José Ramón Franco: "Institutions dedicated to research into neglected tropical diseases are few and far between; their work is very useful"

The WHO expert works in the department for control of neglected tropical diseases

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Dr Paul Nguewa, director of ISTUN and Dr. José Ramón Franco, WHO expert FOTO: Manuel Castells
22/11/17 13:43 Borja Centenera Crespo

Why are there tropical diseases referred to as "neglected" (NTDs)?

In 2003, a series of tropical diseases that were in the background relative to malaria were labelled "neglected tropical diseases". Included were dracunculiasis (Guinea-worm disease), lymphatic filariasis, onchocerciasis (river blindness), intestinal helminthiasis, schistosomiasis (snail fever), echinococcosis, cysticercosis, rabies, leprosy (Hansen's disease), leishmaniasis, American trypanosomiasis (Chagas disease), human African trypanosomiasis (sleeping sickness), trachoma, Buruli ulcer, endemic treponematoses and dengue fever. These are all illnesses that occur principally in the tropics. In terms of   morbidity and mortality, the most notable is malaria. The above list is not a finished list, for example, the following diseases were recently added: eumycetoma, chromoblastomycosis (and other deep mycoses), scabies (and other ectoparasitoses), and poisoning by snake bite.

Generally, the people most affected by these diseases belong to population groups with reduced economic resources and who usually live in remote rural areas, on the outskirts of large urban areas, or in conflict zones. Perhaps it would be more appropriate to talk of diseases in neglected populations, since neglected tropical diseases persist in conditions of poverty and are concentrated almost exclusively in impoverished populations in developing countries. These populations scarcely have a political voice and, consequently, do not imply a priority when it comes to making institutional decisions.

What role does the WHO play with regard to tropical diseases?

The Department of Control of Neglected Tropical Diseases of the WHO was created in 2005 and coordinates and supports policies and strategies to improve global access to operations for prevention, control, elimination and eradication of neglected tropical diseases. There are different resolutions from the World Health Assembly that imply the support of member states for initiatives to increase access to operations in prevention, diagnosis, treatment and medical attention for populations affected by these diseases.

What lines of research are being carried out?

Although research into neglected tropical diseases is not a priority for the great majority of research institutions because it is hardly profitable, there are more and more non-profit organizations that channel funds to open new lines of research into neglected tropical diseases. Research is principally centred on development of new diagnostic and therapeutic tools and on vector control, but there is also research on new approaches to existing strategies: to improve access and uptake of useful projects already being used, for example,  research towards better understanding of the social factors that complicate access to operation strategies. The WHO has developed the  Special Programme for Research and Training in Tropical Diseases (TDR), with the objective of facilitating, supporting and influencing  efforts to combat poverty-related disease worldwide. This program is supported by the United Nations International Children's Emergency Fund (UNICEF), the United Nations Development Programme (UNDP) and the World Bank.

What is the current situation with NTDs?

Neglected tropical diseases affect over a thousand million people. The appearance of these diseases is frequently linked to deficient living and sanitary conditions with limited access to drinking water and deficient or non-existent health services. However, many neglected tropical diseases can be prevented, controlled or even eliminated by relatively simple  measures, and the prospects of reducing the enormous load caused by these illnesses are positive.

Of the 17 objectives agreed by United Nations member states as part of the 2030 Agenda for sustainable development, goal three (Ensure healthy lives and promote well-being for all at all ages) includes putting an end to the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases.

What problems are encountered by the WHO when it comes to getting rid of these diseases?

An essential aspect in the fight against these diseases is tied up with social instability, in some areas of the planet, where organizing control programs becomes an almost impossible task. In addition, the principal impediments to put an end to these diseases are intimately related to the principal problems currently present in public health. Health systems in countries with endemic disease frequently have significant weaknesses, which are more evident at peripheral levels where the populations most-affected by neglected tropical diseases are to be found. In this situation, reinforcing health systems is the key element to ensure sustainable implementation of activities to control NTDs.

Another consideration is that it is frequent to observe that different actors that act in this field have different interests and apply different strategies and methods. In this respect, it is important that work should be coordinated with the national authorities and structures of the countries affected. This is important to make sure that advances are sustained. The WHO has to lead this process, recommending strategies and facilitating technical guidelines, which must be adapted to the local potential and epidemiological conditions. But, in the end, it is the national authorities that have the final responsibility in their countries.

What value is to be put on the work carried out at the Institute of Tropical Health of the Universidad de Navarra?

Institutions dedicated to research into neglected tropical diseases are few and far between and their work to provide new, appropriate solutions is very valuable. The Institute of Tropical Health  of the Universidad de Navarra (ISTUN) is well-known and has been well known for many years for its ongoing work of research into tropical diseases. The collaboration established with research centres, universities and hospitals situated in the countries with endemic disease is a key element in finding appropriate solutions and in contributing to the global development of these countries.

The institute has focussed on different diseases, and there is currently collaboration with the WHO on research into leishmaniasis. Another possible area of collaboration concerns Sleeping sickness, which is one of the most neglected diseases within the category of the neglected tropical diseases. At the moment there is a possibility of collaboration with Institute of Tropical Health of the Universidad de Navarra to use the capacity of this center and to collaborate in research into useful new diagnostic tools for this disease.

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