Neglected tropical diseases demand international attention

International public health efforts focus on control of the ‘big three’ infectious diseases: HIV and AIDS, tuberculosis (TB) and malaria. Other tropical diseases receive much less attention. Two papers urge support for rapid impact interventions to control these neglected diseases, integrated into programmes tackling the big three.

Theauthors, from the UK and USA, list 13 neglected infectious diseases, which alloccur mainly in rural areas of low-income countries. They impair childhoodgrowth and learning and adult worker productivity, increasing poverty. Severalare disabling or carry heavy stigma. The authors argue for integrated controlof these diseases because:

• theycause 500,000 deaths annually and a disease burden one quarter that of HIV andAIDS and half that of malaria
• theyoverlap geographically and many people carry several infections at once
• justfour drugs (albendazole, ivermectin,azithromycin and praziquantel)together could control seven of the neglected diseases (three soil-transmittedworms plus bilharzia, lymphatic filariasis,river blindness and trachoma) for around US$0.40 per person per year
• these drugs are safe, effective and cost-effectiveand share compatible approaches to delivery. As yet, drug resistance is not asignificant problem for any of them
• investment in control of these diseases has aneconomic rate of return of 15 to 30 percent.

Theauthors go further, urging policymakers to integrate neglected disease controlwith global partnerships and initiatives tackling the big three. Theirarguments include:

• HIVand AIDS, TB and malaria occur mostly in populations heavily affected byseveral of the neglected diseases.
• Ifa person is infected with more than one of these diseases, the health impact multiplies.Anaemia is a particular problem in people with multiple diseases, especiallyyoung children and pregnant women.
• Co-infectionwith the neglected tropical diseases worsens the progression and impact of the bigthree.
• Community-basedhealth care systems set up to deliver drugs for neglected diseases could alsodeliver anti-retrovirals, directly observed TBtherapy, anti-malarials and bed nets.
• Meanwhile,bed nets used for malaria control also reduce the spread of lymphatic filariasis.

Thearticles conclude that successful integration of neglected disease control intoprogrammes tackling the big three could greatly cut the number of life yearslost from early death and disability in Africa. The first step could be to addneglected tropical disease control into model health systems. Scaling up theseapproaches would bring extra challenges, the authors admit. These include:

• gettinggood baseline data on the prevalence of each neglected disease
• drawingup treatment protocols that combine several drugs
• monitoringdrug compliance, interactions and emerging resistance
• developingnew drugs for neglected diseases
• integratingthe separate vertical control programmes currently working on neglecteddiseases
• addressingthe root causes of the neglected diseases by improving water supplies andsanitation, upgrading health information systems, building health system capacityand delivering behaviour change communication
• aligning these efforts with regional and nationalhealth policies.