Perspective Piece Integrating Neglected Tropical Disease and Immunization Programs: The Experiences of the Tanzanian Ministry of Health

Global health practitioners are increasingly advocating for the integration of community-based health-care platforms as a strategy for increasing the coverage of programs, encouraging program efficiency, and promoting universal health-care goals. To leverage the strengths of compatible programs and avoid geographic and temporal duplications in efforts, the Tanzanian Ministry of Health and Social Welfare coordinated immunization and neglected tropical disease programs for the first time in 2014. Specifically, a measles and rubella supplementary vaccine campaign, mass drug admin- istration (MDA) of ivermectin and albendazole, and Vitamin A were provisionally integrated into a shared community- based delivery platform. Over 21 million people were targeted by the integrated campaign, with the immunization program and MDA program reaching 97% and 93% of targeted individuals, respectively. The purpose of this short report is to share the Tanzanian experience of launching and managing this integrated campaign with key stakeholders. The neglected tropical diseases (NTDs) contribute to extensive disease and disability globally. The United Republic of Tanzania is endemic for all five NTDs for which preventive chemotherapy via mass drug administration (MDA) is standard of care. In 2013, over 40 million Tanzanians required MDA for onchocerciasis, lymphatic filariasis (LF), soil-transmitted hel- minths (STHs), schistosomiasis, or trachoma. 1 The proportions of the population targeted and successfully reached by MDA campaigns in 2013 were 99%, 86%, 64%, 56%, and 82% for onchocerciasis, LF, STH, schistosomiasis, and trachoma, respectively (Ministry of Health (MOH), unpublished data). Integration of NTD programs may be an effective strategy for reaching global NTD control and elimination benchmarks, the given evidence suggesting that NTD integration is associated with increased coverage and reduced costs. 2-4 Vaccination campaigns delivered according to the Expanded Program on Immunizations (EPI) schedule have consistently attained high coverage in Tanzania due to the availability of funding from the Gavi Vaccine Alliance and the launch of the Reaching Every Child approach. EPI services in Tanzania target children under 24 months of age with a nine-vaccine package, and in 2011, EPI programs integrated the distribu- tion of mebendazole to children under 5 years of age for STH control. Some vaccine-preventable illnesses such as measles and rubella (MR) require supplementary campaigns every 3 years to ensure that epidemics do not occur in areas with low coverage or inadequate seroconversion rates. Although experts suggest that NTD programs consider coordinating with other community-based public health pro- grams to maximize coverage and efficiency, community-wide MDA and EPI campaigns typically operate independently. 5,6