The next few years could be exciting ones for the fight against NTDs, but only if the global health policymakers prioritize these diseases alongside better known ones such as HIV/AIDS, malaria, cancer, and heart disease. In this respect, I believe Forgotten People, Forgotten Diseases can become an important educational instrument and ultimately an ally in the fight against disease and poverty.
Forgotten People, Forgotten Diseases is an enormous contribution to making people in the U.S. aware that neglected tropical diseases are destroying the lives of poor people, not just in the world but in this country, who have no voice or advocate. This book gives the 5 million people suffering in this country both a voice and an advocate in Dr. Hotez. Count me in as another advocate, and someone who will spread the word. Once you’ve read Forgotten People, Forgotten Diseases, you can be the next.
Soledad O’Brien
CNN
Preface to the Second Edition
Much has happened in the neglected tropical diseases (the “NTDs”) field during the five years since the 2008 publication of the first edition of Forgotten People, Forgotten Diseases. In the area of public health control in developing countries, and through support from the United States Agency for International Development (USAID), approximately 250 million people have been treated with all or part of an integrated “rapid impact package” of essential medicines for seven of the most common NTDs—ascariasis, hookworm infection, trichuriasis, lymphatic filariasis, onchocerciasis, and trachoma. Overall, the World Health Organization estimates that currently more than 700 million people annually receive essential medicine against one or more NTDs. Almost all of these individuals live in the poorest parts of Africa, Asia, and the Americas and live on less than US$1–2 per day, including a group known collectively as the “bottom billion.” Thus, programs of mass drug administration for the NTDs represent some of the largest public health control efforts ever undertaken. In the cases of lymphatic filariasis, onchocerciasis, trachoma, and leprosy, mass drug administration is actually leading to the elimination of these diseases as public health problems. Many of these successes are occurring through generous drug donations from multinational pharmaceutical companies and some smaller generic-drug makers. In 2012 a London Declaration for NTDs was advanced which reaffirmed a commitment by the pharmaceutical companies to continue their donations until the elimination targets are met.
For other NTDs, mass drug administration alone will not be sufficient for global elimination. Accordingly, several nonprofit product development partnerships have committed to the development and testing of NTD vaccines to combat hookworm, schistosomiasis, and Chagas disease (including our Sabin Vaccine Institute) as well as leishmaniasis (the Infectious Disease Research Institute) and other diseases. In parallel, there are important drug discovery and delivery efforts by product development partnerships to combat NTDs such as Chagas disease, human African trypanosomiasis (“sleeping sickness”), Buruli ulcer, and other conditions. The Drugs for Neglected Diseases Initiative, working in partnership with Médecins Sans Frontières, has led many of these efforts. Together, these product development partnerships are producing the necessary tools to help ensure that global elimination might one day soon become a reality. In December 2011, in the journal Vaccine, I called for an “audacious goal” of eliminating all 17 major NTDs.1 (I borrowed this concept from the Bill & Melinda Gates Foundation, which a few years earlier had proposed it in the context of malaria eradication.)
The successes of both the mass drug administration and product development activities rely heavily on a substantial alliance of private-public partnerships, including product development partnerships and nongovernmental development organizations. The activities of many of these organizations are described in some detail in Forgotten People, Forgotten Diseases. Almost as important are international advocacy efforts to raise awareness about the NTDs (including the Global Network for Neglected Tropical Diseases) and parallel resource mobilization initiatives. Most of the funding for mass drug administration and NTD product development today comes from the American and some European governments, in addition to important private philanthropies including the Bill & Melinda Gates Foundation, the Wellcome Trust, and the London-based END (End Neglected Diseases) Fund.
Despite these achievements, there is much more that needs to be done. Current levels of public funding are not sufficient to achieve complete mass drug administration targets, and there is an over-reliance on the governments of the United States (mostly through USAID) and the United Kingdom (Department for International Development) for support. Increasingly we need to look to new wealth from the emerging market economies such as the BRICS nations (Brazil, Russia, India, China, and South Africa), the MIST nations (Mexico, Indonesia, South Korea, and Thailand), and the sovereign wealth of the Middle East. Similarly, the U.S. (mostly through the National Institutes of Health) and European governments, in addition to the Gates Foundation and the Wellcome Trust, provide most of the global support for research and development. We need the emerging market economies to step up. In 2010, I built on Fareed Zakaria’s concept of the “Post-American World” to emphasize such new opportunities.2
Another major development since the publication of the first edition has been the realization that NTDs also occur among the poor living in wealthy countries, especially the United States and, to some extent, Europe.3,4 Last year, I committed my life and work to this problem by relocating a group of more than a dozen scientists to Texas in order to establish the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development and a new National School of Tropical Medicine at Baylor College of Medicine. Through the hard work of our new faculty and scientists, we have uncovered an extraordinary disease burden from NTDs in Texas and adjacent Gulf Coast states, including Chagas disease, congenital cytomegalovirus, dengue, murine typhus, toxocariasis, trichomoniasis, and West Nile virus. NTDs and poverty are inextricably linked. There are now 20 million Americans who live in extreme poverty, including 1.5 million families who live on less than $2 per day. We are finding that these people are just as much at risk for the NTDs as are the impoverished populations of less-developed countries. The second edition of Forgotten People, Forgotten Diseases highlights these sobering facts, as this aspect of the NTDs has become a particular passion for me.
Finally, in the first edition I emphasized heavily my belief that NTD control and NTD research and development offer nearly unlimited possibilities on the foreign relations and policy front. While this concept was certainly endorsed by the Clinton administration and then taken to a new level by the administration of George W. Bush, there is now a new office of Global Health Diplomacy in the U.S. Department of State, the brainchild of President Obama and Secretary of State Hillary Clinton. I am very eager and excited to see how this new office and “soft power” approach might become transformative for the world’s poor and developing countries.5 Thus, the next few years will be exciting ones in the NTD field, for diseases both abroad and here at home in the U.S. I cannot wait to see how it all evolves!
Notes
1. Hotez PJ. 2011. Enlarging the “audacious goal”: elimination of the world’s high prevalence neglected tropical diseases. Vaccine 29(Suppl 4):D104–D110.
2. Hotez PJ. 2010. Neglected tropical diseases in the “post-American world.” PLOS NTDs 4:e812.
3. Hotez PJ. 2008. Neglected infections of poverty in the United States of America. PLOS NTDs 2:e256.
4. Hotez PJ. 2011. Europe’s neglected infections of