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The best buy in global public health

June 01, 2015

Some are transmitted by mosquitoes, some are caused by worms and as a diverse group micro-organisms; others by snakebites. They affect the lives and the economic prospects of roughly every fourth person on the planet – usually the poorest.

They are neglected tropical diseases, or NTDs, a group of 17 different infections many experts consider a far more relevant health problem than, say, H.I.V. or malaria in terms of numbers afflicted. David Molyneux, a former Director of the Liverpool School of Tropical Medicine in the UK, is one of the most distinguished experts on these infections – he actually coined the expression for the different maladies that affect not only the poor. He wants the heads of the G7 nations, meeting in Germany on 7 and 8 June, to agree on a plan of action to tackle the NTDs. Open Knowledge spoke to him ahead of the summit to find out what actions need to be taken.

 

Open Knowledge: If we didn’t do anything about the neglected tropical diseases (NTDs) – what would happen?

David Molyneux: One of the objectives of development policy is to enable individuals to live in a better social and economic environment. So if you want to engage in any sort of development, you have to engage in fighting these diseases.

 

Who is most affected by these diseases – and where?

The poorest of the poor! Globally, at least 1 billion people are infected by these organisms – another 2 billion are at risk and will continue to remain at risk. Every year, an estimated 350,000 people die of NTDs. It is basically the rural poor in sub Saharan Africa, Southeastern Asia, and parts of South America.

David Molyneux is a Senior Professorial Fellow and leads advocacy and policy work on Neglected Tropical Diseases at the Liverpool School of Tropical Medicine. Professor Molyneux was Director of the Liverpool School of Tropical Medicine from 1991 to 2000 and is Emeritus Professor of Tropical Health Sciences at the University of Liverpool.
David Molyneux is a Senior Professorial Fellow and leads advocacy and policy work on Neglected Tropical Diseases at the Liverpool School of Tropical Medicine. Professor Molyneux was Director of the Liverpool School of Tropical Medicine from 1991 to 2000 and is Emeritus Professor of Tropical Health Sciences at the University of Liverpool.

So are the NTDs an exclusive problem of the Southern Hemisphere?

Not really. Some of these diseases transmitted by mosquitoes such as dengue are increasing their range due to climate change. So parts of the developed world – in the Caribbean, in South America, in Southern Europe – are becoming more and more exposed to diseases formerly known as “tropical”, and nobody is responding to this because it doesn’t immediately kill people.

 

What is the relevance of these diseases?

The NTDs are the markers of poverty. Many people have more than one of these infections. Someone who has, for instance, survived malaria in Africa, unfortunately still has high chances of becoming blind or disabled or have multiple pathologies because of these other infections. They will depend on care by their children, and therefore you have a vicious cycle, since you’re depriving the children of education – which is maybe the most important aspect of development.

 

What could and should countries do – and what about the corporate sector?

For the approximately 2 billion people at risk or infected by NTDs, we are currently treating 800 million with preventive chemotherapy in various programs for some diseases. The value of these drugs – which are mostly given away by pharmaceutical companies for free – is around 2-3 billion US dollars per year. The cost of delivery to these individuals is on average 20 US cents per person per year, and it makes up around 2 to 3 percent of the very small health budgets of these countries. So this is maybe the best buy in global public health; independent analyses have shown that. If we continue these programs, transmission of some of the infections via mosquitoes and black flies can be stopped in five or seven years.

But so far, only the UK and the US have bilaterally engaged in financing delivery of these free drugs on any scale. We want the rest of the G7 to come up with resources – not only in research, but also in the implementation of these treatments. Our aim should be to eradicate or eliminate some of these diseases by 2020! And the development agendas of the G7 or the European Union don’t really make sense unless you seriously tackle these infections.

The corporate sector has done a fantastic job so far. The pharmaceutical companies should continue to provide the products, to encourage countries to apply for those products and advocate at the highest level of politics in the G7 that this is a good health buy! More health for less dollars. It is part of the corporate social responsibility to help address this problem.

GlaxoSmithKline employees for example are very proud of the fact that over the last 10 or 15 years, they have significantly contributed to reducing elephantiasis as part of their corporate social responsibility program. Employees feel and work better when they have the feeling that their company is making a significant contribution in improving the lives of the poorest of the poor, particularly such a disabling condition – some 20 million people have been spared gross deformity!

 

What are the main successes achieved so far?

One main aspect is the commitment of the pharma industry to providing free drugs. Secondly, we at least have some bilateral contributions from US and UK. Also, a large number of non-governmental organizations have come on board. We have evidence that river blindness in Africa can be eliminated permanently; sleeping sickness is rapidly declining and the guinea worm is about to be eradicated all globally, where you had at least round 1 million cases in 20 countries 20 years ago you now have 126 cases in 2014 in four African countries! Hopefully we will live to see this disease fade into history.

 

What will be the toughest part?

Getting the endemic countries to commit themselves to implement the services needed in the poorest areas where health systems and services are weak. So it is not just about money, it is also about giving the countries the capacities to use the available resources and recognize addressing these infections is a part of the development process. Finally, being aware that there will be technical challenges and ensuring that the scientific community can respond. 

Christian Thiele 

The World Health Organization defines neglected tropical diseases (NTDs) as a diverse group of diseases with distinct characteristics that thrive mainly among the poorest populations. The 17 NTDs prioritized by WHO are endemic in 149 countries and affect more than 1.4 billion people, costing developing economies billions of dollars every year. Some of the more well-known examples include:

  • Leprosy (Hansen disease)
  • Trachoma
  • Dengue and Chikungunya
  • Rabies

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