Amidst a year filled with public concern surrounding diseases such as COVID-19 and monkeypox, global leaders met at the Kigali Summit in Rwanda to continue the fight against a lesser known, longer existing, but similarly dangerous threat to humanity: Neglected Tropical Diseases (NTDs). At this summit, leaders, such as Rwandan President Paul Kagame, WHO Regional Director Matshidiso Moeta, and philanthropist Melinda Gates expressed the desire of the Commonwealth of Nations to adhere to the WHO’s NTD Roadmap, which aims to reduce the number of people needing treatment for NTDs by 90 percent and eliminate at least one NTD in 100 countries by 2030. These goals were then affirmed by the Kigali Declaration, which officially committed to the WHO Roadmap, while also highlighting the importance of partnerships between governments, private companies, and individual organizations in NTD advocacy, funding, and prevention.
Elimination of NTDs on the scale outlined by the WHO could have monumental effects on the more than one billion people who are currently affected by at least one disease as well as the 1.7 billion people at risk for contracting one. The end of NTDs would not only improve the standard of living for roughly 1/6 of the world’s population, but also potentially lift entire nations out of poverty. However, the WHO’s goals are ambitious, especially considering outside factors, such as the COVID-19 pandemic and climate change that could slow or even reverse current progress. As the world enters a new decade of disease prevention, the race between humanity’s collective efforts and the diseases it seeks to fight continues, bringing forth both solutions and consequences on an international scale.
What are NTDs, and Whom Do They Affect?
NTDs, as suggested by their name, refer to a group of 20 historically under-researched and under-funded illnesses found in tropical regions of Africa, Asia, and Latin America. Spreading primarily through vectors—living agents that transmit diseases between animals or humans—or parasitic means, NTDs predominantly affect impoverished populations that lack access to healthcare, sanitation, and clean water. Dracunculiasis, for example, is a NTD caused by the ingestion of a parasitic worm in regions where people source their drinking water directly from stagnant sources. Trypanosomiasis, another NTD, is spread through insect bites and is common in rural communities that are dependent on animal agriculture. The isolated nature of these communities combined with the complex life cycles of the organisms that transmit NTDs made research surrounding NTDs virtually nonexistent until the emergence of multinational pharmaceutical companies and new infectious disease models in the early 2000s. According to the CDC, 149 out of the 195 officially recognized countries of the world are affected by at least one NTD, including all countries classified as having low-income economies (having a GNI per capita of US$1,085 or less). While most NTDs are not fatal on their own, many can cause permanent disabilities, such as blindness, physical disfigurement, and cognitive impairment, which has led to social stigmatization of those affected and an estimated 19 million disability-adjusted life years lost annually.
In addition to disproportionately affecting underdeveloped regions, NTDs tend to create cycles of poverty and disempowerment for socially disadvantaged groups within affected countries. A 2021 study in Kenya found that women were more likely than men to be exposed to NTDs due to traditional gender roles mandating that women perform housekeeping duties, such as fetching water from potentially contaminated sources and caring for ill family members. These norms have made women more likely to become permanently disabled by NTDs by two to three times in extreme cases and have thus increased the number of women who cannot gain an education or work. Furthermore, malnourishment in children (which can occur as a result of parasitic NTD infections) has been linked with impaired brain development, weaker immune systems, and physical disabilities throughout childhood. As children grow, this can lead to poor academic performance and continued poverty as those affected may struggle to gain a higher education or participate in the workforce.
Global Efforts to Prevent NTDs
Throughout history, NTDs and the actions taken to combat them have become deeply intertwined with global development and international humanitarian efforts. After they were first recognized in 1976, the complex life cycles of the organisms responsible for most NTDs made the most efficient solution to NTDs distributing preventative measures, such as chemotherapy drugs, to entire communities. The large scale of this method of disease control has necessitated multilateral partnerships between individual countries and international donors, such as Johnson & Johnson, which provide drugs at reduced costs. In 2012, over 100 global companies signed the London Declaration, which aimed to provide funding and programming to eliminate several NTDs by 2020 through cooperation between governments and companies. Most recently, NTDs have caught global attention through their inclusion as part of the United Nations’ Sustainable Development Goal to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases” and the new Kigali Declaration, which renewed and expanded many of the goals of the London Declaration. In the United States alone, funding for NTD prevention has increased from US$15 million in 2006 to US$103 million in 2020 as a result of increased awareness and collaboration. Globally, an estimated US$17.8 billion worth of NTD-treating drugs have been donated between 2014 and 2020.
Beyond the international scale, many grassroots efforts in NTD prevention have also been established to work towards universal health coverage in areas that need it the most. Typically, grassroots efforts focus on increasing awareness both globally and locally. On a global scale, organizations dedicated to NTD elimination advocate for increased political prioritization of NTDs, resource funding from the private sector, and inclusivity within the decision-making processes of NTD eradication. Locally, efforts seek to increase the effectiveness of existing national protocols through community collaboration and education. According to one study conducted in Tanzania, the establishment of interactive NTD discussion boards in village governments increased the villagers’ level of education surrounding NTDs and eased tensions between outsiders aiding in NTD relief and community members. Furthermore, communities with these boards participated in activities, such as village clean-ups, construction of safe waste management spaces, and various new income-generating activities, like selling soap and lending money, which served to stimulate local economic growth and reduce the prevalence of unsafe practices, such as public defecation. In the long run, local support and participation in NTD prevention will likely increase the sustainability and self-sufficiency of policies to prevent NTDs.
