BRICS in the response to neglected tropical diseases

Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – are transitioning from emerging economies to leaders in geopolitical affairs. While BRICS face increasing prevalence of noncommunicable disease and injury, they also continue to be burdened by many infectious diseases, including neglected tropical diseases.

Neglected tropical diseases are endemic in all of the BRICS countries except the Russian Federation. Lymphatic filariasis is endemic in Brazil and India, soil-transmitted helminths are endemic in Brazil, China, India and South Africa, trachoma is endemic in Brazil, China and India, schistosomiasis exists in Brazil and China and onchocerciasis persists in parts of Brazil. BRICS account for more than 30% of the world’s children at risk of infection with soil-transmitted helminths.¹ India alone accounts for nearly half of the world’s population at risk of lymphatic filariasis.^2,3 The morbidity and disability caused by neglected tropical diseases – such as lymphoedema caused by filarial infection or blindness caused by trachoma – perpetuate poverty and inequality.⁴ Since these diseases prevent children from attending school and parents from working, they also decrease education, worker productivity and overall wealth.

The five BRICS countries are uniquely positioned – as a group and as individual countries – to ensure that neglected tropical diseases receive the international attention they deserve. Each of these countries is increasing its role in international cooperation. It has been estimated that BRICS provided 5.6 billion United States dollars in foreign assistance in 2010.⁵ As BRICS launch a new development bank and institutionalize dialogue between their heads of state, they will expand their influence from the regional stage to the global stage and strengthen their role as drivers of innovative cooperation.⁵

By demonstrating leadership and addressing their domestic disease burdens, Brazil, China, India and South Africa can make a substantial contribution to reducing the global burden of neglected tropical diseases. By building on their individual and collective mechanisms for shaping policy and promoting cooperation, all five of the BRICS countries can enhance the global response to neglected tropical diseases and help other countries to scale up their neglected tropical disease programmes – to reach the remaining 1.4 billion people worldwide who are at risk of developing one or more of these debilitating diseases of poverty.⁴

Global progress

Since the World Health Organization (WHO) released its neglected tropical disease roadmap in 2010, the World Bank, major pharmaceutical companies, bilateral aid agencies, endemic countries and other public and private sector organizations have increased their support for the global neglected tropical disease response. In January 2012 – in the London declaration on neglected tropical diseases – these partners pledged to increase drug donations, research and development and bilateral efforts in support of the goals set by WHO. The goals are to control or eliminate guinea worm, leprosy, lymphatic filariasis, trachoma and sleeping sickness and to control schistosomiasis, onchocerciasis, soil-transmitted helminths, Chagas disease and visceral leishmaniasis by 2020. The growing momentum to address these diseases was further demonstrated by the Sixty-sixth World Health Assembly’s adoption of a resolution that urged Member States to increase their ownership of – and financing for – neglected tropical disease programmes.

Although more than 70 endemic countries have now developed national plans to control and eliminate neglected tropical diseases and more than 700 million preventive treatments are being delivered annually, these activities are still reaching less than 40% of the global population at risk.⁴

BRICS’ engagement

Leading by example

In recent years, the four BRICS countries where neglected tropical diseases are endemic have made great strides in controlling and eliminating such diseases within their borders – by scaling up and sustaining their national neglected tropical disease programmes. Such effective national leadership should encourage other countries and advance the global neglected tropical disease response.

Brazil launched a national integrated neglected tropical disease plan in 2012. By linking this plan to Brasil sem Miséria – the national plan for poverty reduction – Brazil has institutionalized the strong links between poverty and neglected tropical diseases and helped to implement effective cross-sector approaches.

India, which accounts for more than 35% of the global neglected tropical disease burden, is already implementing the world’s largest programme against lymphatic filariasis and has contributed greatly to the research and body of knowledge on this disease. India is also using innovative models, such as integrating deworming with school health and nutrition programmes, to expand the reach of its neglected tropical disease programmes.

