Lusaka, Zambia — As the world moves towards a growing prevalence of non-communicable diseases and mental health concerns, Africa faces a dual challenge of addressing these emerging health threats while combating the persistent burden of infectious diseases, particularly neglected tropical diseases (NTDs).
Despite promising strategies outlined in the NTD roadmap, gaps in diagnostics, treatments, and antimicrobial resistance pose significant obstacles to achieving disease control and elimination goals. Africa must harness its existing solutions, prioritize low-hanging fruit interventions, and invest in research and development to effectively navigate this complex epidemiological landscape.
Dr. John Amuasi, the Executive Director of the African Research Network for Neglected Tropical Diseases (ARNTD), offers insights into the most pressing challenges and promising strategies for combating infectious diseases, neglected tropical diseases (NTDs), and antimicrobial resistance (AMR) in Africa. Based at the Kumasi Center for Collaborative Research in Tropical Medicine in Kumasi, Ghana, Dr. Amuasi also holds a teaching position in the Global Health Department at the Kwame Nkrumah University of Science and Technology's School of Public Health. His research encompasses NTDs, global health, and infectious diseases, with a particular focus on clinical trials for emerging and re-emerging infectious diseases. allAfrica's Melody Chironda spoke with him in Lusaka during the 3rd International Conference on Public Health in Africa (CPHIA 2023).
What are the biggest challenges to combating infectious diseases, NTDs, and antimicrobial resistance (AMR) in Africa?
"The world is undergoing an epidemiological transition, with Africa mirroring this trend," said Dr Amuasi. "While non-communicable diseases and mental health concerns are gaining prominence, infectious diseases remain a persistent challenge on the continent. Neglected tropical diseases, in particular, disproportionately affect the poorest populations."
"Africa possesses solutions to address these issues, and some of the solutions are low-hanging fruit (that are readily attainable). The NTD roadmap, which has been diligently followed, provides a framework for controlling or even eliminating certain diseases."
"However, gaps persist in diagnostics and treatments for some of these diseases, hindering progress towards achieving the roadmap's objectives, particularly with antimicrobial resistance, there's a challenge because it could easily undo all the gains that we've made so far in addressing infectious diseases," he said. "If we do not roll back the resistance or find new, more effective tools, then we can find ourselves in a very difficult situation in the future."
A roadmap to tackle Africa's most devastating NTDs
The NTD roadmap serves as a comprehensive guide for controlling and even eradicating certain neglected tropical diseases. Unveiled in 2021, "Ending the Neglect to Attain the Sustainable Development Goals: A Road Map for Neglected Tropical Diseases 2021–2030" outlines ambitious targets to prevent, control, eliminate, and eradicate a diverse range of NTDs and disease groups by 2030.
Despite significant progress, achieving these targets demands intensified efforts and investments to overcome delays and accelerate advancements.
The current epidemiological transition poses challenges for Africa in addressing non-communicable diseases and mental health concerns while managing infectious diseases, particularly NTDs.
NTDs are a group of diseases that disproportionately affect the world's poorest populations, particularly in Africa, where they take a devastating toll on individuals and communities. These diseases hinder early childhood development, reproductive and sexual health, and quality of life, ultimately impeding economic growth. Caused by a range of pathogens, including viruses, bacteria, parasites, fungi, and toxins, NTDs are often linked to environmental factors and have far-reaching consequences, including lifelong social stigma and economic hardship. While some NTDs may not be fatal, their debilitating effects can persist for a lifetime, trapping individuals in a cycle of poverty and deprivation.
Africa bears over one-third of the global NTD burden, highlighting the critical imperative for effective interventions to combat these debilitating diseases.
So what are the most effective strategies for success?
"Strategy is operational at different levels," said Dr Amuasi. "The key goal, the general strategy, I would say is to reduce the consumption of unnecessary antibiotics and antimicrobials."
Antimicrobials are medicines used to prevent and treat infectious diseases. Antimicrobial Resistance (AMR) occurs when germs no longer respond to these medicines. AMR makes infections difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability, and death.
"This is the key," Dr. Amausi said, "because the more pressure we put on the drugs, the greater the risk of emerging and spreading resistance."
"So the first thing is making sure that there's an adequate supply of high-quality, effective antibiotics coupled with diagnostics. That way, we can tell who really has an infection, and what that infection is susceptible to, and we can target our treatment accordingly."
"It's more like being a sharpshooter," Dr. Amausi explained. "We need to target the bug in the correct way and the correct place, therefore reducing waste and unnecessary use, which will then increase the resistance. And, of course, more research into more effective drugs, vaccines, and diagnostics is essential."
How effective do you think is it to address NTDs on a global platform?
"Over 80% of the NTD burden lies in Africa, and so, the focus is rightly on the African continent," said Dr Amuasi.
"We now have what we call the score sheet, where countries are assessed based on their progress towards eliminating NTDs. This has been a game-changer because it has brought the attention of the highest levels, the offices of the presidents, to ensure that their country programs are making significant progress. This is a positive step, but we need to continue to highlight these efforts and provide mutual support to achieve these targets."
"The pressure must be increased," he said. "Because this is a battle we can win and win within a reasonable timeframe if we are committed to this goal sheet. It's easily accessible online. Just Google 'NTD score sheet' and you'll find it, and it's regularly updated. And it aligns with the Kigali Declaration."
What role can international organizations, donors, and governments play in supporting Africa's efforts to combat infectious diseases, NTDs, and AMR?
"Raising public awareness of these challenges, particularly emerging and reemerging infectious diseases and their interplay with NTDs, is of paramount importance," said Dr. Amausi. "These entities disproportionately affect the poorest of the poor, creating a double burden."
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"When infectious diseases impact everyone, the poorest of the poor bear the brunt of the impact, compounded by the NTDs they already face," he said. "Therefore, maintaining visibility on these issues and demonstrating the substantial economic savings achievable by addressing NTDs and other interventions can help align everyone's efforts."
"For instance," Dr. Amausi continued, "studies have shown that millions of dollars could be saved in Nigeria by addressing just the five preventive chemotherapy NTDs. We have the tools to achieve this."
What are the potential long-term impacts of infectious diseases, NTDs, and AMR on African economies and societies?
"That's an excellent question," Dr. Amausi said. "The impact of NTDs is twofold: lives are lost, and productive time is lost. It's a matter of both mortality and morbidity."
"The loss of life is particularly concerning in a continent where skilled labor is already scarce," he said. "Every life lost represents a significant setback. The economic impact extends beyond mortality. When people are unable to work due to illness or disability, it translates into economic losses. Longer hospital stays also contribute to economic strain."
"The evidence is very clear that when these are addressed, it translates into massive economic savings, and it's really what we call a "Best Buy."
The continent's experts need to keep their "eyes on the ball" in terms of these developments, Dr. Amausi said, and "sustained pressure" for growth on the continent.
AllAfrica's reporting from CPHIA2023 is supported by the African Union and Africa CDC.
