A road map for neglected tropical diseases 2021–2030

To neglect something is to fail to take care of it properly, particularly through inattention. Twenty diseases and disease groups comprise the WHO’s portfolio of neglected tropical diseases (NTDs) and each could provide a case study for that definition. Historical inattention by policymakers to these disabling, disfiguring and sometimes lethal health problems is probably explained by the fact that most NTDs predominantly affect people whose individual political power is wielded only very lightly, if at all. The 20 NTDs are each aetiologically, epidemiologically and clinically unique. It can be difficult, at times, to gather them together. They do share one defining characteristic, however: they impact the poorest communities and trap those communities in cycles of poverty. They collectively affect more than 1 billion people in such communities worldwide, heaping devastating health, social and economic consequences on affected individuals and their families. Since 2010, significant progress has been made, catalysed in part by a road map for intervention published by the WHO in 2012.1 Today, 500 million people no longer require interventions against one or more NTDs, and 42 countries, territories and areas have eliminated at least one NTD.2 Dracunculiasis is on the verge of eradication, with just 54 human cases reported in four countries in 2019. Lymphatic filariasis and trachoma have been eliminated as public health problems in 16 and 10 countries, respectively. Onchocerciasis has been eliminated in four countries. The annual number of cases of human African trypanosomiasis has fallen from more than 7000 in 2012 to fewer than 1000 in 2018, eclipsing the previous target of 2000 cases by 2020. The number of new leprosy cases reported globally has also continued to decline since 2010, at an average of 1% per year. These are notable achievements. They have required some extraordinary efforts at all levels. They should in noway be underestimated or downplayed. They should not obscure either, however, the fact that an immense task remains before us. The road map for NTDs 2021–20302 sets out global targets and milestones to prevent, control, eliminate and eradicate these diseases. It also defines cross-cutting targets, aligned with the WHO’s 13th General Programme of Work (2019–2023) and the United Nations’ Sustainable Development Goals (SDGs).3 Crucially, the road map proposes strategies for attaining these targets over the next decade.2 This new road map was drafted after an extensive global consultation that began in 2018 and culminated in the document’s endorsement bymember states at the 73thWorld Health Assembly in November 2020. The process involved regional workshops with managers of NTD programmes, country workshops with stakeholders in NTDs and related areas of work, as well as detailed input from disease experts, disease modellers, donors and partners. More than 100 bilateral interviews were conducted and more than 300 written responses, from two rounds of online consultations, were received and analysed. It is to be hoped, therefore, that the new road map is an accurate and thorough depiction of the perspectives of member states and a wide range of their supporters. The process was designed to ensure that the vision embodied in the 2021–2030 road map belongs not to the WHO alone, but to the entire global community dedicated to fighting NTDs. As the NTD community began to plan and develop the 2021– 2030 road map, it became clear that fundamental shifts in strategy were indicated. Three shifts, in fact, form its pillars. The first is a shift frommeasuring process to measuring impact. The second is a shift from vertical programming to horizontal, cross-cutting programming. The third shift, and potentially the most significant, calls for a move away from partner-led to country-driven and country-owned work. During the road map’s development, a thorough review of existing evidence was undertaken to identify and analyse critical gaps—both within and across diseases—which have led to bottlenecks in progress. Without addressing these, no meaningful advance seems likely. This resulted in the production of a heat map, offering an at-a-glance view of the global position.2 As the road map is rolled out, the WHO and partners will support countries to develop analogous national-level heat maps, allowing investments to be directed to areas where they will have the greatest possible impact. This may be particularly vital