* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
The world must address the inequities that lie behind their persistence and treat people, not the diseases they carry
Dr Mwele Malecela is Director of the World Health Organization’s Department of Control of Neglected Tropical Diseases.
I started my career in neglected tropical diseases (NTDs) many decades ago working on elephantiasis, a mosquito-transmitted disease that causes severe swelling of the lower limbs, in my home country of Tanzania. It may not always have been the most popular field, but it does have the virtue of being rooted in the best of our values as public health workers and as people, namely a commitment to community and our shared humanity.
Neglected tropical diseases are a diverse group of parasitic, bacterial, viral, fungal and toxin-mediated conditions. The one thing they have in common is that they disproportionately affect the poorest and most vulnerable communities in the world. Their impact is felt more often than not by the very people who are least equipped to bear the burden of suffering and disability, not to mention the profound social and economic burdens of disease.
And yet we see – very often, in fact – that when it comes to putting in place the programmes needed to treat patients and protect communities in the future, those who have themselves been affected are there in the forefront. These people, working in conjunction with partners, donors and supporters, are a living testimony not only to a spirit of resilience but also to the most ordinary, human determination to make things better. It has been my privilege to witness such deep commitment on many occasions during my career.
But this inspiring goodness ought not to mask the inequity that many of these people and communities face – an unfairness impossibly measured in the lost potential of children unable to attend school or parents unable to provide for their families and contribute fully to their own lives and the life of their communities.
That cold reality of the NTD world has been mirrored in the COVID-19 pandemic. When the novel coronavirus struck last year, it left no country, community or person untouched in one way or another. But the impact of the virus was not felt equally by all. COVID-19 too has disproportionately affected poor communities, minorities, a whole range of vulnerable populations, in fact. Moreover, the collateral effects of the pandemic – from economic obstacles to social isolation and restricted movement – are also unequally affecting those in the poorest strata of our world community.
It is clear from our experience both of NTDs and COVID-19 that combating overarching structures of inequality cannot be done piecemeal. That is why my team and I, in the two years since I became Director of the Department of Control of NTDs, have developed a new NTD road map for the period between 2021 and 2030.
The road map was conceived and developed hand in hand with representatives of the worldwide NTD community – national governments, regions, NGOs, academia, and youth movements. The fruit of that collaboration is less a policy document or programme implementation guide as it is a vision. It attempts to articulate those things that we can and must do differently if we are to ensure the control, eradication and elimination of NTDs as a threat to the world population. It is a vision in which we treat people, not the diseases they carry, and where countries themselves are able to exert proper influence and address inequity directly.
Our new road map is as visionary and as pragmatic as the community that shaped it initially and which will now be responsible for its successful implementation. I have absolute faith in the dedication and commitment of our community of public health workers. I know that they will do all they can to pool resources, technical expertise and practical know-how, in order to ensure the fullest possible impact on the obstacles we face.
Our new road map is therefore a call to action; it encourages and requires different health and development communities to work together; working across sectors, sharing plans and knowledge, adopting each other’s goals and strategies as our own, will enable us all to maximize progress in our respective fields.
This means in practice that all our programmes become ONE health programmes, that they all have mental health, for example, or WASH or any number of other, complementary goals at their heart. Only through collaboration will we succeed in advancing our own NTD agenda and ensuring the global realization of the Sustainable Development Goals. And with greater collaboration comes greater accountability, of course. Our new road map is based on circles of reciprocal accountability – to countries, to co-workers and to the people whose lives are blighted by NTDs.
In difficult times, and the last year has been incredibly challenging for everyone (not least those whose careful planning on the ground was upended by COVID-19 uncertainty), pessimism is a luxury we can ill afford. I am proud, therefore, that our new NTD road map is an optimistic, principled and practical statement; it promotes good practice, goodwill and the good work of every member of our NTD community. I have every confidence that it will enable us to move towards the change we all so desperately want to see, and which so many people across the world so thoroughly deserve.