The 13th meeting of the WHO Strategic and Technical Advisory Group (STAG) for neglected tropical diseases (NTDs) was held virtually on 15–17 September 2020 in Geneva, Switzerland.
Conclusions and recommendations to the Director-General
The Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD):
- delivery of at least one NTD intervention to 1.05 billion people in 2019, including more than 1 million life-saving treatments delivered through specialized individual case management;
- validation of elimination as a public health problem of lymphatic filariasis, human African trypanosomiasis, rabies or trachoma in six countries;
- new donations of niclosamide and praziquantel (to treat taeniasis and cysticercosis) and of benznidazole and nifurtimox (for paediatric treatment of Chagas disease) secured in 2020, adding to the range of donated medicines;
- continued reductions in the global incidence of gambiense human African trypanosomiasis, the global prevalence of lymphatic filariasis and trachoma and the incidence of visceral leishmaniasis in Bangladesh, India and Nepal;
- release of a much-needed mobile app to support diagnosis of skin NTDs; and
- advocacy and information-sharing for NTD activities since the beginning of the COVID-19 pandemic.
- that the focus of the NTD department be maintained at least until 2023 on the plan set out in the 2021–2030 NTD road map;
- that consideration for inclusion of any new diseases into the NTD portfolio be deferred until 2023 at the earliest, with subsequent review every 3 years; and
- that the description of category B diseases be amended to make clear that diseases in that category will not require the WHO secretariat to make a specific work plan.
- documented by quantifying and monitoring the disruption caused by and the impact of COVID-19 on NTD programmes and activities; and
- mitigated by:
- maintaining or resuming health services for NTDs, as indicated in the interim guidance issued by WHO; and
- strengthening advocacy and information-sharing for continuous support by partners, stakeholders and donors.
- mitigated by:
- maintaining or resuming health services for NTDs, as indicated in the interim guidance issued by WHO (5–8); and
- strengthening advocacy and information-sharing for continuous support by partners, stakeholders and donors.
(1) Welcomes the Director’s report describing the significant progress made against NTDs since the previous meeting, in April 2019, which includes:
(2) Expresses its appreciation to partners, donors and stakeholders for their contributions to the global NTD agenda.
(3) In line with the strategic shift towards the more holistic, cross-cutting approaches identified in the 2021–2030 NTD road map, recommends acceleration of interventions that may be in danger of falling behind for some NTDs, in particular:
(a) for onchocerciasis: to accelerate development and implementation of protocols for elimination mapping by convening a fourth meeting of the Onchocerciasis Technical Advisory Group;
(b) for scabies: to implement rapid mapping (as set out at the 2019 WHO informal consultation (4)) in all WHO regions to define areas of high endemicity for which mass drug administration might be recommended and support scaling-up of mass drug administration by national control programmes in endemic districts, in line with NTD road map 2021–2030 targets; interventions might be scaled up in stand-alone programmes or with measures against other diseases, depending on local epidemiology and public health priorities; important building blocks are likely to be inclusion of scabies in national universal health coverage guidelines and identification of potential sources of funding for mapping and for use of ivermectin and topical treatments;
(c) for dengue and control of Aedes spp. mosquitoes: to engage with innovators in developing new, sustainable interventions; to collate information on new control tools and provide guidance on their use; and to promote integration of control tools of proven effectiveness into existing strategies;
(d) for schistosomiasis: to provide clear, evidence-based definitions of “elimination as a public health problem” and “elimination” (interruption of transmission) in the framework of the NTD road map 2021–2030; to develop global guidance and specific advice to programme managers on sustaining progress with available interventions; and to continue engagement with the paediatric praziquantel consortium to ensure that preschool-age children in need have access to the paediatric formulation of praziquantel, once it is licensed; the secretariat and partners should work together in the context of the NTD road map 2021–2030 to address the alarmingly low coverage of praziquantel in adults; establishment of a technical advisory subgroup on schistosomiasis would be useful in addressing specific issues with regard to this NTD;
(e) for yaws: to evaluate the effectiveness of treating entire communities with azithromycin and monitor the emergence of macrolide resistance when this intervention is delivered at scale;
(f) for rabies and snakebite envenoming: to include consideration in the deliberations of the NTD Supply Chain Forum of delivery of rabies immunoglobulin and human vaccine for post-exposure prophylaxis and of snakebite antivenom immunoglobulins to individuals in need; and
(g) for visceral leishmaniasis: to invite Member States in the South-East Asia Region, where the disease is targeted for elimination as a public health problem, and relevant stakeholders to ascertain local transmission and to assess the endemicity status of non-endemic areas from which new cases are being reported, as an essential step towards validation of elimination as a public health problem. To work with partners to secure quality-assured, affordable generic products for visceral leishmaniasis and coordinate procurement among major procurers, leishmaniasis programmes and suppliers.
