The unfinished agenda: Why NTD elimination remains a political choice Eradicating Neglected Tropical Diseases is a public health imperative to prioritise equity, dignity and the right to health
Kelly Zongo, Vincent Okungu and Carol Karutu
P olitics, health equity and the and structural inequality influence both the burden of disease and the response to it. Health is always political, because decisions about whose needs are prioritised, how resources are allocated, and which communities are heard or ignored inevitably shape health outcomes. Nowhere is this clearer than in the global fight against neglected tropical diseases. NTD elimination is also one of the most cost-effective public health investments elimination of neglected tropical diseases (NTDs) are closely connected, highlighting how power dynamics, prioritisation in history – at just $0.50 per person, it delivers not only health benefits but also measurable economic, educational, and social gains. For governments, this means stronger human capital and national prosperity; for donors, some of the highest returns on investment in global health. Affecting the poorest and most marginalised populations – who in many countries also represent the majority of citizens and therefore a significant voting bloc – NTDs sit at the intersection of poverty, inequality, and fragile health systems. Their elimination is not simply a public health challenge – it is a political choice that reflects priorities, values, and commitments to equity. THE UNFINISHED AGENDA OF NTDS 1.5 billion people remain at risk of NTDs such as lymphatic filariasis, river blindness, trachoma, and schistosomiasis each year. Far from being rare conditions, these diseases of poverty flourish where health systems are weakest and safe water and sanitation are out of reach. The communities most affected are
often those with the least political influence: rural farmers, women and girls burdened by caregiving, and displaced populations living in fragile settings. The persistence of NTDs is therefore not only a health failure – it is an indictment of global inequity. This unfinished agenda is also a missed opportunity for governments to reduce poverty, increase school attendance, and strengthen workforce productivity – and for donors to achieve maximum impact with modest resources. In our work, we have seen how NTDs erode both human potential and community resilience. The disability and stigma associated with these diseases reinforce cycles of poverty, preventing children from attending school and adults from earning livelihoods. Addressing NTDs is not an optional extra; it is fundamental to building fairer and more sustainable societies. CHOOSING EQUITY: HOW POLITICAL DECISIONS SHAPE HEALTH AND NTD ELIMINATION NTD elimination is inseparable from the pursuit of health equity. By definition, equity demands that we prioritise those furthest from access – those with the least ability to demand or pay for services. Yet it is precisely these populations that are most vulnerable when resources tighten. For just $0.50 per person, countries can deliver treatments that break cycles of poverty, improve school attendance, and expand workforce participation. Few other health investments yield such outsized returns. But as international aid plateaus and donor priorities shift, NTDs risk being deprioritised in favour of higher-profile health issues.
The choice to sustain or cut NTD funding is therefore not a technical decision – it is a political one. It reflects how governments and donors value the lives and dignity of those at the margins. In choosing to continue investing in NTDs, leaders make a powerful statement: that no life is too peripheral, too poor, or too voiceless to matter. BEYOND AID: DOMESTIC OWNERSHIP AND INTEGRATION International funding has been vital in driving down the burden of NTDs. Global partnerships and mass drug administration campaigns have achieved extraordinary results, preventing millions of cases of disability and averting untold suffering. Yet the future of NTD elimination cannot depend on aid alone. With international resources dwindling, the spotlight now falls not only on national governments but also on a broader set of domestic actors. Domestic political leadership remains decisive, yet African philanthropists, businesses, and communities – including an expanding middle class increasingly willing to pay for services like deworming for their children – are also shaping the future of NTD elimination. For governments, sustaining NTD programs is not just about health – it is about building national competitiveness and ensuring that no community is left behind. For donors, continued support is a chance to amplify domestic progress and safeguard decades of investment. Where countries have integrated NTD services into primary health care, mobilised diverse streams of domestic financing, and built accountability into
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Health: A Political Choice – The Future of Health in a Fractured World
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