IMPACT OF THE COVID-19 PANDEMIC ON NTD PROGRAMMES …

IMPACT OF THE COVID-19 PANDEMIC ON

NTD PROGRAMMES AND ACTIVITIES

MODULE 2

LEARNING

OBJECTIVES• Describe how the COVID-19

pandemic has impacted

Neglected Tropical Diseases

(NTDs), in terms of:

o Clinical picture of people

affected by NTDs

o Disruption of NTD

health services

o Projected increase of

NTD transmission

Photo Credit: © WHO / Blink Media - Juliana Tan

• Describe WHO’s response to NTDs in the

context of COVID-19

By the end of this module,

you should be able to:

MODULE 2: OUTLINE

PART 1

COVID-19 AND NTDs: CLINICAL INTERACTIONS

PART 2

IMPACT OF COVID-19 ON

NTD PROGRAMMES AND ACTIVITIES

PART 3

IMPACT OF COVID-19 ON THE TRANSMISSION

OF NTDs

PART 4

WHO’S RESPONSE

TO NTDs IN THE CONTEXT OF

COVID-19

PART 1

COVID-19 AND NTDs:

CLINICAL

INTERACTIONS


• Very limited information available on the

impact of one condition on the other

• So far:

– No documented impact of COVID-19 on

clinical prognosis of underlying NTD

condition

– No documented impact of underlying

NTD condition on clinical prognosis of

COVID-19


• People at higher risk of developing severe

illness from COVID-19 include those:

– aged ≥60 years; or

– with pre-existing medical conditions

such as diabetes, hypertension, cardiac

disease, chronic lung disease,

cerebrovascular disease, chronic kidney

disease, immunosuppression and

cancer


• Some NTDs cause chronic complications in

the above categories (e.g. cardiac disease

in Chagas disease), and could therefore

potentially lead to higher risk of developing

severe COVID-19, though a specific

association of NTD-related conditions with

severe COVID-19 has not yet been shown

• There is some overlap in clinical presentation

• Cases of false-positive dengue serology due

to COVID-19 have been reported

• In some countries, simultaneous epidemics

of COVID-19 and dengue could overwhelm

the healthcare system

• In some countries, public health measures to

decrease SARS-CoV-2 transmission could

increase dengue transmission

COVID-19 AND DENGUE: CLINICAL INTERACTIONS

PART 2

IMPACT OF COVID-19

ON NTD

PROGRAMMES AND

ACTIVITIES

IMPACT OF COVID-19 ON NTD

PROGRAMMES

• The outbreak of COVID-19 and the

subsequent development of the

pandemic have affected

implementation of essential health

services for NTDs.

• Four main programmatic areas of

disruption have been identified

IMPACT OF COVID-19 ON NTD PROGRAMMES

Suspension of

mass treatment

interventions, active

case-finding and other

community-based activities

Delays in diagnosis,

treatment, morbidity

management, disability

prevention and other health

facility services

1 2


Discontinuance of

monitoring and evaluation

activities (routine

surveillance and

population-based surveys)

Delays in manufacture,

shipment, transport and

delivery of NTD medicines

and consumables to target

countries and of their

distribution within countries

3 4


Causes of disruption include:

WHO’s recommendation

to postpone some

community-based activities

Risk of amplification of

COVID-19 transmission

associated with mass

gatherings

Implementation of public

health and social measures

such as movement

restrictions, curfew and

suspension of public transport

Re-assignment of financial

resources and NTD personnel

to the COVID-19 response


With regards to the production and supply chain for NTD medicines

and consumables, further causes of disruption include:

Reduced

labour forces

Implementatio

n of minimum

order

quantities by

some

manufacturer

s

Shifts in

production

priorities (to

respond to

COVID-19

supply needs)

