Dr. Solomon Zewdu, a seasoned global health leader and the newly appointed CEO of the END Fund, joins us for an in-depth conversation on the future of neglected tropical diseases (NTD) elimination in Africa and beyond. With a distinguished career spanning the public, private, military, philanthropy such as the Bill & Melinda Gates Foundation and Mastercard Foundation, Dr. Solomon brings a unique blend of medical, strategic, government and donor expertise to the helm of the world’s largest philanthropic fund dedicated to fighting NTDs.
Under his leadership, the END Fund is intensifying its mission to eliminate six major neglected tropical diseases by 2030, focusing on philanthropic collaborative capital aggregating approaches that leverages local knowledge, public-private partnerships, communities and blended financing. In this interview with Capital’s Groum Abate at the Africa CEO Forum in Abidjan, Côte d’Ivoire, Dr. Solomon discusses the challenges and opportunities facing NTD elimination, the impact of shifting global aid dynamics, and the importance of integrating NTD programs within broader health and development agendas. The Africa CEO Forum, held on May 12 and 13 this year was two days of conferences, debates and high-level meetings dedicated to highlighting the driving role of the private sector in the development of the continent where the END Fund was an industry partner. Dr Solomon refers to panel discussions that ranged from improving economic governance, optimizing public policy; as well as supply chain resilience, and the role of philanthropy and domestic financing in a changing world. He also shares his vision of harnessing African resources and leadership to drive sustainable progress, ensuring that no community is left behind in the fight against these ancient, yet entirely preventable, diseases. Excerpts:
Capital: Can you tell us about the END Fund?
Solomon Zewdu: The END Fund is an organization established in 2012. It is a philanthropic collaborative fund that pools philanthropic and corporate capital to grant for the elimination of neglected tropical diseases.
While the conventional effort against NTDs were mostly to reduce diseases burden, the END fund was established to eliminate these diseases based on a proof of concept that eliminating these diseases in lower to middle income countries was actually possible and therefore a strategy to focus on eliminating six diseases by 2030.
We operate solely with philanthropic and corporate funds, which include contributions from individual donors. We also collaborate with pharmaceutical companies that provide medications at no cost. These live saving donations for high to middle income countries are a critical building block of our success in demonstrating that NTD elimination efforts are global health’s best buy. We partner with African governments and implementing partners by financing the delivery of the necessary services into the community leveraging the resources mobilized from our philanthropic and individual donors.
Capital: These six diseases primarily affect rural areas in Africa, which are often difficult to access. How do you plan to reach these communities?
Solomon: We work directly with governments, local populations, and community partners to reach the most remote areas of any country. This collaboration allows us to leverage the local ownership that comes with the agency of participating in your treatment options and restoration of dignity. We codesign the programs that our implementing partners execute under the model of one plan (sovereign country), one budget and one measuring and evaluation and learning model. We aggregate the capital and program it into focused investments based on the best available data and science, eliminating wastage and duplication of valuable and scares resources.
The six diseases we target classified as neglected tropical diseases, still exist in Africa, part of the middle east and Southeast Asia, while the rest of the world has long eliminated them. Their persistence is primarily linked due to poverty, poor infrastructure and neglect. Our goal is to support local governments to eliminate these diseases entirely. Our target diseases are trachoma, river blindness, visceral leishmaniasis, schistosomiasis and soil transmitted Helminths (Intestinal worms), that affect low socioeconomic and marginalized rural communities
Capital: How do you assess the effectiveness of your funding?
Solomon: We collaborate with our in-country program partners to co-create the most effective interventions, aligned with the priority of the health authorities of the countries and develop robust Key Performance Indicators before we make grants. Since our benchmark is elimination, we track reductions in cases, interruption of disease transmission and track disease burden in partnership with all that are involved in the community of disease eradication. This data in turn guides our fund-raising efforts and programming success measurement and trajectory towards elimination of these six diseases.
Capital: Recently, there has been ongoing conflict in Sudan. Does that impact your work?
