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Official Development Assistance for Health-How Neglected are Neglected Tropical Diseases? An Analysis of Health Financing
Abstract
The increasing amounts of official development assistance (ODA) for health have been aimed primarily at fighting HIV/AIDS, malaria and tuberculosis. Neglected tropical diseases (NTD), one of the most serious public health burdens among the most deprived communities, have only recently drawn the attention of major donors. While frequently stated, the low share of funding for NTD control projects has not been calculated empirically. Our analysis of ODA commitments for infectious disease control for the years 2003 to 2007 confirms that Development Assistance Committee (DAC)-countries and multilateral donors have largely ignored funding NTD control projects. On average, only 0.6% of total annual health ODA was dedicated to the fight against NTDs while the average share of control projects for HIV/AIDS was 36.3%, for malaria 3.6%, and for tuberculosis 2.2%. This allocation of health ODA does not reflect the diseases' respective health burdens. Furthermore, the availability of cost-efficient treatments for NTDs supports the call for an increase in funds dedicated to the control of NTDs.
... These donations are often in the form of commitments for large or unlimited quantities of medicines, leading to increased treatment coverage that has been enabled by campaigning and fund raising by the WHO and Carter Center (45). NTD policies have also benefited from recent increased political attention and prioritization, new partnerships, and funding commitments specifically devoted to combating NTDs, including some US$1.2 billion in grants from the Bill and Melinda Gates Foundation (BMGF) aimed to fill gaps in, rather than duplicate, disease research funding streams (35,44,45,68,69). ...
... Specific to NTD funding, the relatively small total share of global public health financing allocated for NTDs acts as critical factor hampering effective scale-up of NTD control and treatment and meeting WHO's goals of NTD elimination and eradication, many of which are less than a decade away (35,45,57,69). At a mere average of 0.6% of total official development assistance for health as tracked by the Institute for Health Metrics and Evaluation, NTD-dedicated funding remains dwarfed by investments in diseases such as HIV/AIDS (36.3%), malaria (3.6%), and TB (2.2%) (69,72). ...
... Specific to NTD funding, the relatively small total share of global public health financing allocated for NTDs acts as critical factor hampering effective scale-up of NTD control and treatment and meeting WHO's goals of NTD elimination and eradication, many of which are less than a decade away (35,45,57,69). At a mere average of 0.6% of total official development assistance for health as tracked by the Institute for Health Metrics and Evaluation, NTD-dedicated funding remains dwarfed by investments in diseases such as HIV/AIDS (36.3%), malaria (3.6%), and TB (2.2%) (69,72). ...
In global health, critical challenges have arisen from infectious diseases, including the emergence and reemergence of old and new infectious diseases. Emergence and reemergence are accelerated by rapid human development, including numerous changes in demographics, populations, and the environment. This has also led to zoonoses in the changing human-animal ecosystem, which are impacted by a growing globalized society where pathogens do not recognize geopolitical borders. Within this context, neglected tropical infectious diseases have historically lacked adequate attention in international public health efforts, leading to insufficient prevention and treatment options. This subset of 17 infectious tropical diseases disproportionately impacts the world's poorest, represents a significant and underappreciated global disease burden, and is a major barrier to development efforts to alleviate poverty and improve human health. Neglected tropical diseases that are also categorized as emerging or reemerging infectious diseases are an even more serious threat and have not been adequately examined or discussed in terms of their unique risk characteristics. This review sets out to identify emerging and reemerging neglected tropical diseases and explore the policy and innovation environment that could hamper or enable control efforts. Through this examination, we hope to raise awareness and guide potential approaches to addressing this global health concern.
... While progress was made since 2003 on drug donations for NTDs and technical support and advocacy, a review of the Official Development Assistance (ODA) for Health 2003-2007 revealed that NTDs as a whole had only attracted 0.6% of available funds, in contrast to almost 37% allocated to HIV/AIDS. 15 In light of the changing landscape for NTDs, this paper will attempt to review progress in funding and advocacy efforts since 2009. ...
... ODA commitments were extracted from the Organization for Economic Co-operation and Development (OECD) Creditor Reporting System (CRS) as previously described. 15 The CRS collects ODA data from donors, including all 22 members of OECD's Development Assistance Committee (DAC) and, on a voluntary basis, from non-DAC countries and multilateral agencies such as The Global Fund to Fight AIDS, Tuberculosis and Malaria. 16 Donors' commitments, instead of disbursements, were analyzed for the period 2008-2012 because ODA commitments are nearly 100% complete, whereas disbursements are closer to 90% complete. ...
... The lack of funding for NTD control has been noted by WHO, academics and non-governmental organizations. 15,[62][63][64] In 2009, a systematic review of ODA commitments for infectious diseases In 2012, less than 20 countries reported over 1000 new cases of leprosy, indicating that it is becoming limited to a small number of countries 45,57 ...
Neglected tropical diseases (NTDs) is an umbrella term for a diverse group of debilitating infections that represent the most
common afflictions for 2.7 billion people living on less than US$2 per day. Major efforts have recently re-focused attention
on NTDs, including structured advocacy by the Bill and Melinda Gates Foundation, technical and political support by WHO and
large-scale drug donation programs by pharmaceutical companies. An analysis of the Official Development Assistance (ODA) for
NTDs in 2009 showed that Development Assistance Committee members and multilateral donors had largely ignored funding NTD
control projects. This study reviews the changes since 2009 and finds an increased engagement by pharmaceutical manufacturers
through drug donation programs substantially increased by the ‘London Declaration’ in 2012, a focused effort of 77 public
and private partners on control or elimination of the 10 most common NTDs, but no increase in ODA for NTDs between 2008 and
2012. The allocation of ODA still does not reflect the respective importance of these diseases.
... In addition to this, from the data used in this study, the ODA for water and sanitation is greater in countries with higher rates of maternal mortality and with more interventions against neglected tropical diseases (see Supplementary Material Table S5). However, some authors consider it necessary to increase the share of ODA for NTD control (Liese and Schubert, 2009). Another link identified by the BN model points out the relationship with the growth rate inequalities (10.1.1). ...
... Maternal mortality rate 3.3.5: People requiring interventions against NTD Relatively, ODA for health is much greater in countries with highest levels of maternal (and child) mortality (GLAAS, 2017;Pitt et al., 2010) ODA for water and sanitation is greater in countries with higher rates of maternal mortality and more interventions against NTD (see Supplementary Material Table S5) Some authors consider increasing the share of ODA for NTD control to be necessary (Liese and Schubert, 2009) 6.4.1: Water-use efficiency Support for water efficiency programmes included in Target 6.a definition N40% of surveyed agencies consider it as a "very high" priority area (GLAAS, 2017) ODA effectiveness might become negative as countries scale up the income ladder (Gopalan and Rajan, 2016) 10.1.1: ...
The Sustainable Development Goals (SDGs) are presented as integrated and indivisible. Therefore, for monitoring purposes, conventional indicator-based frameworks need to be combined with approaches that capture and describe the links and interdependencies between the Goals and their targets. In this study, we propose a data-driven Bayesian network (BN) approach to identify and interpret SDGs interlinkages. We focus our analysis on the interlinkages of SDG 6, related to water and sanitation, across the whole 2030 Agenda, using SDG global available data corresponding to 179 countries, 16 goals, 28 targets and 44 indicators. To analyze and validate the BN results, we first demonstrate the robustness of the BN approach in identifying indicator relationships (i.e. consistent results throughout different country sample sizes). Second, we show the coherency of the results by comparing them with an exhaustive study developed by UN-Water. As an added value, our data-driven approach provides further interlinkages, which are contrasted against the existing literature. We conclude that the approach adopted is useful to accommodate a thorough analysis and interpretation of the complexities and interdependencies of the SDGs.
... However, the disparity of the financing for NTDs in the context of equity of distribution of global external resources for health is best summarised by the conclusions of Liese and Schubert. 33 Their analysis showed that only 0.6% of Official Development Assistance for health was allocated towards NTDs. Given the ubiquity of the infections, their association with the poorest populations, their impact on productivity of individuals and communities and the ability to deploy effective interventions, the figure is a reflection of true neglect by the donor community and national governments given that over one billion are infected and perhaps 2 billion at risk. ...
... However, the funding provided is a fraction of that available for other diseases and a reflection of the gross inequity to implement programmes that address the diseases of the poor. 33 In addition, the DALYs attributable to NTDs by the GBD Study should be re-examined as there is considerable dispute about both DWs and the allocation of the conditions caused by NTDs to other categories. ...
Neglected tropical diseases (NTDs) have become recognised as important health problems facing at least a billion people in the low-income countries and the poorest communities in middle-income countries. WHO plays a leading role in developing strategies to address these diseases, pharmaceutical companies provide drug donations to treat or control the NTDs and many partners from different constituencies have become increasingly committed to their control or elimination. This review looks to the post-2015 agenda and emphasises that despite the progress made over recent years, if the targets established are to be achieved, then not only will additional financial resources be required to up-scale treatments and increase access, but increased applied and operational research will be necessary to address problems and human capacity in NTD skills will need to be strengthened. Continuing advocacy for the relevance of control or elimination of NTDs must be placed in the context of universal health coverage and access to donated essential medicines for the poor as a right. The evidence that investment in NTD interventions are cost-effective and impact not only on health, but also to enhance socio-economic development, must be refined and promulgated. The global burden of disease attributable to NTDs requires reassessment to appropriately define the true burden, while the potential for unexpected events, political, climatic, environmental as well as biological, have the potential to reduce future progress towards the agreed post-2015 targets. NTD progress towards the WHO Roadmap targets and the fulfilment of the World Health Assembly Resolution 66.12 of 2013 demand continued commitment from all partner constituencies when challenges emerge.
... The design and implementation of effective disease control is often limited by a poor ecological evidence base, specifically by lack of knowledge of which different vector and host species, and which processes, are contributing to transmission and human spillover [4,7]. This is particularly the case for neglected zoonotic diseases that primarily affect poor and marginalised populations in low-resource settings [8], in which less attention and funding is available for research and interventions [4,9,10]. ...
