The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague

Abstract

Background Among the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue. Methods To understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron’I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment. Results During the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases. Discussion COVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected.

Research on HTLV-1 and HTLV-2 in Latin America and the Caribbean over the last ten years

“…Previously, a reduction in scientific productivity on HTLV-1 was reported around the world [ 36 ], with some relative growth by LAC researchers [ 20 ]. Despite the COVID-19 pandemic complicating the surveillance of some diseases and the development of research in recent years, especially in relation to neglected diseases [ 37 , 38 ], our analysis did not show a substantial variation in the number of articles produced during 2020–2021. However, scientific production remains modest and without great advances in the treatment of viral infection [ 9 ].…”

Excess mortality associated with the COVID-19 pandemic during the 2020 and 2021 waves in Antananarivo, Madagascar

“…Moreover, during the first waves of the pandemic, the virology unit at IPM was mainly focused on the diagnosis of SARS-CoV-2 due to logistic constraints and a lack of human resources, and this may have resulted in an underdiagnosis of other respiratory viral infections responsible for other causes of death. Similarly, a decrease in consultations was observed at health centres during the first and second waves of the pandemic,40 which resulted in an under-reporting of other infectious diseases. Second, in our analysis, the estimation of excess mortality focused on the weeks when the excesses were most evident—using Farrington surveillance algorithm,17 which may induce an underestimation of mortality excess versus relative change method based on of P-scores 18.…”

Public-private partnerships influencing the initiation and duration of clinical trials for neglected tropical diseases

“…Within PPP-initiated collaborations, the synergy between the R&D and delivery processes is essential for the elimination of NTDs [25]. Until With rising investments coming from both public and private stakeholders, PPPs are expected to continue to show their promise in the coming years [36][37][38][39]. In private or public sector-led collaborations, academic and industrial scientists are more likely to work together…”

“…By classifying these influential factors as 'logistic dimensions', the present study groups together determinants that are related to practical and managerial issues. Toor and coauthors predicted that during the Covid-19 period ongoing and planned PPP NTD trials could be confronted with challenges in enrolment, funding, and execution [36][37][38]. The logistic determinants arise during the clinical trial, which may impact the conduct and outcome of the trial.…”