(4) Recommends that NTD strategic interventions at the human–animal interface, such as dog rabies vaccination, be strengthened through adoption of the One Health approach to address health risks at the source and assure the sustainability of control and elimination.
(5) To ensure that national programmes and the WHO secretariat optimize progress against the current group of 20 diseases and disease groups labelled as NTDs, recommends:
(6) Acknowledges that people affected by NTDs and young people are critical stakeholders in the global NTD community and recommends inclusion of representatives of those groups on STAG-NTD, either as members or as official observers, and also in other global and regional groups dedicated to promoting NTDs.
(7) Acknowledges the importance of the five companion documents of the NTD road map 2021–2030 in promoting and coordinating sustainability, investment, monitoring, evaluation, implementation of WASH and research on NTDs and in supporting cohesiveness in this diverse group of topics and recommends that the companion document entitled Investment case call for maintenance of at least current levels of investment in NTD programmes; WHO and partners should make greater efforts to convince health ministries of NTD-endemic countries to dedicate funds for NTDs.
(8) Lauds the anti-racism and diversity initiatives within WHO, such as those recommended by the NTD department.
(9) Welcomes WHO’s initiative to develop a global framework for multi-disease elimination but cautions that the initiative should not interfere with countries’ work on individual diseases; current momentum should be sustained and gaps addressed simultaneously.
(10) Recommends that the secretariat investigate the effects of climate change and other environmental changes on the prevalence and incidence of NTDs and other infectious diseases, including by modelling, for example by extending projects already being implemented in the Pacific, the Caribbean and Africa to other regions and areas.
(11) Recommends that programmes learn from experience in the context of the COVID-19 pandemic to strengthen the sustainability of NTD programmes, including: innovative methods of delivering mass treatment, integrated vector management and other interventions; management of logistics and meetings; high-level coordination of funding for COVID-19 and for NTDs; advocacy for principles of water, sanitation and hygiene; platforms for sharing diagnostics; data collection systems; partnerships and further research on the emergence and re-emergence of diseases at the animal–human interface.
(12) Recommends that, in the context of the COVID-19 pandemic, communities be engaged by innovative methods, such as social media platforms, to achieve the goals in the NTD road map 2021–2030.
(13) Recommends that the impact of the COVID-19 pandemic on NTD programmes at global, regional and country level be:
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A systematic technically driven process for the adoption of additional diseases as NTDs
In January 2016, the 138th session of the WHO Executive Board requested the Strategic and Technical Advisory Group (STAG) for Neglected Tropical Diseases to develop a 'systematic, technically driven process for the adoption of additional diseases as NTDs.'
The proposed criteria for classifying a condition as an NTD and the process for review of the list of NTDs can be accessed here.
The STAG is the principal advisory group to WHO for the control of NTDs and reports directly to the Director-General of WHO. Its mandate is to advise WHO on overall global policies and strategies, ranging from monitoring of implementation to delivery and linkages with other health interventions. Its remit is to facilitate and monitor the coverage of control interventions and to provide WHO with high-quality, well considered advice and recommendations on matters described in its terms of reference.