The risk of spillover of zoonotic diseases to humans is changing in response to multiple environmental and societal drivers, particularly in tropical regions where the burden of neglected zoonotic diseases is highest and land use change and forest conversion is occurring most rapidly. Neglected zoonotic diseases can have significant impacts on poor and marginalised populations in low-resource settings but ultimately receive less attention and funding for research and interventions. As such, effective control measures and interventions are often hindered by a limited ecological evidence base, which results in a limited understanding of epidemiologically relevant hosts or vectors and the processes that contribute to the maintenance of pathogens and spillover to humans. Here, we develop a generalisable next generation matrix modelling framework to better understand the transmission processes and hosts that have the greatest contribution to the maintenance of tick-borne diseases with the aim of improving the ecological evidence base and framing future research priorities for tick-borne diseases. Using this model we explore the relative contribution of different host groups and transmission routes to the maintenance of a neglected zoonotic tick-borne disease, Kyasanur Forest Disease Virus (KFD), in multiple habitat types. The results highlight the potential importance of transovarial transmission and small mammals and birds in maintaining this disease. This contradicts previous hypotheses that primates play an important role influencing the distribution of infected ticks. There is also a suggestion that risk could vary across different habitat types but currently more research is needed to evaluate this relationship. In light of these results, we outline the key knowledge gaps for this system and future research priorities that could inform effective interventions and control measures.
... Most drugs and vaccines developed under these 3 FDA incentive programs are for diseases that have large funding investments, adding to the significant gap in funding and R&D efforts directed towards the "big three" diseases, while sidelining other neglected diseases. Indeed, an analysis of official development assistance (ODA) commitments for control of infectious disease between 2003 and 2007 reported only 0.6% of total annual health ODA directed to combat NTDs; in contrast, ODA health shares for HIV/AIDS was 36.3%, for malaria 3.6%, and for tuberculosis 2.2% [73]. Recently, the 2019 Policy Cures Research G-FINDER survey, tracking annual investment into R&D for global health, reported that 71% of total investments in neglected diseases were concentrated on HIV/AIDS, tuberculosis, and malaria; investments in R&D for several neglected diseases such as human African trypanosomiasis, lymphatic filariasis, and helminthiases declined significantly [74,75]. ...
The availability and accessibility of safe and effective drugs, vaccines, and diagnostics are essential to reducing the immense global burden of neglected tropical diseases (NTDs). National regulatory authorities, such as the United States Food and Drug Administration (FDA), play an essential role in this effort to ensure access to safe and effective medical products by working within a set of legal frameworks and regulatory functions. However, medical product development for NTDs remains neglected, as combating NTDs is not a viable commercial market for pharmaceutical companies. To spur research and development (R&D) of NTD products, the US government has authorized various programs and policies to engage pharmaceutical companies, many of which provide FDA with the legal authority to implement NTD programs and pathways. Thus, this review provides a clear overview of the various regulatory pathways and programs employed by the FDA to increase the availability of NTD drugs, vaccines, and diagnostics. The review assesses the available information on various regulatory considerations and their impact on NTD product development as a first step in estimating the importance of such programs. Next, findings related to currently approved NTD products through these programs are discussed. Lastly, gaps in NTD R&D are identified and suggestions on how to address these are presented. The available data shows that while such incentive programs are factored into companies’ decisions to pursue NTD R&D, approved products for NTDs remains vastly insufficient. Most approved products that utilize these NTD regulatory pathways and programs are overwhelmingly for tuberculosis and malaria—both of which are not considered NTDs by the World Health Organization (WHO). Dedicated efforts are needed to facilitate and accelerate NTD product including employing multiple incentive programs, regular assessment of such programs, and leveraging on public–private partnerships.
... US$150 million have been spent on controlling neglected tropical diseases, including schistosomiasis, in sub-Saharan Africa (Gray et al. 2010). In 2008, a presidential initiative was announced calling for a commitment of US$ 350 million funding by the USA over five years to combat neglected tropical diseases, and an increase in the number of targeted countries (Liese and Schubert 2009). It has been estimated that 1.2 billion PZQ tablets will be needed annually to treat 400 million people in Africa for at least five years, at an annual cost of US$100 million (Utzinger et al. 2009). ...
Schistosomiasis is a vector-borne water-based disease caused by Schistosoma blood flukes. It mostly affects people in low-income regions, 90% of reported cases being in developing countries. Schistosoma has a complex lifecycle, alternately infecting mammalian hosts and snails. The snails hosting the parasite are the most viable targets. Selective preparations for reducing the parasite pool in snails and infected water are required as current molluscicides are also nontoxic to other organisms, including fish, and thus affect food supplies in infected areas. Plants (e.g. Annona crassiflora Mart., A. muricata L., and A. montana Macfad.) are attractive potential sources as alternative molluscicides and novel entity to treat the disease owned to their diverse biologically potent compounds including; saponins, alkaloids, terpenoids, and tannins. Additionally, they can be locally cultivated, providing income for farmers and reducing treatment costs. Here, we review plants, plant extracts and isolated compounds that have shown activities against the host snails or Schistosoma in various parts of its life cycle. Plants have a lot of potential and will continue to contribute feasible, effective medicines and/or pesticides; more research is warranted to fully explore their future applications.
Graphical abstract
... US$150 million have been spent on controlling neglected tropical diseases, including schistosomiasis, in sub-Saharan Africa (Gray et al. 2010). In 2008, a presidential initiative was announced calling for a commitment of US$ 350 million funding by the USA over five years to combat neglected tropical diseases, and an increase in the number of targeted countries (Liese and Schubert 2009). It has been estimated that 1.2 billion PZQ tablets will be needed annually to treat 400 million people in Africa for at least five years, at an annual cost of US$100 million (Utzinger et al. 2009). ...
Cadmium (Cd) causes pervasive harm on human health as a poisonous heavy metal. This study proposed a surface-enhanced Raman spectroscopy (SERS) approach using sodium alginate (SA) as green reductant in combination with edge enrichment and chemometrics to build label-free Cd quantitative models. The silver nanoparticles synthesized by SA had good dispersion and enhancement factor (3.48 × 10⁵). The optimal detection system was established by optimizing the concentration of specific molecules (trimercaptotriazine) and the droplet volume of measured liquid. Partial least squares models based on preprocessing methods and selection algorithms were compared. The results indicated that the model combined with first-order derivative preprocessing and competitive adaptive reweighted sampling algorithms achieved the best performance (Rp = 0.9989, RMSEP = 1.6225) with the limit of detection of 2.36 × 10⁻⁵ μg L⁻¹ in food. The SERS approach combined with edge enrichment and chemometrics holds promise for rapid and label-free determination of Cd in food.
... Yet, as their name suggests, they continue to be left out from most of the affected countries' public health agendas. Development Assistance Committee (DAC) countries and multilateral donors have largely ignored funding NTD control projects [20]. Impoverished populations throughout the world are commonly burdened by one or several NTDs, not to mention other communicable and non-communicable diseases, and now also COVID-19. ...
Background
The damage inflicted by the coronavirus diseases 2019 (COVID-19) pandemic upon humanity is and will continue to be considerable. Unprecedented progress made in global health over the past 20 years has reverted and economic growth has already evaporated, giving rise to a global recession, the likes of which we may not have experienced since the Second World War. Our aim is to draw the attention of the neglected tropical disease (NTD) community towards some of the major emerging economic opportunities which are quickly appearing on the horizon as a result of COVID-19.
Main text
This scoping review relied on a literature search comprised of a sample of articles, statements, and press releases on initiatives aimed at mitigating the impact of COVID-19, while supporting economic recovery. Of note, the donor scenario and economic development agendas are highly dynamic and expected to change rapidly as the COVID-19 pandemic unfolds, as are donor and lender priorities.
Conclusions
The NTD community, particularly in low- and middle-income countries (LMICs), will need to work quickly, diligently, and in close collaboration with decision-makers and key stakeholders, across sectors at national and international level to secure its position. Doing so might enhance the odds of grasping potential opportunities to access some of the massive resources that are now available in the form of contributions from corporate foundations, trust funds, loans, debt relieve schemes, and other financial mechanisms, as part of the ongoing and future economic development agendas and public health priorities driven by the COVID-19 pandemic. This paper should serve as a starting point for the NTD community to seek much needed financial support in order to sustain and revitalize control and elimination efforts pertaining to NTDs in LMICs.
... Clearly, social consequences because of recessionary forces have the potential to adversely affect the most vulnerable. The grouping of diseases under one NTD umbrella was developed because of the low level of resource provided for conditions which disproportionately affect "the bottom billion", given only 0.6% of Official Development Assistance (ODA) was devoted to interventions addressing these conditions, estimated to be afflicting up to two billion people [6,7]. As it has been predicted that COVID-19 will enhance global inequity particularly in LMICs, it is essential that neglected tropical disease (NTD) programmes, with recognised success over the past decade, remain on the health and development agenda given their key role in promoting many of the Sustainable Development Goals [8]. ...
With the coronavirus disease 2019 (COVID-19) pandemic showing no signs of abating, resuming neglected tropical disease (NTD) activities, particularly mass drug administration (MDA), is vital. Failure to resume activities will not only enhance the risk of NTD transmission, but will fail to leverage behaviour change messaging on the importance of hand and face washing and improved sanitation-a common strategy for several NTDs that also reduces the risk of COVID-19 spread. This so-called "hybrid approach" will demonstrate best practices for mitigating the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by incorporating physical distancing, use of masks, and frequent hand-washing in the delivery of medicines to endemic communities and support action against the transmission of the virus through water, sanitation and hygiene interventions promoted by NTD programmes. Unless MDA and morbidity management activities resume, achievement of NTD targets as projected in the WHO/NTD Road-map (2021-2030) will be deferred, the aspirational goal of NTD programmes to enhance universal health coverage jeopardised and the call to 'leave no one behind' a hollow one. We outline what implementing this hybrid approach, which aims to strengthen health systems, and facilitate integration and cross-sector collaboration, can achieve based on work undertaken in several African countries.
