Recommendations for Safely Restarting MDA for NTDs in Settings with Heightened Risk of COVID-19 Community Transmission

The following are recommendations and best practices to consider when developing plans for safely restarting mass drug administration (MDA) campaigns in the context of COVID-19. This document is meant to supplement WHO’s guidance note entitled, Considerations for implementing mass treatment, active case-finding and population-based surveys for neglected tropical diseases in the context of the COVID-19 pandemic,1 released on 27 July, 2020.

This document should only be used after a thorough COVID-19 risk-benefit assessment (including assessment of community acceptance and readiness) has been completed and the decision has been made to proceed with MDA. Considerations for a risk-benefit assessment can be found in the WHO guidance cited above.

These recommendations were designed for settings that are potentially at higher-risk of community transmission of COVID-19, with limited testing capacity and availability of reliable surveillance data. Countries experiencing these conditions may opt for a more conservative approach to resumption of MDA, as reflected in this document. In order to minimize potential risks in these settings, the recommendations were developed with two key principles in mind.

First, that an absence of cases in a region or village does not necessarily indicate absence of risk of COVID-19 transmission. As such, mask wearing (as well as other appropriate Personal Protective Equipment [PPE] and proper hand hygiene) should be mandatory during all activities that involve person-to-person interactions.

Second, that the COVID-19-related risks associated with an MDA at a fixed location are greater for community members than MDA conducted house-to-house. House-to-house MDA is therefore prioritized in the considerations below. These recommendations are not meant to serve as a comprehensive standard operating procedure, but rather should supplement existing NTD/MDA SOPs so that they can be adapted for the local setting, both in terms of the NTDs being targeted and the COVID-19 situation. In particular, social mobilization strategies and communication messages will need to be crafted based on the context in which the MDA will take place.