The Policy Forum highlighted the critical challenges and acknowledges that not all countries will be able to achieve the goals set out in the 2020 Roadmap. The recommendations highlighted the critical issues to accelerate progress towards those 2020 goals and surfaced considerations towards the post-2020 strategies. However, since STH control is a long term proposition and achieving elimination of STH as a public health problem requires the WASH and other economic and infrastructure development, there is a likely need for protracted interventions over the next years and maybe even decades. The technical and operational recommendations are poignant. However, the article did not address the fundamental issue of sustainability through access to medicines and health systems strengthening.
In the 4th Report on NTDs, the WHO acknowledges that the progress in controlling and eliminating the preventive chemotherapy diseases would not be possible without the generous donations from the pharmaceutical companies. About 500 million treatments of albendazole and mebendazole are projected to be donated by GSK and Johnson & Johnson, respectively, in 2019 (https://www.who.int/negle...). This is about 60% of what is required to cover the almost 850 million SAC that needs treatment (http://apps.who.int/iris/...). The policy forum notes that in addition to SACs, recent data suggest a need to treat other risk groups if effective control and elimination of transmission is to be achieved. This further increases the demand for medicines to achieve adequate coverage. What are the considerations and recommendations for securing the more than 1 billion treatments over the next decade or more?
The global health community applauds and appreciates the donation of medicines that have had such profound impact on these diseases of neglected populations around the world. However, it must be acknowledged that the world cannot and should not depend on donations in perpetuity as a global health solution. All forms of development aid and assistance are built on a foundation of driving recipient countries towards reducing dependency on assistance and achieving self-sufficiency. The donation of medicines for controlling STH or other NTDs should not be any different. Improving access to affordable and efficacious medicines through health systems strengthening must be part of the conversation and key to the post-2020 STH strategy. It is the perfect time to have this conversation and develop strategies that can be wrapped around the SDGs. Specifically, SDG #3 on access and health systems and SDG #9 on innovation and development for the next generation of medicines to mitigate resistance and improve efficacy against all species of STH.
The donations have been invaluable to catalyze programs in the endemic countries. But in the long run, R&D pharmaceutical companies should be strategically poised to respond to emerging health threats and priorities and not be depended upon to continue expending valuable resources to supply medicines that are available through generic manufacturers. Building up the capacity and capability of the generic manufacturers are also a critical component of economic development and global health security.