Millions struggle with tropical diseases causing blindness and other disabilities. DW talks to expert Martin Kollmann about getting vital drugs to the communities that need them the most – amid war, famine and unrest.
The World Health Organization, together with a group of health institutions, has published its annual scorecard on the progress of the 2012 London Declaration on neglected tropical diseases (NDTs). Around the world, over a billion of the most vulnerable and disadvantaged people suffer from a range of NDTs. The global effort has focused on treating and eradicating 10 of them, including Chagas’ diesease, trachoma, visceral leishmaniasis, leprosy and lymphatic filariasis.
DW: Professor Martin Kollmann, since 2012 there have been new efforts globally to fight, eradicate and also treat these diseases. Have much progress have we actually seen?
Martin Kollmann: I think we’ve seen fantastic progress since the London Declaration in 2012, when a very broad partnership of various stakeholders came together and made concrete pledges. The pharmaceutical sector pledged to donate drugs so that programs can become as cost effective as possible. We have the NGDOs, governments and funders coming together to make this happen and scale up efforts. And now we have a mechanism to actually track progress in a transparent way and hold each of the stakeholder groups accountable.
Could you give us some examples of where there’s been progress?
Particularly in the area of lymphatic filariasis and onchocerciasis, preventative chemotherapy and the distribution of donated drugs that are free have been fantastic. In Latin America, river blindness for example is on its way out. There are just six indigenous communities in the Amazon border area between Brazil and Venezuela that still have this disease. And we have very good treatment coverage now in Africa. Keep in mind that we’ve impacted countries like the South Sudan, the Central African Republic and Congo. These countries have unrest, war, famine, huge populations, migration, and year after year we’ve been able to get those donated drugs to affected communities with the help of NGOs like the Christian Blind Mission (CBM) and others. Now we are in a position to actually have a paradigm shift moving from control of some diseases to elimination.
You’ve worked in Africa for many years – in Ethiopia, Kenya and many other countries. Can you give an example of what happens in a community where many people are affected by these diseases?
In river blindness you may have seen the image of a young child leading a blind father, mother, grandfather or grandmother on a stick. This child cannot go to school. As we prevent blindness in their parents and grandparents’ generation, we actually give this child back a future. And if you go to these villages, in most parts of Africa you don’t see new people going blind from river blindness anymore, and that is a fantastic success. But because the adult worm that produces the disease-causing baby worms live for many many years, we need to deliver these drugs year after year. Despite war, famine and all the other catastrophes, the drugs need to be delivered to the entire community. And that has been done through this public-private partnership of health institutions in the most astonishingly successful way. That is why now these children have a chance to go to school – they have a future.
We’ve also seen whole villages that left their arable land around rivers where the black fly breeds – because they were “cursed” with blindness – can now go back and farm there again. So that’s a typical example of the immense socio-economic impact that tackling NTDs can have.
Where do you see the biggest challenges?
Oh, there are huge challenges. We’ve made fantastic progress, but by far not enough. In 2015, we should have reached 75 percent coverage in treatment of all the population globally to achieve our goals. But we need better data, we have to know better where the disease is in the virus countries in Africa, then we need to identify the barriers – why didn’t we achieve everything we wanted to achieve, despite all this fantastic progress in the past year? And how do we overcome these barriers to become even more effective than we already are? These are not so much neglected diseases, but diseases affecting neglected people, the poorest of the poor living in areas with weak health systems. In many cases there is a dire need for more tools and more research. And there has been little investment in the past because these people don’t have any economic power. They don’t have a voice.
Do you think in your lifetime you will see a complete elimination of these neglected tropical diseases?
I’m very optimistic. We are aiming to eliminate trachoma as a public health problem by the year 2020, and we are on track to do this. But we have to scale up our efforts. We need to do more, we need more funding, we need more research. Latin America shows us that it is achievable, as well as the progress that we’ve seen in Africa. But initiatives can only succeed if you work in a really open, transparent and close partnership with national programs and communities. So rebels may move in, and the drugs that are not distributed might be hidden in a hole in the backyard until the rebels have moved away. Then they’ll be dug out and the distribution continues. We need to use whatever means available to get drugs out, year after year, to the people who need them most. This is not about charity. It is about empowering people and boosting local capacity.
Professor Martin Kollmann is part of the global network against NTDs and senior advisor on neglected diseases for CBM, the Christian Blind Mission in Nairobi, Kenya. Kollmann is a medical doctor and eye diseases specialist. He also teaches at the University of Nairobi’s Institute of Tropical and Infectious dieseases and serves as Chair of the International Coalition for Trachoma Control (ICTC) and on the board of the German Network against NTDs.
This interview has been condensed for clarity.