Given their geographical and demographic diversity and the large scale of their neglected tropical disease programmes, both Brazil and India serve as useful incubators of innovation in the fight against neglected tropical diseases. The lessons learned from their unique approaches can be applied to many other countries.

Sharing expertise

As BRICS advance their national goals, they can share their acquired knowledge and technical expertise with other endemic countries. Brazil and India are already working with their neighbours to address onchocerciasis and visceral leishmaniasis. Such collaboration not only helps reduce the problem of the transmission of communicable diseases across borders but also serves as a model for collaboration and partnership that can be applied beyond countries that share borders.

China eliminated lymphatic filariasis in 2007 and is now working towards the elimination of trachoma and schistosomiasis and sharing its expertise through a growing portfolio of bilateral cooperation. The 2013 Ministerial Forum on China–Africa Health Development identified schistosomiasis as a priority for their cooperation. A pilot project is now underway to test the feasibility of China’s approach to schistosomiasis control in the African context.⁶ China has also signed an agreement with Australia to deliver aid and address health issues together in the Asia–Pacific area.⁷

Multilateral and regional meetings that bring global decision-makers together – such as the Group of 20 (G20) Summit – could serve as useful platforms for the exchange of experiences and the sharing of expertise in the field of neglected tropical disease control. The annual BRICS’ heads of state and BRICS’ health ministers meetings – both of which will be hosted by Brazil in 2014 – are also occasions to discuss this topic.

Shaping the policy agenda

As they continue to shape their collective agenda and pursue joint cooperation projects on poverty reduction and health, BRICS can use their voices to ensure that neglected tropical diseases are included at the forefront of global development.

South Africa – the only African nation that is a member of both the G20 and BRICS – can help draw the attention of the rest of sub-Saharan Africa to the issue of neglected tropical diseases. With strong support from the WHO Regional Office for Africa, over 35 African governments have developed national neglected tropical disease plans. These plans reflect recognition of the devastating impact that neglected tropical diseases have had on economic growth and development in many areas of Africa. In 2013, at the Sixth Conference of African Union Ministers of Health, officials identified neglected tropical diseases as a top priority. As Chair of the African Union Commission, South Africa can build on these milestones and advance the regional neglected tropical disease response.

The Russian Federation has played an important role in elevating global health on the world stage, particularly by making infectious diseases a top priority of the Group of Eight (G8), for the first time, at the Saint Petersburg Summit in 2006. The Russian Federation has also provided technical assistance to help its neighbours in the Commonwealth of Independent States control leishmaniasis and other infectious diseases. In 2013, leaders of the G20 nations issued the Saint Petersburg Development Outlook Report, which renewed the G20’s commitment to economic growth as a way of reducing poverty and promoting inclusive growth. Future G20 meetings offer further opportunities for the Russian Federation to shape the G20’s approach to neglected tropical disease treatment and control.

The India–Brazil–South Africa trilateral dialogue was established as early as 2003, to encourage cooperation and support national ownership and leadership in the field of inclusive sustainable development. By building on this experience, a BRICS’ development bank and a renewed commitment to continued dialogue could be instrumental in mobilizing more resources and partners to strengthen the fight against neglected tropical diseases. Additionally, all of the BRICS countries could support the inclusion of neglected tropical diseases in national and regional discussions on the post-2015 development agenda.

Call to action

In 2013, at the fifth BRICS summit, the countries reiterated their commitment to the eradication of poverty and the promotion of sustainable, inclusive and balanced growth.⁸ BRICS’ leaders have an opportunity to pool capacity, technical expertise and financial resources to accelerate progress towards the 2020 goals for neglected tropical disease control and elimination. First, they can lead by example. Brazil, China, India and South Africa can help close the treatment gap by prioritizing neglected tropical diseases, scaling up national programmes and achieving domestic goals for control and elimination of the diseases relevant to their settings. Second, by sharing expertise – each BRICS country can help other countries tackle neglected tropical diseases, through new partnerships. Third, BRICS can shape the policy agenda, increasing political commitment, mobilizing resources and implementing policies that support neglected tropical disease control and elimination on the international level.