Similar to prevention efforts, the benefits of eliminating NTDs in individual countries can be felt far beyond their regions of origin. The increase in healthy workers created by the elimination of NTDs would generate approximately US$623 billion in additional revenue globally between 2011 and 2030, stimulating the global economy. Furthermore, the social gains from NTD elimination would not only empower communities, provide higher quality healthcare, and increase individual standards of living, but also reduce other societal issues, such as global overpopulation and unsustainability. Overpopulation can cause strain on existing infrastructure, ecological damage, and increased scarcity of basic materials needed to survive. Birth rates are currently highest in Sub-Saharan African nations that are also affected by NTDs, and 47 percent of the population in urban Sub-Saharan regions in Africa currently live in slum areas—a potential sign of unsustainable growth. However, research has shown that decreased maternal and child mortality, increased education for women, and enhanced economic opportunities all tend to reduce birth rates and could potentially be achieved through efforts to eliminate NTDs.
Roadblocks to a Healthier Future
As of today, the fight to reduce NTDs has been overwhelmingly successful. At least 46 countries have eliminated one or more NTDs, and over one billion people have been able to receive treatment for existing illnesses. Furthermore, some illnesses, like African Trypanosomiasis, which has seen an incredible 96 percent decrease in cases since 2000, are bringing them closer than ever to the brink of global eradication. The benefits of NTD elimination are increasingly visible around the globe; in the southern United States and Kenya, efforts to treat hookworm have increased future earnings by 40 and 29 percent, respectively, decreasing the number of work days lost to sicknesses in Kenya by a third. However, the next decade continues to be pivotal in overall NTD progress, with emerging issues, such as the COVID-19 pandemic and climate change, contesting the ability of progress to continue at its past pace.
Within the past two years, the ongoing COVID-19 pandemic has severely strained healthcare resources in already deficient regions, leading to a backslide in preventative measures and new NTD initiatives. New outbreaks are slower to be recognized due to underreporting, and areas that had fewer preventative measures in place before the pandemic could face up to five years of setback for each year the pandemic continues. Currently, the most effective method of mitigating NTD spread during the pandemic is the continued control of vectors, the organisms responsible for transmitting many NTDs. However, these efforts still have the potential to fall short as rising temperatures and disrupted rainfall patterns caused by climate change increase the reproduction rate of vectors and introduce NTDs to regions that have not encountered them in the past. An estimated one billion additional people could become exposed to mosquito-borne illnesses, such as malaria and dengue fever, by 2080 if climate change continues on its current path, most greatly affecting African countries that harbor both 35 percent of all global NTD cases and 7 out of the 10 countries most affected by climate change. Furthermore, rising temperatures could even lead to the introduction of novel diseases in Asia and Africa, compounding the strain placed on the healthcare system and potentially becoming the source for a new disruptive pandemic.
The Next Step
While the obstacles to NTD elimination are certainly growing in magnitude, the recent expansion in international collaboration and innovation could effectively keep pace for the time being. Since their discovery, preventative and treatment drugs have played a critical role in controlling NTDs; new drugs work to more effectively treat illnesses in stages in which they were previously incurable, are simpler to use and distribute, and have a lower possibility of harmful side effects. While NTD drugs only made up 0.93 percent of all new drugs tested between 1975 and 1999, that percentage increased to 1.65 percent from 2004 to 2014. Due to the high cost and risk of failure associated with drug testing, agreements, such as the “world’s biggest public-private partnership” between corporations and governments described in the Kigali Declaration, have been instrumental towards providing the funding necessary for these innovations.
Another key item addressed by the Kigali Declaration is the significance of advocacy for the underrepresented populations affected by NTDs. By recognizing NTDs as “diseases of poverty and inequality” and focusing prevention campaigns on women, children, the disabled, and minority groups, the health of the most vulnerable populations will be protected more than with previous one-size-fits-all approaches that failed to account for inequities in healthcare access. The protection of these citizens could be central to ending endemic diseases from within a population rather than merely controlling their spread.
Finally, the age of technology and data science has not only provided instantaneous connection for citizens around the globe, but has also served as a catalyst for the information processing needed to track the spread of disease on larger scales and develop more effective treatments. Data centers located in NTD-affected regions have reduced the time required to collect data from drug trials from weeks to “almost instantaneous” in Kenya; mobile apps have been developed to quickly share NTD information to healthcare providers in Latin America; and AI software has been used to predict the shape of NTD proteins in Britain. These methods have simultaneously increased the speed of outbreak responses while decreasing the amount of time needed to share information and find a cure. Further funding in NTDs as a result of political awareness could enhance this innovation even more, expanding access to cutting-edge technology in rural regions and improving healthcare infrastructure as a whole.Although the fight against NTDs is far from over, humanity has made great progress in the five decades that NTDs have caught the world’s attention. Five NTDs are now on track to be completely eradicated within the near future, and more could be eliminated if NTDs continue to be prioritized as a legitimate health concern. The past and future progress on NTD elimination demonstrates the efficiency and thoroughness that societies can possess in their collective actions—should one dare to bring the neglected to light.