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Our NTD experience will be invaluable for COVID vaccine rollout

Simon Bush, February 2021
A man pours clean water for a woman to wash her hands.
Maryam Adamu, a distributor, washes her hands before a mass drug administration to the Guri community, Jigawa state, Nigeria.

Restarting the distribution of neglected tropical disease (NTD) preventative treatments in Africa can teach us a lot about the rollout of a COVID-19 vaccine.

The battle to deliver vaccines for COVID-19 around the world is on. We’ve only just begun, but the true complexity of the task ahead as well as the consequences of not reaching everyone, or ‘leaving no-one behind’ – so familiar to those working to tackle NTDs – has taken on a new relevance.

‘Leave no-one behind’ – reaching everyone, everywhere no matter how remote – is vital to fighting NTDs because by their nature they tend to affect the most marginalised and isolated communities. For decades, those working in NTDs have had to hone their skills at reaching out to communities which traditionally have been neglected – not just as a moral imperative but an epidemiological one.

An estimated 1.7 billion people around the world are affected by an NTD, a group of 20 plus diseases which – while easily treatable and preventable – can cause debilitating levels of pain and disability and can stop people from going to school or being able to work.

The campaign to prevent, treat and eliminate NTDs has been a decades-long exercise in organisation, cooperation, monitoring, and mitigation. It has also given us robust links to communities who themselves are working to control and eliminate NTDs. It has taught us a lot about how to treat and prevent infectious bacterial diseases which spread through environmental and human contact, as well as how to meet the challenge of reaching everyone.

Most recently, it has also taught us how to mitigate the risks of working in the middle of a pandemic. And we’ve done it! Despite the challenges of COVID-19 over the past year we have forged ahead. We have supported the delivery of over 35 million antibiotic treatments across 11 countries in west and central Africa, with millions more treatments due to be delivered over the next few months. We have also supported COVID-19 preventative messaging with a behaviour change campaign which reached millions of people across Africa.

“Reaching everyone, everywhere, no matter how remote, is vital to fighting NTDs.”

A man, wearing a mask, presents in front of a chalk board during a training.
Mallam Aminu Mohammed runs a training session on how to distribute NTD medication with COVID-19 precautions.

Lessons learned

Some of the lessons we have learned, which may become invaluable as the vaccine is rolled out, include:

Governments must be in the driving seat. If programmes are to be successful and sustainable, they need to be supported and often delivered by each country’s ministry of health. Before a programme starts, we ensure that the country can support supply chains for the safe delivery of antibiotic or antiparasitic treatments and surgical equipment to communities at risk.

Co-operation is central. No one organisation can deliver medical treatment on the scale needed to eliminate disease on their own. Supporting governments, as well as collaborating with partners, multilateral organisations, drug companies, other NGOs and researchers, has been essential to tackling NTDs.

Excellence in organisation is the cornerstone of any treatment distribution. Delivering treatments internationally, across vast geographic expanses and remote areas, requires systematic processes and a microscopic attention to detail. The human logistics of drug distribution take on even greater complexity at ground level. Delivery in the community also involves managers, various cadres of public health workers, volunteers, data experts, village leaders and more. Many of these groups need to be trained in developing and implementing policies, processes, and the quality control checks required to successfully deliver billions of treatments each year.

Working with communities is vital. Getting buy-in from the communities to which we are distributing is essential for successfully rolling out any medical treatment. Over decades, NTD programmes have involved the mobilisation of millions of community health workers – many of them volunteers – to deliver treatment. Most of these health workers live and work in the same community, which is crucial for gaining the trust of its members.

“Getting buy-in from the communities is essential for successfully rolling out any medical treatment.”

Behaviour change messaging must be effective and integrated. As the world has learned over the past year, encouraging people to develop everyday practices, such as hand and face washing to minimise infection, is one of the most important ways to prevent disease and halt its spread. The WASH (water, sanitation and hygiene) initiative and behavioural change work have been crucial in changing long-term habits, therefore making a lasting and sustainable difference to reducing all disease in communities. And the work we have done on the COVID-19 behaviour change campaign has strengthened our core work in NTDs.

COVID and other risks need to be mitigated. When the pandemic forced us to pause our programmes, we developed a series of mitigation measures, including social distancing, staff training and funding PPE, to be able to resume NTD treatments safely. Over the years, we have also developed ways of working during elections, social unrest, difficult road conditions and high crime rates. We understand the risk, and we mitigate around it, but it doesn’t stop us working – it means we might work differently. This way of working will prove useful to those delivering the vaccine.

Monitoring and data collection is important. NTD treatments can only be distributed to the right people if we know who and where they are. We conduct door-to-door surveys in every village to document where the problem is, who needs treatment and when they receive it. We are at the forefront of finding new ways of gathering data using mobile phone technology. These not only make the task of gathering data easier, but they are helping to build robust public health records for governments, which could help create a more integrated approach to all disease prevention and management.

We must work towards strengthening health systems. One of the key concerns when rolling out preventative treatments for COVID-19 internationally is that many health systems are not equipped to cope with a pandemic.  One of the most sustainable ways of ensuring effective response to COVID and other health challenges is to support the strengthening of as many of these systems as we can. NTD programmes have a proven track record of addressing gaps in national health systems in order to manage and implement integrated disease control responses and build resilience for health crises of the future.

“Treatments can only be distributed to the right people if we know who and where they are.”

Author


Sightsavers logoSimon Bush is Director of Neglected Tropical Diseases at Sightsavers.

 

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