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Abstract：
BACKGROUND: This study investigates the impact of the COVID-19 pandemic on the prevalence, management, and control of the neglected tropical diseases (NTDs) highlighting the current or prospective impact of COVID-19 on research and development funding for, and execution of, NTD programmes. This review was conducted to determine if, and how, NTDs were affected by COVID-19, and whether those effects will delay the elimination goals of the Sustainable Development goals.
METHODS: Using open-source available data from policy and documentation from official websites of the relevant stakeholders including but not limited to World Health Organization (WHO) documents and policies, government foreign aid documents, and the Policy Cures G-Finder reports, this scoping review explored ongoing challenges to supporting research and development (R&D) for the NTDs and in maintaining NTD control programs; examined the constraints posed for NTD management by the pandemic from disruptions to healthcare services, reduction of finance and explored the potential long-term implications and consequences for those poorer, neglected populations in low and middle income-countries (LMICs). This was done by a scoping review literature search, publications were subject to an initial practical screening step to ensure the most relevant publications were selected for full screening, with the focus on scoping the designated topic of the impact of COVID-19 on NTDs. We further undertook an evaluation of the socio-economic factors exacerbating the impact of COVID-19 on NTD burden.
RESULTS: Multiple disruptions and setbacks, likely to affect NTD programmes and progress towards their elimination targets were identified in this study. R&D funding for the NTDs and AIDs and TB has declined since the funding high point of 2019, and for malaria since the high point of 2018. Significant changes in allocation of R&D funding within the NTDs are observed post pandemic, likely because of prioritization among donors. Diseases for which the least R&D investment was reported in place, prior to the pandemic (mycetoma, taeniasis/cysticercosis, trachoma and Buruli ulcer) have been particularly impacted post pandemic. We identified specific NTDs including schistosomiasis, leprosy, and rabies that have been affected by the COVID-19 pandemic and disruptions caused to on ongoing NTD control and elimination programs. Pandemic restrictions disrupted essential medical supply manufacturing and distribution impacting immunization programs and hindered efforts to control the spread of infectious diseases. NTD programmes have experienced numerous setbacks including delays in mass drug administration programs (e.g. for schistosomiasis), cancelled or delayed vaccination programs (e.g. for rabies) and closure of testing facilities has resulted in reduced diagnosis, treatment, and disease elimination for all NTDs. Lockdowns and clinic closures causing disruption to essential healthcare services restricted NTD surveillance and treatment programs. Community fears around contracting COVID-19 exacerbated the constraints to service delivery. Disparities in global vaccine distribution have widened with LMICs facing limited access to vaccines and disruption to immunization programs. Finally, the pandemic has led to increased poverty with poor and marginalized communities, impacting nutrition, healthcare access and education all of which have long term implications for NTD management and control.
CONCLUSIONS: The COVID-19 pandemic profoundly impacted global health research and global health equity. Attention and funding were diverted from all sectors, significantly affecting research and development efforts set out in the World Health Organization\'s NTD elimination Roadmaps. Ongoing changes to funding, economic crises, logistics and supply chain disruptions as well as deepening poverty has put a strain on already weak healthcare systems and exacerbated LMIC healthcare challenges. In particular, the delays and constraints to NTD management and elimination programs will have long-reaching consequences highlighting the need for global cooperation and renewed investment to put the NTD roadmap back on track. Targets and milestones are unlikely to be met without significant investment for recovery, in place.
METHODS: Using open-source available data from policy and documentation from official websites of the relevant stakeholders including but not limited to World Health Organization (WHO) documents and policies, government foreign aid documents, and the Policy Cures G-Finder reports, this scoping review explored ongoing challenges to supporting research and development (R&D) for the NTDs and in maintaining NTD control programs; examined the constraints posed for NTD management by the pandemic from disruptions to healthcare services, reduction of finance and explored the potential long-term implications and consequences for those poorer, neglected populations in low and middle income-countries (LMICs). This was done by a scoping review literature search, publications were subject to an initial practical screening step to ensure the most relevant publications were selected for full screening, with the focus on scoping the designated topic of the impact of COVID-19 on NTDs. We further undertook an evaluation of the socio-economic factors exacerbating the impact of COVID-19 on NTD burden.
