Briefs

WHAT YOU SHOULD KNOW

Neglected tropical diseases (NTDs) are a group of 17 infectious diseases and conditions afflicting over 1.5 billion of the world’s poorest people, including 836 million children, and threatening the health of millions more.[1]

NTDs disproportionately affect poor and rural populations lacking access to safe water, sanitation, and essential medicines. NTDs cause sickness and disability, compromise maternal health and fetal growth, inhibit children’s mental and physical development, and can result in blindness and severe disfigurement. Without treatment, a number of NTDs are fatal.

The United States is a leading partner in efforts to control and eliminate seven major NTDs: lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma, and three types of soil-transmitted helminthiasis — ascariasis (roundworm infection), trichuriasis (whipworm infection), and necatoriasis and ancylostomiasis (hookworm infections). Since Fiscal Year 2006, the United States has supported the delivery of more than 2.3 billion treatments for more than 1.1 billion people around the world through the U.S. Agency for International Development (USAID) NTD Program.[2]

This program embraces a public-private partnership with the pharmaceutical industry, enabling USAID to carry out the largest integrated NTD program in the world. To date, every $1 invested has leveraged an estimated $26 in donated medicines, totaling $19 billion in added value.

For more than 12 years, the USAID NTD Program has also led a large-scale implementation of integrated treatment — supporting 31 other programs in Africa, Asia, and the Americas — to reach treatment targets and to monitor and evaluate the achievement of global NTD goals.

Since 2014, the USAID NTD Program has invested in research and development (R&D) to ensure that promising new breakthrough medicines are rapidly evaluated, registered, and made available as soon as possible. Other U.S. agencies involved in research and control efforts include the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD).

RECOMMENDATIONS FOR CONGRESS

Maintain strong funding levels for the USAID NTD Program. Robust funding for this unique and successful public-private partnership allows USAID to maximize the benefits of donated medicines and to ensure new products are available for patients with NTDs.

Maintain U.S. leadership in efforts to control and eliminate NTDs by supporting the commitments of the 2012 London Declaration on NTDs to achieve targeted 2020 NTD goals — and by urging other bilateral partners to do the same.

Seek strategic, cross-sector coordination of NTD treatment and control programs. In addition to support for the USAID NTD Program, the inclusion of NTD control measures within other USAID initiatives and broader U.S. programming is necessary to advance progress in controlling and eliminating NTDs. Opportunities for cross-sector coordination may include maternal and child health services, such as childhood immunizations; the delivery of vitamin supplements; or water, sanitation, and hygiene (WASH) projects.

Expand investments in product development for NTDs through USAID. To achieve U.S. goals for disease control and elimination, the U.S. government should address the urgent needs of patient populations suffering from particularly neglected diseases — including those with the highest death rates — and respond to the perpetual challenge of drug resistance by developing new medicines, tools, diagnostics, and vaccines.

Expand current R&D investments in DoD, CDC, and NIH programs that target NTDs. Additional investments in R&D will ensure the availability of new tools and treatments for people living with NTDs.

Disease detective in the field. Credit: PATH/Aaron Joel Santos
Lab technicians in the field. Credit: PATH/Gabe Bienczycki

WHY THIS INVESTMENT IS IMPORTANT

Many of the most common NTDs can be treated using safe and effective medicines. USAID funding enables these medicines to reach people at risk. However, for NTDs with the highest death rates — including human African trypanosomiasis (African sleeping sickness), visceral leishmaniasis (black fever), and Chagas disease — treatment options are extremely limited. To meet World Health Organization (WHO) NTD 2020 goals, R&D investments are urgently needed for NTD diagnostics, medicines, and vaccines.

The fight against NTDs has recently gained momentum and received widespread bipartisan support from U.S. policymakers. WHO developed its first NTD strategic plan in 2003, and the United States allocated $15 million to create an integrated NTD control program at USAID in Fiscal Year 2006. In January 2012, inspired by WHO 2020 NTD goals, public and private partners — including pharmaceutical companies, donor governments, endemic countries, research organizations, the World Bank, and the Bill & Melinda Gates Foundation — announced the London Declaration on NTDs, a coordinated commitment to control and eliminate 10 NTDs by 2020. In 2014 the USAID NTD Program began investing in R&D to ensure the development and availability of promising medicines for filarial diseases. Progress is real and measurable: in USAID-supported countries, an estimated 253 million people are no longer at risk for lymphatic filariasis, more than 102 million people are no longer at risk for trachoma, and approximately 3 million people are no longer at risk for onchocerciasis. Thousands of people at risk of blindness from trachomatous trichiasis, a consequence of trachoma, have received quality, sight-preserving surgery.

In addition to USAID, other U.S. agencies maintain NTD programs. NIH is the largest funder of early-stage R&D for neglected disease[3] through the National Institute of Allergy and Infectious Diseases and through the Fogarty International Center. CDC efforts to fight NTDs include control programs, diagnostic research, capacity-building in endemic countries, progress evaluation, and monitoring and identifying new tools. DoD also plays a significant role in the effort to defeat NTDs through R&D for the military.

It is essential to continue U.S. commitments to NTD control and R&D programs across agencies. Ongoing U.S. investment in NTD control and R&D programs is needed to ensure that new discoveries make it all the way down the pipeline and become available to the people who need them most. If this support is sustained, the United States can save the lives and reduce the suffering of hundreds of millions of people.

Resources

  1. USAID NTD Program http://bit.ly/2fT8yrC
  2. Uniting to Combat NTDs: 2nd Progress Report on the London Declaration http://bit.ly/2eRBLQU
  3. CDC Fast Facts: NTDs http://bit.ly/2gQfk1X

Contributors

Jodie Curtis, American Society of Tropical Medicine & Hygiene, jodie.curtis@dbr.com
James Hunter, RTI International, jvhunter@rti.org


Citations

[1] “Why are some tropical diseases called ‘neglected’? Online Q&A,” WHO. http://bit.ly/2h5DGCh.

[2] “Working to Protect Against Neglected Tropical Diseases,” USAID, 2018. http://bit.ly/2DQCcvQ.

[3] “Neglected Disease Research and Development: A Five Year Review,” G-FINDER, 2012. http://bit.ly/2fJ0xFE.

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