Sleeping sickness is a neglected tropical disease that is caused by protozoan parasites (single-celled microorganisms) belonging to the genus Trypanosoma. The parasites are transmitted by infected tsetse flies and if untreated the disease is almost always fatal.  

“Togo is a pathfinder in eliminating sleeping sickness, a disease which has threatened millions of Africans,” Dr. Matshidiso Moeti, WHO Regional Director for Africa, said on Thursday. 

“I congratulate the Government and people of Togo for showing the way. I am sure the country’s efforts will inspire others to push towards a final eradication of sleeping sickness,” she added. 

Sleeping sickness is only found in 36 countries in sub-Saharan Africa, in areas where health systems are often weak. The people most exposed to the tsetse fly and to the disease live in rural areas and depend on agriculture, fishing, animal husbandry or hunting. 

Over two decades of sustained commitment 

Togo’s achievement comes after more than two decades of sustained political commitment, surveillance and screening of cases, according to the UN health agency. 

Beginning in 2000, the country’s public health officials implemented control measures. In 2011, Togo established surveillance sites at hospitals in the cities of Mango and Tchamba, which cover the main areas at risk of the disease. Public health officials have since maintained heightened disease surveillance in endemic and at-risk areas. 

Togo first applied for certification of elimination of sleeping sickness in 2018 and a team of WHO experts studied the data, made recommendations and requested a revision by the country before giving their approval. 

National efforts were supported by WHO-led global collaboration that facilitated the donation of medicines and resources from pharmaceutical companies, helped strengthen local capacity and ensured the sustained availability of tools required to control the disease. 

Two forms of sleeping sickness 

There are two forms of sleeping sickness: the first, caused by Trypanosoma brucei gambiense that is found in 24 countries in west and central Africa, accounting for more than 98 per cent of cases. The second form, due to Trypanosoma brucei rhodesiense, is found in 13 countries in eastern and southern Africa and represents the rest of cases.  

In the first stage, the symptoms generally include bouts of fever, headaches, enlarged lymph nodes, joint pains and itching. In the second stage parasites cross the blood-brain barrier to infect the central nervous system, resulting in changes of behaviour, confusion, sensory disturbances and poor coordination. The disturbance of the sleep cycle, which gives the disease its name, is an important feature. 

WHO and partners are targeting the elimination as a public health problem of the gambiense form of the disease from all endemic countries by 2030. Benin, Burkina Faso, Cameroon, Cote d’Ivoire and Ghana have started the validation process with the support of WHO. 

Wiping out the gambiense form of sleeping sickness will require maintaining the commitment of endemic countries and of donors as well as integrating control and surveillance activities into the regular health systems, said WHO, adding that such efforts need to be supported by improved tools, innovative disease control approaches and effective coordination of efforts.

COVID-19 is posing potential catastrophic impacts on people living with HIV and tuberculosis (TB) , with projected deaths to increase up to 10, 20 and 36 per cent for HIV, TB and malaria patients, respectively, over the next five years, according to UNAIDS, the UN agency dedicated to tackling the virus.

“Countries must ensure that everyone is able to receive essential services, including health care, and they must invest adequately in social protection programmes to keep people safe and to shield them from the consequences of losing their livelihoods,” said Winnie Byanyima, Executive Director of UNAIDS.

The most impacted

The highly disadvantaged will be most gravely impacted, particularly those in countries already afflicted by conflict, economic or climate crises. 

And refugees are among the groups facing the greatest dangers. 

At the same time, some 150 million full-time jobs were lost in the first quarter of the year and millions of other people are set to lose their livelihoods in the months ahead.

“Today, only 29 per cent of the world’s population has access to adequate social protection coverage,” said Guy Ryder, Director General of the International Labour Organization (ILO). 

“Governments must act to ensure the sustainability of livelihoods, businesses and jobs and the protection of workers’ health, rights and incomes during and after COVID-19”.

A case for women

Women are particularly vulnerable to the economic crisis. 

Disproportionately employed in the informal sectors, they are most likely to lose their incomes. 

Comprising 70 per cent of the health and social care workforce, they are also often employed on the frontline of the COVID-19 response.

Furthermore, women carry out the bulk of unpaid domestic duties in the home, childcare and other caring functions.

And with the lockdown triggering and increase in gender-based violence, it is imperative for Governments to invest in social protection programmes designed specifically for women and girls, UNAIDS said.

Countries need to live up to their commitment for social protection for everyone who needs it — UNICEF chief

Youth in crosshairs

School closures, which have affected more than 90 per cent of the world’s student population, have not only interrupted education but also pupils’ access to crucial social services, such as school meals.

“Children and young people are suffering disproportionately from the socio-economic impact of the COVID-19 crisis,” said Henrietta H. Fore, Executive Director of the UN Children’s Fund, UNICEF. 

“Before the outbreak, two-out-of-three children had no or inadequate social protection fund.” 

Moreover, the socio-economic crash caused by the pandemic is placing an entire generation of young people at risk. 

“Countries need to live up to their commitment for social protection for everyone who needs it,” she added.

Call for action

The call for Governments to invest adequately in social protection programmes is endorsed by UNAIDS, UNICEF and the International Labour Organization (ILO) and supported by the World Food Programme (WFP), the Office of the  UN High Commissioner for Refugees (UNHCR), the UN Entity for Gender Equality and the Empowerment of Women (UN Women), the UN Office on Drugs and Crime (UNODC), the UN Educational, Scientific and Cultural Organization (UNESCO) and the World Bank.