Infection Medicine, Edinburgh Medical School: Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, 1 George Square, Edinburgh, EH8 9TB, Scotland, UK.
Zhejiang University - University of Edinburgh Institute: Biomedicine, Zhejiang University School of Medicine, 718 East Haizhou Road, Haining, 314400, People's Republic of China.
Infect Dis Poverty. 2024 Jul 29;13(1):55. doi: 10.1186/s40249-024-01223-2.
BACKGROUND: This study investigates the impact of the COVID-19 pandemic on the prevalence, management, and control of the neglected tropical diseases (NTDs) highlighting the current or prospective impact of COVID-19 on research and development funding for, and execution of, NTD programmes. This review was conducted to determine if, and how, NTDs were affected by COVID-19, and whether those effects will delay the elimination goals of the Sustainable Development goals. METHODS: Using open-source available data from policy and documentation from official websites of the relevant stakeholders including but not limited to World Health Organization (WHO) documents and policies, government foreign aid documents, and the Policy Cures G-Finder reports, this scoping review explored ongoing challenges to supporting research and development (R&D) for the NTDs and in maintaining NTD control programs; examined the constraints posed for NTD management by the pandemic from disruptions to healthcare services, reduction of finance and explored the potential long-term implications and consequences for those poorer, neglected populations in low and middle income-countries (LMICs). This was done by a scoping review literature search, publications were subject to an initial practical screening step to ensure the most relevant publications were selected for full screening, with the focus on scoping the designated topic of the impact of COVID-19 on NTDs. We further undertook an evaluation of the socio-economic factors exacerbating the impact of COVID-19 on NTD burden. RESULTS: Multiple disruptions and setbacks, likely to affect NTD programmes and progress towards their elimination targets were identified in this study. R&D funding for the NTDs and AIDs and TB has declined since the funding high point of 2019, and for malaria since the high point of 2018. Significant changes in allocation of R&D funding within the NTDs are observed post pandemic, likely because of prioritization among donors. Diseases for which the least R&D investment was reported in place, prior to the pandemic (mycetoma, taeniasis/cysticercosis, trachoma and Buruli ulcer) have been particularly impacted post pandemic. We identified specific NTDs including schistosomiasis, leprosy, and rabies that have been affected by the COVID-19 pandemic and disruptions caused to on ongoing NTD control and elimination programs. Pandemic restrictions disrupted essential medical supply manufacturing and distribution impacting immunization programs and hindered efforts to control the spread of infectious diseases. NTD programmes have experienced numerous setbacks including delays in mass drug administration programs (e.g. for schistosomiasis), cancelled or delayed vaccination programs (e.g. for rabies) and closure of testing facilities has resulted in reduced diagnosis, treatment, and disease elimination for all NTDs. Lockdowns and clinic closures causing disruption to essential healthcare services restricted NTD surveillance and treatment programs. Community fears around contracting COVID-19 exacerbated the constraints to service delivery. Disparities in global vaccine distribution have widened with LMICs facing limited access to vaccines and disruption to immunization programs. Finally, the pandemic has led to increased poverty with poor and marginalized communities, impacting nutrition, healthcare access and education all of which have long term implications for NTD management and control. CONCLUSIONS: The COVID-19 pandemic profoundly impacted global health research and global health equity. Attention and funding were diverted from all sectors, significantly affecting research and development efforts set out in the World Health Organization's NTD elimination Roadmaps. Ongoing changes to funding, economic crises, logistics and supply chain disruptions as well as deepening poverty has put a strain on already weak healthcare systems and exacerbated LMIC healthcare challenges. In particular, the delays and constraints to NTD management and elimination programs will have long-reaching consequences highlighting the need for global cooperation and renewed investment to put the NTD roadmap back on track. Targets and milestones are unlikely to be met without significant investment for recovery, in place.
背景:本研究调查了 COVID-19 大流行对被忽视的热带病(NTD)的流行、管理和控制的影响,重点关注 COVID-19 对 NTD 研究与开发资金的当前或预期影响,以及对 NTD 规划的执行情况。 进行这项审查是为了确定 NTD 是否受到 COVID-19 的影响,以及这些影响是否会延迟可持续发展目标的消除目标。
方法:使用来自相关利益攸关方官方网站的政策和文件中的公开可用数据,包括但不限于世界卫生组织(WHO)文件和政策、政府外国援助文件以及政策治愈 G-Finder 报告,本范围界定审查探讨了支持 NTD 研究与开发(R&D)和维持 NTD 控制规划所面临的持续挑战;检查了大流行对医疗服务中断、资金减少的 NTD 管理带来的限制,并探讨了这些限制对那些较贫穷的、被忽视的中低收入国家(LMICs)人口的潜在长期影响和后果。这是通过范围界定文献检索来完成的,出版物经过初步实际筛选步骤,以确保选择最相关的出版物进行全面筛选,重点是确定 COVID-19 对 NTD 影响的指定主题。我们还进一步评估了加剧 COVID-19 对 NTD 负担影响的社会经济因素。
结果:本研究确定了多个可能影响 NTD 规划和消除目标进展的中断和挫折。自 2019 年资金高峰以来,NTD 和艾滋病及结核病的 R&D 资金减少,自 2018 年疟疾资金高峰以来减少。大流行后,NTD 内部的 R&D 资金分配发生了重大变化,可能是因为捐助者之间的优先排序。在大流行之前,报告的 R&D 投资最少的疾病(足菌肿、带绦虫病/囊尾蚴病、沙眼和布鲁里溃疡)在大流行后受到的影响尤其大。我们确定了一些特定的 NTD,包括血吸虫病、麻风病和狂犬病,它们受到了 COVID-19 大流行和正在进行的 NTD 控制和消除规划中断的影响。大流行限制扰乱了基本医疗用品的制造和分销,影响了免疫规划,并阻碍了控制传染病传播的努力。NTD 规划遇到了许多挫折,包括大规模药物管理方案的延迟(例如,用于血吸虫病)、取消或延迟疫苗接种方案(例如,用于狂犬病)以及检测设施的关闭导致所有 NTD 的诊断、治疗和消除减少。封锁和诊所关闭导致基本医疗服务中断,限制了 NTD 监测和治疗规划。人们对感染 COVID-19 的担忧加剧了服务提供的限制。全球疫苗分配的不平等现象加剧,中低收入国家获得疫苗的机会有限,免疫规划受到干扰。最后,大流行导致贫困加剧,贫困和边缘社区受到影响,这对 NTD 管理和控制产生了长期影响。
结论:COVID-19 大流行深刻影响了全球卫生研究和全球卫生公平。关注和资金从所有部门转移,对世界卫生组织 NTD 消除路线图中规定的研究和发展工作产生了重大影响。正在进行的资金、经济危机、物流和供应链中断以及贫困加剧,给已经脆弱的医疗体系带来了压力,并加剧了中低收入国家的医疗挑战。特别是,NTD 管理和消除规划的延迟和限制将产生深远的后果,突出了全球合作和重新投资以恢复 NTD 路线图的必要性。如果没有重大的恢复投资,目标和里程碑不太可能实现。
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