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The biggest global health program you’ve never heard of – NTDs

Nigerian woman with long-term effects of the parasitic river blindness
Nigerian woman with long-term effects of the parasitic river blindness

Nigerian woman with long-term effects of the parasitic river blindness

Mike Urban

What if you could treat a poor person in Africa to cure or prevent seven horrible afflictions – river blindness, hookworm, elephantiasis, trachoma, snail fever and two other parasitic worm diseases – for only 50 cents?

Better yet, what if the drug industry could be compelled to give more than a billion of the planet’s poorest people worldwide life-saving and curative drugs for free?

Well, you can and they were.

One of the world’s biggest efforts aimed at fighting the most neglected diseases of poverty has been underway for a few years now. Chances are, you know very little about it – which may be thanks to this massive project getting launched in 2012 with an incredibly boring name, the London Declaration on Neglected Tropical Diseases.

Uff da. The global health community desperately needs help with branding.

“It’s actually incredibly exciting,” said Julie Jacobson, a physician and program officer at the Bill & Melinda Gates Foundation. I ran into Jacobson, whom I’ve known for many years and who always seems both happy and excited, when we were commuting in opposite directions via bicycle in Seattle’s Ballard neighborhood a while ago. We didn’t actually collide, but I did make her stop to see what she was up to.

A woman having a guinea worm removed.

A woman having a guinea worm removed.

Mike Urban

It turned out Jacobson had been working away at getting more than a billion of the world’s poorest people the treatments they need to be free of some of the most horrible afflictions anyone can imagine – parasitic diseases like lymphatic filariasis which causes people’s lower extremities to swell to monstrous sizes; guinea worm, in which a three-foot-long worm that looks like spaghetti takes a year to eat its way through your body; or river blindness, in which the worm’s life cycle often includes destroying your eyeballs.

These are all members of the Neglected Tropical Disease community, a not-altogether accurate name for these diseases because they are not always confined to the tropics. The NTDs, arguably, also have a branding problem because of a chronic debate over what to call them (some prefer ‘Neglected Infectious Diseases’) or which affliction deserves to be included.

But they all certainly qualify as neglected and as a much bigger problem than you might think.

So why are they neglected, as compared to say malaria or HIV (or erectile dysfunction or male pattern baldness)? The simple answer: Because they afflict the poorest people on Earth.

This is also what made them such an attractive target for Jacobson and the world’s biggest philanthropy. Many of these NTDs, as they are known, are easily and cheaply treated with existing drugs.

The drug company Merck, for example, has for 25 years been donating for free a drug, ivermectin, to treat Africans against the parasitic worms that cause elephantiasis and river blindness (the drug is mostly sold in the West for treating canine heartworm infections). But Merck was unusual. Jacobson wanted to see what it would take to get others in the drug industry to do the same.

“Most firms were willing to donate the drugs but they didn’t want to be on the hook for anything else,” she said. The drug companies agreed to get the donated meds to the countries, she said, but other needs such as coordinating the donations in country, incorporating them effectively into broader health programs, monitoring for safety and compliance and so on were to be the responsibility of other players.

So Jacobson and her colleagues began drafting a proposal aimed at enlisting the drug companies to commit to donating the needed drugs if others like the World Health Organization, government aid agencies, developing world governments, the World Bank and others committed to dealing with the other logistics. The goal was simple enough – to set up a collaborative initiative aimed at getting these critical and often life-saving drugs freely available to the poorest people around the world.

But the scope of it was incredibly ambitious. According to one of the collaborators in this new initiative, the Global Network for Neglected Tropical Diseases, one in six people on Earth (half a billion of them children) suffer from NTDs.

Yet last year, this collaboration that involves so many moving parts and different players collected under the boring banner of the London Declaration has gotten more than a billion treatments for 10 leading NTDs out to the poorest people. Seven of these diseases can be treated for just 50 cents.

Julie Jacobson

Julie Jacobson

“I don’t think it’s an exaggeration to say this has become the biggest public health program in the world,” Jacobson said. “It’s an incredible success story that hardly anybody seems to know about.”

In the first annual progress report for the London Declaration (aack! Somebody re-brand this thing…) issued last month, the authors noted the 1.12 billion NTD treatments distributed, new donor funding to help endemic countries develop integrated disease control plans for the long term, new funding for research aimed at improving treatments for some afflictions and plans for how to scale this up even more in the near future.

Despite the success of this initiative, some may still see it as an extension of an approach many in the international community think is too old school – targeting specific diseases. Some want to see the global health community move away from disease-specific projects to emphasize more comprehensive or fundamental change.

After all, these parasites don’t afflict the poor because the worms have a special love for low-income people. Poverty is why these people get these diseases. So isn’t this just more treating the symptoms rather than the cause?

“These diseases fuel the cycle of poverty,” Jacobson said. “These diseases afflict the poor because of many other problems of poverty like lack of access to clean water, food or health services. But they also keep people poor by undermining their productivity and adding even more burdens to their lives. Fighting these diseases is part of how we fight poverty.”

Now that the collaborative group is up and running, she said, the goal is to use this novel push against NTDs as a means to accomplish other related, complementary efforts aimed at helping the poorest communities. For example, Jacobson explained, lack of clean water or proper sanitation are twin health burdens and often the source of these diseases. So the NTD collaborative is exploring how to better incorporate the vast water-and-sanitation improvement sector into this program.

“I think our approach can be transformative well beyond dealing with NTDs, serving as a platform or springboard for any number of efforts aimed at helping the poorest communities,” she said.

Sounds great. All they need now is a better brand.


About Author

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] or follow him on Twitter @tompaulson.