Sustainability
All along and for several reasons, in our project, we decided to highlight the issues and the reality of canine Visceral Leishmaniasis (VL). This decision had to do with our region's specificity regarding the disease and our personal experiences with the unwanted losses of our dear pets. In our researches, we understood that the scenery of human Leishmaniases is just as concerning as the canine one. In fact, humans are a crucial part of the disease cycle that we aim to tackle. We made sure to always bring up the human Leishmaniasis reality every time we presented BioPank or the importance of prevention.
To talk about the leishmaniases first, we must know that they "constitute among the most severely neglected tropical diseases (NTDs)" and that they're also a vector-borne disease, which means that vector transmits them. 1 "Neglected diseases and vector-borne diseases are a set of infectious diseases, that primarily affect the most vulnerable populations."2 It is also known that the presence of Leishmaniasis 3 "is directly linked to poverty, but social, environmental, and climatalogic factors directly influence the disease's epidemiology."
Knowing this, it is important to understand that, when dealing with NTDs, it's not only superficial but impossible to imagine a combat plan without considering all the affected instances. NTDs are "debilitating" and prevent poor people worldwide "from escaping poverty by impacting livelihoods such as agriculture and livestock, and affecting cognitive, developmental and education outcomes." 1 These diseases are now recognized in the Sustainable Development Goals (SDGs), which are a set of propositions (goals) that "provides a shared blueprint for peace and prosperity for people and the planet, now and into the future." 4 There are 17 of them and they are part of the 2030 agenda adopted by the United Nations in 2015.
The goal more directly related with NTDs and therefore with Leishmaniasis is goal number 3 - "Ensure healthy lives and promote well-being for all at all ages" more specifically "target 3.3 articulated as "the end of NTDs" by 2030, to be measured by "number of people requiring interventions against" these diseases." 1 Thus, "focusing on VL and other NTDs is necessary to achieving specific SDGs including the goal for universal healthcare coverage (UHC) by 2030" which can also be found in the target 3.8.5
Considering all this, we see how intrinsically connected are VL, as an integrating part of NTDs, and the SDGs. If we think bigger we get to understand that "a critical component in reducing the disease burden and averting fatalities is early detection and treatment. However, these remain a challenge notably in poor, remote, rural settings and areas with conflict, instability, climate change impacts, and population movements."1 All these dots that the authors connected with VL show us that NTDs have an extensive effect in several instances, individually or collectively. They often relate to the social, economic and geographic situation of the affected causing, just as physical bruises, like their symptoms and undesirable evolutions, as several vulnerabilities. Among them, we can cite: psychological ones, for pointing out social differences, livelihood ones, because the person affected hardly can work and therefore maintain their family and collectively ones, for the extended treatment costs and for a reflection of the personal difficulties on the community.
We crossed with the wonderful and impactful work of Bangert et al. that link all the SDGs with all of the NTDs, demonstrating how the superation of these diseases is aligned to the success of the goals. From it, we understood that there ain't no easy tasks, that a few people won't do the process and that it isn't a "one-way road". The fight for the achievement of Sustainable Development Goals is the very same as the one of surpassing the difficulties that surround Neglected Tropical Diseases.
So beyond relating VL only with the 3rd goal we also can and must relate it to other seven goals, as shown by Table 1 of the article we cited above - The sustainable development goals, the linkage between SDGs and NTDs and the NTDs referenced.
| SDG | NTD-SDG linkage | NTDS referenced |
|---|---|---|
| 1 - End poverty in all its forms everywhere. | NTDs and the medical poverty trap: Debilitating diseases cause significant economic burden to affected individuals, households and communities. Free of charge and community directed interventions in addition to preventive care can reduce this burden. | Dengue, Chikungunya, Lymphatic filariasis, onchocerciasis Leishmaniasis, Buruli Ulcer, Cysticercosis. Trachoma, Schistosomiasis |
| 2 - End hunger, achieve food security and improved nutrition and promote sustainable agriculture. | Worm infections reduces nutrient uptake in human and animal hosts while infections from other NTDs reduces ability to work. Treating the affected can improve food security and ensure healthy livestock. | STH, schistosomiasis, Chagas, Dracunaliasis, trachoma, lymphatic filariasis, onchocerciasis, HAT, dracunculiasis |
| 3 - Ensure healthy lives and promote well-being for all | NTDs affect all aspects of healthy lives. The promotion of Universal Health Coverage as part of NTD interventions ensures well-being beyond the NTDs. | All NTDs |
| 4 - Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. | NTDs can cause stigma and reduce school attendance, performance and cognitive ability. School based programs, including deworming and health education, ensure children can attend school. | Lymphatic filariasis, cutaneous leishmaniasis, STH, Schistosomiasis, |
