The Invisible Elements that Drive the Engine of Disease Elimination
On a cool October day in a village high up in the mountainous reaches of northern Pakistan, men, women, and children gathered to take a drug that can save their sight. It’s the first mass drug administration (MDA) for trachoma in a country where the bacterial eye disease is the leading infectious cause of blindness.
For The Task Force, the mass treatment campaign – a proven elimination strategy for many neglected tropical diseases (NTD) such as trachoma – was the culmination of a long and persistent engagement with Pakistan.
“It took years and years of behind-the-scenes relationship building to get to this. The government’s willingness to work with us and other partners on MDA was an act of faith and a demonstration of trust,” said Paul Emerson, PhD, who leads the trachoma program at The Task Force.
Making inroads in countries where there is some wariness of outsiders requires a mindset that is culturally sensitive and open to different approaches – one that is often more ephemeral and certainly less quantifiable. “We nurture individual relationships, from the person at the village level to the official at the national ministry of health,” said Emerson.
The Task Force manages Pfizer’s donations of Zithromax® to prevent and treat trachoma in countries where the disease is endemic. However, the antibiotic alone cannot eliminate trachoma and countries have to demonstrate their ability to use the drug in combination with other World Health Organization (WHO) recommendations.
Emerson said the trachoma program model has changed over the years from asking countries to “prove their worth” to be eligible for drug donations to a framework in which “we are in this together and we’ll work with you to help make this happen.” For instance, The Task Force – understanding that disease elimination is a daunting prospect for many countries – works closely with officials on trachoma action plans that map out how to reach all affected populations.
Creating the Building Blocks for Trust
And so what starts as a tentative, delicate relationship between The Task Force and the country’s ministry of health blooms into a sustained collaboration – built on genuine respect, trust, and understanding. “When countries recognize that we’re trying to empower them, the equation changes, especially because we are not telling them what to do but are there to simply enable them. Our job is to make the national program look good and that’s what we do,” said Emerson.
This willingness to let others shine makes The Task Force distinctive, says Eric Ottesen, MD, head of its NTD Support Center. “We focus on all the good things that are done by programs and partners rather than all the good things we do,” he said. “We have learned that the best way to nurture partnerships and build trust is to beam the light on others.”
A widely respected expert on the disfiguring NTD called lymphatic filariasis (LF), Ottesen believes this foundation of trust is perhaps most essential when walking down that ‘last mile’ of disease elimination. The final phase of addressing a disease is fraught with complications as it typically addresses the hardest-to-reach groups and requires exceptional coordination of efforts.
The Task Force is well aware of this as it stands with the vanguard of countries eliminating LF, trachoma, and river blindness using a multi-pronged approach of drug donations, partnerships, and operational research (OR).
Of the three NTDs, LF elimination is closest to the finish line. The disabling and disfiguring disease, which threatens 856 million people worldwide, received a boost last November when the WHO approved new treatment guidelines.
Collaboration Requires More Than Just Good Intentions
The new triple drug therapy includes ivermectin and is the first accepted new treatment strategy for LF elimination in more than a decade. The Task Force’s Mectizan® Donation Program (MDP) stewards Merck’s* donation of ivermectin, the anti-parasitic drug for LF and river blindness.
MDP is a perfect example of a program for which a foundation of trust laid years ago with disparate partners benefits the greater good. More than a billion people have benefitted over the years with MDP supplying Mectizan® and partners delivering it at the local level.
Merck has expanded its drug donation commitment to achieve LF elimination by 2025 through the new triple drug strategy. Weeks after the therapy was green-lighted, The Task Force, partner organizations, and WHO were in Kenya to support the Kenyan NTD program in persuading ministry of health officials to make implementation of the new treatment a priority. Kenya will now be one of the first countries in Africa to roll out the new therapy later this year.
The Task Force is able to work quickly with countries like Kenya on ambitious initiatives such as the implementation of the new LF therapy because of its long-standing relationship with ministries of health and local organizations. “We have worked closely with national programs for years now,” said Task Force epidemiologist Katie Gass, PhD. “They know we share their goal of eliminating LF from their country.”
Kenya’s NTD head Sultani Matendechero agrees with Gass, and said he is excited about rolling out the new therapy because it will reduce the projected duration of elimination from five to two years in his country. “We are positive that implementation of triple drug therapy, coupled with the outstanding improvement in coverage across endemic areas during the last two years, will get us past the tape before 2020.”
A significant part of the new therapy’s success will depend on ensuring that issues impeding program implementation are defined and tackled rapidly and effectively. A few years ago, support from the Bill & Melinda Gates Foundation and the U.S. Agency for International Development enabled The Task Force to create a coalition focused on Operational Research (OR) to address just that. The Coalition for Operational Research on Neglected Tropical Diseases, or COR-NTD, connects researchers with program implementers and provides countries with actionable findings for disease control and elimination. “This is about research that actually helps public health outcomes, not research meant solely for academic discussion and journals,” said Ottesen.
In an increasingly polarized world, The Task Force’s commitment to building bridges with key players has perhaps never been more critical. “Disease elimination goals are coming up quickly and there’s no time to waste. We have no choice but to do more, better and faster,” said Emerson.
*Merck is known as MSD outside the United States and Canada.