The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague.

BACKGROUND: Among the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue. METHODS: To understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron'I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment. RESULTS: During the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases. DISCUSSION: COVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected.

Strategies supporting the prevention and control of neglected tropical diseases during and beyond the COVID-19 pandemic.

Emerging and re-emerging zoonotic diseases represent a public health challenge of international concern. They include a large group of neglected tropical diseases (NTDs), many of which are of zoonotic nature. Coronavirus disease 2019 (COVID-19), another emerging zoonotic disease, has just increased the stakes exponentially. Most NTDs are subject to the impact of some of the very same human-related activities triggering other emerging and re-emerging diseases, including COVID-19, severe acute respiratory syndrome (SARS), bird flu and swine flu. It is conceivable that COVID-19 will exacerbate the NTDs, as it will divert much needed financial and human resources. There is considerable concern that recent progress achieved with control and elimination efforts will be reverted. Future potential strategies will need to reconsider the determinants of health in NTDs in order to galvanize efforts and come up with a comprehensive, well defined programme that will set the stage for an effective multi-sectorial approach. In this Commentary, we propose areas of potential synergies between the COVID-19 pandemic control efforts, other health and non-health sector initiatives and NTD control and elimination programmes.

Gender and neglected tropical disease front-line workers: Data from 16 countries.

BACKGROUND: Delivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors-the NTD front-line workers-to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed data collected by USAID-supported NTD projects from national NTD programs from fiscal years (FY) 2012-2017 to assess availability of sex-disaggregated data on the workforce. What we found was sex-disaggregated data on 2,984,908 trainees trained with financial support from the project. We then analyzed the percentage of males and females trained by job category, country, and fiscal year. During FY12, 59% of these data were disaggregated by sex, which increased to nearly 100% by FY15 and was sustained through FY17. In FY17, 43% of trainees were female, with just four countries reporting more females than males trained as drug distributors and three countries reporting more females than males trained as trainers/supervisors. Except for two countries, there were no clear trends over time in changes to the percent of females trained. CONCLUSIONS/SIGNIFICANCE: There has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.

Reflections on the decade of the neglected tropical diseases.

Neglected tropical diseases (NTDs) are a group of diseases that disproportionately affect the poorest of the poor. While for years attention has focused on single diseases within this group, efforts during the past decade have resulted in their being grouped together to highlight that they are fundamentally diseases of neglected populations. The formation of a World Health Organization department to address these diseases consolidated the efforts of the many stakeholders involved. In the past decade, focus has shifted from the Millennium Development Goals (MDGs), where NTDs are not mentioned, to the Sustainable Development Goals (SDGs), where NTDs are not only mentioned, but clear indicators are provided to measure progress. It has also been a decade where many NTD programmes have scaled up rapidly thanks to work by affected countries through their master plans, the commitment of partners and the unprecedented donations of pharmaceutical manufacturers. This decade has also seen the scaling down of programmes and acknowledgement of the elimination of some diseases in several countries. Given the successes to date, the challenges identified over the past decade and the opportunities of the coming decade, the NTD Programme at the WHO is working with partners and stakeholders to prepare the new NTD roadmap for 2021 to 2030. The focus is on three major paradigm shifts: a change of orientation from process to impact, a change in technical focus from diseases to delivery platforms and a change from an external-based agenda and funding to a more country-led and funded implementation within health systems. This article reviews the past decade and offers a glimpse of what the future might hold for NTDs as a litmus test of SDG achievements.

Needs and coordination mechanism for capacity building by the RNAS.

For the Regional Network on Asian Schistosomiasis and Other Helminth Zoonosis (RNAS+), capacity building with emphasis on modern technology with correspondence to traditional techniques was found to be a priority. This article summarized the actual needs of capacity building among RNAS+ member countries and the working mechanism of capacity building during the last 20 years. The needs with respect to the RNAS+ target diseases are highly correlated with the research priorities, since most problems with regard to the performance of the national disease control programme in the member countries are connected with inadequate capacity in relation to implementation of innovative research, epidemiological investigations, laboratory performance; and sociological investigations. The capacity building arranged through RNAS+ platform includes short training courses, individual training in member institutions, e.g., supervision of Ph.D./Masters students; postdoctoral training; and internship training in institutions of southeast Asia as well as in famous institutions of Europe and the United States. In the future, capacity building will focus on platform design and technical standardization aiming at fostering research capacity in the future. Moreover, new training projects, such as massive online courses (MOOC) will be explored under RNAS+ platform.

Preface: Sustained cooperation on research and control of neglected tropical diseases among multisectors and multipartners across borders in Southeast Asia.

This special issue is going to introduce the origins of the "Regional Network on Asian Schistosomiasis (RNAS)" which can be traced back to 1996. RNAS was originally a collaboration of scientists from China and Philippines, and then expanded to Cambodia, Indonesia, Japan and Laos, with focusing on research and control of schistosomiasis japonica. However, at its fifth meeting in Bali, Indonesia in 2005, more countries such as Vietnam, Thailand and Korea were brought on board along with a string of neglected tropical diseases such as cysticercosis, clonorchiasis, opisthorchiasis and fascioliasis, and RNAS thus became RNAS+. We all expected that the progress made so far will be enough to persuade donors to assist RNAS+ in its current activities and forward movement.

