Modelling the impact of COVID-19 on NTD programmes
We were really delighted – this week – to host the second webinar in partnership with the NTD Modelling Consortium, part of the Big Data Institute at the University of Oxford.
We started working in partnership with Professor Deirdre Hollingsworth, Lead of the Consortium, and Andreia Vasconcelos late in 2020 as part of their development of a special issue of our journal, Transactions. The issue entitled, Modelling the Potential Impact of Covid-19 Related Programme Interruptions on Seven Neglected Tropical Diseases, was launched in March 2021 and we had our first webinar in December 2020 to further discuss some of the points raised in the articles from that issue.
The second webinar gave us an opportunity to see how COVID-19 has continued to affect NTD programmes across Africa.
Group of experts
We welcomed a group of experts to the webinar chaired by Professor Hollingsworth. These included:
- Pauline Mwinzi, Technical Officer, SCH/STH, Expanded Special Project for Elimination of Neglected Tropical Diseases, WHO Regional Office for Africa
- Fikre Seife, National NTD Program team leader, FMOH , disease prevention and control directorate, Ethiopia
- Sultani Hadley Matendechero, Head, Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Kenya
The webinar gave our experts the chance to share their experiences of the effects of COVID-19 past and present, the role of modelling in NTD programmes and what the future may look like for NTD programmes with COVID-19 as our context.
Impact of the pandemic
We started off by trying to unpack the views of the panel on the impact of the pandemic on NTD programmes.
The panel talked about the challenges of the initial intense period in which attention was taken away from NTDs programmes and put towards COVID-19 and managing this new pandemic.
Some of the initial and direct impacts included medical staff and community health workers being redeployed to emergency response, some getting ill from the disease themselves and needing to quarantine, as well as others having to take time off work to care for loved ones who contracted the virus.
As Dr Sultani said: “we started by throwing everything at COVID as we didn’t know what we were dealing with.”
The speakers talked about how NTD programme activities needed to stop following the initial WHO guidance as they involved travelling to communities for treatment, surveillance or community support. Alongside travel restrictions were equipment movements which in the case of mass drug administration programmes led to large amounts of unused drugs being stuck in warehouses.
Dr Mwinzi talked about the results of an early survey on the impact of COVID-19 which showed that MDA and morbidity management activities were the most affected, followed by surveillance. However, she went on to talk about how, by later in the year, a large number of countries had started to resume NTD programme activities.
Dr Fikre spoke about districts having missed rounds of MDA and that, although they are getting back on track, they haven’t caught up yet. He stated that procurement of PPE was difficult and had cost implications.
There were, however, gains mentioned particularly in healthcare infrastructure and preparedness for health emergencies, which have been used to improve NTD activities.
One of the panellists stated that public health awareness of areas such as WASH has also increased which is useful for NTD programmes and laboratory capacities have also increased.
Watch the webinar here
Ongoing issues
The panellists talked about how, now many NTD programmes have bounced back, it is important to focus back on NTD elimination and consider specific strategies for vulnerable groups, e.g., children.
In Ethiopia, the interruption of MDAs is a big factor in achieving elimination goals, this is due to COVID-19 but also ongoing insecurity.
Also mentioned was the importance now of focusing on joint coordination with cross-cutting areas such as WASH, which is crucial for most NTDs.
Role of modelling
Dr Sultani mentioned that modelling can be used to look at mapping baseline assessments to know where we need to focus interventions. The alternative at the moment is conducting epidemiological surveys which are expensive, and don’t always translate accurately into existence of disease at community visits.
In Kenya, they use a strategy called “breaking transmission” which is aiming for elimination of STH and schistosomiasis. To deliver this they focus on two strategies outside of MDA – working with the WASH sector and mainstreaming behaviour change. Modelling will help understand the best mix of these three interventions.
The MDA approaches have been focused on two models up to now – house to house delivery and then school based delivery. Now the approach is a fixed point delivery which can target multiple age groups. Modelling will help understand the best ways to approach this and plan activities accurately.
He said: “we want to explore the opportunities modelling can help provide to improve our NTD programmes.”
Dr Fikre agreed, saying: “it’s all about having accurate data in specific districts. So it's good to use modelling technology.”
Dr Mwinzi commented: “we need to focus on how modelling can help health strengthening and the importance of adapting modelling to specific country priorities.”
The Chair agreed stating that malaria programmes have been through this stage of pushing towards elimination and used modelling for the next step, NTD programmes are now getting to this stage and there may be learnings for us.
Resistance
From these points, we moved to discuss the need for innovation in dealing with issues around data. We also mentioned that the NTD community needs to start focusing on elimination before donor and community fatigue kick in.
This led to some discussion around resistance. It was acknowledged that if MDA continues, we are likely to see drug resistance. Modelling could help establish finite limits for current working and therefore help establish new ways of working.
Dr Sultani said: “Moving forwards, there will be a huge demand for modelling as a way to address not just data management and surveillance, but all aspects of programmes focused on disease elimination and control.”
Funding cuts
There were many strong opinions on funding cuts.
“The cuts have made clear that international donors do not prioritise NTDs” and "this could be taken as wake up call to countries to work in a different way" among them. To plan, finance and implement programmes incrementally and show impact as they go, using modelling to do so.
Dr Mwinzi said: “countries need to be fully in charge of activities. We need to revise what support needs to be and programmes need to be able to stand on their own in terms of planning and delivery.”
Final messages and questions
We are so grateful to our speakers and those who took part in the webinar who made the discussion so rich and interesting.
We were left with some thoughts and questions as to how our role in this area of work.
We would like to explore the role of modelling in tracking resistance, as has been done with AMR previously.
It is clear there was great support for modelling as a tool for helping some programmes to potentially be more targeted. We would like to look more in depth at whether modelling is an accessible tool for countries and communities.