... Linkages between the burden and the resources allocated to NTDs have been described. For example, a commonly cited reference made in the reviewed articles was that of a study by Liese and Schubert [67] who found that despite the burden and the affected populations, from 2003 to 2007 official development assistance (ODA) for health only allocated 0.6% for NTDs. ...
The global burden attributed to Neglected Tropical Diseases (NTDs) is 47.9 million Disability-Adjusted Life Years (DALYs). These diseases predominantly affect disadvantaged populations. Priority for NTDs has grown in recent years, which is observed by their inclusion in the sustainable development goals (SDGs). This study analyzed the process that allowed these diseases to be included on the global health policy agenda. This global policy analysis used the Shiffman and Smith framework to understand the determinants of global health political priority for NTDs. The framework comprises four categories: actor power, ideas, political contexts, and issue characteristics. Global documents and World Health Assembly (WHA) resolutions were examined, key-informant interviews were conducted, and academic publications were reviewed to understand the four categories that comprise the framework. A total of 37 global policy documents, 15 WHA resolutions, and 38 academic publications were examined. Twelve semi-structured interviews were conducted with individuals representing different sectors within the NTD community who have been involved in raising the priority of these diseases. This study found that several factors helped better position NTDs in the global health agenda. These include the leadership of actors that mobilized the global health community, the creation of a label combining these diseases as a group to represent a larger disease burden, the presence of mechanisms aligning the NTD community, and the agreement on ways to present the NTD burden and potential solutions. The process of building the priority of NTDs in the global health agenda shows that several determinants led to positive outcomes, but these diseases continue to have low priority at the global level which requires the implementation of actions to increase their global priority. These include sustaining the commitment of current actors and engaging new ones; increasing the attention given to diseases formerly categorized as “tool-deficient”, including zoonotic NTDs; continue leveraging on policy windows and creating favorable policy moments to sustain commitment, as well as setting realistic targets. Findings from this study can help develop strategies to build the momentum and drive actions to implement the goals of the new Roadmap for NTDs in the pathway to universal health coverage (UHC) and sustainable development.
... Neglected tropical diseases (NTDs) have been chronically underfunded, making it necessary to allocate limited resources efficiently [1,2]. Although investments in disease mapping have increased in the past decade, in many parts of the world, the prevalence of NTDs remains unknown or patchy, or the data are outdated [3,4]. ...
Background: It is vital to share details of concrete experiences of conducting a nationwide survey, so that the global health community could adapt it to expand geographic mapping programs, eventually contributing to the development of control and elimination strategies with limited resources. A nationwide survey of schistosomiasis and nine other intestinal helminthiases was conducted from December 2016 to March 2017 in Sudan.
Objectives: We aimed to describe details of the key activities and components required for the nationwide survey of schistosomiasis and other intestinal helminthiases and to analyze its costs.
Methods: We estimated financial and economic costs from the provider's perspective. Cash expenditures incurred to implement the survey were defined as financial costs. We took into account all of the resources invested in the survey for economic costs, including the components that were not paid for, such as vehicles and survey equipment provided by the Ministry of Health, Sudan and the opportunity costs of primary school teachers' time spent on the survey. We ran one-way sensitivity and probabilistic analyses using Monte-Carlo methods with 10,000 draws to examine the robustness of the primary analysis results.
Results: A total of USD 1,465,902 and USD 1,516,238 was incurred for the financial and economic costs, respectively. The key cost drivers of the nationwide survey were personnel and transportation, for both financial and economic costs. Personnel and transportation accounted for around 64% and 18% of financial costs, respectively.
Conclusions: The cost is expected to vary depending on the quantity and quality of existing laboratory facilities, equipment, and consumables, and the capability of laboratory technicians and sample collectors. Establishing central-level and independent supervision mechanisms to ensure the quality of the survey is equally important. We expect the global health community to draw on this study when developing nationwide surveys of schistosomiasis and other intestinal helminthiases.
... Neglected tropical diseases (NTDs) are among the seventeen life threatening endemic ailments that occur in tropical and subtropical regions covering 149 countries [2]. Billions of people were affected with the NTDs and people died from these infections is more than half million every year [3][4][5][6]. The infections mainly affect peoples who live on less than US$ 2 per day or under the World Bank poverty level of US$ 1.25 per day [7]. ...
The WHO reports that billions of people and animals in tropical and subtropical regions are affected by helminthiasis as neglected tropical disease. It is predominant in underdeveloped areas; nevertheless, the increase in the number of travelers and migrants has made this infection more common. The current mass drug treatment produces severe side effects and many strains of helminths are resistant to them. None of the chemotherapeutic drugs meets the ideal requirements of anthelmintics, such as broad spectrum of activity, single dose cure, free from side effect and cost-effectiveness. Today, many researchers are screening the traditional herbal system in search of the anthelmintic herbal constituents which overcome all the problems of synthetic drugs. Several researchers proclaim anthelmintic activity of herbal medicines by using different experimental models. The present review demonstrates natural product drug discovery, outlining potential of herbal constituents from natural sources as natural leads against helminthiasis.
... The importance of partnerships There are opportunities for holistic multi-sectoral action to support robust, resilient and responsive health systems responses to mediate challenges and sustain NTD control. Notably, NTD partnerships require financial resources and management time and the overall financial envelope has not increased; in 2010, the proportion of Official Development Assistance (ODA) committed to NTD programmes was 0.6% (Liese and Schubert, 2009) ...
The drive to control neglected tropical diseases (NTDs) has had many successes but to reach defined targets new approaches are required. Over the last decade, NTD control programmes have benefitted from increased resources, and from effective partnerships and long-term pharmaceutical donations. Although the NTD agenda is broader than those diseases of parasitic aetiology there has been a massive up-scaling of the delivery of medicines to some billion people annually. Recipients are often the poorest, with the aspiration that NTD programmes are key to universal health coverage as reflected within the 2030 United Nations sustainable development goals (SDGs). To reach elimination targets, the community will need to adapt global events and changing policy environments to ensure programmes are responsive and can sustain progress towards NTD targets. Innovative thinking embedded within regional and national health systems is needed. Policy makers, managers and frontline health workers are the mediators between challenge and change at global and local levels. This paper attempts to address the challenges to end the chronic pandemic of NTDs and achieve the SDG targets. It concludes with a conceptual framework that illustrates the interactions between these key challenges and opportunities and emphasizes the health system as a critical mediator.
... Direct costs illustrate the need to carry out measures to control infestation or block the epidemiological chain. This will reduce or avoid the expenses associated with hospitalization and the treatment of severe forms of the disease, allowing care capacity to be used for other diseases that are more prevalent within Brazil [15][16][17][18][19][20][21]. ...
Human echinococcosis, also referred to as hydatid disease, is a neglected disease in Brazil and many other
countries. Its distribution and hospitalization characteristics are poorly known and so can be little used in the
development of public health policy. From January 2000 to December 2015, we recorded national patterns of
hospitalization and symptoms using the International Classification of Diseases and estimated the costs of
treatment. The number of hospitalizations may have been underestimated due to lack of awareness of health
workers of this disease and a resulting inability to identify the disease symptoms and record them accurately in the National Hospitalization Information System.
... Columbia became the first country achieving elimination of onchocerciasis; Ecuador and Mexico have also been verified as free from transmission (verified by WHO in 2013). Likewise, Brazil and the Bolivarian Republic of Venezuela have embarked on reciprocal, cross-border interventions finding ivermectin very effective in controlling the disease [36][37][38]. Ivermectin is provided as MDA once or twice annually to millions of the most vulnerable children and adults populations in most LMICs [3,4,39,40]. Interruption of transmission of O. volvulus and reduction of the burden of visual impairment and blindness have been achieved [41,42]. ...
Abstract
The Millennium Development Goals (MDGs) made a marked transformation for neglected and vulnerable
communities in the developing countries from the start, but infectious diseases of poverty (IDoPs) continue to
inflict a disproportionate global public health burden with associated consequences, thereby contributing to the
vicious cycle of poverty and inequity. However, the effectiveness and large-scale coverage of artemisinin
combination therapy (ACT) have revolutionized malaria treatment just as the control of lymphatic filariasis (LF) and
onchocerciasis have benefitted from harnessing the broad-spectrum effect of avermectin-based derivatives. The
paradigm shift in therapeutic approach, effected by these two drugs and their impact on community-based
interventions of parasitic diseases plaguing the endemic low- and middle-income countries (LIMCs), led to the
Nobel Prize in Physiology or Medicine in 2015. However, the story would not be complete without mentioning
praziquantel. The huge contribution of this drug in modernizing the control of schistosomiasis and also some
intestinal helminth infections had already shifted the focus from control to potential elimination of this disease.
Together, these new drugs have provided humankind with powerful new tools for the alleviation of infectious
diseases that humans have lived with since time immemorial. These drugs all have broad-spectrum effects, yet they
are very safe and can even be packaged together in various combinations. The strong effect on so many of the
great infectious scourges in the developing countries has not only had a remarkable influence on many endemic
diseases, but also contributed to improving the cost structure of healthcare. Significant benefits include improved
quality of preventive and curative medicine, promotion of community-based interventions, universal health
coverage and the fostering of global partnerships. The laudable progress and benefits achieved are indispensable in
championing, strengthening and moving forward elimination of the IDoPs. However, there is an urgent need for
further innovative, contextual and integrated approaches along with the advent of the Sustainable Development
Goals (SDGs), replacing the MDGs in ensuring global health security, well-being and economic prosperity for all.
