Neglected: Raising Funds for the “Best Buy” in Global Public Health

| February 1, 2012 | 0 Comments

By Sheba Mathew

Neglected disease campaigns, like any other, demand money, but they do it to save lives. $25 to save a life with an HIV test. $20 to save a life with six months of tuberculosis medications. $10 to save a family with a malaria net.

What about fifty cents a year to save a life by treating neglected tropical diseases?

This question drives the “Just 50 Cents” Campaign, an effort of the Global Network for Neglected Tropical Diseases. The campaign illustrates the cost-effectiveness of treating neglected tropical diseases (NTDs), which are now recognized to have a global burden of disease exceeding that of TB or malaria. Yet current funds for NTD control programs, while generous, represent just a fraction of those available for AIDS, TB, and malaria programs.

According to Dr. Peter Hotez, one of the founders of the Global Network and current President of the Sabin Vaccine Institute, the U.S. government funds “upwards of 100 million dollars to treat people in developing countries with rapid-impact packages [of drugs] for neglected tropical diseases…which still pales in comparison to the roughly eight billion dollars annually for PEPFAR.” On average, NTD control programs receive just 16% of the amount of Official Development Assistance for health given to malaria or TB annually.

As a result, experts assert that funds for NTDs are not only insufficient but also inequitable. This inequitable funding persists largely because the metrics emphasized for priority setting in health have undervalued the global burden of NTDs, though investment has been increasing significantly over the past few years.

Courtesy of the Global Network for Neglected Tropical Diseases

NTDs share two primary characteristics that have made them historically neglected. In Hotez’s words NTDs “generally occur among the poor, the really forgotten people,” and puts them in a stranglehold of poverty. This salient factor, says Hotez, coupled with the tendency of NTDs to be “long-standing, chronic, and debilitating conditions with high morbidity and low mortality,” suggests why NTDs, until recently, have been undervalued in the global health agenda.

The metric of Disability-Adjusted Life Years, or DALYs, has been the primary tool for global health priority setting since its inception. Two seemingly minor calculation flaws, however, resulted in a significant underestimation of the global burden of disease caused by NTDs. The first was an emphasis on acute morbidity. The chronic burden of NTDs meant that the most long-term complications of NTDs, including cognitive impairment, growth stunting and other negative outcomes such as impaired economic productivity and food security, were overlooked in the calculation of their DALYs.

The second crucial flaw was a failure to incorporate co-morbidities into the original DALY calculations. This masked the critical role NTDs play in increasing the incidence rate of “the big three”—malaria, TB, and AIDS. Hotez claims that schistosomoiasis, which causes ulcers in women’s cervix, uterus, and genital tract, is “now probably the most important co-factor in Africa’s AIDS epidemic that no one has ever heard of.” Yet the DALY system’s disaggregation of these diseases from the big three reinforces the status quo, making NTDs appear unimportant and an expected part of life in poverty despite the ease with which they can be treated.

Since their installment in 1990, the DALY calculations have evolved to more accurately depict reality. Although this undervaluation has historically undermined efforts to acquire equitable funds for NTD control, research, and development, treatment programs formed in the past decade alone have been notably effective. Director of the Schistomiasis Control Initiative Dr. Alan Fenwick praised the “unbelievable and unprecedented success” of such programs and cited lymphatic filariasis control programs, which now treat 600 million people annually, as one example. These programs do not simply treat; they in fact produce some of the highest rates of economic return of any public health program.

Courtesy of the Global Network for Neglected Tropical Diseases

This success can be largely attributed to the integrated delivery of safe and highly affordable medicines, some that are donated and others that cost as little as one US cent per treatment. According to Hotez, trained healthcare providers aren’t even necessary to distribute the medicines, which “can be given by community health workers or even schoolteachers because of their excellent safety profile.”

The high impact of NTD control programs has been paired with a recent increase in philanthropic and public funding. The U.S. Global Health Initiative alone has increased its NTD funding by a factor of five in the past three years. Yet funding remains insufficient and inequitable. The U.S. and the U.K. are the only nations that currently finance NTD programs, and Hotez is calling on the BRIC countries, particularly Brazil, India, and China, “to really step up and invest in neglected tropical diseases, both for mass-drug administration and innovation,” which would double the impact of U.S. commitment.

Fenwick adds that “we could eliminate severe morbidities [caused by the seven most common NTDs] in Africa if we had a billion dollars spread out over the next seven to ten years.”

The need to rally political will around funding for NTDs is dire, and their financially neglected status compared to their sister diseases of AIDS, TB, and malaria underscores the highly beneficial effects of integrating NTD control with programs for the big three. Yet NTDs have never before been more clearly presented as the “best buy” in global public health. Perhaps now, more countries will start buying in. q

Category: Panorama, Policy, Spring 2011

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