India made significant gains with many NTDs, challenges remain: Experts

New Delhi, Feb 12: India has made significant gains with many neglected tropical diseases (NTDs) like leprosy, lymphatic filariasis and visceral leishmaniasis, but challenges still remain, health experts said here on Monday.

Neglected tropical diseases (NTDs) are a diverse group of conditions caused by a variety of pathogens (including viruses, bacteria, parasites, fungi and toxins) and associated with devastating health, social and economic consequences.

The diseases are called ‘neglected’ because they are almost absent from the global health agenda; in addition, are associated with stigma and social exclusion. They are mainly prevalent among impoverished communities in tropical areas, although some have a much larger geographical distribution.

NTDs affect an estimated more than 1 billion people, but India has the highest number of cases for each of the major neglected tropical diseases (NTDs) in the world.

Yet, “India has done very well in eliminating many diseases,” Dr N K Ganguly, Former Director General, ICMR, told IANS.

“In 2005, it brought leprosy below the levels of being a public health problem, it was also the first from all the tropical countries to eradicate guinea worm in the year 2000, we have also managed to bring down infective trachoma to a negligible new number, and Yaws, which was prevalent largely in tribal areas has also been eliminated.

“We have also made significant gains with many other diseases like Lymphatic Filariasis and Visceral Leishmaniasis from 2000 to now. India has not performed poorly at all, but when you look at the numbers, they will always appear high due to the large population, almost comparable to China,” Ganguly said.

According to recent data from the National Centre for Vector-Borne Diseases Control (NCVBDC), India has seen a decline in major vector-borne diseases like lymphatic filariasis (elephantiasis, haathipaon), leishmaniasis (kala-azar), dengue and chikungunya in the last two years.

Leishmaniasis cases declined from 1,276 in 2021 to 520 in 2023 (till September). Similarly, chikungunya cases dropped from 11,890 in 2021 to 3,711 in 2023 (till September), while dengue cases fell to 94,198 in 2023 from 193,245 in 2021, the data showed.

Dr. K Madan Gopal, Advisor, Ex Senior Health Consultant at NITI Aayog told IANS that “NTDs are not just medical conditions; they are a reflection of societal and economic challenges, in fact these are priority diseases for elimination for India”.

“In the case of Lymphatic Filariasis, often known as elephantiasis, India accounts for about 40 per cent of the global burden. It's a staggering figure, affecting numerous lives across 336 districts in 20 States and Union Territories.

“Our goal is ambitious yet critical -- to eliminate Lymphatic Filariasis by 2027, advancing the global target by three years,” Dr. Gopal said.

Further, Visceral Leishmaniasis remains a formidable challenge, with India comprising 18 per cent of the global burden as of 2020.

“Despite this, we've seen remarkable progress in 632 blocks in endemic regions across states like Bihar, Uttar Pradesh, Jharkhand, and West Bengal, now reporting less than one case per 10,000 people. This success is a testament to the dedication of our health workers and volunteers, who provide a range of services from prevention to rehabilitation, backed by an efficient case referral system,” Gopal said.

Ganguly said that the major hurdles for India in the elimination of NTDs include the need for a structure capable of addressing SDG elements in the elimination programme; India's federal structure poses challenges in coordinating across states effectively, as health is a state subject; urbanisation and environmental degradation are additional challenges.

Vector densities increase due to climate change, spreading diseases to new areas. Other challenges include providing diagnostics and drugs to all states at a given time, coordinating efforts across various ministries, encouraging innovation, and ensuring research aligns with control programmes, the expert said.

Using GIS and other tools effectively, along with the strategic use of the best kinds of pyrethroids and combinations, is essential.

“India has taken significant steps to address major NTDs through dedicated programmes, be it for leprosy or the elimination of filariasis or Kala azar. The number of cases across all have come down significantly. There are national days for NTDs and dedicated days like National Filaria day also exist,” Ganguly said.

He called for innovations in surveillance, including using newer tools for dealing with vectors like better traps and sugar baits, etc; test systems to diagnose many diseases like LF, malaria, dengue in the vector together; diagnostic tools like urine tests and isothermal PCR LAMP tests for early detection of diseases. Innovations in diagnostics for dengue include kits and PCR tests made in India.

“The challenge is to create a global market commitment and maintain a stockpile for emergencies,” Ganguly said.

“Our journey against NTDs is far from over. It calls for sustained efforts, increased awareness, and stronger international cooperation. Together, we can turn the tide against these diseases, improving countless lives and strengthening our health systems for a healthier future,” Gopal noted.