Keywords: Nobel Prize, Artemisinin, Avermectin, Ivermectin, Praziquantel, Schistosomiasis, Intestinal helminths,
Lymphatic filariasis, River blindness, Malaria, Discovery, Poverty
... Moreover, raised ambient temperature, huge population, overcrowded cities with poor resource settings and lack of health facilities (in terms of vaccination access and coverage) also serve as important prerequisites for reproduction of mosquitoes. This situation further exacerbates transmission of pathogens dwelling within these host vectors causing long-term illnesses [31,40]. ...
Dengue virus syndrome is an emerging global health challenge which is endemic in tropical countries like Pakistan. In recent years dengue incidences have increased considerably in different areas of Pakistan with more sever impacts on urban and peri-urban populations. This review is an effort to highlight the changing epidemiology of dengue fever, role of Government of Pakistan in disease management and control using preventive and community based approaches in the region. Moreover, there is an emphasis on application of Wolbachia as novel, inexpensive and environmentally benign candidate for control and eradication of dengue transmitting vectors.
... An empirical analysis of official development assistance (ODA) for health during 2003-2007 showed that on average only 0.6% of annual health ODA supported NTD control programmes, in comparison to the "big three" HIV and AIDS, malaria, and tuberculosis programmes, which had average shares of 36%, 3.6%, and 2.2%, respectively [53]. This does not correspond to the burden of disease caused by NTDs (Table 3). ...
Dengue is currently listed as a "neglected tropical disease" (NTD). But is dengue still an NTD or not? Classifying dengue as an NTD may carry advantages, but is it justified? This review considers the criteria for the definition of an NTD, the current diverse lists of NTDs by different stakeholders, and the commonalities and differences of dengue with other NTDs. We also review the current research gaps and research activities and the adequacy of funding for dengue research and development (R&D) (2003-2013). NTD definitions have been developed to a higher precision since the early 2000s, with the following main features: NTDs are characterised as a) poverty related, b) endemic to the tropics and subtropics, c) lacking public health attention, d) having poor research funding and shortcomings in R&D, e) usually associated with high morbidity but low mortality, and f) often having no specific treatment available. Dengue meets most of these criteria, but not all. Although dengue predominantly affects resource-limited countries, it does not necessarily only target the poor and marginalised in those countries. Dengue increasingly attracts public health attention, and in some affected countries it is now a high profile disease. Research funding for dengue has increased exponentially in the past two decades, in particular in the area of dengue vaccine development. However, despite advances in dengue research, dengue epidemics are increasing in frequency and magnitude, and dengue is expanding to new areas. Specific treatment and a highly effective vaccine remain elusive. Major research gaps exist in the area of integrated surveillance and vector control. Hence, although dengue differs from many of the NTDs, it still meets important criteria commonly used for NTDs. The current need for increased R&D spending, shared by dengue and other NTDs, is perhaps the key reason why dengue should continue to be considered an NTD.
... Recent quantitative studies tracking aid for health and policy setting have targeted specific diseases or areas of health; for example Snow et al. (2010) explore aid for malaria, Liese and Schubert (2009) track aid for neglected tropical diseases, Pitt et al. (2010) explore trends in maternal and child health, and Patel et al. (2009) investigate reproductive health in conflict areas. In an effort to examine fiscal tradeoffs, Shiffman (2008) explores empirically whether funding for HIV/AIDS has had a negative impact on support for other health concerns. ...
We use Punctuated Equilibrium Theory (PET) to examine the distribution of annual change in national government spending on global health through bilateral agencies by 17 OECD nations for 1990–2009. Consistent with our expectations and the PET literature, we find that the distribution of annual log percent change in commitments and disbursements for global health is leptokurtic rather than close to the normal distribution anticipated under incrementalism. Our findings illustrate the value of PET's focus on distributions rather than on time trends in levels alone when examining government allocation behavior, while adding to the literature on global health finance. This study also highlights the impact of choice of log percent change or percent change in examining budgetary change distributions. Better understanding of allocation patterns in this arena can inform those interested in global health policy and its vital outcomes.
... One billion people, referred to as the "bottom billion", are estimated to be infected by the seven most prevalent NTDs (schistosomiasis, trachoma, soil-transmitted helminths, lymphatic filariasis and onchocerciasis) in over 100 countries [1][2][3]. Taken together, NTDs are thought to be second to HIV/AIDS in terms of infectious disease burden yet they receive only a small proportion of development assistance allocated to health [4]. The impact of these infectious pathogens is often difficult to quantify due to under-reporting, focal clustering, poly-parasitism, diverse morbidity, stigmatisation and multifaceted influences on local livelihoods. ...
Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the “neglected” status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.
Electronic supplementary material
The online version of this article (doi:10.1186/2049-9957-3-35) contains supplementary material, which is available to authorized users.
... The socioeconomic and physical conditions of those living in poverty create environments that facilitate the transmission of vectors and pathogens consequently leading to long-term illness that further exacerbates poverty by diminishing productivity. Furthermore, global attention and resources have been focused on HIV/AIDS, malaria, and TB as these are specifically outlined in MDG 6, while NTDs have consequently been relegated into the group of "other diseases", and until 2010, NTDs represented only 0.6% of the total international development assistance for health [13] despite affecting as many poor people as the big three diseases. ...
Infectious diseases of poverty (IDoP) disproportionately affect the poorest population in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness, disability, and social stigma. In 2010, the global deaths from HIV/AIDS have increased to 1.5 million and malaria mortality rose to 1.17 million. Mortality from neglected tropical diseases rose to 152,000, while tuberculosis killed 1.2 million people that same year. Substantial regional variations exist in the distribution of these diseases as they are primarily concentrated in rural areas of Sub-Saharan Africa, Asia, and Latin America, with geographic overlap and high levels of co-infection. Evidence-based interventions exist to prevent and control these diseases, however, the coverage still remains low with an emerging challenge of antimicrobial resistance. Therefore, community-based delivery platforms are increasingly being advocated to ensure sustainability and combat co-infections.
Because of the high morbidity and mortality burden of these diseases, especially in resource-poor settings, it is imperative to conduct a systematic review to identify strategies to prevent and control these diseases. Therefore, we attempted to evaluate the effectiveness of one of these strategies, that is community-based delivery for the prevention and treatment of IDoP. In this paper, we describe the burden, epidemiology, and potential interventions for IDoP. In subsequent papers of this series, we describe the analytical framework and the methodology used to guide the systematic reviews, and report the findings and interpretations of our analyses of the impact of community-based strategies on individual IDoPs.
... GiveWell's own calculation was somewhat lower, at $82.54 per DALY prevented, but was still significantly higher than the original DPC2 estimate. Unfortunately, the inaccurate figure was used widely as justification for increased attention to STH infections and MDA expansion by nongovernment organizations (NGOs) and academics (Laxminarayan et al., 2006;Hotez, 2007;Liese and Schubert, 2009;Alexander, 2011). ...
Abstract Soil transmitted helminths (STH) refer to several parasitic nematode species that infect over 1 billion people worldwide. Infections with Ascaris lumbricoides, Trichuris trichiura, and the hookworms Necator americanus and Ancylostoma duodenale cause significant morbidity in more than 450 million people, primarily children and pregnant women, resulting in over 39 million disability adjusted life years lost. Considerable effort and resources have been, and continue to be, spent on top-down, medical based programs to control STH infections, with little success. This review discusses the problems with these methods, and proposes a new emphasis on sustainable, long-term investments in sanitation-based approaches using improved latrines (the "box") to provide bottom-up, culturally appropriate and economically desirable solutions to STH control in endemic areas. One such approach is the use of biogas technology. Waste undergoes fermentation in specially designed septic systems, generating a methane gas mixture ("biogas") that can be burned to augment or replace household energy needs like cooking and light generation. Also, the effluent from the fermentation chamber provides a high-quality, nitrogen rich fertilizer. Using China as an example, the use of biogas technology as a solution to rural sanitation and energy problems is described, and its advantages over current strategies of mass drug administration and vaccination for STH control highlighted.
... The 17 NTDs identified by the World Health Organization (WHO) represent some of MDG6's ''other diseases.'' This neglected tag stems from the disparity between the attention and funding these diseases receive (0.6% of official development assistance for health) and their catastrophic impact in terms of disabilityadjusted life years (DALYs) [3,4]. The perception of the neglect of these diseases is exacerbated when one considers the importance of the role the NTDs play as drivers and indicators of poverty [5], undermining efforts to meet the targets of virtually all the other goals [6,7]. ...
The United Nations (UN) Millennium Development Goals (MDGs) expire in 2015. A high-level panel, appointed to discuss the global development agenda post-2015, reported back in May 2013 with its recommendations. These are likely to prove extremely important for determining the global health budget over the coming decade. Who the “winners”—those who will benefit from UN endorsement and enhanced funding—and the “losers”—those not receiving such recognition or resources—will be in the new agenda is not yet decided, but certain parties hope that this time around NTDs will gain a special mention.
The MDGs, established in 2000, gave a new prominence to the health issues affecting the poor. However, the spotlight they provided was restricted and derived from a top-down process of deliberation, rather than informed by inclusive analysis and/or a thorough prioritisation of development needs. Subsequently, the narrowly focused and largely sector-specific MDGs left gaps in coverage and failed to realise synergies between the foci covered by the goals (education, health, poverty, and gender) [1]. MDG 6 in particular—“combat HIV/AIDS, malaria and other diseases”—sidelined many of the communicable and non-communicable diseases that perpetuate the cycle of poverty in developing countries. And yet, the very act of naming HIV/AIDS and malaria raised the profile of these diseases immeasurably. It stimulated a reconfiguration of official development assistance for health. Global health initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the President's Emergency Plan for AIDS Relief (PEPFAR) ushered in an era of vertical aid on an unprecedented scale and diverted resources away from existing health programmes [2]. In this funding climate, diseases were pitted against one another and advocacy groups were left to argue that it was their disease being referred to in the ambiguous wording “other diseases.” In this respect, the case of tuberculosis is instructive; the success of the tuberculosis campaigning was such that it is now widely assumed that it too received a special mention in the MDG 6. Of course, parallel to this misapprehension, tuberculosis was considered so central to the GFATM that it was even incorporated into the name; the extent to which this is due to lobbying or to the specific interactions between HIV/AIDS and tuberculosis has not been established. Clearly, however, effective networking and alliance building can blur the boundaries of the MDGs and raise the profiles of diseases.
