Gates initiative on “neglected diseases” advances cause, but neglects key questions

The Bill & Melinda Gates Foundation today announced, together with more than a dozen drug makers and others, a new initiative aimed at fighting a select group of mostly developing world ailments called “neglected tropical diseases” such as river blindness, parasitic elephantiasis and others.

These diseases affect an estimated 1.4 billion people, killing perhaps half a million a year, but have not been high on the global health radar screen. As Dr. Peter Hotez writes for Huffington Post, for only 50 cents per child many of these diseases may now be eliminated.

The new public-private initiative aims to rid the world of 10 of these diseases by 2020.

It’s widely regarded as a positive step forward for global health, but there are some important questions that went unanswered:

  1. What is a neglected disease? This is actually a hotly debated question in global health circles right now.
  2. Many think the solution to fighting diseases of poverty should be to focus on poverty as much as on disease. Will this initiative get at the root problem or just address symptoms?

We’ll get back to the neglected issues of neglected diseases in a bit. First, more on the news:

For this initiative called the London Declaration on Neglected Diseases, the Gates Foundation pledged $363 million to support research into new treatments. Drug makers like GlaxoSmithKline, Merck, Johnson & Johnson and others have likewise pledged to step up research as well as to expand donation programs of medications to poor countries.

Others involved in the initiative include the World Bank, the United Arab Emirates as well as the U.S. and U.K. governments The total estimated commitment is $785 million.

The size and scope of this commitment to fighting neglected diseases, or neglected tropical diseases (NTDs), is what’s new here. The idea of drug makers donating drugs to the poor is not new.

Merck, for example, has for many decades donated its drug mectizan (originally developed to deal with worms in dogs) to fight river blindness in Africa. In 1998, Glaxo teamed up with Merck to donate in combination a drug against lymphatic filiariasis (elephantiasis). The program has had a significant impact in reducing these diseases throughout sub-Saharan Africa.

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The Carter Center’s work aimed at eradicating one neglected disease, guinea worm, received a special boost of $40 million with this announcement. Guinea worm, a horrific parasitic disease, has almost been eradicated thanks to decades of work by President Jimmy Carter’s philanthropy throughout Africa.

Some of the news reports on this announcement

NPR A Bid to Replace Neglect for Tropical Diseases With Attention

Bloomberg Drugmakers join Gates Foundation in tropical diseases fight

Guardian Drug companies join forces to combat deadliest tropical diseases

CNN Gates Pledges $363 million to fight tropical diseases

Most of the media just covered the basics of this announcement, stating what the initiative was intended to accomplish and who was promising to do what. Unlike some select journalists who got the information in advance, I didn’t get word of this announcement until after it was made.

So I’ve had to scramble a bit to try to put it in perspective. Let’s return to my questions:

1. What is a neglected disease?

There is no consensus on this. Many say cancer is a neglected disease when it comes to global health because it kills so many in poor countries yet receives little attention as a global health issue. As a recent UN meeting demonstrated, there is big push on now to get cancer and other non-communicable diseases on the global health agenda.

Some say mental illness is the most neglected disease on the planet, if you compare its stunningly large burden of disease with the tiny amount of money going to deal with it. And what about podoconiosis? Why are we only interested in “tropical” neglected diseases when these same diseases are clearly causing a lot of death and destruction in non-tropical areas (like, say, Kyrgyztan)?

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That last one is the easiest question to answer. The “tropical” designation is mostly an artifact of old-timey colonial medicine days when we thought all the neglected diseases were only in the tropics (i.e., poor countries). I know it’s hard to get rid of a well-used term, but perhaps it’s time to dump “tropical” and just see if we can define “neglected diseases.”

2. Will this initiative improve health if it is focused on just targeting neglected diseases in poor communities rather than attacking the root cause of many of these diseases – poverty?

Obviously, it’s orders of magnitude easier to give drugs to the poor than to help them stop being poor. It sounds like a silly question. But I’m not the only one to raise it. The Financial Times’ Andrew Jack quotes a number of people questioning the effectiveness of this approach including a World bank official, Caroline Anstey, who notes:

“These are not neglected diseases but diseases of neglected people.”

Médecins Sans Frontières (aka Doctors Without Borders) welcomed the announcement of the new initiative but raised a few questions of its own.

MSF said in a response to the announcement today that it was concerned this strategy of drug donation may provide tax (and PR) benefits to drug companies but will do little to support sustainable treatment systems in poor countries. In addition, MSF said it was worried this would distort global health priorities:

By putting so much emphasis on drug donations, MSF is concerned that the WHO’s priorities are at risk of being influenced by what products companies are offering. Ultimately, the commitments outlined above by Gilead, Novartis and other companies reflect the policies of the companies, but do not necessarily reflect public health priorities.

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.