Besides being difficult to spell, NTDs are have a huge impact on people’s lives; they wreak havoc on health, education, income potential, especially affecting the poorest of the poor. Imagine trying to concentrate in school as your eyelids grow inward due to trachoma, the leading cause of preventable blindness in the world, spread in large part due to poor waste management and sanitation. Or, imagine that because you weren’t wearing shoes in contaminated soil or entered dirty water to wash, worms that carry diseases entered your body, laying thousands of eggs in your intestines? Trachomaand worms are only a few of the NTDs, which together impact 1.4 billion people globally, 800 million of whom are children.
NTD burden is measured in disability-adjusted life years (DALYs), or one year of healthy life lost. NTDs account for approximately 57 million DALYs annually. This ranks just behind HIV/AIDS, and higher than DALYs for malaria and tuberculosis. Children and adults become infected with NTDs by doing everyday activities, such as playing, bathing, growing crops, or washing clothes with contaminated water—often the same water they must drink because they have no other option. When latrines are ignored, they can overflow into streets and streams. This creates perfect breeding grounds for worms or flies that carry a variety of diseases. And different NTDs often coexist, because the impoverished and neglected conditions that breed one often breed others, as well. This means that without comprehensive efforts at preventing all the NTDs in a given place, a child might be treated for worms at school and on the way home get trachoma from a fly breeding on nearby human waste. One critical element of a comprehensive approach to NTDs is safe drinking water, sanitation and hygiene (WASH), which could limit or prevent the spread of many NTDs.
The 2012 London Declaration on NTDs launched a coordinated effort among NGOs (including WaterAid), pharmaceutical companies, and governments, for innovative responses to eliminate NTDs. Pfizer, for example, aims to walk this talk by creating incentives for WASH interventions to prevent trachoma, per the World Health Organization’s SAFE, (Surgery of the lids, Antibiotics, Face cleanliness, and Environmental improvement) Strategy in order for communities to receive donated drugs that stop the worst impacts of the disease. This recognition that WASH and NTDs go hand in hand is critical for the world’s poorest to benefit most. But, it will only work if we do it together.
NTDs are a reflection of underlying social, economic and gender inequities. So is lack of access to WASH. Where sanitation and water are neglected, such as urban slums or rural communities, it is likely you will find NTDs. In turn, where NTDs are prevalent, it is likely that hygiene and good waste management have not been prioritized. With a holistic approach, we can collectively target the roots of NTDs. Overcoming the neglect of WASH services is crucial to stopping the transmission of NTDs.
USAID has committed to combating NTDs and to expanding access to WASH to better fight disease and promote well-being. However, without a requirement that the two be intentionally linked where WASH poverty and NTD burdens coincide, and without ensuring these integrated programs are sustainable, long-term, and monitored and evaluated to ensure efficacy, these separate commitments to action may yield insufficient change.
Since 2005, when the Senator Paul Simon Water for the Poor Act became law, WaterAid has been anxiously awaiting a comprehensive water strategy from USAID, which should promote integration of WASH across other sectors with which WASH is mutually dependent for success. With a meaningful commitment and a very smart approach to making the most of WASH as a benefit to health, education, poverty reduction and gender equality—and vice versa—the double burden of WASH poverty and NTDs can be lifted. The ripple effects could be phenomenal.
With 2.5 billion people living without sanitation, nearly 800 million living without safe drinking water, and 1.4 billion living with NTDs, the impact of this intersecting neglect is staggering. But it is also an opportunity. With such clear connection between these issues, and such a clearly disproportionate impact on the world’s most marginalized and vulnerable people, the opportunity for leadership is immense. It’s time for all of us to put the pieces together, and end NTDs once and for all.