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Reversing the World’s Neglect of Easily Cured Tropical Diseases

• May 18, 2012 • 5:00 AM

Dr. Peter Hotez, president of the Sabin Vaccine Institute, implores the leaders of the G8 countries to focus on an easy and relatively cheap way to save more than one billion people from neglected tropical diseases.

We have the capacity, and the duty, to eliminate neglected tropical diseases (a leading cause of preventable global disease and poverty). An audacious elimination campaign could be implemented at a surprisingly low cost by global leaders starting this weekend when they meet at the 38th G8 Summit at Camp David. This is an opportunity to help millions of poor people with simple, concrete measures.

The 17 neglected tropical diseases defined by the World Health Organization represent the most common afflictions of the “bottom billion”–the poorest people in Africa, Asia, and the Americas. These diseases include ancient scourges such as schistosomiasis, hookworm, elephantiasis, river blindness, leprosy, trachoma, and yaws. Each has plagued humankind for centuries and is responsible for massive burdens of chronic malnutrition, inflammation, disfigurement, pain, and stigma. Yet for many people living in G8 countries, which are the world’s eight largest economies, these diseases are rarely, if ever, included in discussions related to global health and development.

Recent information I presented in the journal Vaccine points to these diseases as a key underlying reason why the bottom billion cannot escape the cycle of poverty. For example, chronic hookworm infection and anemia in childhood impairs physical and mental development and as a result, reduces future wage earning by almost one-half. Elephantiasis renders subsistence farmers too ill to go to work, causing a billion dollars in lost productivity in India alone. Schistosomiasis produces ulcers in the genital tracts of African girls and women that result in horrific pain, bleeding, depression and a three- to four-fold increase in their risk of acquiring HIV/AIDS.

More than 600 million people are infected by hookworm; schistosomiasis is the second leading parasitic killer after malaria, infecting 400 million worldwide and killing more than 200,000 annually. At the geopolitical level, these diseases can destabilize countries, leading to greater upheaval and potential extremism in fragile states.

The good news is that over the last two decades great strides have been made in eliminating many of these public health problems. Guinea worm is on the verge of eradication; elephantiasis has been eliminated in 22 countries, and trachoma in 11, through mass treatment programs using medicines donated by major pharmaceutical companies or low-cost generics; Leprosy has been eliminated in 119 out of 122 previously endemic countries; schistosomiasis has been eliminated in three countries and several Caribbean islands; sleeping sickness is no longer reported in 16 African countries; river blindness is no longer present in Senegal and Mali.

These victories were achieved at astonishingly modest costs—about 50 cents can treat and protect one person against the seven most common neglected tropical diseases for an entire year.

The World Health Organization estimates that in 2010, some 700 million people in 74 countries received treatments for these diseases. But there’s more to be done. It was an exciting moment when, in January 2012, we saw a renewed commitment to these efforts through the “London Declaration” — when pharmaceutical companies, donor governments, and NGOs committed to meeting the 2020 neglected tropical diseases elimination goals outlined by the World Health Organization.

The G8 is the place to start to achieve this goal. If the United States, the United Kingdom, and the other members maintain or expand their existing commitments for mass treatments, it will provide a great example to other donor countries to prioritize this global problem.

Certainly this will require hundreds of millions of dollars in investments, but that is still far less than the billions we currently invest in prevention and treatment for HIV/AIDS or other conditions—and the impact is just as significant.

But donor governments can’t be the only ones committed to controlling these diseases. Emerging market economies—especially China, which is investing billions of dollars in Africa— must also begin to contribute to global neglected tropical disease elimination efforts. Nations such as Brazil, India, Mexico and Nigeria, where the single largest concentration of some of these diseases occurs, have the financial mechanisms to tackle some of their own disease problems.

Finally, we need a global research and development fund to invest in improved drugs and a new generation of “antipoverty vaccines” to prevent some of these diseases—Buruli ulcer, Chagas disease, schistosomiasis, hookworm, leishmaniasias—that can’t be eliminated by mass treatments alone, along with more insect control and greater access to potable water and sanitation.

We have been neglecting the world’s poorest people by ignoring the simple, affordable solutions we have to alleviate the suffering. This G8 Summit should launch a new global effort to eliminate neglected diseases of poverty. For well less than $1 billion annually over the next decade, G8 nations, together with governments of endemic countries, can eliminate the leading neglected tropical diseases as a public health threat by 2020.

Peter Hotez
Peter Hotez. M.D. P.hD., is dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas Children’s Hospital Endowed Chair of Tropical Pediatrics, and director of the Texas Children’s Hospital Center for Vaccine Development.

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