Unlocking the blueprint to eliminating neglected tropical diseases: A review of efforts in 50 countries that have eliminated at least 1 NTD.

Background: Neglected tropical diseases (NTDs) are a group of 21 diseases affecting approximately 1.5 billion people globally. Significant progress has been made in their control: by March 2024, 50 countries had eliminated at least one NTD, with 13 of these countries eliminating at least two. Togo achieved the highest milestone, having eliminated four. The eight NTDs eliminated in at least one country are Guinea worm disease, human African trypanosomiasis, lymphatic filariasis, onchocerciasis, rabies, trachoma, visceral leishmaniasis and yaws. We reviewed elimination efforts of these 50 countries to identify factors underlying their successes and failures to generate a blueprint to inform the acceleration of NTD elimination.

Methodology/principal Findings: We conducted a review of published and grey literature and extracted and recorded data on various features of the elimination programmes, including the durations and organisers of elimination efforts, interventions, strategies including mainstreaming into other health services, partnerships involved, and details of historical failed control efforts. These data were synthesised to generate a blueprint for NTD elimination. Key features of successful NTD elimination included country ownership, dedicated elimination efforts, and use of a combination of strategies. Most elimination programmes targeted one NTD at a time, while fewer utilised integrated approaches. Elimination required at least two decades of sustained efforts and partnerships between the endemic country and international stakeholders. Failure in historical efforts was frequently a result of sociopolitical instability, insufficient resources, deprioritisation, lack of effective interventions, or lax implementation of interventions.

Conclusions/significance: Accelerating NTD elimination requires sustained, intense, and multisectoral approaches. In addition, mainstreaming within the health system, improved cross-cutting One Health strategies including water, sanitation and hygiene, and sustained financing are critical for elimination. While this study provides valuable insights, limitations due to documentation gaps and secondary sources highlight the need for improved data reporting and future research to strengthen elimination frameworks.