Opinion: The Road to Ending Visceral Leishmaniasis
By Aida Meskel
Visceral leishmaniasis, or VL, is a parasitic disease that is spread via sand flies. If left untreated, VL kills 95% of its victims. Endemic in 78 countries and territories, it is the second-deadliest parasitic disease after malaria and presents as a fever, weight loss, enlargement of the spleen and liver, and anemia.
Between 50,000 and 90,000 new cases emerge each year, although only 20% to 45% of cases are reported to the World Health Organization. Those living in the lowest-income communities are the worst affected, as VL thrives in areas where access to clean water, sanitation, and health care is limited. Urgent attention to VL and other so-called neglected tropical diseases is needed to realize any vision of global health equity.
NTDs are considered neglected because they are largely absent from the global health agenda, do not get much funding, and are usually associated with social exclusion and other stigmas.
World Neglected Tropical Diseases Day on Jan. 30 marked 10 years since the launch of the London Declaration on Neglected Tropical Diseases, a multisector commitment to treat and prevent VL and other NTDs among the world’s lowest-income populations.
Though progress has been made, we still have a way to go and, as we look to the next decade, eliminating VL will continue to be a priority for Gilead Sciences.
The history behind the fight
Gilead was one of the original endorsers of the London Declaration a decade ago. But prior to that, Gilead began partnering with WHO in 1992 to supply and distribute our antifungal therapy, which was becoming increasingly important in treating VL.
Since 2011, Gilead has donated more than 825,000 vials of AmBisome for patients in endemic countries, such as Bangladesh, Ethiopia, and India. In 2016, as we renewed our commitment to the elimination of VL, we also provided funding to both governmental and nongovernmental organizations that could be used as investment into the health services that were most needed, such as the building of new clinics, hiring of personnel, and procuring of better diagnostics.
This partnership has significantly broadened access to better treatment and has improved health outcomes for thousands of people. However, an effective elimination strategy calls for strengthening health systems everywhere, including targeted improvements in case detection, surveillance, referral services, to ensure linkage to care, monitoring and evaluation, local protocols and action plans focused on eliminations, and plans that ensure sustainability that enable countries to maintain elimination once targets are achieved.
For World NTD Day last year, WHO unveiled a road map to fight NTDs, with global targets to prevent, control, and eliminate 20 diseases and disease groups by 2030. For VL, WHO has set the goal of achieving less than 1% mortality due to VL in 85% of endemic countries by 2030.
This road map focuses on the value of integrating approaches, using innovative services that have emerged during the COVID-19 pandemic, educating communities, and engaging and supporting community health workers and volunteers to effectively deliver NTD health services, particularly to marginalized groups.
We’ve made great progress on VL in South Asia precisely because of efforts like these, and we will need to apply similarly holistic approaches in other areas of concern, such as East Africa, while still being sensitive to regional differences. This will require commitment from governments, the biotech industry, the health workforce, and donors to listen to each other and the people affected by the disease.
VL and other NTDs are entirely preventable, and it is our collective responsibility to end them.
Looking ahead
To do our part, Gilead will continue to support WHO over the next five years. However, we know that donations alone won’t achieve elimination. So, we are simultaneously looking for other ways to partner with key groups and encouraging renewed commitments from other stakeholders to implement national strategies, expand surveillance of VL, and ensure adequate funding so that countries have an equitable chance at elimination.
Of course, the COVID-19 pandemic has impacted progress in VL elimination — and other NTDs — and exacerbated chronic inequity in virtually every aspect of life. Despite this, a total of 757 million people received NTD treatment in 2020. We can continue to build on this momentum.
Partners across sectors have helped build a strong foundation for renewed progress against NTDs. Now it’s time for a new, more ambitious phase that strengthens local health systems that enable countries to reach elimination targets and sustain the progress made once those targets are achieved. VL and other NTDs are entirely preventable, and it is our collective responsibility to end them.
