Neglected Tropical Diseases: 21st Century Ancient Afflictions of the Poor and Vulnerable
Sabin Vaccine Institute President Dr. Peter Hotez gave the keynote address on NTDs at the Pontifical Council for Health Care Workers’ XXXI International Conference, focused on NTDs and rare diseases. The Pontifical Council for Health Care Workers was established by Pope John Paul II to help coordinate the Vatican’s health care related activities. Its work is rooted in the Church’s mission to care for the sick by dedicating its efforts to help health care workers and those serving the sick and suffering. Below is the speech Dr. Hotez delivered before more than 500 participants from around the world.
I’m deeply appreciative of the honor to present here at the Vatican and to the Pontifical Council for Health Care Workers. I’m especially grateful to Msgr. Jean-Marie Mupendawatu, the Secretary of the Pontifical Council for Health Care workers for the invitation.
Today I am going to introduce a group of diseases I sometimes call “the most important diseases you have never heard of,” what we first named back in the early 2000s as the ‘neglected tropical diseases’ or NTDs. These are diseases borne of poverty and conflict — two challenges at the heart of the social mission of the Catholic Church.
The concept of the NTDs was born out of the Millennium Development Goals (MDGs) first launched in 2000, when infectious diseases were highlighted as through Goal 6, “to combat AIDS, malaria, and other diseases”. Whereas AIDS and malaria benefited from massive overseas development assistance, those called “other diseases” were ignored or neglected. In response, we created the framework of NTDs to embrace a group of 13–14 chronic and debilitating parasitic and related infections. NTDs are the most common diseases of the poor; one in six people in the world have at least one NTD.
Through the Global Burden of Disease Study we have now derived specific numbers for the prevalence of the world’s NTDs, led by intestinal helminth infections, schistosomiasis, lymphatic filariasis, dengue, and foodborne trematode infections.
Why do we care so much about the NTDs? NTDs promote poverty. NTDs can cause blindness, horrible swelling of the limbs and even death. Schistosomiasis is the second largest parasitic killer after malaria, trachoma is the leading cause of preventable blindness. Lymphatic filariasis causes extreme, debilitating swelling of the legs and genitals. Intestinal worms such as ascariasis, hookworm and trichuriasis impede children’s cognitive and physical development, and can make them too sick to attend school. Schistosomiasis and other NTDs disproportionately affect girls and women making them more susceptible to HIV/AIDS and other catastrophic infections. The stigma associated with some of the most disfiguring neglected tropical diseases isolates patients from their families and communities. These adverse health consequences translate to lost economic productivity and development opportunities, trapping families and communities in a cycle of disease and poverty.
NTDs are ancient afflictions described in the Bible and other ancient texts. Today, NTDs are having a horrific impact on the world’s Christian populations living in poverty. Christian majority countries account for most of some of the highest disease burden NTDs such as Chagas disease, sleeping sickness, schistosomiasis, and others.
Many of the most common NTDs can be treated and prevented with existing drugs at an extremely low cost. A few, such as lymphatic filariasis and onchocerciasis, could be eliminated entirely if everyone at risk received treatment. Pharmaceutical companies have donated billions of doses of medication and have pledged to donate billions more, but increased investment is needed to expand treatment programs and ensure the delivery of these drugs to everyone at risk.
This global effort guided by the World Health Organization has scaled up NTD treatment programs in the last decade. This is now the largest public health program in the world. More than 978 million people were treated last year for NTDs. But that is still just half of people living in at risk communities who require medication. Treatment programs are underfunded, leaving hundreds of millions of people without access to these essential medicines, despite the low cost of treatment — just $0.50 per person, per year.
This global effort to control and eliminate NTDs has successfully reduced the prevalence of some NTDs such as lymphatic filariasis, onchocerciasis and trachoma. Just this year, four countries in the Western Pacific Region eliminated lymphatic filariasis. In the Americas, onchocerciasis has been eliminated from all but one region on the border of Venezuela and Brazil. These are great successes — millions free from disability and unnecessary suffering. But for other neglected tropical diseases, progress has stalled. Parasites such as hookworm and trichuriasis have barely decreased and the prevalence of schistosomiasis has actually increased.
For some NTDs, such as hookworm, trichuriasis and schistosomiasis, existing drugs are less effective and will not be sufficient to achieve elimination. New strategies and tools are needed. Vaccines such as those currently in development by the Sabin Vaccine Institute could be powerful tools. Yet this research and development is severely underfunded.
Today, we are entering a new era of global health and development. The Sustainable Development Goals look at health in the context of many other factors including climate change and Earth sciences and the social fabric. Likewise, the Catholic Church is advancing this concept through the establishment of the new Dicastery for Promoting Integral Human Development.
We are adjusting our development strategy because the face of poverty is changing. NTDs are found among the poor, even those living in wealthy economies, especially G20 nations. This map shows the concentrated pockets of poverty-related neglected diseases in the world’s wealthiest countries. Our old norms of global health focused in developing versus developed nations are no longer accurate. In a new book just published I refer to this changing paradigm as ‘blue marble health.’ As Pope Francis put it, “On the one hand we are seeing a reduction in absolute poverty, on the other hand we cannot fail to recognize that there is a serious rise in relative poverty, that is, instances of inequality between people and groups who live together in particular regions.”
