International Conference on Innovations for the Elimination and Control of Visceral Leishmaniasis

28 November 2018, New Delhi, India

Hon’ble Vice Chancellor, Professor Dr Seyed Ehtesham Hasnain; Professor N K Ganguly, scientists, colleagues, ladies and gentlemen,

A very good morning to you.

It is a privilege to address you today. I am particularly inspired by this conference’s billing: walking the last mile of visceral leishmaniasis elimination.

As many of you know, since 2014 eliminating key neglected tropical diseases has been one of WHO South-East Asia Region’s Flagship Priorities.

We have achieved significant Region-wide success, making strong gains against yaws, lymphatic filariasis and leprosy among other NTDs.

We must do the same for visceral leishmaniasis, or kala-azar, which is precisely why we are gathered today.

Kala-azar continues to be reported from five of the Region’s countries – Bangladesh, India, Nepal, Bhutan, and Thailand. The first three of these countries have some of the highest burdens globally. Sri Lanka is meanwhile endemic for cutaneous leishmaniasis while reporting sporadic cases of kala-azar, though very rarely.

Despite kala-azar’s ongoing burden, we have made significant progress. In our quest to eliminate the disease, we now face last-mile challenges. Overcoming those challenges requires our joint commitment, as well as our collective wisdom.

On the first point, I am pleased to note that all five kala-azar affected countries have committed to eliminating the disease and signed a memorandum of understanding for collaboration to do so.

On the second point, I recognize and commend recent progress, with all countries having brought case incidence down, partly by applying a single dose of Ambisome, which WHO provides free of cost.

For the first time ever, our Region is no longer reporting the highest number of cases globally. But as is often the case, last-mile challenges are the most complex and difficult to overcome.

Nepal provides a salient example. To their immense credit, Nepal’s health authorities reached the elimination target for kala-azar in all endemic areas and sustained it for three consecutive years.

Nevertheless, in 2018 case incidence climbed above the elimination threshold, posing additional challenges to the national programme. The fact that the cases were recorded in a previously non-endemic district was indeed remarkable, reflecting the disease’s ever-changing epidemiology and dynamics of transmission.

Examples like Nepal require us to rethink the strategies we employ and reassess the programmatic reach we have using current tools. Importantly, they also require us to expand surveillance beyond areas known to be endemic.

As WHO has emphasized for many years now, the most important means to overcome last-mile challenges is building country capacity and strengthening national programmes.

That means, first: rolling out a standardized service delivery package. Active case detection should be carried out on a quarterly basis in all category 1 villages and should include house-to-house screening, while RK39 tests should be applied as and where needed. Contact tracing should be carried out where positive results are delivered, and indoor residual spraying should be performed as a matter of priority in villages reporting cases, including within 48 hours of a confirmed case.

Second, national programmes must have one authority and one division of labor, with all stakeholders working towards the same goal: kalazar’s elimination. Too often we see the duplication of activities, demonstrating the need for greater leadership by national authorities and greater cooperation by non-government organizations. By establishing clear roles and responsibilities, the resources at our disposal will be magnified many times over, thereby allowing us to achieve the elimination target.

Third, all programmes should ensure there is just one monitoring and evaluation system that collects, analyzes and presents data on a common platform, accessible to all partners. This should be linked to action at the local level, where problems and bottlenecks identified through the M&E system are collectively discussed, enabling corrective measures to be taken. In addition, a situation room should be identified at the national level that oversees all aspects of implementation and ensures quality services are delivered on the ground, where they matter most.

Distinguished participants, colleagues,

Alongside these key imperatives, I take this opportunity to emphasize the need for ongoing research and innovation, both in terms of the policies and technologies adopted.

This is especially important given kala-azar’s changing epidemiology, as I have already outlined. But it also crucial in terms of the effectiveness of the drugs used to treat the disease, the tests applied to diagnose it, and the role of asymptomatic infections in the disease’s transmission. Similarly, the possibility of developing a prophylactic vaccine against kala-azar should be of immense interest to us all.

It is indeed inspiring to know you will be focusing specifically on innovation in coming discussions, and I very much look forward to hearing of the conclusions you reach.

I have no doubt that by implementing the key interventions mentioned, as well as harnessing the full power of innovation, together we can make kala-azar history and achieve the regional target of finishing off all key NTDs by 2020.

Together we can show the world that leaving no one behind is more than a mantra: that it is an imperative we can – and must – achieve.

I wish you an engaging and informative conference.

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