Managing uncertainty and complexity during a public health emergency: Understanding the immediate and ongoing effects of the COVID-19 epidemic on a global Neglected Tropical Disease program

When COVID-19 emerged as a global pandemic, the World Health Organization (WHO) recommended a pause in the delivery of neglected tropical disease preventative chemotherapy and surveillance. The Act to End NTDs | East program (Act | East) worked with country neglected tropical disease (NTD) programs to develop, support, and implement guidelines that allowed NTD service delivery and surveillance to resume. This paper examines those adaptations that Act | East made as a program to support numerous countries, over a discrete time period, to resume NTD program operations. This paper also examined how the pause and the resumption of service delivery with new guidelines and standard operating procedures in place affected program operations. Specifically, we examine delays in scheduled mass drug administration and disease surveys, coverage achieved by resumed mass drug administration campaigns, and the impact that COVID-19 had on planning and budgeting. We review which adaptations have been retained in a post-COVID-19 landscape, and which may inform NTD and other global health programs, to better respond in future public health emergencies.