| 5 - Achieve gender equality and empower all women and girls | NTDs disproportionally impact the health of girls and women. Community directed distribution programs and women's groups as part of drug distribution programs can empower women. | STH, Zika, Chagas, Schistosomiasis, onchocerciasis, lymphatic filariasis |
| 6 - Ensure access to water and sanitation for all. | Water and sanitation play an important role in the lifecycle of most NTDs. The joint WASH-NTD strategy aims to improve access to water and sanitation for the most disadvantaged populations. | STH, Dracunculiasis, Trachoma, Schistosomiasis, Onchocerciasis, Lymphatic filariasis, Dengue, Chikungunya |
| 7 - Ensure access to affordable, reliable, sustainable and modern energy for all | Construction of dams can serve as breeding sites while biogas material used can be infectious. Impact of dams on water tables can change vector ecology. Vector control and the disinfection of biogas material can leverage the proliferation of rural sustainable energy projects. | Schistosomiasis, Onchocerciasis, Lymphatic filariasis |
| 8 - Promote inclusive and sustainable economic growth, employment and decent work for all | NTD infections are a large burden to health care system and reduce economic productivity of the workforce. Deworming and sustained vector control ensures limited impact on health care system and a healthy workforce. | STH, lymphatic filiarisis, rabies, dengue, hookworm, schistosomiasis. |
| 9 - Build resilient infrastructure, promote sustainable industrialization and foster innovation | Interventions to the most neglected populations requires development and investment in supply chains including transport and storage infrastructure as well as clinics for distribution of donated medicines. | STH, Dracunculiasis, Trachoma, onchocerciasis, Schistosomiasis, Lymphatic filariasis |
| 10 - Reduce inequality within and among countries. | Inequalities in disease prevalence across socioeconomic groups is a hallmark of NTDs. Interventions aimed at the most disadvantaged and marginalized populations aims to reduce this inequality. | All NTDs |
| 11 - Make cities inclusive, safe, resilient and sustainable | Mosquito and other disease vectors have adapted and proliferated in urban environments. Actively removing breeding sites through community based interventions ensures cities are resilient to this threat. | Leishmaniasis, Chagas, Dengue, Chikungunya, Zika, Yellow Fever |
| 12 - Ensure sustainable consumption and production patterns | Chemicals are frequently used to combat nuisance or disease vector mosquitos. The sustainable use and management of chemicals is ensured through continued pesticide safety and efficacy evaluation. | Dengue, Chikungunya, Zika, Yellow Fever |
| 13 - Take urgent action to combat climate change and its impacts | Vector borne disease epidemics increase with changes in temperature, rainfall and relative humidity. A better understanding of the effect of climate change can be gained through modelling and surveillance of the interaction between NTDs and climate. | Dengue, Chikungunya, Zika, Yellow Fever, schistosomiasis, lymphatic filariasis |
| 14 - Conserve and sustainably use the oceans, seas and marine resources | Clean water bodies are important to maintain food security and good sanitation. NTD interventions can address contaminated water through treatment programs and by providing educational service to affected communities. | Trematodes |
| 15 - Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss | Deforestation leads to the proliferation of vector borne disease affecting people who work or live at interface with forest. Active vector control and providing educational service to affected communities can mitigate the impact of disease vector proliferation. | Dengue, Chikungunya, Zika, Yellow Fever, cutaneous leishmaniasis, loiasis, |
| 16 - Promote just, peaceful and inclusive societies | NTD disease epidemics frequently occur during times of war and crisis. Advocating for interventions to affected populations in times of crisis can be used as a tool to promote peace. | Dracunculiasis, leishmaniasis |
| 17 - Revitalize the global partnership for sustainable development | Public-private partnerships for NTD interventions have been key and effective. Experience gained from working with these partnerships can be used to build on partnerships for other SDG themes. | All NTDs |
Another exciting thing about this paper is that they highlight that "In many ways ending NTDs exemplify the potential of public-private partnership and domestic financing." We believe that BioPank represented, on a minor scale, this potential. A team of young scientists, engaged with the community, that carried out a project applying frontier science to the prevention of an NTD with the support of public and private institutions.
Beyond the SDGs, what else did we thought?
Our choice to use synthetic biology to optimise the paratransgenesis technique was based on the underlying possibility of keeping the Leishmania vector alive. This choice came from us considering the importance of the ecological relations surrounding the sand fly and the diminishing impact that implementing our solution could cause.
"Now you know."
The February 30th marks the World Neglected Tropical Disease Day, and you can learn more about it on the official website: https://worldntdday.org/
Citations
https://www.e-jghs.org/DOIx.php?id=10.35500/jghs.2020.2.e3 - Wamai RG, Kahn J, McGloin J, Ziaggi G. Visceral leishmaniasis: a global overview. J Glob Health Sci. 2020 Jun;2(1):e3. https://doi.org/10.35500/jghs.2020.2.e3
https://www.paho.org/en/topics/neglected-tropical-and-vector-borne-diseases
https://www.who.int/health-topics/universal-health-coverage#tab=tab_1
Bangert, M., Molyneux, D.H., Lindsay, S.W. et al. The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals. Infect Dis Poverty 6, 73 (2017). https://doi.org/10.1186/s40249-017-0288-0