RESULTS: Multiple disruptions and setbacks, likely to affect NTD programmes and progress towards their elimination targets were identified in this study. R&D funding for the NTDs and AIDs and TB has declined since the funding high point of 2019, and for malaria since the high point of 2018. Significant changes in allocation of R&D funding within the NTDs are observed post pandemic, likely because of prioritization among donors. Diseases for which the least R&D investment was reported in place, prior to the pandemic (mycetoma, taeniasis/cysticercosis, trachoma and Buruli ulcer) have been particularly impacted post pandemic. We identified specific NTDs including schistosomiasis, leprosy, and rabies that have been affected by the COVID-19 pandemic and disruptions caused to on ongoing NTD control and elimination programs. Pandemic restrictions disrupted essential medical supply manufacturing and distribution impacting immunization programs and hindered efforts to control the spread of infectious diseases. NTD programmes have experienced numerous setbacks including delays in mass drug administration programs (e.g. for schistosomiasis), cancelled or delayed vaccination programs (e.g. for rabies) and closure of testing facilities has resulted in reduced diagnosis, treatment, and disease elimination for all NTDs. Lockdowns and clinic closures causing disruption to essential healthcare services restricted NTD surveillance and treatment programs. Community fears around contracting COVID-19 exacerbated the constraints to service delivery. Disparities in global vaccine distribution have widened with LMICs facing limited access to vaccines and disruption to immunization programs. Finally, the pandemic has led to increased poverty with poor and marginalized communities, impacting nutrition, healthcare access and education all of which have long term implications for NTD management and control.
CONCLUSIONS: The COVID-19 pandemic profoundly impacted global health research and global health equity. Attention and funding were diverted from all sectors, significantly affecting research and development efforts set out in the World Health Organization\'s NTD elimination Roadmaps. Ongoing changes to funding, economic crises, logistics and supply chain disruptions as well as deepening poverty has put a strain on already weak healthcare systems and exacerbated LMIC healthcare challenges. In particular, the delays and constraints to NTD management and elimination programs will have long-reaching consequences highlighting the need for global cooperation and renewed investment to put the NTD roadmap back on track. Targets and milestones are unlikely to be met without significant investment for recovery, in place.
