Bringing elimination within reach
How science and solidarity are ending neglected diseases
The mangrove forests of Guinea provide a livelihood for hundreds of thousands of people along the coast of this small country, but they are also fertile breeding grounds for the tsetse fly, which can transmit sleeping sickness. Historically, Guinea was the country in West Africa most affected by this parasitic disease, which causes devastating neurological symptoms and is almost always fatal if left untreated.
But over the past few decades, an incredible success story in public health has been taking place in the most remote areas of these coastal wetlands. Guinean scientists with their international partners have been working hand-in-hand with mangrove communities to tackle the tsetse fly, raise awareness of the disease, and identify then treat patients in the most remote parts of the vast mangroves.
In January 2025 this story made it to the global stage. The World Health Organization (WHO) officially recognized Guinea as having achieved the elimination of sleeping sickness as a public health problem. This achievement was doubly impressive, having taken place only a decade after the 2014-2016 West African Ebola outbreak devastated the national health system. How was it done?
Teams from Guinea’s National NTD Control Programme and Institut de Recherche pour le Développement (IRD) controlled fly populations by spreading thousands of tiny insecticide-treated traps through swamp canals. Civic leaders and health professionals have also spread awareness – conducting door-to-door visits and radio outreach to encourage early testing and build trust in communities. Screening campaigns and simple rapid diagnostic tests have helped ensure prompt access to treatment and quell onward transmission.
For years, efforts to control the disease have been hampered by treatments that are toxic and complex to administer – and often inaccessible to those most at risk, especially in remote and hard-to-reach communities.
Simpler, safer sleeping sickness treatments developed by DNDi and partners have also played a critical role in Guinea’s elimination journey. Today, we are proud to be partnering with researchers from Guinea and other endemic countries as we complete clinical trials of acoziborole, a single-dose cure in development with our longstanding pharmaceutical partner Sanofi (read more). Seen by many experts as the critical tool needed to sustainably eliminate sleeping sickness, it will allow medical teams to quickly treat small, isolated outbreaks of the disease, even in remote and hard-to-reach settings.
Mamadou Léno (in pink), known simply as Blo, leads a sleeping sickness screening initiative in Siboti, a fishing village in Guinea. A technician nurse and laboratory activity lead for DNDi clinical trials, Blo has treated sleeping sickness patients since 1987. For much of his career, a toxic arsenic-based drug was the treatment option but now he is thrilled to have oral treatments to give to his patients – a dream he helped realize.
But as we celebrate our shared progress, we must also recognize what history has shown: sleeping sickness and other NTDs can resurge when attention wanes. Continued vigilance and medical innovation are critical to sustaining gains and advancing the elimination agenda.
Visceral leishmaniasis (VL), another deadly parasitic disease, is among the numerous NTDs whose characteristics make them suitable targets for elimination. In South Asia, incredible strides against the disease have already been made: Bangladesh achieved VL elimination in 2023, and India looks on track to follow suit thanks to robust training programmes, effective awareness campaigns, tireless advocacy, and evidence for improved treatments generated by DNDi and partners.
We are working to help safeguard South Asia’s success against VL by supporting a growing network of Centres of Excellence (CoEs) across the region. Managed by health authorities, these hubs have trained thousands of healthcare professionals: with fewer and fewer cases, sustained training on VL testing and treatment is key to keeping resurgence at bay. The centres have also conducted crucial research and designed operational strategies tailored to local contexts to help communities stay vigilant and keep patients linked to care.
In Eastern Africa, similar momentum against VL is building. In July 2024, a historic regional framework for the elimination of VL was launched, outlining the essential pillars for success, including cross-border collaboration, strengthened surveillance, and sustained investment. Bold national commitments were formalized at the World Health Assembly in May 2025, with the signing of a landmark Memorandum of Understanding among endemic countries.
DNDi is working to match countries’ leadership and resolve to eliminate NTDs by keeping laser-focused on delivering simpler, safer, more effective treatments still needed to get the job done. This includes our work with partners to develop a very promising new treatment candidate, LXE408, now advancing in Phase II clinical trials in India and Ethiopia (read more). If successful, it could prove a powerful tool for efforts to eliminate VL across dozens of endemic countries.
But while progress is accelerating for affected countries and their allies in science, the risks are, too. Just as climate change threatens to upend decades of progress in global health (read more), so do complacency, shrinking global attention, and crippling cuts in donor funding for NTD programmes. The global community must stand with endemic countries in continuing to fund medical innovation, strengthen research and healthcare capacities, and ensure access to new health tools for everyone affected.
Guinea’s triumph over sleeping sickness and Bangladesh’s success against VL prove that the world can defeat diseases that have persisted for centuries with the right tools, strong partnerships, and enduring commitment.
Elimination is not a final destination – it’s a fragile status that must be maintained through unceasing attention and relentless pursuit of scientific progress. And in the quest to eliminate neglected diseases, innovation is not a luxury – it’s a necessity. We are grateful to all of our partners and supporters who stand with us in helping to ensure that, with solidarity, science, and perseverance, even the most neglected diseases can be consigned to history.
More 2024 highlights:
Photo credits: Thoko Chikondi-DNDi; Brent Stirton/Getty Images
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