Last evening I a lecture on the Neglected Tropical Diseases (NTDs) in my Global Health Policy course at NYU-Wagner. One of my students asked whether the many NTD control programs that had sprung up over the years to address these diseases were in fact sustainable – an excellent question. My response was “who ever said they should be?”.
Later that evening I learned some excellent news on the NTD front. After nearly 20 years of tireless work, and thanks in a large part to the help of the Carter Center, Nigeria – once the country the most afflicted by Guinea Worm – is on the verge of declaring victory in the war on the scourge. Guinea Worm – a worm that enters into your body and can grow as long as 3 feet before getting bored and exiting your body in a painful and debilitating way – is among the group of helminthic NTDs and is among what I consider to be the yuckiest diseases on the planet.
The strategy to eradicate this disease is a slow but effective one – all patients infected with the worm are identified, treated, and educated in such a way so that they do not risk spreading the worm to others. The strategy works, it just takes time. Since the mid-1980s, when the Carter Center waged a war against the disease the number of people infected has fallen from a few million to a few thousand, an impressive and significant global health achievement.
Which brings me back to the question of sustainability. Guinea Worm control program, along with other NTD control programs that aim for elimination or eradication, when successful will eventually work themselves out of a job. That is the point. Some NTD programs are likely to be even more short-lived than Guinea Worm control. Therefore, it is not clear that sustainability of these programs should ever be an important goal. Not all diseases, however, share these characteristics.
Plus, some functions of NTD control, for example ongoing disease monitoring and surveillance, are likely to be needed for years after eradication or elimination are achieved and therefore these programs should be integrated into existing health system infrastructure, this is a lesson that has been learned from onchocerciasis elimination and elsewhere. But this is one example of how vertical programming, when well targeted and well implemented, can be a good thing. The NTD community is years ahead of many other disease control programs in terms of their experiences and their learning. It is great when we can learn from great successes such as this one.
For those that can stomach it, here is an excellent video from the NYTimes Science Times from a few years back, with the mandatory views of Guinea Worm extraction.
Photo credit: Vanessa Vick via the NYTimes