Neglected tropical skin diseases: their global elimination through integrated mass drug administration?

In 2005, the concept of a combination of essential medicines—the “rapid-impact” package—was proposed to simultaneously target 7 high-prevalence neglected tropical diseases (NTDs) in sub-Saharan Africa through programs of annual mass drug administration.¹ The approach relied on the observation that the major NTDs affecting the poorest people in sub-Saharan Africa, led by hookworm infection, ascariasis, schistosomiasis, trichuriasis, trachoma, lymphatic filariasis (LF), and onchocerciasis, have similarities in terms of their abilities to cause long-term disabilities and ultimately poverty by influencing worker productivity in the tropics and child development, as well as having effects on girls and women, especially during pregnancy. Moreover, these NTDs overlap geographically and therefore can be treated at roughly the same time through once-annual administration of an integrated package containing albendazole (or mebendazole), ivermectin, praziquantel, and azithromycin.¹ Together, these medicines could be administered for less than US $1 annually, making this approach highly cost-effective.