... The comparative lack of research investment in neglected diseases other than the "big three" diseases of poverty, and the disparity between burden of disease and investment have been documented (6). It has been calculated that the total investment in neglected tropical disease control (excluding HIV/TB and malaria) is only 0.6% of total Official Development Assistance (ODA) funding for health, despite the over one billion people considered to be at risk (7). This report examines zoonotic and marginalized diseases caused by an array of diverse infective agents, from viruses to worms, with very different transmission mechanisms, epidemiology, geographical distribution, control interventions, evaluation and surveillance procedures. ...
... Over the last decade or two, most of the global funding mechanisms have been directed at HIV/AIDS, malaria, and tuberculosis [2]. However, at least 1 billion people are affected by NTDs globally, with less than 1% of health-development support allocated for NTDs [3,4]. This trend is changing, thanks largely to the efforts of donors and foundations. ...
... From the perspective of funding, the contribution of various partners within GAELF varies considerably. Official development assistance from donor governments for health contributes only 0.6% of all funding for NTDs [32] . In contrast, the drug donation programmes have been major and reliable partners, in part because there is no replacement effect related to their donation. ...
The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF6) was held 1-3 June, 2010 in Seoul, Korea, with 150 participants from 38 countries. The year 2010 marks the midpoint between the first GAELF meeting, in 2000, and the World Health Organization (WHO) 2020 goal of global elimination of lymphatic filariasis (LF) as a public health problem. The theme of the meeting, "Half-time in LF Elimination: Teaming Up with Neglected Tropical Diseases (NTDs)," reflected significant integration of LF elimination programmes into a comprehensive initiative to control NTDs. Presentations on LF epidemiology, treatment, research, and programmes highlighted both accomplishments and remaining challenges.
The WHO strategy to interrupt LF transmission is based on annual mass drug administration (MDA) using two-drug combinations. After mapping the geographic distribution of LF, MDA is implemented for ≥ 5 years, followed by a period of post-MDA surveillance, and, ultimately, verification of LF elimination. Morbidity management further reduces disease burden.
Of 81 countries considered LF-endemic in 2000, 52 (64.2%) have begun MDA; 10 (12.3%) others with low-level transmission are unlikely to require MDA. In 2008, ~695 million people were offered treatment (51.7% of the at-risk population); ~496 million participated. Approximately 22 million people have been protected from LF infection and disease, with savings of ~US $24.2 billion. Morbidity management programmes have been implemented in 27 (33.3%) countries.
Significant challenges to LF elimination remain. These include: initiating MDA in the remaining 19 countries that require it; achieving full geographic coverage in countries where MDA has started; finding alternative strategies to address the problem of Loa loa co-endemicity in Central Africa; developing strategies to treat urban populations; initiating and sustaining MDA in settings of armed conflict; developing refined guidelines and procedures for stopping MDA, for post-MDA surveillance, and for verifying the elimination of LF; and integrating morbidity management into all LF elimination programmes. Scientific research and enhanced advocacy for NTDs remain critical for addressing these challenges.
GAELF6 was characterized by enthusiasm and recognition that "teaming up with NTDs" offers opportunities for new partnerships, fresh perspectives, enhanced advocacy, and greater programmatic integration in a rapidly changing global health environment.
... During the last two decades, with intensified processes of globalisation and proliferation of non-state actors in global governance, the industry has shaped as an unprecedented 'private-public industrial complex around a single disease' (Rennie 2008). This complex is characterised by fluctuating figures, dominance of large pharmaceutical and philanthropic corporations led development and research (Altman 1997), escalating prominence within donor agendas (MacKellar 2005) and a disproportionate worldwide spending, as some would argue, at the expense of other diseases or wider health sector development (Shiffman 2008, Liese andSchubert 2009). This new global order has also witnessed a transition in the role of the business sector, earlier seen as an adversary to fair pricing of drugs particularly antiretroviral, from supplier to a 'partner' in expanding access to medicines, building new markets through infrastructural support and prevention and treatment programmes (Kettler et al. 2003, Caines et al. 2004. ...
The past decade has witnessed a tremendous growth in the scale and policy influence of civil society in global health governance. The AIDS 'industry' in particular opens up spaces for active mobilisation and participation of non-state actors, which further crystallise with an ever-increasing dominance of global health initiatives. While country evaluations of global initiatives call for a greater participation of 'civil society', the evidence base examining the organisation, nature and operation of 'civil society' and its claims to legitimacy is very thin. Drawing on the case of one of the most visible players in the global response to HIV epidemic, the Global Fund to Fight AIDS, Tuberculosis and Malaria, this article seeks to highlight the complex micropolitics of its interactions with civil society. It examines the nature of civil society actors involved in the Fund projects and the processes through which they gain credibility. We argue that the imposition of global structures and principles facilitates a reconfiguration of actors around newer forms of expertise and power centres. In this context, the notion of 'civil society' underplays differences and power dynamics between various institutions and conceals the agency of outsiders under the guise of autonomy of the state and people.
... The Series on NTDs in the Lancet was accompanied by a peer-reviewed Comment [12] outlining the arguments for the increased investment in NTD control whilst the front cover page introducing the Lancet series headlined the following quote " Only 0.6% of overseas development assistance for health is allocated to neglected tropical diseases affecting at least 1 billion people " thereby emphasising the context. This statement comes from the analysis by Liese and Schubert [18] on the official Overseas Development Assistance for health being committed to NTD control in comparison with other health development activities. However, having failed to quote the Lancet Series the month before, Allen and Parker refer to the Lancet editorial of February 2010 [19] and comment as " excoriating " implying " excoriating " refers to NTDs although the editorial was directed at criticism of UNICEF. ...
Since 2004 there has been an increased recognition of the importance of Neglected Tropical Diseases (NTDs) as impediments to development. These diseases are caused by a variety of infectious agents - viruses, bacteria and parasites - which cause a diversity of clinical conditions throughout the tropics. The World Health Organisation (WHO) has defined seventeen of these conditions as core NTDs. The objectives for the control, elimination or eradication of these conditions have been defined in World Health Assembly resolutions whilst the strategies for the control or elimination of individual diseases have been defined in various WHO documents. Since 2005 there has been a drive for the expanded control of these diseases through an integrated approach of mass drug administration referred to as Preventive Chemotherapy via community-based distribution systems and through schools. This has been made possible by donations from major pharmaceutical companies of quality and efficacious drugs which have a proven track record of safety. As a result of the increased commitment of endemic countries, bilateral donors and non-governmental development organisations, there has been a considerable expansion of mass drug administration. In particular, programmes targeting lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and soil transmitted helminth infections have expanded to treat 887. 8 million people in 2009. There has been significant progress towards guinea worm eradication, and the control of leprosy and human African trypanosomiasis. This paper responds to what the authors believe are inappropriate criticisms of these programmes and counters accusations of the motives of partners made in recently published papers. We provide a detailed response and update the information on the numbers of global treatments undertaken for NTDs and list the success stories to date.
The paper acknowledges that in undertaking any health programme in environments such as post-conflict countries, there are always challenges. It is also recognised that NTD control must always be undertaken within the health system context. However, it is important to emphasise that the availability of donated drugs, the multiple impact of those drugs, the willingness of countries to undertake their distribution, thereby committing their own resources to the programmes, and the proven beneficial results outweigh the problems which are faced in environments where communities are often beyond the reach of health services. Given the availability of these interventions, their cost effectiveness and the broader development impact we believe it would be unethical not to continue programmes of such long term benefit to the "bottom billion".
... Over the past decade, the global health community has shown greater interest in understanding general trends in DAH (Ravishankar et al. 2009;Murray et al. 2011;Stuckler et al. 2011), how DAH has been allocated among different health priorities (Greco et al. 2008;Shiffman 2008;Sridhar and Batniji 2008;Liese and Schubert 2009;Patel et al. 2009;Piva and Dodd 2009;Ravishankar et al. 2009;Schaferhoff et al. 2010), the allocations of DAH made by particular donors (McCoy et al. 2009), and the impact of these resources on health outcomes (Mishra and Newhouse 2009). There has also been an increase in the availability of DAH statistics; in the past few years alone two major new datasets have been developed to provide data on DAH. ...
Development assistance for health (DAH) has increased substantially in recent years and is seen as important to the improvement
of health and health systems in developing countries. As a result, there has been increasing interest in tracking and understanding
these resource flows from the global health community. A number of datasets, each with its own strengths and weaknesses, are
available to track DAH. In this article we review the available datasets on DAH and summarize the strengths and weaknesses
of each of these datasets to help researchers make the best choice of which to use to inform their analysis. Finally, we also
provide recommendations about how each of these datasets could be improved.
The Ebola virus disease (EVD) outbreaks impacted the population health due to over-stretched health systems and disrupted essential health services. Despite a call to achieve equal financial allocation depending on public health needs, there has been scant examination of the fair-ness of investment among infectious diseases. This study analyzes the extent to which equitable development assistance for health (DAH) has been provided in accordance with disease burden in EVD-affected countries. Estimates of disability-adjusted life years (DALYs) in the Global Burden of Disease (GBD) Study 2017 and DAH Database 1990–2019 in 2005–2017 were analyzed by disease category: vaccine-preventable diseases (VPDs), HIV/AIDS, malaria, tuberculosis, and EVD. HIV/AIDS generally recorded higher ratios of DAH per DALYs (DAH/DALYs). Malaria and tuberculosis showed different trends by country, and VPDs generally presented lower ratios. In West Africa in 2013–2016, DAH/DALYs surged in EVD and fluctuated in HIV/AIDS and malaria. Tuberculosis and VPDs consistently recorded lower ratios. To achieve the risk reduction during and after health emergencies, optimal funding allocation between diseases based on the disease burden is warranted in the pre-emergency period, along with measurement of immediate health needs of populations in real-time during an emergency.
