Neglected Tropical Diseases

Thoko Elphick-Pooley is the Executive Director of Uniting to Combat NTDs and Co-Chair of the G7 Taskforce on Global Health. Born and educated in Bulawayo, Zimbabwe in business administration and international development. Thoko has a wealth of experience in strategic leadership, partnership development and institutional relations.

Prior to working at Uniting to Combat NTDs, Thoko was leading the institutional funding team at Sight savers, overseeing the growth of institutional funding as a source of income for the organization which grew from 8% in 2009 to over 40% by 2015. Prior to joining Sight savers, Thoko worked for Education Action in London, Practical Action in the UK and Kenya, CIVICUS in South Africa and a number of organizations in Zimbabwe including for UNESCO. Capital caught up with her to talk about climate change and Neglected Tropical Diseases in Ethiopia. Excerpts:

Capital: How does climate change contribute to the prevalence and distribution of Neglected Tropical Diseases in Ethiopia, and what specific challenges does it pose in combating these diseases?

Thoko Elphick-Pooley: Climate change is having a devastating impact on vulnerable individuals, communities, and countries. Extreme weather events such as cyclones, floods, wildfires, heatwaves, and droughts are leading to a loss of homes, livestock and farming lands, the shrinking of vital water sources, food insecurity, displacement, the erosion of economies, and health emergencies, including outbreaks of public health concern, such as yellow fever in central and eastern Africa. 

Over one billion people around the world require treatment and care for neglected tropical diseases (NTDs). NTDs are a group of 20 preventable and treatable diseases that cause suffering, disability, disfigurement, and are fatal in many cases. NTDs are diseases of inequity. By most commonly affecting some of the most vulnerable people in the world – who often live in remote communities – NTDs create cycles of poverty and cost developing nations billions of dollars every year. 

According to the Government of Ethiopia’s NTD masterplan, Ethiopia is disproportionately affected by a century-long scourge of multiple NTDs as compared with other developing countries, including in sub- Saharan Africa. The country is endemic for at least 16 NTDs, such as sleeping sickness, dengue and lymphatic filariasis, which inflict morbidity, mortality and disability on the most disadvantaged population groups in the country and negatively affect socioeconomic development. Moreover, people and communities affected by these disenfranchising diseases are subject to severe stigmatization and isolation from social and cultural life and are vulnerable to mental health problems.  

Climate change is expected to increase the spread of NTDs, or expand or shift their geographic range, as they are directly influenced by changes in temperature, rainfall, relative humidity, and other climatic factors. Climate change is also exacerbating vulnerabilities; it is pushing populations further into poverty, leading to poorer quality of life, marginalisation, and reductions in life expectancy. This has profound effects on equity, particularly in Ethiopia, which takes a particularly heavy toll from climate change and NTDs. 

The country has the fourth highest NTD burden in the world and the second highest NTD burden in Africa, with 57% of its population requiring preventative treatment for NTDs. However, Ethiopia is showing great leadership in tackling NTDs by being one of the first countries to sign the Kigali Declaration on NTDs and recognising its importance in its strategic plan.

Capital: In your assessment, how has climate change affected the patterns of transmission and geographic spread of NTDs in Ethiopia, and what are the implications for public health interventions?

Thoko Elphick-Pooley: Ethiopia’s NTD strategic plan 2021-2025 recognises climate change as affecting vector populations and disease trends. For example, dengue, chikungunya, leishmaniasis, lymphatic filariasis, and schistosomiasis are all vector-borne diseases whose vectors can thrive with warmer temperatures and/or increased rainfall. 500 million more people could become exposed to chikungunya and dengue as these diseases spread to new geographies due to warmer climates. By 2080, this figure doubles to one billion more people. 

We have also seen a 2023 study by Ethiopian scientists, reporting five new cases of sleeping sickness, where none have been reported for decades.

Caused by mosquitoes, the transmission areas for lymphatic filariasis are expected to expand in geographic range, leading to new endemic areas in the northern and southern parts of the African continent which could impact Ethiopia.

Climate change is putting already stretched water resources and services under growing threat as well as accelerating and amplifying unpredictable weather patterns. Droughts, floods, salt-water contamination, and environmental degradation all affect WASH (safe drinking-water, sanitation and hygiene). WASH plays a key role in preventing exposure to NTDs such as trachoma and schistosomiasis

Encouragingly, responding to public health vulnerabilities caused by climate change is one of Ethiopia’s primary goals within the National Adaptation Programme of Action and the Nationally Determined Contributions. In particular, these policy instruments focus on the effective management of drought in order to safeguard human, animal and environmental health.

Capital: What are the key strategies or initiatives that Uniting to Combat NTDs is implementing in Ethiopia to mitigate the impact of climate change on NTDs and improve control and prevention efforts?

Thoko Elphick-Pooley: Uniting to Combat NTDs exists to end NTDs by mobilising resources in support of the World Health Organization’s NTD road map and the Sustainable Development Goals. Demand generation and building political will at a country level is important to drive investment in NTDs and therefore improve control and prevention efforts towards tackling NTDs.

Ethiopia has shown strong country leadership towards tackling NTDs by being one of the first countries to endorse the kigali declaration on NTDs. The Kigali Declaration is a high-level, political declaration that is mobilising political will, community commitment, resources and action, and securing commitments needed to end suffering caused by NTDs. 

