Anyone who primarily thinks of Malaysia as a polished holiday destination would be surprised by a news article from the World Health Organization (WHO) in January 2021, which called for intensified efforts in the country’s fight against neglected tropical diseases (NTDs) (Novakovic, 2021). The diseases focussed upon are dengue, rabies and lymphatic filariasis – diseases more commonly associated with extreme poverty (Engels and Zhou, 2020). However, the article is clear that to meet global targets set by the WHO as part of an effort to meet the Sustainable Development Goals (United Nations, 2021) by 2030, Malaysia must not lose focus in its efforts to eradicate these diseases, particularly as it would be tempting to solely focus on combating covid-19. As a nation, it is making some headway with this: dengue, the biggest killer, is being fought with innovative work against its vector, and public health interventions. Rabies is a particular problem in Sarawak, part of the island of Borneo, and efforts there involve mainly education and collaboration with veterinary services. Lymphatic filariasis, which features lymphoedema caused by parasitic worms, is treated with mass drug administration programs. The article concludes with a promise from the WHO to continue collaborating with the Malaysian government to fight NTDs together.

It should be no surprise that the impact of NTDs is not well recognised; it is, after all, in the name. These 20 diseases were chosen because of their lack of notoriety in comparison with their impact: worldwide, they have the potential to affect over 1.7 billion people, kill 200,000 people and cost 19 million disability adjusted life years (DALYs) a year, (WHO, 2021) but they do not receive as much prominence as other conditions (for example, the 4 big non-communicable disease sets as identified by the WHO: cardiovascular diseases, diabetes, chronic respiratory diseases, cancers (Schwartz et al, 2021)). Malaysia’s big NTDs are dengue, rabies and lymphatic filariasis (Novakovic, 2021). Their distribution across the poorest and least educated members of Malaysian society, while depressing, is not surprising. Dengue is a vector borne disease; its incidence in Malaysia in 2014 was reported as 361 cases per 100,000 population (Malaysian Ministry of Health, 2015; vs 0.42 cases per 100,000 across Europe in 2014 (ECDC, 2014)), and recurrent outbreaks have proved difficult to control (Murphy, A et al. 2020). Rabies is a feared and deadly condition: of the 31 people diagnosed in Sarawak, Malaysia between July 2017 and December 2020, only 2 survived (Novakovic, 2021). Though numbers are incredibly low compared to the biggest NCD in Malaysia, cardiovascular disease (killed 16, 325 people in Malaysia in 2019 (Department of Statistics Malaysia, 2020)), the psychological impact on a community from a fatal case of rabies cannot be underestimated. And 1.12 million people in Malaysia are at risk from lymphatic filariasis (Dickson BFR, 2017).

However, in spite of the impact of NTDs, it may seem that Malaysia currently has bigger fish to fry. While its initial response to covid-19 was relatively successful, later peaks of infection have wrought their toll on the country (Al Jazeera, 2021). Understandably, Malaysia, and the world, has been focussed on covid-19. However, this ‘covidization’ (the reallocation of research capacity, finances and resources to pursue control of the pandemic (Pai, M. 2020)) has led to neglect of other conditions, including NTDs. This would be bad enough if you were a person suffering from an NTD, but to make matters worse, there is a synergistic relationship between poverty, NTDs and covid-19 (which has led to some referring to covid-19’s spread around the globe as a ‘syndemic’ (Horton, 2020)). Suffering from one makes you more likely to suffer from all of them, and suffering from all of them has a greater impact on a person than simply the effect of each combined. Despite recent encouragement, (WHO, 2021) Malaysia cannot afford to let its NTDs become a self-fulfilling prophecy.

