Prevalence of Neglected Tropical Diseases and Poor Health Care Systems: A Chicken and Egg Debate?

One of the most surprising things that I found from the readings was not only the widespread prevalence of tropical diseases that are actually treatable, but also how interconnected this disease spread is to a country’s economy.  Even if countries with the highest disease burden were to receive sufficient funding for treatment and prevention, a lot of times the funds are not appropriated to those in need, due to poorly structured governments and health care systems.  And it almost becomes a “chicken vs. egg” debate – the disease prevalence is causing productivity loss in an economy, although the poorly structured governments and health systems are not reaching the right populations for treatment.

The bottom billion of the world’s population are among the poorest and suffer from disease and conflict.  The neglected tropical diseases affect nearly everyone in this bottom billion, and include diseases, such as: hookworm infection (mostly arising from sanitation issues), onchocerciasis (transmitted via black flies), and schistosomiasis (resulting from contaminated water).1  Seven out of the thirty or so diseases with the highest burden are worthy of our focus as we are able to control their prevalence.  The seven main diseases are usually seen in the same rural region, and these infections can last for decades, causing life years lost and extreme poverty.  Since the main tropical diseases are most prominent in rural areas where families are involved with farming, agricultural productivity suffers when a family gets sick. For example, when river blindness rates reach 10% in a community, the land is often abandoned, which also puts a dent in productivity.1

There are several initiatives being taken for investment in disease control, which ultimately results in lower poverty rates, elimination of some of these neglected tropical diseases, and universal access to medicines.  Research shows that investing $3.50 per child results in the gain of a whole school year for that child.  Mass drug administration by some of the multinational pharmaceutical companies has proven to be one of the most cost-effective approaches to aiding the treatment of these diseases.  It has shown an economic return in public health programs from 15-30%, since the pharmaceutical companies provide many of the drugs free of charge. Also, many public-private partnerships working with the WHO and World Bank have distributed “rapid effect packages” of drugs, which is low-cost and effective.1

However, additional funds are required if we are going to continue making a dent toward eradication of these diseases.  It’s estimated that $2-3 billion is needed over the next 5-7 years, which includes funds for monitoring, assessment and research, and for improving healthy systems.  In addition, the funds would go to new drugs, vaccines and even insecticides.  Both the US and the UK government departments committed at least $100 million toward disease control over the next 5 years.1  Given the current state of our government and lack of funds available in our budget, I think that having pharmaceutical companies provide free drugs to tackle these diseases should be a major continued initiative across the pharma sector.  These companies are global and are not at the mercy of one country’s economy – it is a stable and cost effective solution that should remain a priority in tackling disease burden.

There are additional challenges that face each of the countries with the highest burden of neglected tropical disease.  Even if there was enough funding to help battle these diseases, many countries do not honor human rights and have poor governance – several populations are neglected, and typically these are the populations that need the most health aid.1  With health systems falling apart in these countries, the money would not be going to the right place and the people that needed assistance would not be served.  What the public-private partnerships should be concentrating their efforts and funds toward is creating a more stable health system in each of the countries needing assistance.  There should be a team assigned to a demographic to do a thorough analysis on that country’s health structure and if there is corruption, thinking of ways to distribute the drugs most effectively so they reach the right people.

1 Hotez PJ, Fenwick A, Savioli L, Molyneux DH.  Rescuing the bottom billion through control of neglected tropical diseases.  Lancet 2009; 373: 1570-75.

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