G20’s secret shame: ignoring tropical diseases among world’s profoundly poor

An Afghan receives treatment for a tropical skin disease at a clinic south of Kabul, Afghanistan. The Afghan capital, Kabul, has one of the highest concentrations of the disfiguring skin disease, Cutaneous leishmaniasis, which is a parasitic disease transmitted by a sand fly.

HOUSTON, Texas — This past weekend, the Sherpas for the group of 20 nations met for the third time in St. Petersburg to lay the ground work for the G20 Leaders Summit in September.

Absent from any public disclosures of these meetings and the proposed fall agenda, so far, have been a newly revealed underbelly of disease and poverty in the G20 countries resulting from a group of chronic and debilitating infections known as the neglected tropical diseases or “NTDs.”

NTDs are long-lasting and disabling parasitic and related infections that few people know about, such as leishmaniasis, elephantiasis, liver fluke, Chagas disease, and hookworm infection. They are the most common infections of poor people, rendering them too sick for work or productive activities and with the ability to reduce child intellect and future wage earning. The NTDs disproportionately affect girls and women.

Whereas most people think about the NTDs as exclusive to destabilized countries such as South Sudan, Somalia, or Haiti, my recent analysis, published in Foreign Policy, has found that most of the world’s NTDs paradoxically occur in G20 countries in addition to Nigeria.

These diseases are found mostly among the large number of poor in these nations, including an estimated 600-700 million people — one half of the “bottom billion” — that live below the World Bank poverty level. The large emerging economies of Brazil, India, Indonesia, and China have the largest number of NTDs; our research indicates that even the United States has at least five million people living with these diseases. NTDs are also widespread in Eastern Europe and among Aboriginal Australians.

If the G20 countries would take ownership of their NTD problem and aggressively implement programs of treatment and prevention, I estimate that the world could see a reduction in up to three-quarters of the world’s most fearsome NTDs.

Such efforts are not expensive and in most cases so profoundly cheap that they would not require overseas development assistance. For example, elephantiasis, hookworm infection, and food-borne trematode infections — mostly occurring in G20 countries — could be treated through mass drug administration using a packet of pills mostly donated by Pharma and costing less than 50 cents per person to administer annually.

Leprosy can be eliminated through case detection and several months of multi-drug therapy using drugs donated from Novartis, while leishmaniasis and Chagas disease can in many cases be controlled or eliminated through low-cost insecticidal spraying. For some NTDs, we need a program of research and development but here again the G20 countries have enormous capabilities on that front.

There is an urgent need to get this information in the hands of the G20 Sherpas who could raise this issue in time for the fall agenda in Russia. Doing so would be transformational in terms of removing one-half of the world’s bottom billion away from severe poverty and advancing rapidly to achieving Millennium Development Goals and Targets by 2015.

In terms of their socioeconomic impact, the NTDs are as important as better-known diseases such as HIV/AIDS and they currently exert a far greater public health impact than potential pandemic threats such as avian flu or H7N9 influenza.

The fact that NTD treatments and preventions are mostly inexpensive and are easily afforded by the G20 governments makes one wonder why these diseases and their global control and elimination efforts remain neglected. I believe it is the fact that the NTDs only affect the profoundly poor — marginalized people with no voice and largely hidden from view. The NTDs and the people affected by them are currently out of sight and out of mind from the global policymakers.

Dr. Peter Hotez is the Fellow in Disease and Poverty at Rice University's James A. Baker III Institute for Public Policy and Dean of the National School of Tropical Medicine at Baylor College of Medicine. He is the author of Forgotten People Forgotten People, Second Edition.