Solomon: Any conflict can hinder programs and cause delays; which is unfortunate. However, we strive to work around these challenges and evaluate every crisis case by case. By partnering with community organizations that can often maintain their capacity to provide services, we continue our efforts, even amidst unrest or displacement. We engage with displaced populations and refugee camps, adapting our programs to address these diseases wherever they appear.
Capital: The recent aid cut from the US raises concerns about your future. To what extent will it affect you, and how do you plan to address these cuts?
Solomon: As I mentioned earlier, we don’t directly receive US government aid. We pool philanthropic and individual donors fund and leverage other corporate partnership opportunities. When the US government cuts took effect, we felt the impact to the ecosystem and the strain on the opportunities to leverage US government aid programs. Our partnerships are built on symbiotic relationships across programs and resources. When their programs face challenges, our capacity for effective delivery and record collective impact is also compromised. Our efficient and effective delivery model is based on leveraging all opportunities to collaborate and stretch resources.
Capital: How do you plan to cope with these challenges?
Solomon: The broader community has recognized the need to prioritize the most critical issues, given that the reported deficit in overseas development assistance ranges from $41 to $60 billion—an amount no single entity can cover. In discussions with the broader NTD community, we have focused our immediate attention to first ensure that the donated drugs in our pipeline or in country ready for distribution do not expire and are delivered to the intended populations. Additionally, any planned surveys that aid our programming need are carried out. We have categorized our needs into urgent priorities and a longer-term programming.
The long-term plan, as discussed in yesterday’s panel, will require innovative thinking and programming to bridge this gap. This will includes exploring greater efficiencies in local member states budget allocation and use. There are various strategies to consider and it will need to be contextualized. We are currently in the early stages of analyzing the full impact of these cuts and understanding the resulting shortfalls.
Capital: As their name suggests, these are neglected tropical diseases, which often do not receive government attention. How do you plan to address this issue?
Solomon: Neglected tropical diseases situation (NTDs) have recently become more mainstream, and this is encouraging. There seems to be a growing momentum around this issue. Yesterday, during the panel, I mentioned that it’s difficult to dismiss the financial commitments governments have already made. The focus now should be on how we can implement programs more efficiently in addition to securing additional funding. This conversation with shouldn’t be just about allocating more money. It should look at efficiency gains.
If we leverage existing structures effectively, we can better look at better integrating NTD initiatives within current systems. Addressing these diseases doesn’t require a separate track; we can utilize the same supply chains, same community health workers, and pharmaceutical resources already in place. If the system functions well, it will also have to include multisectoral programming in matters such as water and sanitation, Education, public health mindsets, and elimination of harmful hygiene practices.
Creating good hygiene practice awareness and availing clean water access is crucial. By improving access to clean water and sanitation, we can resolve a significant portion of some of the persistent issues we face. The deworming medications we provide are administered at a cost of just 50 cents per treatment per year, representing an excellent return on investment. Combined with access to clean water and sanitation interventions these diseases elimination trajectory could have a compounded impact. It requires better resource allocation, better coordination and trusted and sustained partnerships.
Capital: How do you plan to engage policymakers and the government to focus more on these diseases?
Solomon: Most governments already allocate resources and I know there are designated coordinator for all neglected tropical disease programs but they are chronically underfunded to reach elimination goals,. However, if effectively coordinated could require a lot less direct in investment of large amount of resources.
For example, while drug delivery already leveraged community health workers, these interventions need to be accompanied with communities’ having access to improved and reliable water and sanitation to prevent reinfection, especially as we aim to eliminate diseases. Ultimately, if our goal is elimination, unlike chronic conditions management such as hypertension or diabetes, which persist indefinitely, our focus will need to be laser focused on more effective collaboration, a clear division of labor, elimination of duplication and wastage. A function that is best suited for governments. If we are able to reach that state, we can aspire to frontload our collective efforts and I don’t see why we can’t reach our elimination goals even sooner that the milestones we have set forth.
Capital: I’m returning to the topic of aid cuts. During periods of reduced aid, neglected tropical diseases (NTDs) haven’t received sufficient attention from the government. How do you plan to address this issue?
