As a scientist dedicated to neglected tropical diseases, I have noticed with concern the shifting patterns in the spread of visceral leishmaniasis (also known as kala-azar) in Kenya. Once confined to specific regions, this deadly parasitic disease has been spreading to previously unaffected counties.
It's not just kala-azar that worries me; dengue and chikungunya, both mosquito-borne viral diseases, are making their way inland from their traditionally endemic coastal region. It is suspected that this shift is fuelled by climate change.
In Kenya, 16 out of 21 neglected tropical diseases (NTDs) are either suspected, confirmed or endemic, according to the World Health Organization. These diseases affect approximately 25 million Kenyans. However, activities that are crucial for control and elimination efforts are often unavailable.
I have firsthand experience with the challenges of controlling these diseases. In Kacheliba, a pastoral community in West Pokot, where my organisation, the Drugs for Neglected Diseases initiative (DNDi), has operated a research and treatment centre for Kala-azar for almost 20 years, we’ve encountered difficulties with the supply chain, leading to critical stockouts of essential medicines and diagnostic kits.
But now, there is hope. Earlier this year, the Ministry of Health took a step forward in its NTD control efforts and unveiled a bold multi-year master plan spanning 2023-2027.
One of the key highlights of the master plan is the goal of securing certification from WHO for the elimination of river blindness and sleeping sickness by 2025. The plan also aims to reduce the case fatality rate for kala-azar to less than one per cent by 2025, followed by eradicating elephantiasis and trachoma by 2025, with dossier submission by 2026. Another priority is also to eliminate rabies, intestinal worms, and bilharzia as public health problems by 2027.
While Kenya's aspiration to eliminate six NTDs within the next four years, up from the current one, may seem ambitious, it is possible with the right tools and partners.
The first step is collaboration. We cannot rely solely on the government to execute this master plan. We need to create a space where all stakeholders in the NTD space in Kenya come together to share their unique experiences and propose solutions for jointly implementing these strategies.
One critical area where we can collaborate is addressing the lack of funding. Funding shortfalls not only hinder treatment and prevention efforts but also slows research into new diagnostics and medicines.
In the face of limited resources, we can consider elimination strategies that cover multiple diseases. For instance, in 2019, DNDi partnered with other stakeholders to establish the Helminth Elimination Platform to find new treatments for river blindness, intestinal worms and elephantiasis. By combining resources and knowledge, we are addressing these three NTDs simultaneously.
Secondly, elimination is only possible if we leave no one behind. This means actively engaging marginalised groups, especially at the grassroots level in response efforts. Since women are disproportionately affected by NTDs, we can train those with prior experiences of the disease as community health workers and advocates. Similarly, young people can play a pivotal role in raising awareness within their communities.
Thirdly, because some NTDs can be transmitted between humans and animals, successful elimination needs a one-health approach that integrates the environment into public health strategies. With climate change altering the geographical spread and incidence of neglected diseases, it's important to use climate data to better understand and predict climate-sensitive NTDs. These diseases should also be integrated into primary healthcare so that health workers screening for common diseases can also test for NTDs.
We still need better, safer and affordable treatments for many NTDs. We still need diagnostics that can be deployed at primary health facilities. We still need effective surveillance and disease mapping. Ensuring access is also a priority because developing a drug doesn't guarantee access. Therefore, to achieve elimination, we must continue collaborating and developing innovative solutions that will end the ‘neglect’ of neglected diseases.
Professor Samuel Kariuki is the Eastern Africa Director for DNDi