Background
Neglected Tropical Diseases (NTDs) affect more than one billion people globally. A Public Library of Science (PLOS) journal dedicated to NTDs lists almost forty NTDs, while the WHO prioritises twenty NTDs. A person can be affected by more than one disease at the same time from a range of infectious and non-infectious agents. Many of these diseases are preventable, and could be eliminated with various public health, health promotion and medical interventions. This scoping review aims to determine the extent of the body of literature on NTD interventions and health promotion activities, and to provide an overview of their focus while providing recommendations for best practice going forward. This scoping review includes both the identification of relevant articles through the snowball method and an electronic database using key search terms. A two-phased screening process was used to assess the relevance of studies identified in the search–an initial screening review followed by data characterization using the Critical Appraisal Skills Program (CASP). Studies were eligible for inclusion if they broadly described the characteristics, methods, and approaches of (1) NTD interventions and/or (2) community health promotion.
Principal findings
90 articles met the CASP criteria partially or fully and then underwent a qualitative synthesis to be included in the review. 75 articles specifically focus on NTD interventions and approaches to their control, treatment, and elimination, while 15 focus specifically on health promotion and provide a grounding in health promotion theories and perspectives. 29 of the articles provided a global perspective to control, treatment, or elimination of NTDs through policy briefs or literature reviews. 19 of the articles focused on providing strategies for NTDs more generally while 12 addressed multiple NTDs or their interaction with other infectious diseases. Of the 20 NTDs categorized by the WHO and the expanded NTD list identified by PLOS NTDs, several NTDs did not appear in the database search on NTD interventions and health promotion, including yaws, fascioliasis, and chromoblastomycosis.
Conclusions
Based on the literature we have identified the four core components of best practices including programmatic interventions, multi sectoral and multi-level interventions, adopting a social and ecological model and clearly defining ‘community.’ NTD interventions tend to centre on mass drug administration (MDA), particularly because NTDs were branded as such based on their being amenable to MDA. However, there remains a need for intervention approaches that also include multiple strategies that inform a larger multi-disease and multi-sectoral programme. Many NTD strategies include a focus on WASH and should also incorporate the social and ecological determinants of NTDs, suggesting a preventative and systems approach to health, not just a treatment-based approach. Developing strong communities and incorporating social rehabilitation at the sublocation level (e.g. hospital) could benefit several NTDs and infectious diseases through a multi-disease, multi-sectoral, and multi-lateral approach. Finally, it is important the ‘community’ is clearly defined in each intervention, and that community members are included in intervention activities and viewed as assets to interventions.
The United States relies primarily on market forces to determine prices for drugs, whereas most other industrialized countries use a variety of approaches to determine drug prices. Branded drug companies have patents and market exclusivity periods in most industrialized countries. During this period, pharmaceutical companies are allowed to set their list price as high as they prefer in the United States owing to the absence of government price control mechanisms that exist in other countries. Insured patients often pay a percentage of the list price, and cost sharing creates some pressure to lower the list price. Pharmacy benefit managers negotiate with drug companies for lower prices by offering the drug company favorable formulary placement and fewer utilization controls. However, these approaches appear to be less effective, compared with other countries’ approaches to containing branded drug prices, because prices are substantially higher in the United States. Other industrialized countries employ various forms of rate setting and price regulation, such as external reference pricing, therapeutic valuation, and health technology assessment to determine the appropriate price.
Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Background Four initiatives have estimated the value of aid for reproductive, maternal, newborn, and child health (RMNCH): Countdown to 2015, the Institute for Health Metrics and Evaluation (IHME), the Muskoka Initiative, and the Organisation for Economic Co-operation and Development (OECD) policy marker. We aimed to compare the estimates, trends, and methodologies of these initiatives and make recommendations for future aid tracking.
Methods We compared estimates of aid for RMNCH from the four initiatives for all years available at the time of our analysis (1990–2016). We used publicly available datasets for IHME and Countdown. We produced estimates for Muskoka and the OECD policy marker using data in the OECD Creditor Reporting System. We sought to explain differences in estimates by critically comparing the methods used by each approach to identify and analyse aid, and quantifying the effects of these choices on estimates.
Findings All four approaches indicated substantial increases over time in global aid for RMNCH, but estimates of aid amounts and year-on-year trends differed substantially, especially for individual donors and recipient countries. Muskoka (US) and Countdown’s RMNCH estimates (10·8 billion in 2013), which often indicated different trends from the other approaches. The OECD policy marker produced by far the lowest estimates ($2·0 billion in 2013) because half of bilateral donors did not report on it consistently and those who did tended to apply it narrowly. Estimates differed across approaches primarily because of differences in methods for distinguishing aid for RMNCH from aid for other purposes; adjustments for inflation, exchange rates, and under-reporting; whether donors were credited for their support to multilateral institutions; and the handling of aid to unspecified recipients.
Interpretation The four approaches are likely to lead to different conclusions about whether individual donors and recipient countries have fulfilled their obligations and commitments and whether aid was sufficient, targeted to countries with greater need, or effective. We recommend that efforts to track aid for the Sustainable Development Goals reflect their multisectoral and interconnected nature and make analytical choices that are appropriate to their objectives, recognising the trade-offs between simplicity, timeliness, precision, accuracy, efficiency, flexibility, replicability, and the incentives that different metrics create for donors.
Funding Subgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.
The Millennium Development Goals’ focus on just three infectious
diseases (HIV/AIDS, malaria, and belatedly, tuberculosis) configured the global health funding landscape for 15 years. neglected tropical diseases (NTDs), a group of 17 or so diseases that disproportionately afflict the world’s ‘bottom billion’, are a symbol of global health inequities, in terms of prioritisation, research attention, and treatment. This article traces efforts to include NTDs in the Sustainable Development Goal (SDG) agenda and, having achieved that goal, lobby for an influential position in the post-2015 aid agenda. The SDGs herald a shift to a more expansive approach and there is a risk that NTDs will once again be left behind, lost in a panoply of new goals and targets. There is, however, an opportunity for NTDs to lever their ‘neglect’ and be recast as a tool of accountability, acting as both a target for and proxy indicator of health equity for the SDGs.
Neglected tropical diseases (NTDs) affect at least 1 billion people worldwide and are estimated to threaten millions more. NTDs are widespread, primarily affect socially marginalized and vulnerable populations, and contribute to and reinforce global poverty. Although NTDs have significant medical, social, economic and political implications, they receive low priority in global health policies. Moreover, the existing literature has not yet examined the inherently social linkages of NTDs to global inequality, power and “development.” This article takes a critical sociological approach in order to construct a conceptual model to explain NTDs’ “neglect.” Distal level factors in the model include: global inequality and non-modifiable biological aspects (geographic isolation, chronic and disfiguring disease outcomes and concurrent infections). Intermediate level factors include: poverty and neoliberal health policy. Proximal level factors include: lack of research and development; lack of funding for interventions; the dominance of disease-specific interventions; lack of infrastructure and medical services; social isolation; epidemiological methods that underestimate NTDs’ disease burden; and social stigma. Further refinement of such a model may enable global health advocates to create more effective and comprehensive strategies to end not only the “neglect” of NTDs but the social contexts that have created this “neglect.”
Emerging but neglected diseases (ENDs) are a significant burden on global economies and public health. ENDs impact over 1 billion of the world's poorest populations and require special attention. However, within the ENDs recognized by the World Health Organization, some are also dually categorized as emerging and re-emerging infectious diseases. The diagnosis of the ENDs presents a great challenge to African economies. It has a potential impact on efforts and strategies aimed at attaining the health targets of the Millennium Development Goals. This paper reviewed literature on ENDs, presenting a new angle on Emerging but neglected diseases (ENDs) with emphasis on diagnosis. Multi-sectorial efforts and targeted public-private partnerships is needed to develop capacity not only for effective and accessible ENDs treatments but also in the general health system strengthening efforts. This is essential for enhancing knowledge to address public health aspects of these ENDs, which are now spreading rapidly to non-endemic regions. During diagnose of emerging and neglected diseases in Africa, certain challenges are confronted by laboratory technicians. These challenges arise due to inadequate resources, inadequacy of specialized medical practitioners, noncompliance of citizens due to superstitious beliefs, etc. thus making diagnosis procedures less accurate and the tendency of misdiagnosis. It is therefore expected that The WHO and allied health organizations should focus international funds into developing new technologically advanced diagnostic tools and make them broadly available for use in poor countries.
Neglected tropical diseases (NTD) are a group of 17 diseases transmitted by virus, protozoa, helminthes and bacteria. These illnesses are responsible for millions of deaths per year, affecting mainly the poorest populations in the world. The therapeutic drugs available are obsolete, toxic, have questionable efficacy and there are reports of resistance. Therefore, the discovery of new, safe, effective and affordable active molecules is urgently needed. Considering that, the main purpose of this mini-review is to show the current scenario concerning drug design for neglected disease in Brazil. NTD are a very broad topic. Thus, we selected four infections for discussion: Chagas disease, leishmaniasis, malaria and tuberculosis. According to CNPq (National Counsel of Technological and Scientific Development) directories, there are many Brazilian groups studying these respective diseases. The papers published possess high quality and some of them, the most recent, are briefly discussed here. Medicinal chemistry approaches such as synthesis of novel series of molecules and biological activity evaluation, studies of structure-activity relationships (qualitative and quantitative), molecular modeling calculations and electrochemistry are some of the tools applied in the design of the compounds.