Malaysia must continue its efforts against NTDs, including education, early treatment (at population level) and research. This will only be achieved through continued allocation of resources and collaboration with local government agencies, multi-professional groups and the WHO. For dengue, prevention is key, as there is no specific treatment. An innovative approach is the release of Wolbachia bacteria carrying mosquitos: the bacteria renders the mosquito unable to act as a vector. Early reports in January 2020 showed that dengue incidence had decreased following release of these mosquitos in Kuala Lumpur, Malaysia’s capital (Chrostek, E. 2020). Similarly, as rabies has such a high mortality rate, prevention, in the form of education around dog behaviour and avoiding bites, is essential. (WHO, 2018). And for lymphatic filariasis, mass drug administration aims to eradicate the condition entirely (Dickson BFR, 2017). It seems prevention is better than cure.

As the world emerges from the covid-19 pandemic, there is an opportunity for Malaysia and other countries impacted by NTDs to refocus their efforts, and use this time of re-organising of priorities to finally break the power of NTDs over the poor and multiply co-morbid people whose lives they devastate.

References

1. Novakovic, D. 2021. ‘It’s time to act to beat neglected tropical diseases in Malaysia’. World Health Organization News release. 30 January. At https://www.who.int/malaysia/news/detail/30-01-2021-it-s-time-to-act-to-beat-neglected-tropical-diseases-in-malaysia
2. Engles, D. Zhou XN. 2020. ‘Neglected tropical diseases: an effective global response to local poverty-related disease priorities’. Infectious Diseases of Poverty. 9, 10 (2020)
3. United Nations, 2021. ‘The 17 Goals’ https://sdgs.un.org/goals [Accessed on 8/10/2021]
4. World Health Organization, 2021. ‘Neglected tropical diseases’ https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_2 [Accessed on 8/10/2021]
5. Schwartz, L et al. 2021. ‘The origins of the 4 x 4 framework for noncommunicable disease at the World Health Organization’. SSM – Population Health. Vol 13; 100731
6. Malaysia, M. O. H. 2015. ‘Clinical Practice Guidelines’. Ed Ministry of Health Technology Assessment
7. Department of Statistics Malaysia. 2020. ‘Statistics on Causes of Death, Malaysia, 2020’ https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=401&bul_id=QTU5T0dKQ1g4MHYxd3ZpMzhEMzdRdz09&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09[Accessed on 8/10/2021]
8. Murphy A, Rajahram GS, Jilip J, Maluda M, William T, et al. (2020) ‘Incidence and epidemiological features of dengue in Sabah, Malaysia.’ PLOS Neglected Tropical Diseases 14(5): e0007504.
9. Dickson BFR et al. 2017. ‘Lymphatic Filariasis in Mainland Southeast Asia: A Systematic Review and Meta-Analysis of Prevalence and Disease Burden’. Tropical Medicine and Infectious Disease. 2017; 2(3):32
10. Chai, J. 2021. ‘Malaysia: From COVID role model to a mini-India’. Al Jazeera. 3 August. At https://www.aljazeera.com/opinions/2021/8/3/malaysia-from-covid-role-model-to-a-mini-india
11. Pai, M. 2020. ‘Covidization of research: what are the risks?’ Nature Medicine 26, 1159
12. Horton (2020). ‘Offline: COVID-19 is not a pandemic.’ The Lancet. 396(10255), p.874
13. World Health Organization, 2021. ‘Update on the Dengue situation in the Western Pacific Region’. Dengue Situation Update. No. 629
14. Chrostek E, Hurst GDD, McGraw EA. 2020. ‘Infectious Diseases: Antiviral Wolbachia Limits Dengue in Malaysia.’ Current Biology. Jan 6;30(1):R30-R32.
15. World Health Organization, 2018. ‘Education is vital to prevent rabies deaths’ Newsroom 26 September https://www.who.int/news-room/feature-stories/detail/education-is-vital-to-prevent-rabies-deaths [Accessed on 11/10/2021]

Malaysia still has work to do in its fight against neglected tropical diseases / Esther Westwood / Global Health Challenges: An Introduction by blogadmin is licensed under a Creative Commons Attribution CC BY 3.0