Neglected Tropical Diseases Require a Parallel Approach: Treatment and Research

Caitlin Cotter, DVM, MPH

Neglected Tropical Diseases (NTDs) affect over one billion of the world’s poorest people, impairing families’ health, nutrition, cognition, and even productivity at work. These parasitic and bacterial infectious diseases broadly threaten education as well as social, emotional, and physical health. The NTDs include lymphatic filariasis, trachoma, river blindness, schistosomiasis, hookworm and other intestinal worms, Chagas disease and African sleeping sickness, among others. According to the CDC, over 500,000 people die from NTDs across the globe each year, and all low-income countries suffer from at least five of these diseases simultaneously.

Dr. Peter Hotez, Dean of Baylor College of Medicine’s National School of Tropical Medicine and President of the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, explained, “NTDs promote poverty and cause poverty and reinforce poverty because they have long term deleterious effects on child development and intellect, long term consequences on pregnancy outcomes and the health of girls and women, and they make people too sick to work. The most direct approach and one of the most cost effective ways of lifting people out of poverty is to prevent their NTDs.”

According to Dr. Hotez, along with the devastating disabilities, economic losses, social stigmas and health damages that NTDs present, they also work collectively to worsen chronic diseases. “NTDs have a lot of collateral effects on other groups of diseases. For example, schistosomiasis has been shown to be a major cofactor in Africa’s AIDS epidemic. Female genital schistosomiasis has been linked to a 4-fold increase in HIV/AIDS transmission, and this is not a rare disease. Female genital schistosomiasis is actually the most common gynecological condition in Africa; more than 50 million girls and women suffer from it.”

“Neglected Tropical Diseases have been the most common afflictions of people living in poverty within the poorest countries of Africa and Asia,” Dr. Hotez confirmed, “but now we’re finding quite a lot of NTDs among the poor in G20 countries, including Southern Europe. The poor living among the wealthy now account for most of the NTD infections in the world. The United States has to recognize we have 12 million Americans living with an NTD, and we’re doing very little for them right now.”

END7, an advocacy campaign of the Sabin Vaccine Institute, has been raising awareness and funds to expand NTD treatment programs. This global effort to distribute donated medications to entire communities reached more than 978 million people last year. “This is one of the largest public health interventions known, and it has the potential to eliminate certain NTDs like lymphatic filariasis, trachoma, and river blindness,” Dr. Hotez asserted.

“According to the World Health Organization, we have reached about half of the people in the world who need these treatments. We still need to scale up,” said Dr. Hotez. “The other important message is we need to expand the use of these existing interventions while in parallel doing research and development for new and improved control tools, diagnostics, drugs and vaccines. You have to do both. If you do just one without the other, the impact will be far less.”

The medicine used by END7 to treat these most common NTDs has been donated, so treatments cost less than 50 cents per person per year. Implementation of this intervention, recommended by the World Health Organization, has been accepted worldwide. “But when you tell people we also need parallel research and development, somehow that seems like an inconvenient truth,” admitted Dr. Hotez. “For every major disease out there, even if we have one intervention, that doesn’t mean we can stop there. We’ve already learned the lesson that when we do stop there, we pay the price. Back in the 1960s, the World Health Organization said they were going to eradicate malaria using chloroquine and DDT. At that time, these medications looked pretty good, but then resistance developed to both and we lost ground. This is a wake-up call that we always need to have that parallel, two-system approach to maximize the use of existing interventions but keep that R&D pipeline going.”

Caitlin Cotter is the Science and Policy Fellow at Research!America.

This blog post is part of a series focusing on different aspects of public health in recognition of Public Health Thank You Day, held each year on the Monday before Thanksgiving. Visit www.publichealththankyouday.org for more information, and join us on social media using the hashtag #PHTYD.

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