For the past decades, public health experts and economists have been warning of the large human toll and economic losses caused by diseases of poverty, especially malaria, dengue fever, and sleeping sickness. To tackle this, funding agencies, philanthropies, and pharmaceutical companies have greatly invested in research to find a solution. However, most of these diseases are overlooked or unknown by most of us. Many scholars and activists have suggested that the pharmaceutical industry is failing to devote sufficient R&D effort towards finding effective solutions and treatments for tropical neglected diseases while investing billions of dollars for marketing in developed countries. But why are these diseases of poverty so often neglected?
The Problem of NTDs
Disease of poverty is the term used to describe diseases that are more prevalent in low-income populations. It includes infectious diseases, as well as diseases related to malnutrition and poor health behaviours. HIV/AIDS, malaria, or tuberculosis – these are some of the well-known diseases of poverty. But while these “big three” conditions have drawn most of the public, funders’ and scientists’ attention, it has become clear through the past few years that many other diseases also have a considerable impact on populations. The World Health Organization has designated about 20 of these conditions as neglected tropical diseases (NTDs). This diverse range of conditions ―such as leprosy, dengue, Chagas, and elephantiasis, to name a few― have barely attracted any global media’s attention or funding that the “big three” have obtained in recent years.
Neglected Tropical Diseases Portfolio (World Health Organisation, 2017)
Neglected diseases cost developing economies billions of dollars every year and drag affected people into a cycle of poverty that is nearly impossible to escape. Poverty and diseases are a ramification of each other. On one hand, poverty increases chances of having these diseases; the deprivation of shelter, and clean water and food, as well as the lack of knowledge and scarcity of health services, contributes towards poor health behaviours which often enhance the risk of developing a tropical disease. On the other hand, these diseases act as a barrier for economic growth to affected people which in turn results in increased poverty. The World Health Organisation estimated in 2004 that diseases associated with poverty accounted for 45% of the disease burden in the poorest countries. However, nearly all of these deaths are either treatable with existing medicines or preventable in the first place.
Treating Diseases… or Not?
A large proportion of illnesses in low-income populations are entirely avoidable or treatable with existing medicines or interventions. To highlight this, the Global Forum for Health Research created the 10/90 Gap – a term used to state that 10% of worldwide resources devoted to health research are put towards health in developing countries, where 90% of all preventable deaths worldwide occur. Until present, the importance of neglected tropical diseases has been underestimated mainly because most of the NTD are asymptomatic and have long incubation periods. But there are more reasons why the world has overlooked these diseases.
Many of Them Are Not Deadly – in fact, neglected diseases that kill (such as Chagas, sleeping sickness, and rabies) account for 170,000 deaths globally, a relatively small number. In both developed and developing nations, NTDs tend to have low mortality (measured in years lost), but high morbidity, (measured in years lived with some form of disability). This illustrates how disease impacts on quality of life and equates to economic productivity. Because they are not big killers, these diseases don’t attract a lot of funding that would go towards research or greater support for affected areas. And because these diseases are not already well-funded, individuals and potential funders do not know about them or do not pay attention.
They Affect the Most Marginalised Communities – people living in poor rural areas don’t usually have many advocates. The NTDs can be found in 149 countries across the world, but they predominantly affect the poorest people living in developing or remote areas. These people often don’t have a developed health infrastructure around them and their access to medicine is limited.
Treatments Exist – But They Need Improvements. Neglected tropical diseases often arise from the ingestion of polluted water or spread by mosquitoes and other vectors. In these cases, improved sanitation conditions and hygiene can help control some of these diseases. However, some illnesses require proper medicine distribution in affected communities. These drugs can tackle the disease but they present several challenges, such as the availability of these drugs, its adherence to the local community, or the possible side-effects that may arise. Advocates state that better drugs are needed for the NTD; however, with a limited global focus on these illnesses, there is often a lack of funding to improve the efficiency of treatments.
Unaligned Economic Incentives. Treatments for these diseases pose a greater risk for investors in terms of economic return, and consequently, private companies and patents may not find any economic incentive to stimulate innovation. Due to the lack of incentive in the pharmaceutical industry, successful NTD treatment programs have often relied on the donation format, provided by governments and philanthropies. But while often developed countries will rely on government-run and private partnerships to fund such projects, developing nations frequently have significantly lower private spending on these diseases.
Currently, more than 1 billion people worldwide are infected with diseases of poverty. These conditions disproportionately afflict the world’s poorest countries, but also pose a threat to human health in developed nations (in the U.S. alone, for example, there are at least 12 million people suffering from NTDs). Although there are many differences between the NTDs and how they affect their victims, the disease profiles are similar in terms of their adverse impact on child development, pregnancy outcome, and worker productivity.
Despite these challenges, some of the neglected diseases have been eliminated in specific countries. For instance, over the past five years, river blindness ― a parasitic disease that affects the eyesight ― has been eradicated in four Latin American countries: Colombia, Ecuador, Mexico, and Guatemala. This success was possible through an ongoing global effort involving the mass distribution of drugs to affected communities. However, just like river blindness still exists in 20 other countries, there are still many other NTDs that pose a threat to millions of people around the world. We may have the resources to find a solution, but greater efforts, funding and awareness are required to tackle them.