate the generated information into interventions. Or how concerted action speaks louder than numbers and histograms.
Other challenges and knowledge gaps for NTD control were highlighted throughout the session, including our limited understanding of the role of animal reservoirs in disease transmission and the need for improved clinical guidelines for the hands-on management of NTDs. Nevertheless, there was reason for optimism, as several NTDs are coming close to elimination in Southern Asia. However, given the current resurgence of malaria in India after it was previously considered to be under control, we should learn from past lessons. Vigilance is in order. With the few NTD elimination goals that are currently within our reach in Southern Asia, complacency is a luxury we clearly cannot afford.
So are we close to NTD elimination in Southern Asia? What is your take?
A very very ambitious last line, I must say. 🙂 In my opinion, the “politics” of health in India has too much of a bearing on such considerations. See for example the dismal proportion of public discourse around healthcare issues in India. Given this, I find very little “pressure” on governments in India (other LMICs?) to feel accountable to organising an equitable health system. Issues of “neglected” diseases are then a downstream problem. That said, I find that the focus among public health professionals has increased. More research is happening, more “talk” and advocacy is happening. I try my best to be optimistic that the “politics” will get in line. 🙂