Eliminating Neglected Tropical Diseases

By Peter Hotez, MD, PhD on 07.12.10

As a new member of the Medical Advisory Committee of Raising Malawi, it is an extraordinary honor for me to launch a new initiative for the control and elimination of the neglected tropical diseases (NTDs). Research indicates that NTDs are among the most common afflictions of the poorest people of Malawi and a key reason why the poorest people of Malawi cannot escape a vicious cycle of disease and poverty.

The NTDs are a group of 13 parasitic and bacterial infections affecting an estimated 1.4 billion people living on less than $1.25 per day—a group sometimes referred to as the “bottom billion”. Intestinal worms (hookworm. roundworm and tapeworm), schistosomiasis (snail fever/bilharzia), lymphatic filariasis (elephantiasis), and onchocerciasis (river blindness) are among the most common seven NTDs. These infections result in lifelong disability and adversely affect childhood development and worker productivity.

Many are surprised to learn that the majority of the bottom billion and most Malawians suffer from at least one NTD. Of the 14 million people who live in Malawi, 11 million are at risk for infection with schistosomiasis and almost all of the children have intestinal worms. Typically these worms live throughout their childhood years and the consequences are devastating. Hookworm infection and schistosomiasis stunt physical growth and fitness and also reduce intelligence and memory. As a consequence, NTDs are one of the leading health problems in Malawi and a major reason why children do not learn or succeed in school. Ultimately, when these children grow to become adults are less successful when they enter the work force. Research indicates that hookworm, and presumably other NTDs, reduce future wage earning by 43%.

Adults are also deeply affected by the NTDs. Much of the adult population of Malawi suffers from the NTD known as lymphatic filariasis, which causes a disfiguring condition of the limbs and genitals. As a consequence, they are too sick to go to work and harvest crops. Another NTD, onchocerciasis, transmitted by infected Simulium black flies living near streams, rivers, and other bodies of water, is a leading cause of blindness. More than one million people in Malawi are at risk for river blindness.

NTDs are particularly devastating for young girls and women. In Malawi, schistosomiasis results in ulcers of the cervix and uterus, so that young girls grow up suffering from chronic genital pain and bleeding. New information also indicates that these ulcers increase the susceptibility of girls and young women to HIV/AIDS three-fold. In Malawi, schistosomiasis is an important co-factor in the country’s AIDS epidemic. Furthermore, lymphatic filariasis stigmatizes girls and women and prevents them from marrying or holding and caring for their children—even though the disease is not transmitted by physical contact.

But there is hope. At the Global Network for NTDs we are promoting a package of drugs, (sometimes called the “rapid impact” package) most of which are either donated by the pharmaceutical companies or the drugs are available at extremely low cost. Indeed, we can control or prevent the most common NTDs such as intestinal worm infections, schistosomiasis, lymphatic filariasis, and onchocerciasis with the rapid impact package and do this for as little as 50 cents per person per year! Imagine taking on a group of diseases that affect more than 1 in 6 people worldwide—more than HIV/AIDs, TB, and malaria combined—for less than US $1 annually!

In the coming weeks and months I look forward to writing additional blog posts on NTDs and calling attention to the plight of Malawi’s poorest who needlessly suffer from these conditions. In the meantime, I am providing some links on our papers in the New England Journal of Medicine, and Public Library of Science so you can learn more about the NTDs in Africa, as well as my book Forgotten People, Forgotten Diseases.

I am excited that Madonna has lent her time to learn more about NTDs and how they affect the people she cares about in Malawi.

The 16th century Kabbalist, Rabbi Isaac Luria, admonishes us to “repair the world” tikkun olam, embarking on an ambitious initiative to eliminate the NTDs in Malawi and elsewhere in Africa represents the most vital and urgent way I can think of to initiate repair.