To have greater impact on application it is desirable to integrate machines and their associated power electronic converters into complicated systems that share component count to minimise cost. However, while compactness of systems is achieved, reliability of the power conversion components can be compromised by the arduous nature of system operating environments. This paper investigates the impact of using higher phase numbers for electromagnetic machines and their associated power electronic converters specifically targeting improved specific and volumetric power density and increased lifetime. Key findings are improved prediction of iron-loss and electromagnetic power density, performance, packaging and hence cost.
According to WHO, the Neglected Tropical Diseases (NTDs) are a large group of chronic tropical
diseases, mainly parasitic but also bacterial. They have high morbidity including pain, disfigurement
and severe disability. Over 1.2 billion people - one sixth of the planet's population - suffer
from one or more of these diseases. Every year 534,000 people die, despite the fact that for the
majority of NTDs therapy does exist and the cost is minimal. NTDs are neglected diseases because
they occur exclusively in the poorest countries and marginalized communities, whereas in
the developed countries they have been largely wiped out. During the recent years there is rising
interest on this group of diseases, as NTDs control is a critical component of reaching the United
Nations Millennium Development Goals (MDGs). The first WHO report on NTDs was released in
October 2010. While the report highlights a number of remaining challenges, it sends a positive
message. With the new strategic approaches it seems entirely achievable to control NTDs. It is a
prerequisite that the strong and emerging economies of the world support these efforts, in order to
achieve the goals set.
Aid for fighting infectious and parasitic diseases has had a statistically significant role in the under-five mortality reduction in the last decade. Point estimates indicate a country average reduction of 1.4 deaths per thousand under fives live-born attributable to aid at its average level in 2000-2010. The effect would be an average drop of 3.3 in the under-five mortality rate at the aid levels of 2010. By components, a dollar per capita spent in fighting malaria has caused the largest average impact, statistically higher than a dollar per capita spent in STD/HIV control. We do not find statistically significant effects of other infectious disease aid, including aid for the control of tuberculosis.
Background
In the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives
The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods
This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. DiscussionOur in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion
By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised.
Infectious diseases account for 15 million deaths per year worldwide, and disproportionately affect young people, elderly people, and the poorest sections of society. We aimed to describe the investments awarded to UK institutions for infectious disease research.
Methods: We systematically searched databases and websites for information on research studies from funding institutions and created a comprehensive database of infectious disease research projects for the period 1997–2010. We categorised studies and funding by disease, cross-cutting theme, and by a research and development value chain describing the type of science. Regression analyses were reported with Spearman's rank correlation coefficient to establish the relation between research investment, mortality, and disease burden as measured by disability-adjusted life years (DALYs).
Findings: We identified 6170 funded studies, with a total research investment of UK£2·6 billion. Studies with a clear global health component represented 35·6% of all funding (£927 million). By disease, HIV received £461 million (17·7%), malaria £346 million (13·3%), tuberculosis £149 million (5·7%), influenza £80 million (3·1%), and hepatitis C £60 million (2·3%). We compared funding with disease burden (DALYs and mortality) to show low levels of investment relative to burden for gastrointestinal infections (£254 million, 9·7%), some neglected tropical diseases (£184 million, 7·1%), and antimicrobial resistance (£96 million, 3·7%). Virology was the highest funded category (£1 billion, 38·4%). Leading funding sources were the Wellcome Trust (£688 million, 26·4%) and the Medical Research Council (£673 million, 25·8%).
Interpretation: Research funding has to be aligned with prevailing and projected global infectious disease burden. Funding agencies and industry need to openly document their research investments to redress any inequities in resource allocation.
Neonatal mortality accounts for 43% of global under-five deaths and is decreasing more slowly than maternal or child mortality. Donor funding has increased for maternal, newborn, and child health (MNCH), but no analysis to date has disaggregated aid for newborns. We evaluated if and how aid flows for newborn care can be tracked, examined changes in the last decade, and considered methodological implications for tracking funding for specific population groups or diseases.
We critically reviewed and categorised previous analyses of aid to specific populations, diseases, or types of activities. We then developed and refined key terms related to newborn survival in seven languages and searched titles and descriptions of donor disbursement records in the Organisation for Economic Co-operation and Development's Creditor Reporting System database, 2002-2010. We compared results with the Countdown to 2015 database of aid for MNCH (2003-2008) and the search strategy used by the Institute for Health Metrics and Evaluation. Prior to 2005, key terms related to newborns were rare in disbursement records but their frequency increased markedly thereafter. Only two mentions were found of "stillbirth" and only nine references were found to "fetus" in any spelling variant or language. The total value of non-research disbursements mentioning any newborn search terms rose from US717.1 million in 2010 (constant 2010 US5.7 million in 2010. The United States and the United Nations Children's Fund (UNICEF) provided the largest value of non-research funding mentioning and exclusively benefitting newborns, respectively.
Donor attention to newborn survival has increased since 2002, but it appears unlikely that donor aid is commensurate with the 3.0 million newborn deaths and 2.7 million stillbirths each year. We recommend that those tracking funding for other specific population groups, diseases, or activities consider a key term search approach in the Creditor Reporting System along with a detailed review of their data, but that they develop their search terms and interpretations carefully, taking into account the limitations described. Please see later in the article for the Editors' Summary.
Here, we review studies that have investigated the activity of plant-derived compounds against Trypanosoma cruzi, the etiologic agent of Chagas’ disease. In the last decade, more than 300 species belonging to almost 100 families have been evaluated for activity, and here we describe the compounds isolated; 85 references are cited.
Summary One-third of the world's population lacks access to essential drugs, often because of cost. These drugs could prevent or treat many of the communicable diseases that are killing 14 million people each year. As a response, some multinational pharmaceutical companies have initiated drug donations to combat specific diseases. Yet in its experience, Médecins Sans Frontières has witnessed serious drawbacks and problems with these donation programs. This paper examines the costs borne by the donor countries for drug donations. It also examines after-tax gains to the donor company and the impacts of tax incentives. The donation model is also compared with other models that can improve access to essential medicines, including the purchase of generics, concessionary pricing, discounted pricing, and differential pricing. The data show that drug donations can cost the public sector of a donor country (in this case, the United States) more than four times as much as other models that achieve the same end result; these models are to purchase either the lowest-priced quality generic on the world market, or the branded drug at a differential price. The data also show that the donor company does not have an incentive to lower its prices to a level affordable to the developing world, although its real manufacturing costs may allow it. The current system of incentives encourages drug donations over better policy options that would be more sustainable and less costly to the public. These other options also offer support to the generic industry and greater autonomy to developing countries in meeting their drug needs. In light of the numerous drawbacks to drug donations, they should neither be relied upon nor portrayed as a long-term solution to the ongoing crisis of access to essential medicines. National governments, NGOs, and intergovernmental organisations including the WHO, the World Bank, UNICEF, and UNAIDS, should promote solutions that are more sustainable than donations for the access crisis, such as encouraging generic production and negotiating dramatically reduced differential pricing for branded products. They should invest in the development of generic production and facilitate the use of TRIPS-compliant safeguards where appropriate. Finally, they should create a favorable policy framework that encourages differential pricing by proprietary pharmaceutical companies.
Tropical diseases are infectious diseases that are found predominantly in the tropics, where ecological and socioeconomic conditions facilitate their propagation. Climatic, social, and economic factors create environmental conditions that facilitate transmission, and the lack of resources prevents affected populations from obtaining effective prevention and adequate care. Tropical diseases are diseases of the poor, and investments in control and research to develop more effective intervention tools and strategies have been minimal (Gwatkin, Guillot, and Heuveline 1999; Remme and others 2002). For some, however, effective intervention methods have been developed, and successful control has been achieved. This chapter focuses on four tropical diseases—Chagas disease, lymphatic filariasis (LF), onchocerciasis, and leprosy—for which effective means of control are available. All four diseases are targeted for elimination as a public health problem. Control strategies are being implemented at scale and have already achieved a major reduction in the burden of disease, and the causative agent has even been eliminated in some previously endemic areas. Those successes have not come easily, and much remains to be done to ensure complete and sustained control of the diseases.
Mary Moran and colleagues survey global investment into research and development of new pharmaceutical products to prevent, manage, or cure diseases of the developing world.
In its first 8 years, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) achieved an unprecedentedly rapid scale-up: >1.9 billion treatments with anti-filarial drugs (albendazole, ivermectin, and diethylcarbamazine) were provided via yearly mass drug administration (MDA) to a minimum of 570 million individuals living in 48 of the 83 initially identified LF-endemic countries.
To assess the health impact that this massive global effort has had, we analyzed the benefits accrued first from preventing or stopping the progression of LF disease, and then from the broader anti-parasite effects ('beyond-LF' benefits) attributable to the use of albendazole and ivermectin. Projections were based on demographic and disease prevalence data from publications of the Population Reference Bureau, The World Bank, and the World Health Organization.
Between 2000 and 2007, the GPELF prevented LF disease in an estimated 6.6 million newborns who would otherwise have acquired LF, thus averting in their lifetimes nearly 1.4 million cases of hydrocele, 800,000 cases of lymphedema and 4.4 million cases of subclinical disease. Similarly, 9.5 million individuals--previously infected but without overt manifestations of disease--were protected from developing hydrocele (6.0 million) or lymphedema (3.5 million). These LF-related benefits, by themselves, translate into 32 million DALYs (Disability Adjusted Life Years) averted. Ancillary, 'beyond-LF' benefits from the >1.9 billion treatments delivered by the GPELF were also enormous, especially because of the >310 million treatments to the children and women of childbearing age who received albendazole with/without ivermectin (effectively treating intestinal helminths, onchocerciasis, lice, scabies, and other conditions). These benefits can be described but remain difficult to quantify, largely because of the poorly defined epidemiology of these latter infections.
The GPELF has earlier been described as a 'best buy' in global health; this present tally of attributable health benefits from its first 8 years strengthens this notion considerably.
PJH is President of the Sabin Vaccine Institute. He is an inventor on two international patents on hookworm vaccines. PJH and DHM are co-founders of the Global Network for Neglected Tropical Disease Control.
