WHO framework to eliminate visceral leishmaniasis (VL), a deadly disease most prominent in East Africa, was launched Thursday.

It can play an important role in eliminating VL as a public health problem by 2030: a goal key countries of the East African region committed to in last year’s Nairobi Declaration.

“The VL elimination framework will offer important direction to countries in the region and provide momentum to reach the finish line of elimination,” said Dr Dereje Duguma, the Health Minister of Ethiopia, a co-host of the launch.

“The Government of Ethiopia remains committed to working with partners to develop programs at all levels, from national to community, to expand access to healthcare and achieve the targets of elimination by 2030.”

Visceral leishmaniasis, or kala-azar, is a deadly parasitic disease causing fever, weight loss, spleen and liver enlargement, transmitted by the bite of infected female sandflies. Lethal if left untreated, the disease is endemic in 80 countries worldwide, with 73% of the estimated 50,000 to 90,000 cases annually occurring in the Eastern African region in 2022, according to the WHO. Children under 15 account for half of the infections.

Malnutrition, but also poor sanitary and housing conditions increase the risk of leishmaniasis infection. Sandflies, which transmit the disease, often live next to crowded buildings or spaces with open sewages or bad waste management. VL outbreaks are also frequent when many people without immunity to the parasite migrate to areas where it is endemic or with environmental changes, such as deforestation, building of dams, but also climate change.

Successful elimination thanks to framework

A good implementation of a regional Strategic Framework for VL led to a total elimination of the disease in Bangladesh in 2023 – becoming the first country worldwide to achieve the status – and a significant reduction of cases in the region. Eastern Africa wants to follow a similar path.

Between 2004 and 2008, Bangladesh, India and Nepal accounted for 70% of global visceral leishmaniasis cases. The regional framework adopted in 2005, paired with sustained stakeholder support and a political will for an accelerated program implementation contributed to a successful case reduction.

The combined number of cases for the three countries decreased almost forty times, from 39,809 in 2005 to only 1,074 in 2022, according to WHO data.

Nairobi Declaration commitments

Representatives of eight East African countries pledged to follow the path to VL elimination, signing the Nairobi Declaration in 2023. The ministries of health of Chad, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan, and Uganda, along with key stakeholders in the region set the goal of significantly curbing VL cases by 2030. Djibouti has also signed the declaration and co-hosted the WHO elimination framework launch last Thursday.

The framework, developed in partnership with the Drugs for Neglected Diseases initiative (DNDi) and Ministries of Health across the region, outlines five main strategies for VL elimination: early diagnosis and treatment, vector management, surveillance, social mobilisation, and operational research.

It also features a step-by-step guide through elimination phases as well as sets regional and country targets, such as a 90% reduction in VL burden in Eastern Africa by 2030, decreasing the number of cases to 1,500 annually.

“By providing countries with tailored tools and strategies, we are laying a strong foundation for sustained progress in the fight against this neglected tropical disease,” said Dr Saurabh Jain, WHO’s Focal Point for VL.

Image Credits: WHO.