Solomon: At this point it’s really about prioritization. We are currently undertaking a continent-wide disease burden mapping exercise to best appreciate the size of the remaining task and what resources will be needed while also recognizing that there will not be a separate track for NTDs funding and there will be gaps such like the rest of the entire health sector.. But we will have l progressed and costed the gap to be able to have one single agreed upon data sheet to program from whatever the funding source is. So, we will actively be monitoring what can be supported and sadly what will need to be cut. We recognize that NTDs will not be immune to these challenges much like other programs, including nutrition, family planning, and maternal and child health, etc, will be affected.
Capital: Africa has a deeply rooted culture of giving. How do you plan to navigate that?
Solomon: The ongoing discussions at this conference emphasize the need for member states and citizens to take responsibility for their health, economy, and overall well-being. As such, we need to develop a inclusive and complementary strategy focused on engaging individuals and organizations with the capacity of making contributions to impact the NTD situation of their respective country or region.
The current aid situation serves as an undeniable opportunity to rethink the model. We must begin to redesign our approach. Private companies will need to take a more of active role, and governments should facilitate better and more efficiently public sector processes to support a more robust private sector enabling environment. Discussions at various panels have addressed eliminating poor and illegal practices and exploring innovative approaches to sustainable development.
There are significant opportunities here, and the idea is to share the burden rather than outsourcing African problems to the rest of the world. NTDs elimination is no different than any other health sector interventions. It will need to adopt the resounding theme of solving inequities in partnership with any foreign assistance. Maximizing limited resources with deep rooted community involvement and ownership.
Capital: This has been discussed for many years, and the situation remains unchanged. Are you hopeful that it will improve?
Solomon: Well, being hopeful is necessary. I’m always hopeful because the incentive to change has never been greater. And I believe in the inherent quality of humanity. The situation now does not offer much choices and it could be the variable that would change the status quo. We have a new reality that we will need to internalize it.
Therefore, we must rethink our approach. As I mentioned earlier, it’s not just about adding more money; it’s equally about being more efficient. I believe that countries will need to reassess their national budget allocations to determine the most efficient and effective ways to proceed as we will effectively have money to go around but it shouldn’t be grounds for coming undone.
Capital: Will you be successful in ending it by 2030?
Solomon: I remain steadfast to reaching our goals. We’ve faced many challenges, including the UK’s Foreign, Commonwealth & Development Office (FCDO) withdrawal some years back and the recent US government decision on ODA but we will continue to leverage partnerships, add even more rigor to our approach and look forward to seeing as many countries as possible to cross the finish line. A fact to be celebrated is that out of the target of 100 countries that would have eliminated at least one disease by 2030, 57 countries have already reached that milestone. Our north star remains the elimination of all of the six diseases.
Capital: Anything to add?
Solomon: We discussed earlier that these diseases exist because they were neglected. They are ancient diseases that the rest of the world has effectively eradicated. There are proven methods of effective service delivery for disease elimination; we don’t need to reinvent the wheel. We just need to stay the course and support what are undeniable extremely resilient communities beat these odds once and for all and restore dignity, improve economic standing and offer a chance to better life outcomes.
We already have countries that are already making strides; for instance, Niger celebrated the elimination of river blindness this past April, while Senegal, Kenya, and Ethiopia are also making significant progress in reducing their burden of soil-transmitted helminths. We are truly making progress through partnership and leveraging existing resources and efficiencies. But we also need greater participation of African citizens with means and African governments to play a more significant role in determining the future of the continent and in this case eliminating these diseases to restore dignity, hope and close the inequity gap often determined by simply where you were born.
Shortly after this interview with Dr. Solomon Zewdu, Mauritania achieved validation from the World Health Organization (WHO) for eliminating trachoma as a public health problem. The END Fund commends this milestone and reaffirms its commitment to supporting African nations in replicating such successes across the continent through its current philanthropic collaborative pooled funding model and locally-led efforts and sustainable investments.
