Aiming to eliminate Lymphatic Filariasis —a vector-borne disease caused by mosquitoes—by 2027, three years ahead of the global target, India has chalked out a five-pronged endgame strategy including multi-drug administration (MDA) in a mission mode, an early diagnosis, and treatment; engagement of medical colleges for strengthening morbidity management and disability services among others.
Though India’s National Health Policy 2002 had set a goal to eliminate LF as a public health problem by 2015, it had to be later extended to 2017. Again, the goal set by the Global Program to Eliminate Lymphatic Filariasis was to eliminate LF by 2020. The target has been subsequently revised to 2030. While national goals across endemic countries have aligned to meet that target, India has taken the challenge head-on, keeping the elimination goal at 2027.
In keeping with this commitment, the Union Health Ministry shared its five-pronged strategy to tackle the disease at the ‘National Symposium on India's Roadmap to Eliminate Lymphatic Filariasis’ held here which was inaugurated by Union Health Minister Mansukh Mandaviya.
He said, “Lymphatic filariasis is not a neglected disease for India as may be the case in some other countries but is a priority for elimination in a time-bound manner.” To begin with, the Government will kick off the pan-India MDA Campaign in mission mode on February 10 this year and August 10. The campaign envisages triple drug therapy (IDA) that administers a single dose of three anti-filarial drugs: Ivermectin, Diethylcarbamazine and Albendazole.
The Ministry will observe these days with necessary mass visibility campaigns at the national, state, district, sub-district, and block levels to ensure that no one is left behind when it comes to accessing LF-preventing drugs.
Mandaviya called for the "right synergy of governmental action and societal improvement" while highlighting that 133 districts across 20 states and Union Territories provide anti-filarial drugs for free.
The other aspects of the strategy include early diagnosis and treatment; engagement of medical colleges for strengthening morbidity management and disability services; integrated vector control with multi-sectoral coordinated efforts; inter-sectoral convergence with allied departments and ministries; leveraging existing digital platforms for LF and exploring alternative diagnostics.
Although the National Program to Eliminate LF has made significant progress, India still has over 23 million people suffering from lifelong disability due to the vector-borne disease, also known as neglected tropical disease (NTD) as it mainly inflicts poor people. It causes damage to the lymphatic system leading to long-term disfigurement and disability. Apart from physical health impact, LF also inflicts stigma, mental suffering, and social deprivation.
India bears around 40% of the global disease burden, with 272 LF endemic districts from 16 states and 5 union territories; close to 670 million people are at risk of contracting the disease, according to government reports.
As of 2020, according to the World Health Organization (WHO), 430 million people in India continue to require annual preventive treatment through the MDA campaigns.
Public health experts Bhupendra Tripathi from the Bill & Melinda Gates Foundation, Nupur Roy from the National Vector Borne Diseases Control Programme (NVBDCP) of the Union Health Ministry, and Neeraj Dhingra, ex-director of the NVBDCP in a review article published in a journal last year suggest a string of measures that, they opine, will assist in the achieving the desired results.
These are a revision of public funding and budget allocation for triple-drug MDA rounds, and focused attention on urban areas as there is a lack of an updated population registry for all individuals.
The experts have also stressed on giving IDA to migrant populations of daily wage workers if they are in large cluster groups from LF endemic areas working in various industries such as mines and factories located in other mosquito-endemic geographies.
Besides, strong monitoring and evaluation system is required to measure the success and provide evidence for corrective action, say the health experts.