The authors received no specific funding for this study.
To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil.
An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 microg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment.
Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient.
Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.
To assess the effects of a 3-year programme aimed at controlling scabies on five small lagoon islands in the Solomon Islands by monitoring scabies, skin sores, streptococcal skin contamination, serology and haematuria in the island children.
Control was achieved by treating almost all residents of each island once or twice within 2 weeks with ivermectin (160-250 microg/kg), except for children who weighed less than 15 kg and pregnant women, for whom 5% permethrin cream was used. Reintroduction of scabies was controlled by treating returning residents and visitors, whether or not they had evident scabies.
Prevalence of scabies dropped from 25% to less than 1% (P < 0.001); prevalence of sores from 40% to 21% (P < 0.001); streptococcal contamination of the fingers in those with and without sores decreased significantly (P = 0.02 and 0.047, respectively) and anti-DNase B levels decreased (P = 0.002). Both the proportion of children with haematuria and its mean level fell (P = 0.002 and P < 0.001, respectively). No adverse effects of the treatments were seen.
The results show that ivermectin is an effective and practical agent in the control of scabies and that control reduces the occurrence of streptococcal skin disease and possible signs of renal damage in children. Integrating community-based control of scabies and streptococcal skin disease with planned programmes for controlling filariasis and intestinal nematodes could be both practical and produce great health benefits.
This report attempts to quantify the economic losses due to Echinococcus multilocularis and E. granulosus in Shiqu County, Sichuan, People's Republic of China, as well as illustrate the cost effectiveness of dog anthelmintic prophylaxis combined with a sheep and goat vaccination program in terms of disability-adjusted life years (DALYs) saved. We evaluated human losses associated with treatment costs and loss of income due to morbidity and mortality, in addition to production losses in livestock due to E. granulosus infection. Annual combined human and animal losses (95% confidence interval) is estimated to reach 218,676 U.S. dollars (189,850-247,871 U.S. dollars) if only liver-related losses in sheep, goats, and yaks are taken into account. This equates to approximately 3.47 U.S. dollars per person annually or 1.4% of per capita gross domestic product. However, total annual losses can be nearly 1,000,000 U.S. dollars if additional livestock production losses are assumed. Eventual prevention of 65-95% of annual losses due to cystic echinococcosis is suggested with proposed biannual dog anthelmintic prophylaxis and a sheep and goat vaccination program. Prevention of 9-50% of human alveolar echinococcosis-associated losses is suggested based on stochastic models for the current epidemiologic situation. The median estimated cost of the program would be approximately 56,000 U.S. dollars per year, which is a fraction of the estimated combined livestock and human financial losses due to the disease. Overall cost for the proposed control program is within the World Health Organization second most cost-effective band of less than 150 U.S. dollars per DALY averted. However, cost per DALY averted would be less than 25 U.S. dollars dollars for the human health sector if cost sharing was implemented between the public health and agricultural sectors based on proportional benefit from control.
Controlling seven tropical infections in Africa would cost just 40 cents per person per year, and would permanently benefit hundreds of millions of people.
Hotez et al. argue that achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases.
The Disease Control Priorities Project (DCPP), a joint project of the Fogarty International Center of the US National Institutes of Health, the WHO, and The World Bank, was launched in 2001 to identify policy changes and intervention strategies for the health problems of low-income and middle-income countries. Nearly 500 experts worldwide compiled and reviewed the scientific research on a broad range of diseases and conditions, the results of which are published this week. A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease. DCP2 also examines crosscutting issues crucial to the delivery of quality health services, including the organisation, financial support, and capacity of health systems. Here, we summarise the key messages of the project.
To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock.
Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled. The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle. Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome.
In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49,027 DALYs could be averted. Estimated intervention costs were US 26.6 million. This results in a net present value of US 19.1 per DALY averted (95% confidence interval 5.3-486.8). If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US$ 71.4 per DALY averted.
If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors.
In addition to malaria, tuberculosis, and human immunodeficiency virus infection, several other infectious diseases are associated with substantial morbidity and mortality. In particular, 13 tropical diseases infect billions of people and cause disabilities such as blindness and heart failure, especially in persons who live in impoverished conditions. This review article describes approaches to the global control of these diseases.
The need for timely and reliable information about global health resource flows to low-income and middle-income countries is widely recognised. We aimed to provide a comprehensive assessment of development assistance for health (DAH) from 1990 to 2007.
We defined DAH as all flows for health from public and private institutions whose primary purpose is to provide development assistance to low-income and middle-income countries. We used several data sources to measure the yearly volume of DAH in 2007 US5.6 billion in 1990 to 13.8 [corrected] billion DAH in 2007 for which project-level information was available, 0.6 [corrected] billion for tuberculosis, 0.9 billion for health-sector support. Total DAH received by low-income and middle-income countries was positively correlated with burden of disease, whereas per head DAH was negatively correlated with per head gross domestic product.
This study documents the substantial rise of resources for global health in recent years. Although the rise in DAH has resulted in increased funds for HIV/AIDS, other areas of global health have also expanded. The influx of funds has been accompanied by major changes in the institutional landscape of global health, with global health initiatives such as the Global Fund and GAVI having a central role in mobilising and channelling global health funds.
Bill & Melinda Gates Foundation.
This letter discusses HIV in girls/women and focuses on Mozambique. It examines the link of urinary schistosomiasis and the infection of HIV due to irreversible lesions in the vulva vagina cervix and uterus. It calls for action to treat the urinary infection early with the safe effective and cost-effective drug praziq uantel.
The Bill & Melinda Gates Foundation is a major contributor to global health; its influence on international health policy and the design of global health programmes and initiatives is profound. Although the foundation's contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. We undertook an analysis of 1094 global health grants awarded between January, 1998, and December, 2007. We found that the total value of these grants was US5.82 billion (65%) was shared by only 20 organisations. Nevertheless, a wide range of global health organisations, such as WHO, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, prominent universities, and non-governmental organisations received grants. 3.27 billion) of funding was allocated to research and development (mainly for vaccines and microbicides), or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.
Here we outline low-cost opportunities to control the neglected tropical diseases through preventive chemotherapy, and propose fi nancial innovations to provide poor individuals with essential drugs.13 parasitic (helminthic and protozoan) and bacterial tropical infections, and dengue are the highest-burden neglected tropical diseases; another 20 include fungal, viral, and ectoparasitic infections (panel 2).
The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions.
A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review.
Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective.
As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.
Since 1999, the funding available for the control of diseases of poverty (neglected diseases) has increased mainly due to leverage resulting from donations by the Bill and Melinda Gates Foundation and loans from the World Bank. Many countries have embarked on control programmes on a national scale due to drug donations by pharmaceutical companies through vertical programmes. The Schistosomiasis Control Initiative has expanded its operations to cover six countries in sub-Saharan Africa, but overlap of treatments between different vertical programmes is now a reality, and so care is needed to ensure that too many different drugs are not given together. Dialogue between programme managers has increased, and integration of some programmes may offer chances of synergy.
In this paper David Canning argues that interventions against 'neglected' tropical diseases should be thought of as investments in human capital and form an integral part of global poverty reduction. He argues that overall burden of disease should not be the criterion for priority setting; if the goal is to maximize health benefits from a fixed health budget then cost-effective interventions should be prioritized. Whilst many people find objectionable the assignment of a monetary value to health, a cost-benefit approach, combining health and economic benefits, would allow the health sector to present arguments to policy makers, based on the rate of return on investment. Since many health interventions in low-income countries have exceptionally high rankings in terms of cost-benefit ratios, this should result in large flows from other sectors to the health sector.
Advocates for many developing-world health and population issues have expressed concern that the high level of donor attention to HIV/AIDS is displacing funding for their own concerns. Even organizations dedicated to HIV/AIDS prevention and treatment have raised this issue. However, the issue of donor displacement has not been evaluated empirically.
This paper attempts to do so by considering donor funding for four historically prominent health agendas—HIV/AIDS, population, health sector development and infectious disease control—over the years 1992 to 2005. The paper employs funding data from the Organization for Economic Cooperation and Development's (OECD) Development Assistance Committee, supplemented by data from other sources.
Several trends indicate possible displacement effects, including HIV/AIDS’ rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV/AIDS control receives in US funding, and HIV/AIDS aid levels in several sub-Saharan African states that approximate or exceed the entirety of their national health budgets. On the other hand, aggregate donor funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some health issues even as HIV/AIDS acquired an increasingly prominent place in donor health agendas. Overall, the evidence indicates that displacement is likely occurring, but that aggregate increases in global health aid may have mitigated some of the crowding-out effects.
This paper suggests that the 'other diseases' of Millennium Development Goal 6 (MDG 6) are ignored by policy-makers and politicians who overfocus on unachievable objectives and targets around the 'big three' diseases of HIV, tuberculosis (TB) and malaria, which if the planet was viewed by aliens would be seen as the only diseases that existed on the planet. The diseases of the majority of the poor represent 'low hanging fruit' for control and elimination and opportunities are ignored despite the availability of cheap or donated drugs and ample evidence that such interventions are effective and reduce incidence, as well as mortality and morbidity. The time frame available to achieve the MDGs of some 7-8 years requires a re-evaluation of what can be done with the tools available now and which can address the problems faced by the majority of poor people afflicted by disabling conditions which together represent a global burden greater than malaria or TB. The author considers also the volume of research relevant to the MDGs and their achievement is distorted by the focus on high tech end research which cannot be delivered by 2015 and that in terms of the 90:10 gap in research relevant to the problems of the poorest the real gap is 99:1. The concepts of distortion of donor funding for diseases of MDG 6 for implementation of largely curative interventions which do not reduce incidence as well as research which addresses problems that cannot reach poor people in the time frame to 2015 is emphasised. New paradigms are required if any impact on MDG 6 is to be achieved recognising the needs of the majority via an equitable distribution of funding.
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