The World Neglected Tropical Diseases (NTD) day, which is observed on 30 January every year, is a seminal moment in the fight against these infectious diseases.

In this interview, Prof NK Ganguly, former Director General, Indian Council of Medical Research (ICMR), New Delhi, alludes to the close relationship between neglected tropical diseases, Nutrition and Water, Sanitation and Hygiene (WASH) services and highlights the impact of COVID-19 on interventions to eliminate NTDs.

The Government of India is 100% committed to ending Neglected tropical diseases (NTDs), including Lymphatic Filariasis (LF), Visceral Leishmaniasis (Kala-Azar), Leprosy, Soil transmitted Helminthiasis (hookworm) etc.

NTDs are widespread among the world’s poorest regions, where safe water, sanitation and access to health care are limited.

In 2004, the Government of India launched the National Programme for Elimination of LF with the adoption of the globally recognized Mass Drug Administration (MDA).

During MDA, a combination of two drugs i.e., diethylcarbamazine (DEC) and albendazole or three drugs - Ivermectin, DEC, and Albendazole is administered to eligible population after proper surveillance.

The triple drug combination has added benefits including treating infections caused by intestinal worms, scabies, and lice, and improving nutrition uptake, physical and cognitive development of children.

Even today, a large section of the society remains unaware of the disease and its irreversible impact, if not diagnosed and treated in time. Mass awareness is key to ensuring that people understand the importance of consuming preventive medication.

Currently, slow pace of innovations and research and limited resource allocation means that NTDs will remain neglected.

There is a need to look for renewed funding and new partnership models for medical R&D – driven by collaboration and focused on patient’s needs.

Comprehensive policy for neglected diseases research in India should be prepared to foster innovation in drugs, diagnostics, and vaccines, critical for evolving needs of elimination programmes.

There are significant opportunities for programme synergies - NTDs and Non-Communicable Diseases (NCDs) could be linked to integrate resources like surveillance and laboratory networking.

We need to continue to expand our definition of partnership and explore how NTD programmes can strengthen our health systems and benefit other disease programmes as well.

Last year, WHO released a Global Strategy on Water, Sanitation and Hygiene (WASH) to Combat NTDs.

The strategy highlighted collaboration between WASH and NTDs stakeholders as an essential aspect to meet many of the NTD roadmap targets while offering important co-benefits to both communities.

There is a need for inter-sectoral coordination for better service delivery, which could be achieved with support from NITI Aayog.

Like I said the relationship between NTDs, and nutrition is, quite literally, a competition. Parasites and bacterial diseases live in the same space, taking over the human body and compete for their nutrients from food.

Some NTDs, like intestinal worms and schistosomiasis (a parasitic worm) affect the poorest and most deprived communities and cause anaemia and acute malnutrition among children.

Under the LF elimination programme, the preventive drugs administered during MDA such as Albendazole have additional benefits which helps in de-worming among children and increases absorption of nutrients thereby helping in their physical and cognitive development.

During the pre-MDA surveys, understanding nutrition status of a population must be prioritized and certain nutritional interventions like vitamin A and D is given to children and their mothers to supplement nutritional needs.

Because NTDs can impact nutritional status at any point of life — including during pregnancy, childhood, and adulthood — it is essential that populations living in endemic areas receive routine deworming treatment, the results of which are compelling.

During the pandemic, we witnessed that the most cost-effective strategies for increasing pandemic preparedness, especially in resource-constrained settings, is investing in core public health infrastructure, including water and sanitation systems.

Likewise, WASH services are critical in the prevention and care for all NTDs. Provision of safe water, sanitation and hygiene is one of the five key interventions in the global NTD roadmap.

However, the WASH component has received little attention; the potential to link efforts on WASH and NTDs has been untapped.

There are numerous NTD transmission routes that can be interrupted with improved WASH, examples being soil-transmitted helminthiasis, schistosomiasis, trachoma and LF.

Limb-washing for lymphatic filariasis, in which worms invade the lymph system and cause severe oedema, especially of the legs is an important self-care strategy which is difficult for many even today.

Integrated vector management (IVM) and vector control measures can improve the efficacy, cost-effectiveness and sustainability of disease-vector control.

The pandemic has caused disruptions in providing routine health care services. It has impacted elimination targets for various diseases like Tuberculosis (TB), Kala-Azar and Lymphatic Filariasis.

The mandatory lockdowns, migration of workers and disruption of supply chain management have hugely impacted the NTDs interventions.

For example, during the lockdown it was difficult for people with lymphoedema (swelling in limbs) and hydrocele (swelling in scrotal sac) to access the services they need. However, there has not been any formal assessment on the impact yet.

Integrated efforts to address NTDs must be built by countries that will help strengthen health systems response and help achieve universal health coverage.

Improving awareness about NTDs is a powerful and long-term intervention for eliminating these diseases. Effective communication and advocacy are the major pillars of NTD elimination programme.

New mass communication campaigns using digital technologies should be developed to reach the larger population. Acceptance of an intervention, particularly drug administration, becomes very important and people will only accept it when they are aware.

Besides this, using real-time monitoring and technological intervention also becomes important to enable closer monitoring of service delivery.

Creating awareness of social stigma among health professionals and communities is necessary to reduce patient suffering, change health-seeking behaviour and promote treatment adherence. Mass awareness also affects political commitment for disease control.

States like Tamil Nadu, Kerala, Telangana, Goa, Jharkhand, and some areas of Odisha have done well when it comes to implementing NTD interventions during the pandemic.

13 endemic districts of the state were covered during the campaign with a range of local innovations that complied with COVID appropriate behaviour while administering preventive medicines to millions through house-to-house visits by trained health workers.

In 2021, The National Centre for Vector Borne Disease Control (NCVBDC) in close coordination with state health departments and partners were successful in conducting mass drug administration rounds in 112 districts across states like Uttar Pradesh, Bihar, Maharashtra, Telangana, Karnataka, West Bengal, Odisha, Jharkhand, Chhattisgarh etc.

This is a major achievement even during these difficult times.