We hope to see Ethiopia continue to prioritise NTDs interventions through domestic health financing, and advocating for other African countries to follow their leadership by endorsing the Kigali Declaration on NTDs.

Capital: How does Uniting to Combat NTDs collaborate with local communities, government agencies, and other stakeholders in Ethiopia to build resilience against climate change and address NTDs effectively?

Thoko Elphick-Pooley: Uniting to Combat NTDs works with over 150 partners including communities, government agencies and other stakeholders around the world to create the political will and an enabling environment for change to collectively address the NTD crisis.

Sustainable financing for tackling NTDs is critical if we are to control and eliminate NTDs, and help to build resilience against the health impacts of climate change, such as the resurgence of vector-borne diseases.

However, for some time, a lack of resources has been a significant barrier to the control, elimination, and eradication of NTDs. This challenge has only been intensified by COVID-19 which has caused severe delays and disruption to NTD programmes (NTD services were the second most disrupted health services from COVID-19), as well as a massive repurposing and diversion of resources. 

But the good news is the political will is there. In July 2022, Heads of State, including Ethiopia, adopted the Africa Union Continental Framework and Common Africa Position on NTDs committing to an Africa free of NTDs by 2030, in line with the Sustainable Development Goals and the WHO’s NTD road map to 2030. The Continental Framework calls for the prioritisation of these diseases at national level and for international and domestic resources to be invested to fight NTDs. Equally, Ethiopia has shown strong country leadership towards tackling NTDs by being one of the first countries to endorse the Kigali Declaration on NTDs. 

The next major moment to celebrate progress and announce new commitments to tackle NTDs will be the 2023 reaching the last mile forum which will take place alongside the 28th session of the Conference of the Parties to the United Nations Framework Convention on Climate Change (COP28), forming an anchor event within COP’s first dedicated Health Day. In addition to galvanizing awareness, partnerships, and resources towards disease elimination, the Forum will highlight the impact of climate change on global health goals and seed new momentum for building resilient health systems that best serve at-risk communities. 

Capital: Are there any innovative approaches or technologies being employed to tackle NTDs in Ethiopia, taking into account the challenges posed by climate change?

Thoko Elphick-Pooley: According to Dr Akeza Awealom Asgedom from the School of Public Health at Mekelle University, Ethiopia, Ethiopia has an initiative for climate resilient developmental activities related to WASH services.

Capital: How important is the integration of climate change adaptation measures into the overall NTD control programs in Ethiopia, and what steps are being taken to ensure such integration?

Thoko Elphick-Pooley: In Ethiopia’s NTD strategic plan 2021-2025, climate is recognised as both a gap and a priority in the country’s strategic objectives to enable Ethiopia to achieve the 2025 goals to eliminate, control and eradicate targeted NTDs. In particular, climate-sensitive NTD programming is highlighted as a planning priority.

The strategic plan also highlights the need to strengthen integration of NTD with safe drinking-water, sanitation and hygiene (WASH). Climate change is putting already stretched water resources and services under growing threat. WASH plays a key role in preventing exposure to diseases, and it has been recognised that more integration between WASH and NTD programmes can have mutual benefits and reach underserved populations.

Capital: In your view, what are the priority areas for research and investment to better understand and address the intersection of climate change and NTDs in Ethiopia?

Thoko Elphick-Pooley: The Kigali Declaration on NTDs outlines the importance of delivering a coordinated and country-led research agenda that places greater emphasis on strengthening research capacity, innovation, access and equity.  

Fostering interdisciplinary research (involving biomedical and social sciences) to build a better understanding about the impact of climate on NTDs in Ethiopia, and how NTD services can be successfully integrated into national and local health systems, is also key. More broadly, supporting R&D for new treatments, and their delivery to people and programmes for safe and impactful scale-up, is required to meet the WHO 2030 NTD road map’s goals and beyond.

Capital: How can partnerships and collaborations contribute to strengthening Ethiopia’s capacity to respond to climate change-related health challenges, including NTDs?

Thoko Elphick-Pooley: Partnerships and collaboration is key. The movement to end NTDs has been defined by partnerships and collaboration among a wide range of stakeholders, including affected countries, industry partners, donor countries, private philanthropy, research institutions and civil society organisations. 

The fight against NTDs is one of global health’s success stories. 50 countries have so far eliminated at least one NTD (as of September 2023), of which 21 are in Africa. Country ownership has been critical. Without countries embracing the WHO NTD road map and SDG targets, translating them into national strategies and then delivering on these, progress would not have been possible. It’s essential that countries continue to lead on and take ownership of ending NTDs if we are to carry on seeing tangible results at scale.

Interventions to prevent and control NTDs are one of the “best buys” in global public health, yielding an estimated net benefit to affected individuals of about US$25 per US$1 invested in preventive chemotherapy. 

Additionally, investing in NTD programmes creates a ripple effect in society. It leads to better education, health, and employment outcomes, and transforms lives and communities.  

That’s why financing to tackle NTDs is needed and we’re looking forward to seeing countries come together and commit to action at the Reaching the Last Mile Forum at COP28. 

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