Neglected Tropical Diseases A personal insight in a world where neglected tropical diseases continue to have no voice.
My first encounter with neglected tropical diseases came during my medical training in the early 1970s. On an exchange programme in Brazil, one of my tasks was to trap reduvid bugs and carry them back to the US to rejuvenate the breeding stock used in Chagas Disease research. I learned much about Chagas - the long term disability it causes - and the efforts to prevent the bite of the reduvid bug - the kiss of death as described locally. It was only the poorest parts of Brazil, and of other Latin American countries, that Chagas could be found - many days travel from the major cities. Chagas is a disease of neglect and poverty.
My next encounter with neglected tropical diseases was later in that decade among the pygmies living in the rain forest of Eastern Cameroon. The pygmies had yaws, a disabling disease causing ulcers on the skin that are spread from one person to another by close contact - often a mother to her children - and the ulcers become infected with other bacteria resulting in severe scarring and long-term disability. And again it was far from the capital city where this disease was found, among those who could afford it least.
Worldwide attempts to eradicate yaws beginning in the 1950s had faltered, in part because of the lack of a simple test to diagnose yaws in the field, and among the pygmies I was assessing a newly developed test that was hoped to be the tool that would lead to complete eradication. But though the test was shown to be easy to use and effective, the political was not again generated to begin a worldwide eradication effort.
Back in Yaounde, the capital city of Cameroon, there was another reminder of a neglected tropical disease - a statue of Jamot with an inscription that he had awoken the African continent. Indeed his efforts, and those of many other colonial health systems all over Africa, had been able to decrease sleeping sickness using crude, but effective medicines and simple diagnostic procedures.
But those efforts have been hard to sustain, while at the same time global funding mechanisms for the highly endemic diseases such as malaria, TB and HIV have proliferated using 21st century innovation and leaving the neglected tropical diseases behind.
At the end of the 20th century, NTDs continued to maim and kill - leprosy, schistosomiasis, Guinea Worm, lymphatic filariasis, and trachoma to name a few. And as Chagas, yaws and sleeping sickness, they remained diseases of neglect by governments and the international community.
But by then short term solutions were being found - through political will generated at each year's world health assembly targeted elimination programmes were being developed, and public private partnerships formed. Pharmaceutical companies and private foundations were partnering with NGOs and governments to provide the necessary medications, and progress was beginning.
But much more needs to be done to finally conquer these neglected diseases of the poor. For some it is a need for safer and easier to administer drugs, for others it is a vaccine, and for still others it is the need for a simple point of care diagnostic test. To address these needs new partnerships have developed to develop safer and more effective medicines, and other initiatives for vaccines and better diagnosis. And increasing political will has led to increased funding. But there is still more to do in a world where neglected tropical diseases continue to have no voice.
While the world is fortunate to have innovative funding mechanisms that provide for the needs of high mortality communicable diseases such as AIDS, TB measles, and Malaria; and private/pubic partnerships to develop new medications and vaccines for these high mortality endemic diseases, similar innovations are lacking for NTDs.
What is the formula for overcoming this neglect? It is the same: research and development for the new medicines, vaccines and diagnostic tests; governments committed to ensuring that their populations have access to health care including that for neglected tropical disease; and an international community willing to provide the needed funds.