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    • As Becerra Posada writes attention

    2019-06-11

    As Becerra-Posada writes, attention must be given to the development of capacities and structures for taking health into account in all policies. But should the public health mm concentration also give attention to raising the standing of health on the political agenda and to helping induce political solutions through often contentious and divisive political policy processes?
    The Royal Society of Tropical Medicine and Hygiene is holding a 1-day meeting in London, UK, on Sept 25, 2015, to discuss “The disease elimination agenda: the role of science, policy and advocacy”. Important meetings such as this are a welcome forum at which to discuss progress and challenges and to reflect on important milestones, particularly with regard to neglected tropical diseases (NTDs). Such NTD milestones include the London declaration and the WHO roadmap. However, the success of these elimination initiatives is contingent on inclusive programming and on addressing the problem in its entirety. Most of the targets for elimination focus on interrupting transmission and infection cycles, yet many of the NTDs cause severe morbidity including disabling lymphoedema, massive hydrocele, disfigurement, and blindness. Despite the huge burden of morbidities, there are no clear targets towards their elimination, and, with the exception of trachoma, there are no morbidity indictors to measure the success of elimination. A more inclusive approach to addressing morbidity in the elimination of NTDs should focus on the following points. First, elimination targets should clearly include indicators related to morbidity. Such indicators should go beyond measuring access to care and should bind success to the extent of morbidity alleviation. WHO\'s trachoma elimination target of a prevalence of active trachoma of less than 5% among children aged 1–9 years and a prevalence of trachoma trichiasis of less than one case per 1000 population successfully combines both prevention of new infections and reduction of morbidity, and should be replicated across the different diseases. Second, resources should be clearly committed to the morbidity management aspect of these NTDs. Funding such as the USAID\'s support of Helen Keller International\'s Morbidity Management and Disability Prevention for Blinding Trachoma and Lymphatic Filariasis Project is welcome. Given the scale of the problem, more resources to address the morbidity challenge are required. As resources are directed towards preventing new infection, equally resources should also be targeted to improving the quality of life of the people suffering from the consequences of the diseases.
    Waleed Al-Faisal and colleagues (July, 2015) call for an end to sanctions in Syria. Sanctions do have unintended consequences for innocent citizens, but those imposed on Syria have been mostly on weapons and items of dual use, many of which were imposed years before the onset of the present conflict, including the period of the positive achievements in health care mentioned by Al-Faisal and colleagues. Furthermore, humanitarian items and drugs were exempted from the sanctions. We believe that the reasons behind the present health-care crisis in Syria are much more complex. Since the beginning of the crisis, there were systematic attacks on health-care professionals and targeting of health-care facilities by the Syrian Government and to lesser extent some armed groups, as a tactic of warfare. According to the most recent report of Physicians for Human Rights, 633 health-care workers have been killed and 271 health-care facilities attacked since the beginning of the conflict. Of these, 611 and 243, respectively, were by Syrian Government forces. Another factor is the improper distribution of available resources. For example, immunisation coverage for poliomyelitis in 2013 was 100% in Tartous Province but only 36% in Deir Azzor province, which is where the first case of the recent epidemic occurred. Aid agencies are essentially prohibited from sending materials to opposition-controlled areas, the assumption being that they could be used to treat rebel fighters.