Strength in numbers? Grouping, fund allocation and coordination amongst the neglected tropical diseases.

Abstract

Neglected tropical diseases (NTDs) is a term used to describe a heterogeneous group united not by pathophysiology or geography, but by their perpetuating the poverty of “invisible people”. Their burden is laid on one billion of the world’s poorest, who are both at greater risk of contracting the diseases, and of being trapped in poverty by the ensuing effects on their health [1]. The diseases tend to co–exist and can be found in 149 of the 193 countries in the world, of which 100 countries are co–endemic for at least two of the NTDs and 30 countries are endemic for six or more [2]. Photo: Graphic designed by Jennifer Matsumoto for UAEM (courtesy of the author) As use of the term “NTD” has grown in recent years, its success in collecting together a group of diseases that are largely unheard of in high–income countries and using their combined burden to give the whole group added moral, political and economic weight, has been significant. Although precise estimates vary, grouped together the NTDs have a combined global disease burden comparable to that of diseases such as tuberculosis, malaria and human–immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) [3]. This combined power has brought these diseases from the halls of global health institutions to the attention of a wide range of stakeholders including the media, politicians, philanthropists and the general public. Both scientific interest in the diseases, as measured by research publications, and internet searches for constituent diseases through Google and Yahoo!, have increased over the last decade [4]. Similarly, from 2007 to 2011, the funding for NTDs increased by over 70% [5]. However, the concept of NTDs is not being utilized to its full potential. Lobbying for funding, particularly regarding increasing access to currently available treatment, is still often done on an individual disease basis, and there is no discernible link between indicators such as research and development (R&D) funding and attributable disease burden in DALYs and deaths. Greater global coordination for the diseases, to a degree met by the London Declaration [6], may unravel with competing health issues coming to the fore and the partial completion of the main aims of the declaration. Over the past 18 months great progress has been made towards achieving the goals of the WHO roadmap to NTD control. Yet, as seen with previous control programmes, long–term international support and coordination is needed if gains are to be built upon rather than allowed to slide [7,8]. Although initiatives such as the London Declaration have improved collaboration in this field, they are limited in their scope to truly coordinate the fight against NTDs in the post–2020 era. An international coordinating committee should harness the combined power of these diseases to lobby on their behalf, collecting funds that will then be distributed on a more equitable and transparent basis, whilst ensuring the long–term monitoring and viability of programmes put in place. We aim to expand on the need for an international coordinating committee and attempt to outline the roles of such a committee.