Evaluating and mitigating the potential indirect effect of COVID-19 on control programmes for seven neglected tropical diseases: a modelling study

Anna Borlase, Epke A. Le Rutte, NTD Modelling Consortium, Soledad Castaño, David J. Blok, Jaspreet Toor, Federica Giardina, Emma L. Davis

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BACKGROUND: In line with movement restrictions and physical distancing essential for the control of the COVID-19 pandemic, WHO recommended postponement of all neglected tropical disease (NTD) control activities that involve community-based surveys, active case finding, and mass drug administration in April, 2020. Following revised guidance later in 2020, and after interruptions to NTD programmes of varying lengths, NTD programmes gradually restarted in the context of an ongoing pandemic. However, ongoing challenges and service gaps have been reported. This study aimed to evaluate the potential effect of the programmatic interruptions and strategies to mitigate this effect. METHODS: For seven NTDs, namely soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, visceral leishmaniasis, and human African trypanosomiasis, we used mathematical transmission models to simulate the effect of programme interruptions on the dynamics of each of these diseases in different endemic settings. We also explored the potential benefit of implementing mitigation strategies, primarily in terms of minimising the delays to control targets. FINDINGS: We show that the effect of the COVID-19-induced interruption in terms of delay to achieving elimination goals might in some cases be much longer than the duration of the interruption. For schistosomiasis, onchocerciasis, trachoma, and visceral leishmaniasis, a mean delay of 2-3 years for a 1-year interruption is predicted in areas of highest prevalence. We also show that these delays can largely be mitigated by measures such as additional mass drug administration or enhanced case-finding. INTERPRETATION: The COVID-19 pandemic has brought infectious disease control to the forefront of global consciousness. It is essential that the NTDs, so long neglected in terms of research and financial support, are not overlooked, and remain a priority in health service planning and funding. FUNDING: Bill & Melinda Gates Foundation, Medical Research Council, and the UK Foreign, Commonwealth & Development Office.

Original languageEnglish
Pages (from-to)e1600-e1611
JournalThe Lancet. Global health
Issue number11
Publication statusPublished - Nov 2022

Bibliographical note

Funding Information:
This work was supported by the NTD Modelling Consortium, funded by the Bill & Melinda Gates Foundation (OPP1184344). JT and M-GB report funding from the Medical Research Council (MRC) Centre for Global Infectious Disease Analysis (MR/R015600/1), jointly funded by the UK MRC and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC–FCDO Concordat agreement, which is also part of the European and Developing Countries Clinical Trials Partnership programme supported by the EU.

Funding Information:
We thank Pauline Mwinzi, Fikre Seife, and others for interesting discussions at the NTD Modelling Consortium and Royal Society of Tropical Medicine and Hygiene webinar held on Sept 2, 2021, about modelling the impact of COVID-19 interruptions on NTD programmes. We also acknowledge the help and support of members of the Department of Control of NTDs at WHO for their guidance and invaluable conversations around the framing of this work. AB would like to thank representatives from The Carter Center, the International Trachoma Initiative, and Sightsavers for their insights and useful discussions regarding modelled trachoma scenarios. DJB would like to thank Adrian Hopkins and representatives from Sightsavers for their contribution to conceptualising the modelled onchocerciasis scenarios. EALR would like to thank Jose-Antonio Ruiz-Postigo from WHO and Amresh Kumar from PATH India for their insights regarding the interruptions of the visceral leishmaniasis control programmes in India. SC would like to thank the Democratic Republic of the Congo National Sleeping Sickness Control Programme for original data collection, WHO for data access (in the framework of the WHO human African trypanosomiasis Atlas), and the sciCORE Centre for Scientific Computing at the University of Basel. FG would like to thank Kevin McRae-McKee and Sumali Bajaj for their technical support, and Rosie Maddren, Elodie Yard, Iain Gardiner, Jane Lillywhite, and Laura Appleby for their insights about the implementation of soil-transmitted helminths control programmes during the COVID-19 pandemic.

Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license


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