Neglected Diseases Take the Spotlight
February 29, 2012
Written by Alisha Kramer
Imagine: a mosquito bite that leads to a lifetime of disfigurement and chronic pain, a swim in a lake that results in the slow, permanent loss of eye sight, or a game played on a dirt road that puts a young child at risk for anemia and impaired growth and cognitive development.
That mosquito transmitted a parasitic worm that caused elephantiasis—a painful and debilitating swelling of limbs. That unassuming gulp of water from the lake contained a roundworm that led to river blindness, and the child playing in the dirt ingested a parasite—a soil-transmitted helminth—that significantly impeded healthy development.
These are a few of the many neglected tropical diseases (NTDs) that afflict individuals around the world. They are primarily parasitic and bacterial infections spread by insects, contaminated water, and soil infested with the eggs or larvae of worms. Diseases with obscure names like dracunculiasis, schistosomiasis, and leishmaniasis are responsible for a host of painful and dangerous symptoms—skin ulcers, blindness, limb deformities, chronic pain, and lesions to internal organs.
According to the World Health Organization (WHO), there are still 149 countries and territories where NTDs are considered native. One hundred of these countries are native, also termed endemic, for two or more NTDs, while thirty countries are endemic for six or more diseases. This burden equates to over one billion people affected by NTDs, 500 million of whom are children.
Beyond their impact on the health of individuals and communities, NTDs also impede economic development: it is estimated that de-worming could raise per-capita earnings in Kenya by 30 percent, and in India, the control of elephantiasis could add$1.5 billion to the country’s annual GNP. Global NTD control could increase worker productivity and add hundreds of billions of dollars to developing economies. With treatments as cheap as 50 cents per person per year and a return on investment estimated at 15-30 percent, NTD treatment is financially feasible and cost-effective.
Why then have these diseases been neglected?
Although medically diverse, NTDs share an association with poverty. They are primarily found in the heat and humidity of tropical environments and, due to their modes of transmission, are less likely to be found in wealthier, industrialized nations. Instead, they usually affect remote rural areas or urban slums and shantytowns; they afflict communities that lack political power and the resources to prevent and treat infections. In the United States, where the threat of NTDs is negligible, NTD treatment has taken a back seat on the policy agenda.
Existing, inexpensive NTD treatments face delivery challenges: a lack of political will, an absence of substantial financing, and weak health care systems prevent them from reaching the “bottom billion.”
In addition, NTDs must compete with higher-profile diseases such as HIV/AIDS, malaria, tuberculosis, and polio—a challenge reflected not only in national and international health programs but also in the minimal research and development activities devoted to NTD treatment and elimination.
Perhaps, however, an end to NTDs is in sight.
The London Declaration on NTDs, announced on January 30th 2012, may mark the beginning of a new era in which these neglected diseases share the spotlight. The London Declaration calls for the eradication, elimination, and control of many NTDs, with target dates set for the year 2020.
The declaration represents a coordinated effort involving the WHO, 13 pharmaceutical companies, the U.S., UK and UAE governments as well as the Bill and Melinda Gates Foundation, and other global health organizations. It calls for ambitious targets to reduce the burden of NTDs by 2020; through increased financial support, free or low cost distribution of drugs supplied by pharmaceutical companies, and a new, more collaborative system for sharing research and programmatic information.
To this end, pharmaceutical companies will donate 1.4 billion treatments per year, USAID will put $89 million towards drug delivery and distribution, and the Gates Foundation will contribute $363 million to a combined $785 million for the fight against NTDs over the next eight years.
Pharmaceutical companies and research institutions will also allow unprecedented access to databases of research compounds, knowledge, and expertise in an effort to fast-track drug development.
U.S. efforts to tackle NTDs in earnest began in 2008 when former President George W. Bush announced a NTD initiative that promised $350 million over the following 5 years. The initiative sought to increase U.S. commitment to NTDs, deliver integrated treatment to roughly 300 million people, and expand the number of target countries receiving aid from 10 to 30 by 2013. President Obama continued to ramp up the fight by requesting $155 million for NTDs in FY 2011—the largest presidential request for NTDs at the time—and $100 million was appropriated by the Senate.
There are grounds for optimism. In the last 20 years, cases of Guinea worm disease have declined by more than 99%. Elephantiasis has been successfully eliminated in China and Korea. River blindness has been eliminated in ten West African countries, and blinding trachoma has been eliminated in Iran, Mexico, Morocco, and Oman.
None of this, however, reduces the urgency of the London Declaration; seven hundred million people are still at risk of acquiring snail fever, forty million people are still in need of treatment for trachoma, and NTDs still kill an estimated 534,000 people every year.
Now, with funds flowing in, commitments made, and targets set, it is time to see if the London Declaration can achieve its ambitious goals.