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Taking on the Neglected Diseases

sleepingsickness.jpgThere's little question that one of the triggers for pervasive poverty in the developing world is disease. HIV/AIDS, tuberculosis and malaria afflict millions, and correspondingly receive most of the attention -- and research money -- from international development and donor agencies. But these "big three" diseases aren't alone; so-called "neglected" tropical diseases also ravage populations across South America, Africa and South Asia, but receive far less attention. Compounding the tragedy, these neglected tropical diseases are far more readily (and inexpensively) treated than the big three.

Drs. David H. Molyneux, Peter J. Hotez, Alan Fenwick, all three specialists in tropical diseases, write in the current issue of Public Library of Science: Medicine that low-cost "rapid-impact interventions" against these neglected diseases could dramatically improve the standard of living across the developing world, and would serve both to bring nations closer to the Millennium Development Goals and make interventions against the "big three" diseases a bit easier.

There are 13 tropical diseases generally considered to be "neglected" diseases, with insufficient money spent on researching and/or distributing cures (see the footnote inside for the difference between "neglected" and "orphan" tropical diseases). These include parasitic illnesses like leishmaniasis and hookworm, as well as bacterial diseases like trachoma and leprosy. Molyneux, Hotez and Fenwick argue that the 13 all have some fundamental traits in common -- not in terms of their biology, but in terms of their societal characteristics:

  • Ancient afflictions that have burdened humanity for centuries
  • Poverty-promoting conditions
  • Associated with stigma
  • Rural areas of low-income countries and fragile states
  • No commercial markets for products that target these diseases
  • Interventions, when applied, have a history of success
  • In aggregate, the neglected tropical diseases are responsible for half a million deaths worldwide every year, the greatest portion of which is in Africa. Evidence from small-scale public-private partnerships attacking some of these diseases suggests that many of the best medicines available can work against more than one disease; indeed, four drugs could handle at least seven major tropical diseases in Africa. The authors therefore argue for an "integrated" disease control effort, one which would dramatically reduce the incidence of disease-caused blindness, disfigurement and death; what's more, this program would cost as little as forty cents per person per year for five years, or roughly $200 million each year for Africa. Such an effort would improve the lives of over 500 million people.

    The cost of such a rapid-impact package is a tiny fraction of what is spent on HIV/AIDS and TB, per person, every year; moreover, the authors argue that much of the treatment used against the "big three" has little impact on transmission rates. The rapid-impact interventions, conversely, would directly reduce the transmission of tropical infectious diseases. This would have a significant impact both economically and on the fight against the "big three:"

    Let us define end points and outcomes for integrated control. In the case of Ascaris, Trichuris, and schistosome infections, the major goal is a sustainable reduction in worm burden and control of morbidity, while for lymphatic filariasis, onchocerciasis, and trachoma, the major goals are to reduce or eliminate transmission of diseases, resulting in much-reduced morbidity in future generations. The externalities of these two goals are considerable and include improved education and economic productivity. The calculated loss of US$1 billion annually from lymphatic filariasis in India, and US$5.3 billion from blinding trachoma, and substantial reductions in future wage-earning capacity as a result of chronic hookworm infection in childhood, illustrates the burden and costs of these diseases to poor individuals and communities. An added externality is the impact that the neglected tropical diseases have on the big three. Several recent papers highlight the immunosuppressive features of helminths (especially the STHs, schistosomes, and filariae) and their possible impact on promoting susceptibility to HIV/AIDS, TB, and malaria. Conversely, the control of helminth infections has been suggested as a means to facilitate control of the big three, especially by reducing the frequency of malaria fevers, the frequency of severe and cerebral malaria, and the prevalence of anaemia.

    By no means do the authors argue that less money should be spent on combatting HIV/AIDS, tuberculosis and malaria. Rather, they demonstrate that the costs of dealing with these other diseases is so low that there's no good reason not to invest in rapid interventions. More to the point, there are good reasons to do so: aside from the humanitarian value, stopping the transmission of the tropical diseases will reduce the costs incurred fighting the "big three," and will have a direct positive impact on the economies of the affected nations, potentially making available greater local funds for medical work.

    We don't get too many opportunities for low-cost, fast-return, high-impact interventions; we should move as rapidly as possible to deal with these diseases.

    Footnote: There is some overlap between the "neglected" diseases and what the open-source Tropical Disease Initiative refers to as "orphan" diseases (illnesses on which pharmaceutical companies tend to do little research), but the latter group includes TB and malaria. For both categories, some work is being done in academia; this summer, an international research team sequenced the genomes of the pathogens responsible for three major tropical diseases, African Sleeping Sickness, Chagas and leishmaniasis. Nonetheless, for the "neglected" tropical diseases, the problem remains of the lack of funds for distribution of cures.

    Comments (1)

    If I am correct, there are companies like OneWorld, the first non-profit pharm. company in the U.S. One of their goals is to make medicines to fight disease and illness in developing countries using drugs which aren't seen as being highly profitable by the money-hungry pharm. companies. So in a way, they focus on helping treat and fight disease in developing countries, by focusing on problems other than the big "3". It's a neat concept, and a great company. Check them out!


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