Nigeria’s campaign against neglected tropical diseases is facing mounting pressure as drug shortages, donor exits and funding gaps threaten decades of progress, leaving more than 100 million Nigerians at risk.

As the world marks World Neglected Tropical Diseases Day, health experts warn that the country’s elimination drive stands at a crossroads. Although Nigeria has eradicated Guinea worm and recorded major reductions in trachoma and lymphatic filariasis, insecurity, weak primary healthcare integration and restrictive import policies are slowing momentum.

Nigeria remains one of the highest burden countries globally. Of the 21 neglected tropical diseases listed by the World Health Organisation, 15 are endemic in the country, with all states and the Federal Capital Territory affected by at least one disease. The infections, which thrive in communities marked by poverty, poor sanitation and limited access to clean water, continue to trap families in cycles of disability and deprivation.

Despite life-saving medicines being donated free of charge by international pharmaceutical companies, regulatory bottlenecks are creating shortages. Some essential medicines, including Mebendazole, Albendazole and Praziquantel, are listed on the import prohibition ceiling of the National Agency for Food and Drug Administration and Control, which seeks to promote local manufacturing. Health officials say there is currently no budgetary provision to procure these medicines locally, leaving programmes stranded.

Chairperson of the International Federation of Anti-Leprosy Associations and National Director of The Leprosy Mission Nigeria, Dr Sunday Udo, said elimination cannot rely solely on mass drug campaigns.

He said beyond preventive chemotherapy, diseases such as lymphatic filariasis and onchocerciasis, Nigeria still records a significant burden of case-managed diseases, including leprosy and Buruli ulcer, where success depends on early diagnosis, stigma reduction and strong routine services.

He emphasised that achieving the 2030 elimination target requires a “whole of government, whole of society” approach, with predictable domestic financing at federal and state levels and dedicated budget lines for neglected tropical diseases.

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Udo warned that delays in accessing leprosy multi-drug therapy in 2024 due to regulatory bottlenecks disrupted treatment and risk recurring. “There is weak routine health system integration, and NTDs still depend largely on campaign mode, whereas elimination requires strong routine Primary Health Care, laboratory support, referral systems, and community health worker networks,” he said.

He added that without sustained improvements in water and sanitation, reinfection will continue, particularly for intestinal worms and schistosomiasis. “Stigma and late presentation, particularly for skin NTDs such as leprosy, delay care seeking, increase disability risk, and undermine contact management.”

Country Director of Sightsavers, Prof Joy Shu’aibu, said Nigeria accounts for about a quarter of the global NTD burden and roughly half of Africa’s burden. She noted that one in three Nigerians is affected by at least one of the diseases.

She explained that while treatment campaigns are conducted regularly at no cost to beneficiaries, insecurity has made assessments and drug distribution difficult in several states. “For the past four years, we have been exploring the safest ways to conduct assessments in 14 LGAs in Zamfara to enable the country to make decisions on stopping long-term treatment for elephantiasis in the state, but this has not been feasible due to the volatile security situation,” she said.

She added that new policies restricting the importation of donated medicines have far-reaching implications for sustaining gains, alongside dwindling donor funding following recent cuts.

National Coordinator for NTDs at the Federal Ministry of Health and Social Welfare, Dr Fatai Oyediran, said controlling the diseases is critical to achieving Sustainable Development Goal Three and breaking the cycle of poverty.

“We also noticed that Nigerians who are at risk or exposed number over 100 million. To worsen the situation, there is what we call co-endemicity; the existence of more than one disease in a single person,” he said.

On misconceptions surrounding the diseases, he added, “Some people believe that enlarged legs, breasts, or scrotum are inflicted by witches. Whereas elephantiasis is caused by mosquitoes and river blindness by blackflies, some people still say it is witchcraft.”

Oyediran acknowledged progress, noting that more than 30 million Nigerians have exited treatment programmes and that the country has achieved major reductions in lymphatic filariasis and trachoma. However, he warned that unless funding gaps are closed, medicine supply chains are stabilised, and services are embedded into routine primary healthcare, Nigeria risks reversing hard-won gains and missing its elimination targets.

Meiza Nigeria