Winning the war

In March, the world’s newest nation made history. Against a backdrop of civil war, famine and displacement, South Sudan announced it had stopped Guinea worm within its borders, marking a major victory in the race to make the disease only the second after smallpox to be eradicated worldwide.

“Having known the suffering it inflicts, one is very happy today,” Dr Riek Gai Kok, the country’s health minister, told reporters. “Future generations will just read of it in the books as history.”

Guinea worm–also known as dracunculiasis, or ‘affliction with little dragons’ - is one of 18 debilitating conditions known collectively as neglected tropical diseases, or NTDs. Between them, this band of diseases blind, disable and disfigure millions of the world’s poorest people, miring sufferers in poverty and social exclusion, and draining billions of dollars from developing economies each year.

They thrive in the most marginalised corners of the world – remote, rural communities or conflict zones, where health systems are weak – and despite being preventable and treatable, continue to blight communities.

NTDs are both a symptom and a cause of poverty. One, lymphatic filariasis (LF) begins with a simple mosquito bite. As the fly feeds, in some regions of the world, it can transmit a parasite, which invades the host’s lymphatic system and develops into an adult worm.

The infection can lead to vast swelling, blockages and fevers, leaving sufferers too ill to work or attend school, and often shunned by their communities.

Guinea worm larvae are ingested in dirty water, growing internally to as long as a metre before pushing, excruciatingly, through the skin over several weeks. There is no treatment, except to wind the emerging worm around a stick to speed its removal.

These diseases have afflicted the poor since ancient times. And yet, the tide is turning. For some decades, a global assault on NTDs has been quietly gathering speed, halting transmission and driving infection rates to new lows. Galvanised by funding, drug donations and political will – and backed by an army of frontline health workers – the alliance against neglected diseases has expanded into one of the most successful public health initiatives in history.

The wins are myriad. In the five years since health and development experts, donors, charities and drug firms joined together in London and pledged to control, eliminate or eradicate 10 NTDs by 2020, the number of people affected by these diseases has shrunk to 1.5 billion from almost 2 billion in 2011.

Eight countries have eliminated trachoma – a leading cause of blindness – as a public health problem. Much of Latin America has rid itself of river blindness, while Vietnam in October became the newest nation to eliminate lymphatic filariasis.

In 2017, more than 1 billion people were dosed for infections such as sleeping sickness and leprosy, as strengthened public health systems and disease surveillance helped health workers reach patients in more than 130 countries.

Philanthropy has been an engine of this success. The Carter Center, a foundation set up by former US president Jimmy Carter in 1982, has led global efforts to eradicate Guinea worm.

In 1986, when it began its campaign, there were an estimated 3.5 million cases annually worldwide. Last year the global tally was 30, reported in Chad and Ethiopia.

The Bill & Melinda Gates Foundation has invested millions of dollars in funding drugs and diagnostic tools, tightening surveillance, and vector control – for example, the suppression of insects and worms that spread diseases.

Multiple other donors – including the crown prince of Abu Dhabi, who last year unveiled a $100m fund aimed at eliminating river blindness and LF – have lent their support, alongside $17bn worth of medicine donated by industry partners.

In stamping out NTDs, the last mile will be the hardest. As diseases fade, so too can political momentum and funding.

The endgame will hinge on hunting down the last pockets of disease, in finding new tools for diagnosis and treatment, and in shoring up surveillance efforts. It will require painstaking effort, and the support of multiple partners to drive NTDs out of existence. But for the first time in history, this goal is within humanity’s grasp. — PA

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