Delays in

administrative

processes

such as

greenlight for

shipment and

customs

clearance

Reduced

freight

movement

due to

restrictive

measures on

flights, border

crossings and

road transport

Reduced

availability

of storage

facilities

–

PART 3

IMPACT OF COVID-19

ON THE

TRANSMISSION OF

NTDs

IMPACT OF COVID-19 ON TRANSMISSION

OF NTDs

The suspension of disease control

interventions (e.g. mass treatment, active

case-finding, passive surveillance) is

expected to generate a rebound in

transmission of selected NTDs, with

negative consequences on the

attainment of elimination goals set for

2030

Figure 1: Predicted impact of a 12-month delay to mass drug administration for

schistosomiasis in a hypothetical population with high baseline transmission intensity in school-

age children(SAC) but a low adult burden of infection. The lower line represents the prevalence

of heavy intensity infection over time if MDA had proceeded as originally planned, and the

upper line represents the prevalence of heavy intensity infection over time with a missed

second MDA round; there is a consequent delay to achievement of elimination as a public

health problem (EPHP) from 2025 to 2027. The area shaded blue represents the increased

burden of heavy intensity infection which occurs as result of the delay.

WHO. Impact of the COVID-19

pandemic on seven neglected

tropical diseases: a model-

based analysis [report in

preparation].

Missed MDA round in 2020

Coffeng LE et al. Impact of Changes

in Detection Effort on Control of

Visceral Leishmaniasis in the Indian

Subcontinent. J Infect Dis.

2020;221(Supplement_5):S546-S53

Figure 2: Deterministic model predictions for impact of improved case

detection on visceral leishmaniasis (VL) incidence and mortality over time.

True VL incidence

Observed VL incidence

Deaths due to untreated VL

IMPACT OF COVID-19 ON TRANSMISSION

OF NTDs

Modelling undertaken by the NTD

Modelling Consortium in collaboration

with WHO has forecasted long-term

effects ranging from minimal to severe,

varying by:

• disease

• level of disease endemicity

• programme stage

• duration of programme delay

IMPACT OF COVID-19 ON TRANSMISSION OF NTDs

• Many NTD

programmes are

expected to recover

from a brief delay (≤

1 year)

• Longer delays (> 1 year)

will require more intensive

remedial strategies to get

back on track

– Remedial strategies

may include higher

frequency and/or

higher coverage of the

health intervention, or

adoption of more

effective treatment

tools (e.g. IDA for

lymphatic filariasis)

• Populations with

high transmission/

intensity of

schistosomiasis,

trachoma or visceral

leishmaniasis face

the greatest risk as

resurgence will be

greatest in these

areas

IMPACT OF COVID-19 ON TRANSMISSION OF NTDs

• Programmes in their

early stages are

expected to return to

pre-treatment

endemicity levels

• Advanced programmes

which have already

managed to

reduce/control

transmission, will

observe lower levels of

resurgence, provided

the transmission rate is

not too high

PART 4

WHO’S RESPONSE

TO NTDs IN THE

CONTEXT OF

COVID-19

WHO’S RESPONSE TO NTDs DURING COVID-19

• Normative response

– Development of a set of technical guidance on

implementation of NTD activities in the context of the COVID-

19 pandemic

• Leadership response

– Dissemination of information and provision of tailored

technical advice to Member States and partners by the three

levels of WHO (headquarters, regional offices and country

offices) through webinars, teleconferences, e-mail, other

communication platforms and products, and duty travels

WHO’S RESPONSE TO NTDS DURING COVID-19

Operational response

• Follow-up on production, shipment, delivery and

distribution of NTD medicines and other

consumables with all relevant actors:

– With manufacturers on maintenance of

production lines for medicines and other

consumables, and on extension of their shelf-life;

– With freight services for timely delivery, including

troubleshooting when required;

– With relevant agents for administrative steps such

as shipping notification, green light provision and

customs clearance;

WHO’S RESPONSE TO NTDS DURING COVID-19

Operational response

– With relevant focal points in national health

services for safe, timely delivery to warehouses

and eventually to health facilities and designated

treatment points, including monitoring of stock

balances and their expiry status

• Collaboration with WHO’s Health Emergencies

Programme (WHE) to use emergency operations to

address transportation challenges

Documents

IMPACT OF THE COVID-19 PANDEMIC ON NTD PROGRAMMES …