Emerging Trends in Clinical Tropical Medicine Research.

The American Society for Tropical Medicine and Hygiene recently inaugurated an award for the best clinical research article published in the society's journal in the previous year. This article summarizes both the process of selecting the winner and several themes that stood out in those articles which rose to the top for consideration. Themes of note included the importance of doing clinical research outside of referral centers, the complexity that must be considered when implementing interventions, incorporation of both ends of the age spectrum into studies, and considering cost-effectiveness and opportunity cost of interventions.

People are neglected, not diseases: the relationship between disability and neglected tropical diseases.

People with disabilities and the neglected tropical diseases (NTDs) are separately receiving increased focus. In light of this positive development, and the similarities and intersections between the negative impacts experienced by both people with disabilities and people with NTDs, we believe now is the right time to focus attention on the overlap between the two. Both people with NTDs and people with disabilities experience a myriad of overlapping negative health, financial and socio-cultural consequences. Despite this, we believe that disability is not yet properly prioritised on the development agenda, and that there are multiple opportunities to make NTD programming more inclusive, to the benefit of those at this neglected intersection and beyond. There are both opportunities and need to scale up, integrate, and invest in inclusive, health system-focused NTD programming. Realisation of the Sustainable Development Goals, Universal Health Coverage, and the control and elimination of NTDs all rely on ensuring people with disabilities are not left behind.

Mobile Phone Devices and Handheld Microscopes as Diagnostic Platforms for Malaria and Neglected Tropical Diseases (NTDs) in Low-Resource Settings: A Systematic Review, Historical Perspective and Future Outlook.

The accurate, rapid, and cost-effective diagnosis of malaria and neglected tropical diseases (NTDs) in low-resource settings may benefit by significant technological advances in handheld and mobile phone microscopy. We systematically review the available literature in this field and discuss the future directions in which these technologies may be applied. English-language studies from the PubMed, Embase, and Web of Sciences were searched through April 2018 for observational and interventional studies reporting diagnostic characteristics of handheld and mobile phone microscopy devices as compared to field-established gold standard reference tests. Seventeen studies were included in the analysis. Findings included the high performance of the Newton Nm1 microscope in the diagnosis of Plasmodium species, Schistosoma mansoni, and soil-transmitted helminths (STHs), exhibiting sensitivity and specificity values often greater than 90%. Similarly, the CellScope was shown to have excellent diagnostic characteristics in the detection of Loa loa and Schistosoma species. Fluorescent microscopy was found to have high specificity and sensitivity in the diagnosis of Plasmodium species. Mobile phone technologies and handheld microscopes hold significant promise in the rapid and effective diagnosis of malaria and NTDs in areas where accurate diagnosis is vital. Although many of these technologies have yet to be securely embedded within the health system and studied directly in this context, the foundations for significant healthcare advances and impact have already been laid by several studies conducted within the last decade.

Challenges and recent progress in drug discovery for tropical diseases.

Infectious tropical diseases have a huge effect in terms of mortality and morbidity, and impose a heavy economic burden on affected countries. These diseases predominantly affect the world's poorest people. Currently available drugs are inadequate for the majority of these diseases, and there is an urgent need for new treatments. This Review discusses some of the challenges involved in developing new drugs to treat these diseases and highlights recent progress. While there have been notable successes, there is still a long way to go.

Climate Change and the Neglected Tropical Diseases.

Climate change is expected to impact across every domain of society, including health. The majority of the world's population is susceptible to pathological, infectious disease whose life cycles are sensitive to environmental factors across different physical phases including air, water and soil. Nearly all so-called neglected tropical diseases (NTDs) fall into this category, meaning that future geographic patterns of transmission of dozens of infections are likely to be affected by climate change over the short (seasonal), medium (annual) and long (decadal) term. This review offers an introduction into the terms and processes deployed in modelling climate change and reviews the state of the art in terms of research into how climate change may affect future transmission of NTDs. The 34 infections included in this chapter are drawn from the WHO NTD list and the WHO blueprint list of priority diseases. For the majority of infections, some evidence is available of which environmental factors contribute to the population biology of parasites, vectors and zoonotic hosts. There is a general paucity of published research on the potential effects of decadal climate change, with some exceptions, mainly in vector-borne diseases.

The changing global landscape of health and disease: addressing challenges and opportunities for sustaining progress towards control and elimination of neglected tropical diseases (NTDs).

The drive to control neglected tropical diseases (NTDs) has had many successes but to reach defined targets new approaches are required. Over the last decade, NTD control programmes have benefitted from increased resources, and from effective partnerships and long-term pharmaceutical donations. Although the NTD agenda is broader than those diseases of parasitic aetiology there has been a massive up-scaling of the delivery of medicines to some billion people annually. Recipients are often the poorest, with the aspiration that NTD programmes are key to universal health coverage as reflected within the 2030 United Nations sustainable development goals (SDGs). To reach elimination targets, the community will need to adapt global events and changing policy environments to ensure programmes are responsive and can sustain progress towards NTD targets. Innovative thinking embedded within regional and national health systems is needed. Policy makers, managers and frontline health workers are the mediators between challenge and change at global and local levels. This paper attempts to address the challenges to end the chronic pandemic of NTDs and achieve the SDG targets. It concludes with a conceptual framework that illustrates the interactions between these key challenges and opportunities and emphasizes the health system as a critical mediator.