Evaluating the Potential Indirect Impact of COVID-19: A Modelling Study of Programme Interruptions for Seven Neglected Tropical Diseases

Background: In line with the movement restrictions and physical distancing essential for the control of the current global COVID-19 pandemic, the World Health Organization (WHO) recommended postponement of all neglected tropical disease (NTD) control activities which involve community-based surveys, active case-finding and mass drug administration (MDA). This study aimed to evaluate the potential impact of this interruption.  Methods: For seven of the NTDs, namely soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis, trachoma, visceral leishmaniasis and human African trypanosomiasis, we use mathematical transmission models to assess the potential impact of the current disruption to programmes on the dynamics of each of these diseases in different endemic settings. We also explore the potential benefit of implementing mitigation strategies once restrictions are relaxed, both in minimising the delays to control targets and reducing longer-term morbidity.  Findings: We demonstrate that the impact of the COVID-19 induced interruption in terms of delay to achieving elimination goals is likely to be greatest in those areas where NTD endemicity is highest. We also show that these delays can largely be mitigated by measures such as additional MDA or enhanced case-finding, and that the sooner these mitigation strategies are implemented, the greater the benefit in terms of long-term morbidity reduction.  Interpretation: The COVID-19 pandemic has brought infectious disease control to the forefront of global consciousness. It is essential that the NTDs, so long neglected in terms of research and financial support, are not overlooked during the current crisis, and remain a priority in health service planning and funding. Funding Statement: This work was supported by the NTD Modelling Consortium, funded by the Bill and Melinda Gates Foundation (OPP1184344). JT acknowledges joint funding by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MR/R015600/1). Declaration of Interests: All authors declare no competing interests.