Unlocking the blueprint to eliminating neglected tropical diseases: A review of efforts in 50 countries that have eliminated at least 1 NTD

Background: Neglected tropical diseases (NTDs) are a group of 21 diseases affecting approximately 1.5 billion people globally. Significant progress has been made in their control: by March 2024, 50 countries had eliminated at least one NTD, with 13 of these countries eliminating at least two. Togo achieved the highest milestone, having eliminated four. The eight NTDs eliminated in at least one country are Guinea worm disease, human African trypanosomiasis, lymphatic filariasis, onchocerciasis, rabies, trachoma, visceral leishmaniasis and yaws. We reviewed elimination efforts of these 50 countries to identify factors underlying their successes and failures to generate a blueprint to inform the acceleration of NTD elimination. Methodology/principal findings: We conducted a review of published and grey literature and extracted and recorded data on various features of the elimination programmes, including the durations and organisers of elimination efforts, interventions, strategies including mainstreaming into other health services, partnerships involved, and details of historical failed control efforts. These data were synthesised to generate a blueprint for NTD elimination. Key features of successful NTD elimination included country ownership, dedicated elimination efforts, and use of a combination of strategies. Most elimination programmes targeted one NTD at a time, while fewer utilised integrated approaches. Elimination required at least two decades of sustained efforts and partnerships between the endemic country and international stakeholders. Failure in historical efforts was frequently a result of sociopolitical instability, insufficient resources, deprioritisation, lack of effective interventions, or lax implementation of interventions. Conclusions/significance: Accelerating NTD elimination requires sustained, intense, and multisectoral approaches. In addition, mainstreaming within the health system, improved cross-cutting One Health strategies including water, sanitation and hygiene, and sustained financing are critical for elimination. While this study provides valuable insights, limitations due to documentation gaps and secondary sources highlight the need for improved data reporting and future research to strengthen elimination frameworks. Author summary: The World Health Organization has set a target of 100 countries each eliminating at least one neglected tropical disease (NTD) by 2030. By March 2024, we had reached half that target with 50 countries each eliminating at least one NTD. These countries provide an opportunity to learn lessons that can inform elimination efforts in other countries. Thus, we have studied the NTD elimination programmes of these 50 countries to develop a blueprint detailing common characteristics of successful and unsuccessful NTD elimination efforts. We identified the following as key components of successful elimination: country ownership of the programmes, dedicated elimination programmes, and development partner support. Our investigation also showed that elimination required sustained efforts, with elimination frequently taking approximately two decades. Most elimination programmes targeted a single NTD at a time. Moreover, the study showed the need for intensification of cross-sectoral interventions including water, sanitation and hygiene (WASH), prioritisation of NTD control in national health strategies, and increased domestic and international funding. Failed historical elimination efforts were characterised by disruption due to various factors including socio-political instability and insufficient resources. This underscores the importance of sustained and well-financed elimination programmes.