Skin diseases disable, stigmatize and cause suffering and mental health conditions
The first World Health Organization (WHO) global meeting on skin-related neglected tropical diseases (skin NTDs) took place on 27-31 March 2023 in Geneva, Switzerland. The week-long hybrid meeting was attended by about 300 in-person and over 1000 online attendees from 86 countries.
This historic meeting brought together experts in skin NTDs, policy-makers, health workers, national programme managers, scientists, representatives of partner organizations and research institutions, patients’ organizations, and WHO regional and country focal persons for NTDs. The objectives were to discuss the medical, socioeconomic and research aspects of the 10 NTDs with skin manifestations; review lessons learnt on the ground and in the laboratory; strengthen integrated approaches; and contribute to advancing research, prevention and clinical care for patients worldwide, thereby accelerating progress towards the 2030 road map targets.
Skin NTDs are a major public health problem
Overall, skin conditions are estimated to affect 1.8 billion people at any point in time. In tropical and resource-poor settings, skin infections, which can be of bacterial, viral, fungal or parasitic origin, are the commonest cause of disease. In most communities, skin NTDs form about 10% of skin diseases. It is therefore important that endemic countries adopt holistic, community-oriented approaches to addressing comprehensively skin NTDs and all other skin conditions as part of universal health coverage and leaving no one behind.
The participants called for greater investments in NTDs to accelerate efforts to achieve the 2030 road map targets. Of the skin NTDs, yaws is targeted for eradication, leprosy and onchocerciasis for elimination (interruption of transmission) and lymphatic filariasis (lymphoedema and hydrocele) for elimination as a public health problem. Buruli ulcer, cutaneous leishmaniasis, mycetoma, chromoblastomycosis and other deep mycoses (including sporotrichosis), post-kala-azar dermal leishmaniasis, scabies and other ectoparasitoses (including tungiasis) are targeted for control.
Integrating efforts can maximize benefits
In 2016, WHO conceived the skin NTDs approach based on their similar geographical distribution, epidemiological characteristics and social impact, and on the premise that training, community mobilization, case detection and management strategies can be integrated to optimize use of resources. In 2020, the integrated management of skin NTDs was included as an example of a strategic approach to illustrate the cross-cutting, holistic shifts advocated by the road map. In 2022, WHO published the skin NTD framework to guide countries and partners in implementing integrated public health interventions.
“Integration is not competing for resources: we should keep the specificity of diseases while improving access to service delivery through common platforms that combine similar activities,” said Dr Daniel Argaw Dagne, Head, Prevention, Treatment and Care unit, WHO Global NTD Programme.
Without early diagnosis and treatment, skin diseases can negatively impact individuals, families and communities by causing long-term disability, stigmatization and mental health conditions.
The presentations and discussions during the 5 days covered a wide range of topics and enabled participants to share best practices in implementation of integrated skin NTD activities at country level. Many programmes reported that they are still recovering from the disruptions to health services caused by COVID-19.
Skin NTDs make up half of all NTDs: they must be addressed if the road map targets are to be achieved
Participants also highlighted the need to raise the visibility of skin NTDs within the broader context of NTDs, primary health care and universal health coverage. To meet the 2030 road map targets, NTDs need to be prioritized and funded at local and global levels; they need to be integrated across sectors, for stronger, more consistent and sustainable programmatic support and funding.
“NTDs need to be recognized in the global health architecture. An investment in NTDs is an investment in many of the priority public health agendas,” said Dr Ibrahima Socé Fall, Director, WHO Global NTD Programme.
The meeting also discussed the importance of digital technologies including online courses, artificial intelligence to aid diagnosis; surveillance and mapping of co-endemicity to guide integrated interventions; integrated management of disability, rehabilitation, stigma, mental health and inclusion; and knowledge and gaps in understanding the mode of transmission of diseases such as Buruli ulcer.
Newer diagnostic tests are needed for most of these NTDs and WHO has published target product profiles (TPPs) to guide their development. On treatment, better and shorter regimens for diseases such as Buruli ulcer, cutaneous leishmaniasis, mycetoma and tungiasis are needed. Other challenges include access to ivermectin for scabies, which is one of the most common skin NTDs.
In his remarks, the WHO Director-General Dr Tedros Adhanom Ghebreyesus committed to ensuring that NTDs are better supported by WHO in terms of resources, policy and advocacy. “Count me in as one of you: NTDs are where I started. I will follow up on your asks. I don’t want the conversations you had this week to be in vain,” he stated.
Together towards 2030
Upon closing the meeting, its chair Professor Roderick Hay, King’s College London and International Foundation for Dermatology, stressed the importance of stronger country leadership, more funding and strategic advocacy: “NTDs must be considered when other critical global policies are being developed and discussed, whether around health emergency planning, universal health coverage, One Health or primary health care. Putting patient needs at the centre and training front-line health workers are absolutely critical to better care.”
The second global skin NTD meeting is scheduled for March 2025 in Geneva, Switzerland, which gives two years to advance work. Participants were encouraged to continue collaboration with each other and with WHO to keep the momentum going towards 2030.
More information about the meeting can be found here.