A positive consequence of the COVID-19 pandemic: how the counterfactual experience of school closures is accelerating a multisectoral response to the treatment of neglected tropical diseases

Abstract

Global access to deworming treatment is one of the public health success stories of low-income countries in the twenty-first century. Parasitic worm infections are among the most ubiquitous chronic infections of humans, and early success with mass treatment programmes for these infections was the key catalyst for the neglected tropical disease (NTD) agenda. Since the launch of the ‘London Declaration’ in 2012, school-based deworming programmes have become the world's largest public health interventions. WHO estimates that by 2020, some 3.3 billion school-based drug treatments had been delivered. The success of this approach was brought to a dramatic halt in April 2020 when schools were closed worldwide in response to the COVID-19 pandemic. These closures immediately excluded 1.5 billion children not only from access to education but also from all school-based health services, including deworming. WHO Pulse surveys in 2021 identified NTD treatment as among the most negatively affected health interventions worldwide, second only to mental health interventions. In reaction, governments created a global Coalition with the twin aims of reopening schools and of rebuilding more resilient school-based health systems. Today, some 86 countries, comprising more than half the world's population, are delivering on this response, and school-based coverage of some key school-based programmes exceeds those from January 2020. This paper explores how science, and a combination of new policy and epidemiological perspectives that began in the 1980s, led to the exceptional growth in school-based NTD programmes after 2012, and are again driving new momentum in response to the COVID-19 pandemic. This article is part of the theme issue ‘Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs’.

Accelerating Progress Towards the 2030 Neglected Tropical Diseases Targets: How Can Quantitative Modeling Support Programmatic Decisions?

“…One key area identified as being very likely to benefit from modeling insights was the impact of disruptions to NTD programs due to COVID-19. NTD interventions were some of the health services most severely affected by the pandemic, due to both direct impacts on service delivery as well as indirect impacts including resource re-allocation [ 18 , 19 ]. While WHO and the NTD Modelling Consortium have previously collaborated to determine how COVID-19–related disruptions impacted NTD programs and to estimate how different strategies could assist in program recovery [ 9 , 18 ], the meeting highlighted several additional areas that require further studies.…”

Introduction to the special issue: challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs

“…This timely collection of papers marks 10 years since the London Declaration and the first WHO roadmap on NTDs and celebrates the progress made over the last decade. The first paper traces the evolution of the NTD concept, its formal emergence and adoption in the year 2000, and the impetus that ensued to establish a new WHO department for NTD control in 2005 [ 8 ].…”

“…Three pillars provide the foundations to this roadmap: (i) accelerate programmatic action; (ii) intensify cross-cutting approaches, and (iii) facilitate country ownership. This volume brings examples of studies that can contribute to strengthening these pillars, such as the modelling analysis on the use of moxidectin mass drug administration (MDA) to accelerate onchocerciasis EOT based on clinical trial data generated by country actors [ 9 ], and multi-sectoral and country-ownership approaches for school-based deworming programmes [ 8 ].…”

“…Bundy and colleagues open this collection with a two-part paper [ 8 ]. This begins with a brief history of the scientific and policy foundations of school-based deworming for STH (one of the largest public health interventions in low- and middle-income countries (LMIC)), and moves on to examine the impact, on children's health, of almost universal school closures in the spring of 2020 owing to the COVID-19 pandemic.…”

“…This (un)natural opportunity allowed an unintended experiment in the counterfactual scenario to understand the impact on children's health when schools are closed for a prolonged time. MDA campaigns were the second most affected public health intervention globally owing to COVID-19, after mental health services [ 8 ]. The impact of school closures on young people has resulted in national governments in LMIC strengthening their resolve in using schools to deliver public health campaigns, recognizing the value they had once they were, regrettably, temporarily suspended.…”