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24 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES
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Towards 2020
The Roadmap’s targets for 2020 remain critical milestones on the path towards universal
coverage against NTDs. Excluding medicines, the total investment target for the period
2015–2020 is US$ 18 billion. Excluding investments in vector control, the target for the
same period is US$ 4.5 billion, with a peak of US$ 900 million in 2020 (panel A). The target
for medicines is estimated at about US$ 4.5 billion for the period, peaking at about US$
810 million in 2017 (panel B). Most of this amount has been committed in donations from
the pharmaceutical industry. Follow-through on these commitments will be critical to the
achievement of 2020 targets. Just as important, however, is the US$ 2.8 billion targeted
for delivery of those medicines, through preventive chemotherapy (panel C), active casefinding
(panel D) and individual treatment and care by the general health system (panel
E). This treatment and care includes costs related to diagnosis, surgery and general health
services – namely hospital bed days and clinic visits – for Buruli ulcer, human African
trypanosomiasis, leprosy and the leishmaniases. It does not yet include the cost of treatment
and care for Chagas disease.
Donations of azithromycin for yaws eradication have not yet been secured and are
therefore included in the total for yaws eradication – about US$ 550 million for the period
2015–2020 (panel F). A more complete treatment of the investment case for yaws eradication
is available in Chapter 4.
Preventive chemotherapy will continue to require the biggest investments in delivery of
donated medicines. At least US$ 2.3 billion is targeted for 2015–2020. In advocating for this
intervention, the NTD community has typically cited values of US$ 0.10 to US$ 0.50 as the
delivery cost per person per year. While useful for advocacy, the focus on single numbers
risks misrepresenting the complexity of delivering “free” medicines to more than a billion
people across the world. For this report, the global average unit cost benchmark is about
US$ 0.30 (0.22–0.36) in 2015. Country-specific benchmarks were found to be very sensitive
to the scale of implementation and density of the population. Many of the available costing
studies are from peri-urban areas rather than from the rural areas in which most of the
population requiring treatment is found. In the push towards 2020 targets, future updates
to this analysis will need to factor in the cost of the “last mile” of preventive chemotherapy
in more diverse settings.
Evidence about co-endemicity suggests that integrating the delivery of preventive
chemotherapy for multiple NTDs could lower the total number of deliveries of anthelminthic
medicines by 13–24% over the period 2015–2030. The scope for integration varies
significantly among countries. Further research is needed to identify the potential costs,
especially coordination costs inherent in financing and managing across stakeholder groups.
The only published study based on real expenditures rather than projections found overall
savings of 16–21% in an integrated programme against lymphatic filariasis, schistosomiasis,
soil-transmitted helminthiases and trachoma in Niger (27). More such studies are needed.
However, integration is not just about integrated delivery of preventive chemotherapy.