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Neglected Tropical Diseases Hidden and silent : Key problemsKey problemsNeglected Tropical Diseases

Hidden and silent : Key problemsKey problems

Complacency, lack of information and commitmentComplacency, lack of information and commitment

The poor, with little political voice, suffer mostThe poor, with little political voice, suffer most

Not perceived as a threat to western societyNot perceived as a threat to western society

Incapacitating more than killingIncapacitating more than killing

Low profile in public health prioritiesLow profile in public health priorities

Negative image, complicated names and complex Negative image, complicated names and complex strategies strategies

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Global distribution: the burden Global distribution: the burden divides the world in twodivides the world in two

Global distribution: the burden Global distribution: the burden divides the world in twodivides the world in two.

Approximately 1 billion people are affected by more than one of NTDs

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Rapid Impact InterventionsImproving access

Focused interventionsImproving innovation

Large scale interventions

Lymphatic filariasisLeprosyOnchocerciasisSchistosomiasisHelminthiasisTrachomaYaws

Case management and development of new tools

Human African trypanosomiasisChagas diseasesBuruli ulcer Leishmaniasis

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The importance of the Right to health for the control of NTDs

The importance of the Right to health for the control of NTDs

Advocacy: Participation of Paul Hunt in two international meetings on NTDs, and several meetings in WHO. Goodwill Ambassador Mr Sasakawa

Help scientific community to focus thinking on strategies adapted to the local reality: Berlin and Bangalore

Assessment at country level...Mission report in Uganda

Specific recommendations to Governments, private sector, NGOs and international community

If integrated into policies, programmes and projects, the right to health helps to ensure that they are evidence-based, robust, sustainable, equitable and meaningful to those living in poverty.

Key role of the civil society, NGOs and people affected by NTDs

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The case of LeprosyThe case of LeprosyThe case of LeprosyThe case of Leprosy

Leprosy is considered shameful and people hid their symptoms for fear of ostracism despite free and effective multidrug treatment.

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Leprosy situation in 2008 Leprosy situation in 2008 Leprosy situation in 2008 Leprosy situation in 2008

Between 1985 and 2008, more than 15 million cases have been cured with MDT. The number of persons registered for treatment fell from 5.4 million in 1985 to 250 000 in 2008.

Global case detection continues to fall every year

Only 3 countries remain with prevalence rates above 1 per 10,000 population (1985: 122 countries): Brazil, Nepal and Timor Leste)

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* Patients registered for treatment, excluding Europe

Registered prevalence by WHO RegionRegistered prevalence by WHO Region in 2007 and 2008, and % change*in 2007 and 2008, and % change*

Region Prevalence at beginning of 2007

Prevalence at beginning of 2008

% change from 2007 to 2008

Africa 29 548 30 055 +1.71%

Americas 64 715 49 388 -23.68%

East Mediterranean 3 986 4 240 +6.37%

South East Asia 116 663 120 967 +3.69%

Western Pacific 9 805 8 152 -16.86%

World 224 717 212 802 -5.30%

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New case detection by WHO Region New case detection by WHO Region in 2006 and 2007, and % change*in 2006 and 2007, and % change*

New case detection by WHO Region New case detection by WHO Region in 2006 and 2007, and % change*in 2006 and 2007, and % change*

Region Cases detected during 2006

Cases detected during 2007

% change from 2006 to 2007

Africa 34 480 31 037 - 9.99%

Americas 47 612 41 978 - 11.83%

East Mediterranean 3 261 4 091 + 25.45%

South East Asia 174 118 171 552 - 1.47%

Western Pacific 6 190 5 867 - 4.20%

World 265 661 254 525 - 4.19%

* excluding Europe

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Milestones in MDT treatmentMilestones in MDT treatmentMilestones in MDT treatmentMilestones in MDT treatment

Multidrug therapy (MDT) recommended as a standard treatment for leprosy by WHO in 1982, contains rifampicin, clofazimine and dapsone

1986: only 5% of registered patients on MDT

1991: World Health Assembly resolution to eliminate leprosy as a public health problem

1995: WHO started global supply of high quality MDT free of cost

1998 onwards : 100% of registered cases on MDT

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MDT changes the face of leprosyMDT changes the face of leprosyMDT changes the face of leprosyMDT changes the face of leprosy

Highly effective - cures patients in 6 – 12 months

Single MDT dose renders patient non-infectious

Best way to prevent disabilities through early cure

Treatment is safe with few side effects

No drug resistance following MDT has yet been reported

The numbers of relapses after treatment remains very low, at less than one case per 1,000 patients per year.

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But still a long way to goBut still a long way to goBut still a long way to goBut still a long way to go

Stigma and discrimination are still present in developed and developing countries

An estimated one million persons live with severe disabilities and are highly vulnerable

Despite the medical progress and information, a significant number of countries have regulations aiming at isolating, limiting access to work, public transport, international travel, divorce

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Key features of a right to health approach to neglected diseases

Key features of a right to health approach to neglected diseases

Community participation

Fighting stigma and discrimination

Research and development

An integrated health system that is responsive to local priorities

Monitoring and accountability: monitor and hold to account national and international actors in the public and private sectors. The guiding question should be: have all duty-bearers done all they reasonably can to promote and protect the right to health of those suffering from, or vulnerable to, neglected diseases?