The Neglect of Tropical Diseases
Although the word “Zika” is now familiar to many, it was not long ago that the virus was unknown to most of the world and grouped by the World Health Organization (WHO) into a class of diseases known as “Neglected Tropical Diseases” (NTDs). This category includes illnesses ranging from snakebites to schistosomiasis that all disproportionately affect the poor and marginalized in low-resource settings.
Although NTDs continue to be neglected—Chagas Disease is by no means a household name—they do receive more consideration these days than they did in the past. WHO Director-General Margaret Chan discussed this increase in attention, stating that she believes “the world is now paying attention to these [neglected] diseases” and that the world is “making progress in unprecedented ways, with ambitious goals, excellent interventions, and growing evidence of multiple benefits for health.” These initiatives to better approach the current global burden of NTDs are becoming increasingly popular—and increasingly ambitious. The official WHO NTD roadmap states that the WHO aims to completely eradicate at least two NTDs by 2020. This would be no small feat, but even more hopeful than the roadmap is the London Declaration, a document signed by pharmaceutical companies, donors, endemic countries, and non-government organizations outlining a commitment to work collaboratively to control or eliminate at least ten NTDs by 2020. In 2015 alone, pharmaceutical companies and other WHO partners provided around 1.5 billion treatments to endemic countries, treating an estimated 979 million people.
Attention to NTDs is indeed increasing, but maybe not enough. Even though all NTDs together cost developing economies billions of dollars annually and affect about one in seven people, only around 3 percent of the money currently spent on research and development in the global pharmaceutical industry is devoted to NTDs. More specifically, funding is usually low until an NTD becomes a health emergency that impacts high-income countries, such as in the cases of Zika and Ebola. Both Zika and Ebola are by no means new diseases; it was a lack of existing knowledge, prevention systems, and treatment infrastructure that led to their catastrophic spreads. Global funding for Zika, for example, has dramatically increased since the epidemic was declared the WHO’s fourth-ever health emergency.
Dr. Dirk Engels, director of the WHO Department of Control of Neglected Tropical Diseases, recognizes that funding suddenly becomes more available when NTDs become “no longer strictly tropical,” and urges that the “potential for spread” provides yet another reason for making the needed investments. Tackling NTDs before the diseases spread out of countries where they are endemic should be a priority—it is cheaper to treat fewer people than more people, after all—yet it does not happen nearly often enough.
The current tendency to wait to react until these diseases emerge in the high-resource world is not sustainable. Waiting for a disease to reach epidemic levels results in the need to make swift funding allocations to create research and treatment programs more or less from scratch. Expeditious government action, even in the face of health emergencies, is rare. This in turn leads to spread of disease that could have been prevented. For example, Congress has yet to pass the bill for emergency Zika funding, greatly limiting the programs that can currently be implemented. In fact, much of the money that has already been spent by the United States on Zika has been taken from the surplus of what was originally allocated to fight Ebola.
But this trend cannot continue; Congress cannot continue to allocate money for such diseases only when it is experiencing a crisis. Although Ebola is not nearly as much of a threat as it once was, that money is still needed for local and foreign programs to continue providing resources for ongoing prevention, education, and treatment. The same holds true for Zika.
Additionally, alleviating the NTD disease burden would benefit more than simply the United States. Like all global health initiatives, alleviation would benefit the economies of low- and middle-income nations. Successful eradication of even two NTDs, as proposed by the WHO NTD roadmap, would free up millions of dollars for other pressing programs necessary for developing countries’ progress. Zika is estimated to cost the world at least $3.5 billion; treating the disease before it spread to its current public health emergency levels would have cost substantially less.
Whether a disease is neglected or well-known, foreign and domestic governments and research institutions should not wait until it becomes a pandemic to try to stop it. Prevention and early treatment provide the most cost-effective solutions. It is only with continued ambitious, collaborative, and well-funded programs that the world can avoid the next Zika.
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