Today the wealthiest economies of Latin America are found in the G20 nations of Argentina, Brazil and Mexico, yet these three nations account for most of the world’s Chagas disease cases led by Argentina. Less than 1% of people living with Chagas disease in these wealthy nations have access to essential NTD diagnostic and medicine. Or if we look to Brazil, while it is Latin America’s largest economy, the northeastern region that includes Pernambuco, Bahia, Paraiba, Ceara States also accounts for the single largest concentration of NTDs in the Americas led by schistosomiasis, leishmaniasis, Chagas disease and dengue, among others. Therefore it’s no surprise that Zika virus infection, with devastating effects for mothers and their unborn children, concentrated in this same region, where poverty especially urban poverty is severe and widespread.
We need prophetic voices in these countries to call attention to the health problems affecting their poorest citizens. Catholic leaders could be a witness to this hidden suffering, urging policymakers to take strong action and invest in treatment and prevention.
It is clear that poverty is one key driver of NTDs; the other is conflict. For example, Ebola virus emerged due to the political destabilization following conflict, and now these same forces are in play in the conflict zones of the Middle East and North Africa, including Syria, Iraq, Yemen, and Libya. This region appears to be likely to become the next big ‘hot zone’ of emerging NTDs. We are witnessing a catastrophic situation with leishmaniasis for example where there have been hundreds of thousands of disfiguring cases that the locals call “Aleppo evil”.
In this new era of development, as we seek an integrated approach to combat the diseases that thrive in poverty and conflict, we urgently need new diagnostics, drugs, and vaccines to end the suffering caused by these diseases.
The Sabin Vaccine Institute is an organization of scientists, researchers and advocates dedicated to reducing needless human suffering from vaccine-preventable diseases and NTDs. Since its founding in 1993 in honor of Dr. Albert B. Sabin, the developer of the oral polio vaccine, Sabin has been at the forefront of global efforts to eliminate, prevent and cure infectious and neglected tropical diseases.
At Sabin, we are leading efforts to develop half a dozen vaccines to combat NTDs affecting the world’s poorest people. We relocated our vaccine development team to Texas, where diseases once thought to be limited to low-income countries are now found in areas of extreme poverty in our own backyard. I established the National School of Tropical Medicine at Baylor College of Medicine to advance efforts against these diseases. We are developing a vaccines for Chagas that will hopefully soon enter the clinic. We’re also developing vaccines for leishmaniasis, schistosomiasis and human hookworm.
Increased funding is needed in order to help increase momentum for the development and testing of new vaccines, advance products currently in development and create a sustainable path to deliver them to people in need worldwide. Greater investment today will lay the foundation for tomorrow’s new and better vaccines to tackle neglected tropical diseases.
We call our NTD vaccines “antipoverty” vaccines because of their potential not only to improve health but also lift the poorest people out of poverty. The global effort to control and eliminate NTDs shares three key principles with the Church’s social teaching: the life and dignity of the human person, the preferential option for the poor and vulnerable, and the commitment to the common good.
It is clear that NTDs are an affront to human dignity and obstacle to human flourishing. No one should suffer unnecessarily from these ancient diseases in the twenty-first century. NTDs make a preferential option for the poor and vulnerable, targeting marginalized communities denied basic human rights such as health care, clean water and education. To succeed in the effort to end extreme poverty, the global community must make a preferential option for the poor and vulnerable by scaling up the effort to fight NTDs. One of the most basic things we can do to overcome what Pope Francis has termed the “globalization of indifference” and advance the common good is to take decisive action against NTDs: expanding treatment coverage to reduce prevalence today, advancing research and development of new tools to achieve elimination in the coming years, and in the interim, ensuring the basic rights and dignity of patients, combatting all forms of stigma and discrimination.
The unnecessary suffering of over one billion people is a challenge to the conscience of the Church and the world. As one of the largest social service providers in the world and as an institution with a powerful moral voice, the Catholic Church is in a unique position to advance the fight against NTDs in three ways.
First, Catholic institutions can directly support NTD treatment and prevention programs, working through the Church’s vast network of hospitals, health centers, schools, and parishes to reach every at-risk community with treatment and encourage healthy behaviors to prevent NTDs. Second, Church leaders in communities affected by NTDs can minister to sick individuals and their families and tackle stigma and discrimination. Third, the Church can mobilize much-needed financing by encouraging charitable giving by Catholic institutions and individuals and public investment by world leaders to support NTD treatment and advance research. Indeed, a coordinated push at every level of the Church could be the tipping point in the effort to control and eliminate these diseases for good.
For this reason, it has been an honor to speak at this conference. I am deeply grateful for this opportunity to share with you a vision for how we can one day eliminate the world’s NTDs as a powerful expression of solidarity with the poor.