The 14th meeting of the WHO Strategic and Technical Advisory Group (STAG) for neglected tropical diseases (NTDs) was held virtually on 22–24 June 2021.
Conclusions and recommendations to the Director-General
The Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG-NTD):
(1) Thanks the Director and WHO regional offices for their comprehensive reports on developments since the previous meeting (Geneva, 15–17 September 2020).
(2) Commends the quantity and quality of work undertaken by the Department and progress against NTDs globally, despite the limitations imposed by COVID-19.
(3) Recommends that:- as efforts are made to better harmonize data collection tools, capacity for data use and analytics be strengthened at country level;
- at the time of the next review of the road map and companion documents, the relevance of recommended indicators be reviewed to ensure that all recommended indicators have genuine utility for programmes;
- consideration be given to establishing an advisory group to identify the major gaps in diagnosis and management of visceral leishmaniasis and propose strategic interventions to address these gaps;
- efforts be made to prioritize support for rabies in the African and Eastern Mediterranean regions, through targeted advocacy to national governments, practical support for surveillance, human vaccination and provision of rabies immune globulin, technical assistance and collaboration with other relevant organizations to ensure canine vaccination;
- greater attention be paid to assessment of the burden of NTDs and implementation of appropriate interventions in refugee populations and internally-displaced peoples, particularly relating to cutaneous leishmaniasis programmes in conflict-affected areas of the Eastern Mediterranean Region;
- WHO, through its prequalification programme, develop a robust and comprehensive mechanism for post-market quality assurance of insecticide products, to guard against unacceptable deterioration in the quality of products delivered to programmes and consumers;
- increased attention to echinococcosis and cysticercosis, and greater work to develop and implement One Health approaches relevant to NTDs;
- intensified efforts for countries in the last mile or at the stage of finalizing dossiers, and consideration of pre-emptive dossier preparation prior to the likely period of submission.
(4) Notes the predicted and emerging empirical evidence of the impact of COVID-19 on NTD programmes and recommends that:
- health systems be alerted and assisted to be prepared for increased numbers of cases of NTDs, more intense transmission of infection and accumulating disability following COVID-19-related reductions in intensity of active screening programmes, notably for leprosy and cutaneous leishmaniasis; this should include calculation of likely requirements for relevant health products;
- medicines without proven evidence of efficacy against COVID-19 (e.g. azithromycin, ivermectin) be protected from being diverted for use against COVID-19, and that even in the event of efficacy of such drugs against COVID-19 being established, the agreement of medicine donors for repurposing be obtained before the donations are used for that purpose;
- urgent action be taken to avoid expiration and stock-outs of medicines, particularly praziquantel, due to delays in programme implementation;
- consideration be given to the use of intensified strategies against NTDs to not lose previously hard-won gains, build back better, and increase the chance of reaching 2030 targets defined in the 2021–2030 NTD road map.
(5) Notes with concern the impact of the cuts in funding to NTD programmes in general and the impact on diseases with outbreak potential, such as visceral leishmaniasis (in East Africa and South Asia) and dracunculiasis in particular, and recommends that:
- WHO develop an advocacy plan and networking platform to maintain and strengthen coordination among and advocacy with current donors and engage new donors, to help secure new resources to achieve the road map targets for 20212030;
- cost-saving options be considered, including through reviewing interventions to find greater efficiencies, for example by integration of work across NTDs and beyond;
- supplies of medicines and diagnostics be maintained if all other options/mitigation strategies fail;
- because it is an eradication programme, activities against dracunculiasis be prioritized (if funding gaps not filled) with a focus on transmission zones, including endemic and non-endemic countries and areas at high risk of disease resurgence;
- Sudan and the Democratic Republic of the Congo be prioritized for the certification of interruption of dracunculiasis transmission at the earliest appropriate opportunity.
(6) Notes ongoing interest in the designation of additional diseases as NTDs, and recommends that:
- the moratorium on not adding diseases to the NTD portfolio be maintained at least until 2023;
- consideration be given to developing exclusion criteria and a process for removing from the list those diseases that no longer meet the inclusion criteria, taking into account how the global NTD programme operates, the particular needs (e.g. research versus surveillance) of each disease, and whether those needs might be better served if a disease was placed under the stewardship of another technical area;
- the appropriateness of category B be reconsidered;
- consideration be given to assigning management of certain NTDs to other WHO departments/programmes, e.g. noma/oral health;
- WHO address the issue of the NTD Department having a mandate to work on some diseases but no resources/funding to actually do so;
- work continue to “maintain the gains” on the current 20 NTDs, with future discussion on potential revision of the criteria for designation of NTDs to incorporate broader considerations, e.g. regional perspectives on disease burden.
(7) Recommends that WHO continues cross-cutting work to address the mental health of persons affected by NTDs, such as through establishing networks for affected persons, inclusion, social support, addressing stigmatization, and links to social services for vocational training/income generation, while remembering that declaring someone to have a mental health condition can itself be stigmatizing. In integrating services, a component on health education and engagement at community and health facility level needs be included so that the person who is already stigmatized with an NTD is not further stigmatized and labelled as having a mental health problem. Attention to mental health issues will likely considerably increase attention and adherence to the management of NTDs and improve individuals’ socioeconomic prospects.
(8) Acknowledges the impressive progress towards elimination of visceral leishmaniasis in the South-East Asia Region, expresses concern about the impact of COVID-19 on visceral leishmaniasis and other diseases amenable to individual case management, and invites Member States and relevant stakeholders to implement mitigating strategies through active surveillance and other measures as well as scaling up the detection of local transmission in new areas.
(9) Acknowledges the challenges posed by new in-vitro diagnostic regulations and of funding in maintaining production of diagnostic tests and life-saving antileishmanial medicines and other health products, and recommends that WHO collaborates and coordinates with donors, partners, regulatory authorities, Member States, and manufacturers to streamline forecasts, regulation and production.- (10) Requests that the next STAG-NTD meeting includes on the agenda the issue of efficient prequalification of NTD diagnostics, the issue of diagnostics for dengue being particularly noted.
- (11) Agrees with the request by the secretariat to hold STAG-NTD meetings twice a year (the next in November–December 2021).