The latest World Health Organization (WHO) 'pulse survey',1 conducted in almost 135 countries, shows that the SARS-CoV-2 pandemic continues to severely disrupt the delivery of health services - with services for neglected tropical diseases (NTDs) disrupted in 44% of countries.
"Community-based interventions such as large-scale treatment programmes are affected in almost 60% of countries. Other activities including community awareness and health education campaigns are affected in 52% of countries," said Dr Gautam Biswas, Head, Strategic Information and Analytics, WHO Department of Control of Neglected Tropical Diseases. "Critical services that involve support for self-care, rehabilitation and psychosocial services, as well as diagnosis, treatment and care, are also being compromised."
Due to the potential transmission of SARS-CoV-2 associated with the delivery of large-scale treatment programmes, other public health approaches for NTDs are also considerably affected. These include vector control, veterinary public health, and water, sanitation and health education activities (in addition to population-based surveys for mapping, monitoring and evaluation).
The delays experienced in diagnosis, treatment and care, and also in manufacture, shipment, transport and delivery of donated medicines, are significant.
Measures to mitigate the impact of COVID-19
WHO used a range of measures to tackle the impact of COVID-19 on NTD services.
Between May and July 2020, 3 key guidance for the COVID-19 context were issued to assist countries. WHO's tailored technical advice to Member States and partners included advice to identify repurposing of NTD staff and platforms to support community handwashing, contact tracing, addressing misinformation and providing vital sanitation supplies.
Production, shipment, delivery and distribution of NTD medicines and other consumables were closely monitored.
Consequences for NTDs
Despite these measures, COVID-19 can result in increased NTD burden, in terms of both mortality and morbidity. This can, in turn, cause delays in the achievement of public health goals - including elimination as a public health problem and eradication of Guinea-worm disease and yaws by 2030.
In terms of clinical outcomes, the impact of COVID-19 on NTDs is overwhelming, since the prognosis of COVID-19 can be more severe in people suffering from chronic NTD manifestations. Example includes:
people with chronic Chagas disease develop cardiac complications, meaning coinfection with SARS-CoV-2 is more likely to be life-threatening;
soil-transmitted helminthiasis can result in anaemia, which renders millions of affected individuals (particularly children and pregnant women) vulnerable to severe COVID-19 outcomes;
overlaps in clinical presentation between dengue and COVID-19 may mislead diagnosis and public health systems;
cases of false-positive dengue serology due to COVID-19 may lead to confusion and the overwhelming of health systems, in places where COVID-19 and dengue are both endemic.
When responding to COVID-19, many countries are having to make important decisions, often involving the repurposing of staff and suspension of services. Nevertheless, many NTD interventions are gradually resuming in an entirely changed public health landscape.
1This survey was conducted to gauge the impact of the pandemic on essential health services and how countries are adapting their strategies to maintain essential services. It considered 63 health services and health areas in 216 countries and territories across the 6 WHO regions. A total of 135 responses were received (63% response rate) between January and March 2021.