During his nearly 30 year career in medicine, Dr. Peter Hotez has earned a reputation as a relentless researcher and advocate in the fight against Neglected Tropical Diseases.
The 57-year-old American pediatrician and professor — with his characteristic bow tie and round eyeglasses — has no shortage of titles. He is president of the Sabin Vaccine Institute, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and co-founder of the Global Network for Neglected Tropical Diseases. Global health colleagues know him as a sturdy champion for policies to address diseases that are, by their very title, underrepresented in global health initiatives.
Earlier this month Hotez spoke to college students on Capitol Hill in Washington, D.C. He told them that fighting NTDs is “like peeling away the layers of an onion.” He said that the global health community has made a “huge impact on reducing neglected tropical diseases in the world’s most devastated countries in Africa and South Asia,” — peeling away a layer of the onion only to find a new challenge waiting to be confronted. And there is a new challenge to be confronted.
“We now find that most of the world’s neglected diseases are actually… in wealthy countries. They’re in G-20 countries,” Hotez said, referring to the group of 20 wealthiest countries. “It’s the poor living among the wealthy that account for the world’s Neglected Tropical Diseases.” Hotez described the scourge of NTDs in China’s “forgotten southwestern provinces” and in the poorest parts of northeastern Brazil.
And he added, “we’re drawing a new map of global health.”
Responding to a new NTD map
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According to Hotez’s own analysis, 77 percent of registered leprosy cases, 71 percent of foodborne trematodiases cases and 61 percent of Chagas’ disease cases are in G-20 countries plus Nigeria.
Other experts agree with Hotez’s general finding, that the poor in wealthier countries increasingly shoulder the NTD burden.
“Most of the people affected by Neglected Tropical Diseases today are in middle-income countries — lower- and upper-middle-income countries,” Dr. Dirk Engels, director of the Department of Control of Neglected Tropical Diseases at the World Health Organization, told Devex.
The problem in middle-income countries — many which have the resources to treat NTDs — is that there can be a lack of political will to extend those resources to people most in need, according to Angela Weaver, senior technical adviser at USAID’s NTD program.
But there are steps donors, advocates and global health organizations can take to improve their responsiveness to the shifting burden inflicted by some of the world’s most debilitating illnesses.
In upper middle income countries in particular, the U.S. Agency for International Development works with donor partners and the WHO not always to provide financial assistance, but to support advocacy and build political will to take on NTDs, Weaver said.
“Many of the countries we support have very decentralized [health] systems … Some of the decisions get made at the lower levels, and so that advocacy at the national level needs to be quite strong and it has to flow down,” Weaver told Devex. She called this type of advocacy “trickle down advocacy” and said that high level and high visibility events that highlight the need to tackle NTDs can be a good place to start.
Weaver added that USAID works with regional partners like the Pan American Health Organization and the Onchocerciasis Elimination Program for the Americas to provide technical support to middle-income countries that have financial resources but lack the technical capacity to confront NTD prevalence in their populations.
The PAHO, with the support of a grant from USAID, helped countries in Latin America to implement a “tool for integrated planning and costing.” It is meant to help governments manage the cost and logistics of large-scale NTD programs. PAHO helped Latin American countries “adapt it to their needs” and “roll it out,” said USAID spokesperson Ryan Essman.
USAID also supported OEPA to provide assistance to countries in the Amazon region to carry out impact evaluations and surveillance with the aim of eliminating onchocerciasis — also known as river blindness — from the region, Essman added.
Donors and other global health organizations can also play a role in enabling research and development environments for neglected disease innovations within middle income countries. One way to do this is by partnering with pharmaceutical companies and vaccine manufacturers in places such as India, China or Indonesia, according to Hannah Kettler, senior program officer for industry relations at the Bill & Melinda Gates Foundation.
The global health organization PATH, for example, developed a Product Development Partnership with the Indian vaccine manufacturer Serum Institute of India to help produce a meningitis vaccine at less than 50 cents a dose. And the Gates Foundation partnered with the Chinese Ministry of Science and Technology to encourage global health innovation and discovery, Kettler said.
While these partnerships are geared towards innovation that benefits the poorest countries, product development partnerships — partnerships often involving private sector companies designed to develop products such as vaccines for global health benefits — can be effective tools to help build up domestic R&D and can benefit the poor within India, China, Indonesia or other middle-income countries, Kettler explained.
Where direct donor funding typically comes into play is in lower middle income countries such as Cameroon, Nigeria, Ghana and Indonesia — countries that Weaver said are targets for donors because of their high prevalence of NTDs and financial need.
What are some other ways the global health community can tackle debilitating NTDs in middle income countries? Let us know by leaving a comment below.