New Dawn for Neglected Diseases?
The recent launch of new initiatives on helminth diseases and HIV/AIDS drugs for infants by the Drugs for Neglected Diseases initiatives led me to wonder about the broad burden of neglected diseases. One such is the benign sounding sleeping sickness disease which, carried by the tsetse fly, still today causes devastating human deaths. Another is the disease known as elephantiasis that causes people to suffer from debilitating swollen limbs and genitals as a result of thread like worm infections.
World Health Organisation (WHO) defines human African trypanosomiasis (sleeping sickness) and lymphatic filiarisis (elephantiasis) as just two among 17 neglected tropical diseases that viciously affect at least one million people each year, leaving debilitating illnesses and deaths in their wake for sufferers and families. Referring to the 17 neglected tropical diseases, WHO comments that these diseases “thrive in impoverished settings, where housing is often substandard, environments are contaminated with filth, and disease-spreading insects and animals abound”.
Neglected tropical diseases are endemic infections in 149 countries and territories, varying in their source of infection from viral, to bacterial and protozoal origins. The burden of these diseases adds to the already heavy burden of respiratory tract, diarrhoeal, HIV, tuberculosis and malaria infections that make up the top 5 global infectious disease killers, additionally considered as neglected diseases.
Knowledge about how prevent and treat many neglected diseases is not lacking; instead, the intimate relationship that they share with poverty shapes their opportunities to infect, maim and kill. These diseases have not been specifically neglected by robust health systems, but rather poverty and failure to implement proven solutions has driven their neglect for centuries. So neglected tropical diseases define a neglect which accompanies many other aspects of daily life for poor people in modern day tropical countries.
“Cities are growing and growing but without infrastructure of sanitation… Do we need more research on that?” Peter Piot, Director of the London School of Hygiene and Tropical Medicine asks rhetorically. “I doubt it. We need more on the how to do it” he considers. Emphasising the lack of well implemented solutions, Kevin De Cock, Director of the Centre for Global Health at the US Centres for Disease Control, adds “underlying social and developmental factors like inadequate access to water and sanitation, or to adequate living conditions – often dismissed as “old problems” – have been frustratingly difficult to address”.
As of October 2010, with the publication of their first report ‘Working to overcome the global impact of neglected tropical diseases’, WHO has considered controlling these diseases to be a feasible goal. For Piot “the ‘so-called’ neglected tropical diseases are nearly fully funded, except for basic research”. At the World Health Assembly meeting in May 2011, the feasibility of controlling and eliminating neglected tropical diseases was re-affirmed with resolutions on the progress towards eradicating guinea-worm disease (dracunculiasis). Reflecting on advances made, De Cock comments “a number of neglected tropical diseases, including onchocerciasis and lymphatic filariasis, are currently being controlled or are close to being eliminated because of mass drug administration”.
While the global dilemma grows between high-income countries’ provision of financial support for lower-income countries with rapidly growing economies like Brazil, Russia, India and Brazil, the poor in these developing country superstars remain marginalized and disproportionately affected by neglected diseases of poverty. “Health in general requires more funding, and global health needs global financing” affirms De Cock. “This is especially true for some important areas that have been neglected, such as sanitation”. Prioritizing the control of neglected tropical diseases in endemic countries will inevitably mean effectively implementing known health interventions like sanitation. Piot considers that “because of AIDS there has been a real interest in funding for global health” and adds that “collateral benefits” could ensue for neglected diseases. Ensuring that this collateral benefit opportunity is grasped for neglected tropical diseases requires collaboration and “HIV, polio, and malaria programs offer an entry point for other interventions at the community level” advises De Cock.
Global health advocacy to combat neglected diseases has been highlighted by the Millennium Development Goals, and a spotlight shines brightly on the top 5 killer infectious diseases; it would seems that with globalization, a global political imperative to tackle neglected diseases effectively is growing. After increasing the pledge made by the Bill and Melinda Gates Foundation towards delivering vaccines with the Global Alliance for Vaccines and Immunization (GAVI), Bill Gates reflects that tackling neglected diseases through vaccination programs is cost effective and “helps countries to get to a point where they will be self sufficient”.
“It’s a question of values” considers Gates. As such, provision of sustainable and substantial health benefits for citizens globally, and progress towards prevention of neglected tropical diseases could herald social and economic progress. Governments from the 149 countries and territories whose citizens suffer disproportionately from these diseases, are now being challenged to meet the new aspirational values of equity and partnership that high-income global health donor players are increasing throwing their way. By working with high-income partners and ensuring public health as a policy and implementation priority for their citizens, there is opportunity for endemic country governments to act as powerful advocates for neglected tropical disease prevention and control.
Potential future collaborative approaches to global health which integrate health systems could benefit neglected tropical diseases, making these diseases an integral part of the health systems strengthening packages endorsed by global donors and endemic country authorities. But in order to gain health benefits, sincere reflection on why existing methods have not been implemented to combat diseases must inform collaborative approaches to health system strengthening. Without reflection and collaboration at all levels, diseases could remain neglected, while both established and new interventions continue along the same neglectful route as the diseases which they seek to eliminate.
An additional global pandemic imperative for control, elimination and deeper understanding of neglected tropical diseases underlines the self-interest benefits for high-income countries. De Cock observes “we never know which ones could become global threats… we have to be ready to diagnose, investigate, and respond to them wherever they occur”.
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