SEATTLE — While HIV/AIDS, tuberculosis, and malaria are often the focus of global health and development agendas, another group of 17 diseases, collectively referred to as Neglected Tropical Diseases (NTDs), take a back seat to those deadlier ailments.
However, despite the fact that NTDs are less harmful than AIDS and malaria, they are far more widespread, affecting an estimated one in six people on the planet.
And though they are not as deadly, NTDs can cause disfigurement, blindness and other disabilities which prevent the ill from contributing to the economy, living full lives, and costing an incalculable amount of money in recurring health expenses.
Among the most common of these debilitating diseases are sleeping sickness, Chagas, river blindness, leprosy, elephantiasis, bilharzia and various intestinal worms. The fact that most of these are easily and inexpensively curable reveals the shortcomings of efforts to treat them thus far.
Recently, the third progress report on the London Declaration on NTDs was aimed at addressing these shortcomings and creating strategies to better treat tropical diseases.
Among the main points of the report was an estimation that every $1 invested in treating NTDs would yield $50 to $200 in increased productivity and reduced healthcare costs by 2030, amounting to a total of $623 billion.
While it’s difficult to assess the validity of that claim, the report describes several reasons to be optimistic about an eventual solution. It only costs about 50 cents per person per year to effectively treat the seven most common NTDs, making it much less expensive than treating many other less widespread diseases.
Furthermore, the report pointed out that large pharmaceutical companies are prepared to donate nearly $18 billion worth of drugs over the next several years. Thus, the only remaining barrier to treating NTDs is mass distribution and complementary long-term health care.
However, treating NTDs is not as simple as handing out inexpensive drugs. First of all, even delivering medications can be a huge challenge in the poorest, most remote areas of the world. Furthermore, knowing which areas are most affected is a barrier to efficient distribution.
The final challenge in treating NTDs is creating a durable public health system which can support long-term care and treatment, fulfilling needs for corrective surgeries and even mental health care for the ill.
Unfortunately, the inexpensive medicine used to treat NTDs does not render a patient immune to contracting the disease a second time. This can be a huge problem in areas where the vectors for disease include the soil and water supply.
If an area is treated with NTD drugs, but continues to rely on an infected water source, the point is moot. Mass drug administration has to be accompanied by more costly and difficult-to-implement integrative strategies like improved sanitation, mapping and health education.
Fortunately, progress is being made in crafting long-term solutions as well. For example, the Global Trachoma Mapping Project (GTMP) is working with 23 affected countries to accurately map the prevalence and location of the estimated endemic population of 212 million people who have this blindness-causing disease.
The GTMP has been so successful that it is now recognized by the WHO as the standard of epidemiological data-gathering.
Public health programs, such as those in Ethiopia, also are emphasizing integrative approaches which should help improve the long-term sustainability of treating NTDs. These approaches include focusing on the last two letters of the SAFE strategy, i.e. facial hygiene and environmental improvements.
Another acronym which emphasizes an integrated approach is Wash, or water, sanitation and hygiene. Increasingly, aid recipients and the global health community are recognizing the need for initiatives such as SAFE and Wash to prevent the recurrence of NTDs in previously treated populations.
Implementing these integrative strategies could be an unprecedented opportunity for country-led approaches to distribution and treatment.
Indeed, there is overwhelming support among recipient countries to start building robust public health programs to treat NTDs, especially from the health ministries of Bangladesh, the Philippines and Honduras, which are funding all, or almost all, of their own initiatives.
Tackling a group of diseases which so disproportionately affects the poor will take strong leadership and global support.
Luckily, Dr. Matshidiso Moeti, the World Health Organization’s regional director for Africa, has said that “in a region that is currently experiencing the highest burden of NTDs, I made a commitment to Ministers of Health that tackling NTDs will be one of my top priorities.”
Hopefully, tackling Neglected Tropical Diseases will remain a top priority for Moeti, endemic countries, and global donors, as they move into the next phase of public health policy implementation.
– Derek Marion
Sources: New York Times, The Guardian 1, The Guardian 2, Uniting to Combat NTDs