摘要：
背景：这项研究调查了COVID-19大流行对患病率的影响，管理,以及对被忽视的热带病(NTDs)的控制，突出了COVID-19对研发资金的当前或未来影响，和执行，NTD方案。进行这项审查是为了确定，以及如何，NTD受到COVID-19的影响，以及这些影响是否会推迟可持续发展目标的消除目标。
方法：使用来自相关利益相关者官方网站的政策和文档的开源数据，包括但不限于世界卫生组织（WHO）文件和政策，政府对外援助文件,和政策治愈G-Finder报告，本次范围审查探讨了在支持NTD的研发（R＆D）和维持NTD控制计划方面面临的挑战；研究了大流行对NTD管理造成的限制，包括对医疗保健服务的破坏，减少资金，并探讨对穷人的潜在长期影响和后果，低收入和中等收入国家(LMICs)的被忽视人口。这是通过范围审查文献检索完成的，出版物要经过初步的实际筛选步骤，以确保选择最相关的出版物进行全面筛选，重点是确定COVID-19对NTD影响的指定主题。我们进一步评估了加剧COVID-19对NTD负担影响的社会经济因素。
结果：多重中断和挫折，这项研究确定了可能影响NTD计划和实现其消除目标的进展。自2019年的资金高点以来，NTD、艾滋病和结核病的研发资金有所下降，自2018年的高点以来，疟疾的研发资金有所下降。大流行后，观察到NTD内部研发资金分配的重大变化，可能是因为捐助者之间的优先次序。据报道研发投入最少的疾病，在大流行之前（霉菌瘤，带菌者/囊虫病,沙眼和布鲁里溃疡）在大流行后尤其受到影响。我们确定了特定的NTDs，包括血吸虫病，麻风病,以及受COVID-19大流行影响的狂犬病，以及对正在进行的NTD控制和消除计划造成的干扰。大流行限制扰乱了基本医疗供应的制造和分配，影响了免疫计划，并阻碍了控制传染病传播的努力。NTD计划经历了许多挫折，包括大规模药物管理计划(例如血吸虫病)的延误，取消或延迟接种疫苗计划(例如狂犬病疫苗)和检测设施的关闭导致诊断减少，治疗,和消除所有NTD的疾病。封锁和诊所关闭导致基本医疗保健服务中断，限制了NTD监视和治疗计划。社区对感染COVID-19的担忧加剧了对服务提供的限制。全球疫苗分配的差距已经扩大，低中等收入国家面临获得疫苗的机会有限和免疫计划中断的问题。最后,这种流行病导致贫困和边缘化社区的贫困加剧，影响营养，所有这些都对NTD管理和控制具有长期影响。
结论：COVID-19大流行深刻影响了全球卫生研究和全球卫生公平。注意力和资金从所有部门转移，显着影响世界卫生组织消除NTD路线图中规定的研发工作。资金的持续变化，经济危机,物流和供应链中断以及贫困加深给本已薄弱的医疗保健系统带来了压力，并加剧了LMIC医疗保健挑战。特别是,NTD管理和淘汰计划的延误和限制将产生深远的后果，突显了全球合作和重新投资的必要性，以使NTD路线图重回正轨。如果不为复苏进行大量投资，就不可能实现目标和里程碑，到位。
方法：使用来自相关利益相关者官方网站的政策和文档的开源数据，包括但不限于世界卫生组织（WHO）文件和政策，政府对外援助文件,和政策治愈G-Finder报告，本次范围审查探讨了在支持NTD的研发（R＆D）和维持NTD控制计划方面面临的挑战；研究了大流行对NTD管理造成的限制，包括对医疗保健服务的破坏，减少资金，并探讨对穷人的潜在长期影响和后果，低收入和中等收入国家(LMICs)的被忽视人口。这是通过范围审查文献检索完成的，出版物要经过初步的实际筛选步骤，以确保选择最相关的出版物进行全面筛选，重点是确定COVID-19对NTD影响的指定主题。我们进一步评估了加剧COVID-19对NTD负担影响的社会经济因素。
结果：多重中断和挫折，这项研究确定了可能影响NTD计划和实现其消除目标的进展。自2019年的资金高点以来，NTD、艾滋病和结核病的研发资金有所下降，自2018年的高点以来，疟疾的研发资金有所下降。大流行后，观察到NTD内部研发资金分配的重大变化，可能是因为捐助者之间的优先次序。据报道研发投入最少的疾病，在大流行之前（霉菌瘤，带菌者/囊虫病,沙眼和布鲁里溃疡）在大流行后尤其受到影响。我们确定了特定的NTDs，包括血吸虫病，麻风病,以及受COVID-19大流行影响的狂犬病，以及对正在进行的NTD控制和消除计划造成的干扰。大流行限制扰乱了基本医疗供应的制造和分配，影响了免疫计划，并阻碍了控制传染病传播的努力。NTD计划经历了许多挫折，包括大规模药物管理计划(例如血吸虫病)的延误，取消或延迟接种疫苗计划(例如狂犬病疫苗)和检测设施的关闭导致诊断减少，治疗,和消除所有NTD的疾病。封锁和诊所关闭导致基本医疗保健服务中断，限制了NTD监视和治疗计划。社区对感染COVID-19的担忧加剧了对服务提供的限制。全球疫苗分配的差距已经扩大，低中等收入国家面临获得疫苗的机会有限和免疫计划中断的问题。最后,这种流行病导致贫困和边缘化社区的贫困加剧，影响营养，所有这些都对NTD管理和控制具有长期影响。
结论：COVID-19大流行深刻影响了全球卫生研究和全球卫生公平。注意力和资金从所有部门转移，显着影响世界卫生组织消除NTD路线图中规定的研发工作。资金的持续变化，经济危机,物流和供应链中断以及贫困加深给本已薄弱的医疗保健系统带来了压力，并加剧了LMIC医疗保健挑战。特别是,NTD管理和淘汰计划的延误和限制将产生深远的后果，突显了全球合作和重新投资的必要性，以使NTD路线图重回正轨。如果不为复苏进行大量投资，就不可能实现目标和里程碑，到位。
