In a region where war, displacement, and weak health systems fuel a deadly disease, nine African governments are trying a new approach: eliminate visceral leishmaniasis by working together.

As neglected tropical diseases (NTDs) continue to strain underfunded health systems across Africa, a regional political coalition has formalised its intent to eliminate visceral leishmaniasis (VL) through cross-border collaboration.

Six countries – Chad, Djibouti, Ethiopia, Somalia, South Sudan, and Sudan – signed a Memorandum of Understanding (MoU) during a World Health Assembly side event, outlining a joint strategy for surveillance, treatment, and disease control across borders.

The initiative aligns with WHO’s 2021–2030 NTD roadmap and the regional visceral leishmaniasis elimination framework launched in June 2024.

“This is more than a health initiative. It is a movement for social justice, equity and development,” said Dr Ibrahima Socé Fall, Director of the Global NTD Programme at the World Health Organization, who delivered remarks on behalf of WHO Director-General Dr Tedros Adhanom Ghebreyesus.

But while ministerial signatures and declarations signal a shift in political will, national officials said frameworks alone will not fill treatment gaps, rebuild surveillance in conflict-affected regions, or overcome decades of structural neglect.

Visceral leishmaniasis is endemic to much of Eastern Africa, where outbreaks have historically defied borders, and weak infrastructure has complicated responses. The disease has killed over 200,000 people in the region in the past 40 years, and about 74 million remain at risk, according to Ethiopia’s health ministry.

Sudan, currently affected by one of the world’s most severe humanitarian crises, illustrates the fragility of progress. Displacement, vector breeding in camps, and disrupted supply chains are driving a surge in untreated cases amid the raging civil war.

“Today, only 21 of 44 diagnostic and treatment centres are functioning across seven states,” said a Sudanese representative.

The country’s health officials are now prioritising adaptive, conflict-aware strategies, including mobile teams and decentralised logistics, but warned that regional gains could unravel without sustained support.

Nigeria, while not among the signatories, voiced its intent to establish a similar MoU with neighbours. With 67 border-region local government areas, officials described cross-border VL transmission as a pressing risk.

“The cost of care is steep, and we bear 25% of the global NTD burden,” said a representative on behalf of Nigeria’s Coordinating Minister of Health. “We cannot address this in isolation.”

Tanzania echoed the call for accountability. “We must hold each other accountable, track progress, and adapt strategies,” said its health minister. “There is no more time for words, but we still have time for action.”

Beyond coordination, speakers drew attention to persistent barriers: limited domestic financing, weak integration into primary care, and outdated tools.

DNDi’s CEO, Dr Luis Pizarro, described current VL treatments as “toxic, painful, and costly,” particularly for rural populations, emphasising that research and development must no longer be viewed as a luxury.

“It is not acceptable in 2025 to rely on outdated treatments,” Pizarro said.

The Africa CDC urged states to rethink the framing of NTDs. “These are not neglected diseases—they are priority diseases,” said the representative of Dr. Jean Kaseya, Director General, Africa CDC, citing the need to embed NTD strategies in health security planning and push for domestic investment despite fiscal constraints.

The meeting closed with ministers endorsing a call to action that commits signatory countries to concrete steps in eliminating VL, including shared data systems, joint planning, and community-based delivery.