When I say “neglected tropical disease“, I don’t mean the diseases that most people in the US have heard of or have even purchased a Starbucks coffee to help treat in Africa, I mean the real nasty ones like onchocerciasis, schistosomiasis, trachoma, lymphatic filariasis, and even a bunch that are so less well known that they often get grouped into catch-all categories like “soil transmitted helminths” – even by the experts who are crazy enough to devote their careers to tackling them. What these diseases have in common is that they actually affect a boatload of people and despite their massive burden of disease, relatively alarming outward manifestations (blindness, long-term educational problems, peeing blood on a regular basis), and even a well developed pharmacological war chest to treat them, they get little attention from donors, by countries, and even by people directly affected by the diseases themselves. How can anyone get excited about diseases that even people who regularly pee blood and suffer measurable learning problems won’t even pay $0.10 cents a year to avoid?
Over the past couple of years, there has been an incredibly hard working and dedicated group of parasitologists and entomologists-cum-global health advocates that have been trying to raise the profile of these neglected tropical diseases (aka the NTDs). Whether it is due to a lack of information, time-inconsistent preferences, short-term liquidity constraints, or some other behavioral model that we don’t fully understand, poor people in poor countries are not going to anytime soon take it upon themselves to protect themselves adequately from these diseases. Due to the massive positive spillovers that come from treating these diseases on interrupting transmission it also provides additional rationale for intervention. Unfortunately, NTDs are not sexy enough for us to care.
So how might we get more excited about these diseases? The strategy of these brilliant advocates thus far has been to make the case that treating NTDs is a great way to also help reduce the burden of diseases we do care about. In the latest iteration of this strategy, the worm guys have now made a clear case as to why NTD treatment could go a long way to improve the treatment of malaria. Their arguments?
First, there is evidence that the existing infrastructure for NTDs, such as the CDTI infrastructure tireless built up over 15 years by the APOC program (the most successful public health program you have never heard of) can instantly be used to further increase access to insecticide bed-nets and home-managmeent of malaria interventions. They even have a well controlled multi-country study evidence to support this claim.
Second, many of the helminthic infections discussed above lead to anaemia and anaemia makes malaria worse. So if we deworm with inexpensive drugs, we can reduce the burden or severity of malaria.
So for a few quick additional dollars, by thinking of NTD control as a means to achieve improved malaria outcomes, we might actually trick ourselves into wanting doing a whole heck of a lot of good. Hey if it works….Share on Facebook