How the world’s biggest medicine delivery effort is being rebuilt to eliminate neglected diseases

In 2025, the global system delivering medicines for neglected tropical diseases reached a turning point, as WHO and its partners shifted from reactive drug donations to data-driven, country-led supply chains. Despite digital and planning advances, delays, funding shocks and logistics gaps continue to threaten progress toward eliminating these diseases by 2030.

In 2025, one of the world’s least visible but most ambitious public health efforts reached a moment of reckoning. Led by the World Health Organization (WHO), with research and technical collaboration from institutions such as the University of Oslo and support from pharmaceutical companies including Novartis, Bayer, Merck, Sanofi and GlaxoSmithKline, the global system that delivers medicines for neglected tropical diseases (NTDs) began to confront the limits of its own success. Since 2011, more than 31 billion tablets and vials have been sent to endemic countries, with almost 1.5 billion delivered in 2025 alone. What started as a humanitarian donation effort has evolved into one of the largest and most complex medicine supply chains in global health.

From donations to a global supply chain

Today, WHO manages donations of 18 medicines from 10 manufacturers to treat 11 neglected diseases, ranging from schistosomiasis and lymphatic filariasis to leprosy and trachoma. The goal is simple: ensure people in the world’s poorest regions receive safe, effective medicines on time. But as volumes increased, the system became harder to manage. Delays at ports, inaccurate population data, funding gaps and weak coordination can result in medicines arriving too late or expiring unused. In some countries, an abundance of paper has translated into shortages on the ground.

Fixing the bottlenecks in medicine requests

A major pressure point is the annual process through which countries request medicines for mass treatment campaigns. In 2025, the WHO received 61 joint requests for drugs planned for use in 2026, most of them from Africa. By the end of the year, fewer than one-third had been fully approved. Incomplete paperwork, weak demographic data and uncertainty over financing slowed approvals. To fix this, WHO introduced a digital tracking dashboard that sharply reduced approval times in pilot countries, cutting delays from several months to just weeks. While approval rates improved in 2025, preparedness for 2026 dropped, revealing how fragile planning remains.

Planning ahead instead of reacting

For years, NTD programmes relied on one-year planning cycles, reacting to immediate needs rather than anticipating future demand. In 2025, the WHO and its partners introduced a three-year forecasting tool that allows governments and manufacturers to see medicine needs well in advance. This shift helps prevent stock shortages, avoids overproduction and gives donors more time to commit funding. It also aligns medicine supply with long-term disease elimination goals, rather than short-term campaign schedules.

At the same time, WHO is pushing for stronger country leadership. Health ministries are being encouraged to run national coordination groups that bring together government officials, WHO country offices, donors and implementing partners. These groups jointly prepare medicine requests and oversee distribution plans. Early results show fewer errors, better data and stronger accountability, while helping embed NTD programmes within broader health systems.

Digital tools reach the last mile

Technology is playing a growing role in strengthening the weakest link in the supply chain: last-mile delivery. In partnership with the University of Oslo, WHO developed a new logistics module within the District Health Information Software 2 platform. This tool allows health officials to track medicine stocks, expiry dates and distribution in real time and links directly to national health information systems. When piloted in 2026, it is expected to reduce waste and stock-outs. WHO also introduced standardized logistics indicators in 2025, giving countries clearer tools to manage inventories and improve transparency at the community level.

Progress, setbacks and the road to 2030

There have been notable successes. WHO secured sustained funding from Novartis for single-dose rifampicin to prevent leprosy, enabling long-term planning and wider rollout. Sixteen medicines for neglected tropical diseases are now prequalified by WHO, ensuring quality and safety. At the same time, challenges persist. Customs delays in several African countries continue to raise costs and risk expiry. New regulations prioritizing local drug manufacturing have slowed the clearance of donated medicines in places like Nigeria. In Uganda, millions of tablets are at risk of expiring due to postponed campaigns. The sudden suspension of USAID-funded activities in 2025 disrupted programmes across multiple regions, while shortages of trained logistics staff undermine continuity.

Despite these obstacles, 2025 marks a clear shift. The global fight against neglected tropical diseases is moving away from reactive logistics toward proactive, data-driven and country-led systems. Whether this transformation can be sustained will determine if the world meets its goal of eliminating these diseases by 2030, or once again leaves the most neglected communities waiting.