WHO Control and Elimination of Neglected Tropical Diseases in the Western Pacific

EXECUTIVE SUMMARY

Neglected tropical diseases (NTDs) are a diverse group of disease conditions that are most common in tropical and subtropical regions. These diseases most heavily affect people living without access to adequate sanitation, basic infrastructure and health services. In addition to significant morbidity and mortality, these diseases can lead to stigma and discrimination in communities.The World Health Organization (WHO) prioritizes 20 diseases affecting more than 1 billion people in 149 countries as NTDs. Of these, 15 are endemic in 28 countries and areas in the Western Pacific Region. These diseases are prioritized not only because of the magnitude and impact of their burden, but also because they are amenable to broad control, elimination or eradication by delivering one or more of the five interventions recommended by WHO. The interventions are: (1) preventive chemotherapy; (2) case management and rehabilitation; (3) vector and intermediate host control; (4) veterinary public health; and (5) safe water, sanitation and hygiene. In 2012, WHO and partners adopted Accelerating Work to Overcome the Global Impact of Neglected Tropical Diseases: A Roadmap for Implementation. The Roadmap set out goals and targets to be reached by 2020 and strategies for each NTD based on World Health Assembly resolutions and global initiatives. In the same year, the Regional Committee endorsed the Regional Action Plan for Neglected Tropical Diseases in the Western Pacific Region (2012–2016) (WPR/RC63.R4), setting disease-specific elimination and control goals, in line with the NTD Roadmap. Since then, the Western Pacific Region has seen remarkable progress, primarily through preventive chemotherapy or mass drug administration. From 2016 to 2018, nine countries and areas (Cambodia, Cook Islands, the Marshall Islands, Niue, Palau, Tonga, Vanuatu, Viet Nam, and Wallis and Futuna) were validated for elimination of lymphatic filariasis as a public health problem. These are the first countries and areas in the world to be validated, since China in 2007 and the Republic of Korea in 2008. Cambodia and the Lao People’s Democratic Republic became the first countries in the Region to be validated for elimination of blinding trachoma in 2017. The burden of schistosomiasis in many endemic areas of the Region has also been reduced significantly, to the point that elimination is now within reach. In addition, many countries have institutionalized nationwide annual or semi-annual rounds of deworming in children, resulting in reduced prevalence of soil-transmitted helminthiases in many areas. In 2017 alone, more than 43 million people in 11 countries in the Region received preventive chemotherapy for at least one NTD. With these achievements, the NTD landscape in the Western Pacific Region is changing. While intensified campaigns can accelerate elimination of some NTDs, efforts are under way to gradually expand the focus from dependence on preventive chemotherapy to combining preventive chemotherapy with a whole-of-system multisectoral approach to accelerate control and elimination of NTDs. This approach will be informed by accurate determination of burden and distributions through strengthened surveillance, including in pre- and post-elimination settings.In 2017, three disease conditions were added to the global NTD portfolio, namely scabies and other ectoparasitic infestations, snakebite envenoming, and chromoblastomycosis and other deep mycoses. As new disease conditions are added, actions must be taken to assess the most effective way to integrate them into the overall framework for control and elimination of NTDs. NTDs are included in the Sustainable Development Goals (SDGs). Universal health coverage will be key for NTD control and elimination, helping sustain gains by ensuring that needed health services reach all people, particularly marginalized and neglected populations. The SDGs present opportunities to accelerate progress on NTDs through whole-of-system multisectoral interventions, such as improvements in water and sani-tation, food safety, environmental health and veterinary public health, in addition to health services. The Regional Action Framework is intended to guide Member States, WHO and other donors and partners to work together to systematically and progressively strengthen various weaknesses in programmatic areas and/or contribute to enhancing relevant health system components so that universal and equitable access to essential NTD interventions and services, particularly in hard-to-reach marginalized populations, is achieved and control and elimination of NTDs are accelerated. The vision of the Western Pacific Region free from NTDs is achieved through twingoals:

1. Achieve and sustain the status of elimination of NTDs targeted in resolutions of the World Health Assembly, namely leprosy, lymphatic filariasis, rabies, schistosomiasis, trachoma and yaws.
2. Achieve and sustain control of other NTDs and alleviate suffering from NTD-associated morbidity and disabilities.

The goals are achieved through four interrelated strategic pillars with seven focus areas:

• P I L L A R 1 CATALYSING COORDINATED MULTISECTORAL ACTIONS

  • FOCUS AREA 1. Strategic planning and programme review

  • FOCUS AREA 2. Advocacy and partnership

• P I L L A R 2 ENHANCING INTERVENTION AND SERVICE DELIVERY

  • FOCUS AREA 3. Supply and logistics management

  • FOCUS AREA 4. Intervention and service delivery

• P I L L A R 3 ENGAGING AND EMPOWERING COMMUNITIES

  • FOCUS AREA 5. Health risk communications and social mobilization

• P I L L A R 4 MEASURING IMPACTS AND GENERATING EVIDENCE

  • FOCUS AREA 6. Surveillance, laboratory and health information systems

  • FOCUS AREA 7. Research and innovation.

There is a significant diversity in endemic diseases, their burden, the progress of control interventions and local context between countries and areas in the Western Pacific Region. The Regional Action Framework provides a framework for countries and areas in the Region to use when they develop or update national plans to strengthen key aspects of the NTD programme and to accelerate control and elimination of NTDs endemic in each country. Guided by an analysis of their respective situation, each country and area is encouraged to identify key programmatic areas and issues to be addressed, identify relevant sectors and partners to cooperate, and jointly plan and deliver key actions.