Joseph J. Amon
When Dr Tedros Adhanom Ghebreyesus was elected as WHO Director-General earlier this year, there was a sense among people working on Neglected Tropical Diseases (NTDs) that there may be new attention, and resources, for efforts at eliminating NTDs. The diverse group of bacterial, viral, and parasitic diseases collectively identified as “neglected tropical diseases” are understood as both a cause and a consequence of poverty, causing physical and intellectual impairments, preventing children from attending school, and reducing economic productivity. NTDs can also be severely stigmatizing; people with NTDs have suffered a long history of isolation and discrimination.
Dr Tedros’ election came soon after a global NTD Summit that highlighted the significant progress that has been made, especially in efforts to eliminate trachoma and lymphatic filariasis as public health problems, despite limited funds. In May 2013, the World Health Assembly adopted a resolution calling on Member States to intensify efforts to address NTDs with the goal of reaching previously established targets for the elimination or eradication of 11 NTDs. The resolution also called for the integration of NTD efforts into primary health services and universal access to preventive chemotherapy and treatment. NTDs were subsequently included in the Sustainable Development Goal #3 which called for an end of the “epidemics of AIDS, tuberculosis, malaria and NTDs” by 2030.
At the summit, delegates highlighted NTDs as “one of the best buys” in public health and while the meeting secured on-going commitments from private donors and pharmaceutical companies, the discussions also emphasized the need for national governments to increase their own financial commitments to ensure that final targets were met and sustainability was ensured.
These issues, of expanding universal access to health, especially for those most impoverished, and of local ownership to ensure sustainability, echoed comments Dr Tedros made on human rights in this journal prior to his election. In that Q&A, Dr Tedros discussed the “hundreds of millions of people missing out on essential health care or falling into poverty trying to pay for it. That is a violation of the human right to health that demands our full attention and urgent action.” Dr Tedros also stated: “I am committed to transforming the way that WHO operates with the core principles of health as a human right and universal health coverage for the most vulnerable are at the forefront of all our work. Too often, human rights and gender equity are secondary considerations when UN organizations develop programming. This is outdated and must change. When it comes to rights issues in the reform, importantly, it’s not so much the design of the processes or structures that will make a difference. Far more important is ensuring that health as a human right is engrained into the mindset and attitudes of staff. We need to make sure WHO staff take this core value of the organization to heart and truly believe in it. That is how I believe we will most effectively mainstream human rights in WHO’s public health programming.”
Now that Dr Tedros is in office and his staff have just released a draft scope of work, the question is: amidst the shifting NTD landscape, recognizing the successes to date, as well as some on-going challenges and still inadequate funding, what is the way forward on NTDs and human rights? How will NTDs and the priority of universal health coverage fit together?
Currently, we are reaching only one-third of the people requiring trachoma treatments, and less than one-half of school-aged children needing treatment for schistosomiasis or pre-school-aged children needing deworming for their soil-transmitted helminthiases. Migrant and refugee populations are often neglected, and cross-border initiatives need to be strengthened to ensure complete coverage of those at risk. Some NTD experts have called for a comprehensive universal health coverage program for soil-transmitted helminth infections, schistosomiasis, LF, onchocerciasis, trachoma, yaws, and scabies to simultaneously fulfill priority focus areas of UHC and children, adolescents, and women. Morbidity management must be strengthened to reach millions of individuals with Chagas disease, podoconiosis, and lymphedema and hydrocele due to lymphatic filariasis. Integrated nutrition and NTD programs should be expanded, allowing children to not only be “dewormed” but to be nourished and to recover from the consequences of intestinal helminth infections.
WHO has described a rights-based approach to NTDs, emphasizing the human rights principles of participation, nondiscrimination, and accountability. In addition, Paul Hunt, the United Nations’ Special Rapporteur on the Right to Health from 2002–2008 addressed issues related to NTDs on country visits and in several reports to the Commission on Human Rights. Key issues raised by these reports included the importance of community participation; the obligations for governments, international organizations and the private sector (including pharmaceutical companies); and the need for transparency and accountability in NTD programs. Nonetheless, few NTD programs have adopted explicit human rights approaches and few human rights scholars have engaged with the issue of NTDs and human rights.
WHO, under Dr Tedros’ leadership, has a new opportunity to demonstrate the links between NTDs, SDGs, and human rights, and to make the SDG goal of leaving no one behind real.
Papers are being accepted until 30 November for the Health and Human Rights Journal special section on NTDs and Human Rights, June 2018.
Joseph J. Amon, PhD, MSPH, is a Visiting Lecturer of Public and International Affairs at the Woodrow Wilson School, Princeton University, Princeton, USA, and Vice President for Neglected Tropical Diseases at Helen Keller International. He is also a Guest Editor on the Health and Human Rights Journal special section on NTDs and Human Rights, June 2018.